The Lautenbach method for chronic osteomyelitis: nursing roles, responsibilities and challenges

Osteomyelitis is serious for both the orthopaedic surgeon and the patient. Bone infection is very difficult to treat and if not eradicated has long-term effects for the patient. The current techniques available have a low success rate and sometimes the only alternative is amputation.This article discusses:

• What is bone infection and how it effects a person's life

• Existing methods of treatment and compares them with the Lautenbach method

• Pre, peri and post-operative care of patients undergoing the Lautenbach method of treatment

• A case study to illustrate how the method was used to successfully treat a patient.

Effects of antisera raised against native and denatured human α-glucosidase and β-hexosaminidases on native enzyme activity

Antisera were raised in rabbits against native and sodium dodecylsulfate denatured forms of human acid α-glucosidase and β-hexosaminidases A and B.

1. (1) Anti-native enzyme antisera were able to precipitate all or nearly all enzyme activity from cell extracts, and to eliminate all stainable activity on electrophoresis.

2. (2) Antisera prepared against denatured enzymes precipitated only a minor part of enzyme activity. Electrophoretic analysis showed that these antisera were able to bind to the enzyme molecule. The result was a slowing down of the anodic migration but not immobilization. The use of variants with hexosaminidase deficiencies helped to clarify the action of the antisera on the various hexosaminidase isozymes.

Surgical fires--learn not to burn

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CONSEQUENCES OF A SURGICAL FIRE can be deadly. Fires can occur in any setting where invasive procedures are performed. The basic principle to remember is that people start most fires, and people can prevent them.

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FIRE SAFETY TRAINING IS ESSENTIAL so that staff members recognize the elements of the fire triangle and how these elements come together every day in their practice.

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FIRE DRILLS ARE AN IMPORTANT ASPECT of this training. Education also must include review of written policies and procedures on fire safety and prevention. Staff members must learn how to respond to and fight fires on or in the patient. Fire safety and prevention must be a priority for managers and staff members. AORN J 80 (July 2004) 24-36.

     

A successful transition: Urban hospital director to rural nurse executive

The art of a successful transition into any new role, large or small, requires you to:

• Take care of yourself

• Know and understand the people and resources available to you

• Build on a focused strategy, setting clear expectations

Health care is a rewarding and challenging career opportunity. We are in the business of taking care of people. By properly aligning our personal strategies, we can be better adept at meeting the more challenging times and celebrating our successes.     

A grounded theory of taking control after fall-induced hip fracture

Purpose: We applied the grounded theory method to explore the post discharge concerns of older people after fall-induced hip fracture repair. It was anticipated that this understanding would increase awareness of issues that may impact on recovery and rehabilitation. Method: Semi-structured interviews were carried out with 19 older people after discharge home. Initially, purposive sampling guided data collection and thereafter theoretical sampling was employed. Interviews were analysed using the constant comparative method. Results: We generated a theory of how older people ‘take control’ after hip fracture. Conceptually, taking control was about ‘balancing’ and was both a process and a range of strategies. The three stages of the process that people moved through were: ‘going under’, ‘keeping afloat’ and ‘gaining ground’. Nautical metaphors conceptualise the precarious and unstable conditions that older people faced as they struggled to regain their independence. Older people struggled to balance help and risk, in their attempt to manage their concerns relating to losing control of their future independence. Conclusion: Older people are vulnerable to losing a sense of control after a health trauma. This theory adds a new dimension to our understanding of recovery from hip fracture and highlights that older people and their families need tailored information and support to enable them to take control safely and appropriately.

Implications for Rehabilitation

• Older people are vulnerable to losing a sense of control after traumatic injury such as hip fracture.

• Our research suggests that older people engage in a precarious process of balancing as they strive to take control after fall induced hip fracture.

• Successful balancing entails the provision of tailored information and support.

• This theoretical explanation aims to help practitioners understand the older person’s perspective of recovery from traumatic injury in a new light.

     

Rigid endoscopes--ensuring quality before use and after repair

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RIGID ENDOSCOPES are complex, expensive, and fragile devices that routinely are subjected to harsh conditions.

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AN ENDOSCOPE used during only one procedure typically will be handled by a minimum of six people.

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UNDERSTANDING what can go wrong with endoscopes and how to test them can help staff members detect problems before rather than during surgery.

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THIS ARTICLE REVIEWS some simple tests that can be used to ensure endoscope quality and provides information about how to demand excellence in endoscope repair. AORN J 80 (July 2004) 103-109.

     

Developments in the RN first assistant role during the Korean War

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DURING TIMES OF WAR, demand for health care providers has stimulated increased employment of nurses and broadened the dimensions of the scope of nursing practice in the surgical arena.

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THIS ARTICLE EXAMINES how the work of army nurses during the Korean War helped develop the role of the RN first assistant. AORN J 82 (October 2005) 644-647.

     

The impact of different methods of wound closure and dressing on the rate of wound infection in patients with fracture of the neck of femur

A prospective, pilot study was conducted to compare infection rates in four groups with different methods of wound closure and dressing among a convenience sample (n = 65) of patients with a fracture of the neck of femur. The four groups were:

Clips with Mepore dressing (n = 25)

Subcuticular suture with Mepore (n = 11)

Clips with Opsite dressing (n = 16)

Subcuticular suture with Opsite (n = 13)

There were a total of 65 participants (5 males and 60 females) with ages ranging from 70 to 103 years (mean = 86, sd = 5.7). Patients were followed during their stay on the ward. The four groups were evaluated with respect to infection rates. Gross purulent discharge, dehiscence, or purulent discharge from a single suture was considered a wound infection and this was confirmed microbiologically. Infection was noted in 6/25 (24%) of cases in which clips were used with Mepore dressing as compared to 1/11 (9%) when subcuticular sutures and Mepore were used. Infection rates for clips and Opsite, and subcuticular and Opsite were 2/16 (12.5%) and zero, respectively. Statistically there was no difference in infection rates between Mepore dressing and either type of skin closure (p = 0.4) and similarly for Opsite and either skin closure type (p = 0.48). The authors feel that the methods of wound closure and type of dressing probably have no additional benefit for the prevention of wound infection rate among elderly patients with fractures of the neck of femur, and that a larger randomized controlled study would be useful.

Salary and staffing surveys help estimate compensation and future trends

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CALCULATING COMPENSATION for perioperative nurses can be complicated because of their unique workplace situations.

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THIS SALARY SURVEY uses a multiple regression model to examine how a variety of variables, including job title, education, certification, experience, and geographic region, affect nursing compensation.

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IN ADDITION, this survey examines the effect of other forms of compensation (eg, overtime, shift differential, on-call compensation) on average base compensation rates. AORN J 78 (December 2003) 935-944.

     

From handmaiden to right hand--World War I--the mud and the blood

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BY THE BEGINNING of World War I, modern innovations and advances in the field of medicine were common. Physicians knew about bacteria, how disease spread, and the importance of antisepsis.

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TO PREPARE FOR THE WAR, Great Britain developed elite corps of army nurses, fully-equipped military hospitals, and trained personnel who established field hospitals and base hospitals.

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ALICE FITZGERALD, a nurse from Baltimore, was drawn into the conflict when she was asked to serve as the Edith Cavell Memorial Nurse with the British Army. AORN J 80 (October 2004) 652-665.

     

From hand maiden to right hand--the birth of nursing in America

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AT THE ONSET of the American Civil War, women were asked to leave their homes and serve as suppliers and caregivers for the armies on both sides of the conflict.

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MANY WOMEN suddenly found themselves in situations that required real strength, stamina, and fortitude, and some found an inner strength as they organized others to provide care.

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WOMEN LIKE Dorthea Dix and Clara Barton were among the first to champion the ability of and the need for women to provide nursing care, which until then had been a male bastion.

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THIS ARTICLE, which is the second in a two-part series on nursing during the Civil War, tells how Dorthea Dix, Clara Barton, and other women worked to establish nursing as a viable career choice for women in the United States. AORN J 78 (October 2003) 618-632.

     

A United Kingdom-wide survey of physiotherapy practice in the treatment of pelvic organ prolapse

Background and purpose Pelvic organ prolapse is a common female condition. It is estimated that 50% of parous women experience some degree of prolapse and that 10-20% seek medical care [Br. Med. J. 324 (2002) 1258]. The aim of the survey was to investigate current physiotherapy practice in the treatment of pelvic organ prolapse, specifically the use of pelvic floor muscle training, across the United Kingdom. An additional aim was to gauge the level of interest of individuals and centres in becoming involved in planned multi-centre research exploring the effectiveness of pelvic floor muscle training in the treatment of pelvic organ prolapse.Methods A questionnaire was mailed out to 484 physiotherapist members of the Association of Chartered Physiotherapists in Women’s Health, and 54 non-member physiotherapists working in women’s health, which asked about current practice in the treatment of pelvic organ prolapse.Results A total of 364 physiotherapists completed the questionnaire (a response rate of 71%, after excluding 27 cases) representing a range of clinical experience and practice. Of the respondents 92% (n=333) were assessing or treating women with pelvic organ prolapse.

The questionnaire data showed that the various elements of pelvic floor muscle training and outcome measurement were being practised by physiotherapists working across the United Kingdom.

However, access to pelvic floor muscle training may be inconsistent, as more than three-quarters of the study respondents reported that they did not have access to clinical guidelines (n=264, 79.3%) or referral guidelines (n=296, 88.9%) for the management of pelvic organ prolapse.

The majority of the sample expressed an interest in being involved in future research in this area of practice. There was interest at both an individual level (n=275, 82.5%) and as a centre (n=205, 86.1%).

Conclusions This survey has revealed that physiotherapy treatment for prolapse is being offered throughout the country despite the poor evidence base and lack of clinical and referral guidelines. There is a gap in the research evidence and therefore a need for randomised controlled trials looking at the effectiveness of pelvic floor muscle training, in the management of pelvic organ prolapse. Evidence-based guidelines should follow on from this. Standardised referral guidelines are also required to ensure equal access to assessment and physiotherapy treatment.