Liver Transplantation Following Life-threatening Abdominal Trauma: A Case Series of 5 Patients at a Single Institution

Managing traumatic liver injury (TLI) is always challenging and demands precise clinical judgment. Currently, treatment of TLI in most circumstances is non-operative; however, surgical therapy might be required for severe TLI, particularly those that result in extensive blood loss. In the current institutional study carried out from June 1995 to April 2017, we describe our experience with 5 patients who received an orthotopic liver transplant for severe TLI. One patient passed away postoperatively from cerebral edema; 1 patient died of renal failure 4 years after the liver transplantation, and 3 patients are still alive. Based on our experience, we conclude that in patients with TLI, especially those with uncontrollable bleeding or those who develop liver failure, liver transplantation should be taken into consideration.     

Dissected Aorta Repair Through Stent Implantation trial: Canadian results

Objectives

We describe the Canadian results of the Ascyrus Medical Dissection Stent (AMDS), a novel partially uncovered aortic arch hybrid graft implanted antegrade during hypothermic circulatory arrest to promote true lumen expansion and enhance aortic remodeling.

The experiences and perceptions of newly qualified nurses in the UK: An integrative literature review

AimThis integrative review aimed to develop an understanding of the experiences and perceptions of newly qualified nurses in the United Kingdom (UK).BackgroundIn the transitional period following registration, newly qualified nurses may feel socially isolated and overwhelmed by increases in accountability, workplace pressures and the psychological demands of the role. Despite this, the experiences and perceptions of newly qualified nurses remains an under-researched area in the UK, with much of the existing research having been conducted internationally.MethodAn integrative framework methodology was used as a basis for the literature review. The methodology comprised of five stages: problem identification, literature search, data evaluation, data analysis and presentation of the findings. 20 papers were assessed for quality and analysed thematically.ResultsData were synthesised under four themes: Preparation for real-world practice, the transition experience, growing into the role and preceptorship and support from the wider team.ConclusionThe review suggests that newly qualified nurses require on-going support post qualification. Workplace culture appears to have a significant impact on the transition experience. The review provides further evidence in relation to the experiences of newly qualified nurses in the UK context. The review may help to inform the development of strategies to support and retain newly qualified nurses in an ever-changing health care environment.     

Lateral Lymph Nodes in Rectal Cancer: Do we all Think the Same? A Review of Multidisciplinary Obstacles and Treatment Recommendations

Lateral lymph nodes in low, locally advanced, rectal cancer have proven implications for local recurrence rates, which increase drastically in the presence of persistently enlarged lateral lymph nodes. These clinical implications warrant a thorough understanding of lateral nodal disease with awareness and knowledge from all three specialties involved – radiology, radiation oncology, and surgery – to ensure proper treatment. Relevant literature for each specialty, including all current guidelines and perspectives, were examined. Variations in definitions and treatment paradigms were evaluated. There is still no consensus for the standardized treatment of lateral nodal disease. Each discipline works according to their own available evidence, but relevant data are scarce. Current international guidelines and standard recommendations for the diagnostics and treatment of lateral lymph nodes are lacking. This results in differing perspectives and interpretations between the disciplines which can lead to challenging communication in an area where multidisciplinary collaboration is essential. This review addresses this by presenting the current evidence, perspectives and practices of each specialty and makes suggestions for each phase of the diagnostic and treatment process for patients with lateral nodal disease. By doing this, steps are taken toward achieving international consensus, and multidisciplinary collaboration.     

Crisis and continuity: Rural health care students respond to the COVID-19 outbreak

The COVID-19 outbreak in Winter (2020) has caused widespread disruption for health sciences students undergoing clinical placements—vital periods of experiential learning that cannot be substituted with distance alternatives. For students placed in rural areas, already coping with isolation, precarious supply chains and shortages of essential personnel, the effects of the COVID-19 outbreak may have far-reaching implications for psychosocial wellness, self-efficacy and clinical judgment. Four nursing and eight medical students (n = 12) supplied photographs and commentary documenting the experience of withdrawing suddenly from clinical sites in rural Alberta. Collaborative, thematic analysis revealed continuities between pre- and post-outbreak life, both for the students and their rural hosts. Social determinants of health such as seclusion, environmental hazards, and health-seeking behaviors carried over and compounded the effects of the outbreak on the placement communities and clinical sites. Other continuities included the reliance on technology for clinical and social connectivity, and capitalizing on natural settings to cope with isolation and confinement. Prolonged liminality, lack of closure, and the loss of team identity were the greatest stressors brought on by the suspension of clinical activities. However, the participants felt well equipped to deal with these circumstances through the resilience, adaptability, and community ethos acquired during their placements.     

Who is failing who? A survey exploration of the barriers & enablers to accurate decision making when nursing students’ competence is below required standards

Healthcare practice supports the achievement of programme learning outcomes for nursing students internationally. Within this context the issue of reluctance to fail nursing students, when warranted, is extensively examined within the literature with few definitive solutions emerging. Little is known about the perceived barriers that exacerbate this reluctance, or about factors that might enable and support nurses to fail students. To address this issue our study employed a non-experimental cohort study of nurses (n = 365) from two large teaching hospitals in the Republic of Ireland (ROI). Preceptors in this study clearly enjoyed their role with students, and received positive feedback from students. However, findings suggest that preceptors require more support from colleagues in providing comprehensive evidence in assessment. They also require additional training for providing negative feedback to students. A collaborative approach to competence assessment is recommended, whereby the professional burden can be borne by the team, and where students can engage in a holistic, reflective, learning experience that will ultimately improve their competence.