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Inflammatory changes in the paranasal sinuses are a common incidental finding on magnetic resonance imaging (MRI) of the head and neck. This study aimed to assess the prevalence and seasonal variation of inflammatory paranasal sinus changes in an asymptomatic Irish population. Retrospective analysis was performed on 221 patients who underwent brain MRI at the time points of winter and summer. T2-weighted sequences were evaluated for paranasal sinus disease. Nearly half the patients in the study exhibited morphological paranasal sinus changes on imaging suggesting that these could be considered a normal variant. Correlation of imaging findings with clinical symptoms and signs remain crucial to the diagnosis of sinusitis.
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Hallazgos Incidentales , Imagen por Resonancia Magnética/estadística & datos numéricos , Senos Paranasales , Estaciones del Año , Sinusitis/diagnóstico por imagen , Enfermedades Asintomáticas/epidemiología , Humanos , Irlanda/epidemiología , Prevalencia , Estudios Retrospectivos , Sinusitis/epidemiologíaRESUMEN
The aim of the study was to determine the added value of stroke protocol MRI following negative initial CT brain in the acute stroke setting. A retrospective study was performed over a 6 month period in a tertiary referral stroke centre. Patients were selected from the stroke and radiology databases. Inclusion criteria: clinical stroke syndrome, negative initial CT with subsequent MRI study with diffusion weighted sequences. Ninety two patients were reviewed and 73 (M:F of 39:34, mean age 62.1 ± 14.0 years) met the inclusion criteria. Twenty MRI studies (27.4%) were positive for acute/subacute ischaemia in the setting of a normal initial CT. The average time interval between initial CT and MRI brain imaging was 4.7 ± 2.6 days. Whilst CT continues to be the first line imaging investigation for acute stroke, MRI has substantial added value following negative initial CT in the diagnosis of stroke.
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Imagen de Difusión por Resonancia Magnética/estadística & datos numéricos , Accidente Cerebrovascular/diagnóstico , Anciano , Protocolos Clínicos , Reacciones Falso Negativas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Atención Terciaria de Salud/estadística & datos numéricos , Tomografía Computarizada por Rayos XRESUMEN
Carbapenemase-producing Enterobacterales (CPE) is an increasing public health concern; these bacteria are highly transmissible in hospital environments and the number of patients with these multidrug-resistant bacteria is rising. Healthcare workers caring for patients colonized with CPE offer insight into care delivery and processes in the hospital setting. The aim of this review was to explore healthcare workers' experiences of caring for patients colonized with CPE. A scoping review method was employed and seven electronic databases (CINAHL, Academic Search Complete, Cochrane, Embase, Medline, Web of Science and Scopus) and four grey literature databases (Open Grey, Grey Literature Report, Clinical trials. gov and WHO International Clinical Trials Registry Platform) were searched using specific search terms and inclusion/exclusion criteria. A PRISMA flow diagram was used to illustrate the process of article selection and thematic analysis used to form themes. Three studies met the criteria to be included in this review. Two main themes were identified from analysing the articles: 'Safeguarding' and 'Power of Knowledge'. The desire to protect themselves, their families and patients was evident from the studies. Healthcare workers were aware of the importance on infection prevention and control measures such as hand hygiene, in preventing the transmission of CPE, however barriers to these were identified, such as time constraints. In conclusion, healthcare workers have negative associations when it comes to caring for patients with CPE. Very little research has been conducted in the area and there is an opportunity to further explore the experience of healthcare workers caring for patients with CPE to identify opportunities for improvement and support of staff.
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Infecciones Bacterianas , Gammaproteobacteria , Personal de Salud , Control de Infecciones , Humanos , Proteínas Bacterianas , Gammaproteobacteria/patogenicidad , Personal de Salud/psicología , Hospitales , Atención al Paciente , Control de Infecciones/métodos , Infecciones Bacterianas/prevención & control , Infecciones Bacterianas/transmisiónRESUMEN
Coeliac disease is a malabsorption syndrome in which dietary gluten damages the small bowel mucosa. Gluten contains gliadin, the primary toxic component that is primarily found in wheat, barley and rye products. The initial diagnosis of coeliac disease is usually made by endoscopic biopsy of the jejunum although sometimes imaging features can suggest the diagnosis. Once a diagnosis is made, patients need to be diet compliant and monitored for potential complications. Many complications are more common when dietary compliance is poor. Complications include intussusception (usually intermittent), ulcerative jejunitis, osteomalacia, cavitating lymph node syndrome and an increased risk of malignancies such as lymphoma, adenocarcinoma and squamous cell carcinoma. Radiological evaluation is central in the evaluation of these complications. Imaging may assist both in the diagnosis and staging of complications as well as enabling radiological guided percutaneous biopsy for complications of coeliac disease such as lymphoma. As coeliac disease is a relatively common disorder, it is likely that most radiologists will encounter the disease and its potential complications. The aim of this review article is to discuss and illustrate the role of modern radiology in evaluating the many presentations of this complex disease.
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Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/diagnóstico por imagen , Sulfato de Bario , Medios de Contraste , Humanos , Ileítis/diagnóstico por imagen , Ileítis/etiología , Neoplasias Intestinales/diagnóstico por imagen , Neoplasias Intestinales/etiología , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Linfoma/diagnóstico por imagen , Linfoma/etiología , Tomografía Computarizada por Rayos XRESUMEN
WHAT IS KNOWN ON THE SUBJECT?: Caring for people with dementia and responsive behaviours is challenging; however, little is known of nurses' experiences of responsive behaviours. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: To demonstrate understanding nurses need to be aware of their own actions, thoughts, attitudes and reactions. Time, education and management support are essential in enabling a person-centred approach. A decision regarding the place of care is difficult to come to, and given the drive to a person-centred approach, there is a need to consider the views of people with dementia. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nursing staff supporting people with dementia should engage more frequently in reflective practice, ongoing education and decision-making. Service providers/managers need to have an understanding of the complexities of caring for a person with dementia and responsive behaviours and provide their staff with relevant supports and education that is accessible to all staff. ABSTRACT: Introduction Caring for people with dementia and responsive behaviours can challenge nurses, and little is known of their experiences. Aims To explore nurses' views of supporting people with dementia and responsive behaviours in long-stay facilities. Methods A qualitative descriptive study utilizing in-depth audio-recorded interviews of nine nurses, recruited from private and public care facilities. Qualitative content analyses conducted involving iterative comparisons of transcripts, summaries and memos, where coding, key quotes and tables were developed to determine themes. Results Four themes emerged: recognizing and understanding responsive behaviour, resources and interventions to support people with dementia and responsive behaviour, the impact of education on nursing practice and the care environment. Discussion Availability of staff, adequate time and financial restraints hinder nurses' ability to provide care. Access to ongoing education and being able to provide one-to-one care was valued as dementia-specific education changed nursing practice. Implications for practice Place of care was seen as dependent on the type of responsive behaviour in question, the duration of the behaviour and the impact of the behaviour on the person, other residents and staff. Dementia education needs to be accessible to all staff, and a collaborative approach is necessary in order to develop management guidelines and support strategies.
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Actitud del Personal de Salud , Centros Comunitarios de Salud , Demencia/enfermería , Demencia/psicología , Conocimientos, Actitudes y Práctica en Salud , Hospitales , Casas de Salud , Personal de Enfermería , Anciano , Femenino , Humanos , Cuidados a Largo Plazo , Masculino , Investigación Cualitativa , Adulto JovenRESUMEN
Peripancreatic pseudoaneurysm formation is a recognized complication of pancreatitis. When associated with an acute episode of pancreatitis, surgical treatment is often difficult due to the inflammatory process that surrounds the pseudoaneurysm. In the stable patient, transcatheter embolization is the treatment of choice of this complication. However, this is not always technically feasible, as the aneurysm may be supplied by small inaccessible branch vessels. Recently, percutaneous thrombin injection has been described as a possible alternative for pseudoaneurysms. This is generally performed under computed tomography guidance in stable patients with non-ruptured pseudoaneurysms. We describe an acutely ruptured peripancreatic pseudoaneurysm in a critically ill patient, in whom percutaneous thrombin injection under computed tomography guidance resulted in immediate stabilization and cure of the pseudoaneurysm.
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Aneurisma Falso/terapia , Aneurisma Roto/terapia , Embolización Terapéutica , Hemostáticos/administración & dosificación , Enfermedades Pancreáticas/terapia , Trombina/administración & dosificación , Humanos , Masculino , Persona de Mediana EdadRESUMEN
WHAT IS KNOWN ON THE SUBJECT?: Current policy advocates for the participation of family carers in care planning. Caring for a person with a mental illness requires a significant commitment from families to support their relative's recovery. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The evidence of family involvement in care planning is generally fraught with conflicting experiences related to different requirements between mental health professionals, families and service users. Confidentiality remains contentious at a practice level in terms of information sharing and decision-making. There is a requirement and need for a shared understanding around care planning between families and mental health professionals. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The provision of written information pertaining to families regarding confidentiality is required at service level. Educational workshops concerning care planning and treatment options should be provided for service users, families and mental health professionals. Further research into effective service-wide strategies that explore with families how their engagement can be positively fostered in mental health services is warranted. ABSTRACT: Introduction Mental health service policy stipulates that family carers be involved in care planning. Aim To identify families' experiences of care planning involvement in adult mental health services. Method An integrative review where electronic databases and grey literature were searched for papers published between 01 January 2005 and 10 February 2016. Results Fifteen papers met the inclusion criteria. Thematic analysis generated three themes: (1) families' experience of collaboration, (2) families' perceptions of professionals and (3) families' impressions of the care planning process. Collaborative decision-making is not regularly experienced by families with an 'us' and 'them' divide, perpetuated by a lack of communication, confidentiality constraints and a claim of 'insider knowledge' of service users. When involved, families perceive care planning to be uncoordinated and that their lived experiences are not always appreciated. Discussion Families need to be valued, empowered and engaged in care planning and the partnership distance be addressed. Accommodating the views of family, service user and professionals is preferable but not always possible. Our findings suggest that the key element for professionals is to value all 'insider knowledge' where possible. Implications for Practice Services should develop written information on confidentiality for families and facilitate open communication concerning their involvement in care planning.
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Familia , Trastornos Mentales/enfermería , Servicios de Salud Mental , Planificación de Atención al Paciente , HumanosRESUMEN
Congenital adrenal hyperplasia (CAH) is a genetic autosomal recessive condition most frequently as a result of a mutation in the 21-hydroxylase enzyme gene. Patients with poorly controlled CAH can manifest characteristic imaging findings as a result of adrenocorticotrophic hormone stimulation or the effects of cortisol precursor excess on various target organs. We present a spectrum of imaging findings encountered in adult patients with poorly treated CAH, with an emphasis on radiological features and their clinical relevance.
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Glándulas Suprarrenales/patología , Hiperplasia Suprarrenal Congénita/diagnóstico , Gónadas/patología , Hiperplasia Suprarrenal Congénita/complicaciones , Adulto , Enfermedades del Sistema Nervioso Central/complicaciones , Enfermedades del Sistema Nervioso Central/diagnóstico , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Enfermedades Musculoesqueléticas/complicaciones , Enfermedades Musculoesqueléticas/diagnóstico , Tomografía Computarizada por Rayos X/métodosAsunto(s)
Aneurisma Falso/terapia , Duodeno/irrigación sanguínea , Hemostáticos/uso terapéutico , Trombina/uso terapéutico , Aneurisma Falso/etiología , Arterias , Embolización Terapéutica/métodos , Humanos , Inyecciones Intraarteriales , Pancreatitis/complicaciones , Estómago/irrigación sanguínea , Tomografía Computarizada por Rayos X/métodosRESUMEN
Within intellectual disability nursing students are prepared within a biopsychosocialeducational model and curriculum address these challenges. Using a simulated learning environment has great potential for promoting competence and in-depth knowledge of substantive topics relevant to practice. This article presents an assignment designed to more closely resemble real-world activities to allow students develop and exercise skills that translate to practice activities and incorporates a student's reflective comments on the process. The assignment was designed to foster intellectual disability student nurses ability to facilitate family/client education. The aim of the assignment was fulfilled through the students designing a clinical skill teaching session that could be used with families/clients. The sessions were recorded and the student reviewed their recording to reflect on their performance and to self assess. To facilitate student learning the modules academic lecturer also reviewed the recording and both lecturer and student meet to discuss the reflection and self assessment.
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Competencia Clínica , Bachillerato en Enfermería/métodos , Aprendizaje , Estudiantes de Enfermería/psicología , Grabación en Video , Actitud del Personal de Salud , Femenino , Humanos , Discapacidad Intelectual/enfermería , Masculino , Relaciones Enfermero-Paciente , Investigación en Educación de Enfermería , Investigación en Evaluación de Enfermería , Investigación Metodológica en Enfermería , Educación del Paciente como Asunto , Relaciones Profesional-Familia , Autoevaluación (Psicología)Asunto(s)
Colelitiasis/cirugía , Obstrucción de la Salida Gástrica/cirugía , Anciano , Fístula Biliar/complicaciones , Fístula Biliar/cirugía , Colelitiasis/complicaciones , Obstrucción Duodenal/etiología , Obstrucción Duodenal/cirugía , Femenino , Obstrucción de la Salida Gástrica/diagnóstico , Obstrucción de la Salida Gástrica/etiología , Gastroscopía , Humanos , SíndromeRESUMEN
Assessment has long been recognised as the single most influential factor in shaping what and how students in higher education choose to learn and the quality of learning outcomes depends on the quality of assessment. Within intellectual disability nursing the student are prepared within a biopsychosocial educational model and curriculum address these challenges. Structured student debates have great potential for promoting competence and in-depth knowledge of substantive topics relevant to practice. Like other interactive assignments designed to more closely resemble real-world activities, issue-oriented debates actively engage students in course content. Allowing students to develop and exercise skills that translate to practice activities. Most importantly debates help to stimulate critical thinking by shaking students free from established opinions and helping them to appreciate the complexities involved in practice. This article identifies the use of a debate as an assessment method within an intellectual disability nursing programme and a student's reflective comment on the process, and their experience of a debate as their assessment method.
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Competencia Clínica , Educación en Enfermería/organización & administración , Evaluación Educacional/métodos , Estudiantes de Enfermería/psicología , Aprendizaje Verbal , Actitud del Personal de Salud , Humanos , Investigación en Educación de Enfermería , Investigación en Evaluación de Enfermería , Investigación Metodológica en EnfermeríaRESUMEN
INTRODUCTION: Adrenal gland injury (ADGI) is quite rare and mostly associated with other organ injuries secondary to blunt thoracoabdominal trauma. Bilateral ADGI has severe consequences if not discovered in the treatment course of trauma victims. PURPOSE: To review our experience of management of ADGI, epidemiology, and outcomes in a major Australian trauma institute. METHODS: A retrospective analysis of all patients presenting with thoracoabdominal trauma to the Alfred Hospital who had been diagnosed with adrenal gland injury between July 2001 and July 2007. RESULTS: Of 3,921 patients with blunt thoracoabdominal injuries, 2.4% were identified with blunt ADGI (70 males and 26 women, age range 15-85 years). Right adrenal injuries occurred in 72.9%, left adrenal injuries in 22.9%, and bilateral ADGI in 4.2%. Computed tomography (CT) scan findings revealed 82.2% of acute injuries to be hyperdense hematoma expanding and distorting the adrenal gland. Periadrenal stranding and hemorrhagic changes around the adrenal limbs were seen in 12.5%. Oval or round lesions were seen in 3.1%. Surgery was performed in 25% of the study group for associated thoracoabdominal injuries. Patients with left adrenal gland injury had higher rates of mortality and morbidity, and length of stay. CONCLUSION: ADGI is being increasingly recognized with the widespread use of CT scan in the evaluation of multitrauma patients. ADGI is usually self-limiting and typically managed nonoperatively. Acute adrenal insufficiency should be considered and investigated in case of unexplained hypotension in uni- or bilateral ADGI.
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Fibromuscular dysplasia (FMD) describes a group of conditions which cause nonatheromatous arterial stenoses, most commonly of the renal and carotid arteries, typically in young women. We report a rare case of bilateral segmental renal infarction secondary to FMD in a young male patient. His initial presentation with loin pain and pyrexia resulted in a delay in the definitive diagnosis of FMD. He was successfully treated with bilateral balloon angioplasty. The delayed diagnosis in this patient until the condition had progressed to bilateral renal infarcts highlights the need for prompt investigation and diagnosis of suspected cases of FMD.
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Displasia Fibromuscular/complicaciones , Infarto/etiología , Enfermedades Renales/etiología , Riñón/irrigación sanguínea , Adulto , Angiografía , Angioplastia de Balón , Displasia Fibromuscular/diagnóstico por imagen , Humanos , Infarto/diagnóstico por imagen , Infarto/terapia , Enfermedades Renales/diagnóstico por imagen , Enfermedades Renales/terapia , Masculino , Tomografía Computarizada por Rayos XRESUMEN
This study aimed to assess the role of percutaneous vertebroplasty (VP) in the management of acute traumatic burst fractures. We describe three cases where percutaneous VP was carried out for traumatic non-osteoporotic burst vertebral fractures. For clinical symptoms and the effect of the VP procedure to be assessed, all patients completed a visual analogue scale and a mobility score before the procedure and at day 1 and 3 months post procedure. Improvements in both pain and mobility scores immediately post procedure were seen in all patients, and these results persisted at 3-month follow up. Percutaneous VP provided a successful, minimally invasive treatment of these patients' traumatic fractures while avoiding major surgical procedures and associated surgical morbidity and complications.
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Fracturas Conminutas/diagnóstico , Fracturas Conminutas/terapia , Fracturas de la Columna Vertebral/diagnóstico , Fracturas de la Columna Vertebral/terapia , Vertebroplastia/métodos , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Resultado del TratamientoRESUMEN
BACKGROUND: We present the case of a 14-year-old with a 3-month history of back pain, who on presentation, was demonstrated to have neurological signs. METHOD: Investigation with radiographs and subsequent magnetic resonance imaging was performed, which demonstrated an expansile lesion in the tenth thoracic vertebra with posterior extension causing spinal cord compression. This was treated with surgical resection and spinal cord decompression. RESULTS: Diagnosis of aneurysmal bone cyst was made following histopathological examination of the resected lesion. CONCLUSION: Back pain in childhood is a significant and often sinister symptom, which requires careful evaluation.
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Dolor de Espalda/etiología , Compresión de la Médula Espinal/complicaciones , Vértebras Torácicas/patología , Adolescente , Dolor de Espalda/diagnóstico por imagen , Dolor de Espalda/cirugía , Humanos , Masculino , Radiografía , Compresión de la Médula Espinal/cirugía , Vértebras Torácicas/cirugíaRESUMEN
The aim of this study was to evaluate our experience with the retrievable Cook Celect inferior vena cava (IVC) filter (William Cook, Europe) with regard to insertion, efficiency, ease of retrieval, and any associated complications. A retrospective review was performed of 115 patients (41 female, 74 male, mean age 47.97 years) who underwent Cook Celect IVC filter insertion between December 2005 and October 2007. Filter insertion was successful in all patients. Of the 115 filters inserted, 57 have been successfully retrieved (49.6%) to date. The successful retrieval rate from attempted retrieval was 93.4%. The mean dwell time of successfully retrieved filters was 114.9 days (range 14-267 days). Failed retrievals were due to a thrombosed vena cava (n = 1) and endothelialisation of the filter (n = 3). In the failed retrieval group the mean implantation time was 142 days (range 78-211 days). While this is the first retrospective clinical study on the Cook Celect filter, results to date are promising. We demonstrated an efficacious filter with a high successful retrieval rate of 93.4% and a low complication rate. The filter was assessed with extended dwell times (range 14-267 days). Failed retrieval secondary to hook endothelialisation continues to be an issue with this filter. We recognize that a limitation of our study was the lack of systematic follow-up for clinically silent complications. Further studies to evaluate longer term outcomes and effectiveness of this filter are warranted.
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Remoción de Dispositivos/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Embolia Pulmonar/epidemiología , Embolia Pulmonar/prevención & control , Filtros de Vena Cava/estadística & datos numéricos , Trombosis de la Vena/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Seguridad de Equipos/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico por imagen , Radiografía , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Trombosis de la Vena/diagnóstico por imagen , Adulto JovenRESUMEN
Traumatic vascular injuries involving the extremity are rare and penetrating trauma accounts for the majority of such injuries. The remaining arterial injuries are as a result of either blunt or iatrogenic injuries. The rapid detection, localisation and characterisation of vascular injuries in patients who have a traumatic extremity injury is essential for the effective management and treatment of such injuries. This review will discuss the expanding role of multi-detector computed tomography angiography in diagnosing vascular injuries and its implications on conventional diagnostic angiography. The roles of other non-invasive imaging modalities are reviewed. The presentation and types of vascular injuries in blunt and penetrating injuries are discussed. While surgery remains the gold standard in the management of vascular extremity injuries it has significant morbidity rates. Endovascular techniques are increasingly being used for the treatment of vascular traumatic injuries and various techniques including balloon occlusion, embolisation and stent/stent graft placement are discussed.
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Brazo/irrigación sanguínea , Vasos Sanguíneos/lesiones , Pierna/irrigación sanguínea , Heridas no Penetrantes/terapia , Heridas Penetrantes/terapia , Adulto , Embolización Terapéutica/métodos , Extremidades/diagnóstico por imagen , Extremidades/lesiones , Femenino , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Stents , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnóstico , Heridas Penetrantes/diagnósticoRESUMEN
Horseshoe kidney is the most common renal fusion anomaly and the patients are prone to a variety of complications, such as stone disease, pelviureteric junction (PUJ) obstruction, trauma, infections and tumours. As result of the abnormal anatomy of a horseshoe kidney, imaging and treatment pathways vary substantially from the normal kidney. In this review, we describe the role of modern imaging in depicting horseshoe kidneys and their complications, in tandem with the role the interventional radiologist plays in treating these patients.