SANE-A-PALOOZA: Logistical Development and Implementation of a Clinical Immersion Course for Sexual Assault Nurse Examiners.

SANE-A-PALOOZA, a continuing education program that utilizes hands-on practice with standardized patients and human simulators, was developed to fulfill a portion of the required supervised clinical experience for certification as a sexual assault nurse examiner. The program is designed to provide concentrated clinical skill practice application, eliminate the time gap between gaining and applying clinical knowledge, and decrease discontinuity among multiple preceptors. This article provides an overview of SANE-A-PALOOZA logistics, with the goal of aiding other organizations in developing skill-building experiences for new or less-experienced sexual assault nurse examiners.

SANE-A-PALOOZA: A Clinical Immersion Experience to Close the Gap for New Sexual Assault Nurse Examiners.

BACKGROUND: Traditional educational methods for new sexual assault nurse examiners (SANEs) have had a gap in time between didactic instruction and the application to forensic nursing practice. In this interval, which can take several months, SANE trainees must locate a preceptor and perform at least 10 pelvic examinations. Only then can they apply their didactic knowledge and pelvic examination skills to actual patients presenting for forensic examinations. In 2011, Kansas City educators developed SANE-A-PALOOZA, a program that eliminated this gap, facilitated a unified educational experience, and ensured rapid integration of knowledge and skills. OBJECTIVES: The aims of this study were to briefly describe an educational method for SANEs based on adult learning principles and constructivist learning theory and to provide preliminary quantitative evaluation data, which are limited in contemporary literature. METHODS: Immediately after the formal 40-hour didactic educational experience, trainees took part in an 8-hour SANE-A-PALOOZA, a clinically focused continuing education course that included standardized pelvic examination patients, skills immersion experience with advanced practice nurses and experienced sexual assault nurses, and a hands-on practicum with a crime scene photographer. Each of the 44 trainees performed 8-10 female pelvic and two male genital examinations on standardized patients and took forensic genital photographs in three of those examinations. Participants completed a variety of preevaluation and postevaluation instruments, including knowledge, clinical skills checklists, and confidence measures. RESULTS: SANE-A-PALOOZA participants' self-evaluations indicate high satisfaction with the educational program. Pretest/posttest scores indicate increased comfort, competence, and confidence after this immersion practicum. CONCLUSION: Skills education via a hands-on immersion experience can address the gap between didactic and hands-on clinical experience for SANEs.

Eight versus 16-week re-evaluation period in rheumatoid arthritis patients treated with leflunomide or methotrexate accompanied by moderate dose prednisone.

In a step-up approach of DMARD treatment of RA a fast response and an early DMARD switch in the case of non-response is important. Therefore, we performed an open trial in which we compared an 8-week and a 16-week observation period during treatment of RA with MTX or LEF, both given in intensified starting doses and accompanied by moderate dose prednisone. MTX and LEF naïve patients with RA (mean time since diagnosis: 2.3 years) were randomised to receive either LEF in a 3-day-loading dose of 100 mg/day followed by 20 mg/day (n = 19) or MTX intramuscularly in a dose of 25 mg once weekly (n = 21). All patients received concomitant treatment with oral prednisone in an initial dose of 20 mg/day with weekly dose reductions of 5 mg/day. The disease activity was re-evaluated 8 and 16 weeks after the start of the treatment. Mean DAS28 before the start of treatment was 5.36 +/- 0.8 for the MTX-group and 5.46 +/- 0.8 for the LEF-group. After 8 weeks of treatment the DAS28 in the MTX-group was 2.59 +/- 1.0 and 3.16 +/- 0.8 in the LEF group (difference not significant). The mean DAS28 at re-evaluation 16 weeks after the starting of treatment (2.58 +/- 1.5 for the MTX-group and 3.25 +/- 1.16 for the LEF-group) was significantly different neither in between the both treatment groups nor in comparison to the week 8 evaluation. Efficiency of RA treatment with MTX or LEF in intensified doses and in combination with moderate dose prednisone can be sufficiently judged 8 weeks after its initiation.

Articular involvement in patients with relapsing polychondritis.

Our objective was to study joint symptoms in patients with relapsing polychondritis (RP) and their relationship to other clinical manifestations and laboratory findings. Fourteen patients who met the diagnostic criteria proposed by Michet et al. for RP were studied. Clinical symptoms were recorded and a detailed laboratory analysis with HLA-DR typing was carried out. In 2 patients arthritis was the first manifestation. During the follow-up, 10 patients developed arthritis. It was polyarticular in 6, and oligoarticular in 4 cases. The development of arthritis was unrelated to the appearance of chondritis at other sites. HLA class II typing was determined in 7 patients. Six of them were positive for HLA-DR4. Arthritis in RP is a frequent manifestation occurring in approximately 70% of patients with an asymmetric articular involvement. There is no correlation between articular involvement and any particular clinical or laboratory feature. Susceptibility to RP is significantly related to the presence of HLA-DR4.

[Generalized IgG-lambda plasmocytoma and stenosis of a Cimino shunt caused by plasma cell infiltration]. / Generalisiertes IgG-lambda-Plasmozytom und Stenose eines Cimino-Shunts durch plasmazelluläre Infiltration.

A 56-year-old apparently healthy man was on routine examination found to have a paraproteinaemia, classified as an IgG-lambda plasmocytoma in stage 1 on the basis of a raised IgG level (1950 mg/dl) and partly binuclear plasma cells in bone marrow. When 5 months later the IgG concentration had increased to 2980 mg/dl and the proportion of plasma cells in bone marrow to 15%, treatment was begun with melphalan (0.25 mg/kg) and prednisolone (2 mg/kg), both on 4 successive days every 6 weeks. The patient's general condition rapidly worsened after 6 months. The extent of osteolysis increased, necessitating radiotherapy of the vertebrae as well as a change in treatment to vincristine, cyclophosphamide, doxorubicin and prednisolone. At that time renal failure set in. But the prophylactically placed Cimino shunt had become infiltrated with plasma cells causing shunt stenosis and soft-tissue swelling. The infiltration was reduced by irradiation with 18 Gy. Numerous bluish skin discolorations now appeared and plasma cell infiltrates were shown in lung and pleura, as well as in the abdomen. The patient died 15 months after the diagnosis had been made.