Addressing clients' sexual health in occupational therapy practice.

BACKGROUND.: Sexuality is an important dimension of one's health and well-being. Studies show that occupational therapists regard clients' sexual health as a legitimate domain of practice but do not adequately address it in their clinical work. PURPOSE.: This study aims to describe occupational therapists' perspectives regarding clients' sexual health. METHOD.: This exploratory study surveyed Canadian occupational therapists using an online questionnaire that collected information on beliefs, knowledge, comfort, barriers, and facilitators with regard to addressing sexuality. Descriptive analysis was conducted on questionnaire data, and content analysis was used to organize respondents' comments. FINDINGS.: While most respondents believed that addressing sexuality was within their scope, few actually did so in practice. Participants reported comfort with sexuality but identified lack of knowledge as a barrier to addressing clients' sexual health. IMPLICATIONS.: This study provided a greater understanding of factors that require consideration for occupational therapists to effectively meet clients' sexual health needs.

Improved bleeding scores using Gelfoam(®) Powder with incremental concentrations of bovine thrombin in a swine liver lesion model.

Topical hemostatic agents are used intra-operatively to prevent uncontrolled bleeding. Gelfoam(®) Powder contains a hemostatic agent prepared from purified pork skin gelatin, the efficacy of which is increased when combined with thrombin. However, the effect of increasing concentrations of thrombin on resultant hemostasis is not known. This study sought to evaluate the ability of various concentrations of thrombin in combination with Gelfoam Powder to control bleeding using a swine liver lesion model. Ten pigs underwent a midline laparotomy. Circular lesions were created in the left medial, right medial, and left lateral lobes; six lesions per lobe. Gelfoam Powder was hydrated with Thrombin-JMI(®) diluted to 250, 375, and 770 IU/mL. Each concentration was applied to two lesion sites per lobe. Bleeding scores were measured at 3, 6, 9, and 12 min using a 6-point system; comparison of bleeding scores was performed using ANOVA with the post hoc Tukey test. The bleeding scores with thrombin concentrations at 770 IU/mL were significantly lower than at 250 and 375 IU/mL at all four time points. The percentage of biopsies with a clinically acceptable bleeding score rose from 37.9, 46.6, and 71.2 % at 3 min to 55.2, 69.0, and 88.1 % at 12 min in the 250, 375, and 770 IU/mL thrombin groups, respectively. The study showed that the hemostatic response to thrombin was dose-related: using higher concentrations of thrombin with Gelfoam Powder yielded improved hemostasis, as determined by lower bleeding scores.

Comparison of a new mineral based hemostatic agent to a commercially available granular zeolite agent for hemostasis in a swine model of lethal extremity arterial hemorrhage.

BACKGROUND: Gaining hemostatic control of vascular injuries sustained in combat using topical agents remains a challenge. We previously developed a new hemostatic agent consisting of a granular combination of a smectite mineral and a superabsorbent polymer (WoundStattrade mark; WS) which demonstrated the ability to stop high pressure bleeding. We have since modified WS to contain only the smectite mineral and compared the performance of WS to QuikClot'strade mark zeolite granules (QCG) in a lethal vascular injury model. METHODS: Fourteen (seven per group) anesthetized swine (35-44kg) had a lethal femoral artery injury produced by creating a 6mm arteriotomy in the vessel. After 45s of hemorrhage, animals were randomized to be treated with either WS or QCG for 3min. A second application was provided if hemostasis failed. Fluid resuscitation was begun at the time of application to achieve a mean arterial blood pressure of 65mmHg. Animals were observed for 120min or until death. Primary endpoints were survival, survival time, post-treatment blood loss, and resuscitation fluid volume. RESULTS: WS resulted in 100% survival to 120min. No animal in the QCG group survived (p=0.0005). Survival times for WS animals were significantly greater compared to QCG (p=0.0001). Post-treatment blood loss (p=0.0043) and post-resuscitation fluid volume (p=0.0043) was significantly less for animals treated with WS compared to QCG. CONCLUSION: WS consisting of just the smectite mineral was superior to QCG tested in this model. Additional study is warranted to determine its potential for use in combat and civilian trauma.