Clinical challenges of preventing incontinence-associated dermatitis

Incontinence-associated dermatitis (IAD) is a common skin disorder in patients with faecal and/or urinary incontinence. The past decade has seen a huge growth in publications focusing on the complexity and inconsistency of the clinical observation of IAD and the differentiation between IAD and pressure ulcers. IAD and superficial pressure ulcers cause confusion in clinical practice when trying to determine the true nature and underlying pathology of the lesion. It is a daily challenge for health professionals in hospitals, nursing homes and community care to maintain a healthy skin in patients with incontinence. The aim of this article is to provide a brief update on recent developments regarding the differentiation between pressure ulcers and IAD and the prevention of IAD. Recommendations for clinical practice and research are provided.     

Detection of Atrial Fibrillation During Sinus Tachycardia Induced by Exercise in Patients with Implantable Atrial Defibrillators

Accurate detection of atrial fibrillation (AF) is essential for appropriate operation of an implantable atrial defibrillator (IAD). However, during episodes of sinus tachycardia, distinction between AF and sinus rhythm (SR) using the "quiet interval" and "baseline crossing" analysis in the detection algorithm of the IAD may be difficult. The efficacy of this AF detection algorithm was tested in five patients implanted with an IAD (MFTRIX, Model 3000 or 3020, InControl Inc.) during treadmill exercise testing. The IADs were programmed to Monitor Mode with a wake up cycle of 1 minute for AF detection using the device nominal parameters or modified parameters, and to mark rhythms appropriate for shock delivery. A mean peak heart rate of 137 ± 26 beats/min was reached during maximum exercise, and one patient developed transient AF. Seventy-eight (75 in SR, 3 in AF) and 91 (89 in SR, 2 in AF) runs of AF detection were performed using the nominal and modified parameters, respectively. The IAD detected AF and SR accurately, except for one episode of false-positive AF detection during sinus tachycardia at the nominal settings, but inappropriate shocks were prevented by minimum RR interval criteria that limited discharge at high heart rate. These results indicate that the AF detection algorithm in the IAD may become more vulnerable to false-positive AF detection during sinus tachycardia, which were avoided by reprogramming the Quiet Interval and minimum RR interval criteria for AF detection. Exercise testing appeared useful to program optimal settings of the IAD in preparation for daily activities.     

ICU成人失禁相关性皮炎预防及管理的循证护理实践

目的 将ICU成人失禁相关性皮炎预防和管理的最佳证据应用于临床实践,提高ICU护士对失禁相关性皮炎预防和管理的能力和依从性,从而降低ICU成人失禁相关性皮炎和导尿管相关泌尿道感染的发生率。方法 根据前期研究获得的最佳证据制定ICU成人失禁相关性皮炎预防及管理的审查指标,指导并规范ICU护士的临床实践;开展多渠道培训结合模式,对ICU护士进行ICU成人失禁相关性皮炎预防及管理最佳证据的培训,比较最佳证据应用前后ICU成人失禁相关性皮炎和导尿管相关泌尿道感染的发生率及质量审查结果,培训前后ICU护士对成人失禁相关性皮炎的认知水平。结果 最佳证据应用后,ICU成人失禁相关性皮炎发生率从12%下降至3%;导尿管相关泌尿道感染发生率从4%下降至0%;失禁性皮炎证据的执行率和ICU护士对失禁相关性皮炎的认知水平显著提高,差异具有统计学意义（P<0.05）。结论 将基于循证的最佳证据应用于临床实践,可促进ICU患者失禁相关性皮炎的预防及管理工作,降低成人失禁相关性皮炎和导尿管相关泌尿道感染的发生率,提高临床护理质量。     

某三级甲等医院失禁相关性皮炎现状调查分析

目的了解住院患者失禁相关性皮炎患病率及相关因素。方法采用横断面观察法,以某时点某所三级甲等医院1375名住院患者为观察对象。结果失禁现患率为13.81%,失禁相关性皮炎现患率为13.15%,IAD合并压疮46.2%,合并皮肤撕裂伤11.5%。IAD现患率前三位科室为重症监护室42.9%,神经内科22.2%,普通内科12.9%。80岁以上患者占65.4%,住院7 d患者占80.8%,卧床患者占96.2%。失禁患者使用与皮肤p H值相近清洁溶液及皮肤保护剂比例只有3.14%和9.9%。结论卧床患者,年龄80岁、住院时间7 d、频繁失禁患者需要重点预防IAD发生。护理人员对IAD发生预见性不足,失禁患者皮肤保护性预防措施有待加强。     

多功能蝶形底盘造口袋在治疗失禁相关性皮炎中的应用

目的探讨多功能蝶形底盘造口袋引流大便治疗失禁相关性皮炎(IAD)的应用效果。方法采用便利抽样法,选择2019年1—9月入住浙江省人民医院ICU因大便失禁而发生IAD的84例患者为研究对象,按照随机数字表法将其分为观察组(42例)和对照组(42例)。对照组采用IAD皮肤管理三部曲联合普通造口袋,观察组采用IAD皮肤管理三部曲联合多功能蝶形底盘造口袋。比较两组患者的IAD治疗总有效率、治疗IAD护理人员的护理时间以及造口袋平均留置时间、造口袋平均使用时间、更换频次、两组患者家属满意度。结果观察组患者的IAD治疗总有效率为95.24%(40/42),高于对照组的73.81%(31/42),两组比较差异有统计学意义(P<0.05)。观察组所用护理时间为(1.89±0.32)h/d,短于对照组的(5.73±1.64)h/d,两组比较差异有统计学意义(P<0.05)。观察组的留置时间为(5.20±0.40)d/人,短于对照组的(9.40±1.20)d/人,两组比较差异有统计学意义(P<0.05)。观察组的使用时间为(98.27±12.18)h/袋,长于对照组的(72.18±4.63)h/袋,两组比较差异有统计学意义(P<0.05)。观察组的更换频次为(1.20±0.10)次/人,短于对照组的(3.10±0.70)次/人,两组比较差异有统计学意义(P<0.05)。观察组的家属满意度高于对照组,两组比较差异有统计学意义(P<0.05)。结论相较于传统的造口袋,多功能蝶形底盘造口袋可有效治疗IAD,缩短治疗IAD所用护理时间,延长造口袋使用时间,减少平均留置时间和更换频次,提升家属满意度,可在临床推广。     

Independent risk factors for the development of incontinence-associated dermatitis (category 2) in critically ill patients with fecal incontinence: A cross-sectional observational study in 48 ICU units

BackgroundCritically ill patients suffering from fecal incontinence have a major risk of developing incontinence-associated dermatitis (IAD). The presence of moisture and digestive enzymes (lipase, protease) negatively influences skin barrier function. Additional risk factors will make some patients even more vulnerable than others. In order to provide (cost) effective prevention, this specific patient population should be identified timely.ObjectivesTo identify independent risk factors for the development of IAD category 2 (skin loss) in critically ill patients with fecal incontinence.DesignA cross-sectional observational study.Setting and participantsThe study was performed in 48 ICU wards from 27 Belgian hospitals. Patients of 18 years or older, with fecal incontinence at the moment of data collection, were eligible to participate. Patients with persistent skin redness due to incontinence (IAD category 1) were excluded.MethodsPotential risk factors were carefully determined based on literature and expert consultations. Data were collected over a period of eight months by trained researchers using patient records and observation of skin care practices. At the time a patient was included in the study, all relevant data from the past six days, or since admission at the ICU, were recorded. Simultaneously, direct skin observations were performed and high definition photographs were ratified by an expert IAD researcher. A multiple binary logistic regression model was composed to identify independent risk factors. Variables with P < .25 in single binary logistic regression analyses were added to the multiple model using a forward procedure. A cut-off value of P < .1 was established to retain variables in the final model. Nagelkerke’s R² and Hosmer-Lemeshow statistic were calculated as measures of model fit.ResultsThe sample comprised of 206 patients, of which 95 presented with IAD category 2, and 111 were free of IAD. Seven independent risk factors were identified: liquid stool [odds ratio (OR) 4.69; 95% confidence interval (CI) 2.28–9.62], diabetes (OR 2.89; 95% CI 1.34–6.27), age (OR 1.05; 95% CI 1.02–1.08), smoking (OR 2.67; 95% CI 1.21–5.91), non-use of diapers (OR 2.97; 95% CI 1.39–6.33), fever (OR 2.60; 95% CI 1.23–5.53), and low oxygen saturation (OR 2.15; 95% CI 1.03–4.48). Nagelkerke’s R² was 0.377. The Hosmer-Lemeshow statistic indicated no significant difference between the observed and expected values (p = .301).ConclusionsLiquid stool, diabetes, age, smoking, non-use of diapers, fever, and low oxygen saturation were independently associated with IAD category 2 in critically ill patients with fecal incontinence.     

Idiopathic adulthood ductopenia with elevated transaminase only: A case report

BACKGROUNDIdiopathic adulthood ductopenia (IAD) is a chronic cholestatic liver disease of unknown etiology that usually presents as unexplained jaundice. It is characterized by adult onset, lack of autoantibodies, inflammatory bowel disease and loss of interlobular bile ducts.CASE SUMMARYThis case presents a 27-year-old woman with elevation of transaminases and alkaline phosphatase without clinical symptoms. Five years ago, the patient had abnormal transaminases but no cholestasis. Three months before admission, physical examination revealed an increase in transaminases. Oral hepatoprotective drugs did not show any significant improvement, and she was admitted to hospital for further diagnosis and treatment. Liver biopsy confirmed IAD. After about 2 wk of ursodeoxycholic acid treatment, serological and histological examination showed a significant response.CONCLUSIONIAD is a manifestation of cholestasis, but also may be an abnormal increase in transaminase in the early stage.     

Reliability and reproducibility of interapical distance assessment of the lateral deviation of vertebrae in scoliosis

[Purpose] The purpose of this study was to investigate the interobserver reliability and intraobserver reproducibility of interapical distance (IAD) and to analyze its correlation with the Cobb angle (CA). [Subjects and Methods] IAD, a handy tool for assessment of the lateral deviation of vertebrae with a metric scale, was defined as the horizontal distance between one apical vertebra and its counterpart, the opposite apical vertebra in the case of a double curve and the farthest vertebra in the case of a single curve. Fifty full-length, standing anteroposterior radiographs of “idiopathic scoliosis” were reviewed. Three investigators independently measure the CA and IAD at the same time and remeasured the IAD on the same radiograph a week later. [Results] There was no interobserver difference (reliability) in the measurement of IAD or statistical differences in intraobserver reproducibility for each observer. IAD was well correlated with the CA for each observer (r=0.765, r=0.737, and r=0.764). [Conclusion] IAD is useful when assessing lateral deviation in scoliosis and may be a reliable and reproducible index that is well correlated with the CA, and it can be used as a supplementary measure to describe the overall derangement of scoliosis in the coronal plane.Key words: Scoliosis, Interapical distance, Lateral deviation     

网瘾患者人格障碍的康复模式研究

目的 探讨改善网瘾患者人格障碍的有效措施,重建其健康人格,提高社会适应能力.方法 60例网瘾患者随机分为观察组(32例)和对照组(28例).两组均按常规药物治疗,对照组给予功能制护理,观察组给予8w的学校教育和医院护理管理相结合的矫治模式.两组采用卡氏16种人格量表(16PF)和症状自评量表(SCL-90)进行效果评定.结果治疗前两组16PF和SCL-90量表各因子分值无统计学差异(P＞0.05),治疗后观察组16PF和SCL-90量表各因子分值的改变均明显优于对照组(P＜0.01).结论学校教育和医院护理管理相结合的矫治模式能够有效地改善网瘾患者的人格障碍,提高他们的心理健康水平和社会适应能力.     

山西省3所高校大学生网络成瘾调查

背景青少年网络成瘾问题正随着中国互联网迅速普及而日益凸现出来,目前国内的研究尚不多见.目的分析大学生网络使用现状及行为特点,为预防青少年网络成瘾的发生提供科学数据.设计以大学生为研究对象的现况调查.单位一所医科大学附属医院精神科.对象于2003-11/2004-02分别在山西省3所不同类型的高校山西医科大学、太原理工大学、山西财经大学调查在校大学生510人.方法使用网络成瘾诊断量表及自编的大学生上网一般情况调查表对山西省3所不同类型高校的510名本科生进行测试.主要观察指标①大学生中网络成瘾检出率.②成瘾与非成瘾大学生上网行为特点的比较.结果山西省大学生中网络成瘾检出率为6.2%.网络成瘾者男性(29人)多于女性(3人),成瘾者每周上网时间[(18.59±16.12)h]显著大于非成瘾者[(5.61±5.64)h](P＜0.001).成瘾组与非成瘾组在每月上网费用、经常上网地点、认为上网有无负面影响、父母对其使用网络功能是否了解、上网的目的方面差异有显著性意义(P＜0.05～0.001),在上网历史及使用网络功能方面差异无显著性意义(P＞0.05).结论大学生网络成瘾的检出率较高,网络成瘾者与非网络成瘾者在上网行为特点方面存在差异,应引起有关部门的重视,以预防网络成瘾的发生.     

Prostate Cancer Patients' Preferences for Intermittent vs. Continuous Androgen Deprivation—A Pilot Institutional Study

IntroductionWith locally advanced, recurrent, and metastatic prostate cancer patients, patient preference between intermittent (IAD) and continuous (CAD) androgen deprivation therapy has not been investigated. The goal of the study was to determine patients' preference for IAD vs. CAD therapy. The secondary aim was to elucidate demographic or treatment variables that may affect a patient's preference for one type of hormonal treatment.Materials and MethodsUsing a tradeoff model that demonstrates the difference in outcome between IAD and CAD, a survey questionnaire was developed and administered to prostate cancer patients at the Odette Cancer Centre at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. Only patients who had (1) locally advanced prostate cancer, (2) been previously treated for prostate cancer with relapsing prostate-specific antigen, or (3) slow metastatic disease were asked to participate. Data related to patients' demographic information and their decisional preference factors were collected.Results and ConclusionsOverall, 36 of 53 (68%) patients completed the survey. Most patients favoured IAD (n = 32) over CAD (n = 4). Patients currently on radical treatment (adjuvant hormone therapy and radiation therapy) preferred CAD compared with patients who were not on radical treatment (P = .044). Patients with high (>20 ng/L) pretreatment prostate-specific antigen showed preference for CAD; however, this was not statistically significant (P = 0.07). Patients from both groups viewed quality of life as the strongest influence on their treatment preference, but had diverging opinions on side effects and general well being. The results of this pilot study could serve as a guide for future studies; a larger study combined with qualitative methodology may better address patients' needs and minimize any regret over their hormonal treatment.     

Effect of coexisting cardiovascular disease on the long-term efficacy and safety of the implantable atrial defibrillator

The long-term efficacy and safety of implantable atrial defibrillator (IAD) therapy in patients with AF and cardiovascular disease is unclear. The aim of this study was to evaluate the efficacy and safety of IAD therapy in patients with and without coexisting cardiovascular disease. In 115 patients implanted with an IAD, 85 patients had cardiovascular disease: 41 (48%) patients had 1 cardiovascular abnormality, 29 (35%) patients had 2, 13 (15%) patients had 3, and 2 (2%) patients had 4 different cardiovascular abnormalities. The device was programmed into a rhythm monitoring mode for the first 3-month postimplant period. All defibrillation therapy was performed under physician supervision to monitor safety and efficacy. After this initial monitoring period, patients were allowed to activate their device away from the hospital or clinic. A total of 357 spontaneous AF episodes occurred in 83 (72%) patients during observed operation and the mean shock efficacy was 93.5+/-20.3% (lower 95% confidence interval [CI] 89.8%). As of the lastfollow-up, 58 (55%) patients had transition to receive nonphysician observed therapy. Forty-two (72%) patients had experienced 332 episodes of AF for which theyhad received device therapy away from the hospital/clinic (mean shock efficacy 90.5+/-39.7%). The presence of hypertension, valvular heart disease, and ischemic heart disease did not affect the shock efficacy of the IAD during physician observed and nonobserved therapy (P > 0.05). However, the presence of congestive heart failure was associated with a lower clinical efficacy during observed and nonobserved therapy (P < 0.05). Overall, 5,262 shocks have been delivered with the IAD without any episode of proarrhythmia. The observed proarrhythmic risk was 0%, with an estimated maximum proarrhythmic risk of 0.06% per shock (95% upper CI). A stand-alone IAD appears to be safe in the presence of cardiovascular disease. The lower clinical efficacy for AF associated with congestive heart failure might be related to a higher rate of early reinitiation of AF after defibrillation.     

Internal Atrial Defibrillation: Effect on Sinus and Atrioventricular Nodal Function and Implanted Cardiac Pacemakers

Internal atrial defibrillation (IAD) has been extensively evaluated for clinical efficacy but the need for concomitant demand pacing and the effect of IAD shocks on pacemaker function is not well studied. We prospectively evaluated: (l) the incidence of bradycardia as a result of IAD shocks; and (2) effect of these shocks on functioning of implanted cardiac pacemakers. Consecutive consenting patients with atrial fibrillation (AF) requiring cardioversion or undergoing electrophysiologi-col study were selected for IAD. IAD shocks were delivered using the right ventricle to right atrium (RV-RA), right ventricle to superior vena cava (RV-SVC), right atrium to axillary patch (RA-AX), and right atrium to left pulmonary artery or coronary sinus (RA-LPA/CS) lead configurations. Mean RR interval before and after the shocks and the time interval from shock delivery to first QRS complex were analyzed for unsuccessful and successful shocks. Pacing and sensing function was analyzed in patients with previously implanted pacemakers. Twenty-five patients, 18 men, mean age 67.9 ± 10 years were included in the study. A total of 305 shocks (264 unsuccessful, 41 successful) were analyzed. For unsuccessful shocks the mean post-IAD shock RR interval (795 ± 205 ms) and the time to first post-IAD shock QRS complex (970 ± 438 ms) were both significantly greater than the pre-IAD shock RR interval (685 ±131 ms, P < 0.001). The increase in post-IAD shock RB interval and time to first post-IAD shock QRS complex was seen with all four lead configurations used. With successful shocks the mean post-IAD shock sinus cycle length (1.105 ± 450 ms) and time to first post-IAD shock QRS complex (1,126 ± 443 ms) were both also significantly greater than the pre-IAD shock RR interval (766 ±172 ms). Nine patients (36%) had episodes of significant bradycardia after shock delivery. Shocks of up to 20 J using the RA-LPA/CS lead configuration did not affect pacemaker function. IAD can result in transient bradycardia related to sinus and atrioventricular nodal effects requiring backup ventricular pacing. Shocks can be safely delivered using RA-LPA or RA-CS lead configurations in patients with implanted bipolar cardiac pacemakers.     

前馈控制在预防急性重症中毒患者失禁性皮炎中的应用研究

目的探讨前馈控制在预防急性重症中毒患者失禁性皮炎中的应用。方法选取2014年1月至12月ICU收治的64例急性重症中毒患者为对照组,2015年1月至12月ICU收治的72例急性重症中毒患者为观察组。对照组采用常规护理模式,观察组在此基础上采用针对失禁性皮炎的前馈控制模式,比较两组失禁性皮炎发生率与发生时间,评估严重程度,比较疼痛程度评分、住院天数、重返ICU率。于患者发生失禁性皮炎并治疗2周后进行疗效评价,于患者出院时进行护理满意度评价。结果对照组与观察组失禁性皮炎发生率分别为32.81%与8.33%(P<0.01),发生时间为(6.25±0.65)d、(13.37±2.02)d(P<0.05),症状以Ⅰ度红肿居多。观察组疼痛程度评分、住院天数、重返ICU率均低于对照组(P<0.05)。结论前馈控制在预防急性重症中毒患者发生失禁性皮炎方面具有较好的效果,不仅显著降低了其发生率,且也延迟了发生时间,经过治疗具有较高的临床有效率和护理满意度,值得临床护理借鉴和推广应用。     

基于评估的分级皮肤护理干预方案在防治ICU失禁相关性皮炎中的应用

目的 探讨基于评估的分级皮肤护理干预方案在防治ICU失禁相关性皮炎(IAD)中的应用效果.方法 选取2015年1月~2016年10月该院收治的152例ICU失禁患者作为研究对象,根据随机数字表法将患者分为对照组和观察组各76例.对照组患者给予常规护理干预,观察组患者给予基于评估的分级皮肤护理干预方案.观察比较ICU治疗期间的IAD发生情况和发生IAD患者的治疗情况.结果 ICU治疗期间,观察组的IAD发生例数、IAD平均形成时间以及IAD严重程度均明显低于对照组,差异有统计学意义(均P<0.05);观察组的治疗有效率高于对照组,但差异无统计学意义(P>0.05);观察组的平均IAD愈合时间明显低于对照组,差异有统计学意义(P<0.05).结论 基于评估的分级皮肤护理干预方案在防治ICU失禁相关性皮炎中的应用效果显著,能够有效地降低ICU失禁患者的IAD发生率,提高发生IAD患者的治疗效果,值得临床推广应用.     

基于布里斯托大便分型的结构化管理在ICU失禁患者护理中的应用研究

目的 探讨基于布里斯托大便分型的结构化管理在ICU失禁患者中的应用效果.方法 选取2019年12月至2020年3月ICU收治的大便失禁患者为对照组,2020年5月至8月ICU收治的大便失禁患者为试验组,每组54例,对照组实施常规的护理方法,试验组在布里斯托大便分型的指导下实施皮肤结构化管理,比较两组患者失禁性皮炎(IA...     

Internal Atrial Defibrillation During Electrophysiological Studies and Focal Atrial Fibrillation Ablation Procedures

Induction of sustained AF during electrophysiological studies requires electrical cardioversion to restore sinus rhythm for continuation of the electrophysiological study and mapping procedure. The study included 104 consecutive patients (age 59 +/- 12 years, 74 men), who were in stable sinus rhythm at the beginning of the electrophysiological study, underwent internal atrial defibrillation (IAD) of AF (> 15 minutes) that was induced during electrophysiological study. In 21 patients, AF was regarded to be the clinical problem (group I), and in the remaining 83 patients other arrhythmias represented the primary target of the electrophysiological study (group II). A 7.5 Fr cardioversion catheter (EP Medical) equipped with a distal array was used and placed in the left pulmonary artery and a proximal array of the same size was located along the lateral right atrial wall. All patients were successfully cardioverted with a mean energy of 6.2 +/- 4.0 1. In 18 (78%) of 21 group I patients and in 12 (14%) of 81 group II patients, AF recurred 3.7 +/- 3.4 and 2.4 +/- 1.4 times during electrophysiological study, respectively. The IAD shock did not suppress focal activity, thus the mapping of atrial foci responsible for AF could be continued even after several IADs. No IAD related complications occurred during the study. In conclusion, (1) IAD can be safely and successfully performed during electrophysiological study without using narcotic drugs or high electric energies; (2) IAD does not suppress focal activity; and (3) even if AF recurs frequently during the electrophysiological study, IAD can be performed several times without significant time delay.     

失禁相关性皮炎患者中西医护理研究进展

本文从目前国内外研究现状出发,阐述了失禁相关性皮炎(IAD)的流行病学、风险因素,介绍了IAD的评估方法,并对IAD的中西医护理方法进行了分析与归纳,旨在为护理人员进行IAD的管理与预防提供依据,并在此基础上对IAD的护理措施提出更多可行性建议。     

结构化护理规程在预防EICU患者失禁相关性皮炎中的应用

目的:探讨结构化护理规程在预防EICU患者失禁相关性皮炎中的应用效果,为其他护理人员提供临床参考。方法:选取该院入住EICU的患者416例,采用历史对照实验方法分为试验组264例和对照组152例。对照组采用常规护理,试验组采用结构化护理规程。比较两组临床护理效果。结果:两组患者在性别、年龄、意识状态、失禁类型、大便失禁频次、血红蛋白、白蛋白等方面比较,差异均无统计学意义(均P>0.05);两组在未发生IAD、轻度IAD、中度IAD、重度IAD及真菌性皮疹方面比较差异均有统计学意义(均P<0.05)。结论:实行IAD的结构化护理规程后能有效降低患者发生IAD的风险,提高护理工作效率与质量,对临床护理人员具有指导意义。     

神经内科护士失禁性皮炎知信行的访谈分析

目的：探讨神经内科护士对失禁性皮炎(IAD)的知识、态度、信念及行为现状,为 IAD 的培训、教育及规范管理提供参考依据。方法采用随机抽样,运用半结构式访谈法,对50名神经内科护理人员进行一对一深入访谈,记录、整理并分析资料,归纳主题。结果被访者对于 IAD 知识缺乏,态度积极,护理行为有待提高。结论降低 IAD 发生率、减少 IAD 患者痛苦需多部门合作,护理人员需进行相关知识培训,对家属行健康指导,管理部门需制定相关处理策略,从而提高 IAD 护理质量。