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Facts, Views & Vision in ObGyn Jun 2024Vesico-vaginal fistula (VVF) is a rare but debilitating condition, characterised by an abnormal connection between the bladder and vagina. While obstetric-related cases...
BACKGROUND
Vesico-vaginal fistula (VVF) is a rare but debilitating condition, characterised by an abnormal connection between the bladder and vagina. While obstetric-related cases prevail in developing countries, iatrogenic fistulas are more common in industrialised ones, often resulting from pelvic surgeries.
OBJECTIVES
The optimal timing for surgical correction of VVF remains debated, often leaning towards delayed intervention. Here we report a successful early laparoscopic repair of an iatrogenic VVF following hysterectomy.
MATERIALS AND METHODS
The patient, a 54-year-old woman, presented with VVF after a hysterectomy. The laparoscopic repair was performed promptly upon diagnosis.
MAIN OUTCOME MEASURES
To assess the feasibility and effectiveness of an early repair of a gynaecological-related VVF.
RESULTS
First, cystoscopy identified the bladder edge of the VVF. Second, laparoscopy was performed and the vesico-vaginal dissection was carried out. The excision of the previous stitches and of the fibrotic tissue was undertaken to create free flaps for suturing. The bladder was repaired in a double layer, and a single layer was applied to the vagina. Finally, the omentoplasty was done. The patient was discharged on postoperative day 5. No complications occurred.
CONCLUSIONS
This successful case demonstrates the feasibility and safety of early laparoscopic repair for gynaecological surgery-related vesico-vaginal fistulae. While acknowledging the need for further studies to standardise techniques, this report contributes to the evolving understanding of optimal management for this complex condition.
PubMed: 38950535
DOI: 10.52054/FVVO.16.2.014 -
Oncology Nursing Forum Jun 2024To update the American Society of Clinical Oncology (ASCO)-Oncology Nursing Society (ONS) standards for antineoplastic therapy administration safety in adult and...
PURPOSE
To update the American Society of Clinical Oncology (ASCO)-Oncology Nursing Society (ONS) standards for antineoplastic therapy administration safety in adult and pediatric oncology and highlight current standards for antineoplastic therapy for adult and pediatric populations with various routes of administration and location.
METHODS
ASCO and ONS convened a multidisciplinary Expert Panel with representation of multiple organizations to conduct literature reviews and add to the standards as needed. The evidence base was combined with the opinion of the ASCO-ONS Expert Panel to develop antineoplastic safety standards and guidance. Public comments were solicited and considered in preparation of the final manuscript.
RESULTS
The standards presented here include clarification and expansion of existing standards to include home administration and other changes in processes of ordering, preparing, and administering antineoplastic therapy; the advent of immune effector cellular therapy; the importance of social determinants of health; fertility preservation; and pregnancy avoidance. In addition, the standards have added a fourth verification.
STANDARDS
Standards are provided for which health care organizations and those involved in all aspects of patient care can safely deliver antineoplastic therapy, increase the quality of care, and reduce medical errors.
Topics: Humans; Antineoplastic Agents; Adult; Child; Oncology Nursing; Neoplasms; Patient Safety; Female; United States; Male; Societies, Nursing
PubMed: 38950089
DOI: 10.1188/24.ONF.297-320 -
PloS One 2024To analyze the psychometric properties of the cross-culturally adapted version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC)...
OBJECTIVE
To analyze the psychometric properties of the cross-culturally adapted version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) Compact Form Brazil.
METHODS
A methodological study was conducted with 281 adult Primary Health Care users. Data collection took place online. Confirmatory Factor Analysis (CFA) was used to evaluate the psychometric properties of the PREOS-PC after the process of cross-cultural adaptation to the Brazilian context. Internal consistency was evaluated through Cronbach's alpha coefficient (α) and McDonald's omega coefficient (ω).
RESULTS
The sample consisted of 73.3% women. The mean age was 36.1 years (SD = 12.2). Of the 23 items of the PREOS-PC that were eligible for CFA, a model with four correlated domains and 16 items presented satisfactory fit indexes. The domains were Practice Activation (PrA) (four items), Patient Activation (PaA) (two items), Experiences of patient safety events (EPaS) (five items) and Outcomes of patient safety (OPaS) (six items). One domain (GPeS) presented one question with a 0 to 10 response scale and two open questions, which cannot be inserted in the CPA due to the nature of the items, but can be included in the application of the scale, being evaluated individually. In this factorial model, five items (EPaS2, EPaS3, EPaS4, EPaS5, EPaS6 and EPaS8) presented factor loadings ≤ 0.30. The α and ω values demonstrated good internal consistency for all domains of the PREOS-PC.
CONCLUSIONS
The Brazilian version of the PREOS-PC Compact Form Brazil composed of four domains (PrA, PA, EPaS and OPaS) and 16 items presented evidence of validation of its psychometric properties and can be used to evaluate the experiences and results of patient safety in Primary Health Care in the Brazilian context.
Topics: Humans; Female; Brazil; Primary Health Care; Adult; Male; Middle Aged; Psychometrics; Patient Safety; Patient Reported Outcome Measures; Surveys and Questionnaires; Factor Analysis, Statistical; Young Adult
PubMed: 38950012
DOI: 10.1371/journal.pone.0305414 -
Nephrology Nursing Journal : Journal of... 2024ANNA's Administration SPN created this proposal as a clinical practice project to re-evaluate how training and education are provided to individuals working in the...
ANNA's Administration SPN created this proposal as a clinical practice project to re-evaluate how training and education are provided to individuals working in the dialysis setting. This article describes an education initiative based on the escape room methodology to provide a fresh approach on dialysis curriculum.
Topics: Humans; Renal Dialysis; Patient Safety; Nephrology Nursing; Curriculum; United States
PubMed: 38949803
DOI: No ID Found -
Nephrology Nursing Journal : Journal of... 2024The importance of the Life Safety Code (LSC) cannot be understated. The LSC is composed of a set of components, measures, and protocols with the overarching goal of...
The importance of the Life Safety Code (LSC) cannot be understated. The LSC is composed of a set of components, measures, and protocols with the overarching goal of protecting and preserving human life. This article describes the LSC survey process in dialysis facilities. Ensuring the physical plant and its infrastructure is critical for patient safety. The survey tasks, provider, and building management responsibilities are reviewed. Implications for nephrology nursing regarding survey readiness and best practices for an LSC survey are discussed.
Topics: Renal Dialysis; Humans; Patient Safety; Nurse Administrators; Nephrology Nursing; Safety Management; United States
PubMed: 38949802
DOI: No ID Found -
Nephrology Nursing Journal : Journal of... 2024Nurse leaders play a critical part in supporting the safety of patients and their staff. Their guidance in establishing a robust safety culture and engagement in...
Nurse leaders play a critical part in supporting the safety of patients and their staff. Their guidance in establishing a robust safety culture and engagement in preparing their organizations for the survey is important in eliminating patient harm. Ensuring the dialysis facility and staff are survey-ready promotes a culture dedicated to patient wellbeing and safety. This article describes the survey process in dialysis facilities and provides survey tips to guide nurse managers in being survey-ready every day.
Topics: Nurse Administrators; Humans; Surveys and Questionnaires; Renal Dialysis; Nephrology Nursing
PubMed: 38949799
DOI: No ID Found -
Liver Transplantation : Official... Jul 2024Advances in immunosuppression have extended patient and graft survival rates after solid organ transplantation; however, this is not free of side effects. Balancing...
INTRODUCTION
Advances in immunosuppression have extended patient and graft survival rates after solid organ transplantation; however, this is not free of side effects. Balancing safety and efficacy is of paramount importance, particularly in the pediatric setting. Current literature comparing different protocols is scarce, and decisions are mostly guided by physician preference. We aimed to compare three different protocols from four different centers to identify differences in outcomes after one year of follow-up.
MATERIALS AND METHODS
A retrospective analysis of the databases of the participating centers was performed. Consecutive patients aged <18 years with a first liver-only transplant and no other underlying congenital or acquired immunodeficiency were included. Patients were classified according to the immunosuppression protocol as follows: Group A (Prednisone + Tacrolimus + Basiliximab), Group B (Prednisone + Tacrolimus + Basiliximab + anti-thymocyte globulin), and Group C (Prednisone + Tacrolimus). Differences in survival, frequency of rejection, infections, and other complications were analyzed in the entire group (n=97) and in the group with biliary atresia (n=48).
RESULTS
After one year of follow-up, no differences in patient or graft survival were observed when comparing either the entire group (n=97) or patients with biliary atresia only (n=48). The frequencies of rejection and episodes of infection were similar. Renal function showed no differences either before or after transplantation or between the groups.
CONCLUSION
Immunosuppression protocols used in this study appeared to be equally safe and effective. This could offer the opportunity to tailor them to the patient's individual characteristics without compromising the outcome.
PubMed: 38949782
DOI: 10.1097/LVT.0000000000000427 -
Drugs Jul 2024Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease which can induce progressive disability if not properly treated early. Over the last 20...
Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease which can induce progressive disability if not properly treated early. Over the last 20 years, the improvement of knowledge on the pathogenesis of the disease has made available several drugs targeting key elements of the pathogenetic process, which now represent the preferred treatment option after the failure of first-line therapy with conventional drugs such as methotrexate (MTX). To this category of targeted drugs belong anti-cytokine or cell-targeted biological agents and more recently also Janus kinase inhibitors (JAKis). In the absence to date of specific biomarkers to guide the therapeutic choice in the context of true precision medicine, the choice of the first targeted drug after MTX failure is guided by treatment cost (especially after the marketing of biosimilar products) and by the clinical characteristics of the patient (age, sex, comorbidities and compliance) and the disease (presence or absence of autoantibodies and systemic or extra-articular manifestations), which may influence the efficacy and safety profile of the available products. This viewpoint focuses on the decision-making process underlying the personalized approach to RA therapy and will analyse the evidence in the literature supporting the choice of individual products and in particular the differential choice between biological drugs and JAKis.
PubMed: 38949688
DOI: 10.1007/s40265-024-02059-8 -
Journal of Patient Safety Jun 2024Despite advances in patient safety, perioperative patient falls continue to be a persistent and preventable harm. Patient falls in procedural areas have been associated...
Despite advances in patient safety, perioperative patient falls continue to be a persistent and preventable harm. Patient falls in procedural areas have been associated with multiple postoperative complications such as additional falls, functional decline, and hospital readmissions. Although fall-related databases exist, the specific number of periprocedural falls is difficult to ascertain, and the causes of such falls also remain elusive. We explore various solutions and recommend the creation of a national, focused database of periprocedural falls that will allow institutions to track numbers of falls in patients receiving anesthetic care and to identify the most common etiologies to enable the implementation of targeted strategies to prevent falls. Lacking this, we suggest specific screening and procedural recommendations during all phases of anesthetic care to increase providers' awareness and vigilance surrounding patient falls.
PubMed: 38949673
DOI: 10.1097/PTS.0000000000001248 -
Pain Practice : the Official Journal of... Jul 2024Gabapentin, a widely prescribed medication for various neuropathic pain conditions, has demonstrated efficacy in managing diverse neurological disorders. While...
BACKGROUND
Gabapentin, a widely prescribed medication for various neuropathic pain conditions, has demonstrated efficacy in managing diverse neurological disorders. While conventional side effects are well-documented, a growing body of evidence suggests the existence of atypical side effects, necessitating comprehensive exploration. This paper aims to systematically review and summarize the literature on the atypical side effects of gabapentin, shedding light on manifestations beyond the conventional spectrum.
METHODS
A systematic review was conducted, encompassing peer-reviewed articles published up to the knowledge cutoff date in November 2023. Databases, specifically PubMed, were searched for relevant studies, focusing on atypical side effects such as myoclonus, ataxia, pediatric aggression, respiratory depression, pneumonia, pregnancy complications, sleep interference, encephalopathy, peripheral edema, suicidal ideation, dyskinesia, anorgasmia, and myopathy. Inclusion criteria comprised studies with a focus on gabapentin-related atypical side effects, published in recognized journals and involving human subjects.
RESULTS
The review identified a spectrum of atypical side effects associated with gabapentin use, ranging from neurological manifestations like myoclonus and ataxia to behavioral changes such as pediatric aggression and suicidal ideation. Additionally, respiratory complications, pregnancy-related issues, sleep disturbances, and rare complications like encephalopathy and myopathy were observed. Literature synthesis provided insights into the incidence, clinical presentation, and potential mechanisms underlying these atypical side effects.
CONCLUSION
This comprehensive review highlights the diverse range of atypical side effects associated with gabapentin use, expanding beyond conventional knowledge. Healthcare practitioners must be cognizant of these manifestations, recognizing their potential impact on patient well-being. As clinical decision-making relies on a thorough understanding of a medication's side effect profile, this review contributes to enhancing awareness and fostering informed practices in the prescription and management of gabapentin. Further research is warranted to elucidate the mechanisms and risk factors associated with these atypical side effects, refining our understanding of gabapentin's safety profile.
PubMed: 38949515
DOI: 10.1111/papr.13400