Learning and unlearning dignity in care: Experiential and experimental educational approaches.

Guarding against loss of human dignity is fundamental to nursing practice. It is assumed in the existing literature that 'dignity' as a concept and 'dignity in care' as a practice is amenable to education. Building on this assumption, a range of experiential and experimental educational approaches have been used to enhance students' understanding of dignity. However, little is known about student nurses' views on whether dignity is amenable to education and, if so, which educational approaches would be welcomed. This mixed-methods study used an online questionnaire survey and focus groups to address these questions. Student nurses in Scotland completed online questionnaires (n = 111) and participated in focus groups (n = 35). Students concluded that education has transformative potential to encourage learning around the concept of dignity and practice of dignity in care but also believed that dignity could be unlearned through repeated negative practice exposures. Experiential and experimental educational approaches were welcomed by student nurses, including patient testimony, role-play, simulation, and empathy exercises to step into the lives of others. Nurse educators should further integrate experiential and experimental educational approaches into undergraduate and postgraduate nursing curricula to guard against the loss of learning around dignity students believed occurred over time.

The case of the mysterious vanishing spleen: autosplenectomy complicating pneumococcal sepsis.

A 57-year-old previously healthy fisherman was admitted in fulminant pneumococcal septic shock, with disseminated intravascular coagulation, requiring aggressive management including bilateral below-knee amputations for ischaemic necrosis. He began to recover and was discharged for rehabilitation, however during his convalescence was found to be hypercalcaemic. No malignancy was found on CT scan, but it was noted that his spleen was absent, replaced by a 4 cm smooth-walled, fluid-filled lesion. This was unexpected as an ultrasound in intensive care 10 weeks previously had demonstrated a normal spleen. Functional hyposplenism was confirmed on a peripheral blood film with evidence of target cells, spherocytes and Howell-Jolly bodies. A diagnosis of autosplenectomy complicating pneumococcal sepsis was therefore made, of which there is just one case previously reported. The patient continues to recover well and was discharged on penicillin prophylaxis after receiving vaccinations for hyposplenism.

Student nurses' perceptions of dignity in the care of older people.

AIM: The aim of this research was to investigate student nurses' perceptions of the concept of dignity in the care of older people. Student nurses regularly move between the classroom and the clinical setting and are thus ideally placed to cast light on the barriers that exist to providing dignity in care and the way in which their theoretical understanding of dignity is shaped by exposure to the practice setting. METHOD: All student nurses on a three-year undergraduate nursing programme at one university were invited to participate in an online questionnaire survey and focus groups. RESULTS: Students equated the practice of upholding dignity with listening to individuals, involving them in decision making and maintaining their privacy. Participants were mostly confident about what dignity meant in practice, but were unsure about the more theoretical aspects. Four major barriers to the promotion of dignity were highlighted-these were organisational, environmental, professional and personal in nature. CONCLUSION: Dignity education should occupy a more prominent position in pre-registration nursing programmes.

Alemtuzumab in combination with methylprednisolone is a highly effective induction regimen for patients with chronic lymphocytic leukemia and deletion of TP53: final results of the national cancer research institute CLL206 trial.

PURPOSE: In chronic lymphocytic leukemia (CLL), TP53 deletion/mutation is strongly associated with an adverse outcome and resistance to chemotherapy-based treatment. In contrast, TP53 defects are not associated with resistance to the anti-CD52 monoclonal antibody alemtuzumab or methylprednisolone. In an attempt to improve the treatment of TP53-defective CLL, a multicenter phase II study was developed to evaluate alemtuzumab and methylprednisolone in combination. PATIENTS AND METHODS: Thirty-nine patients with TP53-deleted CLL (17 untreated and 22 previously treated) received up to 16 weeks of treatment with alemtuzumab 30 mg three times a week and methylprednisolone 1.0 g/m(2) for five consecutive days every 4 weeks. Antimicrobial prophylaxis consisted of cotrimoxazole, itraconazole, and aciclovir (or valganciclovir for asymptomatic cytomegalovirus viremia). The primary end point was response as assigned by an end-point review committee. Secondary end points were safety, progression-free survival (PFS) and overall survival (OS). RESULTS: The overall response rate, complete response rate (including with incomplete marrow recovery), median PFS, and median OS were 85%, 36%, 11.8 months, and 23.5 months, respectively, in the entire cohort and 88%, 65%, 18.3 months, and 38.9 months, respectively, in previously untreated patients. Grade 3 to 4 hematologic and glucocorticoid-associated toxicity occurred in 67% and 23% of patients, respectively. Grade 3 to 4 infection occurred in 51% of the overall cohort and in 29% of patients less than 60 years of age. Treatment-related mortality was 5%. CONCLUSION: Alemtuzumab plus methypredisolone is the most effective induction regimen hitherto reported in TP53-deleted CLL. The risk of infection is age related and, in younger patients, seems only marginally higher than that associated with rituximab, fludarabine, and cyclophosphamide.

A case of primary cardiac lymphoma: analysis of the role of echocardiography in early diagnosis.

Primary Cardiac Lymphoma (PCL) is defined as a non-Hodgkin's lymphoma involving only the heart and/or pericardium. Diagnosis of this rare disease is particularly difficult due to its nonspecific clinical manifestations. In this review the role of echocardiography in the early diagnosis of PCL is assessed, moreover we report an improvement in the outcome of PCL related to increased availability and utilization of echocardiography.