Mcginnishorton5636
To determine the performance and user experience of a novel ostomy barrier ring over a 4-week period.
This single-arm investigation conducted across three clinical sites included 25 adult participants with an ileostomy for 3 months or longer. The participants used their standard ostomy pouching appliance along with a novel barrier ring for a period of 4 weeks. Skin condition was assessed using the Ostomy Skin Tool. Change in skin condition over the study period was recorded for each participant. The participants' experience in using the novel barrier ring was measured using a five-point Likert-type scale.
Twenty of the 25 participants (80%) completed the trial. Of those participants, the median Ostomy Skin Tool score at both the beginning (range, 0-8) and end was 0 (range, 0-6). In terms of skin condition, 7 participants experienced an improvement in skin condition, 11 experienced no change, and 2 got worse. A median score of 5 out of 5 was recorded for all questions relating to user experience.
Although not statistically significant, there was a clear trend toward improvements in peristomal skin condition using the novel barrier ring, even for participants who were already using a barrier ring. User feedback was positive with respect to comfort, device handling, and the perception of the device's ability to protect the skin. Further, most participants who already used a barrier ring indicated that the novel barrier ring would result in a longer wear time.
Although not statistically significant, there was a clear trend toward improvements in peristomal skin condition using the novel barrier ring, even for participants who were already using a barrier ring. User feedback was positive with respect to comfort, device handling, and the perception of the device's ability to protect the skin. Further, most participants who already used a barrier ring indicated that the novel barrier ring would result in a longer wear time.
Survival after living donor liver transplantation (LDLT) in the United States is excellent. However, the significance of pretransplant kidney disease on outcomes in this population is poorly understood.
This was a retrospective cohort study of 2806 LDLT recipients nationally between January 2010 and June 2020. Recipients with estimated glomerular filtration rate <40 mL/min/1.73 m2 (eGFR-low) or requiring dialysis were compared. Multivariable survival analyses evaluated (1) eGFR-low as a predictor of post-LDLT survival and (2) the survival of LDLT versus deceased donor liver transplant (DDLT) alone with eGFR-low.
From 2010 to 2020, 140 (5.0%) patients had eGFR-low and 18 (0.6%) required dialysis pre-LDLT. The number of LDLTs requiring dialysis between 2017 and 2020 outnumbered the prior 7 y. Overall LDLT experience was greater at centers performing LDLT in recipients with renal dysfunction (P < 0.001). LDLT recipients with eGFR-low had longstanding renal dysfunction mean eGFR 3-6 mo before LDLT 42.7 (±15.1) mL/min/1.73 m2. Nearly half (5/12) of eGFR-low recipients with active kidney transplant (KT) listing at LDLT experienced renal recovery. Five patients underwent early KT after LDLT via the new "safety net" policy. Unadjusted survival after LDLT was worse with eGFR-low (hazard ratio 2.12 versus eGFR ≥40 mL/min/1.73 m2; 95% confidence interval, 1.47-3.05; P < 0.001), but no longer so when accounting for mean eGFR 3-6 mo pre-LDLT (hazard ratio, 1.27; 95% confidence interval, 0.82-1.95; P = 0.3). The adjusted survival of patients with eGFR-low receiving LDLT versus deceased donor liver transplant alone was not different (P = 0.08).
Overall, outcomes after LDLT with advanced renal dysfunction are acceptable. These findings are relevant given the recent "safety net" KT policy.
Overall, outcomes after LDLT with advanced renal dysfunction are acceptable. These findings are relevant given the recent "safety net" KT policy.
Norovirus (NoV) infection frequently progresses to chronic disease after kidney transplant (KTx). This study aims to assess potential risk factors helping to determine patients at risk of chronic NoV infection and to analyze the effect of NoV on allograft outcome. Additionally, we assessed the effectiveness of intravenous immunoglobulin (IVIg) therapy for chronic NoV infection.
The study enrolled 60 KTx patients requiring hospitalization because of NoV infection. Clinical parameters, severity of NoV infection and potential risk factors were evaluated. Outcome parameters were clinical symptoms, rehospitalizations, persistent shedding of virus, and effects on allograft function.
Patients were divided into 2 groups 29 had acute NoV infection only, 31 progressed to chronic NoV infection. Chronic NoV infection was defined as a recurrence of clinical symptoms plus redetection of NoV in stool. Lymphocyte-depleting induction therapy and diabetes mellitus were independent risk factors for chronic infection. find more For patients with chronic NoV infection, length of stay in hospital was significantly prolonged (P = 0.024). Allograft function remained impaired in the chronic NoV group 6 and 12 mo after initial admission. IVIg was administered to 18 patients with chronic NoV infection. No further clinical symptoms of NoV infection occurred in 13 (72%) of these patients. However, NoV was still detectable in stool specimens from 10 (77%) of these patients.
Chronic NoV infection is associated with reduced allograft function. Administration of IVIg to patients with chronic NoV infection seems beneficial in achieving freedom from clinical symptoms, despite limited effects on shedding of virus.
Chronic NoV infection is associated with reduced allograft function. Administration of IVIg to patients with chronic NoV infection seems beneficial in achieving freedom from clinical symptoms, despite limited effects on shedding of virus.
Cardiovascular disease is the major cause of death in patients with type 1 diabetes. Of the available risk predictors for this population, the Steno Type 1 Risk Engine (STENO T1) is the only one that includes kidney function as a risk factor, which is a well-described independent risk factor for cardiovascular disease.
We explore how simultaneous pancreas-kidney transplantation (SPKT) modifies the predicted cardiovascular risk by the STENO T1 through a retrospective study including recipients of a first SPKT between 2000 and 2016.
Two hundred sixty-eight SPKT recipients with a mean age of 40 y old and a median follow-up of 10 y were included. Before transplantation, the expected incidence of cardiovascular events (CVEs) at 5 and 10 y according to STENO T1 would have been 31% and 50%, respectively, contrasting with an actual incidence of 9.3% and 16% for the same timepoints, respectively (P < 0.05). These differences were attenuated when STENO T1 was recalculated assuming 12th-mo glomerular filtration rate (at 5 and 10 y predicted CVE incidence was 10.5% and 19.4%, respectively). Early pancreas graft failure (hazard ratio [HR] 3.00, 95% confidence interval [CI], 1.14-7.88; P = 0.02) was an independent risk factor for post-SPKT CVE, alongside kidney graft failure (HR 2.90, 95% CI, 1.53-5.48; P = 0.001), and diabetes duration (HR 1.04, 95% CI, 1.00-1.09, P = 0.04).
SPKT decreases in more than two-thirds of the predicted cardiovascular risk by the STENO T1. A functioning pancreas graft further reduces CVE risk, independently of kidney graft function.
SPKT decreases in more than two-thirds of the predicted cardiovascular risk by the STENO T1. A functioning pancreas graft further reduces CVE risk, independently of kidney graft function.
Simulation is a valuable tool in nursing education, including during preparation for students going on medical mission trips. Faculty assessed the learning and management of expectations of undergraduate nursing students who participated in a simulation prior to an international medical mission experience. Through student focus groups postsimulation and posttrip, faculty discovered three learning themes and student recommendations for future simulation use.
Simulation is a valuable tool in nursing education, including during preparation for students going on medical mission trips. Faculty assessed the learning and management of expectations of undergraduate nursing students who participated in a simulation prior to an international medical mission experience. Through student focus groups postsimulation and posttrip, faculty discovered three learning themes and student recommendations for future simulation use.
A focal point for nurses and nurse practitioners is developing trust within the nurse-patient relationship. A stable foundation of trust between patient and nurse can diminish patients' mistrust of the healthcare system while engaging patients in their own care and improving health outcomes. Trust can be fostered through active listening as well as strengthening verbal and nonverbal communication skills. Biblical elements that undergird a trusting and honest nurse-patient relationship are described along with a patient narrative with some strategies for nursing implementation.
A focal point for nurses and nurse practitioners is developing trust within the nurse-patient relationship. A stable foundation of trust between patient and nurse can diminish patients' mistrust of the healthcare system while engaging patients in their own care and improving health outcomes. Trust can be fostered through active listening as well as strengthening verbal and nonverbal communication skills. Biblical elements that undergird a trusting and honest nurse-patient relationship are described along with a patient narrative with some strategies for nursing implementation.
Research regarding faith community nursing termination is scarce. Ziebarth (2018) surveyed faith community nurses (FCNs) who had experienced termination of their position. This article explores FCN feelings related to termination and provides an evidence-based practice component to translate the research into practice. Given that FCNs engage in deep relationships with clients, their feelings following termination express grief and lack of support. Support strategies as well as preemptive strategies that may be useful to prevent loss of an FCN position or ministry are presented.
Research regarding faith community nursing termination is scarce. Ziebarth (2018) surveyed faith community nurses (FCNs) who had experienced termination of their position. This article explores FCN feelings related to termination and provides an evidence-based practice component to translate the research into practice. Given that FCNs engage in deep relationships with clients, their feelings following termination express grief and lack of support. Support strategies as well as preemptive strategies that may be useful to prevent loss of an FCN position or ministry are presented.
Cultural sensitivity and improved communication and assessment skills for undergraduate nursing students are the primary aims of a medical mission experience based on an innovative learning environment in a rural African village. Nursing faculty implement components of Irby's Conceptual Framework for Learning Environments to facilitate students' integration and understanding of didactic information and the holistic practice of nursing while decreasing students' dependence on technology.
Cultural sensitivity and improved communication and assessment skills for undergraduate nursing students are the primary aims of a medical mission experience based on an innovative learning environment in a rural African village. Nursing faculty implement components of Irby's Conceptual Framework for Learning Environments to facilitate students' integration and understanding of didactic information and the holistic practice of nursing while decreasing students' dependence on technology.
