Severe vitamin D deficiency in a patient with sickle cell disease: a case study with literature review.

PURPOSE: Vitamin D is essential for the normal absorption of calcium and to maintain calcium homeostasis. Vitamin D deficiency results in rickets, osteomalacia, and bony changes in the spine. Sickle cell disease patients are at an increased risk of vitamin D deficiency. CASE PRESENTATION: We describe a case of severe vitamin D deficiency and response to vitamin D supplementation in a patient with sickle cell disease. CONCLUSIONS: Currently, there are no recommendations for calcium and vitamin D supplementation in sickle cell patients. Vitamin D deficiency in these patients may be due to poor absorption.

Culture-change training: nursing facility staff perceptions of culture change.

Identifying effective alternative strategies for training staff and implementing culture change can be useful to nursing facilities striving to provide optimal resident-centered care. This study assessed the perceptions of nearly 400 nursing facility staff experiencing organizational culture change. Formal and informal training methods were used. We used a pre- and post-test to evaluate leadership practices and 6 subscales related to culture change (systemwide culture change, resident choice, organization design, empowering supervision, job design, decision making, and permanent assignments). Staff of formally trained facilities perceived improvements in all subscales; 2 were statistically significant (resident choice and organization design). Respondents for informally trained facilities identified improvement in decision making, although this was not statistically significant. Formalized culture-change training produced better outcomes than did the informal strategy. Culture change is a complex process and may continue to evolve over time. A 3-year evaluation period may be insufficient to demonstrate the full extent of these changes.