Douglasreid9278

BACKGROUND The availability of bare metal stents (BMS) followed by drug-eluting stents of first- (DES1) and second-generation (DES2) progressively increased the rate of the percutaneous revascularizations [percutaneous coronary intervention (PCI)] with unknown impact on the long-term outcome of real-world patients with established coronary artery disease. We sought to investigate treatments applied in patients with coronary artery disease in BMS, DES1 and DES2 eras and their 5-year outcome. METHODS A total of 3099 consecutive patients with at least one coronary stenosis more than 50% observed in 2002 (BMS era), 2005 (DES1 era) and 2011(DES2 era) were enrolled at 13 hospitals in Veneto region, Italy. RESULTS Moving from BMS to DES1 and DES2 eras patients became significantly older, had more comorbidities and received more frequently statins, betablockers, renin-angiotensin modulators and antiplatelets (P  less then  0.0001 for all). The PCI/conservative therapy ratio increased from 1.9 to 2.2 and 2.3, the PCI/coronary artery by-pass surgery ratio from 3.6 to 4.0 and 5.1. The crude 5-year survival was 84.9, 83.4 and 81.4% (P = 0.20) and survival free of myocardial infarction, stroke or further revascularizations was 62.1, 60.2 and 60.1% (P = 0.68), with cardiovascular mortality accounting for 60.9, 55.6 and 43.4% of deaths. At multivariable analysis cardiovascular mortality was significantly lower in patients enrolled in 2011 vs. 2002 (hazard ratio = 0.712, 95% confidence interval 0.508-0.998, P = 0.048). CONCLUSION From BMS to DES1 and DES2 eras progressive worsening of patients characteristics, improvement of medical treatment standards and increase in PCI/conservative therapy and PCI/coronary artery by-pass surgery ratios were observed. Five-year outcomes remained similar in the three cohorts, but in the DES2 era cardiovascular mortality was reduced.Hope is a double-edged sword when it comes to end-of-life choices.Editor's note The mission of Cochrane Nursing is to provide an international evidence base for nurses involved in delivering, leading, or researching nursing care. Cochrane Corner provides summaries of recent systematic reviews from the Cochrane Library. For more information, see https//nursing.cochrane.org.This is the first of three articles exploring ways in which frontline nurses may be affected by recommendations of the forthcoming National Academy of Medicine Future of Nursing 2020-2030 study.Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely-and often more personal-perspectives on professional, policy, and clinical issues. Best of the Blog is a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. RAD001 To read more, please visit www.ajnoffthecharts.com.This is the seventh article in a new series about evidence-based practice (EBP) that builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step-published between 2009 and 2011 (to access the series, go to http//links.lww.com/AJN/A133). This follow-up series features exemplars illustrating the various strategies that can be used to implement EBP changes-one of the most challenging steps in the EBP process.In recognition of the Year of the Nurse and the Midwife initiative, AJN will periodically highlight the works of key nursing leaders. Sometimes it will be in the form of articles from our archives, at other times it will be excerpts from or summaries of nurses' work with related commentary. Here, courtesy of Margretta Madden Styles's daughter, we've reprinted Styles's "Declaration of Belief About the Nature and Purpose of Nursing," originally published in her book, On Nursing Toward a New Endowment (C.V. Mosby Company, 1982). We hope it will inspire you.BACKGROUND People with low vision or blindness may experience anxiety, fear, and depression-sometimes severe-as a result of the challenges encountered when they seek medical care. Such patients deserve, and health care professionals must provide, equal opportunities to participate in and benefit from their health care in a safe environment. A search of the literature yielded information on the needs of visually impaired people but failed to find a comprehensive program that health care facilities could use to meet the needs of this vulnerable population. This gap in the literature on visually impaired patients (VIPs) and implications for their care led us to conduct focused meetings with this population. OBJECTIVE The specific aims of this quality improvement (QI) project were to determine the needs of hospitalized VIPs, develop educational and other resources that would help clinicians and ancillary hospital staff in their interactions with VIPs, and assemble a toolbox of useful materials for VIPs themselvesg received education on caring for VIPs. After the program, however, 56.4% of 140 staff members reported having received such education. Former patients requested bracelets and room identifiers that would alert staff members to VIPs' needs, and the team provided these. The team also introduced a braille version of the hospital menu and provided VIP toolboxes at each nursing station that contained many useful daily care items. link2 CONCLUSIONS VIPs have specific needs when hospitalized. Patients' and staff members' responses to this QI project were overwhelmingly positive; both groups were appreciative of the newly implemented initiatives to meet the special needs of the visually impaired.Editor's note This is the first in a new series on electrocardiography (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.Nurses caring for critically ill adults are challenged to balance patient comfort with the risk of complications associated with analgesic therapy. Evidence gathered since 2013, when the Society of Critical Care Medicine (SCCM) published the Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit, known as the PAD guidelines, gave rise to the SCCM 2018 publication of the Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU, known as the PADIS guidelines. This article discusses how the PADIS guidelines go beyond the PAD guidelines, providing specific guidance related to risk factors for pain, the assessment and management of pain in critical illness, and the ways in which the experience of pain in critical illness is intertwined with that of agitation, delirium, immobility, and sleep disruption. Tables summarize the key points in the PADIS guidelines, clarify the distinctions between PADIS and PAD, and describe the implications for nurses.BACKGROUND Critical illness survivors may develop posttraumatic stress disorder (PTSD) following critical illness and hospitalization. Left untreated, PTSD may result in poor health outcomes. PURPOSE This study sought to examine the effects of a nurse-initiated diary intervention on PTSD development and symptom severity in critical illness survivors with varying levels of mentation. METHODS The study used a pretest-posttest control group design. Patients who were hospitalized in a critical care unit for more than 24 hours were recruited at a single medical center with two such units. All participants completed a pretest on day 2 of critical care hospitalization; the intervention group participants also received a diary. All participants received a posttest one month after critical care discharge. The variables examined were PTSD severity and symptoms of avoidance, intrusion, and hyperarousal. Variables were measured using the Impact of Event Scale-Revised. Diaries were written by the patient, visitors, and interdisciplinary team members, and kept by the patient. RESULTS A total of 134 participants completed the study. The intervention group participants experienced significantly fewer PTSD symptoms than the control group participants. PTSD was found to be of concern in 35 (26%) of all participants five in the intervention group and 30 in the control group. CONCLUSIONS For critical illness survivors, a collaborative diary-writing intervention during hospitalization and after discharge can mitigate post-critical care PTSD. Participants who received diaries had a lower incidence of PTSD symptoms than controls; and at follow-up, they indicated that the diary intervention was worthwhile. We recommend the use of collaborative diary writing to help critical illness survivors in working through their experiences.Patients, health care providers, and communities are all affected.Despite long-standing ethical concerns, the practice has persisted.Changed rules may limit services under Medicare, Medicaid, and Title X.Ventilators, masks, and tests are in short supply.School nurses, teachers question wisdom of active shooter drills.What our profession needs to look like in the upcoming decade.The effects of COVID-19 are still unfolding.OBJECTIVE To determine if an injectable thrombin product (THM) at closure of a Kocher-Langenbeck approach reduces the risk of heterotopic ossification (HO) formation after an acetabular fracture. DESIGN Case Control SETTING Two Level 1 trauma centers PATIENTS Patients with operatively treated acetabulum fractures fixed via Kocher-Langenbeck (KL) from 2013-2018. INTERVENTION Records were reviewed for demographics, history of traumatic brain injury, HO medication or radiation prophylaxis, thrombin hemostatic matrix (THM) (Surgiflo, Ethicon, Bridgewater New Jersey) administration, and length of follow-up. Radiographs were reviewed for dislocation, fracture, Letournel and Orthopaedic Trauma Association classifications, HO, and Brooker grade if applicable. link3 Patients receiving HO prophylaxis (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs], radiation) were excluded. Remaining patints were divided into two groups THM administration (intervention) and no THM. Continuous variables were compared using t-tests and cahe risk of HO formation by 50% after an acetabular fracture. LEVEL OF EVIDENCE III.OBJECTIVES To compare the effect of different wound closure techniques on wound drainage, postoperative length of stay and complications in patients with proximal femoral fractures including femoral neck fractures (31A fractures) and peritrochanteric fractures (31B fractures). DESIGN Prospective cohort study SETTING Footscray Hospital, Western Health, Victoria, Australia, an acute teaching hospital. PATIENTS/PARTICIPANTS Between May 2016 and August 2017 all inpatients receiving surgery for proximal femoral fractures at our facility. A total of 486 consecutive patients who presented during the study period were included in the study. INTERVENTION Three cohorts of consecutive patients were assigned to utilize either skin staples, monofilament absorbable subcuticular sutures (Monocryl), and sutures with the addition of OCA (Monocryl and Dermabond) respectively for skin closure according to when the patients entered the study. MAIN OUTCOME MEASUREMENTS The primary outcome of interest was prolonged wound drainage measured using a standardised technique after postoperative day three.