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1.
Contemp Nurse ; 33(1): 13-9, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19715491

RESUMO

AIM: To examine the effectiveness of the implementation of a clinical practice guideline on nurses screening patients for alcohol and other substance use, providing brief interventions, and referring patients at risk for treatment. METHOD: Medical record audits were conducted in selected medical and surgical wards of two metropolitan hospitals in Sydney prior to and three months following the guideline implementation. RESULT: Seventy-nine (pre) and 84 (post) patient records were audited. There were no differences in screening rates for alcohol (28% and 29%), tobacco (29% and 23%) and illicit drug use (16% and 8%) before and after implementation of the guideline. PRACTICE IMPLICATION: Factors which may have limited the effectiveness of the clinical practice guideline dissemination included design of the education program, existing level of nurses' knowledge and competence, and strategies in place to ensure sustainability of the program. We also provided suggestions for improvement of screening for alcohol and other substance use.


Assuntos
Difusão de Inovações , Fidelidade a Diretrizes/organização & administração , Programas de Rastreamento/estatística & dados numéricos , Recursos Humanos de Enfermagem Hospitalar/educação , Guias de Prática Clínica como Assunto , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Atitude do Pessoal de Saúde , Distribuição de Qui-Quadrado , Competência Clínica , Educação Continuada em Enfermagem/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento/enfermagem , New South Wales , Papel do Profissional de Enfermagem/psicologia , Avaliação em Enfermagem , Auditoria de Enfermagem , Pesquisa em Educação em Enfermagem , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Recursos Humanos de Enfermagem Hospitalar/psicologia , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta/estatística & dados numéricos
2.
Obes Surg ; 24(4): 584-7, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24272886

RESUMO

BACKGROUND: Past medical or family history of autoimmune diseases and patient chronic steroid use are label contraindications for laparoscopic placement of adjustable gastric band (LAGB). We reviewed our experience with placement of LAGB in patients with autoimmune disease or chronic steroid use. METHODS: This was a retrospective review of our prospective bariatric database. All patients who underwent LAGB and had a diagnosis of autoimmune disease or chronic steroid use with at least 1-year follow-up data were included in the study. Data on demographics, weight loss, and complications were collected. RESULTS: Sixteen patients with autoimmune diseases or chronic steroid use underwent LAGB. Diseases included were lupus (n = 6), sarcoidosis (n = 4), renal transplant (n = 2), rheumatoid arthritis (n = 1), ulcerative colitis (n = 1), Grave's disease (n = 1), and celiac disease (n = 1). No patients developed infectious complications. One patient required port replacement due to malfunction, and one patient underwent a conversion to gastric bypass due to failure of weight loss. The average preoperative body mass index was 46.8 kg/m(2) with an average weight of 292.0 lbs. Average excess weight loss was 39.8 % (range, 7.4 to 95.5 %) at a median follow-up of 54 months. CONCLUSIONS: Our review indicates that LAGB in patients with autoimmune diseases or chronic steroid use is safe, with no infectious complications and only one explant. Some of these autoimmune conditions may improve following significant weight loss, but larger studies are required to further substantiate these findings.


Assuntos
Corticosteroides/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Gastroplastia , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Rim , Obesidade Mórbida/cirurgia , Adulto , Doenças Autoimunes/complicações , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Redução de Peso
3.
Surg Obes Relat Dis ; 10(5): 795-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25012775

RESUMO

BACKGROUND: Few treatments for idiopathic and diabetic gastroparesis exist beyond symptom management, and no study has described gastric surgery for gastroparesis in obese and morbidly obese patients. The objective of this study was to describe treatment of recalcitrant gastroparesis in obese adults with Roux-en-Y gastric bypass (RYGB) surgery. METHODS: A retrospective review was conducted of adult patients who underwent laparoscopic RYGB. Clinical data pre- and postsurgery and at a follow-up of up to 2 years were reviewed. Total symptom scores for gastroparetic symptom severity and frequency were compared presurgery and at follow-up using paired t tests. RESULTS: Seven obese and morbidly obese patients (body mass index [BMI] = 39.5, range = 33-54; 6 women) with idiopathic or diabetic gastroparesis reported marked symptom improvement, and total symptom scores significantly decreased after RYGB. All 4 patients who were taking prokinetics preoperatively no longer required their medication after surgery. Three patients required prolonged treatment with antinausea medications in the postoperative period. Mean BMI change was 9.1 units and mean percent excess weight lost was 71.6 lbs. No perioperative complications were experienced. Two required readmissions due to various concerns (dysphagia, nausea, anastomotic ulcer). CONCLUSIONS: In our cohort, no patients required the use of prokinetics after surgery and everyone experienced significant improvement in symptoms. Importantly, we found that RYGB is a safe surgical treatment for gastroparesis in obese patients. Our results indicate that gastroparesis, primarily believed to result in being underweight, can present in morbid obesity and can be markedly improved with RYGB.


Assuntos
Complicações do Diabetes/cirurgia , Derivação Gástrica/métodos , Gastroparesia/cirurgia , Laparoscopia/métodos , Obesidade/cirurgia , Adulto , Índice de Massa Corporal , Doença Crônica , Feminino , Gastroparesia/complicações , Humanos , Masculino , Obesidade/complicações , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Redução de Peso
4.
Perspect Psychiatr Care ; 45(2): 128-39, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19366423

RESUMO

PURPOSE: This study aims to assess the impact of an education program on Australian general nurses' knowledge and competence in identifying and managing patients with alcohol and substance use and misuse, and compare findings with existing literature on mental health nurses. DESIGN AND METHODS: Pre- and posttest design without a control group. FINDINGS: The nurses' knowledge of safe drinking limits and alcohol withdrawal management improved following the education. Nevertheless, overall the nurses reported a lack of adequate knowledge and competence. Compared to mental health nurses, the nurses in this study had lower levels of knowledge and competence. PRACTICE IMPLICATIONS: We suggest several opportunities for general nurses to strengthen their knowledge and skills and the need for a comprehensive and regular education program.


Assuntos
Delirium por Abstinência Alcoólica/enfermagem , Alcoolismo/enfermagem , Competência Clínica , Capacitação em Serviço , Recursos Humanos de Enfermagem Hospitalar/educação , Transtornos Relacionados ao Uso de Substâncias/enfermagem , Adulto , Delirium por Abstinência Alcoólica/diagnóstico , Delirium por Abstinência Alcoólica/reabilitação , Alcoolismo/diagnóstico , Alcoolismo/reabilitação , Currículo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/reabilitação
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