The AAWC conceptual framework of quality systems for wound care.

When the Association for Advanced Wound Care Quality of Care Task Force members determined there was no unanimously accepted definition of quality as it relates to wound care, they: 1) identified relevant components of quality wound care, and 2) created a framework of quality wound care indicators to enable the creation or assessment of wound care delivery systems. The framework is an innovative conceptual model that serves as a basis for the Association strategies to facilitate high quality wound care for patients/clients across the continuum of care and recognizes the role of the supporting systems necessary to provide wound care services. It uses the Institute of Medicine's Crossing the Quality Chasm: A New Health System for the 21st Century to define quality systems for wound care and includes safety and effectiveness coupled with the delivery of timely, efficient, equitable, collaborative, patient-centered care. This framework can be utilized during clinical, managerial, or regulatory review of wound care service delivery.

Assessment and management of stomal complications: a framework for clinical decision making.

Assessment and management of stoma complications are often the responsibility of nurses across the continuum of care. These complications can occur at different times based on their etiology - immediately postoperatively or even several years after surgery - and often require modifications in a person's daily stoma management. This article presents a conceptual framework to help categorize types of stoma complications based on either etiology or location and offers management options to facilitate quality care. The five major categories of complications include Poor Siting, Stoma Proper, Peri-Intestinal Area, Mucocutaneous Junction, and Iatrogenic. Most of these suggested approaches to care are the recommendations of certified ostomy nurses based on their educational training, expert opinion, and successful experiences. Although these recommendations have often solved the specific problems and greatly improved the quality of life for the person with stomal complications, much research is still needed to confirm and/or improve these nursing approaches.

Experimental intrauterine infection with Prevotella bivia in New Zealand White rabbits.

OBJECTIVE: The purpose of this study was to develop a model of chronic intrauterine and fetal infection with Prevotella bivia, an anaerobe of the lower genital tract that is associated often with bacterial vaginosis. STUDY DESIGN: Thirty timed pregnant New Zealand White rabbits on gestational day 21 were inoculated with P bivia or saline solution in a planned ratio of 4:1 (24 P bivia: 6 saline solution). Rabbits were inoculated 6 cm transcervically with 10(5) to 10(8) colony-forming units/uterine horn of P bivia or with saline solution. Necropsy was scheduled on days 4, 6, or 7 after inoculation. Cultures were collected from blood, uterus, amniotic fluid and fetal brain, lung, and heart. Tissues from placenta, uterus, fetal brain, and lung were evaluated with the histologic inflammation score, with a range of 0 to 13. Amniotic fluid was assayed for tumor necrosis factor-alpha by bioassay. Animals with contamination by other organisms were excluded. Categoric data were evaluated with the use of the Fisher exact test, and continuous data were evaluated with the use of the Wilcoxon rank sum. RESULTS: After the exclusion of 8 animals because of contamination with other organisms, 22 animals were evaluated. Of 3 rabbits with an inoculum of 10(8) P bivia colony-forming units/horn, 2 animals (67%) had fever within 24 hours. These results were not compatible with chronic, subclinical infection. Therefore, 14 does had inocula of 10(5-6) P bivia colony-forming units/horn, with necropsy planned at day 4 (n=5 animals), day 6 (n=3 animals), and day 7 (n=6 animals), and 5 animals were inoculated with saline solution. Animals that had been inoculated with P bivia were significantly more likely to have a positive culture than were those animals that were inoculated with saline solution (64% vs 0%; P<.04). Preterm delivery without fever occurred in 21% of does (3/14 does) that were inoculated with P bivia overall and in 33% of the does (3/9 does) that were followed for 6 to 7 days. No saline-solution inoculated animal had preterm birth. There was an increase in amniotic fluid tumor necrosis factor-alpha levels over time in the P bivia group (P=.12). Histologic inflammation scores were not significantly different between P bivia and saline solution groups. CONCLUSION: Inoculation with P bivia at 10(5-6) colony-forming units/horn leads to chronic intrauterine and fetal infection that are accompanied by preterm birth in up to 33% of cases. This model may serve to explore the mechanism of preterm birth that is induced by chronic infection with genital tract anaerobes.

Chronic intrauterine and fetal infection with Gardnerella vaginalis.

OBJECTIVE: We sought to develop a model of chronic intrauterine and fetal infection with Gardnerella vaginalis. STUDY DESIGN: The uterine horns of pregnant New Zealand White rabbits were inoculated on day 21 of gestation with either 10(7) colony-forming units (cfu) of G vaginalis or saline solution. At necropsy, cultures were taken from blood, uterus, amniotic fluid, and fetal tissues. Amniotic fluid was assayed for tumor necrosis factor (TNF)-alpha by bioassay. Maternal and fetal tissue samples were evaluated using the histologic index score. A P value <.05 was considered significant. RESULTS: Compared with saline solution-inoculated animals, the G vaginalis group had significantly more positive cultures from uterus, amniotic fluid, and fetal brain and lung (P =.02 to <.01). For the G vaginalis group, mean TNF-alpha levels and fetal brain scores increased significantly over time (P <.001 for both). CONCLUSION: Chronic intrauterine and fetal infection with G vaginalis is accompanied by progressive increases in amniotic fluid TNF-alpha concentrations and fetal brain histologic index scores.