Improving Skin Assessment Documentation in the Electronic Health Record to Prevent Perioperative Pressure Injuries.

Perioperative leaders at a pediatric trauma hospital initiated an examination of the existing processes for pressure injury prevention. They assembled a workgroup comprising a wound and skin clinical nurse specialist, a nursing informatics specialist, and a perioperative nurse specialist who applied a proven change management framework to guide their efforts. The workgroup identified a critical gap in the documentation features in the electronic health record: nurses were unable to communicate skin assessment and pressure injury information easily and consistently across services (eg, inpatient, emergency department, surgical services). Using evidence from nursing and pressure injury associations on skin assessments, interventions, and documentation, the workgroup developed, trialed, and implemented updated documentation fields, making them consistent throughout the electronic health record. Based on postimplementation survey responses, nurses at the hospital are highly satisfied with the changes. The surgically acquired pressure injury rate at the hospital continues to remain low.

The influence of coping styles on long-term employment in multiple sclerosis: A prospective study.

BACKGROUND: The aim was to investigate predictive values of coping styles, clinical and demographic factors on time to unemployment in patients diagnosed with multiple sclerosis (MS) during 1998-2002 in Norway. METHOD: All patients ( N = 108) diagnosed with MS 1998-2002 in Hordaland and Rogaland counties, Western Norway, were invited to participate in the long-term follow-up study in 2002. Baseline recordings included disability scoring (Expanded Disability Status Scale (EDSS)), fatigue (Fatigue Severity Scale (FSS)), depression (Beck Depression Inventory (BDI)), and questionnaire assessing coping (the Dispositional Coping Styles Scale (COPE)). Logistic regression analysis was used to identify factors associated with unemployed at baseline, and Cox regression analysis to identify factors at baseline associated with time to unemployment during follow-up. RESULTS: In all, 41 (44%) were employed at baseline. After 13 years follow-up in 2015, mean disease duration of 22 years, 16 (17%) were still employed. Median time from baseline to unemployment was 6 years (±5). Older age at diagnosis, female gender, and depression were associated with patients being unemployed at baseline. Female gender, long disease duration, and denial as avoidant coping strategy at baseline predicted shorter time to unemployment. CONCLUSION: Avoidant coping style, female gender, and longer disease duration were associated with shorter time to unemployment. These factors should be considered when advising patients on MS and future employment.

"I refer to them as my colleagues": the experience of mutual recognition of self, identity and empowerment in multiple sclerosis.

PURPOSE: To explore how persons with multiple sclerosis (MS) experience participating in inpatient rehabilitation, and how it might provide psychosocial benefits. METHOD: Ten participants with MS who had completed inpatient rehabilitation in Norway and on Tenerife participated in two focus groups. A semi-structured interview protocol was used. Data were analyzed using qualitative content analysis informed by a phenomenological perspective. RESULTS: During inpatient rehabilitation participants shared experiences with symptoms of the disease, of social stigma and coping strategies. They communicated experiences of living with MS and they created a sense of community, they became "colleagues". This experience gave rise to mutual recognition of ability, impairment, self and identity, and thus facilitated personal empowerment to counteract social stigma through adequate coping strategies. CONCLUSION: Participating in inpatient rehabilitation gave people with MS the possibility to exchange information and communicate strategies for coping with the disease-related conditions and societal demands. They established social relations recognizing each other's resources. Participants felt equipped to make decisions and to mobilize individual and collective resources. Recognition of the individual with both ability and impairment can be a key to empowerment. Implications for Rehabilitation In multiple sclerosis (MS), the clinical symptoms and the unpredictability of the disease may have consequences for how patients relate to self and to others, and hence how they perform socially. Stigmatization is commonly experienced among people with MS. The recognition experienced from peers create a sense of community. We recommend health care professionals to acknowledge the importance of peer support for self, identity and empowerment in MS.

Genital ulcers as initial manifestation of Epstein-Barr virus infection: two new cases and a review of the literature.

Genital ulceration is an uncommon manifestation of primary Epstein-Barr virus (EBV) infection. We present here two cases of genital ulcers probably caused by EBV. The first case is a 12-year-old girl with a genital ulcer appearing before specific EBV serology could identify a primary infection. However, serology was positive 13 days after the ulcer appeared. Polymerase chain reaction for EBV was positive in the biopsy from the ulcer as well. The second case is an 18-year-old female in whom the specific EBV serology was positive 8 days after appearance of the ulcer. The ulcers in both cases healed after 21 days. We reviewed the literature and a total of 26 cases of EBV-associated genital ulcers in females are now published. Median age of the 26 cases is 14.5 years of whom only 6 reports previous sexual contact. Mean healing time for the ulcers is 18 days. Our two cases correspond well with clinical reports of 24 EBV-associated genital ulcers in the literature.

Serum adiponectin concentration prior to clinical onset of preeclampsia.

OBJECTIVE: This study assesses whether the adipokine adiponectin is a useful marker in pregnant women who subsequently develop preeclampsia (PE). METHODS: A retrospective case-control study was conducted to measure the total serum levels of adiponectin, measured by radioimmunoassay kit, in serum samples stored in serological biobanks. RESULTS: Total serum adiponectin concentrations between the groups were not significantly different (p = 0.22). There were no obvious clinical signs of the preeclamptic inflammatory process at the time when samples were drawn. CONCLUSION: Using this design, total adiponectin appeared not be a useful pre-clinical marker of PE.