ABSTRACT
Background: Dual-mobility (DM) total hip arthroplasty (THA) combines the stabilization advantage provided by large head articulation with the low friction advantage provided by small head articulation. There is momentum for DM to be used in a wider selection of patients, with some advocating for DM to be the routine primary total hip construct. Further investigation is needed to determine whether the use of DM in younger adults is validated by aggregate data. Our objective was to review the literature for the clinical performance of DM THA in patients aged 55 years and younger. Methods: A systematic review of the literature was performed according to the guidelines of Preferred Reporting in Systematic Reviews and Meta-Analyses. Inclusion in the review required clinical outcome reporting for DM primary THA in ambulatory patients aged 55 years or younger. The risk of bias was appraised using the Cochrane risk of bias in nonrandomized studies of interventions and the quality of the evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: Across a sample of 1048 cases, the frequency weighted term of follow-up was 87.7 months. The pooled rate of revision was 9.5%. The Harris Hip Score significantly improved from 49.1 preoperatively to 93 postoperatively. The Postel-Merle d'Aubigné score significantly improved from 10.5 preoperatively to 17.1 postoperatively. Conclusions: The literature demonstrates satisfactory short-term outcomes with a mitigated risk of dislocation for DM used as primary THA in patients aged 55 years and younger. The current findings suggest that third-generation designs provide reduced rates of intraprosthetic dislocation and improved survivorship.
ABSTRACT
BACKGROUND: Our objective was to describe changes in pressure injury (PI) rates in pediatric hospitals after implementation of an active surveillance and prevention bundle and to assess the impact of bundle elements. METHODS: The Children's Hospitals Solutions for Patient Safety (SPS) Network is a learning collaborative working together to eliminate harm to hospitalized children. SPS used a 3-pronged approach to prevent pressure injuries: (1) active surveillance, (2) implementing and measuring compliance with the prevention bundle, and (3) deploying a wound ostomy team. Among hospitals participating since 2011 (phase 1), we used negative binomial analyses to assess change in PI rates. Only phase 1 hospitals had a baseline period before any prevention bundle intervention. Among all hospitals participating in 2013 (phases 1 and 2), we used funnel charts to assess the association between reliable bundle implementation and PI rates. RESULTS: Among the 33 hospitals that participated in SPS from 2011 to 2013 (phase 1), the rate of stage 3 pressure injuries declined from 0.06 to 0.03 per 1,000 patient-days (P < 0.001). Stage 4 pressure injuries declined from 0.01 to 0.004 per 1,000 patient-days (P = 0.02). Among all 78 hospitals in phases 1 and 2, the cohort that adopted each bundle element, measured compliance, and achieved 80% prevention bundle compliance had significantly lower PI rates compared with all hospitals. CONCLUSIONS: SPS hospitals saw a significant reduction in stage 3 and 4 PIs over a 2-year period. Reliable implementation of each element of a prevention bundle was associated with lower PI rates.
ABSTRACT
In the past five years, the utilization of PET/CT guidance is more commonly used for cancer patients undergoing biopsy and ablations at this NCI-Designated Cancer Center. The interventional use of PET/CT imaging requires nurses to have a thorough understanding of the mechanisms involved in order to provide the best care in an environment that is safe for patients and staff. Evidence suggests cohesive care and safe practice measures are achieved when patients actively participate and understand their care. This article will discuss how a collaborative, patient-centered approach in caring for oncologic patients undergoing PET/CT interventions is necessary for achieving quality patient outcomes.
ABSTRACT
BACKGROUND: Skin injuries are common among neonatal intensive care unit (NICU) patients and may lead to significant complications. Standardized methods of preventing, detecting, and treating skin injuries are needed. PURPOSE: The aim of this project was to standardize the assessment, documentation, and tracking of skin injuries among hospitalized neonatal patients and to determine the incidence of pressure ulcers in this patient population. METHODS: (1) Creation of an interdisciplinary skin team to identify skin injuries through weekly skin rounds. (2) Assessment of all patients at least twice daily for the presence of skin injuries. Interventions were implemented upon identification of a skin injury. Pressure ulcers of Stage II or more were further assessed by wound/ostomy nurses. FINDINGS: A total of 2299 NICU patients were hospitalized and assessed between July 2011 and December 2015. After the initiation of skin rounds, the baseline incidence of pressure ulcers increased from 0.49 per 1000 patient days to 4.6 per 1000 patient days, reflecting an improvement in detection and reporting. The most common skin injuries detected included erythema, skin tears, and ecchymosis; the most common cause of injuries was medical devices. IMPLICATIONS FOR PRACTICE: A dedicated skin team can improve the detection and reporting of skin injuries among NICU patients. Determination of the incidence of pressure ulcers in this population is critical to develop targeted interventions. IMPLICATIONS FOR RESEARCH: Further research is needed to determine the most effective interventions to prevent and treat skin injuries among hospitalized neonates.
