Prospective, Randomized, Controlled Trial of Tissue Adhesive (2-Octylcyanoacrylate) vs Standard Wound Closure Techniques for Laceration Repair

Objective: To compare a new tissue adhesive, 2-octylcyanoacrylate, with standard wound closure techniques for the repair of traumatic lacerations.
Methods: A prospective, randomized, controlled clinical trial enrolled consecutive patients >1 year of age with non-bite, non-crush-induced lacerations who presented <6 hours after injury. Structured closed-question data sheets were completed at the time of laceration repair and suture removal. Patients were randomly assigned to treatment with either 2-octylcyanoacrylate or standard wound closure. Infection was determined at the time of suture removal. Long-term cosmetic appearance (>3 months) was assessed by physicians using a previously validated categorical cosmetic scale and by patients using a 100-mm visual analog scale.
Results : There were 63 patients randomized to the octylcyanoacrylate group and 61 patients treated with standard wound closure techniques. The 2 treatment groups were similar with respect to age, gender, race, medical history, and wound characteristics. At the 5-to-10-day follow-up, only 1 wound was infected and only 2 wounds required reclosure due to dehiscence. These 3 patients received treatment with octylcyanoacrylate. At long-term follow-up, the cosmetic appearances were similar according to the patients (octylcyanoacrylate, 83.8 ± 19.4 mm vs standard techniques, 82.5 ± 17.6 mm; p = 0.72) and the physicians (optimal cosmetic appearance, 77% vs 80%; p = 0.67).
Conclusions: Wounds treated with octylcyanoacrylate and standard wound closure techniques have similar cosmetic appearances 3 months later.     

Exploring patient satisfaction with out-patient services

Despite the widespread use of satisfaction surveys to obtain patients' views about health services, the validity and relevance of self-completion questionnaire surveys has been questioned. This paper reports on an exploratory, qualitative investigation into patients' perspectives on satisfaction and dissatisfaction with out-patient care. Eighty-one new referrals to two out-patient clinics were interviewed before and after their first consultation. Of this initial sample, 23 were interviewed again at their follow-up appointment and a further 10 were interviewed in depth at a location of their choice. The features of the service that drew appreciative comments when they were thought to be present, and criticism when they were felt to be lacking, were: humanity, efficiency, informativeness and continuity of communication. Examples of these features are discussed using patients' own words to illustrate their perspectives. The study demonstrates that unstructured approaches to service evaluation can be employed to develop services which are genuinely listening to their users' views.     

A personal reflection on the nature of somatic treatments and the implications for mental health nursing

Somatic treatments in psychiatry, ECT (electro-convulsive therapy) and pharmacotherapy, are based on a particular conception of our nature as human beings, and on a particular conception of clinically constructed reality. Acceptance of the basis for such treatments constitutes a tacit admission of our nature as being essentially materialist and deterministic biological machines, and undermines the connectedness which ensures that we each acknowledge the humanity and humanness of the other. By objectifying the other as different (by reason of disordered biology), these connections are severed and allow the imposition of physical forms of treatment in the name of cure. In this personal reflection, I draw upon my own experience of ECT from a nursing perspective, and attempt to explain the basis of my antipathy for this treatment. In the course of this exploration I also raise some of the issues which I feel nursing must deal with if it is to continue uncritically to adopt the biological paradigm as the basis of its praxis.     

One Practice Week at a Glance

This is the synopsis of the work week of an RN practicing in a level III neonatal intensive care unit. The married mother of three daughters works three shifts per week. Her husband recently started his own business and, despite the hectic hours, is supportive of her educational goals.