Management of patients with multidrug-resistant tuberculosis.

The emergence of multidrug-resistant tuberculosis (MDR-TB; defined as resistance to at least rifampicin and isoniazid) represents a growing threat to public health and economic growth. Never before in the history of mankind have more patients been affected by MDR-TB than is the case today. The World Health Organization reports that MDR-TB outcomes are poor despite staggeringly high management costs. Moreover, treatment is prolonged, adverse events are common, and the majority of affected patients do not receive adequate treatment. As MDR-TB strains are often resistant to one or more second-line anti-TB drugs, in-depth genotypic and phenotypic drug susceptibility testing is needed to construct personalised treatment regimens to improve treatment outcomes. For the first time in decades, the availability of novel drugs such as bedaquiline allow us to design potent and well-tolerated personalised MDR-TB treatment regimens based solely on oral drugs. In this article, we present management guidance to optimise the diagnosis, algorithm-based treatment, drug dosing and therapeutic drug monitoring, and the management of adverse events and comorbidities, associated with MDR-TB. We also discuss the role of surgery, physiotherapy, rehabilitation, palliative care and smoking cessation in patients with MDR-TB. We hope that incorporating these recommendations into patient care will be helpful in optimising treatment outcomes, and lead to more MDR-TB patients achieving a relapse-free cure.

Social media in nurse education: Utilization and E-professionalism.

OBJECTIVE: To explore faculty and student utilization of social media and its professional implications in nurse education. METHODS: A descriptive study. Five hundred six Bachelor of Nursing students, 112 Practical Nursing students and 74 faculty members were invited to complete a questionnaire of 28 questions relating to social media. RESULTS: Three hundred thirty-seven students and 29 faculty responded. Students spent significantly more time using social media compared to faculty and both groups used it mainly for personal use. However, almost twice as many students used social media for educational purposes than did faculty (58.5% vs 27.6%, p<0.001). While almost 96% of students used social media to talk about academic related problems, only 28% of faculty did so (p<0.000). Almost 60% of faculty expressly disagreed with using social media to discuss academic related problems. YouTube and text messaging were popular platforms for educational purposes. While Facebook was also a popular educational site for students (95% used it for informal learning; 67% for formal learning), it was much less commonly used by faculty (45% used it for informal learning; 17% for formal learning). More students than faculty felt that they were aware of privacy features, and of the professional behavior expected when using social media. In addition, more students (90.7%) than faculty (71.43%) used these privacy features (p<0.000). However, 100% of students compared to only 13.79% of faculty reported that they had posted information that they would not want a prospective employer/member of academic staff to view (p=0.003). CONCLUSION: There is a high reported usage of social media among students and faculty. Utilization of public platforms, while potentially beneficial, can have professional implications if not used appropriately with both personal and academic use. Developing best practice approaches for using social media in nurse education is essential to ensure that faculty and students are informed of e-professionalism.