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Journal scan Patients with Clostridium difficile infection (CDI) can contaminate the environment with spores that are able to survive for months. A previous room occupant with CDI is a significant risk factor for developing the infection. Room cleaning with commonly used disinfectants will not kill spores. Sodium hypochlorite and hydrogen peroxide are effective but correct concentration and contact time are important. Hand hygiene is a crucial element in preventing infection. In the UK, there is a clear recommendation for handwashing, rather than alcohol-based hand rub, when caring for patients with CDI. Ingestion of the organism does not always cause infection because of the protective effect of colonic flora. Disruption of bowel flora can occur after exposure to antibiotics, chemotherapy, antiperistaltic drugs or gastroenterological surgery. Relapse of CDI is common. Therefore, when they are discharged, patients should be warned that future treatment could bring a return of the problem. Mitchell B, Russo P, Race P (2014) Clostridium difficile infection: nursing considerations. Nursing Standard. 28, 47, 43-48.
Rehabilitation intervention not advised for COPD inpatients Acute exacerbation of chronic obstructive pulmonary disease is the second most common cause of unscheduled hospital admissions. Admission to hospital has a negative effect on physical performance and health status from which the patient may not fully recover. Effects on physical fitness and skeletal muscle strength occur rapidly during the inpatient phase. The purpose of this randomised controlled trial was to see if early exercise/mobility intervention enhanced recovery. In addition to usual care – physiotherapy for airway clearance and assessment and supervision of mobility – 196 people in the early intervention group had strength and aerobic training and NURSING OLDER PEOPLE
Science Photo Library
Hand hygiene is crucial to combat Clostridium difficile
To prevent Clostridium difficile from spreading, handwashing, rather than using alcohol-based hand rub, is recommended
neuromuscular electrical stimulation, started within 48 hours of admission. Results showed a higher mortality rate in the intervention group at one year. The reasons for this are not clear but the authors suggest that it may be related to a lower uptake of outpatient pulmonary rehabilitation later in the follow-up period. They conclude that acute admission is not the time to enrol patients in a rehabilitation process that may be beyond the capabilities of many participants. Greening N, Williams J, Hussain S et al (2014) An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial. BMJ 2014; 349:g4315.
Progress towards early diagnosis of Alzheimer’s disease Until recent years it was only possible to give a definitive diagnosis of Alzheimer’s disease by post-mortem examination. In 2007, the International Working Group proposed that diagnosis could be made during the course of the disease. They suggested using clinical criteria such as poor memory that is not helped by giving clues, combined with biomarker evidence such as atrophy of the temporal lobe seen on magnetic resonance
imaging or examination of cerebrospinal fluid (CSF) showing alterations in amyloid-β or tau protein. Drugs to reduce amyloid deposits have, so far, been disappointing possibly because they are given too late in the disease process. Earlier identification of people vulnerable to developing Alzheimer’s disease could open the way for research into new preventative treatments. This article reviewed literature in order to improve this diagnostic framework and help to distinguish Alzheimer’s from other types of dementia. The authors conclude that Alzheimer’s disease can be suspected even before clinical symptoms such as memory loss are seen but changes in brain structure and metabolic changes are not sufficiently specific. CSF or positron emission tomography scan evidence of amyloid or tau protein pathology should be used as these changes can be seen ten to 15 years before the first symptoms. Dubois B, Feldman H, Jacova C et al (2014) Advancing research diagnostic criteria for Alzheimer’s disease: the IWG-2 criteria. The Lancet. Neurology. 13, 6, 614-629. Journal scan is compiled by Ruth Sander, independent consultant, care of the older person October 2014 | Volume 26 | Number 8 15
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Journal scan Patients with Clostridium difficile infection (CDI) can contaminate the environment with spores that are able to survive for months. A previous room occupant with CDI is a significant risk factor for developing the infection. Room cleaning with commonly used disinfectants will not kill spores. Sodium hypochlorite and hydrogen peroxide are effective but correct concentration and contact time are important. Hand hygiene is a crucial element in preventing infection. In the UK, there is a clear recommendation for handwashing, rather than alcohol-based hand rub, when caring for patients with CDI. Ingestion of the organism does not always cause infection because of the protective effect of colonic flora. Disruption of bowel flora can occur after exposure to antibiotics, chemotherapy, antiperistaltic drugs or gastroenterological surgery. Relapse of CDI is common. Therefore, when they are discharged, patients should be warned that future treatment could bring a return of the problem. Mitchell B, Russo P, Race P (2014) Clostridium difficile infection: nursing considerations. Nursing Standard. 28, 47, 43-48.
Rehabilitation intervention not advised for COPD inpatients Acute exacerbation of chronic obstructive pulmonary disease is the second most common cause of unscheduled hospital admissions. Admission to hospital has a negative effect on physical performance and health status from which the patient may not fully recover. Effects on physical fitness and skeletal muscle strength occur rapidly during the inpatient phase. The purpose of this randomised controlled trial was to see if early exercise/mobility intervention enhanced recovery. In addition to usual care – physiotherapy for airway clearance and assessment and supervision of mobility – 196 people in the early intervention group had strength and aerobic training and NURSING OLDER PEOPLE
Science Photo Library
Hand hygiene is crucial to combat Clostridium difficile
To prevent Clostridium difficile from spreading, handwashing, rather than using alcohol-based hand rub, is recommended
neuromuscular electrical stimulation, started within 48 hours of admission. Results showed a higher mortality rate in the intervention group at one year. The reasons for this are not clear but the authors suggest that it may be related to a lower uptake of outpatient pulmonary rehabilitation later in the follow-up period. They conclude that acute admission is not the time to enrol patients in a rehabilitation process that may be beyond the capabilities of many participants. Greening N, Williams J, Hussain S et al (2014) An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial. BMJ 2014; 349:g4315.
Progress towards early diagnosis of Alzheimer’s disease Until recent years it was only possible to give a definitive diagnosis of Alzheimer’s disease by post-mortem examination. In 2007, the International Working Group proposed that diagnosis could be made during the course of the disease. They suggested using clinical criteria such as poor memory that is not helped by giving clues, combined with biomarker evidence such as atrophy of the temporal lobe seen on magnetic resonance
imaging or examination of cerebrospinal fluid (CSF) showing alterations in amyloid-β or tau protein. Drugs to reduce amyloid deposits have, so far, been disappointing possibly because they are given too late in the disease process. Earlier identification of people vulnerable to developing Alzheimer’s disease could open the way for research into new preventative treatments. This article reviewed literature in order to improve this diagnostic framework and help to distinguish Alzheimer’s from other types of dementia. The authors conclude that Alzheimer’s disease can be suspected even before clinical symptoms such as memory loss are seen but changes in brain structure and metabolic changes are not sufficiently specific. CSF or positron emission tomography scan evidence of amyloid or tau protein pathology should be used as these changes can be seen ten to 15 years before the first symptoms. Dubois B, Feldman H, Jacova C et al (2014) Advancing research diagnostic criteria for Alzheimer’s disease: the IWG-2 criteria. The Lancet. Neurology. 13, 6, 614-629. Journal scan is compiled by Ruth Sander, independent consultant, care of the older person October 2014 | Volume 26 | Number 8 15
Downloaded from RCNi.com by ${individualUser.displayName} on Apr 16, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCN Publishing Ltd. All rights reserved.
