Multidrug-resistant and extensively drug-resistant tuberculosis: The new face of an old disease.

PURPOSE: To provide an overview of tuberculosis (TB), especially the persistent threat of multidrug-resistant (MDR) and extensively drug-resistant (XDR), and the role of the nurse practitioner (NP) in diagnosis, treatment, and public health surveillance. DATA SOURCES: Public health sources such as the World Health Organization and the Centers for Disease Control as well as current literature. CONCLUSIONS: One hundred twenty-five years after the discovery of Mycobacterium tuberculosis, the disease remains a persistent threat and a leading cause of death worldwide. Medication adherence and prevention are critical to successfully treating and ultimately eradicating this killer disease. Healthcare providers need to be knowledgeable in the detection and diagnosis of TB and to understand that they assume responsibility for public health by monitoring treatment adherence and/or appropriate referral. IMPLICATIONS FOR PRACTICE: The persistent and increasing threat of MDR-TB and XDR-TB is a significant public health threat. Healthcare providers need to be knowledgeable and vigilant in diagnosing and treating this disease.

PTSD: therapeutic interventions post-Katrina.

August 29, 2006, brought the largest, most deadly hurricane ever to strike the Gulf Coast. According to reports, the storm killed more than 2000 people and destroyed billions of dollars of property, with winds clocked at 160 to 175 mph. More than a million residents were displaced, many requiring care for chronic conditions who suddenly also needed care for acute stress symptoms. Today, many individuals still struggle to cope with major psychiatric posttraumatic stress disorders (PTSD). Using a case study approach, this article discusses PTSD, including what it is, how it is manifested, how to diagnose it, patient education, and how it can be managed with therapeutic interventions. Special circumstances related to children are briefly presented.

Copyright law and distance nursing education.

The authors present essential information regarding the copyright law and online education. This information provides the reader specific aids to assist in designing and implementing distance education courses within the bounds of the Technology, Education, and Copyright Harmonization Act and fair use guidelines. From their research, the authors, who are distance education experts, offer a wide array of educational and legal data to inform nurse educators.

Clinical presentation and therapeutic interventions for posttraumatic stress disorder post-Katrina.

It has been almost 2 years since Hurricane Katrina struck the Gulf Coast. These 2 years can be characterized by constant struggle and pain as the people try to reattain some semblance of life as they knew it before Katrina struck. Some have chosen to leave their ancestral homes, homes where they were raised and where they, in turn, raised their own families. Those who did leave are able, in some way, to reestablish some semblance of normality, but those who stayed showed manifestations of and dealt with psychological trauma. These manifestations include regression, inattentiveness, aggressiveness, somatic complaints, irritability, social withdrawal, nightmares, and crying. Longer lasting effects may include depression, anxiety, adjustment disorders, and interpersonal or academic difficulties. These postdisaster manifestations can linger or remain hidden until well after the traumatic event and could persist for years. This article presents issues about the effects of Katrina on the mental health of the people of New Orleans. It discusses the profile of posttraumatic stress disorder and presents evidence-based review of interventions the health care provider can implement to care for those who continue to suffer the effects of this horrific disaster.

Epidemiology of the brown recluse spider bite.

PURPOSE: The purpose of this article was to provide a comprehensive epidemiological and clinical description of the brown recluse spider bite. DATA SOURCES: Review of evidenced-based scientific literature and practice guidelines. A specific descriptive case study is interwoven through the article to tie in the clinical presenting figure associated with this bite. CONCLUSIONS: The brown recluse lives in a circumscribed area of the United States (the south central Midwest) with a few less common recluse species living in the more sparsely populated southwest United States. In these areas, where spider populations may be dense, recluse spiders may be a cause of significant morbidity. IMPLICATIONS FOR PRACTICE: Most spider bites are asymptomatic but what makes this bite so devastating is the toxin injected by the brown recluse spider, which can cause considerable systemic symptoms as well as necrotic skin ulcers (necrotic arachnidism). The article presents process for diagnosis and stresses the importance of identifying the spider if at all possible.

The relationship of urinary tract infections and falls in a nursing home.

The purpose of this study was to determine if there was a relationship between urinary tract infections and falls in a nursing home population. The incidence of falls in nursing homes is prevalent with the current data suggesting that each nursing home resident falls 1.6 times per year. The consequences of a fall can be devastating to the quality of life of the nursing home resident. Therefore, this study was designed to identify falls as the symptom of a urinary tract infection and to provide treatment. Over 75 patients in a 138 bed community nursing home were followed for 6 months. Data suggests that majority of those residents who had a history of a fall also had a UTI In addition; the study data shows that severely demented patients who fall have a higher probability of having a urinary tract infection.

Post-Hurricane Katrina challenge: Vibrio vulnificus.

PURPOSE: To describe the epidemiology, pathophysiology, diagnosis, treatment, and prevention of Vibrio vulnificus, a rare organism that surfaced following Huricane Katrina and caused serious problems for many victims. DATA SOURCES: Selected scientific literature supplemented with case presentations of patients seen following Katrina. CONCLUSIONS: After Hurricane Katrina and as a result of extensive flooding of below-sea-level New Orleans, toxic waters contaminated many areas of the city. As a result of this extensive flooding of toxic waters, people were exposed to V. vulnificus. IMPLICATIONS FOR PRACTICE: Consider V. vulnificus in the differential diagnosis and culture all wounds for this organism in any patients exposed to contaminated seawater. Prompt initiation of antibiotic treatment, especially before the onset of septic shock, provides the best outcomes.

Measuring nurse practitioner productivity.

As the role of the nurse practitioner (NP) evolves, the need to demonstrate productivity becomes more important. Productivity data provides NPs with practice statistics to generate business or use in contract negotiations with potential clients such as employers, managed care organizations, and insurance companies. However, beyond the numbers of patients seen per day or amount of reimbursement a provider brings to the practice, NPs may provide additional benefit that is not captured with physician productivity measures. Information to acquaint NPs with key aspects of recording productivity and ways NPs can organize productivity data within their practice to determine worth of service are presented.

Natural history and epidemiology of hepatitis C.

The high incidence of hepatitis C virus (HCV) makes it one of the greatest health threats facing the world today. Hepatitis C is the most common blood-borne infectious disease in the United States, and evidence demonstrates that if the disease is not contained it will continue to spread and the death rate from hepatitis C will rise to a level far greater than that of AIDS. The epidemiological patterns of hepatitis C transmission will be reviewed.