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Emergency Medicine Australasia : EMA Dec 2022The optimal approach for peripheral intravenous catheter (PIVC) insertion in adult hospitalised patients with difficult intravenous access (DIVA) is unknown. The present... (Review)
Review
Review article: Peripheral intravenous catheter insertion in adult patients with difficult intravenous access: A systematic review of assessment instruments, clinical practice guidelines and escalation pathways.
The optimal approach for peripheral intravenous catheter (PIVC) insertion in adult hospitalised patients with difficult intravenous access (DIVA) is unknown. The present study aimed to critically appraise the quality of (i) assessment instruments and (ii) clinical practice guidelines (CPGs) or escalation pathways for identifying and managing patients with DIVA. Cochrane Central Register of Controlled Trials, EBSCO MEDLINE, EMBASE (OVID) and EBSCO CINAHL databases were searched on 22 March 2021. Studies describing a DIVA assessment measure, CPG or escalation pathway for PIVC insertion in adults (≥18 years of age) were included. Data were extracted using a standardised data extraction form including study design, type of resource and reported clinical outcomes. Quality of DIVA assessment instruments were reviewed using the COnsensus-based Standards for the selection of health Measurement Instruments checklist. Methodological quality of CPGs and escalation pathways was assessed using the Appraisal of Guidelines for Research and Evaluation-II (AGREE-II) instrument. Overall, 24 DIVA resources comprising 16 DIVA assessment instruments and nine CPGs or escalation pathways (including one combined assessment instrument and escalation pathway) were identified. Instruments commonly focused on vein visibility and palpability as indicators of DIVA. CPGs and escalation pathways unanimously recommended use of vessel visualisation technology for patients with or suspected of DIVA. Methodological quality of the resources was mixed. Consensus and standardisation of resources to identify DIVA and recommendations for managing patients with DIVA is limited. Adopting consistent, evidence-based CPGs, escalation pathways or DIVA assessment instruments may significantly improve clinical outcomes.
Topics: Adult; Humans; Catheterization, Peripheral; Administration, Intravenous; Evidence-Based Practice; Checklist; Catheters
PubMed: 36038953
DOI: 10.1111/1742-6723.14069 -
Przeglad Menopauzalny = Menopause Review Sep 2022Carcinoma of the accessory breast tissue (CABT) is an extremely rare occurrence, representing 0.3% of all breast malignancies. A 65-year-old, postmenopausal woman was...
Carcinoma of the accessory breast tissue (CABT) is an extremely rare occurrence, representing 0.3% of all breast malignancies. A 65-year-old, postmenopausal woman was referred to our Breast Clinic complaining of a palpable, growing, and painful mass in her right axilla. Physical examination revealed a palpable tender mass, approximately 3 cm in size, visibly infiltrating the overlying skin area, while physical examination of the breast revealed no palpable lesions. Core biopsy of the mass was promptly scheduled, and the histological report came back positive for Nottingham Grade II NST invasive carcinoma of the breast. The patient underwent breast-conserving surgery and concomitant axillary lymph node dissection (ALND) for removal of the malignant mass. Care was taken to preserve the axillary vein and the long thoracic nerve. Closure of the axillary incision required mobilization of skin flaps to ensure optimal cosmetic results. Despite the ectopic breast tissue being a largely benign and infrequent occurrence, the breast surgeon must remain vigilant for the possibility of CABT development. At any rate, further epidemiological studies incorporating as many patients as possible are required in order to formulate recommendations on the management and prognosis of CABT. Until such guidelines exist, excision of the carcinoma, along with ALND performance, is a reasonable and justified approach to the surgical treatment of CABT.
PubMed: 36254132
DOI: 10.5114/pm.2022.119528 -
Cureus Apr 2023Peyronie's disease is an acquired connective tissue disease of the tunica albuginea of the penis which usually presents with penile curvature/deformity and a palpable... (Review)
Review
Peyronie's disease is an acquired connective tissue disease of the tunica albuginea of the penis which usually presents with penile curvature/deformity and a palpable penile plaque. It is more common in Caucasian men over the fifth decade of life, but it is an under-reported disease. Conservative and non-surgical options are supported by limited evidence except for intralesional injection of collagenase clostridium histolyticum and have limited success. The improved outcome of surgical treatment is accompanied by the risk of erectile dysfunction. This is a brief overview of Peyronie's disease, its impact on the patient, and the available treatment options.
PubMed: 37143639
DOI: 10.7759/cureus.37037 -
Zeitschrift Fur Rheumatologie Sep 2023IgA vasculitis (IgAV) is an immune complex-mediated vasculitis characterized by IgA1-dominant immune deposits in small vessels. It is the most common systemic vasculitis...
IgA vasculitis (IgAV) is an immune complex-mediated vasculitis characterized by IgA1-dominant immune deposits in small vessels. It is the most common systemic vasculitis in childhood with a mostly uncomplicated and self-limiting course. Adults are less affected but the course is frequently more complicated and more frequently accompanied by renal involvement. IgAV characteristically manifests itself on the skin with palpable purpura and in joints, the kidneys and the gastrointestinal tract. In cases of incomplete or atypical symptoms a differential diagnostic work-up is required. A number of triggers have been suggested, especially infections and drugs. Disease management is tailored to organ manifestations and the severity of the symptoms. For children, optimized supportive care and targeted symptom relief are usually sufficient. Management of renal and gastrointestinal manifestations follows recommendations for ANCA-associated vasculitis and IgA nephropathy. Treatment options include glucocorticoids and immunosuppressive agents with varying and mostly insufficient evidence.
Topics: Adult; Child; Humans; IgA Vasculitis; Glomerulonephritis, IGA; Immunoglobulin A; Skin; Immunosuppressive Agents; Polyarteritis Nodosa; Giant Cell Arteritis; Granulomatosis with Polyangiitis
PubMed: 37266676
DOI: 10.1007/s00393-023-01355-0