Manningruiz5184
A final version of the guidelines with definitive recommendations was elaborated and prepared for publication.
This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.
This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.
Malignant fungating wounds (MFWs) afflict up to 14% of patients with advanced cancer. The bacterial community structures of MFW may influence the development and severity of wound symptoms. The purpose of this systematic review was to evaluate existing evidence regarding the relationship between microbiome and symptoms of MFWs.
A systematic review of the published literature from January 1995 to January 2020 was conducted. An established quality assessment tool was used to assess the quality of the included studies.
We searched 4 major electronic databases and retrieved 724 articles; 7 met inclusion criteria.
Seven studies were included; the overall quality of the included 7 studies was ranked as adequate. Findings from the studies provided an incomplete characterization of the microbiome and metabolome of MFW; none included modern genomic technologies. Twenty different species of aerobes and 14 species of anaerobes were identified, with inconsistent identification of biofilms and multi-drug-resistant bacteria. Symptom occurrence increased with the number of bacteria species (P = .0003) and the presence of at least 1 anaerobe (P = .0006) in malignant wound beds. Cancer wound-derived odor was associated with dimethyl trisulfide and 4 fatty acid volatiles. Periwound and moisture-associated skin damage were associated with higher putrescine levels in exudates.
Understanding the role of microbiota of MFW in developing or amplifying the severity of wound symptoms is the first step toward development of more precise and effective topical interventions.
Understanding the role of microbiota of MFW in developing or amplifying the severity of wound symptoms is the first step toward development of more precise and effective topical interventions.
We studied pressure injury (PI) stage II-IV cumulative incidence and the change of PI status in the sacral area of nursing home residents associated with the use of a fully automated pulsating support system air mattress in use for 30 days. We also assessed caregivers', residents', and their family members' experiences and perceptions of mattress comfort and other factors such as pain.
Multicenter cohort study.
A convenience sample of 40 residents residing in 10 Belgian nursing homes was recruited.
Pressure injury classification was confirmed using the European Pressure Ulcer Advisory Panel classification system. The Pressure Ulcer Scale for Healing (PUSH) tool was used to assess and measure PI status change. A comfort assessment was performed at end of the study. Cumulative PI incidence of stages II-IV was calculated, and frequencies and percentages were used to describe the results of the comfort assessments.
Residents were allocated to the prevention group (n = 22) and to the treatment group (n =vention of PIs and resulted in improvements in existing PIs, results which are consistent with several existing studies. The majority of the caregivers, residents, and family members evaluated the mattress as comfortable. Future research is needed to corroborate findings in larger randomized clinical trials.
The purpose of this work was to reduce the number of hospital-acquired pressure injuries on the nasal bridge resulting from the use of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) therapy.
Patients with medical device-related pressure injuries (MDRPI) receiving continuous/intermittent CPAP/BiPAP in a 12-bed critical care unit in a Magnet-designated, 182-bed community hospital in the mid-Atlantic region of the United States.
An interprofessional team collaborated to assess factors contributing to an increase in MDRPI development in critical care unit patients using CPAP/BiPAP. Patient dependency on the high-pressurized oxygen results in nurse reluctance to remove the mask and consequently, conduct a partial or incomplete skin assessment. The project consisted of conducting a literature search on MDRPI, developing a standard work process for skin assessment and documentation in the medical record, using skin protection under the mask, and evaluating whether a difents.
The purpose of this interprofessional team-driven quality improvement project was to implement a Bubble continuous positive airway pressure (CPAP) Skincare Protocol proactively to prevent potential device-related pressure injuries.
The setting was a level 3, 60-bed single patient room neonatal intensive care unit (NICU) located within a Midwest urban academic medical center with more than 200 healthcare providers. Prior to the beginning of this project, the NICU had been using the CPAP apparatus that had documented 6 nasal pressure injuries over a 6-month period. Because of ease of use, the NICU moved to using Bubble CPAP (BCPAP), which is known to place patients at a higher risk of nasal pressure injuries due to the way the apparatus sits inside the nares.
An evidence-based practice model provided the guiding framework for the development of our BCPAP Skincare Protocol. Knowing that the unit had already documented nasal pressure injuries, the interprofessional-devised protocol was developed to decrease the risk of nasal injuries with the use of BCPAP in premature infants. The protocol was disseminated via an all-healthcare provider educational program.
During the first 3 months postprotocol implementation period, one stage 2 nasal injury was noted and immediately treated and healed without incident. During the next 24-month, postimplementation period, there were zero nasal pressure injuries reported.
The healthcare providers found that using an interprofessional team approach in developing and implementing an evidence-based BCPAP Skincare Protocol reduced the incidence of nasal pressure injuries associated with the use of BCPAP in the NICU.
The healthcare providers found that using an interprofessional team approach in developing and implementing an evidence-based BCPAP Skincare Protocol reduced the incidence of nasal pressure injuries associated with the use of BCPAP in the NICU.
The proposed advantages of the arthroscopic approach in the Latarjet procedure for shoulder dislocation include improved visualization for accurate positioning of the coracoid graft, the ability to address any associated intra-articular pathologies, and the diminished potential for the formation of postoperative scar tissue and stiffness associated with an open procedure.
Young age, the presence of glenoid and/or humeral bone loss, a history of dislocation, a history of failed arthroscopic stabilization surgery, and an active lifestyle are all associated with recurrent dislocation and are relative indications for an osseous augmentation procedure.
Both the open and arthroscopic Latarjet procedures result in substantial improvements in patient function, with comparable rates of recurrent instability and complication profiles.
Both the open and arthroscopic Latarjet procedures result in substantial improvements in patient function, with comparable rates of recurrent instability and complication profiles.
We report the case of a 29-year-old man with a displaced mid-diaphyseal clavicle fracture that healed in anatomic position without fracture callus after surgical treatment but developed symptoms of late venous thoracic outlet syndrome (TOS) 19 months postoperatively. He was diagnosed with proximal subclavian vein thrombosis and was treated with urgent thrombolysis and staged first rib resection with resolution of symptoms.
Late venous TOS is a potential complication of clavicle fracture, even in the setting of anatomic reduction and primary bone healing. This entity has previously only been described in the setting of nonunion and malunion.
Late venous TOS is a potential complication of clavicle fracture, even in the setting of anatomic reduction and primary bone healing. This entity has previously only been described in the setting of nonunion and malunion.
We present the case of a 57-year-old woman who sustained a comminuted transverse sternal fracture that failed primary open reduction internal fixation (ORIF). The patient underwent staged nonunion reconstruction with a tricortical iliac crest bone graft and mesh plate. With 18 months of a sustained successful outcome, we propose a treatment strategy for a challenging clinical problem.
When primary ORIF fails, bone healing and resolution of a painful sternal nonunion can be effectively managed with a tricortical iliac crest in-lay autograft and locking mesh plate.
When primary ORIF fails, bone healing and resolution of a painful sternal nonunion can be effectively managed with a tricortical iliac crest in-lay autograft and locking mesh plate.
To verify if the efficacy of the triple therapy with tamsulosin, dutasteride, and imidafenacin (TDI) is influenced by any background characteristics in patients with overactive bladder (OAB).
A subanalysis of data from the DIrecT study was conducted. Superiority of TDI over tamsulosin and dutasteride in terms of efficacy based on the Overactive Bladder Symptom Score (OABSS), total International Prostate Symptom Score (IPSS), IPSS quality of life index, and postvoid residual (PVR) was evaluated in binary subgroups.
In the treatment groups, there was a significant interaction of total OABSS with testosterone level (≥4.8 vs. <4.8 ng/mL, p = 0.043) and PVR (≥20 vs. Selleckchem VTP50469 <20 mL, p = 0.018). For the total IPSS, no significant interaction was found except for the IPSS QOL index. For the IPSS QOL index, a significant interaction was found with testosterone level (≥4.8 vs. <4.8 ng/mL, p < 0.0001) as well as with total IPSS and total OABSS. For the PVR, no significant interaction was found except with total OABSS.
Triple therapy with TDI is suggested to be a therapeutic option for benign prostatic hyperplasia in patients with residual OAB symptoms refractory to tamsulosin and in patients with various background characteristics regardless of severity of OAB symptoms. Trial Registry No. UMIN 000011980.
Triple therapy with TDI is suggested to be a therapeutic option for benign prostatic hyperplasia in patients with residual OAB symptoms refractory to tamsulosin and in patients with various background characteristics regardless of severity of OAB symptoms. Trial Registry No. UMIN 000011980.Childhood cancer survivors (CCS) are at increased risk of developing thyroid disorders during follow-up. Radiation therapy to a field that includes the thyroid gland and 131I-meta-iodobenzylguanidine (131I-MIBG) treatment are the main risk factors for thyroid sequelae, which include decreased thyroid function, hyperthyroidism, thyroid nodules, and differentiated thyroid cancer, specifically papillary thyroid carcinoma. In addition, treatment with anti-neoplastic drugs or immunotherapy may result in thyroid dysfunction. Central hypothyroidism may be seen in CCS after cranial radiotherapy, after immunotherapy, or secondary to a brain tumor that involves the hypothalamic-pituitary region and will be discussed elsewhere in this series. In this chapter, the prevalence, risk factors, surveillance, and management of primary hypothyroidism, hyperthyroidism, thyroid nodules, and differentiated thyroid carcinoma in CCS are discussed.
