Nurses’ knowledge and self-assessment of their clinical experiences of intraosseous access: A multicentre cross-sectional study

BackgroundIntraosseous access is an effective and safe option when difficult vascular access occurs. The knowledge, competence, and clinical experience of nurses are collectively essential for the successful implementation of this approach in clinical practice. Education and clinical learning are the main pillars supporting this new practice to ensure patient safety. The aim of this study was to identify the nurses’ knowledge and clinical experience of intraosseous access and the factors associated with the adoption of this procedure.MethodsA cross-sectional study was carried out from October to December 2020. A convenience sample of 432 nurses from four Italian hospitals were involved. A structured questionnaire was used to assess the nurses’ knowledge of the intraosseous access guidelines and their clinical experience.ResultsMost participants were female (71.5%) with more than 10 years of experience (63.7%) working in an emergency (38.9%) and medical (37.7%) setting. Most of the participants demonstrated their knowledge of the use of a device e.g., it is used if vascular access is not rapidly achieved in a child (83.1%) and the boluses of liquids required in the intraosseous procedure (72.7%). A few participants reported having placed intraosseous access (3.5%). A higher level of educational preparation and working in emergency and paediatric settings were associated with increased knowledge.ConclusionsOur findings highlighted a sub-optimal level of knowledge of the IO procedure, little experience of this practice in clinical contexts, also associated with a lack of adequate protocols and devices available to nurses. Nurses need to develop their knowledge and practice the skill clinically to embed this practice. University and nurse educators should emphasise the relevance of this practice in nursing education and training, so as to improve the nursing care practice and level of patient safety.     

腕关节镜辅助治疗腕骨内腱鞘囊肿

目的：探讨腕关节镜治疗腕骨内腱鞘囊肿的方法及疗效。方法2013年5月—2014年5月,应用腕关节镜治疗腕骨内腱鞘囊肿5例,其中月骨3例,舟骨1例,三角骨1例。主要症状为腕部不适、疼痛,伴握力下降和活动度降低。 X线平片及CT显示腕骨内圆形或类圆形骨密度减低区,边界清楚,有硬化缘。 MRI显示病灶内为液体。采用腕关节镜下病灶刮除＋自体松质骨或注射型人工骨移植术治疗,术后腕关节功能位固定3周。结果5例均获得随访,平均6.8个月。所有病例无复发,植骨愈合满意。患者腕关节疼痛及不适症状明显缓解,术后均恢复正常的生活工作。结论腕关节骨内腱鞘囊肿是慢性腕关节疼痛原因之一,腕关节镜技术在腕骨内腱鞘囊肿的治疗中,手术方法安全,并发症少,功能恢复快,手术效果满意。     

Stereotactic body radiation therapy for refractory ventricular tachycardia secondary to cardiac lipoma: A case report

We present the case of a 29‐year‐old man who developed ventricular tachycardia (VT) secondary to a cardiac lipoma located adjacent to the interventricular groove, which could not be fully resected. Antiarrhythmic drugs and endocardial and epicardial ablation failed to prevent VT recurrence. Finally, noninvasive stereotactic body radiation therapy (SBRT) targeting the lipoma was performed, with a total dose of 24 Gy delivered in three fractions. The number of VT episodes was reduced from 189/24 h before SBRT to 0 after the procedure. At 4‐month follow‐up, there were no signs of therapy‐related complications. Our experience suggests that SBRT could emerge as a viable treatment option for patients with cardiac tumors who develop refractory ventricular arrhythmias.     

Central papillary cystadenocarcinoma of the mandible: A case report and review of the literature

INTRODUCTION

Central papillary cystadenocarcinoma of the jaw is an extremely rare tumor with only three previously reported cases in the English literature. This tumor is a histologically low-grade cancer, affecting more commonly in the mandible than in the maxilla.

PRESENTATION OF CASE

A 65-year-old woman presented with a two months history of a rapidly growing, painless mass of the right ascending ramus of the mandible. The pathologic report from incisional biopsy was a papillary cystic tumor with a differential diagnosis of cystadenoma versus cystadenocarcinoma. Segmental mandibulectomy, parotidectomy and submandibular gland resection were performed. The final pathology was intraosseous papillary cystadenocarcinoma.

DISCUSSION

Clinical features of central papillary cystadenocarcinoma of the mandible mimic an odontogenic lesion and metastatic bone disease, careful review of radiograph and pathology should be done. Surgical excision with wide margins is the appropriate treatment. Postoperative radiation therapy should be considered in histologically aggressive or high-stage tumor.

CONCLUSION

This is the fourth case of central papillary cystadenocarcinoma of the mandible in the English literature. Although it is usually a low-grade cancer, en bloc resection with adjuvant postoperative radiotherapy in a high-stage disease, and long-term follow-up allow the patient to have a favorable prognosis.     

经侧前方肋间隙胸膜外入路切除胸椎椎体后缘骨内软骨结节的胸椎管减压

【摘要】 目的：探讨侧前方经肋间隙胸膜外入路手术切除胸椎椎体后缘骨内软骨结节治疗胸椎管狭窄症的方法和疗效。方法：2002年4月~2012年9月,对18例明确诊断为胸椎椎体后缘骨内软骨结节所致椎管狭窄症患者采用经侧前方肋间隙胸膜外入路减压内固定融合术治疗,男12例,女6例;年龄33~61岁,平均46岁。影像学证实均为单一节段椎体后缘骨内软骨结节,且不合并胸椎黄韧带骨化及后纵韧带骨化。病变节段：T7/8 2例,T8/9 4例,T9/10 5例,T10/11 7例。术前神经功能Frankel分级：C级6例,D级12例;JOA评分6.6±1.3分。观察术后疗效和并发症发生情况。结果：18例患者均顺利完成手术,平均用时3.5h,平均出血量420ml（350~620ml）,术后无气胸、胸腔积液等并发症发生;1例术后1周发生肺炎,5例术后第2天复查胸片时发现邻近肋骨骨折,均经保守治疗后痊愈。所有患者均获得随访,随访时间2~12年,平均6年。疗效参照Epstein标准评价,优15例,良2例,差1例,优良率94%（17/18）。术前Frankel分级为C级的患者1例无明显改善,1例改善至D级,4例改善为E级;12例D级患者均改善为E级。JOA评分改善到9.4±1.6分,与术前比较有显著性差异（P<0.05）。术后1年复查CT见椎间植骨区表面有连续性骨小梁通过,末次随访时影像学检查未发现内固定断裂、松动和植骨不融合现象。结论：对于胸椎椎体后缘骨内软骨结节所致胸椎管狭窄症患者,采用经侧前方肋间隙胸膜外入路胸椎椎体后缘骨内软骨结节切除减压可取得较好的临床疗效,是一种安全有效的手术方式。     

Dendritic fibromyxolipoma: A variant of spindle cell lipoma with extensive myxoid change,with cytogenetic evidence

Dendritic fibromyxolipoma (DFML), a rare, recently described distinct benign soft tissue tumor, has many clinicopathological features reminiscent of spindle cell lipoma and solitary fibrous tumor with myxoid change. It is distinguished histologically from both entities by the presence of spindle and stellate cells with dendritic cytoplasmic prolongations, prominent myxoid stroma with abundant keloidal collagen and occasional small plexiform vascular proliferation. We describe a case of histologically confirmed DFML of the left shoulder in a 67‐year‐old male, in which subsequent cytogenetic analysis revealed deletion involving 13q14.3 region in all the tumor cells, typically detected in spindle cell lipoma. In the presence of many clinicopathological similarities between DFML and spindle cell lipoma including chromosomal abnormalities, we postulate that DFML is merely a rare variant of spindle cell lipoma with extensive myxoid degeneration, and may not be considered as a separate entity. The possible differential diagnosis and their distinguishing features are briefly discussed.     

骨内高压症的发病机制及诊断治疗

目前许多疾病与骨内高压有关,如股骨坏死、骨性关节炎、跟痛症等。本文对骨内高压的发病机制及临床治疗的现状和进展简要综述。     

Endobronchial Lipoma Accompanied with Primary Lung Cancer: Report of a Case

A 72-year-old man was found to have an endobronchial lipoma accompanied with primary lung cancer. A left lower lobectomy with a mediastinal lymph node dissection and a sleeve resection of the lingual bronchus with telescoping bronchial anastomosis were done. The pathological staging was T1N2M0, stage IIIA. A histological examination showed well-differentiated squamous cell carcinoma in segment 10, in addition to the presence of mature adipose tissue which was diagnosed to be a benign endobronchial lipoma originating from the lingual bronchus. The postoperative course was uneventful and the patient was discharged 13 days after the operation. However, he had a recurrence in the subcarinal lymph node, and died 8 months after surgery. Received: March 2, 2001 / Accepted: November 20, 2001