In the shadows: parents of seriously ill adult children.

Life-threatening diseases are being diagnosed at younger ages and successfully managed for longer periods of time. Adult patients increasingly will have parents who want to be present and help during treatment. Little is known about how best to include parents of adult children in the nursing plan of care. Healthcare professionals must balance the independence and privacy needs of adult patients with parents' desire to help and provide care.

Prospective clinical assessment of the transvaginal mesh technique for treatment of pelvic organ prolapse-5-year results.

OBJECTIVES: : The objective of the study was to assess the effectiveness and complication rates for the transvaginal (TVM) technique in the treatment of pelvic organ prolapse (POP). METHODS: : Women with symptomatic POP (POP-Q stage II-IV) were invited to participate in this institutional review board-approved 5-year study at 3 US centers. All enrolled patients underwent prolapse repair surgery with GYNEMESH PS Prolene Nonabsorbable Soft Mesh using the TVM technique. Success was defined as International Continence Society (ICS) POP-Q stage I or less. The Prolapse-Specific Inventory and quality-of-life questionnaire was used as a subjective outcome measure. RESULTS: : Eighty-five women were included. Sixty-six patients were available for follow-up at 5 years. Overall anatomic success rates were 88% (90% confidence interval [CI], 80%-93%), 69% (90% CI, 59%-78%), and 67% (95% CI, 56%-76%) at 1, 3, and 5 years, respectively. Anatomic success rates in treated compartments were 89% (90% CI, 82%-94%), 76% (90% CI, 66%-84%), and 77% (90% CI, 67%-85%) at 1, 3, and 5 years, respectively. When defined as treated side leading edge above the hymen, success rates were 89% at 5 years. Five patients required reoperation for prolapse by 5 years. Statistically significant improvements in quality-of-life and Prolapse-Specific Inventory scores were sustained over 5 years. Mesh exposure was observed in 16 of 85 patients over the 5 years. Nine required partial mesh excision. There were 3 patients with some degree of dyspareunia, reported between 3 and 5 years, whereas in 8, preexisting dyspareunia resolved. There was 1 rectovaginal fistula reported and 2 reported ureteral injuries, one of which resulted in a ureteral-vaginal fistula; all resolved after repair. CONCLUSIONS: : Five-year results indicated that TVM provided a stable anatomic repair. Improvements in quality of life and associated improvements in specific prolapse symptoms were sustained over the 5-year period. Mesh exposure was the most common complication.

Organ donation after circulatory death: vital partnerships.

OVERVIEW: The authors present the case of a woman in her mid-50s who sustained extensive brain injury in an accident but wasn't declared brain dead. The case highlights some of the clinical and ethical considerations of organ donation after circulatory death (also known as non-heart-beating donation and donation after cardiac death). It also illustrates the interdisciplinary teamwork necessary for organ donation in such cases, involving nurses and other clinicians in the ICU, palliative care, and the local organ procurement organization, among others. KEYWORDS: cardiac death, circulatory death, donation after cardiac death, end-of-life care, ethics, non-heart-beating donation, organ donation, organ donation after circulatory death, organ transplantation, palliative care.