Effectiveness of an advanced practice nurse-led delirium education and training programme.

AIM: To develop an education and training programme to enhance bedside nurses' knowledge, competency and compliance in accurately performing delirium screening in intensive care units. BACKGROUND: Delirium in intensive care units is associated with several poor patient outcomes. Delirium detection can be improved by enhancing nurses' knowledge, competency and compliance in accurately performing delirium screening. METHODS: A descriptive quantitative study with pretest-post-test design was adopted. There were 245 nurses from five intensive care units who participated in the study. Multiple-choice questions were used to assess nurses' knowledge change before and after the education programme. Competency was assessed before and 2 months after the programme by simulation with a standardized patient, followed by real patients at the bedside. Compliance data on screening were collected from the documentation of the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the ICU before and 3 and 10 months after the programme. Data collection took 1 year, from June 2014 to May 2015. RESULTS: Despite nurses' improved knowledge and good competency, delirium screening documentations after 3 months were poor. However, screening documentations subsequently improved when measured at 10 months, following further emphasis by the senior nursing staff. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: Nursing administrators and bedside nurses need to be involved in the policy-making process and plan a training programme for the new nursing staff in the high-risk areas. A short refreshment course should be offered to the nursing staff 3 months after the initial training programme. CONCLUSIONS: Improved knowledge and competency in assessment did not improve compliance and documentation of delirium screening. Therefore, it is important to reinforce nurses' compliance of delirium screening over time.

Radiological and clinical features of basal ganglia infarction in tuberculous meningitis.

A patient with choreoathetosis and dystonia who had computerized tomography evidence of basal ganglia damage resulting from tuberculous meningitis is presented. It is important to distinguish these extrapyramidal movements from fits, and the observation of such movements in a clinical setting of meningitis should alert physicians to the diagnosis of tuberculous meningitis.

[Inhibition of PHA-stimulated T cell conditioned medium (PHA-TCM) on the growth of human myeloid progenitor cells (CFU-C)].

Cord blood T cells were enriched by nylon wool colomn, and effects of PHA-stimulated T cell supernatant collected from 18 h to 7 days on the proliferation of CFU-c were studied. The results showed that the supernatant collected at 18 h (PHA-TCM) could significantly inhibit the growth of CFU-c and the inhibition was PHA-TCM dose dependent, suggesting there is a CFU-c inhibitory activity in PHA-TCM. Kinetic studies demonstrated that the activity was decreased in the supernatant collected at 48 h and disappeared at 7 days. On the other hand, unstimulated T cell supernatant and PHA alone had no inhibitory effect on CFU-c growth. Indomethacin did not affect the production of the inhibitory activity and no interferon activity could be detected in PHA-TCM. These suggested that the inhibition was mediated by a non-interferon, non-prostaglandin suppressor. Further studies revealed that the suppressor was a protein stable at 56 degrees C and lost in pH 2 and pH 11 for 3 h, its molecular weight was large than 10,000 dolton.

Aural tuberculosis.

Tuberculous otitis media can present with very nonspecific clinical features. Five cases of tuberculous otitis media are reviewed over a period of 5 years. Significant clinical findings included the presence of abundant granulation tissue in mastoids with good pneumatization, cervical lymphadenopathy, profound hearing loss, facial palsy, and foci of tuberculous infection at other sites. Histologic examination of granulation tissue showed tuberculoid granulomata in all cases. The mycobacteria could be identified in two of the biopsies but not on cultures. Other conditions that give rise to tuberculoid granulomata should be searched for in cases where the myobacteria cannot be identified. In one case, diagnosis was delayed because the operative specimen was neither histologically examined nor sent for culture. Persistent otorrhea and recurring granulomata after mastoidectomy provided other important clinical features. All cases responded well to antituberculous chemotherapy. Surgery is indicated nowadays for facial palsy, subperiosteal abscess, fistula formation, labyrinthitis, intracranial complication, or infrequency for resistant mycobacterial infection caused by the non-tuberculous mycobacteria.