Maximizing the Impact of Voluntary Medical Male Circumcision for HIV Prevention in Zambia by Targeting High-Risk Men: A Pre/Post Program Evaluation.

A well-documented barrier to voluntary medical male circumcision (VMMC) is financial loss due to the missed opportunity to work while undergoing and recovering from VMMC. We implemented a 2-phased outcome evaluation to explore how enhanced demand creation and financial compensation equivalent to 3 days of missed work influence uptake of VMMC among men at high risk of HIV exposure in Zambia. In Phase 1, we implemented human-centered design-informed interpersonal communication. In Phase 2, financial compensation of ZMW 200 (~ US$17) was added. The proportion of men undergoing circumcision was significantly higher in Phase 2 compared to Phase 1 (38% vs 3%). The cost of demand creation and compensation per client circumcised was $151.54 in Phase 1 and $34.93 in Phase 2. Financial compensation is a cost-effective strategy for increasing VMMC uptake among high-risk men in Zambia, and VMMC programs may consider similar interventions suited to their context.

Complement activation in hidradenitis suppurativa: a new pathway of pathogenesis?

BACKGROUND: Despite the heavy purulence observed in hidradenitis suppurativa (HS), the kinetics of complement anaphylatoxins acting to prime chemotaxis of neutrophils has not been studied. OBJECTIVES: To explore complement activation in HS. METHODS: Circulating concentrations of complement factor C5a, as well as of membrane attack complex C5b-9, were determined in the plasma of 54 treatment-naïve patients and of 14 healthy controls, as well as in the pus of seven patients. Results were correlated with Hurley stage and International Hidradenitis Suppurativa Severity Score. Peripheral blood mononuclear cells (PBMCs) were isolated from seven patients with Hurley stage III HS and seven healthy volunteers and stimulated in the presence of 25% of plasma for the production of tumour necrosis factor-α (TNF-α). RESULTS: Circulating C5a and C5b-9 were significantly greater in patient than in control plasma; however, concentrations in pus were very low. Circulating C5a levels exceeding 28 ng mL-1 were associated with a specificity > 90% with the occurrence of HS. Circulating levels of C5a and C5b-9 were greater in patients with more severe HS. PBMCs of patients produced high concentrations of TNF-α only when growth medium was enriched with patient plasma; this was reversed with the addition of the C5a blocker IFX-1. CONCLUSIONS: Systemic complement activation occurs in HS and may be used as a surrogate biomarker of HS. C5a stimulates overproduction of TNF-α and may be a future therapeutic target.

Clinics aren't Meant for Men': Sexual Health Care Access and Seeking Behaviours Among Men in Gauteng Province; South Africa

Men may be key players in the transmission of sexually transmitted infections (STI); and it is important that STI/HIV health services reach men. The objective of this study was to explore sexual health care access and seeking behaviours in men. This study used focus groups to examine sexual health care access and seeking behaviours in men 5 years after implementation of free antiretroviral therapy (ART) in the South African public sector. Six focus groups (N=58) were conducted with men ?18 years in an urban area of Gauteng province. Men were recruited from various locations throughout the community. Men reported several barriers and facilitators to the use of public and private clinics for sexual health services including HIV testing; and many men reported seeking care from traditional healers. Men often viewed public clinics as a place for women and reported experiences with some female nurses who were rude or judgmental of the men. Additionally; some men reported that they sought sexual health care services at public clinics; however; they were not given physical examinations by health care providers to diagnose their STI syndrome. Most men lacked knowledge about ART and avoided HIV testing because of fear of death or being abandoned by their families or friends. Study findings suggest that men still require better access to high-quality; non-judgmental sexual health care services. Future research is needed to determine the most effective method to increase men's access to sexual health care services

New-building occupancy. The role of nursing staff development.

Orienting hospital staff to a new patient care facility presents many unique challenges for the Nursing Staff Development Department. Today's healthcare climate demands that staff orientation to a new facility be done quickly and with few disruptions to patient care. Nursing staff development specialists are well positioned to lead this process. Their expertise in program design, implementation and evaluation, problem solving and communication skills, and ability to view the learning needs of hospital staff holistically are vital to a successful facility move. This article will describe the opening of a new 150-bed inpatient facility in a large acute rehabilitation center. The principles used by the Nursing Staff Development Department in this new facility orientation process can be applied in multiple health care settings.

Muscle tone abnormalities.

Rehabilitation nurses frequently encounter clients with neurological disorders that adversely affect muscle tone. By understanding the physiological etiology of abnormal muscle tone, individual practitioners can design nursing interventions for various care settings that appropriately protect clients from injury and that can help clients and caregivers learn effective techniques for managing muscle tone problems. This article explains muscle tone abnormalities in detail and offers insight into how rehabilitation nurses can play a key role in managing clients' alterations in muscle tone.

The late effects of poliomyelitis: nursing interventions for a unique patient population.

Over half a million Americans who had paralytic poliomyelitis as children or young adults are at risk for experiencing the unexpected late effects of post-poliomyelitis syndrome (PPS). When hospitalized or treated for a variety of conditions requiring medical or surgical interventions, these individuals present challenges which include life-threatening complications.

Planning an agency-wide inservice.

From planning an inservice program on a relatively simple change to presenting a number of changes together, the challenge for nursing staff development specialists is to provide high-quality programs in an efficient and effective manner to achieve identified outcomes. In this article, the author reviews considerations in the formative stages of a hospital-wide inservice program, with a focus on planning to achieve quality, efficiency and effectiveness, and measurable outcomes.

Using algorithms in rehabilitation nursing: an educational strategy.

The purpose of this article is to describe the use of algorithms in the specialty practice of rehabilitation nursing. Algorithms are particularly useful for the nurse who is new to rehabilitation because they can offer guidance in some important aspects of clinical decision making. In this article, the authors include information on the historical uses of algorithms, the benefits of using algorithms, and the ways in which algorithms are developed. Examples are also included, and suggestions for further development of algorithms in rehabilitation nursing are proposed.

Rehabilitation nursing novices: changing the acute care mind set.

The majority of nurses entering the specialty of rehabilitation have little or no previous rehabilitation experience. Specific strategies are needed to assist new staff in developing skills and concepts congruent with rehabilitation nursing practice. This article describes a two-stage orientation process that has been effective in helping new staff members make the practice transition from acute care to rehabilitation nursing.

Spasticity in head trauma and CVA patients: etiology and management.

Spasticity is a common problem in patients following head trauma and cerebral vascular accident (CVA). Spasticity interferes with mobility and self-care activities which are critical for successful rehabilitative outcomes. While a patient with a spastic muscle about a joint may be able to voluntarily contract the muscle, relaxation of the muscle may be impossible. Severe spasticity can result in joint contractures which further impair function. Shearing movements due to spastic responses precipitate skin breakdown and may disrupt pressure sore repair. In addition, the inability to perform functional activities produces frustration and anxiety for patients and their significant others. The purpose of this article is to review the pathophysiologic basis of spasticity, outline treatment methods used to decrease spasticity, and suggest clinical management strategies for the nurse working with head trauma and CVA patients who exhibit spasticity.