Adherence to HIV Treatment and Care at a Rural Appalachian HIV Clinic.

Persons living with HIV (PLWH) in rural areas face different barriers to care and treatment adherence compared to persons in urban areas. Our project identified strategies used by a rural HIV clinic with high rates of viral suppression, as evidenced by data abstraction from medical records from January 2010 through December 2014, including 411 patients ages 18 years or older. As HIV viral load is used as a marker for adherence and impacts health outcomes and transmission, it is an important assay. The national goal is for 80% of PLWH to be virologically suppressed by the end of 2020. This clinic exceeded the goal in 2014 with observed rates of 80% to 90% suppression. Eleven national guidelines for HIV care have been adopted by this clinic, along with five additional evidence-based interventions. Nurses played a critical role in all of these methods, and our intent was to report success-related factors.

Transparent film dressing vs pressure dressing after percutaneous transluminal coronary angiography.

BACKGROUND: Pressure dressings have been used as the standard following sheath removal after percutaneous transluminal angioplasty in many institutions. Patients complain about discomfort while the dressing is in place, pain when the dressing is removed after discharge, and skin complications afterward. Many patients have experienced skin irritation where tape has been applied. Nurses have also described difficulty assessing the sheath insertion site in the groin when a pressure dressing is in place. OBJECTIVES: To compare 3 different dressings with respect to effect on bleeding, discomfort voiced by patients, and ease of groin assessment in patients after percutaneous transluminal coronary angiography. METHODS: A total of 100 patients were randomly assigned to 1 of 3 groups: pressure dressing, transparent film dressing, or adhesive bandage. Outcome variables were bleeding, patient discomfort, and nurse-reported ease of observation of the groin site. RESULTS: No bleeding occurred in patients with transparent film dressings or adhesive bandages. Patients rated these dressings significantly higher than they rated the pressure dressing. Because two-thirds of the sample had previously undergone percutaneous transluminal coronary angiography, they could compare their experience with the new dressing with previous experiences with pressure dressings. Nurses rated the ease of assessing the groin significantly higher for the transparent film and adhesive bandage dressings than for pressure dressings. CONCLUSIONS: As a result of this study, a practice change was made hospital-wide: rather than a standard opaque pressure dressing, a transparent film dressing is used for all patients after removal of a femoral sheath.