Clinical implication of intra-amniotic sludge on ultrasound in patients with cervical cerclage.

OBJECTIVE: The aim of this study was to determine whether intra-amniotic (IA) sludge, a sonographic finding of hyperechoic matter in the amniotic fluid close to the internal cervical os, is associated with preterm delivery in patients with cervical cerclage. METHODS: A retrospective cohort study of patients who had undergone McDonald cerclage between January 1997 and December 2004 was conducted. Transvaginal ultrasound examinations had been performed at 14-28 weeks of gestation, and the ultrasound images were assessed by three reviewers (blinded to patient outcome) to determine the presence or absence of IA sludge. The primary outcome studied was the gestational age at delivery. RESULTS: A total of 177 patients who had undergone cervical cerclage, and for whom adequate records were available, were identified. Sixty had sonographic evidence of IA sludge (Group 1) and 117 had absence of IA sludge (Group 2). There was no significant difference in the mean gestational age at delivery between the two groups (36.4 ± 4.0 vs. 36.8 ± 2.9 weeks, P = 0.53), and no statistical difference in the rate of preterm delivery at < 28 (6.7% vs. 1.7%, P = 0.18), < 30 (6.7% vs. 3.4%, P = 0.45), < 32 (8.3% vs. 6.8%, P = 0.77) or < 36 (16.7% vs. 19.7%, P = 0.69) weeks of gestation. CONCLUSION: Intra-amniotic sludge on ultrasound is not associated with an increased risk of preterm delivery in patients with cervical cerclage.

Placenta growth factor is not an early marker for the development of severe preeclampsia.

OBJECTIVE: Our purpose was to determine whether plasma concentrations of placenta growth factor may be used as a marker for women who ultimately have severe preeclampsia. STUDY DESIGN: We performed a nested case-control study to compare plasma concentrations of placenta growth factor in women with severe preeclampsia with the concentrations in normotensive pregnant control subjects. Plasma samples were collected at <20 weeks' gestation and again in the third trimester. Twenty-two women who ultimately had severe preeclampsia were matched for gestational age at delivery with 22 normotensive control subjects. Placenta growth factor concentrations were measured by a specific antigen capture enzyme-linked immunosorbent assay. Comparisons were made by using the Mann-Whitney U test for nonparametric data such as placenta growth factor concentrations. The Student t test was used for parametric data. RESULTS: A total of 880 pregnant women were screened. Severe preeclampsia developed in 22, for an incidence of 2.5%. As expected, women with severe preeclampsia had significantly higher systolic and diastolic blood pressures, and their infants had lower birth weights. Placental weights at delivery were similar between those with severe preeclampsia and control subjects (659 vs 699 g; P =.51). During the third trimester, the median placenta growth factor concentrations were significantly lower in women with severe preeclampsia than in normotensive control subjects (125 vs 449 pg/mL; P =.003). When samples drawn at <20 weeks' gestation were compared, there was no difference between the group with severe preeclampsia and those who remained normotensive (98.8 vs 56.34 pg/mL; P =.15). CONCLUSION: During the third trimester, patients with severe preeclampsia have decreased maternal concentrations of placenta growth factor. This difference is not seen earlier in pregnancy. Lower concentrations of placenta growth factor may be a result of severe preeclampsia rather than a causal factor. Placenta growth factor is not a good marker for the subsequent development of severe preeclampsia.

TPN update: making each visit count.

Caring for patients on TPN is a challenge for the home care nurse. These patients may present with either a short- or long-term need for TPN but in either case, the impact on daily life related to administration and monitoring of this complex infusion therapy is significant for both patients and their caregivers. The risks and complications of TPN can be serious. Nurses must possess expert knowledge of TPN administration and a high level of competence in assessment and monitoring of patients on TPN. Patients and caregivers will learn technical procedures in the home that produce anxiety in graduate nurses! The nurse must also possess skill and confidence in teaching patients to effectively administer, manage, and incorporate TPN infusion therapy into their lives.

A clinical pathway for deep vein thrombosis.

The use of low molecular weight heparin to treat deep vein thrombosis at home represents a relatively new patient population for home care agencies. Use of a clinical pathway provides a framework for defining expected outcomes of care and direction for patient assessment, care, monitoring, and documentation. Implementation and evaluation of a clinical pathway are described.

Managed Care: Effects on Home Health Care Providers and Stroke Survivors.

The advent of managed care has changed the delivery of home health care services for stroke survivors and their families. Because clinicians are providing fewer visits, they need to focus their assessment and diagnoses, interventions, and evaluation steps to offer the most effective, efficient, and economic care possible.

Discharge planning for the patient requiring home intravenous antimicrobial therapy.

Home intravenous (IV) antimicrobial therapy is a well accepted and widely practiced form of home infusion therapy. Orthopaedic-related infections, often requiring long courses of therapy, are commonly treated in the home setting after a brief hospitalization. Hospital orthopaedic nurses play an important role in preparing patients for home care. This article addresses patient selection for home IV therapy, the discharge planning process, and educational preparation of the patient. The role of the home care nurse is briefly presented to enhance the orthopaedic nurse's knowledge of the continuum of care.

Home infusion therapy.

OBJECTIVES: To examine issues related to the planning of an effective home infusion therapy program and to provide an overview of specific home infusion therapies for patients with cancer. DATA SOURCES: Published articles, research studies, guidelines, and standards pertaining to infusion therapies. CONCLUSIONS: Advances in technology have expanded and increased the scope and success of home infusion therapy. Antimicrobial therapy, chemotherapy, pain management, total parenteral nutrition, and blood transfusion therapy are commonly administered to cancer patients at home. IMPLICATIONS FOR NURSING PRACTICE: A competent and experienced nursing staff is the cornerstone of a successful home infusion program. Safe provision of infusion therapy and care can be assured through selection of appropriate patients, effective patient education, well-defined agency policies, and effective coordination of home care services.

Patient education in high-tech home care.

High-tech home care requires that nurses have intricate knowledge and skills to care for patients with complicated treatments and equipment. Yet the need for teaching skills is often overlooked. Home care professionals can teach patients to help in their own care if the professionals assess that patients are ready to learn and incorporate principles of adult teaching and learning.