Simultaneous decompressive craniectomy and caesarean section.

A 24-year-old primigravid woman at 29-weeks gestation presented with headache, hypertension and proteinuria. A diagnosis of pre-eclampsia was made. Later that day she developed a left hemiparesis and neuroimaging demonstrated an intracerebral haemorrhage in the right frontal lobe as well as thrombosis of the superior sagittal sinus. She was commenced on an IV heparin infusion to manage the sinus thrombosis, and nifedipine and labetalol to treat the hypertension. GCS remained 15/15. However, 12 hours later, she became progressively agitated. Her GCS decreased to 10/15 (E3V2M5). Repeat imaging demonstrated enlargement of the haematoma, causing significant mass effect and midline shift. A decision was made to perform decompressive hemicraniectomy to save the life of the mother, and caesarean section to protect the foetus as well as providing definitive treatment of pre-eclampsia. Due to further neurological deterioration of the mother it became necessary to perform the two procedures simultaneously. We present the first reported case of decompressive craniectomy and caesarean section performed simultaneously. After discussing the case, we consider why this clinical scenario is rare and why it became necessary in this patient to perform the two procedures simultaneously.

Anti-interleukin (IL)-5 as a steroid-sparing agent in chronic eosinophilic pneumonia.

Introduction: Anti-interleukin (IL)-5 therapy is a novel drug class clinically effective in patients with diverse eosinophil-related disorders such as allergic eosinophilic asthma, eosinophilic granulomatosis with polyangiitis (EGPA), nasal polyposis, eosinophilic COPD, and other non-pulmonary disorders such as eosinophilic esophagitis. Chronic eosinophilic pneumonia (CEP) is a steroid responsive disorder, however, relapses are common following corticosteroid tapering. Case Study: We present the case of a 42-year-old woman with steroid-dependent relapsing CEP successfully treated with anti-IL-5 antibody. Results: Treatment with anti-IL-5 antibody resulted in remission with the ability to taper off the steroids, and no recurrence of the disease for 6 months. Conclusion: Our case report supports the potential use of anti-IL-5 therapy for remission of patients with CEP with recurrent relapses. Whether, it would also be an effective initial therapy might also be an area that deserves future investigation.

The Kids Into Health Careers (KIHC) initiative: innovative approaches to help solve the nursing shortage.

In 2001, the Northern Illinois University School of Nursing was awarded a grant from the Division of Nursing of the Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services, to enhance the School's advanced practice nursing program. As a recipient of this grant, the School of Nursing was required to incorporate activities to meet the goals of the "Kids Into Health Careers (KIHC) Initiative" to encourage children into health care careers. This article describes the strategies developed by the School of Nursing to meet the KIHC goals and encourage children, especially those from minorities, into health care careers. The School's approach was multifaceted and included collaboration with a variety of community organizations and groups. While there is a tremendous amount of work to be accomplished in encouraging middle and high school students to consider nursing as a career, creative strategies through which nurses take an active role in helping resolve the problem are suggested.

Advocating for the rights of the mentally ill: a global issue.

The media has shared with the American public horrors of abuse towards prisoners of war in recent newscasts. Prisoners, and others in vulnerable positions, can fall victim to neglect and abuse at the hands of their captors. Often, human rights can be violated. Therefore, people in vulnerable positions need advocates who will defend and protect their rights. The role of advocate is familiar to nursing professionals. In the mid-1980's advocacy grew attention due to disclosure of human rights abuses in mental health facilities. Today, worldwide, nursing leaders continue to confront abuses in multiple settings. In the United States, the Human Rights Authority was specifically developed to address issues of abuse of persons with physical disabilities and or mental illness. Globally, nurses will want to support the development and enforcement of policies that protect persons in vulnerable positions.

Southeast Asian refugee children: a school-based mental health intervention.

One particular focus of refugee studies in the United States has been the violence experience of Southeast Asian (S.E.A.) refugee children and its impact on mental health and school adaptation. Although virtually all researchers have found that the children have high rates of depression and/or post-traumatic stress disorder, findings concerning successful school adaptation have been inconclusive. Even so, concern has been generated on how to best meet the children's mental health needs. The purpose of our study was to provide an eight-week school-based program that was designed to reduce depression symptoms of S.E.A. refugee children. Specifically, this collaborative program addressed refugee adaptation issues, children's culture and the development of coping skills. All of the children were screened for depression using the Children's Depression Inventory (CDI). Analysis of CDI data revealed that children's depression scores had a significant decrease between screening times 1 (approximately one month before the intervention) and 2 (fourth week of the intervention), 1 and 3 (eighth week of the intervention) and 1 and 4 (one month following the intervention). Globally, culturally sensitive mental health school-based programs may be an appropriate intervention to assist immigrant and refugee children in making a successful adaptation to host countries.

Criminal background checks: necessary admission criteria?

The issues that nursing school admissions staff may face in evaluating potential students' criminal backgrounds are discussed. There has been a trend to require criminal background checks for health care professionals throughout the United States related to taking the NCLEX-RN and securing employment in health care agencies. The majority of state boards of nursing are now requiring criminal background checks on potential licensees. Ultimately, the decision of whether or not to perform criminal background checks rests with individual schools. While admitting students without performing criminal background checks could, in some cases, lead to undesirable consequences and injure the reputation of the school and the nursing profession, denying admission to otherwise qualified applicants because of certain past criminal infractions could exclude potentially well-qualified students. This article offers guidelines for nursing programs that choose to perform background checks.

Southeast Asian refugee children: self-esteem as a predictor of depression and scholastic achievement in the U.S.

The eruption of conflicts and war in this century has led to new masses of refugees and displaced persons. Globally, host countries will continue to confront issues of how to ensure the successful adaptation of refugees who typically are women and children. The United States received three major waves of Southeast Asian (SEA) refugees during the past twenty-five years. One million SEA refugees arrived in the past decade; the majority were children and adolescents. Today, there is still a lack of understanding surrounding mental health issues and their relationship to children's violence experience. We know that SEA refugee children suffered violence during the war in Southeast Asia, their escape from homelands, in camps of asylum and in the U.S. Although researchers have examined the relationship of violence with depression and post-traumatic stress disorder in refugee children, the findings have been unclear and sometimes conflictual in their relationship to scholastic achievement. In the U.S., healthy self-esteem is recognized as an important component of mental health and academic success, while low self-esteem is associated with depression and academic failure. In general, self-esteem and measures of self-esteem have not been studied cross-culturally. The authors report the findings of a measure of self-esteem, depression and academic achievement in a convenience sample of 237 Southeast Asian refugee children aged 6 to 17 years of age in the U.S. Internationally, nurses who assess the mental health of refugee children and design interventions to assist in their adaptation, will want to have an understanding of mental health issues cross-culturally.

"Hope" in the recovery from stroke in the U.S.

Hope and hopelessness are multi-dimensional concepts. Both can be investigated from an aggregate or individual emotional response to life events. Globally, there are many concerns about conflicts, poverty and illness that have led to collective feelings of hopelessness. Yet, some people still hope for a better future. Hope as an individual response, following illness and disability, has received little empirical investigation. Even so, it is believed that hope is an important mediating factor in the coping process that is imperative to optimal recovery. The purpose of this study was to describe the influence of hope in the recovery process of 50 patients who had suffered a stroke. Hope was measured approximately 10 days following a stroke (Time 1) and 3 months later after discharge from a hospital or rehabilitation facility (Time 2). For purposes of this paper, recovery outcomes were examined in two domains, physical functioning and social activities. Understanding hope and hopelessness, is salient to nurses worldwide since fostering hope is an important nursing intervention.

Relationship of perception of radon as a health risk and willingness to engage in radon testing and mitigation.

PURPOSE/OBJECTIVES: To gather data on radon levels and determine correlations among subjects' characteristics, willingness to test for radon, and perceptions of radon as a health risk. DESIGN: Descriptive correlational. SETTING: Rural DeKalb County in northern Illinois. SAMPLE: 473 respondents from a group of 1,620 randomly selected county residences. METHODS: Participants were surveyed via telephone using the Community Radon Program questionnaire. Radon measurements were taken with home radon test kits. MAIN RESEARCH VARIABLES: Gender, income, age, educational level, smoking status, race, home ownership, willingness to test for radon, and radon risk perception. FINDINGS: Most participants were familiar with radon but did not view it as an immediate health hazard and would not have screened for radon on their own. 88% of the radon measurements exceeded the U.S. Environmental Protection Agency's moderate risk potential level, and 53% exceeded the action level (i.e., 4 pCi/L). CONCLUSIONS: Perception of radon as a health risk was correlated positively with planning to conduct further radon testing and to employ radon mitigation methods. More research is needed on people's willingness to obtain radon emission levels and the cancer rates in areas that have high potential for radon. IMPLICATIONS FOR NURSING: According to the environmental literature, the effect of household radon emissions on the development of lung cancer is as great a health risk as secondhand smoke. Virtually no nursing literature on the subject has been published. As the primary source of health information in many rural counties, nurses, especially public health nurses, are at the forefront in public health educational efforts. Nurses are the most likely healthcare professionals to enter patients' homes and can play a significant role in disseminating information about radon as a potential carcinogen.

The impact of depression on stroke recovery in the U.S.

Globally, stroke is an important cause of physical, cognitive and emotional disability. The success of rehabilitation efforts for stroke patients is often measured in terms of physical functioning. However, because the adaptation process also involves psychological and social factors, and nursing goal is to holistically meet patient's health care needs, it is important to address emotional and social variables that impact the healing process. Therefore, the purpose of this prospective longitudinal study was to determine the impact of depression on functional ability in adults (n = 50) who have had a stroke in the U.S. The study was conducted at two large urban medical centers and one community hospital in the Midwest of the U.S. Depression screening and functional status evaluations were conducted within 10 days (Time 1) and three months (Time 2) post-stroke. In the total sample 46% (n = 23) described fewer depressive symptoms at Time 2; while 44% (n = 22) indicated more depressive symptoms, and 10% (n = 5) showed no difference between Time 1 and 2. In the total sample, 27 improved in functional status between Time 1 and Time 2, while 5 lost function at Time 2. The impact of stroke on depression in the U.S. as well as nursing implications globally are discussed.