Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis.

Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired well-being in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection (LTBI) can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.

Driving health promotion into the community: an initiative evaluated.

Health promotion and lifestyle advice is traditionally undertaken within health centres and general practices. However, evidence indicates that it can have modest impact on preventing disease. More contemporary ideas emphasize a community-based approach to health promotion activities and ultimately focus any screening performance according to the needs of the public. Utilizing a multi-level community approach to health promotion and screening activity within the Black Country is highlighted as being highly successful in shaping a dynamic local community initiative.

Providing an alternative to zero tolerance policies.

Until recently, workplace violence and aggression in health care had received little attention. Today, however, there are concerns about growing levels of violence towards health-care workers and in particular nurses. The government is now steadfast in tackling workplace violence and helping NHS staff to apply a zero tolerance approach to reduce risk and ensure the welfare of their employees? This article highlights the issues regarding the application of zero tolerance policies and principles to practice. It looks specifically at the consequences of excluding patients from primary care services and in particular at a scheme that has been set up by one general practice to provide an alternative GP service for patients within the Heart of Birmingham Teaching Primary Care Trust. Initial evaluation of this initiative indicates that patients are being successfully rehabilitated back into the community and suggests that further research is urgently needed to draw conclusions about this project, as well as similar health care services that endeavour to prevent and deal with unacceptable and aggressive behaviour in the workplace.

Operational efficiency of health care in police custody suites: comparison of nursing and medical provision.

AIM: This paper is a report of a study to examine the operational impact of a police custody nursing service on healthcare delivery in one police service in the north of England. BACKGROUND: Medical practitioners, trained specifically for the role of forensic medical examiner, have traditionally provided forensic and custodial medical services. However, there is a trend for police authorities in the United Kingdom to replace forensic medical examiners with custody nurses. Restructuring health care in police custody suites to a multidisciplinary team approach is a practical response to the challenges faced by an overburdened service. However, very few evaluations of the impact of a nursing addition to forensic medical services have been published. METHOD: One nursing service was evaluated by comparing performance indicators over a 6-months period with retrospective data from records of the traditional forensic medical examiner service. Data were extracted from 9,000 calls made by the police for medical assistance across five police stations, and analysed for response and consultation times. Five custody nurses, 20 custody officers and six forensic medical examiners were also interviewed, and the study was conducted in 2003. FINDINGS: In comparison to the traditional service, nurses demonstrated faster response times, comparable consultation times, and were perceived by custody staff as more approachable than their medical colleagues in providing handover information. CONCLUSION: As nurses take on the roles previously performed by medical colleagues, so it will become increasingly important to define role boundaries and assess the impact on the quality of care of detainees.

Multiple endocrine neoplasia type 2A: an unusual clinical presentation and association with renal dysplasia.

We report what we believe to be the first case of a patient with multiple endocrine neoplasia type 2A (MEN 2A) and renal dysplasia associated with an RET 634 mutation. The proband presented at the age of 29 with medullary thyroid carcinoma (MTC), bilateral pheochromocytomas, and primary hyperparathyroidism. Screening of family members identified the syndrome in his father. Both the proband and his father carry RET 634 germline mutation resulting in cysteine to arginine amino acid substitution. The proband had a left nephrectomy at the age of 10 years. Histologic examination of the resected kidney revealed severe dysplasia. His father had normal renal tract on ultrasonography. The proband's clinical presentation was unusual, and initially thought to be an atypical pneumonia. Surgical management after pharmacologic alpha- and beta-blockage consisted of bilateral adrenalectomy, total thyroidectomy, and subtotal parathyroidectomy as a single procedure.