The basics of genetic disease.

Molecular genetics has opened new avenues for medical diagnosis, treatment and prevention of genetic diseases. Major ethical and legal issues regarding applications of this new technology have surfaced and are being discussed at a variety of levels. Policies for use of the new technology have been established, and the first use of gene replacement therapy is anticipated in the near future.     

Ostomy devices. Intestinal and urologic ostomies

The authors provide a brief historical survey analyzing intestinal stomas and the evolution of instruments which can be used. The authors present the characteristics which must be considered when selecting an instrument, what its basic requirements are, and what kinds of instruments are currently on the market. Bags and accessories are other sections included in this article.     

The basics of an exposure control plan.

Prevention and control of employee injury and exposure begins with an organizational commitment to provide a safe work environment for the employees. An Exposure Control Plan (ECP) helps to ensure this safe environment, and is developed by an organization and administered to provide for the elimination and minimization of occupational exposure to blood-borne pathogens, which is one of the greatest areas of risk for the health care provider. The Occupational Safety and Health Administration (OSHA) standard 29 CFR 1010.1030, "Occupational Exposure to Bloodborne Pathogens," outlines the requirements necessary to meet compliance as an institution. However, occupational exposure requirements have changed over the last few years and now incorporate practice advances regarding safety devices (ie, needleless and protected) and their use and implementation. Directives addressing the management of the employee who has been exposed to blood-borne pathogens have also been added. This article focuses on important elements in developing an institutional exposure control plan.     

Promoting outcomes for patients with spinal cord impairments and ostomies.

Patients with spinal cord impairments (SCI) and ostomies have unique needs which must be addressed by medical-surgical nurses. By considering the anatomy and physiology of SCI, functional ability, cognitive limitations, and a myriad of other factors, nurses can positively influence clinical and social outcomes.     

The role of endoscopy in the evaluation of pouches and ostomies

Patients with ileal pouches and ostomies present with management issues that are challenging to the clinician. Endoscopy plays a significant role in diagnosing and guiding therapy in such patients. Unfortunately, there are very few prospective studies that evaluates endoscopy in these situations. Nevertheless, it is clear that endoscopy remains a powerful tool that is important for diagnosis and therapy of complications unique to these surgical procedures. It seems prudent to advocate endoscopic cancer surveillance for patients with pouches and ostomies; however, it remains to be seen whether these efforts will ultimately have an impact on long-term patient morbidity and mortality.     

The basics of laser technology

As the use of laser systems increases, the nurse must be able to cope with the many changes that this new technology brings. An understanding of laser biophysics provides a foundation for laser safety. The nurse must also be aware of the organizational elements needed to provide a comprehensive laser program. Laser technology has definitely revolutionized modern health care delivery, and the nurse is instrumental in the continuing advancement of this science.     

Anaerobic infections. The basics for primary care physicians

Anaerobic bacteria constitute a major portion of the normal human microflora, and some of them can cause disease in contiguous body parts, especially if there is a mucosal break. Most anaerobic infections are polymicrobial. Because anaerobes are difficult to culture, diagnosis is often made on the basis of clinical clues. Thus, knowledge of the common sites, predisposing conditions, and other representative features of anaerobic infections is critical. For anaerobic infections above the diaphragm, where Bacteroides fragilis is not a common isolate, high-dose penicillin G therapy is usually sufficient. Addition of clindamycin (Cleocin) or metronidazole (Flagyl, Metryl, Protostat) may be necessary for serious infections. Cefoxitin sodium (Mefoxin) or clindamycin is adequate for most anaerobic infections occurring outside the central nervous system. Metronidazole, chloramphenicol, imipenem, or beta-lactam antibiotics combined with beta-lactamase inhibitors may be preferable for serious infections. Appropriate coverage for aerobic bacteria must be included in the treatment regimen. Drainage of abscesses, decompression of infected spaces, debridement of necrotic tissue, and removal of foreign bodies are critical in management of many anaerobic infections.