Legalisation of termination of pregnancy in Ireland and the development of a service between primary and secondary care

BackgroundExpanded termination of pregnancy (TOP) was regulated in Ireland in December 2018 and services began within the Irish healthcare system in January 2019.MethodsAn audit was performed of all attendances at a newly established TOP clinic, for pregnancies <12 weeks, over a twelve month period.ResultsSixty-six women were seen in the clinic; 13 underwent medical TOP, 22 underwent surgical TOP, 2 miscarriages, 20 retained products following termination in primary care and 3 were beyond the 12 week limit.ConclusionsIn an age where TOP clinics are under threat, we have demonstrated the successful successfully introduction safe and effective person centred termination services within primary and secondary care. This requires a focus on women’s health with timely care can provided by dedicated nurse specialists and clinicians.     

Patient satisfaction study of unwanted facial and body hair: 5 years experience with intense pulsed light

OBJECTIVE : This retrospective study was performed in order to evaluate patient satisfaction with epilation using an intense pulsed light source. METHODS : Between 1995 and 2000, 416 patients consulted the authors' practice because of unwanted facial and body hair. A total of 309 patients received treatment with a non-coherent, filtered flashlamp intense pulsed light source. In February 2000, a questionnaire was mailed to each patient and 207 replies were obtained. RESULTS : Overall, 45 (22%) of patients were very satisfied, 93 (45%) were satisfied and 69 (33%) remained unsatisfied with the outcome of light-assisted hair removal. The non-coherent, filtered flashlamp intense pulsed light source satisfactorily removed unwanted dark hair. Hair-free periods from weeks to years could be observed. CONCLUSION : Hair removal by a non-coherent, filtered flashlamp intense pulsed light source is an effective and safe method for long-term epilation of unwanted hair. This technique offers a more reliable and practical solution than any other hair removal method, especially for patients with skin irritation and ingrown hair.     

The psychological and emotional impact of acne and the effect of treatment with isotretinoin

Although knowledge concerning the dermatological treatment of chronic acne has grown considerably in recent years, relatively few studies have assessed the impact of effective physical intervention upon the psychoemotional functioning of patients. Hypotheses regarding the psychological impact of acne were developed using concepts drawn from evolutionary psychology. A sample of 34 patients (19 men and 15 women) with chronic acne were assessed for psychological, emotional and dermatological symptomatology using a variety of self-report questionnaires over four time-points during 16 weeks treatment with isotretinoin. Thirty-four patients completed the first assessment, 21 the second, 20 the third and 15 the fourth and final assessment. At the first assessment, prior to isotretinoin treatment, 15 patients (44%) reported clinically significant levels of anxiety, while six patients (18%) reported clinically significant depression. Women with acne were significantly more embarrassed than their male counterparts about their skin disease. Treatment with isotretinoin produced significant improvements across a wide variety of psychological functions, although the emotional status of patients appeared to be more resistant to change. Acne appears to be a condition which has the potential to damage, perhaps even in the long term, the emotional functioning of some patients.     

Contraceptive and pregnancy concerns in the UK during the first COVID-19 lockdown: A rapid study

ObjectivesCOVID-19 resulted in significant disruption to sexual and reproductive health (SRH) services globally and the impact of this remains under explored. This study aimed to explore the impact of COVID-19 on SRH during the initial weeks of the first UK lockdown.DesignThis rapid study employed a cross-sectional anonymous survey design. Between 9th April and 4th May 2020, participants completed an online questionnaire around the impacts of COVID-19 on SRH. The survey was completed by 194 participants. The findings in this paper, report on data from closed and free text questions from 32% (n = 62) of the total sample who said they were able to get pregnant.ResultsParticipants raised concerns around reduced access to, or a denial of, SRH services as well as reduced choice when such services were available. Participants felt their right to access SRH care was impinged and there were anxieties around the impact of COVID-19 on maternal and foetal health.ConclusionsThe study contributes to a better understanding of the concerns, during the first 8 weeks of the UK lockdown, of those who could get pregnant. Policy makers and planners must ensure that SRH policy, that recognises the importance of bodily autonomy and rights, is central to pandemic planning and responses both in the UK and globally. Such policies should ensure the immediate implementation of protocols that protect SRH service delivery, alongside informing service users of both their right to access such care and how to do so. Further work is necessary with members from minority communities who are mostly absent from this study to explore if, and how, COVID-19 may have exacerbated already existing disparities.     

扁平化责任制护理干预对腹腔镜子宫肌瘤剔除术患者胃肠功能恢复、护理质量及满意度的影响

目的探究扁平化责任制护理干预应用于腹腔镜子宫肌瘤剔除术患者后,对患者胃肠功能恢复、护理质量及满意度的影响。方法选取2016年8月至2018年8月无锡市妇幼保健院诊治的行腹腔镜子宫肌瘤剔除术患者142例,采用扁平化责任制护理干预者71例作为观察组,采用常规护理干预者71例作为对照组。比较两组患者胃肠功能恢复情况、护理质量及护理满意度。结果观察组胃肠功能恢复指标均优于对照组,观察组护理满意度高于对照组,观察组基础护理、药物使用、饮食指导、检查操作、并发症预防评分均高于对照组,差异均具有统计学意义(均P<0.05)。结论扁平化责任制护理干预应用于腹腔镜子宫肌瘤剔除术患者可有效促进其胃肠功能恢复,提高护理质量及护理满意度,值得临床推广。     

Dermatological surgery: a comparison of activity and outcomes in primary and secondary care

Background  Dermatological surgery is carried out by a variety of practitioners in primary and secondary care.
Objectives  To explore the activity and histopathological outcomes among different groups of dermatological surgeons dealing with skin cancers.
Methods  Reports for all new skin tumour specimens processed by our histopathology department over a continuous 3-month period were reviewed retrospectively.
Results  One thousand, one hundred and eleven new skin tumour specimens were identified. General practitioners (GPs) were least accurate in clinical diagnosis, with 42·8% (59/138) of their request forms including the eventual histological diagnosis, compared with 69·5% (328/472) for dermatologists (odds ratio, OR 0·33, 95% confidence interval, CI 0·22–0·48). Inappropriate procedures were most often performed by plastic surgeons, usually involving large excision biopsies for benign lesions in elderly patients [6·6% (20/305) of their specimens vs. 0% for dermatologists, exact P  <   0·001]. Excision biopsies performed by GPs had the highest rate of margin involvement by tumour of any specialty [68% (15/22) of such specimens vs. 8% (9/116) for dermatologists; OR 25·47, 95% CI 8·26–78·53]. As per National Institute for Health and Clinical Excellence guidance, 13·8% (19/138) of tumours operated on by GPs should instead have been referred to secondary care for initial surgical management.
Conclusions  This study presents a strong case for dermatologists to continue to provide the lead in diagnosis of skin lesions, and in selection and execution of dermatological surgical procedures.     

急性缺血性脑卒中的重组组织型纤溶酶原激活剂静脉溶栓治疗与护理

目的 探讨急性缺血性脑卒中的静脉溶栓治疗及护理措施。方法 对39例发病在6h以内的急性缺血性脑卒中患者（A组），男27例，女12例，年龄50～75岁，静脉注射重组组织型纤溶酶原激活N（rt-PA）8mg，随后60rain内持续静脉泵入rt-PA42mg。溶栓后12h开始皮下注射依诺肝素，连续应用7d。溶栓前中后给予相应的护理监测和措施。非溶栓组（B组）39例，不用溶栓剂及依诺肝素（使用川芎嗪160mg静脉滴注，连续应用7d，其余治疗同溶栓组）。结果 rt-PA溶栓治疗后39例溶栓患者的神经功能缺损和患肢肌力均获得不同程度的改善，总显效率达79．4％，无护理并发症发生。结论 对发病6h以内的急性缺血性脑卒中患者应用rt-PA溶栓治疗，可降低患者神经功能缺损，最大限度地恢复脑的正常功能，效果满意安全。     

Quality of intrapartum care for healthy women with spontaneous onset of labour in Rwanda: A health facility-based,cross-sectional study

ObjectiveTo investigate the quality of intrapartum care provided at Rwandan healthcare facilities to women undergoing normal pregnancy and spontaneous full-term labour.MethodsA cross-sectional study was conducted over eight weeks during 2014–2015 in 18 healthcare facilities in Kigali City and the Northern Province: eight health centres, seven district hospitals, one provincial hospital, one private hospital, and one referral hospital. Data were collected from medical records and a questionnaire including the Bologna score with its five variables: presence of a companion, use of partograph, no augmentation of labour, birth in a non-supine position, and skin-to skin contact.ResultsAmong the 435 women who fulfilled the inclusion criteria during the study period, mean age was 27.4 years and 41.8% were primiparous. The assisting healthcare professionals were midwives (49.4%), nurses (28.8%), and physicians (22%), and birth occurred at health centres (29%), district hospitals (40%), and the referral hospital (31%). Mean Bologna score was 2.03 of the maximum 5 (range: 0–4). Only one woman (0.2%) had a companion present (her husband). A partograph was used for the majority (84.8%), and 88.0% had no augmentation of labour with oxytocin. Few (6.2%) gave birth in a non-supine position, and few (12.4%) had early skin-to-skin contact with their newborn.ConclusionThere are several areas for improving childbirth care according to the Bologna score. Healthy newborns should be placed skin-to-skin with their mothers shortly after birth, non-supine birthing positions should be encouraged, and the importance of a companion during labour and birth should be considered.     

Risk of skin tears associated with nursing interventions: A systematic review

BackgroundSkin tears are a significant problem for patients and healthcare professionals. They can cause pain, impact quality of life, and become chronic and infected. The risk of skin tears is associated with dependence in daily life activities and with nursing interventions.ObjectivesTo examine which nursing interventions increase the risk of skin tears.DesignSystematic review. Data sources: The MEDLINE, CINAHL, Scopus, and Cochrane Library databases were searched in March 2022.Publication yearsPublications included were from 2012 to 2022.ResultsSeventeen articles were included in the final analysis reporting nursing interventions associated with the risk of skin tears. Hygiene with cold water and soap, not applying leave-on products to moisten/protect dehydrated skin, and wearing short sleeves were found to be associated with skin tears. Transferring patients into and out of bed in a rough manner and wearing jewelry or long nails can increase the risk of skin tears. Removal of adhesive dressings or bandages can also cause skin tears.ConclusionNursing staff need to know which interventions put their patients at risk of skin tears and which interventions are recommended to prevent skin tears. Nursing care can affect the health of the patient's skin.     

The effectiveness of a hydrocolloid crusting method versus standard care in the treatment of incontinence-associated dermatitis among adult patients in an acute care setting: A randomised controlled trial

IntroductionIncontinence-associated dermatitis (IAD) is a type of irritant contact dermatitis due to prolonged exposure of the skin to moisture induced by urine or/and faeces. The main principles when treating IAD involves protecting the skin from further exposure to irritants, establishing a healing environment, and eradicating skin infections. This study aimed to evaluate the effectiveness of the hydrocolloid crusting method (HCM) versus the standard care method (SCM) in treating IAD.MethodA randomised controlled trial was conducted in an acute tertiary hospital in Singapore between August 2019 to September 2021. Using computer-generated numbers, patients were randomised into either HCM or SCM treatment groups. HCM treatment involved cleansing the affected area with a pH-neutral non-rinse moisturising cleanser, and the application of alternate layers of hydrocolloid powder, and non-sting film barrier spray (repeated three times during each use). Patients in the SCM treatment group received the same cleanser followed by a 30% zinc oxide barrier cream. IAD was assessed daily for up to seven days by the wound care nurses using the IAD severity tool. The primary outcome of the study was the mean difference in IAD score per day between both methods.ResultsForty-four patients were eligible and recruited (22 in HCM; 22 in SCM). Patients in both groups were comparable in age and gender. IAD Category 2 was more predominant in both methods. The most common location of IAD was at the perianal skin and diarrhea related to gastroenteritis was the most prevalent cause of IAD. More patients in the SCM group (n = 12; 54.5%) had their IAD healed within seven days compared to HCM, (n = 7; 31.8%) group. However, the average decrease in IAD scores per day for both methods were found to be similar.ConclusionHCM can be considered as a treatment of IAD along with the use of SCM. A skin care regimen should include effective cleansing, skin protection, and moisturization in IAD management.     

经桡动脉途径行冠脉介入治疗后桡动脉闭塞的观察及护理研究

目的观察经桡动脉进行冠状动脉介入诊疗中桡动脉闭塞的发生情况,探讨经桡动脉冠状动脉介入诊疗中的护理。方法经桡动脉冠状动脉介入手术1682例,分为冠状动脉造影组（CAGn=1026例）和冠状动脉介入治疗组（PCIn=656例）,以及初次手术组（1236例）和多次手术组（446例）,比较各组中桡动脉的闭塞发生率。结果1682例患者中,50例出现桡动脉闭塞,占3．0％,其中CAG4．1％,PCI1．8％,初次手术2．6％,多次手术3．9％（均P〈0．05）。进行合适的术后压迫,给予手腕部活动指导以及术后观察指肢血流均有助于预防桡动脉闭塞。结论合适的术后护理有助于预防治;嘲闹塞。     

Transition of care in patients with epidermolysis bullosa: A survey study

There are little published data on the transition of care in EB. We conducted a survey study recruiting EB patients from the Dystrophic EB Research Association (debra) website and centers caring for high numbers of EB patients in the United States and internationally from Sept 17, 2019 to Nov 3, 2021. The majority of participants had not discussed the transition of care with their healthcare providers, nor the healthcare needs to be required as an adult. Ongoing pediatric subspecialty care was reported by 12% of adults, most commonly in pediatric dermatology. Identified barriers to transition included the perceived lack of adult providers' knowledge about EB patient healthcare needs. The results suggest the need for transition guidelines, early discussions with families about transition, and practical information for the adult providers accepting care.     

多形式化心理干预对腹腔镜子宫广切患者心理、情绪及性功能状态的影响观察

目的：观察探讨多形式化心理干预对腹腔镜子宫广切患者心理、情绪及性功能状态的影响。方法：选取2011年1月至2013年4月本院收治的68例腹腔镜子宫广切患者为研究对象,将68例患者根据随机分配的方式分为对照组（常规心理干预组）34例和观察组（多形式化心理干预组）34例,然后将两组患者分别于干预前及干预后不同时间采用医院焦虑抑郁量表、简明心境量表及女性性功能评价表进行心理、情绪及性功能状态的评估,然后将评估结果进行比较。结果：观察组干预后不同时间的医院焦虑抑郁量表及简明心境量表评分均好于对照组,女性性功能评价表各个指标评分均高于对照组,P均〈0.05,均有显著性差异。结论：多形式化心理干预对腹腔镜子宫广切患者心理、情绪及性功能状态的影响好于常规心理干预,更有助于患者术后各方面的恢复。     

Patient satisfaction of microfocused ultrasound treatments on the face and neck laxity: A narrative review

Background

Microfocused ultrasound with visualization (MFU-V) delivers focused ultrasound energy to heat tissue and has emerged as a fast and effective noninvasive method for treating skin laxity. After obtaining approval in 2009 by the Food and Drug Administration, satisfactory feedback was recorded using several scoring systems for MFU-V treatment for facial and neck laxity.

Aim

To evaluate the efficacy and satisfaction rates of MFU-V for facial and neck laxity treatment by providing a basis for developing a validated scoring system for MFU-V treatment.

Method

A constrictive survey was carried out by selecting relevant publications on MFU-V treatment of facial and neck laxity using PubMed, Medline, and Embase electronic databases from January 2017 to March 2022.

Results

Of the 11 original articles used in this review, the majority of the scoring methods used were the subjective global aesthetic improvement scale and the 5-point scale rating global aesthetic improvement in appearance. Around half of the patients were described as much improved or very much improved on days 30 and 90, while most returned to baseline on Day 360. Most of the adverse events reported were mild bruising, redness, and pain. None of the patients reported serious adverse events. A burn occurred in one case because of improper application of the probe.

Conclusion

The MFU-V provides excellent and promising responses for treating facial and neck laxity. A few mild events were observed, such as erythema, pain, edema, and injection-site induration, all of which resolved within approximately 2–3 days.     

Anger and acne: implications for quality of life, patient satisfaction and clinical care

BACKGROUND: Acne is a common skin disorder with a significant psychological and social impact for some people. Little is known about how personality and emotional traits affect acne and its impact on quality of life and treatment. Trait anger (TA), which is related to heart disease and other morbidities, may also affect acne and patients' adjustment to it. OBJECTIVES: To evaluate the relationship between TA and acne severity, skin-related quality of life, satisfaction with treatment, and adherence to treatment. PARTICIPANTS AND METHODS: A sample of 479 individuals with acne completed a survey instrument to assess acne severity, skin care practices, skin-related quality of life, satisfaction with treatment, adherence, TA and demographic variables. Respondents who reported high TA were compared with individuals with low TA on outcome variables. Regression analyses adjusted for covariates and identified the significant predictors of quality of life, satisfaction and adherence. RESULTS: High TA was unrelated to acne severity (P = 0.2) or frequency of face washing (P = 0.9). Anger was significantly related to both global quality of life (P < 0.001) and skin-related quality of life (P = 0.002) as well as to satisfaction with treatment (P = 0.001) and adherence to treatment advice (P = 0.05) in bivariate analyses. Regression analyses revealed that high TA remained a significant predictor of global (P < 0.001) and skin-related quality of life (P = 0.003) and satisfaction with treatment (P = 0.04), but not adherence to treatment advice (P = 0.8) after controlling for covariates. CONCLUSIONS: Anger is associated with the quality of patients' lives and with their satisfaction with treatment. Care of acne patients should include attention to anger and other chronic emotional states, quality of life, as well as to clinical severity. Simple guidelines are suggested for how clinicians might approach this important aspect of care.     

The effectiveness of lying surfaces in nursing care beds,a comparison of spring element systems versus conventional systems: A post marketing clinical follow-up pilot study

BackgroundReduced mobility is a strong risk factor for pressure ulcer development in a nursing home setting. Despite this, there is a surprising lack of data regarding suitable nursing care beds in general and the prevention of pressure ulcers provided by lying surface systems in particular. In this context we aimed to assess the mobility of patients using lying surface systems either with spring elements (SES) and to compare these to conventional systems (CS; wooden slats or steel bars).MethodsThis was a prospective, randomized, controlled study in 29 patients with an age range of 54–95 years. Patients were randomly assigned to SES (n = 15) or CS (n = 14). The primary objective was to show a statistically significant difference in the proportion of patients with normal (up to 4 movements per hour) movements as evaluated by the Mobility Monitor^®. Pressure distribution of the lying body weight was measured by a full body pressure mapping system XSensor^®. Comfort, possibility of movement and recovery of sleep as well as pain at rest were self-rated.ResultsWe screened a total of 39 patients of which 29 were eligible to be randomized into the two groups and 27 were finally analysed (SES = 14; CS = 13). The mean age was 81.7 ± 9.5 years, 81.5% were female and the mean Braden Scale Score 22.4 ± 1.3. We observed no statistically significant difference in the primary evaluation criterion (proportion of patients with a normal number of movements across 14 nights) between the SES group (81.4 ± 10.8%) and the CS group (72.9 ± 16.3%; p = 0.0757). There was a consistent trend for more movements in the normal range in the SES group however, which was observed when the number of hours with normal movement was plotted per night (p = 0.0004). Measured pressure values showed overall higher values for the lateral compared to the dorsal position with the SES but not the CS forming a “shoulder” between 35-55 mmHg in the dorsal position and between 35-45 mmHg in the lateral position. Self-rated comfort was significantly higher with the SES after night 14 (p = 0.0192) than with CS.ConclusionsThe study is not aimed at the hard endpoint pressure ulcer, but at the physiological movement profile of patients in bed, which justifies a much smaller number of cases. For elderly nursing home patients it appears that beds with spring elements may be associated with higher normality of body movements and higher self-rated comfort. The presented study could be a contribution to reduce the care dependency of patients regarding mobility.     

Continuum of care for maternal,newborn and child health: Evidence from a national survey in Mexico

ObjectiveTo compare coverage of maternal, newborn and child health (MNCH) continuum of care between women who had experienced adolescent maternity (AM) and those who had not.MethodsUsing a Mexican probabilistic survey representative at the national level (ENSANUT 2018–19), we developed a cross-sectional analysis of 1,768 women aged 12 to 49 years who had a child within five years before the interview. We used modified Poisson models to estimate prevalence ratios (PRs) and independent and conditional coverage levels based on the probability estimates yielded by these models at different stages of maternal-newborn care process.ResultsPRs for the MNCH continuum of care were approximately 40% lower for women who had experienced AM compared to those who had not (95%CI:0.35, 1.14). The coverage for the MNCH continuum of care was only 7.4% [95%CI: 3.5, 11.2] and 11.7% [95%CI: 9.3, 14.1] in women who had/not experienced AM, respectively.ConclusionsThe provision of a continuum of care for mothers and their children can be achieved through a combination of well-defined policies and strategies that improve health care practices and services throughout the life cycle. It is necessary to expand the coverage and quality of care, which will provide the opportunity to shift the focus from vertical programs to integrated continuous care. Policy makers must implement interventions that are consistent with specific problems of population and health-care providers. Our analysis highlights the deficiencies in the care process, making this study a useful reference for countries with similar characteristics.     

Knowledge,attitude, and practice of Iranian critical care nurses related to prevention of pressure ulcers: A multicenter cross-sectional study

IntroductionPressure ulcers (PU) are a major, but preventable health problem in all health settings, but especially in intensive care units (ICUs). This study aimed to investigate the knowledge, attitude, and practice (KAP) of Iranian ICU nurses related to the prevention of PU.MethodsIn a cross-sectional study, data obtained from 183 ICU nurses working in four hospitals affiliated to Mazandaran University of Medical Sciences, Sari, Iran were evaluated. The study was conducted from July to October 2020. Data were collected using a four-part questionnaire including demographic characteristics, Pieker Pressure Ulcer Knowledge Test (PPUKT), Attitude toward Pressure Ulcer Prevention (APUP) tool, and the practice of nurses related to the prevention of PU.FindingsThe mean scores of KAP of ICU nurses toward PU prevention were 70.57 (SD = 13.51), 52.82 (SD = 6.16), and 22.44 (SD = 5.20), respectively. There was a positive correlation between nurses' attitude and practice (r = 0.232, P = 0.002), and a negative correlation between knowledge and attitude (r = ?0.156, P = 0.035) of nurses regarding PU prevention. Additionally, a positive correlation was found between nurses' years of working experience in ICU and their knowledge regarding PU prevention (r = 0.159, P = 0.032).ConclusionAccording to the results of the present study, the level of KAP of Iranian ICU nurses related to PU prevention were desirable, positive, and relatively desirable. Therefore, nurse managers and policymakers should try to eliminate the main barriers such as heavy workload, inadequate nurse staffing, and lack of appropriate guidelines for PU prevention which consequently affect the practice of ICU nurses in the prevention of PU.