PROBABILITY EXPERTS

Question:

Increasingly nurses are called upon to meet patients' spiritual needs. However, there is evidence to suggest that nurses are unable to do ths adequately because of confusion about the notion of spirituality. This is compounded by the uncertainty surrounding the role of nurses in spiritual care interventions. Emerging research suggests that nurses, as primary carers, may have to initiate spiritual care interventions. This article offers practical guidance to nurses seeking to improve spiritual care for their patients. A working definition of spirituality is offered and spiritual needs are explained in the context of a case scenario. Practical guidance is given on how spiritual care can be put into action, using the Actioning Spirituality and Spirtual care in Education Training (ASSET) model as a framework for assessment of spiritual needs, planning, implementing and evaluating spiritual care, and a spiritual assessment tool for practice is outlined. c6

Question 21

Does the combination of aluminium and magnesium hydroxide, given

as an antacid, decrease the absorption of omeprazole if these are

co-administered to help relieve heartburn quickly?

Question 22

Should proton pump inhibitors be used with caution in patients with

renal impairment?

Question 23

Has cisapride been withdrawn from the market because of the danger of

ventricular fibrillation?

Question 24

In peptic ulcer disease:

1. What are the indications for an upper gastrointestinal endoscopy?

2. As this is an invasive procedure, is an oesophagogastroduodenoscopy

(OGD) or barium meal X-ray preferable?

Question 25

Is telithromycin as, or more, effective than clarithromycin in the

treatment of Helicobacter pylori? If so, what is the recommended dosage

and how long should treatment be continued?

Question 26

Currently favoured regimens for eradication of Helicobacter pylori are

triple therapy with a proton pump inhibitor along with two antibiotics

for 1 week. For example:

Omeprazole 20 mgmetronidazole 400 mg and clarithromycin

500 mg (all twice daily).

Omeprazole 20 mgclarithromycin 500 mg and amoxicillin 1 g (all

twice daily).

Resistance to amoxicillin has not yet been demonstrated.

Previously, regimens such as omeprazole, metronidazole, amoxicillin

and clarithromycin were recommended; are these regimens no longer used?

The reason behind this question is the 'sky-high' cost of clarithromycin in

Pakistan, which is inversely proportional to patient compliance (that is,

low-cost regimens tend to have a higher rate of compliance).

Question 27

What is the difference between the management of a gastric and of a

duodenal ulcer?

Question 28

How does omeprazole suppress Helicobacter pylori?

Question 29

Does omeprazole cause rebound hyperacidity? Does this also apply to

H2-blockers?

Question 30

On (K&C 7e, p. 249), you state that the postsynaptic neurotransmitter that

inhibits the relaxation of lower oesophageal sphincter (LOS) is nitric

oxide (NO). I have understood NO to promote relaxation of LOS by

acting on the non-adrenergic, non-cholinergic (NANC) inhibitory

neurones, which inhibits the action of cholinergic excitatory neurones.

Could you please explain this paradox?