Long-term use of antibiotics and risk of colorectal adenoma.

OBJECTIVE: Recent evidence suggests that antibiotic use, which alters the gut microbiome, is associated with an increased risk of colorectal cancer. However, the association between antibiotic use and risk of colorectal adenoma, the precursor for the majority of colorectal cancers, has not been investigated. DESIGN: We prospectively evaluated the association between antibiotic use at age 20-39 and 40-59 (assessed in 2004) and recent antibiotic use (assessed in 2008) with risk of subsequent colorectal adenoma among 16 642 women aged ≥60 enrolled in the Nurses' Health Study who underwent at least one colonoscopy through 2010. We used multivariate logistic regression to calculate ORs and 95% CIs. RESULTS: We documented 1195 cases of adenoma. Increasing duration of antibiotic use at age 20-39 (ptrend=0.002) and 40-59 (ptrend=0.001) was significantly associated with an increased risk of colorectal adenoma. Compared with non-users, women who used antibiotics for ≥2 months between age 20 and 39 had a multivariable OR of 1.36 (95% CI 1.03 to 1.79). Women who used ≥2 months of antibiotics between age 40 and 59 had a multivariable OR of 1.69 (95% CI 1.24 to 2.31). The associations were similar for low-risk versus high-risk adenomas (size ≥1 cm, or with tubulovillous/villous histology, or ≥3 detected lesions), but appeared modestly stronger for proximal compared with distal adenomas. In contrast, recent antibiotic use within the past four years was not associated with risk of adenoma (ptrend=0.44). CONCLUSIONS: Long-term antibiotic use in early-to-middle adulthood was associated with increased risk of colorectal adenoma.

[NURSING CARE FOR A PATIENT UNDERGONE ENDONASAL ENDOSCOPIC APPROACH PITUITARY SURGERY]. / Cuidados de enfermería a paciente sometido a cirugía hipofisaria MEDIANTE ABORDAJE ENDOSCÓPICO ENDONASAL.

The pituitary gland is an endocrine gland that releases different hormones responsible for controlling the production of hormones in other glands, and maintaining the body's homeostasis. This tiny gland is located in a bone cavity known as the sellaturcica. Anomalous growth of some cells produces pituitary adenomas, which represent between 10 and 15% of intracranial tumors. In the majority of cases, the cause is unknown, but they are usually benign tumors with a slow growth rate. Due to the wide range of functions of the pituitary gland, it can present a wide variety of symptoms which tend to present once the adenoma has reached a certain size. The most commonly used currently access to the pituitary gland is the transphenoidal endoscopic approach. We present here the case of a 28 year old man diagnosed with a non-functioning pituitary macroadenoma, describing the health education, monitoring and emotional support provided during his hospital stay and the recommendations made on his discharge from hospital. It is important to emphasise the role of nursing in order to avoid complications and ensure that care is adapted to the needs of the individual at all times.

Comparisons of screening colonoscopy performed by a nurse practitioner and gastroenterologists: a single-center randomized controlled trial.

Several barriers to colorectal cancer screening have been identified including limited access to trained endoscopists and highlight insufficient capacity to meet projected demand for colonoscopies. Two European studies have found that nonphysician providers can perform colonoscopies as safely and accurately as physicians. Training nurse practitioners (NP) to perform colonoscopy may be an effective strategy to increase access. The goal of this study was to compare accuracy, safety, and patient satisfaction in screening colonoscopy performed by board certified gastroenterologists (GI-MD) and a gastroenterology trained nurse practitioner (GI-NP). A consecutive sample of average risk participants referred for screening colonoscopy was randomized to have their procedure performed by either a GI-MD (n = 100) or a GI-NP (n = 50). Participants completed a preprocedure and postprocedure questionnaire. Endoscopists completed a postprocedure questionnaire. Cecal intubation rates, duration of procedure, sedative, and analgesic use, and patient reported procedural pain scores were equivalent among the groups. The GI-NP group had a higher adenoma detection rate compared with the combined GI-MD groups (42% and 17%, respectively, p = .0001) and a higher satisfaction score when compared with the combined GI-MD groups (mean 5.9 ± 13.81 and 8.6 ± 16.11, respectively, p = .042; visual analog scale 0-100 mm, "0" = completely satisfied, "100" = completely dissatisfied). There were no immediate complications reported in any group. The properly trained GI-NP in our study performed screening colonoscopy as safely, accurately, and satisfactorily as the GI-MDs. Using well-trained NPs for screening colonoscopy can be an effective strategy to increase access to colorectal screening.

Pharmacological management of secreting pituitary tumors.

Because pituitary adenomas can present in many ways, nurses need to be aware of the signs and symptoms of different hormone-secreting tumors and their related pharmacologic treatment. Although long-term medical management of secreting tumors and their hormonal complications is usually carried out on an outpatient basis, diagnosis often occurs during inpatient care. Consequently, nurses in both settings need to be knowledgeable about medications used, outcomes expected, and adverse effects experienced. Patient care should be centered around education and management of complications as patient compliance is increased with knowledge.

Caring for the patient undergoing transsphenoidal surgery in the acute care setting: an alternative to critical care.

Patients undergoing transsphenoidal surgery have complex needs that require expert care and the coordination of a multidisciplinary team of healthcare professionals. In general, patients requiring this surgery are cared for in intensive care units. An innovative program at the University of Virginia, developed 11 years ago, enables these patients to be cared for on an acute care unit for the entirety of their hospitalization. The success of this program is evident in positive clinical and financial outcomes.

Transsphenoidal adenomectomy.

The pituitary gland is a complex organ controlling many of the body's hormonal and metabolic functions. The gland's complexity and location in the brain have a serious impact on the diagnosis and treatment of pituitary pathology. Several surgical approaches are available to treat pituitary tumors; however, the transsphenoidal approach allows the surgeon to remove the tumor with minimal damage to surrounding intracranial structures. Perioperative nurses should be knowledgeable about pituitary pathology (ie, mass effect, hormonal involvement), patient treatment options, surgical approaches, and possible postoperative complications to provide quality nursing care.

Transsphenoidal resection of pituitary adenoma: using a critical pathway.

The use of a transsphenoidal critical pathway can be a vital tool for critical care nurses in anticipating complications and improving patient outcomes. Complications such as diabetes insipidus and cerebrospinal fluid leak associated with posttranssphenoidal patients may result in prolonged hospitalization and worsened functional outcome. Implementing a transsphenoidal critical pathway for these patients can guide their care and alert critical care nurses to potential complications and their prevention and/or treatment.

Pituitary tumors and hypertension: implications for neurosurgical nurses.

Hypertension is found in association with functioning pituitary tumors causing acromegaly and Cushing's disease. In acromegaly, the cure of the disease or decrease in level of HGH is not seen to correlate with a decrease in blood pressure, perhaps due to longstanding changes such as cardiac enlargement or increased blood volume. Many investigators have reported a cure or improvement of the hypertension in patients with Cushing's disease following successful treatment. Nursing management of the patient with a pituitary tumor should emphasize a thorough history and physical examination as well as an awareness of hypertension and its impact. Nurses must also assume responsibility for careful monitoring both before and after the patient's surgery.