Comparison of Mycobacterial Growth Indicator Tube with Culture on RGM Selective Agar for Detection of Mycobacteria in Sputum Samples from Patients with Cystic Fibrosis.

Nontuberculous mycobacteria (NTM) are an important cause of pulmonary disease in patients with cystic fibrosis (CF). A new culture medium (RGM medium) for the isolation of rapidly growing mycobacteria from the sputum of cystic fibrosis patients has recently been reported. The aim of this study was to compare culture of sputum samples on RGM medium with culture using a standard automated liquid culture method. Sputum samples were obtained from 187 distinct patients with CF attending King's College Hospital, London, United Kingdom. Each sample was decontaminated with 3% oxalic acid and inoculated into a mycobacterial growth indicator tube (MGIT) that was monitored for 42 days using the Bactec MGIT 960 instrument. Each sample was also cultured, without decontamination, onto RGM medium, which was incubated for 10 days at 30°C. Mycobacteria were isolated from 28 patients (prevalence, 15%). Mycobacteria were detected in 24 samples (86%) using the MGIT and in 23 samples (82%) using RGM medium (P = 1.00). In this setting, RGM medium showed sensitivity equivalent to that of the MGIT for isolation of NTM from the sputum of patients with CF. RGM medium offers a simple, convenient tool that can be embedded into routine culture methods, allowing the culture of all sputum samples that are submitted from patients with CF.

Meeting the policy agenda, part 1: the role of the modern district nurse.

The challenges posed by the current context of health and social care offer opportunities for different models of care delivery. District nursing has evolved, and continues to evolve to meet these challenges. The traditional reactive role of district nursing has developed as contemporary practice expects district nurses to meet both planned and unplanned care required by practice populations. Modern anticipatory care approaches to care are being adopted, while care and case management is being facilitated and delivered to patients and families with complex health and social care needs. Additionally, district nurses are recognizing the need to further develop management and leadership skills as the teams delivering care consist of a skill mix of nurses and other disciplines. They are also charged with evidencing the impact of what they do and influencing care delivery at every level of healthcare organizations. This first paper of two will explore the current UK policy context and ways in which district nursing services within each country are changing to meet the challenges posed. A second article will argue the need to ensure the district nursing workforce is underpinned by robust educational standards that ensure protection of the public. The influences of education and development from professional and organizational perspectives will be examined.

Meeting the policy agenda, part 2: is a 'Cinderella service' sufficient?

This is the second of two papers that examine district nursing within a changing health policy and service environment. The first paper explored the current UK policy context and the way in which district nursing and community nursing services within each country are changing to meet the challenges posed. This article considers the current district nurse (DN) role, which has constantly evolved over the past 150 years, and considers the educational framework that underpins the preparation of these specialist community practitioners in relation to community colleagues such as specialist community public health nurses (SCPHNs). In the context of the current economic climate, there is concern that the apprenticeship model of staff development is replacing specialist practitioner education for DNs, solely on the basis of resource. This article explores the current challenges for DN education within the UK. The underpinning educational preparation of DN programmes is examined and key issues such as safeguarding the public are discussed. The need to develop a cohesive approach to education for post-qualification nurses in the community is advocated. These are important considerations for the future of a discipline which currently feels under threat.