Cowanrosenthal6583

Type 2 diabetes is a chronic disease process that disproportionately affects minorities, mainly those of African-American descent (CDC, 2017). Decreasing the long-term complications associated with this disease requires substantial vigilance, lifestyle changes, medication adherence, and motivation on the part of the individual. The purpose of this descriptive correlational study, guided by Orem's (1991) Conceptual Framework Theory of Self-Care, was to explore the relationship between family support, self-care, and health outcomes in African-American females between the ages of 40-80 years with type 2 diabetes. Specifically, the investigator set out to determine (a) the relationship between family support and health outcomes in selected African-American females with type 2 diabetes; (b) the relationship between self-care and health outcomes in selected African-American females with type 2 diabetes; and (c) which of the two variables assessed in this study (family support and self-care) best predict health outcomes. A convenience sample of African-American females between the ages of 40-80 years were recruited through Qualtrics survey software. The investigator used the Diabetes Care Profile questionnaires to extract indicators for family support and self-care. Data were analyzed using a hierarchical regression model analysis of variance (ANOVA), and a linear regression model. The investigator hypothesized that health outcomes in African-American females with type 2 diabetes are a function of family support and self-care activities, and when family support and self-care are adjusted, they will positively affect health outcomes. The study findings show that self-care abilities are the better indicator of health outcomes, but that family support does contribute positively to health outcomes. Copyright© by the National Black Nurses Association, Inc.In the fourth quarter issue 2020 of the UHM Journal (46-5) we represented the NNT number (number-needed-to-treat) as “three (3)” rather than simply “3.” This appeared on Page 727 in the letter from Richard Clarke, CHT, National Baromedical Services, entitled “HBO2 for radiation cystitis.” The corrected section should have read “Although not reported, the ‘Number Needed to Treat’ (NNT, an epidemiological measure used to communicate effectiveness of an intervention, and representing the average number of patients needed to be treated in order to produce one favorable outcome) was computed as an encouraging 3. This value was the same for the subjective Expanded Prostate Index Composite (EPIC) and objective Late Radiation Morbidity Grading Scheme (LRMGS) scores, rounded up by convention from 2.56 and 2.17, respectively.”.Despite established exposure limits and safety standards as well as the availability of carbon monoxide (CO) alarms, each year 50,000 people in the United States visit emergency departments for CO poisoning. Carbon monoxide poisoning can occur from brief exposures to high levels of CO or from longer exposures to lower levels. Common symptoms can include headaches, nausea and vomiting, dizziness, general malaise, and altered mental status. Some patients may have chest pain, shortness of breath, and myocardial ischemia, and may require mechanical ventilation and treatment of shock. Individuals poisoned by CO often develop brain injury manifested by neurological problems, including cognitive sequelae, anxiety and depression, persistent headaches, dizziness, sleep problems, motor weakness, vestibular and balance problems, gaze abnormalities, peripheral neuropathies, hearing loss, tinnitus, Parkinsonian-like syndrome, and other problems. In addition, some will have cardiac issues or other ailments. While breathing oxygen hastens the removal of carboxyhemoglobin (COHb), hyperbaric oxygen (HBO2) hastens COHb elimination and favorably modulates inflammatory processes instigated by CO poisoning, an effect not observed with breathing normobaric oxygen. Hyperbaric oxygen improves mitochondrial function, inhibits lipid peroxidation transiently, impairs leukocyte adhesion to injured microvasculature, and reduces brain inflammation caused by the CO-induced adduct formation of myelin basic protein. Based upon three supportive randomized clinical trials in humans and considerable evidence from animal studies, HBO2 should be considered for all cases of acute symptomatic CO poisoning. Hyperbaric oxygen is indicated for CO poisoning complicated by cyanide poisoning, often concomitantly with smoke inhalation. Copyright© Undersea and Hyperbaric Medical Society.Carbon monoxide (CO) exposure is a prevalent cause of poisoning worldwide. The cardiac effects of CO poisoning are well described and can manifest as angina, myocardial ischemia or infarction, cardiogenic shock, and/or life-threatening arrhythmias. Atrial fibrillation has been associated with severe CO poisoning; however, few cases have described atrial fibrillation in acute CO poisoning with regard to hyperbaric oxygen (HBO2) therapy. Herein, we describe a case of severe CO poisoning that caused atrial fibrillation with successful conversion to sinus rhythm following HBO2 therapy and discuss implications for further research. Copyright© Undersea and Hyperbaric Medical Society.Carbon monoxide (CO) poisoning presents with many different cardiac effects, but one important presentation is its effect as a CO stress test to reveal underlying coronary artery disease (CAD). There are a limited number of publications detailing this phenomenon, but after CO intoxication it is important to suspect CAD in association with mild troponin leak or non-ST segment elevation myocardial infarction (NSTEMI) shown on electrocardiogram (EKG). We recently treated three patients with CO poisoning who had underlying CAD. In the first case a man presented to the emergency department with CO toxicity and an ST segment elevation myocardial infarction (STEMI), resulting in emergent angioplasty and the discovery of severe CAD. The second case involved an individual who presented with CO poisoning with rising troponin levels. An angioplasty discovered a stable 90% occlusion. The third case was a patient with CO poisoning and transient inferior T wave inversion EKG with borderline troponin elevation. Angioplasty showed only 30% occlusion, so the patient's presentation was likely due to direct CO cardiac toxicity. These cases demonstrate the varied presentations that CO poisoning can have on patients with underlying heart disease. Copyright© Undersea and Hyperbaric Medical Society.Introduction Altitude chamber exposures are used for training to allow aircrew to experience their hypoxia and pressure effect symptoms. Decompression illness (DCI) can occur subsequent to altitude chamber training or in operational aircraft when the cabin altitude is at least 18,000 feet. Definitive emergent treatment is hyperbaric oxygen (HBO2) to decrease bubble size, dissipate excess nitrogen, hyperoxygenate tissue and reduce inflammation. Case report A 27-year-old female underwent altitude chamber training to 25,000 feet. She developed tingling in both legs and left arm, headache, dizziness, malaise, then difficulty talking. She underwent two HBO2 treatments. Over the next 12 months, she had paresthesia, decreased memory and cognitive function similar to symptoms seen following traumatic brain injury. She was referred 14 months after the event for evaluation. Using pre-deployment Automated Neuropsychological Assessment Metrics (ANAM) and serial tests over 58 HBO2 treatments, the patient demonstrated near-return to her pre-deployment test scores.. Discussion The reason for HBO2 treatment was based on previous experience with chronic traumatic brain injury subjects where HBO2 improved outcome. The patient's chronic neurological symptoms mimicked chronic TBI. The patient was unique in that baseline cognitive tests existed that could be used to monitor her changes during the treatment series. Copyright© Undersea and Hyperbaric Medical Society.Hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (AHSCT) in both children and adults has been associated with significant morbidity and mortality. Early HC can occur within 48 hours of completing the chemotherapy conditioning regimen, is usually associated with agents such as cyclophosphamide, and generally resolves promptly. Late HC is commonly associated with BK and other viruses and can prove refractory to antiviral and supportive therapy. There are limited reports of hyperbaric oxygen (HBO2) therapy showing benefit for refractory HC cases. We describe our experience with salvage HBO2 for a 15-year-old male with refractory HC beginning one month post AHSCT and associated with BK virus. Despite supportive therapies including hyperhydration, forced diuresis, transfusions, intravenous and intravesical cidofovir, macroscopic hematuria persisted and resulted in post-obstructive acute renal failure, need for a suprapubic catheter, then bilateral percutaneous nephrostomy tubes. HBO2 was started two months after the AHSCT and one month after detection of BK viremia. In the week prior to starting HBO2 therapy the patient required transfusion with 25 units of red blood cells and seven units of platelets. After HBO2 was started his transfusion requirements progressively decreased, and he had return of renal function. He had no adverse effect from the HBO2. HBO2 therapy could thus be useful in controlling refractory HC after AHSCT. Copyright© Undersea and Hyperbaric Medical Society.Background Calcific uremic arteriolopathy (calciphylaxis) is a rare and highly lethal vascular disease. Vascular calcification with calcium depositions lead to ischemic ulcers associated with gangrene, severe pain and poor healing. Although hyperbaric oxygen (HBO2) therapy has been used in the treatment of calciphylaxis, evidence of its effectiveness is limited. Objective To determine whether HBO2 therapy has a beneficial effect in the healing of calciphylaxis ulcers. Methods A search was made in PubMed using a comprehensive strategy to identify the effect of HBO2 on calciphylaxis wounds. Included in the analysis were studies published up to October 2018 involving a minimum of four patients receiving HBO2 therapy. Results Ten retrospective (case) series were included. This review included a total of 131 patients with calciphylaxis who were treated with HBO2 therapy; of these, 58 patients (45%) had full response on HBO2 with complete wound closure. Regarding partial response, 17 of the patients (13%) experienced substantial wound improvement on different wound scale scores. Conclusion Patients with calcific uremic arteriolopathy can benefit from HBO2. More research is needed using standardized wound scores. Outcomes related to quality of life and pain relief should also be assessed. Copyright© Undersea and Hyperbaric Medical Society.Aim The aim of this study was to examine first aid measures applied in a large series of Australian dive-related fatalities to better determine where improvements can be made. Methods The National Coronial Information System was searched to identify scuba diving and snorkeling-related cases reported to various Australian Coroners for the years 2001-2013 inclusive. selleck compound Coronial documents examined included witness statements, police reports and ambulance and medical reports where available. Information relating to the recovery, rescue and/or resuscitation of the victims was extracted, compiled and analyzed. Results 126 scuba diving and 175 snorkeling-related fatalities were identified during the study period, with airway management complications reported in one-third. Cardiopulmonary resuscitation was performed in three-quarters of the incidents. An automated external defibrillator was attached to 40 victims as a first aid measure, and shocks were indicated and delivered in five cases. Although three-quarters of the reports included no information about whether supplemental oxygen was provided, it was confirmed in 19% of both the scuba diving and snorkeling incidents.