Heat and moisture exchanger cassettes: Results of a quality/safety initiative to reduce postoperative mucus plugging after total laryngectomy.

BACKGROUND: Tracheal dryness is a concern after total laryngectomy due to the potential for mucus plugs (MP). This study compared heat and moisture exchanger (HME) cassettes to external tracheal humidification (ETH) surrounding MP events. METHODS: A retrospective comparative cohort study comparing outcomes before/after implementation of a patient safety initiative utilizing HME during post laryngectomy hospitalization. The number of MP events were compared with a pre-implementation control group using ETH. Patient characteristics were analyzed for correlation with MP. RESULTS: The rate of MP was significantly lower in the HME group than ETH (0.13 and 0.38 per 10 inpatient days, respectively, P = .02). The proportion of patients with one or more MP events was also significantly reduced in the HME group (50% ETH and 11% HME, P = .01). Method of humidification was the only significant variable associated with MP on logistic regression modeling (P = .008). CONCLUSIONS: HMEs were superior to ETH for prevention of MP.

Responding to 4 gastrointestinal complications in cancer patients.

If your patient has cancer, be prepared to help her manage such serious GI complications as bowel obstruction, peritonitis, fistula formation, and intestinal perforation.

Looking at laryngeal cancer.

Learn how to support your patient through the physical and emotional challenges of diagnosis, treatment, and rehabilitation.

Risk for unplanned hospital readmission of patients with cancer: results of a retrospective medical record review.

PURPOSE/OBJECTIVES: To identify potential factors that place patients with cancer at risk for unplanned readmissions after discharge from the hospital. DESIGN: Retrospective, descriptive, medical record review. SETTING: A National Cancer Institute-designated comprehensive cancer center in an urban area of the Northeastern United States. SAMPLE: 78 patients were selected from those readmitted within seven days of discharge. For each readmission case, a nonreadmitted patient was randomly selected and matched on discharge date and reason for prior admission. The age range was 22-87 years, men and women were equally represented, and 88% were Caucasian. METHODS: The Readmission Criteria Record was developed to collect data from medical records about factors associated with readmission, including demographics, severity of illness, support at home, symptoms, and comorbidities. MAIN RESEARCH VARIABLES: Criteria associated with readmission risk. FINDINGS: Patients who had gastrointestinal cancer, nausea within 24 hours of discharge, financial and insurance concerns, or caregiver difficulty or those who lived alone were more likely to be readmitted within seven days of discharge. Patients were more likely to be readmitted on Friday than any other day. Among readmitted patients, 48% were readmitted within one to two days postdischarge. CONCLUSIONS: Knowledge of factors that may place patients with cancer at an increased risk for readmission and subsequent implementation of appropriate interventions during hospitalization may help to decrease risk of readmission. IMPLICATIONS FOR NURSING: The factors identified provide a basis for assessment, planning, interventions, and follow-up of patients to help reduce the risk of readmission and, thus, poor outcomes.

Malignant cutaneous wounds.

Very little literature is available about malignant cutaneous fungating wounds, and most of the research has been conducted in England. Although only a small number of patients with cancer develop the traumatic and devastating complication of a malignant cutaneous wound, it can be a very distressing occurrence. These patients usually are in the last few months of their lives, and the presence of a wound may be a constant reminder of their disease (Naylor, 2002). In addition, patients may need to cope with bleeding, exudates, odor, or infection. Caring for these patients may be challenging but it can be rewarding if the patients are able to maintain or improve their quality of life.

Quality of life after esophagectomy for cancer.

PURPOSE/OBJECTIVES: To examine symptoms and quality of life (QOL) of esophagectomy patients after curative surgery. DESIGN: Longitudinal, descriptive pilot study. SETTING: Comprehensive cancer center in the northeastern United States. SAMPLE: 23 patients were surveyed: 20 men and 3 women. The mean age was 62.3 years. METHODS: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (version 2.0) and the esophageal-specific module were used. Data collection included three or four time points: before neoadjuvant treatment (if administered), before surgery, and three and six months after surgery. MAIN RESEARCH VARIABLES: The effects on symptoms and QOL of curative esophagectomy performed by a thoracic surgical oncologist. FINDINGS: Global QOL declined slightly over time; this change was not statistically significant. A significant inverse relationship was found between symptom intensity and global QOL. The intensity of hoarseness, reflux, and diarrhea increased significantly pre- to postsurgery. The average symptom intensity for the esophageal-specific subset of 24 symptoms increased significantly over time; the greatest intensity was found before surgery. CONCLUSIONS: Over the six-month observation period, the study found little average change in global QOL or functional status. However, symptoms increased significantly during this time period. Increased symptoms were associated with decreased QOL. IMPLICATIONS FOR NURSING: Symptom management should focus on symptoms that interfere with patients' QOL. Further research should target the evaluation of specific interventions for symptoms.