The association between oil spill cleanup-related total hydrocarbon exposure and diabetes.

BACKGROUND: Although evidence suggests relationships between some crude oil components and glycemic dysregulation, no studies have examined oil spill-related chemical exposures in relation to type 2 diabetes mellitus (DM) risk. This study examined the relationship between total hydrocarbon (THC) exposure among workers involved in the 2010 Deepwater Horizon (DWH) oil spill and risk of DM up to 6 years afterward. METHODS: Participants comprised 2660 oil-spill cleanup or response workers in the prospective GuLF Study who completed a clinical exam and had no self-reported DM diagnosis prior to the spill. Maximum THC exposure was estimated with a job-exposure matrix based on interview data and personal measurements taken during cleanup operations. We defined incident DM by self-reported physician diagnosis of DM, antidiabetic medication use, or a measured hemoglobin A1c value ≥ 6.5%. We used log binomial regression to estimate risk ratios (RRs) for DM across ordinal categories of THC exposure. The fully adjusted model controlled for age, sex, race/ethnicity, education, employment status, and health insurance status. We also stratified on clinical body mass index categories. RESULTS: We observed an exposure-response relationship between maximum daily ordinal THC exposure level and incident DM, especially among overweight participants. RRs among overweight participants were 0.99 (95% CI: 0.37, 2.69), 1.46 (95% CI: 0.54, 3.92), and 2.11 (95% CI: 0.78, 5.74) for exposure categories 0.30-0.99 ppm, 1.00-2.99 ppm, and ≥3.00 ppm, respectively (ptrend = 0.03). CONCLUSION: We observed suggestively increasing DM risk with increasing THC exposure level among overweight participants, but not among normal weight or obese participants.

When is a pressure ulcer not a pressure ulcer? ... external pressure versus internal pressure.

This case study presents a nontraditional explanation for recurring and difficult to heal pressure ulcers: internal pressure rather than external pressure. The authors are hopeful that this discussion will assist colleagues in recognizing this alternative diagnosis.

Using the nursing process to solve a problem: post-op tape blisters.

ET nursing consultation was requested for the treatment of ten cases of tape blisters within six months, the majority of which were post-op following hip surgery. When the ET nursing staff was asked to develop a standard treatment protocol for these blisters, they used the nursing process. They identified the problem, assessed the situation, planned and implemented a response, and evaluated the results in an ongoing manner. It was then theorized that lack of "stretch" in the tape might be causing the tape blisters. After five stretch tapes were assessed for ease of removing the paper backing, handling, application, flexibility, and adhesion, one tape was preferred by the operating room and nursing unit staffs and was put into routine use in October 1992. No further blisters have been noted since this change was made. By using the nursing process, the authors ultimately eliminated post-op tape blisters in the facility.

Low profile gastrostomy devices.

Many styles of gastrostomy tubes have been developed and used over the years by patients requiring long-term enteral feedings. As an alternative to the use of the traditional gastrostomy tube, the low profile gastrostomy device (LPGD) was introduced in the mid-1980s. The purpose of this article is to provide an historical overview of gastrostomy tubes and the LPGD. The authors will highlight advantages and limitations of the two main types of LPGDs. Teaching guidelines are included. Nurses who possess a strong knowledge base on the latest trends in low profile gastrostomy devices will be better prepared to educate patients, family members, and caregivers.