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Polio is Gone From Nigeria, WHO Says

by MAGGIE FOX
Nigeria has been declared free of transmission of polio, leaving just two countries in the world where the virus is still regularly spreading: Pakistan and Afghanistan.

It’s a big step towards the eradication of a disease that paralyzes children for life and that’s easy to prevent with a vaccine that costs just a few cents.

The World Health Organization announcement means that polio is no longer endemic in Nigeria, which was the last country in Africa with regular, ongoing transmission of the virus.

“Eradicating polio will be one of the greatest achievements in human history, and have a positive impact on global health for generations to come,” WHO said in a statement.

“Nigeria has brought the world one major step closer to achieving this goal and it’s critical that we seize this opportunity to end polio for good and ensure future generations of children are free from this devastating disease.”

Vaccine workers battled mistrust and rumors, and worked around attacks by the militant group Boko Haram, to get kids vaccinated against the paralyzing virus, said John Vertefeuille, polio incident manager for the U.S. Centers for Disease Control and Prevention.

“They would just go out day after day and make sure they were getting vaccine into kids,” Vertefeuille told NBC News.

It’ll be two more years before Africa is declared polio-free. The virus can lurk in the body and it can go unreported in rural areas, so it takes a few years to be certain the virus isn’t popping up anywhere. But it is not being actively transmitted, WHO said.

“The outstanding commitment and efforts that got Nigeria off the endemic list must continue, to keep Africa polio-free. We must now support the efforts in Pakistan and Afghanistan so they soon join the polio-free world,” said WHO director-general Dr. Margaret Chan.

WHO is part of the Global Polio Eradication Initiative, which includes national governments, the non-profit Rotary International, the CDC, UNICEF, and the Bill & Melinda Gates Foundation. They’ve been pushing hard to eliminate polio, which infects only humans so it could be eliminated by vaccinated, as smallpox was in 1979.

Just 41 cases of polio have been reported globally, compared to 200 cases this time last year.

“As recently as 2012, Nigeria accounted for more than half of all polio cases worldwide,” the Global Polio Eradication Initiative said in a statement.

“Since then, a concerted effort by all levels of government, civil society, religious leaders and tens of thousands of dedicated health workers have resulted in Nigeria successfully stopping polio. More than 200,000 volunteers across the country repeatedly immunized more than 45 million children under the age of five years, to ensure that no child would suffer from this paralyzing disease.”

War and unrest is the biggest barrier to vaccination. Rumors and fears about the vaccine also interfere. Nigerian workers had to fight rumors that the vaccine was deliberately formulated to make Muslims sterile, and one successful approach was getting a vaccine that was manufactured in Indonesia, a Muslim country.

Attacks by Boko Haram, a militant Islamist group that is fighting Nigeria’s government, added to the complications.

Militants still make it very difficult to vaccinate people in Afghanistan and Pakistan. Attacks on vaccination teams make the work dangerous.

“As long as polio exists anywhere, it’s a threat to children everywhere,” the polio initiative group said.

Polio is the virus. Poliomyelitis is the disease caused when the virus infects the spinal cord.

It’s transmitted through contaminated food and water. Most people who are infected develop no symptoms and don’t even know they’ve got it. But in about 1 in 200 cases, the virus destroys the nerve cells that activate muscles, causing irreversible paralysis, usually in the legs. It can paralyze breathing muscles, too, sometimes causing death.

There are two types of vaccine, on oral and one injected. Vaccination has reduced the number of cases by 99 percent since 1988, which polio paralyzed 350,000 children a year. The last U.S. case of polio was in 1979, although many people survive with the permanent effects of the virus.

Missing just a few years of vaccination can allow the virus to come back and spread. Travelers often spread the virus.

“This is a clear example of success under very difficult circumstances. It shows we can eradicate polio if proven strategies are fully implemented,” CDC director Dr. Tom Frieden said in a statement.

“We are moving decisively toward ending a disease that has paralyzed tens of millions of children. In this final mile, we must remain committed to providing the resources and the support to the front lines to make this worthy goal a reality.”

Syria had an outbreak of polio when the fighting there interrupted vaccination programs, and 35 kids were paralyzed by polio in 2013. Groups stepped up vaccination campaigns and there hasn’t been a case reported in Syria since January 2014.

Arthroscopy

Normal Findings

  • Normal knee consisting of a diarthrodial joint surrounded by muscles, ligaments, cartilage, and tendons, and lined with a synovial
    membrane
  • In children, smooth and opaque menisci, with thick outer edges attached to the joint capsule and unattached inner edges lying snugly
    against the condylar surfaces
  • Articular cartilage that’s smooth and white
  • Ligaments and tendons that are cablelike and silvery
  • Synovium that’s smooth and marked by a fine vascular network

Abnormal Findings

  • Meniscal disease, such as a torn medial or lateral meniscus or other meniscal injuries
  • Patellar disease (chondromalacia, dislocation, subluxation, parapatellar synovitis, or fracture)
  • Condylar disease (degenerative articular cartilage, osteochondritis dissecans, and loose bodies)
  • Extrasynovial disease (torn anterior cruciate or tibial collateral ligaments, Baker’s cyst, and ganglionic cyst)
  • Synovial disease (synovitis, rheumatoid and degenerative arthritis, and foreign bodies associated with gout, pseudogout, and osteochondromatosis)





Nursing Implications

  • Report abnormal findings to the practitioner.
  • Educate the patient about his diagnosis and possible treatment options.
  • Depending on test findings, appropriate treatment or surgery can follow arthro scopy. If arthroscopic surgery can’t be performed, arthrotomy is the procedure of choice.

Purpose

  • To detect and diagnose meniscal, patellar, condylar, extrasynovial, and synovial diseases
  • To monitor disease progression
  • To perform joint surgery
  • To monitor the effectiveness of therapy

Description
Arthroscopy is the visual examination of the interior of a joint (most commonly a major joint, such as a shoulder, hip, or knee) with a specially designed fiberoptic endoscope that’s inserted through a cannula in the joint cavity. It usually follows and confirms a diagnosis made through physical examination, radiography, and arthrography. Arthroscopy may be performed under local anesthesia, but it’s usually performed under a spinal or general anesthesia, particularly when surgery is anticipated. A camera may be attached to the arthroscope to photograph areas for later study.

Arthroscopic techniques vary depending on the surgeon and the type of arthroscope used. The procedure typically proceeds as follows:

  • The patient’s leg is elevated and wrapped with an elastic bandage to drain as much blood from the leg as possible, or a mixture of lidocaine with epinephrine and normal saline solution is instilled into the patient’s knee to distend the knee and reduce bleeding.
  • The local anesthetic is administered, a small incision is made, and a cannula is passed through the incision and positioned in the joint cavity.
  • The arthroscope is inserted, and the knee structures are visually examined and photographed for further study.
  • After visual examination, a synovial biopsy or appropriate surgery is performed, as indicated.
  • When the examination is completed, the arthroscope is removed, the joint is irrigated, the cannula is removed, and an adhesive strip and compression dressing are applied over the incision site.





Precautions

  • Arthroscopy is contraindicated in the patient with fibrous ankylosis with flexion of less than 50 degrees.
  • Arthroscopy is contraindicated when the patient has local skin or wound infections with a risk of subsequent joint involvement.

Nursing Considerations

Before the Test

  • Explain to the patient that arthroscopy is used to examine the interior of the joint, to evaluate joint disease, or to monitor his response to therapy, as appropriate.
  • Describe the procedure to the patient and answer his questions.
  • If surgery or another treatment is anticipated, explain that this may be accomplished during arthroscopy.
  • Instruct the patient to fast after midnight before the procedure.
  • Inform the patient who will perform the procedure, and when and where it will be done.
  • If local anesthesia is to be used, advise the patient that he may experience slight discomfort from the local anesthetic injection and the tourniquet pressure on his leg.
  • Also prepare him to expect to feel a thumping sensation as the cannula is inserted in the joint capsule.
  • Make sure that the patient or a responsible family member has signed an informed consent form.
  • Check the patient’s history for hypersensitivity to the anesthetic.
  • Prepare the surgical site by shaving the area 5” (12.7 cm) above and below the joint, and administering a sedative, as ordered.
  • Position the patient, and drape him according to facility policy.





After the Test

  • Observe the patient for fever, swelling, increased pain, and localized inflammation at the incision site. If the patient reports discomfort, provide an analgesic, as ordered.
  • Monitor the patient’s circulation and sensation in his leg.
  • Advise the patient to elevate the leg and apply ice for the first 24 hours.
  • Instruct the patient to report fever, bleeding, drainage, or increased swelling or pain in the joint.
  • Advise the patient to bear only partial weight, using crutches, a walker, or a cane for 48 hours.
  • If an immobilizer is ordered, teach the patient how to apply it.
  • Tell the patient that showering is permitted after 48 hours, but a tub bath should be avoided until after the postoperative visit.
  • Tell the patient that he may resume his usual diet, as ordered.

Reference:
Brunner & Suddarth’s (2010). Handbook of laboratory and Diagnostic Test. New York: Lippincott Williams & Wilkins

Punch Biopsy

Biopsy is the removal of a small piece of tissue from the skin for microscopic examination. Partial or full thickness of skin over the lesion is removed for evaluation.

OVERVIEW

    Punch biopsy is used for full and partial dermal lesions such as

  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Actinic keratoses
  • Seborrheic keratoses
  • Lentigo (freckles)
  • Lipomas
  • Melanomas
  • Nevi
  • Warts—verruca vulgaris

RATIONALE

  • To confirm etiology of lesion for treatment
  • To establish or confirm a diagnosis for treatment and/or intervention

INDICATIONS

  • Partial- or full-dermal-thickness lesion not on the face, eye, lip, or penis

CONTRAINDICATIONS

  • Lesion on eyelid, lip, or penis, REFER to a physician.
  • Infection at the site of the biopsy
  • Bleeding disorder
  • Lesions that are deep or on the face, REFER to a physician.
  • Informed consent required

PROCEDURE

Punch Biopsy
Equipment

  • Antiseptic skin cleanser
  • Drape—sterile
  • Gloves—sterile
  • Disposable biopsy punch
  • Pickups—sterile
  • Scissors—sharp for the fine tissue—sterile
  • 3-mL syringe
  • 27- to 30-gauge, ½-inch needle
  • 1% lidocaine
  • Container with 10% formalin
  • 4 × 4 gauze
  • Nonstick dressing (Adaptic or Telfa)
  • Kling
  • Tape
  • Steri-Strips (if biopsy will be greater than 4 mm) or one suture

Procedure

  • Position the client so that the area to be biopsied is easily accessible.
  • Cleanse the skin with antiseptic skin cleanser.
  • Put on gloves.
  • Drape the area to be biopsied.
  • Anesthetize with 1% lidocaine.
  • With the thumb and index finger, spread the skin to apply tension opposite natural skin tension lines. This allows a more elliptical-shaped wound for easy closure.
  • Apply biopsy punch to skin, rotate per manufacturer’s directions, and remove the punch
  • With pickups, pull up loosened skin.
  • Cut with scissors, and place tissue in tissue container of 10% formalin.
  • If less than 2 to 3 mm, apply nonstick dressing and pressure dressing.
  • If greater than 4 mm, apply Steri-Strips and cover with 4 × 4 gauze.
  • Apply Kling and secure with tape.

Client Instructions

    • Keep dressing clean, dry, and in place for 48 hours to decrease the chance of bleeding and oozing.
    • Avoid touching or contaminating the area biopsied.
    • To prevent the chance of infection, take cephalexin (Keflex) 500 mg three times per day or amoxicillin (Amoxil) 500 mg twice a day for 5 days.
    • Some redness, swelling, and heat are normal. Return to the office if symptoms of infection occur, such as

● Yellow or green drainage
● Red streaks
● Pain
● Elevated temperature

  • Take acetaminophen (Tylenol) or ibuprofen (Motrin) every 4 to 6 hours as needed for pain.

BIBLIOGRAPHY
De Vries HJ, Zeegelaar JE, Middelkoop E, et al. Reduced wound contraction and scar formation in punch biopsy wounds. Native collagen dermal substitutes. A clinical study. Br J Dermatol. 1995;132(5):690–697.

Zuber TJ. Ingrown toenail removal. Am Fam Physician. 2002;65(12):2547–2550.

Blood tests reveal early signs of cardiovascular disease risk in obese African-American teens

By AMERICAN HEART ASSOCIATION NEWS

Long before they have symptoms, blood tests in obese African-American teens, especially girls, reveal immune system changes linked to greater cardiovascular disease risk, according to a study presented at the American Heart Association’s Council on Hypertension 2015 Scientific Sessions.

“Obesity in the formative years is already priming the system to develop cardiovascular disease later in life,” said Carmen De Miguel, Ph.D., study lead researcher and a postdoctoral scholar at the University of Alabama at Birmingham.

There is substantial evidence that the immune system is involved in the development of cardiovascular disease, with changes in immune cells in the blood appearing years before people develop high blood pressure, Type 2 diabetes, or cardiovascular diseases. The new study shows that obesity-related immune cell changes appear early – particularly in African-American girls.

Researchers conducted blood tests on about 100 white and African-American public school students between the ages of 14 and 20 in Augusta, Georgia. Obese teens were over the 95th percentile for weight, while lean teens were below the 60th percentile of weight.

To determine obesity’s effect on inflammation, researchers compared levels of T-cells and their activation status among lean and obese children by race and gender. Activated T-cells are a sign of inflammation. Researchers found:

  • White teenagers displayed less systemic inflammation (marked by smaller numbers of T-cells in the blood) in response to obesity than black teens.
  • Obese black teenage girls had higher levels of activated T cells compared to obese black teenage boys.

“We think that the fact that the girls do not decrease the numbers of activated T cells could be important in explaining the high risk that black females have of developing cardiovascular disease later in life,” De Miguel said.

Since changes in the immune system appear years before symptoms of heart disease, De Miguel suggests that health professionals could use blood tests to identify teens who are at high risk of developing cardiovascular disease in the future.

“This could allow for preventive therapies and help changing exercise and diet habits to make the teen less prone to heart disease in adulthood,” De Miguel said.

Heart risks with newer hepatitis C drugs and amiodarone

The European Medicines Agency (EMA) has warned against the use of antiarrhythmic amiodarone in combination with newer hepatitis C infection treatments, after reports of heart problems in eight patients.

In a review of patients taking amiodarone who then started taking Harvoni (sofosbuvir with ledipasvir) or a combination of Sovaldi (sofosbuvir) and Daklinza (daclatasvir) to treat a hepatitis C infection, there were eight reports of severe bradycardia (slow heart rate) or heart block (problems with conduction of electrical signals in the heart) within the first 12 days of starting the antivirals. Most problems occurred as early as the first day of treatment. Two of these patients needed pacemakers and one patient died from a cardiac arrest.

While it’s not yet clear why this has happened, the EMA has recommended that patients taking these hepatitis C medications should avoid taking amiodarone. If no other antiarrhythmics are suitable, the patients should be monitored closely, potentially in hospital for the first 48 hours. They should also be told to report any symptoms to their doctor straight away, including slow heartbeat, dizziness, faintness, unusual tiredness, shortness of breath or chest pain. Since amiodarone has a long half-life, patients should also be monitored if they have stopped taking the drug in the past few months.

Source: The Pharmaceutical Journal, PJ August 2015 online, online | URI: 20069234

PATIENT SATISFACTION: NURSES ROLE

A major component of quality health care is patient satisfaction. Patient satisfaction is a key determinant of quality of care and an important component of pay-for-performance metrics. It is a composite index of an individual’s evaluative judgement concerning the quality of medical care received from physicians, nurses and other relevant sources to represent the individual’s point of view and compare with the realities of the care received particularly in the aspect of interpersonal process. The American Nurses Association defines ‘patient satisfaction with nursing care’ as patients’ opinion of care received from nursing staffs during their hospitalisation.

Emphasis on patient satisfaction with health and medical care services is on the increase, as evidenced by greater frequency of empirical and theoretical publications regarding satisfaction in recent years. This emphasis is consistent towards holding those who control and provide essential services more accountable to their patients. Patient satisfaction affects clinical outcomes, patient retention, and medical malpractice claim. It affects the timely, efficient, and patient-centred delivery of quality health care. Currently, patient satisfaction is positively linked with higher level of individualized care.

Quality health care is basically influenced by active involvement of the employer towards providing sufficient resources, effective policies of the organization, dedication and commitment of health personnel. Patient satisfaction can be attained by nurses amidst challenges in our work environment that are yet to be successfully addressed. Exploring all measures of therapeutic communication, being mindful of its elements improves patient outcome. Patients are concern with the contribution of affective support such as nurses being caring, supportive, respectful, honest, empathy, patient, attentive, and responsive towards their satisfaction.

Nurses must respect their patients, involve their patients in hospital care, provide patients useful information privately and individually, and render nursing services without delay. Seek patient’s permission and consent before performing nursing procedures, explain nursing procedures clearly before performing it, ensure patient’s privacy, be skilful in performing nursing procedures, be professional and competent when rendering nursing services, and encourage their patient always. Allow patients to make their own decision when being cared for, family members can be involved if patient desire, and ensure patient receives useful information during discharge planning.

Documentation is essential for good clinical communication. Accurate record keeping is an indication of evidenced based practice. As such, it is imperative for nurses to consistently utilize nursing process in all patients’ care, and voluntarily invest in higher education and other professional development programs that will actively boost their knowledge, skills, experience, and competencies in various dynamics of nursing education and practice.

ARUNGWA O. T. (Mrs)
29082015

Schizophrenia through the carers’ eyes results of a European cross-sectional survey

Schizophrenia through the carers’ eyes results of a European cross-sectional survey

Schizophrenia carries a significant burden for families providing care. The Adherencia Terapéutica en la Esquizofrenia (ADHES) carers’ survey was designed to assess the opinions of family and friends of patients with schizophrenia across Europe and ascertain their attitudes towards the illness, medication and adherence to medication. A questionnaire-based cross-sectional survey of 138 carers across 16 European countries. Interpretation of results was based on a descriptive comparison of responses.

Carers recognized the importance of medication to help patients get better (76%) and improve their quality of life (76%) and relationships (74%). Sixty-seven per cent believed medication damages general health. Sixty-five per cent reported that treatment adherence was a burden for patients. Thirty-eight per cent indicated that it was a daily struggle to get patients to take their medication. Fifty per cent perceived that medication administered every few weeks rather than daily was quite/very important. Ninety-three per cent agreed on the importance of family support to boost adherence, with education and information deemed important for families and patients. Carers rely less on the patient themselves when assessing adherence than psychiatrists.

The burden faced by carers and patients in taking medication provides an opportunity for healthcare professionals to provide support in a multidisciplinary ‘team’ involving psychiatrists, nurses and carers.

Click HERE to read more about this

Diagnosis of borderline personality disorder

Experiences of care by Australians with a diagnosis of borderline personality disorder

There is limited understanding of the experience of seeking and receiving treatment and care by people with a diagnosis of borderline personality disorder (BPD), their perceptions of barriers to care and the quality of services they receive. This study aimed to explore these experiences from the perspective of Australians with this diagnosis.

An invitation to participate in an online survey was distributed across multiple consumer and carer organizations and mental health services, by the Private Mental Health Consumer Carer Network (Australia) in 2011. Responses from 153 people with a diagnosis of BPD showed that they experience significant challenges and discrimination when attempting to get their needs met within both public and private health services, including general practice.

Seeking help from hospital emergency departments during crises was particularly challenging. Metropolitan and rural differences, and gender differences, were also apparent. Community supports were perceived as inadequate to meet their needs.




This study provides data on a range of experiences not reported in existing literature, including general practitioner roles, urban and rural differences, public and private hospital differences, and comparison of usefulness of support across multiple support types. Its findings can help inform better training for health professionals and better care for this population.

Click HERE to read more about this

Prevention of Liver Cancer Through the Early Detection of Risk-Related Behavior Among Hepatitis B or C Carriers

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the leading causes of liver cirrhosis and hepatocellular carcinoma. Little is known about the relationship between health-related behaviors and health status among HBV or HCV carriers.

Objective: The purpose of this study was to explore the relationship between health status (eg, specific biomarkers) and health-related behaviors (eg, alcohol consumption) in individuals with or without HBV or HCV infection.

Methods: A cross-sectional descriptive design was used, and a community-based health screening survey was conducted between August 2011 and July 2012 in Taiwan.

Click HERE to read more about this.

Creating Age Friendly Cancer

The World Health Organization’s ‘Age-Friendly World’ initiative deserves careful consideration in cancer care. Age-friendliness is an approach to restructuring our current communities to be suitable and even inviting to older people, especially those who are vulnerable as a result of frailty and changing abilities.

  • Age-friendly communities
  • Recognize the wide range of capacities and resources among older people;
  • Anticipate and respond flexibly to ageing-related needs and preferences;
  • Respect older people’s decisions and lifestyle choices;
  • Protect those who are most vulnerable; and
  • Promote older people’s inclusion in and contribution to all areas of community life.

Click HERE to read more on this.

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