ABSTRACT
Pressure injuries are a common chronic wound in the older adult. Care of pressure injuries is an interprofessional effort and involves physicians, nurses, registered dieticians, rehabilitation therapists, and surgical subspecialties. Numerous treatment modalities exist but have varying evidence to substantiate their efficacy. All primary and other care providers, particularly geriatricians, need to be aware of current evidence-based prevention and treatment standards. When healing is not expected, palliative care should be considered to avoid futile procedures and preserve dignity and quality of life.
Subject(s)
Pressure Ulcer , Humans , Pressure Ulcer/therapy , Pressure Ulcer/prevention & control , Pressure Ulcer/etiology , Pressure Ulcer/diagnosis , Aged , Wound Healing/physiology , Palliative Care/methodsABSTRACT
The treatment, maintenance, and suppression of infection in chronic wounds remain a challenge to all practitioners. From an infectious disease standpoint, knowing when a chronic wound has progressed from colonized to infected, when to use systemic antimicrobial therapy and when and how to culture such wounds can be daunting. With few standardized clinical guidelines for infections in chronic wounds, caring for them is an art form. However, there have been notable advances in the diagnosis, treatment, and management of infected wounds. This article will discuss the pathophysiology of infection in older adults, including specific infections such as cutaneous candidiasis, necrotizing soft tissue infection, osteomyelitis, and infections involving hardware.
Subject(s)
Wound Infection , Humans , Chronic Disease , Wound Infection/microbiology , Wound Infection/therapy , Aged , Osteomyelitis/microbiology , Osteomyelitis/therapy , Osteomyelitis/diagnosis , Wound Healing/physiologyABSTRACT
GENERAL PURPOSE: To review the management of a patient with a chemical burn from wet cement. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Recognize the clinical presentation of a patient with a chemical burn from contact with wet cement.2. Describe features related to the pathophysiology of alkali burns from wet cement.3. Select the proper decontamination procedure after exposure to wet cement.4. Identify steps in the treatment of a patient with a chemical burn from contact with wet cement.
Alkali burn from wet cement is an often unrecognized and completely preventable chemical injury. The prevalence of cement burns is likely underestimated because of a lack of awareness and knowledge among both individuals who work with cement and healthcare providers. Chemical injuries have important differences compared with thermal burns: they are usually produced by longer exposure to noxious agents as opposed to short-term exposure that is quickly stopped. As a result, first aid approaches are different. Chemical burns from cement can be avoided with adequate skin and eye protection as well as immediate first aid if contact occurs. Manufacturers of bagged cement place warning notices on packaging, but these can be small and go unnoticed by consumers. Construction workers and amateur do-it-yourselfers should avoid direct contact with cement for any prolonged amount of time. Watertight boots, gloves, and clothing will prevent contact, and any accidental splash on exposed skin should be immediately washed away. Education and awareness of the consequences of cement burns are the best prevention.
Subject(s)
Burns, Chemical , Humans , Burns, Chemical/etiology , Burns, Chemical/therapy , Construction Materials/adverse effects , Male , Female , Decontamination/methodsABSTRACT
BACKGROUND AND OBJECTIVES: The aim of this study was to examine experiences of New Jersey family medicine residents and preceptors with the etonogestrel subdermal contraceptive implant and to explore barriers to and facilitators of training. METHODS: In this qualitative study, we conducted semistructured individual interviews to explore residents' and preceptors' experiences with contraceptive implant procedural training. We invited residents and preceptors from programs with high (5.2-10.9) and low (0.0-0.1) implant procedures per resident to participate. Participants discussed factors that supported or inhibited implant training and provision. We transcribed, coded, and analyzed interviews on a rolling basis. We used memoing to reflect on the data and identify saturation. We developed and refined our codebook using a collaborative, iterative process. We analyzed interviews using deductive and inductive techniques to identify themes. RESULTS: We interviewed 25 subjects: 14 residents and 11 preceptors from four family medicine residency programs with the highest and lowest implant training numbers. Common barriers included lack of hands-on experience with the procedure, lack of teaching with the procedure, and difficulty scheduling patients. Facilitators included formal training and inclusion of contraception in residency curricula, preceptors' comfort with the procedure, office sessions dedicated to procedures or gynecology visits, and patient familiarity with the implant. CONCLUSIONS: Family medicine residencies provide unique opportunities to impact provision of long-acting reversible contraception (LARC). We identified potential interventions, including formal implant training sessions, dedicated procedure office sessions, stocking of devices in the office, and staff focused on reproductive health that can aid in scheduling, obtaining devices, and setup.
