Nursing management of necrotising fasciitis

Necrotising fasciitis is a soft tissue infection often caused by two or more bacteria, most commonly Group A streptococcus bacteria. This article provides an overview of the symptoms, treatment and nursing care of patients with necrotising fasciitis. Psychosocial considerations, public perceptions, consent and advocacy are also discussed.     

Topical negative pressure and necrotising fasciitis

This article highlights the importance of using evidence-based practice to improve wound care and support clinical practice. It appraises the literature on the use of topical negative pressure therapy for the treatment of complex, acute and chronic wounds. In an effort to contribute to the substantial evidence already available in support of this therapy, a clinical example of how effective it was at managing necrotising fasciitis is described.     

Fatal descending necrotising mediastinitis

Descending necrotising mediastinitis rarely develops and this variety of mediastinitis is a highly lethal disease. A case is reported of descending necrotising mediastinitis caused by an odontogenic infection. The importance is emphasised of prompt diagnosis and aggressive surgical mediastinal drainage for the survival of these patients. Most acute mediastinal infections result from oesophageal perforation, either secondary to oesophagoscopy or tumour erosion. Mediastinitis occasionally develops as descending necrotising mediastinitis originating from the complications of cervical or odontogenic infections. Descending necrotising mediastinitis usually has a fulminant course, leading commonly to sepsis and death.     

Therapies for acid peptic disease

Peptic ulceration is multifactorial in both causes and treatments. Agents that have been shown to be beneficial in the treatment of ulcers include antacids, histamine receptor antagonists, proton pump inhibitors, cytoprotective agents and antimuscarinic agents. Knowledge concerning characteristics of these medications will help nurses to provide more effective health care.     

Evidence-Based Non-Pharmacological Therapies for Fibromyalgia

Purpose of Review

Fibromyalgia (FM) is the second most common rheumatologic pain disorder after osteoarthritis with a multisystem presentation. While the treatment of FM in a clinical setting incorporates both pharmacologic and non-pharmacologic modalities, the present investigation reviews evolving literature on cognitive behavioral and complementary medical therapies. The recent medical literature on FM was reviewed between 2012 and 2017 via MEDLINE and the Cochrane Central Registry of Controlled Trials, with an emphasis on randomized controlled trials, meta-analyses, and evidence-based treatment guidelines.

Recent Findings

Cognitive behavioral therapy continues to play a significant role in the non-medical therapy of FM. It is especially helpful in high catastrophizing patients as evidenced by recent studies that note changes in the brain on functional magnetic resonance imaging. Mindfulness meditation can be helpful in improving pain symptoms and pain perception. No particular diet is found to have a meaningful impact in FM; however, various diets including low fermentable oligo- di –monosaccharides and polyols diet, gluten free, and hypocaloric may be helpful in ameliorating gastrointestinal distress in select patient populations. Current literature does not support the routine use of acupuncture for improving pain or quality of life in FM; however, given its benign side effect profile, it should not be discouraged.

Summary

Goals for symptom management and pain control should be set early, and patient engagement remains critical in the management of this complex pain presentation. While low quality evidence exists for most non-pharmacologic treatment modalities for FM, CBT and mindfulness meditation show promise for future investigation.

     

Emerging Therapies for Chronic Migraine

Medication overuse headache can be described as a chronic headache, presenting 15 or more days per month, in a patient who abuses symptomatic drugs. It has been called an unrecognized epidemic; this is in part true for adults, but is certainly so for children and adolescents. This paper reviews existing data concerning epidemiology, etiopathogenesis and treatment options, with a focus on pediatric age. This leads to evidence of a relevant number of still unanswered questions and some possible strategies to help children and adolescents with this disabling disorder.     

Therapies for HIV with RNAi

RNA interference (RNAi) is a process in which double-stranded RNA triggers the silencing of gene expression in a sequence-specific manner. In mammalian cells, approximately 21-nucleotide small interfering RNA duplexes guide cognate mRNA degradation in a sequence-specific manner by RNA-induced silencing complex. RNAi was successfully applied to inhibit different stages of HIV-1 replication. Recent viral and host cell targets for RNAi that have been used to inhibit HIV-1 are described. The problem with the delivery of RNA duplexes to the target cells and the strategies used by HIV-1 to escape inhibition by RNAi are also discussed.     

Hybrid Therapies for Ventricular Arrhythmias

In recent years several trials demonstrated the efficacy of implantable cardioverter-defibrillation (ICD) therapy in reducing cardiac and total mortality in patients affected by rapid ventricular tachycardia (VT) and/or ventricular fibrillation. Nevertheless, ICD do not prevent arrhythmia recurrences, thus being a palliative and not a curative treatment modality. The tolerance to ICD therapy varies greatly, and within individuals, this leading to a nonuniform acceptance of this form of therapy. The very frequent occurrence of VT, defined as an arrhythmic storm, may be a life threatening condition. The majority of ICD patients is under antiarrhythmic drug therapy, to reduce episodes of VT or to make antitachycardia pacing more effective by slowing the tachycardia rate. Drug therapy, however, may cause additional problems, and does not represent the optimal solution. The prevention of VT and/or ventricular fibrillation episodes and excessive ICD therapy, remains a worthwhile goal. Radiofrequency catheter ablation (RFCA) is a curative approach, and can be expected to reduce the frequency of recurrent VT episodes in the majority of patients. The combination of these treatment modalities (ICD and RFCA) is often described as hybrid therapy, implying that the two treatments act providing some form of synergism. In experienced centers, RFCA is now performed, regardless of whether the VT rate is rapid and/or is hemodynamically unstable. Newer mapping and ablation techniques are now available, enhancing the acute success rate of the procedure. In this review the most recent application of VT catheter ablation and the use of advanced mapping and ablation techniques will be discussed.