Linking public health nursing competencies and service-learning in a global setting.

BACKGROUND: Nurse educators in baccalaureate programs are charged with addressing student competence in public health nursing practice. These educators are also responsible for creating nursing student opportunities for civic engagement and development of critical thinking skills. The IOM report (2010) on the Future of Nursing emphasizes the nurse educator's role in promoting collaborative partnerships that incorporate interdisciplinary and intraprofessional efforts to promote health. AIM: The purpose of this article is to describe an innovative approach to address public health nursing competencies and to improve the health and well-being of indigenous populations in a global setting through promotion of collaboration and service- learning principles. METHODS: As part of a hybrid elective course, baccalaureate nursing students from various nursing tracks participated in a 2 week immersion experience in Belize that included preimmersion preparation. These students were to collaborate among themselves and with Belizean communities to address identified health knowledge deficits and health-related needs for school-aged children and adult populations. RESULTS: Students successfully collaborated in order to meet health-related needs and to engage in health promotion activities in the Toledo district of Belize. They also gained practice in developing public health nursing competencies for entry-level nursing practice. Implementation of service-learning principles provided students with opportunities for civic engagement and self-reflection. DISCUSSION: Some challenges existed from the students', faculty, and global community's perspectives. Lack of culturally appropriate and country specific health education materials was difficult for students and the community. Faculty encountered challenges in communicating and collaborating with the Belizean partners. CONCLUSION: Commonalities exist between entry-level public health nursing competencies and service-learning principles. Using service-learning principles in the development of public health experiences increases the likelihood of success in achieving these competencies. While students demonstrated intraprofessional collaboration in a global setting, these same collaborative opportunities can occur in local communities.

The effects of neurodynamic mobilization on fluid dispersion within the tibial nerve at the ankle: an unembalmed cadaveric study.

OBJECTIVE: To evaluate the effects of neurodynamic mobilization on the fluid dynamics of the tibial nerve in cadavers. BACKGROUND: Evidence showing patients benefit from neural mobilization is limited. Mechanisms responsible for changes in patient symptoms are unclear. METHODS: Bilateral lower limbs of six unembalmed cadavers (n = 12) were randomized into matched pairs and dissected to expose the tibial nerve proximal to the ankle. Dye composed of Toulidine blue and plasma was injected into the nerve. The longitudinal dye spread was measured pre- and post-mobilization. The experimental group received the intervention consisting of 30 repetitions of passive ankle range of motion over the course of 1 minute. The matched control limb received no mobilization. Data were analysed using a 2×2 repeated measures ANOVA with subsequent t-tests for pairwise comparisons. RESULTS: Mean dye spread was 23.8±10.2 mm, a change of 5.4±4.7% in the experimental limb as compared to 20.7±6.0 mm, a change of -1.5±3.9% in the control limb. The ANOVA was significant (P⩽0.02) for interaction between group (experimental/control) and time (pre-mobilization/post-mobilization). t-test results were significant between pre- and post-mobilization of the experimental leg (P = 0.01), and between control and experimental limbs post-mobilization (P⩽0.02). CONCLUSION: Passive neural mobilization induces dispersion of intraneural fluid. This may be clinically significant in the presence of intraneural edema found in pathological nerves such as those found in compression syndromes.

Error reduction when prescribing neonatal parenteral nutrition.

A neonatal intensive care unit audit of 204 parenteral nutrition (PN) orders revealed a 27.9% PN prescribing error rate, with errors by pediatric residents exceeding those by neonatal nurse practitioners (NNPs) (39% versus 16%; P < 0.001). Our objective was to reduce the PN prescribing error rate by implementing an ordering improvement process. An interactive computerized PN worksheet, used voluntarily, was introduced and its impact analyzed in a retrospective cross-sectional study. A time management study was performed. Analysis of 480 PN orders revealed that the PN prescribing error rate was 11.7%, with no difference in error rates between pediatric residents and NNPs (12.3% versus 10.5%). Use of the interactive computerized PN worksheet was associated with a reduction in the prescribing error rate from 14.5 to 6.8% for all PN orders ( P = 0.016) and from 29.3 to 9.6% for peripheral PN orders ( P = 0.002). All 12 errors that occurred in the 177 PN prescriptions completed using the computerized PN worksheet were due to avoidable data entry or transcription mistakes. The time management study led to system improvements in PN ordering. We recommend that an interactive computerized PN worksheet be used to prescribe peripheral PN and thus reduce errors.

Discovery of non-carbohydrate inhibitors of aminoglycoside-modifying enzymes.

Chemical modification and inactivation of aminoglycosides by many different enzymes expressed in pathogenic bacteria are the main mechanisms of bacterial resistance to these antibiotics. In this work, we designed inhibitors that contain the 1,3-diamine pharmacophore shared by all aminoglycoside antibiotics that contain the 2-deoxystreptamine ring. A discovery library of molecules was prepared by attaching different side chains to both sides of the 1,3-diamine motif. Several of these diamines showed inhibitory activity toward two or three different representative aminoglycoside-modifying enzymes (AGMEs). These studies yielded the first non-carbohydrate inhibitor N-cyclohexyl-N'-(3-dimethylamino-propyl)-propane-1,3-diamine (Compound G,H) that is competitive with respect to the aminoglycoside binding to the enzyme aminoglycoside-2''-nucleotidyltransferase-Ia (ANT2''). Another diamine molecule N-[2-(3,4-dimethoxyphenyl)-ethyl]-N'-(3-dimethylamino-propyl)-propane-1,3-diamine (Compound H,I) was shown to be a competitive inhibitor of two separate enzymes (aminoglycoside-3'-phosphotransferase-IIIa (APH3') and ANT2'') with respect to metal-ATP. Thermodynamic and structural-binding properties of the complexes of APH3' with substrates and inhibitor were shown to be similar to each other, as determined by isothermal titration calorimetry and NMR spectroscopy.

Varicella zoster as a manifestation of immune restoration disease in HIV-infected children.

BACKGROUND: Exacerbation of opportunistic infections in HIV-infected patients shortly after initiation of highly active antiretroviral therapy (HAART) has been named immune restoration disease (IRD). Thus far, IRD has not been reported in children. OBJECTIVE: We describe the clinical and immune characteristics of IRD in HIV-infected children treated with HAART. METHODS: A historical cohort study was conducted in a tertiary HIV center in perinatally HIV-infected children who were started on a first stable HAART between January 1996 and July 2002. The incidence of opportunistic infections, newly AIDS-defining events or death after initiation of HAART, and virologic and immunologic information was evaluated at baseline and every 3 months post-HAART. RESULTS: Sixty-one perinatally HIV-infected children were started and maintained on HAART for >6 months. Seven episodes of IRD occurred. All were cutaneous herpes zoster (HZ). Children who developed HZ had significantly lower baseline CD4+ and CD8+ T-cell numbers compared with children who did not. HZ occurred only in children (7 of 34 subjects) with virological and immunological success to HAART. In children with a previous history of varicella infection, the risk of developing HZ after HAART was higher in those without a protective level of varicella-specific IgG (50%, or 5 of 10 subjects) compared with those with seroprotection (10%, or 2 of 20). CONCLUSION: Herpes zoster is a common manifestation of IRD in HIV-infected children after the initiation of HAART. Risks for developing HZ include no protective varicella-specific antibody despite previous varicella infection, severe immunodeficiency at baseline, and vigorous immunologic and virologic responses to HAART.

Improving care of HIV-infected patients in the outpatient setting with patient data flow sheets.

Medical management of pediatric/adolescent HIV has become increasingly complex, requiring a multidisciplinary approach to care. Close clinical monitoring is needed to minimize opportunistic infections, initiate appropriate antiretroviral therapy, and ensure optimal health care to the patient. Monitoring should include evaluation of efficacy and side effects of therapy, early detection and treatment of HIV-associated complications, and maintenance of current immunizations. Tracking clinical data in chronically ill patients is a difficult task without an effective monitoring system. A patient data flow sheet was created to assist in planning care and monitoring disease progression by consolidating clinical information into an organized, one-page summary for each patient. One year after the patient data flow sheets were instituted, there was a significant improvement in the consistency of obtaining and monitoring routine HIV labs as well as serologies, and other recommended tests. The flow sheets have increased effectiveness of patient care and have been used to assist with quality assurance monitoring and quality improvement in the clinic setting.