Giant squamous cell carcinoma as a complication of a chronic enterocutaneous fistula: complex parietal reconstruction

Treatment of an enterocutaneous fistula is complex and may require multidisciplinary management, especially when associated with a neoplastic process. Here, we describe the case of a 59‐year‐old patient with a squamous cell carcinoma that had invaded the abdominal wall through a chronic enterocutaneous fistula identified 30 years ago. We combined parietectomy with small intestine and colon resection and inguinal lymphadenectomy in order to obtain clear surgical margins. At the same time, plastic surgery involved the implementation of a large bioprosthesis and coverage with a vastus lateralis muscle free flap.     

Risk-adapted strategy for the management of febrile neutropenia in cancer patients

Background Among patients who develop fever and neutropenia after having received cancer chemotherapy, we have to distinguish at least three categories of risk levels for complications and death: patients at low risk and eligible for oral treatment and possibly outpatient management, patients at low risk who require intravenous therapy, and patients at higher risk. Results and discussion The Multinational Association for Supportive Care in Cancer scoring system identifies patients at low risk (<5%) of severe complications with very low mortality (<1%) during an episode of febrile neutropenia; this group represents roughly 70% of an unselected population of patients with febrile neutropenia. A significant percentage (≈50%) of these patients are eligible for treatment with orally administered antibiotics and can be discharged early and safely from the hospital after a short (24–48 h) observation period.     

Do proton-pump inhibitors increase the risk for nosocomial pneumonia in a medical intensive care unit?

Purpose

The aim of this study was to determine whether the use of gastric acid-suppressive agents increases the risk of nosocomial pneumonia (NP) in a medical intensive care unit population.

Materials and Methods

Retrospective cohort study in a medical intensive care unit of a 554-bed, university-affiliated, academic medical center.

Results

A total of 924 medical records were included in the database during the study period of which 787 patients were included in the study. Out of this cohort,104 patients (13.2%) eventually developed a NP. The risk for patients who received proton-pump inhibitors (adjusted hazard ratio [AHR] 0.63; 95% CI 0.39-1.01) was not significantly different than in non exposed patients. Variables most strongly associated with NP were the administration of sedatives or neuromuscular blockers for at least 2 consecutive days (AHR 3.39;95% CI 1.99-5.75), an Acute Physiology and Chronic Health Evaluation II (APACHE II) severity score greater than 15 (AHR, 3.34; 95% CI 1.82-6.50), and presence of a central venous catheter (AHR, 1.76; 95% CI 1.12-2.76).

Conclusions

Prior use of a proton-pump inhibitor did not correlate with a significant increase in the risk of developing NP. This risk was higher with the administration of sedatives or neuromuscular blockers, increased disease severity, and placement of a central venous catheter.     

California's minority majority and the White face of nursing

Of the 33 million people in California, the nation's most populous state, minority groups now constitute the majority of the population. Many sources predict that by 2060, the entire country will mirror the diversity of California today. Like the rest of the country, California is experiencing a critical shortage of nurses that is predicted to increase in the coming years, and California's nursing workforce does not represent the racial and ethnic diversity of the state's population as a whole. If the nursing profession is to thrive in the coming years, educators and leaders must create a way to embrace people from diverse ethnicities and cultures. The purposes of this article are to determine whether ethnic minority groups have different success rates in California nursing programs, whether nursing programs with high percentages of diverse students have differing success rates, and to describe the institutional predictors of on-time completion rates, attrition rates, and NCLEX-RN first-time pass rates in California community colleges.     

Concentrations of Pefloxacin in Plasma and Tissue after Administration as Surgical Prophylaxis

Plasma and epiploic-fat drug concentrations determined by high-performance liquid chromatography and fat penetration of pefloxacin and its metabolite (norfloxacin) given for antimicrobial prophylaxis were studied in patients scheduled for colorectal surgery. Concentrations of pefloxacin in plasma decreased about 40% from the beginning of the operation to closure of the peritoneum, and corresponding levels in epiploic fat stayed stable. The plasma and tissue norfloxacin concentrations were very low. Concentrations of pefloxacin in tissue were greater than MIC at which 90% of isolates are inhibited for sensitive bacteria (members of the family Enterobacteriaceae). The penetration of pefloxacin into epiploic fat was about 32%.     

African Americans with cancer: the relationships among self-esteem,locus of control,and health perception

The purpose of this study was to describe and examine the relationships among self-esteem, locus of control, and perceived health status in African Americans with cancer and to identify predictors of perceived health status. A convenience sample of 95 oncology outpatients at two large medical facilities completed the Tennessee Self-Concept Scale, the Multidimensional Health Locus of Control Scale, and the Cantril Ladder, a measurement of perceived health. In an audiotaped interview two open-ended questions were used to clarify participants' Cantril Ladder scores. A significant positive relationship was discovered between self-esteem and powerful others health locus of control (p <.05). Participants tended to view God as the Powerful Other capable of influencing their health and well-being. Self-esteem and an internal health locus of control were found to account for 23% of the perceived variance in health status. In addition, interview data indicated that participants with normal to high levels of self-esteem and an internal health locus of control perceived their state of health and well-being positively.     

A new way of caring for older people in the community

The government's modernisation agenda is challenging traditional practice by introducing new roles and concepts to meet the increasing healthcare needs of the older population and those with long-term conditions. Over the past two years several national pilots have been trialled to examine different models of managing care for these groups. One is the Evercare model, a case management approach to the delivery of care in the community for older people. This article focuses on a cohort of 12 nurses from three local primary care trusts who participated in the national Evercare pilot project from July 2003-April 2005. It examines the context for change, explores and appraises the development of a new role, and evaluates the educational partnership developed with a local university.