Oral care in ventilated intensive care unit patients: Observing nursing behavior through standardization of oral hygiene tool placement.

A quality improvement project developed between 2 intensive care units using a quasiexperimental pre- and postintervention comparison between nonstandardized placement of oral care equipment in patient rooms and standardized placement of equipment in patient rooms. Daily assessments of equipment use were compared for the control (14 days) and the intervention (15 days) periods to identify a difference in the amount of equipment used by nurses. A significant increase in equipment use by nurses was observed after implementation of the intervention. Standardized design and supply of equipment in patient rooms may help to influence desired nursing behavior related to oral care for ventilated patients.

Peptic oesophageal stricture in children: management problems.

BACKGROUND: Peptic oesophageal stricture (PES) is a serious complication of gastroesophageal reflux disease (GERD) in childhood. The treatment of PES is still controversial, ranging from simple oesophageal dilations to resection/anastomosis of the stenotic portion of the oesophagus. In this study, we want to share our experience with 11 children with GERD and PES. PATIENTS AND METHODS: A retrospective review of clinical data obtained from children who underwent dilation and antireflux surgery for PES was performed. RESULTS: A total of 11 patients were diagnosed with PES. The clinical picture was dominated by dysphagia. Barium swallow showed hiatal hernia in nine cases (82%). Oesophageal strictures were located most commonly in the lower third of the oesophagus (91%). Three Children (27%) with PES had a neurologic impairment and patients had a mean duration of symptoms of 20 months (range, 3 month to 6.2 years) before intervention. Children received a median of four dilations (range, 1-21 dilations) for PES. Time to first dilation from age of diagnosis was a mean of 4.5 months (range, 2-14 months). Antireflux surgery was performed in all patients. Post-operatively, seven patients required repeat oesophageal dilation. Patients were followed with serial dilation for a median of 6 years (range, 1-9 years) and only one patient has a continued requirement of oesophageal dilation for PES. CONCLUSION: GERD complicated by PES is an important condition affecting a significant number of children. Early and effective treatment of both stricture and GERD is required to improve the prognosis of this serious condition.