Integrating quality postnatal care into PMTCT in Swaziland.

Swaziland's prevention of mother-to-child transmission (PMTCT) programme is linked to maternal and newborn health (MNH) services, but is mainly focussed on HIV/AIDS. Existing MNH services are inadequate, especially postnatal care (PNC) of mothers and babies, with delayed postnatal visits occurring at 4-6 weeks after delivery. Fifty-seven percent of staff in seven Swazi health facilities were trained in promoting and providing early PNC. A final evaluation showed a 20-fold increase in the number of visits coming for an early postnatal visit (within the first three days after birth). A direct observation of the client-provider interaction showed a significant increase in the competence of the health workers related to postnatal examinations, and care of mothers and babies (p<0.05- < 0.01). The percentage of women breastfeeding within one hour of delivery increased by 41% in HIV-positive mothers and 52% in HIV-negative mothers. Cotrimoxazole prophylaxis for HIV-exposed infants increased by 24%. Although, health workers were observed providing counselling, maternal recall of messages was deficient, suggesting the need for additional strategies for promoting healthy behaviours. High-quality integrated PMTCT programmes and MNH postnatal services are feasible and acceptable, and can result in promoting early postnatal visits and improved care of both HIV-positive and HIV-negative mothers and their babies.

Middle-range theory of chronic sorrow.

PURPOSE: To introduce a middle-range nursing theory of chronic sorrow that presents this sorrow as a normal response to ongoing disparity due to loss. Chronic sorrow is the periodic recurrence of permanent, pervasive sadness or other grief related feelings associated with a significant loss. The theory provides a framework for understanding and working with people following a single or ongoing loss. ORGANIZING FRAMEWORK: The model of chronic sorrow includes antecedents, trigger events, and internal and external management methods. SCOPE: Theory is useful for analyzing individual responses of people experiencing ongoing disparity due to chronic illness, caregiving responsibilities, loss of the "perfect" child, or bereavement. SOURCES: The theory was developed using concept analysis, critical review of research, and validation in 10 qualitative studies of various loss situations. CONCLUSIONS: Chronic sorrow has been shown to explain the experience of people across the lifespan who encounter ongoing disparity because of significant loss. Nurses need to view chronic sorrow as a normal response to loss and, when it is triggered, provide support by fostering positive coping strategies and assuming roles that increase comfort.

Helping spouses with chronic sorrow related to multiple sclerosis.

1. Chronic sorrow is defined as a pervasive sadness that is permanent, periodic, and progressive in nature. 2. Milestones or events which caused the sorrow to recur were major themes in this study. 3. The participants identified what was helpful and not helpful in coping with these feelings, gave practical advice for similar individuals, and offered suggestions for nurses and other caregivers.

Helping spouses with chronic sorrow related to multiple sclerosis.

1. Chronic sorrow is defined as a pervasive sadness that is permanent, periodic, and progressive in nature. 2. Milestones or events which caused the sorrow to recur were major themes in this study. 3. The participants identified what was helpful and not helpful in coping with these feelings, gave practical advice for similar individuals, and offered suggestions for nurses and other caregivers.

Living with multiple sclerosis: the experience of chronic sorrow.

This qualitative nursing research study investigated the occurrence of chronic sorrow in individuals with multiple sclerosis. Using the Burke/NCRCS Chronic Sorrow Questionnaire (Individual Version), 10 participants were interviewed. Data were analyzed in collaboration with one other researcher. Of the participants, 80% evidenced the presence of chronic sorrow in their lives. Data clearly indicated that feelings of chronic sorrow occurred periodically over a protracted span of time when some event reminded participants of their chronic situation. The nursing roles of empathetic presence and caring professional helped participants the most in dealing with their feelings of chronic sorrow.

Coping with chronic sorrow.

This qualitative study was designed to examine the presence of chronic sorrow in diverse populations of individuals with chronic or life threatening conditions and to identify strategies for coping with feelings of chronic sorrow. Chronic sorrow was defined as a pervasive sadness that is permanent, periodic, and progressive in nature. The sample comprised 5 infertile couples, 10 individuals with long-term cancer, 10 individuals with multiple sclerosis, 6 individuals with Parkinson's disease, and 4 spouse caregivers. Data were collected through audiotaped face-to-face or telephone interviews using the Burke/NCRCS Chronic Sorrow Questionnaire. The audiotapes were transcribed, entered into a computer analysis program, and collaboratively analyzed by the researchers. The findings indicate that 83% of the subjects experienced chronic sorrow. The four coping strategies that were identified by the subjects as being helpful to their situation were categorized by the researchers as interpersonal, emotional, cognitive, and action.

Chronic sorrow in multiple sclerosis. A case study.

Multiple sclerosis, one of the most common chronic disabilities among young adults, may potentiate the occurrence of chronic sorrow. Chronic sorrow differs from acute grief because it is permanent, periodic, and progressive in nature; it may be a normal component of chronic illness and disability. This study describes one woman's experience with multiple sclerosis, her chronic sorrow about the trajectory of her disability, her progressive loss of bodily function, and the stigma of chronic illness. It also reports some of the feelings experienced by her husband, the primary caregiver.

Chronic sorrow: a lifespan concept.

Losses are an integral part of chronic illness and disability. The term chronic sorrow, has been used to describe the long-term periodic sadness the chronically ill and their caregivers experience in reaction to continual losses. In this conceptual analysis of chronic sorrow, identified critical attributes are: cyclic sadness over time in a situation with no predictable end; external and internal stimuli triggering the feelings of loss, disappointment, and fear; and, progression and intensification of the sadness or sorrow years after the initial disappointment or loss. Model, borderline, related, contrary, and illegitimate cases illustrate what the concept is and what it is not. The meaning of chronic sorrow is compared to the meaning of unresolvable grief and depression. Chronic sorrow in various stages of life is illustrated in descriptions of: the situation and feelings of parents of handicapped children; multiple sclerosis patients in the middle, productive years; and elderly caregivers of spouses with dementia. Implications for research include the need to study the concept in various populations to determine its prevalence and operation. Through research, the meaning of the concept can be further clarified. This is a beginning step toward developing nursing theory that will give direction for providing care to persons encountering sadness over long periods of time.

Establishing a long-distance research consortium.

With the increased emphasis on the generation of nursing knowledge through research, collaboration has been identified as an effective way of maximizing both personal and financial resources. There are few articles that specifically describe the process for initiating such a collaborative effort, especially when interested persons are far removed, geographically, from one another. This paper outlines the steps involved in establishing a research consortium and chronicles the development of the Nursing Consortium for Research on Chronic Sorrow. Lancaster's (1985) criteria for effective research collaboration are used to evaluate this developmental process.

Tuberculosis of the conjunctiva occurring in association with a neighbouring lupus vulgaris lesion.

A case of tuberculosis of the conjunctiva in association with a neighbouring lupus vulgaris lesion is reported. Both lesions resolved within one month of starting antituberculous therapy. Tuberculosis of the conjunctiva is nowadays a rare condition. It should be considered in the differential diagnosis of any unusual chronic conjunctivitis, particularly in patients who are at risk of contracting tuberculosis.

Pressor responses to tracheal intubation after sublingual captopril. A pilot study.

The effect of sublingual captopril on the pressor response to intubation was studied in 40 patients. Captopril was used in one of two doses (12.5 mg and 25 mg) 25 minutes before tracheal intubation. Both doses were associated with a significant reduction in the pressor response to intubation (p less than 0.05) compared to placebo, but no significant difference existed between the two doses. Neither dose controlled changes in heart rate at intubation. Untoward hypotension occurred in the treatment groups. Caution is advised in the peri-operative use of angiotensin-converting enzyme inhibitors.

Pancreatic somatostatinoma: presentation with recurrent episodes of severe hyperglycaemia and ketoacidosis.

A 47-year-old woman was admitted on four occasions over a four-year period with severe hyperglycaemia associated with marked ketoacidosis. She had weight loss with hepatomegaly and ultrasonography indicated a pancreatic tumour which was shown to be a somatostatinoma. Resection resulted in prolonged survival. The biochemical and morphological features of this rare tumour are presented, and an explanation for the unusual presentation of a somatostatinoma with episodes of ketoacidosis is given.

The fluorescence of melanocytic lesions.

The fluorescence of routine formalin-fixed sections of a variety of melanocytic lesions has been studied. The technique has value in distinguishing benign and atypical nevi from malignant melanomas. Forty-one of 48 melanomas exhibited positive fluorescence, whereas 15 of 86 of a variety of benign nevi were positive. The majority of the negative melanomas were Hutchinson's melanotic freckles, and the majority of the positive nevi were Spitz's nevi. Positive focal junctional fluorescence was a feature in up to half of the cases from established dysplastic nevus syndrome, but was noted only occasionally in sporadic dysplastic nevi. This distinguishes the dysplastic group from banal nevi and may be a marker of malignant potential. It is proposed that positive fluorescence is a marker of a melanocyte with an immature metabolic pathway.