Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 12 de 12
Filter
1.
Kidney Int Rep ; 8(4): 929-931, 2023 Apr.
Article in English | MEDLINE | ID: mdl-37069996
2.
Adv Skin Wound Care ; 35(3): 149-154, 2022 Mar 01.
Article in English | MEDLINE | ID: mdl-35188482

ABSTRACT

GENERAL PURPOSE: To review neonatal pressure injuries (PIs), including clinical features and challenges in evaluation and staging related to the unique anatomic features of preterm neonatal skin as well as the common sites and mechanisms of injury. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Recognize the causes of PIs in preterm neonates.2. Choose the outcomes of PIs in preterm neonates.3. Distinguish the common characteristics of preterm neonates' skin.4. Summarize the challenges clinicians face when classifying the PIs of preterm neonates.


To review neonatal pressure injuries (PIs), including clinical features and challenges in evaluation and staging related to the unique anatomic features of preterm neonatal skin, as well as the common sites and mechanisms of injury. A review of the literature and discussion of clinical experiences at a large children's hospital. Specific topics include the nature and mechanism of PIs, histomorphometric features of skin development in preterm neonates and how these features inform bedside evaluation of PI, and experience-based observations of challenges in evaluating PIs in this vulnerable population. Pressure injury staging in preterm neonates presents unique challenges: (1) The National Pressure Injury Advisory Panel PI staging model is based on visual identification of depth of injury, but because of the immaturity of the preterm neonate, skin lacks many of the visual cues present in adult PIs. Specific qualitative and quantitative differences in skin development impact the macroscopic appearance of skin at different gestational ages. (2) The most common cause of PIs in this population is related to noninvasive respiratory devices, but these injuries may be extremely small and difficult to evaluate visually. The National Pressure Injury Advisory Panel staging system can be difficult to implement accurately in the neonatal population. Further study is warranted to determine whether an alternative staging system may provide more accurate and actionable information for this population.


Subject(s)
Crush Injuries , Pressure Ulcer , Humans , Infant, Newborn , Pressure Ulcer/diagnosis , Pressure Ulcer/etiology
3.
Pediatr Dev Pathol ; 24(2): 96-102, 2021.
Article in English | MEDLINE | ID: mdl-33470919

ABSTRACT

BACKGROUND: The immature skin of preterm infants is uniquely vulnerable to pressure and chemical injury. We sought to qualitatively and quantitatively describe the histopathologic patterns of skin development in preterm infants. METHODS: Autopsy skin samples were examined for 48 liveborn preterm infants born at 18+ to 36 weeks, and control groups of term neonates and older infants/children. Quantitative variables included thickness of the stratum corneum, epidermis, and dermis. Qualitative features included stratum corneum, rete ridges, and hair follicles. RESULTS: Patterns of maturation were reproducible. Compact keratin appeared beginning at 21-22 weeks. Basketweave keratin appeared first around hair follicles, and then became more generalized from ∼28 weeks corrected gestational age (CGA) onward. Rete ridges began to appear at ∼30 weeks. Epidemal and dermal thickness increased with age. Infants who survived ≤7 days had thicker dermis than those who survived longer, even adjusted for CGA. CONCLUSIONS: Skin development in preterm infants has reproducible milestones. Significant structural changes occurring around 28-30 weeks may improve barrier function, with implications for use of topical compounds such as chlorhexidine. The findings also highlight challenges in evaluating pressure injuries in preterm infants, and postnatal changes in skin parameters.


Subject(s)
Infant, Premature , Skin/pathology , Case-Control Studies , Child Development , Gestational Age , Humans , Infant , Infant, Newborn , Skin/embryology , Skin/growth & development
4.
J Trauma Acute Care Surg ; 90(1): 64-72, 2021 01 01.
Article in English | MEDLINE | ID: mdl-33003019

ABSTRACT

BACKGROUND: Prior studies of venous thromboembolism (VTE) after emergency general surgery (EGS) are not nationally representative nor do they fully capture readmissions to different hospitals. We hypothesized that different-hospital readmission accounted for a significant number of readmissions with VTE after EGS and that predictive factors would be different for same- and different-hospital readmissions. METHODS: The 2014 Nationwide Readmissions Database was queried for nonelective EGS hospitalizations. The outcomes were readmission to the index or different hospitals within 180 days with VTE. Multivariate logistic regressions identified risk factors for readmission to index and different hospitals with VTE, reported as odds ratios with their 95% confidence intervals. Patients were excluded if during the index admission they expired, developed a VTE, had a vena cava filter placed, or did not have at least 180 days of follow-up. RESULTS: Of 1,584,605 patients meeting inclusion criteria, 1.3% (n = 20,963) of patients were readmitted within 180 days with a VTE. Of these, 28% (n = 5,866) were readmitted to a different hospital. Predictors overall for readmission with VTE were malignancy, prolonged hospitalization, age, and being publicly insured. However, predictors for readmission to a different hospital are based on hospital characteristics, including for-profit status, or procedure type. CONCLUSIONS: Nearly one in three readmissions with VTE after EGS occurs at a different hospital and may be missed by current quality metrics that only capture same-hospital readmission. Such metrics may underestimate for-profit hospital postoperative VTE rates relative to public and nonprofit hospitals, potentially affecting benchmarking and reimbursement. Postdischarge VTE rate is associated with insurance status. These findings have implications for policy and prevention programming design. LEVEL OF EVIDENCE: Epidemiological study, level III.


Subject(s)
Patient Readmission/statistics & numerical data , Surgical Procedures, Operative/adverse effects , Venous Thromboembolism/epidemiology , Adolescent , Adult , Aged , Emergency Medical Services , Female , Humans , Male , Middle Aged , Risk Factors , Surgical Procedures, Operative/statistics & numerical data , Venous Thromboembolism/etiology , Young Adult
6.
J Pediatr Rehabil Med ; 12(3): 263-269, 2019.
Article in English | MEDLINE | ID: mdl-31476176

ABSTRACT

PURPOSE: To identify factors associated with success of corrective bony hip surgery among patients with cerebral palsy (CP). METHODS: A retrospective review was conducted of medical records of patients diagnosed with CP and hip displacement who underwent surgery from 2004 to 2016 at the authors' institution and who had a one-year minimum follow-up. Patient age, sex, Gross Motor Function Classification System (GMFCS) level, surgical procedure(s), type and extent of CP, presence of preoperative and postoperative hip pain, and hip migration percentages (MPs) were recorded. Surgical success was defined as a postoperative MP ⩽ 30% and no hip pain at final follow-up. RESULTS: Thirty-eight patients (55 hips) met the inclusion criteria. Mean age at surgery was 10.2 years (range, 2-24 years). Mean MP (standard deviation) improved from 64 ± 29% preoperatively to 22 ± 30% at a mean 1.7-year follow-up (p< 0.001). The absence of preoperative hip pain (p= 0.014), surgery after age 5 (p= 0.041), and a milder preoperative MP (p< 0.001) were significantly associated with surgical success. CONCLUSION: In patients with CP and hip displacement, early preventative correction of hip displacement after age 5 may improve clinical outcomes, though future studies are needed to provide more definitive clinical direction.


Subject(s)
Cerebral Palsy/complications , Hip Dislocation/complications , Hip Dislocation/surgery , Adolescent , Child , Child, Preschool , Female , Humans , Male , Orthopedic Procedures/methods , Postoperative Complications/epidemiology , Retrospective Studies , Treatment Outcome , Young Adult
7.
J Wound Ostomy Continence Nurs ; 46(1): 65-68, 2019.
Article in English | MEDLINE | ID: mdl-30543560

ABSTRACT

BACKGROUND: Soft tissue injuries recognized at birth are a common occurrence and well described in the medical literature. Despite this, there has been no discussion of congenital pressure injuries. In this Clinical Challenges article, I describe 3 cases in which congenital skin injuries have occurred, all of which meet the National Pressure Ulcer Advisory Panel definition for a pressure injury and are demonstrably not the result of other etiologies. CASES: Over a 6-month period, in a 44-bed level III-IV neonatal intensive care unit, 3 patients were identified and diagnosed with congenital pressure injuries. All were born to mothers who presented with significantly diminished or a near-absence of amniotic fluid. The amniotic fluid provides essential cushioning for the developing fetus. A number of well-described conditions result from alterations in the character and volume of the amniotic fluid during gestation. Among these is a correlation between severely diminished fluid volume and congenital contractures resulting from immobility of the fetus as it is compressed against the uterine wall. Therefore, it is not unreasonable to speculate that this immobility and pressure could be the very same mechanism that created our congenital pressure injuries noted in these patients. The stages of the congenital pressure injuries noted were a stage 1, a stage 2, and also a deep tissue pressure injury. One infant succumbed to conditions related to extreme prematurity prior to healing, while the other 2 patients' injuries healed without complication or apparent long-term sequelae. CONCLUSIONS: Despite their absence in the medical literature, I assert that congenital pressure injuries occur and are clinically relevant. This lack of recognition and description risks unnecessary diagnostic procedures and inappropriate or delayed treatment.


Subject(s)
Congenital Abnormalities/diagnosis , Pressure Ulcer/diagnosis , Soft Tissue Injuries/diagnosis , Congenital Abnormalities/nursing , Female , Gestational Age , Humans , Infant, Newborn , Intensive Care Units, Neonatal/organization & administration , Male , Pressure Ulcer/physiopathology , Severity of Illness Index , Soft Tissue Injuries/physiopathology , Wound Healing
8.
Obesity (Silver Spring) ; 25(3): 502-505, 2017 03.
Article in English | MEDLINE | ID: mdl-28117556

ABSTRACT

OBJECTIVE: Brown adipose tissue (BAT) generates heat in response to cold, and low BAT activity has been linked to obesity. However, recent studies were inconclusive as to whether BAT is involved in diet-induced thermogenesis and mitigates weight gain from prolonged overeating. Therefore, this study investigated whether BAT activity is related to metabolic adaptation arising from 8 weeks of overfeeding in humans. METHODS: Fourteen men (aged 24 ± 3 years, BMI 24.5 ± 1.6 kg/m2 ) were overfed by 40% for 8 weeks. Before and after, energy expenditure and metabolic adaptation were measured by whole-room respiratory calorimetry. A marker of BAT activity was measured using infrared imaging of the supraclavicular BAT depot. RESULTS: At the end of 8 weeks of overfeeding, metabolic adaptation-defined as the percent increase in sleeping energy expenditure beyond that expected from weight gain-rose from -0.9 ± 3.9% to 4.7 ± 5.6% (P = 0.001). However, BAT thermal activity was unchanged (P = 0.81). Moreover, BAT thermal activity did not correlate with the degree of metabolic adaptation (P = 0.32) or with the change in body weight (P = 0.51). CONCLUSIONS: BAT thermal activity does not change in response to overfeeding, nor does it correlate with adaptive thermogenesis. Our data suggest that BAT does not mediate metabolic adaptation to overeating in humans.


Subject(s)
Adaptation, Physiological/physiology , Adipose Tissue, Brown/metabolism , Hyperphagia/metabolism , Thermogenesis/physiology , Adult , Body Weight/physiology , Energy Metabolism/physiology , Humans , Male , Weight Gain , Young Adult
9.
Adv Neonatal Care ; 16 Suppl 5S: S26-S32, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27676111

ABSTRACT

BACKGROUND: The skin of extremely preterm infants is underdeveloped and has poor barrier function. Skin maintenance interventions initiated in the neonatal intensive care unit (NICU) have immediate and lifelong implications when the potential for infection, allergen sensitization, and altered aesthetic outcomes are considered. In addition, the high-level medical needs of extremely preterm infants demand skin-level medical interventions that too often result in unintended skin harm. PURPOSE: We describe the use of a harm prevention, or consequence-centered, approach to skin care, which facilitates safer practice for extremely premature infants. METHOD: Neonatal and pediatric Advanced Practice Registered Nurses (APRN) came together for monthly meetings to review the evidence around best skin care practices for extremely preterm infants, with an emphasis on reduction of skin harm. Findings were focused on the population of interest and clinical implementation strategies. FINDINGS: Skin care for extremely preterm infants remains overlooked by current literature. However, clinical practice pearls were extracted and applied in a manner that promotes safer skin care practices in the NICU. IMPLICATIONS FOR PRACTICE: Gentle adhesives, such as silicone tapes and hydrogel-backed electrodes, can help to reduce medical adhesive-related skin injuries. Diaper wipes are not appropriate for use among extremely preterm infants, as many ingredients may contain potential allergens. Skin cleansers should be pH neutral to the skin and the prophylactic use of petrolatum-based emollients should be avoided. IMPLICATIONS FOR RESEARCH: Further exploration and understanding of skin care practices that examine issues of true risk versus hypothetical risk of harm.

10.
ABNF J ; 17(2): 78-81, 2006.
Article in English | MEDLINE | ID: mdl-18402348

ABSTRACT

The case scenario illustrates the advantage of using spirituality as a tool for recovery when working with mentally ill African American clients. Often spiritual and clinical perspectives are seen as contradictory. But for African Americans, these perspectives can be mutually reinforcing. Spirituality can serve as a resource of strength. It can provide emotional consolation, inspiration, guidance, and security. It can foster personal responsibility, identity, respect for ethical codes and community building. Mental Health professionals who use spirituality as a tool for recovery can expect to have better client outcomes when working with African Americans than those who do not.


Subject(s)
Black or African American/ethnology , Mentally Ill Persons/psychology , Nursing Assessment/methods , Spirituality , Adaptation, Psychological , Adult , Attitude to Health/ethnology , Christianity/psychology , Depression/diagnosis , Depression/ethnology , Depression/nursing , Female , Health Knowledge, Attitudes, Practice , Health Status Disparities , Humans , Incidence , Prevalence , Psychiatric Nursing/methods , Religion and Psychology , Self Care/methods , Self Care/psychology , United States/epidemiology
12.
Ann Pharmacother ; 37(3): 442-6, 2003 Mar.
Article in English | MEDLINE | ID: mdl-12639178

ABSTRACT

OBJECTIVE: To evaluate the effect of cyclooxygenase-2 selective inhibitors (CSIs) on blood pressure. DATA SOURCES: Clinical literature accessed through MEDLINE (1966-May 2002). Key search terms included COX-2 selective inhibitors; anti-inflammatory agents, nonsteroidal; celecoxib; rofecoxib; and hypertension. DATA SYNTHESIS: Data from prospective studies on the effects of CSIs on blood pressure are conflicting. Several studies have reported increased blood pressure as an adverse effect of CSIs. CONCLUSIONS: Additional studies are needed to evaluate the effects of CSIs on blood pressure. CSIs should be used with caution in hypertensive patients and blood pressure monitored closely if a CSI is indicated.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Blood Pressure/drug effects , Cyclooxygenase Inhibitors/pharmacology , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Celecoxib , Cyclooxygenase 2 , Cyclooxygenase 2 Inhibitors , Cyclooxygenase Inhibitors/therapeutic use , Humans , Hypertension/drug therapy , Isoenzymes/antagonists & inhibitors , Lactones/pharmacology , Lactones/therapeutic use , Membrane Proteins , Prostaglandin-Endoperoxide Synthases , Pyrazoles , Randomized Controlled Trials as Topic , Sulfonamides/pharmacology , Sulfonamides/therapeutic use , Sulfones
SELECTION OF CITATIONS
SEARCH DETAIL
...