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Investigation of optimal hernia repair techniques in patients with inflammatory bowel disease
No full textIntroduction: Multiple laparotomies, immunosuppressive therapy, wound infection, and malnutrition are risk factors for incisional hernia development, which places inflammatory bowel disease (IBD) patients at high risk. With advances in minimally invasive techniques, this study assesses incisional hernia repair techniques and complications in the IBD population.
Methods: A single-center, retrospective review of adults with IBD who underwent incisional hernia repair from 2008 to 2022. Complications relative to operative approach and mesh placement location were assessed using descriptive and univariate statistics.
Results: Eighty-eight IBD patients underwent incisional hernia repair. Fifty-two (59.1%) were on immunomodulators and 30 (34.1%) were repaired primarily. Thirty-five (39.7%) hernias recurred, of whom 19 (33%) had mesh placed. Three (30%) occurred in onlay repairs and 16 (33%) occurred in underlay repairs. Subdivision of underlay repairs into intraperitoneal, preperitoneal and retrorectus mesh placement revealed recurrence rates of 35.1%, 50%, and 14.3%, respectively. Patients with open repair were more likely to have intraoperative bowel injury (28.6% vs 9.7%, p = 0.041) and develop postoperative seromas/abscesses (12.5% vs 0%, p = 0.001) and wound complications (17.9% vs 0%, p = 0.012) compared to laparoscopic. Seromas/abscesses developed more frequently in onlay repairs compared to underlay (40% vs 2.13%, p = 0.001). Twelve (13.6%) patients presented with postoperative small bowel obstruction (SBO), 7 (58.3%) of whom had mesh placed, and 6 (85.7%) were underlay. All SBO after underlay repair had intraperitoneally placed mesh. When comparing surgeons, hernias were more likely to recur performed by colorectal surgeons compared to hernia surgeons (63.3% vs 21.3%, p \u3c 0.001).
Conclusion: In IBD patients, minimally invasive approaches lead to fewer perioperative complications compared to open. Underlay mesh placement demonstrated decreased incidence of seroma/abscess formation compared to onlay. When sub-grouped, underlay placements were similar in terms of complications. Retrorectus placement, however, had fewer recurrences and no readmissions for SBO. This suggests a minimally invasive approach or placement of retrorectus mesh may provide the optimal repair in this patient population.
Keywords: Hernia; Inflammatory bowel disease; Laparoscopic; Onlay; Rectrorectus; Robotic
Prenatal diagnosis of Hartsfield syndrome with a novel genetic variant
No full textA G2P0, 24-year-old woman presented at 17 weeks 3 days gestation for a fetal anatomy scan. Ultrasound identified bilateral upper and lower extremity ectrodactyly, semilobar holoprosencephaly, midface hypoplasia, and cleft lip and palate. Amniocentesis for a chromosome microarray demonstrated no significant copy number changes. Whole exome sequencing was subsequently completed, which revealed a de novo, likely pathogenic variant in FGFR1, c.2044G\u3eA (D682N), consistent with FGFR1-related Hartsfield syndrome. This case highlights the first presumed molecularly confirmed prenatal diagnosis of Hartsfield syndrome and identifies a new pathogenic variant
Assessing Pressure Injuries in Patients with Darker Skin Tones –A Pilot Project
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation/1023/thumbnail.jp
The Checklist: Eradicating the Telephone Game During ICU Nursing Handoff
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation/1016/thumbnail.jp
Evaluating the Accuracy of Peripheral Intravenous Catheter Blood Samples in Pediatric Patients
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation/1015/thumbnail.jp
Implementation of the Georgie™Pediatric Gown in Inpatient Pediatric/Neonatal Units
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation/1011/thumbnail.jp
Nursing News & Views - November 2023
Get PDFhttps://scholarlycommons.libraryinfo.bhs.org/nursing_newsletters/1028/thumbnail.jp
Coronary Artery Aneurysms, Arteriovenous Malformations, and Spontaneous Dissections - A Review of the Evidence
No full textBackground: Coronary artery aneurysms (CAAs), arteriovenous malformations (CAVMs), and spontaneous dissections (SCAD) are rare clinical entities and much is unknown about their natural history, prognosis and management.
Methods: A systematic search of MEDLINE, Embase and Cochrane Library databases was performed in March 2023 to identify published papers related to CAAs, CAVMs and SCAD.
Results: CAAs are found in 0.3-12% of patients undergoing angiography and are often associated with coronary atherosclerosis. They are usually asymptomatic but can be complicated by thrombosis in up to 4.8% of patients and rarely by rupture (0.2%). CAAs can be managed medically, percutaneously using stents or coil embolization, and surgically. The most common surgical procedure is ligation of the aneurysm followed by coronary artery bypass grafting (CABG). The incidence of CAVMs is 0.1-0.2% in patients undergoing angiography and they are most likely associated with congenital abnormal development of the coronary vessels. The diagnosis of CAVMs is usually incidental. Surgical or percutaneous intervention is indicated for patients with large CAVMs, which carry a potential risk of myocardial infarction. SCADs represent 1-4% of all acute coronary syndromes and typically affect young women. SCADs are strongly correlated with pregnancy suggesting the role of sex hormones in their pathogenesis. Conservative management of SCAD is preferred for stable patients without signs of ischemia as spontaneous resolution is frequently reported. Unstable patients should undergo revascularization either percutaneously or with CABG.
Conclusions: Further evidence regarding the management of these rare diseases is needed and can ideally be derived from multi-center collaborations
Addressing the rising trend of high-risk pulmonary embolism mortality: Clinical and research priorities
No full textDeaths from high-risk pulmonary embolism (PE) appear to have increased in the last decade. Modifiable risks contributing to this worrisome trend present opportunities for physicians, researchers, and healthcare policymakers to reduce excess mortality. Emerging advanced therapies for PE appear promising, although we lack clear insight as to the magnitude of potential benefit and which patient subgroup(s) should receive them. Treatment and outcome disparities attributable to social determinants of health demand new healthcare delivery policy. In this article, we examine current PE epidemiology, suggest quality improvement and healthcare policy initiatives, and discuss relevant ongoing clinical trials aimed at addressing excess PE mortality.
Keywords: Pulmonary embolism; catheter directed thrombolysis; health care disparities; quality improvement; systemic thrombolysis
Impact of Remote Patient Monitoring Platform on Patients With Moderate to Severe Persistent Asthma: Observational Study
No full textBackground: Asthma is one of the most common respiratory diseases, with an ever-growing health care burden. Remote patient monitoring (RPM) has gained increasing importance in the respiratory care area with the outbreak of the COVID-19 pandemic. In this pilot study, we introduced a novel platform that remotely monitors patients with chronic respiratory illnesses using Centers for Disease Control and Prevention guidelines to reduce hospitalizations and emergency department visits.
Objective: This study aimed to understand patient and physician engagement with a new virtual care solution (KevaTalk app and Keva365 platform) and the value, for both patients and providers, of using an RPM tool. We assessed real-world use of the platform from both physician and patient perspectives and the impact of devices on engagement and monitoring.
Methods: Participants with a history of moderate to severe persistent asthma, seen by a pulmonologist at a hospital, were included in this study. The inclusion criteria involved being aged ≥18 years and having access to an Android or iOS mobile device with internet. We provided patient questionnaires to assess the app\u27s usefulness and evaluate its features. We monitored remote spirometry and oximetry data, app check-ins, alerts, and escalations during this study\u27s time window. Data were reviewed daily and predetermined criteria were set to escalate for physician review based on the patient\u27s symptoms and objective data.
Results: Overall, 25 patients were included in this pilot. The mean age was 57 (SD 10.7) years and a majority (n=23, 92%) were female. A baseline questionnaire, which was used to rate the app, indicated that the ease of check-in and ease of modification to the patient\u27s asthma plan were the 2 highest rated features. In total, 2066 check-ins (1550 green, 506 yellow, and 10 red check-ins) and 1155 spirometry sessions were recorded during this 3-month period. Further, 64% (14/22) and 91% (20/22) of patients were found to have peak flows in their red and yellow zones at least once, respectively. During the course of this study, 484 alerts were recorded and evaluated by the team, of which 37.2% (n=180) required an escalation to the physician; this included a transfer to a medical facility, change in respiratory medication, or further education.
Conclusions: In this pilot study, we demonstrated the feasibility of implementing a novel RPM platform in patients with asthma. Our platform showed high patient engagement and satisfaction and provided physicians with real-time subjective data to evaluate patients remotely that aids in clinical decision-making. The escalations prevented patients from having an exacerbation or flare up, which led to the prevention of an emergency department visit. Continuous monitoring of chronic disease has benefits over episodic monitoring. It allows for improved quality of life, better outcomes, and huge health care savings.
Keywords: asthma; chronic disease; chronic disease management; decision-making; management; patient monitoring; patient monitoring tool; remote patient monitoring; respiratory; respiratory care; respiratory illness; spirometry; telehealth; tool; virtual care; virtual care solution