ABSTRACT
A 68-year-old woman with known metastatic renal cell carcinoma presented with an acutely swollen right leg. In between the two sessions of palliative radiotherapy to the right hip, she also had right hip modified Harrington procedure for tumour resection with hip replacement. Initial clinical evaluation raised the suspicion of right leg deep vein thrombosis (DVT). However, DVT was excluded and further investigations revealed stenosis of the right external and common iliac veins, likely secondary to radiotherapy.
Subject(s)
Carcinoma, Renal Cell/radiotherapy , Iliac Vein/radiation effects , Kidney Neoplasms/radiotherapy , Peripheral Vascular Diseases/diagnosis , Radiation Injuries/diagnosis , Aged , Constriction, Pathologic/diagnosis , Constriction, Pathologic/etiology , Diagnosis, Differential , Female , Humans , Iliac Vein/diagnostic imaging , Peripheral Vascular Diseases/etiology , Peripheral Vascular Diseases/pathology , Radiation Injuries/etiology , Radiation Injuries/pathology , Venous Thrombosis/diagnosisABSTRACT
BACKGROUND: advanced nurse practitioners (ANPs) are experienced nurses who undertake some activities traditionally performed by medical staff. There are four pillars of advanced practice: advanced clinical skills, leadership, education and research. ANPs are starting to specialise in the management of older adults with frailty in the acute hospital. However, the role and competencies required for this have not been well defined. This study aimed to establish an expert consensus on the role description and essential competencies for ANPs working with older people with frailty to develop a curriculum. METHODS: a literature review and workshops including multi-professional and lay representatives generated a role description and a list of 69 competencies. A modified Delphi process was then conducted with three rounds involving a panel of 31 experts including representatives from the RCN, BGS Education and Training Committee, BGS Senior Nurses and Practitioners Group, Chartered Society of Physiotherapy Older People Network, College of Occupational Therapists Older People Specialist Section and lay representatives. Consensus on the statements was established by 70% panel agreement. RESULTS: the role description reached 100% agreement within three rounds. Twenty-five essential competencies were agreed after Round 1, increasing to 43 after Round 2 and 49 after Round 3. CONCLUSION: this Delphi study has allowed, for the first time, a national panel of clinical experts and lay representatives to refine and agree a set of competencies for ANPs working with older people with frailty. It is the first step towards ensuring consistency in the training of ANPs in geriatric medicine.
Subject(s)
Delphi Technique , Education, Nursing, Graduate/methods , Frail Elderly , Geriatrics/education , Hospitalization , Nurse Practitioners/education , Teaching/methods , Age Factors , Aged , Clinical Competence , Consensus , Curriculum , Education, Nursing, Graduate/standards , Geriatrics/standards , Guidelines as Topic , Humans , Nurse Practitioners/standards , Nurse's Role , Program Development , Teaching/standardsABSTRACT
We describe a 23 year old male who presented with sudden onset of facial swelling, nasal tone of voice and shortness of breath after taking eight tablets of ecstasy. He was found to have surgical emphysema and pneumomediastinum. Though spontaneous pneumomediastinum is well known in inhalation drug users who try to enhance alveolar resorbtion with repeated Valsalva manouvre, it is rather unusual to see it after oral ingestion of ecstasy. The probable causative event is the prolonged and excessive physical exertion involved in dancing at a "rave". Acute physicians should be aware of the association and of its usually benign nature.
