Treatment of adult congenital anal atresia with rectovestibular fistula: A rare case report.

BACKGROUND: Female anorectal malformation is a correctable congenital defect. Delayed manifestations in patients with anal deformities are uncommon, especially after adolescence. CASE SUMMARY: The clinical data of a 19-year-old adult female patient with congenital anal atresia accompanied by rectovestibular fistula as the main manifestation was retrospectively analyzed. Diagnosis was made based on the patient's clinical symptoms, signs, imaging showing the fistula, X-ray and magnetic resonance imaging results. The preoperative examination was improved. Anorectoplasty was performed. The patient exhibited an improvement in quality of life and presented no evidence of fecal incontinence during the 6-mo follow-up. CONCLUSION: Transfistula anorectoplasty is a reasonable and reliable surgical method for the treatment of adult congenital anal atresia and rectovestibular fistula.

[Prevention and nursing care of central line-associated bloodstream infections in critically ill patients].

Catheter-related bloodstream infections are associated with significantly increased morbidity, mortality, and expenditures. Such infections are a serious threat to patient safety in the intensive care unit. This review describes the latest protocols related to preventing and treating central venous catheter-associated bloodstream infections in critically ill patients. According to 2011 Center for Disease Control (CDC) guidelines and central line care bundles by the institute for healthcare improvement (IHI), prevention measures for catheter-related bloodstream infections include the following: hand hygiene, maximal barrier precautions insertion, chlorhexidine skin antisepsis, optimal catheter site selection, proper catheter maintenance, insertion site care, and daily review of line necessity, with prompt removal of unnecessary lines. These are important and effective infection prevention measures. Guidelines and care bundles also recommend organizing care modules based on unit characteristics; integrating resources and empirical measures; education and training to promote comprehensive implementation; and auditing and monitoring to ensure staff continue to follow procedures. Effectively preventing central venous catheter-related bloodstream infections can enhance care quality and move healthcare closer to achieving the goal of zero tolerance.

The effectiveness of valerian acupressure on the sleep of ICU patients: a randomized clinical trial.

BACKGROUND: Severely ill patients often experience problems with sleep. Either acupressure or valerian aromatherapy are reported as helpful in promoting sleep. OBJECTIVES: The purpose of this study was to explore the effectiveness of valerian acupressure on the sleep of patients in the intensive care unit (ICU). DESIGN: A randomized clinical trial. SETTING: A 42-bed adult intensive care unit. PARTICIPANTS: Forty-one subjects in the experimental group and 44 subjects in the control group. METHODS: The measurement included observation, and actigraphy measures during 10 pm-6 am, and the Stanford Sleepiness Scale (SSS) measures on the next morning. Experimental groups received valerian acupressure on the Shenmen, Neiguan, and Yongquan acupoints between 7 pm and 10 pm of the second day while control groups received regular treatment. Heart rate was measured for 5 min before and after valerian acupressure present for HR variability analysis to measure relaxation response. RESULTS: The results indicated that after receiving valerian acupressure, patients' sleeping hours increased, wake frequency reduced and SSS grades declined. The HR variability data indicated relaxation response immediately after valerian acupressure. CONCLUSION: This study supports the hypothesis that valerian acupressure on the Shenmen, Neiguan, and Yongquan acupoints could improve the sleeping time and quality of ICU patients.