Nocardia peritonitis is an uncommon infection complicating peritoneal dialysis (PD). Because of the rarity of data, there is no consensus on the optimal choice of antibiotics and duration of treatment. We report here a case of Nocardia nova peritonitis in a Chinese continuous ambulatory peritonitis dialysis (CAPD) patient.A 68-year-old Chinese CAPD patient was hospitalized because of a 2-day history of abdominal pain and turbid PD effluent. She suffered from end-stage renal disease of unknown etiology. Self-CAPD was commenced March 1999. She enjoyed reasonably good health with no prior episodes of peritonitis. Six months before this admission, she was hospitalized for pseudomonas pneumonia. Computerized tomogram (CT) scan of the thorax showed a 1 ∞2-cm subpleural mass with contrast enhancement. There were fibrotic changes over both right upper lobes and middle lobe. She was treated with oral ciprofloxacin and intravenous gentamicin. Subsequent CT-guided aspiration of the pleural mass was aborted because the mass had disappeared on followup thoraxCT .Concerning the current admission, a preliminary diagnosis of CAPD-related peritonitis was established due to suggestive signs and symptoms and a PD effluent polymorph-predominating cell count of > 250/mm 3 . Intraperitoneal cefazolin and netilmycin were given immediately. No response was observed after 48 hours and intraperitoneal ceftazidime was substituted for netilmycin.Four days after admission, culture of the PD fluid specimen showed scanty growth of gram-positive rods suggestive of Nocardia species. The antibiotic regimen was then changed to intraperitoneal amikacin and imipenem. There was minimal abdominal pain but the PD effluent was persistently cloudy. The patient remained afebrile.No clinical improvement was seen 5da ys after the change in antibiotics. We stopped imipenem and started intraperitoneal trimethoprim-sulfamethoxazole. Three days later, we received the formal bacteriological report: Nocardia nova was identified and it was resistant to trimethoprim-sulfamethoxazole and sensitive to imipenem, amikacin, and ceftriaxone. However, the cell

Introduction The ability to recognise and manage frailty and its associated presentations is variable among acute hospital staff. Patients living with frailty who are admitted to hospital are more likely to suffer adverse effects than those without. We created an inter-professional in-situ simulation programme designed to improve recognition and management of frailty and its common adverse events. The programme objectives align with recommendations from the British Geriatric Society’s ‘Frailty Hub’ and Royal College of Physicians’ ‘Acute Care Toolkit’ for frailty. Method Over a two month period, seven sessions were completed on the Older Persons Unit (OPU) at St Thomas’ Hospital. These comprised a simulated scenario followed by facilitated debrief—including technical skills and human factors highlighted by the scenario. Quantitative data was collected through pre and post session questionnaires using the Human Factors Skills for Healthcare Instrument (HuFSHI) and frailty based questions. Post session qualitative data was also collected. Results 30 participants attended the sessions (nursing, medical and allied health professional). All participants completing the post course questionnaire found the sessions useful. When comparing pre and post session data, participant confidence in 10/12 sections of the HuFSHI and 8/9 frailty based questions demonstrated improvement. The qualitative data showed common learning themes around improved communication, teamwork and escalation. Participants found that the sessions were a valuable ‘opportunity to reflect’ and ‘debrief’, and learn together as a multidisciplinary team. Conclusion In-situ simulation is an effective tool for improving knowledge and confidence in managing frail patients. It increases awareness and understanding of human factors, which are key to the multidisciplinary approach frail patients require. The course is being expanded across the OPU and now has funding for a departmental manikin. The programme can be disseminated to other units to help improve the care and safety of those with frailty in hospital.