Abordaje de una herida por roce o fricción de categoría III, con presencia de biofilm, tras contención mecánica / Approach of a category III rub injury, with the presence of biofilm, after mechanical containment

Objetivo: Reforzar y demostrar lo importante que es identificar, conocer y atender todos los factores relacionados con las biopelículas que nos encontramos en, prácticamente, todas las heridas crónicas. Metodología: Se trata del caso de una paciente de intensivos, con ventilación mecánica invasiva. Durante el destete, presenta cuadro de delirio exacerbado que precisa contención mecánica, que produjo una lesión por fricción de categoría III, que evolucionó de manera muy agresiva hacia la presentación reiterada de biofilm. Resultados: Tras un primer abordaje poco eficaz, instauramos cura en ambiente húmedo y procedimos a aplicar todos los cuidados más actuales indicados en el manejo de heridas con presencia de biofilm. Conseguimos cierre completo en 4 semanas. Conclusiones: Se hace necesario entender qué significa una biopelícula para una herida y para un paciente. Si esto no se consigue, jamás podremos abordarla de manera categórica y eficaz

Objective: Reinforce and demonstrate the importance of identifying, knowing and attending to all the factors related to biofilms, which we find in practically all chronic wounds. Methodology: It is a case of a Intensive Care Unit patient with invasive mechanical ventilation. During weaning, he presents exacerbated delirium that requires mechanical restraint, which produced a category III friction lesion, evolving in a very aggressive way towards the repeated presentation of biofilm. Results: After an ineffective first approach, we established a cure in a humid environment and proceeded to apply all the most current care indicated in the management of wounds with the presence of biofilm. We got complete closure in four weeks. Conclusions: It is necessary to understand what a biofilm means for a wound and for a patient. If this is not achieved, we can never address it categorically and effectively

The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture.

INTRODUCTION: Fracture care often represents the first opportunity for clinical management of osteoporosis; however, many patients do not receive any evaluation after a fracture. In Glasgow, Scotland, fewer than 10% of fracture patients underwent bone mineral density (BMD) testing. In an effort to better meet the needs of fracture patients by providing routine assessment and, where necessary, treatment for osteoporosis after their fracture, a novel service (The Fracture Liaison Service) was designed and implemented in two separate National Health Service trusts in Glasgow. METHODS: An agreed-upon standard of care for men and women 50+ years of age with fractures was established in collaboration with orthopedic surgeons and primary care physicians. The Fracture Liaison Service assumes responsibility for fracture case-finding and for assessing and performing diagnostic evaluations (including axial DXA), and making specific treatment recommendations for the secondary prevention of osteoporotic fractures. RESULTS: During the first 18 months of operation, more than 4,600 patients with fractures of the hip, wrist, humerus, ankle, foot, hand, and other sites were seen by the Fracture Liaison Service's osteoporosis specialist nurses. Nearly three quarters of these patients were considered for BMD testing; treatment was recommended for approximately 20% of the patients without need for BMD testing. Overall, 82.3% of patients who had BMD testing were found to be osteopenic or osteoporotic at the hip or spine. CONCLUSIONS: The Fracture Liaison Service has successfully identified and evaluated most patients with fractures. Only those patients who declined were not evaluated. The ultimate success of the program will be measured by the subsequent fracture experience of these patients, but clear improvements in diagnosing and treating low bone mineral density in patients with fracture have already been demonstrated.

An evaluation of the nurse practitioner role in a major rural emergency department.

The purpose of this pilot study was to investigate whether nurse practitioners are able to provide a level of primary health service applicable to remote/isolated settings in wound management and treatment of blunt limb trauma. It was hypothesized that there would be no significant difference in the quality of care, or the level of client satisfaction, provided by the medical officers and the nurse practitioners in the study. Two groups participated in the study, nurse practitioners and medical officers. The study used a randomized trial design. Data were collected using quantitative and qualitative methods. Two hundred and thirty-two clients participated in the study. Of this number 63 were supervised cases in the pilot trial. In the randomized trial participants were distributed between nurse practitioners and medical officers (n = 169), of which 91 were randomized to medical officers and 78 to nurse practitioners. Telephone interviews were conducted to evaluate client satisfaction. The majority of study participants were surveyed for client satisfaction (n = 132). This represents approximately 78% of the randomized sample and multivariate analysis was carried out on the data. Study results indicate that there were no significant differences between the two groups in relation to client satisfaction. Very positive outcomes of treatment were consistent across groups in the study. The study also found that there was strong support for the role of the nurse practitioner in the rural emergency setting. Recommendations include further research to measure the efficacy of nurse practitioners utilizing the selected competencies in remote/isolated settings.

Crush injuries to the hand and forearm.

Crush injuries to the hand and forearm from mechanical devices and heavy equipment are a frequently seen injury in heavily industrialized areas. These injuries are particularly difficult due to their unpredictability, individualized nature and often devastating results. To optimize the outcome for these patients, it is essential to educate the nursing staff on emergent as well as ongoing care, form a systemized plan of care, and recruit patient and family support. A multiskilled group effort will be required to allow the patient with crushed tissue to realize optimal potential and return to a functional position in society.