The training and development needs of nurses in Indonesia: paper 3 of 3

BACKGROUND: Indonesia's recent economic and political history has left a legacy of widespread poverty and serious health problems, and has contributed to marked inequalities in health care. One means of responding to these challenges has been through a reconsideration of the professional roles of nurses, to enable them to deal with the range and complexity of health problems. However, there are currently a number of obstacles to achieving these aims: there is a serious shortfall in trained nurses; the majority of nurses have only limited education and preparation for the role; and there is no central registration of nurses, which means that it is impossible to regulate either the profession or the standards of care. This study aimed to establish the occupational profiles of each grade of nurse, identify their training and development needs and ascertain whether any differences existed between nurses working in different regions or within hospital or community settings. METHODS: An established and psychometrically valid questionnaire was administered to 524 nurses, covering three grades and coming from five provinces. RESULTS: Significant differences in job profile were found in nurses from different provinces, suggesting that the nature of the role is determined to some degree by the geographical location of practice. The roles of hospital and community nurses, and the different grades of nurse, were fairly similar. All nurses reported significant training needs for all 40 tasks, although these did not vary greatly between grade of nurse. The training needs of nurses from each of the provinces were quite distinct, while those of hospital nurses were greater than those of community nurses. CONCLUSION: The results suggest that the role of the nurse is not as diverse as might be expected, given the different levels of preparation and training and the diversity of their work environments. This may reflect the lack of a central registration system and quality framework, which would normally regulate clinical activities according to qualifications. The differences in training needs between subsections of the sample highlight the importance of identifying skills deficits and using this information to develop customized post-registration education programmes. Together, these results provide a rigorous and reliable approach to defining the occupational roles and continuing education needs of Indonesian nurses

C63. Myocardial bridging on coronary angiography: an innocent bystander or a culprit in myocardial infarction?

Abstract Myocardial bridging is one of the nonatherosclerotic causes of coronary artery disease and is characterized by muscles overlying the intramyocardial course of a major epicardial coronary artery segment, leading to systolic compression. This condition is usually benign but can be associated with unstable angina, myocardial infarction, and death. We report herein a myocardial infarction associated with a subtotal systolic narrowing of the LAD by a myocardial bridge. A 57-year-old-man with chronic heart failure caused by myocardial bridging post-non-ST elevation myocardial infarction and hypertensive heart disease. The electrocardiography showed sinus rhythm, echocardiography shows normal left and right ventricular function, regional wall motion abnormality, grade I diastolic dysfunction and “milking effect” was observed in the mid-segment of the left anterior descending coronary artery on the coronary angiogram. Schwarz type C is categorized in this case, β-blockers and calcium channel blockers remain the mainstay of treatment and relieve hemodynamic disorders caused by myocardial bridging by decreasing heart rate, increasing the period of diastolic coronary filling, and decreasing coronary artery contractility and compression. Other diagnostic modalities needed if symptoms persist despite optimal medical therapy and myotomy, coronary artery bypass graft, or stent implantation can be considered in these patients. At the six-month follow-up visit, the patient had no acute coronary syndrome event, but chest pain and heart failure were felt occasionally.</jats:p

C63. Myocardial bridging on coronary angiography: an innocent bystander or a culprit in myocardial infarction?

Abstract Myocardial bridging is one of the nonatherosclerotic causes of coronary artery disease and is characterized by muscles overlying the intramyocardial course of a major epicardial coronary artery segment, leading to systolic compression. This condition is usually benign but can be associated with unstable angina, myocardial infarction, and death. We report herein a myocardial infarction associated with a subtotal systolic narrowing of the LAD by a myocardial bridge. A 57-year-old-man with chronic heart failure caused by myocardial bridging post-non-ST elevation myocardial infarction and hypertensive heart disease. The electrocardiography showed sinus rhythm, echocardiography shows normal left and right ventricular function, regional wall motion abnormality, grade I diastolic dysfunction and “milking effect” was observed in the mid-segment of the left anterior descending coronary artery on the coronary angiogram. Schwarz type C is categorized in this case, β-blockers and calcium channel blockers remain the mainstay of treatment and relieve hemodynamic disorders caused by myocardial bridging by decreasing heart rate, increasing the period of diastolic coronary filling, and decreasing coronary artery contractility and compression. Other diagnostic modalities needed if symptoms persist despite optimal medical therapy and myotomy, coronary artery bypass graft, or stent implantation can be considered in these patients. At the six-month follow-up visit, the patient had no acute coronary syndrome event, but chest pain and heart failure were felt occasionally.</jats:p

Adult-onset autoimmune diabetes: current knowledge and implications for management

Adult-onset autoimmune diabetes is a heterogeneous disease that is characterized by a reduced genetic load, a less intensive autoimmune process and a mild metabolic decompensation at onset compared with young-onset type 1 diabetes mellitus (T1DM). The majority of patients with adult-onset autoimmune diabetes do not require insulin treatment for at least 6 months after diagnosis. Such patients are defined as having latent autoimmune diabetes in adults (LADA), which is distinct from classic adult-onset T1DM. The extensive heterogeneity of adult-onset autoimmune diabetes is apparent beyond the distinction between classic adult-onset T1DM and LADA. LADA is characterized by genetic, phenotypic and humoral heterogeneity, encompassing different degrees of insulin resistance and autoimmunity; this heterogeneity is probably a result of different pathological mechanisms, which have implications for treatment. The existence of heterogeneous phenotypes in LADA makes it difficult to establish an a priori treatment algorithm, and therefore, a personalized medicine approach is required. In this Review, we discuss the current understanding and gaps in knowledge regarding the pathophysiology and clinical features of adult-onset autoimmune diabetes and highlight the similarities and differences with classic T1DM and type 2 diabetes mellitus