Group B streptococcal toxic shock syndrome in an asplenic patient: case report and literature review.
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Adult↗
Biomedical subjects
T D Barton
Publications and source records attributed to T D Barton.
A prospective cross-sectional study of BK virus infection in non-renal solid organ transplant recipients with chronic renal dysfunction.
BACKGROUND: Polyomavirus (primarily BK virus [BKV]) infection is an important cause of chronic renal dysfunction in renal transplant recipients, but its possible contribution to chronic renal dysfunction in non-renal solid organ transplant (NRSOT) recipients has not been fully explored. METHODS: We performed a prospective, cross-sectional study of consecutive NRSOT recipients with unexplained chronic renal dysfunction of at least a 3 months duration. Medical records were reviewed, and polymerase chain reaction was used to amplify BKV-specific sequences from serum and urine samples. The potential associations between various demographic and transplant variables and BKV infection were assessed. RESULTS: Thirty-four consecutive NRSOT recipients (23 lung, 8 liver, 2 heart, 1 heart-lung) with chronic renal dysfunction were enrolled at a median of 3.5 years (range 0.3-12.5 years) post transplantation. Five of the 34 (15%) patients had BKV viruria (range 1040-1.8 x 10(6) copies/mL), but none had BKV viremia. BK viruria was associated with mycophenolate mofetil use (5 of 19 [26%] vs. 0 of 15, P = 0.03) and a history of cytomegalovirus disease (3 of 4 [75%] vs. 2 of 30 [7%], P < 0.01). However, the mean estimated creatinine clearance was similar in patients with or without BKV viruria (49 vs. 47 mL/min). CONCLUSIONS: BKV viruria was present in a proportion of NRSOT patients with otherwise unexplained chronic renal dysfunction. The possibility that BKV infection might contribute to chronic renal dysfunction in this setting warrants further investigation.
Adult↗
The nurse practitioner: redefining occupational boundaries?
This paper explores aspects of the controversy and conflict that has arisen within the nursing and medical professions regarding the emergence of nurse practitioners in the United Kingdom (U.K.). Difficulties in establishing satisfactory definitions of nurse practitioners, that allow them to be viewed decisively either within nursing or medical occupational roles, are discussed. The paper argues that the key to the debate may hinge on professional and occupational boundary redefinition which is currently resisted by some members of both the nursing and medical professions. The idea that nurse practitioners may be an evolving and discrete professional group, outside the currently accepted professional and occupational definitions of nursing and medicine, is explored. It is argued that both nursing and medicine are faced with a particular challenge in the nurse practitioner movement that is resulting in conflict as new boundaries are established.
Humans↗
The integration of nursing and midwifery education within higher education: implications for teachers--a qualitative research study.
This study was a qualitative narrative that reviewed the historical developments that led to the integration of nursing and midwifery education with higher education in the United Kingdom (UK). A sample of teachers was investigated with particular reference to role conflicts they may have experienced as a result of integration. In addition to this the views of established academic university staff were assessed. The methodology adopted for the research was an eclectic qualitative one, drawing on several approaches, and sought to inquire into individuals personal perception of these events. In this paper the progression of events, nationally and locally, that led to the educational reforms in nursing and midwifery in the 1990s are examined. This narration includes a brief history of the creation of a new university department. Following this there is detail of how data were collected and analysed from a teacher population within this new department. The findings, whilst difficult to generalize to the wider population of nurse and midwife teachers, demonstrate that the sample of teachers examined, all of whom have been involved in the process of integration, have been exposed to stress that has resulted in role conflict. Established university staff, however, were more objective, expressing some broad anxieties regarding the resource demands and research capability of the new department.
Adult↗
The cause of fever following resolution of neutropenia in patients with acute leukemia.
Many studies have examined the etiology of fever complicating neutropenia. Little is known about the etiology of fever occurring immediately following recovery from myelosuppression. We reviewed 165 episodes of fever in patients who were admitted to the University of Pennsylvania Medical Center (Philadelphia) between 1 August 1992 and 15 August 1994 for the treatment of acute leukemia. We included patients who had episodes of fever (temperature of > or = 38 degrees C) for > or = 48 hours within 10 days after an absolute neutrophil count of < or = 500 cells/mm3 was determined. Twenty-nine (20%) of 145 episodes met these criteria. In 5 (17%) of 29 episodes the cause of fever was a bacterial infection, in 6 (21%) of 29 episodes the cause of fever was noninfectious, and in 12 (41%) of 29 episodes the cause of fever was unknown. Six (21%) of 29 episodes were due to documented or suspected fungal infection, four were due to suspected pulmonary aspergillosis, and two were due to systemic candidal infections. Fever following recovery from chemotherapy-induced neutropenia is common. Fungal infections occur frequently after recovery from myelosuppression despite widespread use of empirical and prophylactic antifungal therapy. Improved strategies for diagnosing and preventing fungal infections in patients who have fever following recovery from myelosuppression are clearly needed.
Adolescent↗