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However purchase bactrim with mastercard, psychology and physiology are not two separate and distinct pigeon-holes that some nursing (and other) course timetables might suggest purchase on line bactrim, and the subject of homeostatic imbalances from psychological distress is explored in Chapter 3 purchase bactrim master card. In recognising both the physical and psychological needs of patients, nurses can add a humane, holistic perspective into their care, preparing their patients for recovery and discharge. The importance of assessing and planning nursing care is a recurring theme in many of the later chapters of this book. Following Ashworth’s seminal study of 1980, psychological stresses specific to, or accentuated by, intensive care have been widely discussed in nursing literature. To this end, it is often necessary, unfortunately, to add knowingly to the patient’s suffering, but this is one of the costs of critical illness (Carnevale 1991). Nursing perspectives 5 Holistic care The intrinsic needs of patients derive from their own physiological deficits, including many ‘activities of living’ (e. Waldmann and Gaine (1996) describe one patient, unable to drink, feeling tortured by hearing a can opened—opening cans of enterai feed away from a patient’s hearing may reduce such unintentional, but unnecessary, suffering. Thus, nurses need to question every nursing action proactively, no matter how small and apparently insignificant it may seem to be. Psychological approaches to nursing should be individually planned and implemented according to each patient’s needs. These needs can be assessed through the patients themselves and augmented by information from families and friends. Different nurses will feel comfortable with different approaches, but all should recognise the individual human being within each patient. Unlike the other medical and paramedical professions, nurses do not treat a problem or a set of problems. A fundamental role of a nurse, therefore, is to be with and for the patient; this is compatible with the advocacy role promoted by A Strategy for Nursing (DoH 1989). This role is facilitated by making patients the focus in the organisation of care (such as through primary/named nursing). This constant presence of a specific nurse at the patient’s bedside should allow more holistic, patient-centred care. Intensive care nursing 6 Relatives Relatives, together with friends and significant others, form an important part of each person’s life, and they too are similarly distressed by the patient’s illness. The psychological crises experienced by relatives necessitate skilful psychological care, such as the provision of information to allay anxiety and make decisions, and facilities to meet their physical needs (Curry 1995). Relatives should be offered the opportunity to be actively involved in the patient’s care (Hammond 1995) without being made to feel guilty or becoming physically exhausted, rather than left sitting silently at the bedside, afraid to touch their loved ones in case they interfere with some machine. Having recognised the primacy of the patient, nurses can then develop their valuable technological skills, together with other resources, in order to fulfil their unique role in the multidisciplinary team for the benefit of patients. The beliefs, attitudes and philosophical values of nurses will ultimately determine nursing’s economic value. This chapter is placed Nursing perspectives 7 first in order to establish fundamental nursing values, prior to considering individual pathologies and treatments; nursing values can (and should) then be applied to all aspects of holistic patient care. Henderson, famous for her earlier definition of the unique role of the nurse, wrote a classic article about nursing in a technological age (Henderson 1980). Over the years, many accounts of patients’ experiences have been written; Watt (1996) and Sawyer (1997) are recent, easily accessible and vivid articles, while Dyer (1995) offers further challenging perspectives. Examine the potential conflicts between these strategies and the more technical, physiologically necessary interventions. What do they contribute to actual patient care, and how is their effectiveness evaluated? Chapter 2 Humanism Introduction Philosophical beliefs affect our values, and so influence our approaches to care. This chapter describes and contrasts two influential philosophies to supply a context for developing individual beliefs and values. As this is not a book about philosophy, descriptions of these movements are brief and simplified, and readers are encouraged to pursue their ideas through further reading. The label ‘humanism’ has been variously used throughout human history, probably because its connotations of human welfare and dignity sound attractive. The Renaissance ‘humanistic’ movement included such influential philosophers as Erasmus and Sir Thomas More. In this text, however, ‘humanism’ is a specifically twentieth-century movement in philosophy led primarily by Abraham Maslow and Carl Rogers. The humanist movement, sometimes called the ‘third force’ (the first being psychoanalysis, the second behaviourism), was a reaction to behaviourism. Playle (1995) suggests that the art-versus-science debate within nursing is an extension of the humanistic-versus- mechanistic (i. Behaviourism The behaviourist theory was largely developed by John Broadus Watson (1878–1958) who, drawing on Pavlov’s famous animal experiments, stated that if each stimulus eliciting a specific response could be replaced by another (associated) stimulus, the desired response (behaviour) could still be achieved (‘conditioning’) (1998 [1924]). The behaviourist theory enabled social control and so became influential when society valued a single socially desirable behaviour. Thus behaviourism focuses on outward, Humanism 9 observable behaviours and for behaviourists, learning is a change in behaviour (Reilly 1980). Holloway and Penson (1987) have suggested that nurse education contains a ‘hidden curriculum’ controlling the behaviour of students and their socialisation into nursing culture. Through Gagne’s (1975, 1985) influence, many nurses have accepted and been acclimatised into a behaviouristic culture without always being made aware of its philosophical framework. Hendricks-Thomas and Patterson (1995) suggest that this behaviouristic philosophy has often been covert, masked under the guise of humanism. Thus using aspects from humanism, such as Maslow’s hierarchy of needs in Roper et al. Behaviourist theory draws largely on animal experiments; but humans do not always function like animals, especially where cognitive skills are concerned. Thus if internal values remain unaltered, desired behaviour exists only as long as external motivators remain (see Chapter 48). Options: explanation (cognitive) accepting extubation analgesia and sedation (control) restraint (e. Nevertheless, description remains deliberately behaviouristic, seeing the problem as behaviour (extubation). While extubation causes justifiable concern, behaviour is a symptom of more complex psychology. Until underlying problems are resolved, they remain problems; restraint only delays resolution. Intensive care nursing 10 No philosophy is ideal for all circumstances, and few are without some merit. In this scenario, behaviourism may justifiably ‘buy time’ until underlying pathophysiology is resolved or reduced, when extubation will no longer be a problem, and may be medically desirable. Behaviourial approaches can be useful, but they can also be harmful by dehumanising others to a list of task-orientated responses. Smith (1991) found that preregistration courses still emphasised task-orientated, rather than holistic, nursing. Nurses should analyse their values and beliefs, understanding the implications they have for practice, and selecting appropriate approaches to each context; this is, after all, an extension of individualising care.

Transition metal diamine complexes with antimicrobial activity against staphylococcus aureus and methicillin- resistant S buy bactrim 960mg cheap. In the last decade hypervirulent strains have emerged and been associated with increased severity of disease generic 960 mg bactrim visa, high recurrence and significant mortality order discount bactrim online. Although surveillance in Europe is now a requirement of the European Commission, reporting is not standardised or mandatory. Here we review the current literature, guidelines on diagnosis and treatment and conclude by highlighting a number of areas where further research would increase our understanding. Fighting antibiotic resistance: Marrying new financial incentives to meeting public health goals. However, such strategies directly conflict with the clear need to reduce unnecessary antibiotic prescriptions and could actually increase prescription use. Agricultural use of antibiotics and the evolution and transfer of antibiotic-resistant bacteria. These uses promote the selection of antibiotic resistance in bacterial populations. The resistant bacteria from agricultural environments may be transmitted to humans, in whom they cause disease that cannot be treated by conventional antibiotics. When their job of slaughtering the bacterial enemy is finished, the nanoparticles harmlessly biodegrade away. These conclusions can be tentatively extended to all prescription pharmaceuticals in current use. Clinically significant antibiotic resistance is defined in terms of the concentrations of antibiotic that can be safely maintained in a target tissue in a patient without causing excessive adverse side-effects. Because these ratios are close to one, they suggest the possibility for growth inhibition of some naturally occurring (and potentially beneficial) bacteria, and perhaps for initial acquisition of low level antibiotic resistance by exposed pathogens, particularly if assuming a concentration addition model for mixtures of antibiotics with common modes of action. Such low level antibiotic resistance would not be directly clinically relevant, but it may facilitate faster development of clinically significant resistance when further selection with higher concentrations of antibiotics is applied, for instance in a treated patient. On antibiotic properties of microorganism isolated from various depths of the world oceans. Pharmaceuticals in the environment: Scientific evidence of risks and its regulation. But the first to reach an infant born by cesarean section come mostly from the environment – particularly bacteria from inaccessible or less-scrubbed areas like lamps and walls, and from skin cells from everyone else in the delivery room. Resistance is an ecological phenomenon stemming from the response of bacteria to the widespread use of antibiotics and their presence in the environment. Evaluation of colistin as an agent against multi-resistant Gram-negative bacteria. By 1990, about 80% of drugs were either natural products or analogs inspired by them. The properties of this compound suggest a path towards developing antibiotics that are likely to avoid development of resistance. These changing patterns present major therapeutic and infection control challenges, with the public health intervention points unclear. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Residues from human environments and from farms may contain antibiotics and antibiotic resistance genes that can contaminate natural environments. The same resistance genes found at clinical settings are currently disseminated among pristine ecosystems without any record of antibiotic contamination. Natural antibiotic resistance and contamination by antibiotic resistance determinants: The two ages in the evolution of resistance to antimicrobials. Potential of biological processes to eliminate antibiotics in livestock manure: An overview. Animals discharge in their feces and urine between 70% - 90% of the antibiotic administrated unchanged or in active metabolites. Because livestock manure is re-applied to land as a fertilizer, concerns are growing over spread of antibiotics in water and soil. The main threat associated with these bacteria is that they can transfer resistance genes to pathogenic bacteria. Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant gram-negative bacteria. When rivers become reservoirs of antibiotic resistance: industrial effluents and gene nurseries. Proceedings of the 2011 Georgia Water Resources Conference, held April 11-13, 2011 at the University of Georgia. An investigation of contact transmission of methicillin-resistant Staphylococcus aureus. Different health professional groups have different rates of compliance with infection control procedures. In this study, glove use compliance rates were 75% or above in all healthcare worker groups except doctors whose compliance was only 27%. Emerging antibiotic resistance in ocular infections and the role of fluoroquinolones. In a region of the cave that has been isolated for over 4 million years…some strains were resistant to 14 different commercially available antibiotics. Causing nosocomial bloodstream infections in the last decade, little is known about their virulence-associated properties. By contrast, much has been published on the antibiotic-resistance features of these microorganisms. Occurrence of antimicrobials in the final effluents of wastewater treatment plants in Canada. Wastewater bacterial communities bring together broad-host range plasmids, integrons and a wide diversity of uncharacterized gene cassettes. Release of antibiotic resistant bacteria and genes in the effluent and biosolids of five wastewater utilities in Michigan. Distribution and significance of heterotrophic marine bacteria with antibacterial activity. Among the zooplankton isolates, cladocerans harbored the maximum number of antibacterial strains. Pharmaceutical chemicals and endocrine disrupters in municipal wastewater in Tokyo and their removal during activated sludge treatment. Gram-positive bacteria are a major reservoir of class 1 antibiotic resistance integrons in poultry litter. Dosed without prescription: Preventing pharmaceutical contamination of our nation’s drinking water. Geologic Survey identified both organic wastewater contaminants and pharmaceuticals in 80 percent of the sampled sites.

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In contrast to the proponents of psychoanalysis discount bactrim online amex, humanists Attributed to Charles Stangor Saylor bactrim 480 mg line. Arguing that people are free to choose their own lives and make their own decisions order bactrim once a day, humanistic psychologists focused on the underlying motivations that they believed drove personality, focusing on the nature of the self-concept,the set of beliefs about who we are, and self-esteem, our positive feelings about the self. One of the most important humanists, Abraham Maslow (1908–1970), conceptualized personality in terms of a pyramid-shaped hierarchy of motives(Figure 11. At the base of the pyramid are the lowest-level motivations, including hunger and thirst, and safety and belongingness. Maslow argued that only when people are able to meet the lower-level needs are they able to move on to achieve the higher-level needs of self- esteem, and eventually self-actualization, which is the motivation to develop our innate potential to the fullest possible extent. Maslow studied how successful people, including Albert Einstein, Abraham Lincoln, Martin Luther King Jr. Maslow (1970) believed that self-actualized people are creative, spontaneous, and loving of themselves and others. They tend to have a few deep friendships rather than many superficial ones, and are generally private. He felt that these individuals do not need to conform to the opinions of others because they are very confident and thus free to express unpopular opinions. Self-actualized people are also likely to have peak experiences, or transcendent moments of tranquility accompanied by a strong sense of connection with others. Rogers was positive about human nature, viewing people as primarily moral and helpful to others, and believed that we can achieve our full potential for emotional fulfillment if the self-concept is characterized byunconditional positive regard—a set of behaviors including being genuine, open to experience, transparent, able to listen to others, and self-disclosing and empathic. When we treat ourselves or others with unconditional positive regard, we express understanding and support, even while we may acknowledge failings. Unconditional positive regard allows us to admit our fears and failures, to drop our pretenses, and yet at the same time to feel completely accepted for what we are. The principle of unconditional positive regard has become a foundation of psychological therapy; therapists who use it in their practice are more effective than those who [12] do not (Prochaska & Norcross, 2007; Yalom, 1995). Today the positive psychology movement argues for many of these ideas, and research has documented the extent to which thinking positively and openly has important positive consequences for our relationships, our life satisfaction, and our psychological and [13] physical health (Seligman & Csikszentmihalyi, 2000). Research Focus: Self-Discrepancies, Anxiety, and Depression [14] Tory Higgins and his colleagues (Higgins, Bond, Klein, & Strauman, 1986; Strauman & Higgins, 1988) have studied how different aspects of the self-concept relate to personality characteristics. These researchers focused on the types of emotional distress that we might experience as a result of how we are currently evaluating our self- concept. Higgins proposes that the emotions we experience are determined both by our perceptions of how well our own behaviors meet up to the standards and goals we have provided ourselves (our internal standards) and by our perceptions of how others think about us (our external standards). Furthermore, Higgins argues that different types of self-discrepancies lead to different types of negative emotions. The participants listed 10 thoughts that they thought described the kind of person they actually are; this is the actual self-concept. Then, participants also listed 10 thoughts that they thought described the type of person they would ―ideally like to be‖ (the ideal self-concept) as well as 10 thoughts describing the way that someone else—for instance, a parent—thinks they ―ought to be‖ (the ought self-concept). Those with low self-concept discrepancies were those who listed similar traits on all three lists. Their ideal, ought, and actual self-concepts were all pretty similar and so they were not considered to be vulnerable to threats to their self-concept. The other half of the participants, those with high self-concept discrepancies, were those for whom the traits listed on the ideal and ought lists were very different from those listed on the actual self list. After obtaining this baseline measure Higgins activated either ideal or ought discrepancies for the participants. Participants in the ideal self-discrepancy priming condition were asked to think about and discuss their own and their parents‘ hopes and goals for them. Participants in the ought self-priming condition listed their own and their parents‘ beliefs concerning their duty and obligations. For high self-concept discrepancy participants, however, priming the ideal self-concept increased their sadness and dejection, whereas priming the ought self-concept increased their anxiety and agitation. These results are consistent with the idea that discrepancies between the ideal and the actual self lead us to experience sadness, dissatisfaction, and other depression-related emotions, whereas discrepancies between the actual and ought self are more likely to lead to fear, worry, tension, and other anxiety-related emotions. For participants with low self-concept discrepancies (right bars), seeing words that related to the self had little influence on emotions. For those with high self-concept discrepancies (left bars), priming the ideal self increased dejection whereas priming the ought self increased agitation. Self-discrepancies and emotional vulnerability: How magnitude, accessibility, and type of discrepancy influence affect. One of the critical aspects of Higgins‘s approach is that, as is our personality, our feelings are also influenced both by our own behavior and by our expectations of how other people view us. This makes it clear that even though you might not care that much about achieving in school, your failure to do well may still produce negative emotions because you realize that your parents do think it is important. Based on your understanding of psychodynamic theories, how would you analyze your own personality? Are there aspects of the theory that might help you explain your own strengths and weaknesses? Based on your understanding of humanistic theories, how would you try to change your behavior to better meet the underlying motivations of security, acceptance, and self-realization? Terror management and aggression: Evidence that mortality salience motivates aggression against worldview-threatening others. A new look at defensive projection: Thought suppression, accessibility, and biased person perception. Self-discrepancies and emotional vulnerability: How magnitude, accessibility, and type of discrepancy influence affect. Self-discrepancies as predictors of vulnerability to distinct syndromes of chronic emotional distress. Self-discrepancies and emotional vulnerability: How magnitude, accessibility, and type of discrepancy influence affect. Outline the methods of behavioral genetics studies and the conclusions that we can draw from them about the determinants of personality. Explain how molecular genetics research helps us understand the role of genetics in personality. One question that is exceedingly important for the study of personality concerns the extent to which it is the result of nature or nurture. If nature is more important, then our personalities will form early in our lives and will be difficult to change later. If nurture is more important, however, then our experiences are likely to be particularly important, and we may be able to flexibly alter our personalities over time. In this section we will see that the personality traits of humans and animals are determined in large part by their genetic makeup, and thus it is no surprise that identical twins Paula Bernstein and Elyse Schein turned out to be very similar even though they had been raised separately. A gene is the basic biological unit that transmits characteristics from one generation to the next.

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The membrane lipoteichoic acids are anchored in the cytoplasmic membrane order bactrim 480mg with visa, whereas the cell wall teichoic acids are covalently coupled to the murein bactrim 480mg. Cytokines cause the clinical symptoms of sepsis or septic shock syndrome (see under Lipoid A cheap bactrim 960 mg amex, p. Within the macroorganism, teichoic acids can activate the alternative complement pathway and stimulate macrophages to secrete cytokines. Examples of cell wall-associated proteins are protein A, the clumping factor, and the fibronec- tin-binding protein of Staphylococcus aureus or the M protein of Streptococcus pyogenes. Cell wall anchor regions in these proteins extending far beyond the murein are bound covalently to its peptide components. Cell wall-associated proteins frequently function as pathogenicity determinants (specific adher- ence; phagocyte protection). Here, the murein is only about 2 nm thick and contributes up to 10% of the dry cell wall mass (Fig. It contains numerous proteins (50% by mass) as well as the medically critical lipopolysaccharide. Its outer layer is made up of closely packed lipopolysaccharide complexes (see Fig. Examples include the LamB proteins for maltose transport and FepA for transport of the siderophore ferric (Fe3+) enterochelin in E. This molecular complex, also known as endo- toxin, is comprised of the lipoid A, the core polysaccharide, and the O-specific polysaccharide chain (Fig. Therefore,theparentmaterialsusedinproductionof parenteral pharmaceuticals must be free of endotoxins (pyrogens). L-forms are highly Kayser, Medical Microbiology © 2005 Thieme All rights reserved. The Morphology and Fine Structure of Bacteria 157 unstable when subjected to osmotic influences. They are totally resistant to betalactams, which block the biosynthesis of murein. They may revert to the normal bacterial form when betalactam therapy is discontinued, resulting in a relapse. Capsule Many pathogenic bacteria make use of extracellular enzymes to synthesize a 3 polymer that forms a layer around the cell: the capsule. The bacteria of a single species can be classified in different capsular serovars (or serotypes) based on the fine chemical structure of this polysaccharide. The flagella (singular flagellum) are made up of a class of linear proteins called flagellins. The basal body traverses the cell wall and cytoplasmic membrane to anchor the flagel- lum (see Figs. They are anchored in the outer membrane of the cell wall and extend radially from the surface. Using these structures, bacteria are capable of specific attachment to host cell re- ceptors (ligand—receptor, key—keyhole). Bind to receptors of the uro- epithelium and to the P blood group antigen (hence “P” pili). The specific receptors for these pili are plentiful on the uro- epithelial surface. Pili responsible for specific binding of en- teropathogenic coli bacteria to enterocytes. Gonococcal Used for specific attachment of gonococci mucosal cells of the attachment pili urogenital epithelium. Biofilm A bacterial biofilm is a structured community of bacterial cells embedded in a self-produced polymer matrix and attached to either an inert surface or living tissue. The bacteria lo- cated deep within such a biofilm structure are effectively isolated from im- mune system cells, antibodies, and antibiotics. The polymers they secrete are frequently glycosides, from which the term glycocalyx (glycoside cup) for the matrix is derived. The Morphology and Fine Structure of Bacteria 159 Examples of Medically Important Biofilms & Following implantation of endoprostheses, catheters, cardiac pacemakers, shunt valves, etc. Staphylococci have proteins on their surfaces with which they can bind specifically to the corre- spondingproteins, forexamplethe clumping factor that binds to fibrinogenand the fibronectin-binding protein. The adhering bacteria then proliferate and secrete an exopolysaccharide glycocalyx: the biofilm matrix on the foreign body. Professional phagocytes are attracted to the site and attempt, un- successfully, to phagocytize the bacteria. The frustrated phagocytes then release the tissue-damaging content of their lysosomes (see p. Their develop- ment from bacterial cells in a “vegetative” state does not involve assimilation of additional external nutrients. They are spherical to oval in shape and are characterized by a thick spore wall and a high level of resistance to chemical and physical noxae. Among human pathogen bacteria, only the genera Clos- tridium and Bacillus produce spores. The heat resistance of these spores is their most important quality from a medical point of view, since heat ster- Dental Plaque Fig. Potential contributing factors to spore heat resistance include their thick wall structures, the dehydration of the spore, and crosslinking of the proteins by the calcium salt of pyridine-2,6-dicarboxylic acid, both of which render pro- tein denaturing difficult. When a spore’s milieu once againprovides favorable conditions (nutrient medium, temperature, osmotic pressure, etc. They derive energy from the breakdown of organic nutrients and use this chemical energy both for resynthesis and secondary activities. Bacteria oxidize nutrient substrates by means of either respiration or fermentation. In respiration, O2 is the electron and proton acceptor, in fer- mentation an organic molecule performs this function. Human pathogenic bacteria are classified in terms of their O2 requirements and tolerance as fa- cultative anaerobes, obligate aerobes, obligate anaerobes, or aerotolerant anaerobes. Nutrient agar contains the inert substrate agarose, which liquefies at 100 8C and gels at 45 8C. The growth curve for proliferation in nutrient broth is normally characterized by the phases lag, log (or exponential) growth, sta- tionary growth, and death. They can be subdivided into anabolic (synthetic) reactions that consume en- ergy and catabolic reactions that supply energy. In the anabolic, endergonic Kayser, Medical Microbiology © 2005 Thieme All rights reserved. The Physiology of Metabolism and Growth in Bacteria 161 reactions, the energy requirement is consumed in the form of light or chem- ical energy—by photosynthetic or chemosynthetic bacteria, respectively. Catabolic reactions supply both energy and the basic structural elements for synthesis of specific bacterial molecules. Bacteria that feed on inorganic nutrients are said to be lithotrophic, those that feed on organic nutrients are organotrophic. Human pathogenic bacteria are always chemosynthetic, organo- trophic bacteria (or chemo-organotrophs).

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