Surgical Outcome after Penile Inversion Vaginoplasty: A Retrospective Study of 475 Transgender Women.

BACKGROUND: For many transgender women, vaginoplasty is the final stage in the gender-confirming process. Penile inversion vaginoplasty is considered the gold standard for vaginal construction in transgender women. In this study, the authors assessed intraoperative and postoperative complications after penile inversion vaginoplasty. METHODS: All patients who underwent penile inversion vaginoplasty between January of 2000 and January of 2014 were identified retrospectively from the authors' hospital registry. A retrospective chart review was conducted. Outcome measures were intraoperative and postoperative complications, reoperations, secondary surgical procedures, and possible risk factors. RESULTS: Between January of 2000 and January of 2014, 475 patients underwent penile inversion vaginoplasty, 405 of whom did not have and 70 of whom did have additional full-thickness skin grafts. The median patient age at surgery was 38.6 years (range, 18.1 to 70.8 years). Median follow-up was 7.8 years (range, 1.0 to 15.9 years). The most frequently observed intraoperative complication was rectal injury [n = 11 (2.3 percent)]. Short-term postoperative bleeding that required transfusion [n = 23 (4.8 percent)], reoperation [n = 7 (1.5 percent)] or both [n = 2 (0.4 percent)] occurred in some cases. Major complications comprised three (0.6 percent) rectoneovaginal fistulas, which were successfully treated. Revision vaginoplasty was performed in 14 patients (2.9 percent). Comorbid diabetes was associated with a higher risk of local infection (OR, 9.8; p = 0.003; 95 percent CI, 2.8 to 34.4), and use of psychotropic medication predisposed to postoperative urinary retention (OR, 2.1; p = 0.006; 95 percent CI, 1.2 to 3.5). CONCLUSIONS: Successful vaginal construction without the need for secondary functional reoperations was achieved in the majority of patients. Intraoperative complications are scarce. Postoperative complications occur frequently but are generally minor and easily treated. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The role of the community nurse on health committees.

With the changes in health care occurring in South Africa, new functions concerning the community nurse are being presented. The goal of the study was to explore and describe the role of the community nurse in health committees. An explorative, descriptive design was used and the empirical part was undertaken within the context of a metropolitan local authority. After conducting a literature study, six major roles of the community nurse on health committees were identified. After that a questionnaire was presented to community nurses to explore and describe their perceptions about the role of the community nurse on health committees. An interview schedule based on the literature study was drafted for presentation to selected members of health committees. Lastly guidelines describing the role of the community nurse on health committees were developed based on the findings of the study.

[The function of the community nurse in acute care district health services]. / Die funksie van die gemeenskapsverpleegkundige in kuratiewe distriksgesondheidsdienste.

In South Africa patients are discharged sooner from hospitals, because of a shortage in hospital beds, thus more patients are nursed at home. More prominence should be given to the function of the community nurse in these mainly curative health services. An explorative and descriptive study was performed in order to explore and describe the functions of the community nurse in the context of the district health service in South Africa. These functions described in this article were determined by means of an analysis of duty sheets as well as the use of questionnaires which was based on a literature study. Some conclusions and recommendations were made on which the community nurse can base these nursing services.

[Effective communication with the mentally challenged person during treatment of minor ailments]. / Fasiliterende kommunikasie met die verstandelik vertraagde persoon tydens die behandeling van geringe ongesteldhede.

The research objectives were to explore and describe the nature of communication with the mentally retarded adult during treatment of minor ailments; and to describe guidelines for the community nurse in order to facilitate more effective communication during the treatment of minor ailments in the mentally retarded adult for the promotion, maintenance and restoration of the mentally retarded individual's health. The community nurse pays attention to the protection of the mentally retarded individual's health, and identifies and treats minor ailments encountered by the mentally retarded individual. Because of the disability of the adults, lacking communication and obstacles in the exchange and interpretation of communication, could take place between the community nurse and the mentally retarded adult. The responsibility lies with the community nurse to facilitate effective communication, since the mentally retarded individual is not always capable of speaking on his/her own behalf. Guidelines are needed for the facilitation of effective communication between the community nurse and the mentally retarded adult during the treatment of minor ailments. In this research, use were made of a qulitative, exploratory, descriptive and contextual design. The research method consisted of participative observation during which video recording and the taking of field notes were applied. Two themes were identified during data analysis, namely: Verbal communication is aimed at the treatment of wounds. The more functional and task-orientated the community nurse's interaction with the mentally retarded individual, the more the mentally retarded individual would generate symptoms to establish emotional contact and interaction; The non-verbal behaviour of the community nurse focuses on the treatment of wounds and organisation of the environment. The more structure is created, the more play-out-behaviour is shown by the mentally retarded individual in need of contact. The researcher came to the conclusion that the community nurse refrains form near/close contact with the mentally retarded individual, to bridge her own discomfort. The community nurse is "busy" with the act of treating wounds, in order to refrain from effective interaction.

Perceptions of sexually transmitted diseases among teenagers.

An exploratory descriptive study was undertaken, focussing on sexually transmitted diseases (STD) among teenagers. The aim of the study was to explore and describe the possible reasons for the high rate of sexually transmitted diseases in teenagers. The perceptions of teenagers and community nurses regarding sexually transmitted disease among teenagers involved in the teenage clinic in a specific predominantly black area were assessed. Twenty teenagers and five community nurses were participants in the study. Two focus group interviews were conducted with teenagers and community nurses. It can be concluded that the attitudes of community nurses may have an influence on the high rate of sexually transmitted diseases among teenagers. The knowledge of the teenagers about sexually transmitted diseases is often based on myths and misconceptions which could be intensified by the community nurse. The recommendations made are that the education standards of all community nurses should be reviewed and adapted to meet the needs of teenagers attending the teenage health services. The policy on in-service training must be reviewed and monitored. Community nurses' intensive training on teenage health service delivery and sexually transmitted diseases services should be in accordance with the principles of Primary Health Care. Community nurses need to attend intensive courses on interpersonal skills specifically related to teenagers. Selection procedures for recruiting community nurses to attend to teenagers specifically should be researched. Teenagers should be involved in planning programs and the teenage clinic should be evaluated frequently to improve the standards. The availability of adequate teenage health services can result in a decrease in sexually transmitted diseases among teenagers.

Integration of the primary health care approach into a community nursing science curriculum.

The purpose of this article is to explore and describe guidelines for integration of the primary health care approach into a Community Nursing Science Curriculum in a Nursing College in Gauteng. A qualitative, exploratory, descriptive and contextual research design was utilized. The focus group interviews were conducted with community nurses and nurse educators as respondents. Data were analysed by a qualitative descriptive method of analysis as described in Creswell (1994: 155). Respondents in both groups held similar perceptions regarding integration of primary health care approach into a Community Nursing Science Curriculum. Five categories, which are in line with the curriculum cycle, were identified as follows: situation analysis, selection and organisation of objectives/goals, content, teaching methods and evaluation. Guidelines and recommendations for the integration of the primary health care approach into a Community Nursing Science Curriculum were described.

The utilization of a Midwifery Obstetrical Unit (MOU) in a Metropolitan area.

In this study an explorative, descriptive design which is contextual in nature, is utilized. The objective of the study is three-fold: Firstly, to describe the opinions of members of the community about the reasons for the under-utilization of the Midwifery Obstetrical Unit (MOU); secondly, to describe the suggestions of the community for improving the utilization of the MOU and thirdly, to describe intervention strategies for community nurses to improve the utilization of the MOU. Data was collected by means of focus group interviews, and was analysed using Tesch's (in Cresswell, 1994: 154-155) method of data analysis. Trustworthiness was ensured by using the method of Guba and Lincoln (1985). The respondents were mothers who delivered their babies at the hospital, mothers who delivered their babies at the MOU, members of the Community Health Committee and MOU nurses. Data was collected in two phases. Phase I dealt with the first question: What is your opinion about the reasons for the under-utilization of the MOU? Phase II dealt with the second question: What are your suggestions for improving the utilization of the MOU? The four groups participated in Phase I as well as in Phase II, the reason being to involve the groups in identifying problems and finding solutions with which they would be comfortable, since it would be their ideas. This whole exercise was, however, carried out in line with the RDP principle of people driven approach or community involvement. The investigation revealed that the community was not utilizing the MOU because of the following reasons: Negative attitudes of nurses. Lack of material and human resources. Poor safety and security measures. Lack of community involvement/participation. The focus groups then identified the following suggestions for improving the utilization of the MOU: Change of attitudes by nurses towards the patients. Availability of material and human resources. Proper safety and security measures in the MOU. Community involvement/participation. Integration of health services. Intervention strategies for community nurses to improve the utilization of the MOU were based on the literature as well as the suggestions made by the focus group respondents because the researcher found the suggestions to be realistic.

Clinical skills of nurses in mobile health services.

The purpose of this study is to explore and describe the acceptability of the clinical skills of community nurses in mobile health services. An explorative, descriptive design was employed. After a literature study, interviews were conducted with patients, and analysed, the results were verified by means of observation of the mobile services. The clinical skills were described as favourable and not favourable by patients some of which were confirmed during the observation phase. Guidelines for a more user friendly service were written.

Perceptions of black women of obesity as a health risk.

This article focuses on the exploration and description of perceptions of patients and community nurses of the phenomenon of obesity as well as any potential problems that could be foreseen if health promotion programs were planned for obese people. Whilst the researcher sought to explore patients' perceptions of obesity as a threat to health it was also necessary to obtain similar information from the community nurses who were giving health services to these patients'. The level of knowledge of obesity as a health problem as well as the nurses personal attitude towards the phenomenon of obesity is crucial in the manner and quality of her interventions. A qualitative, exploratory, descriptive and contextual research design was utilised. Semi-structured interviews were conducted amongst patients and community nurses to collect data regarding perceptions of obesity. Data obtained from patients can be used meaningfully for the planning of health promotion programmes for the obese individuals and families. Some negative and ambivalent statements were also identified as problem areas that need to be worked on. Conclusions drawn from the findings on nurses responses highlighted a number of problem areas which were identified in the cognitive, psychomotor and affective domains of the community nurse as health professional. Certain shortcomings were also identified with the community health structures which may not be supportive to the community nurse, individuals and families with problems of obesity.

[Assessment of the community health nursing curriculum in relation to the modified Stake curriculum evaluation model]. / Beoordeling van gemeenskapsverpleegkundekurrikula na aanleiding van die gewysigde Stake-kurrikulumevalueringsmodel.

The modified Stake curriculum evaluation model was implemented in practice to evaluate the Community Nursing Science curricula of three Nursing Colleges and the method used is outlined. Some of the results obtained regarding the model's description matrix are: . students are not familiar with the philosophy of Community Nursing Science; . students doubt their readiness for clinical work directly after training; . only one of the tutors in Community Nursing Science had applicable clinical experience in community nursing; . satisfaction regarding the content and evaluation of Community Nursing Science exists amongst students. The purpose of the evaluation was to identify shortcomings in the curricula and and to facilitate curriculum improvement.

Meclofenamate does not reduce chronic hypoxic pulmonary vasoconstriction.

There was no reduction in the pulmonary pressor response to hypoxia following inhibition of prostaglandin synthesis in rats exposed to chronic hypoxia. A fall in left ventricular weight suggested that systemic pressure may have been reduced after inhibition of prostaglandin synthesis in normoxic rats.