A systematic review of the therapeutic interventions for heterotopic ossification after spinal cord injury.

STUDY DESIGN: Systematic review. OBJECTIVE: To conduct a systematic review of the effectiveness of interventions used to prevent and treat heterotopic ossification (HO) after spinal cord injury (SCI). SETTING: St Joseph's Parkwood Hospital, London, Ontario, Canada. METHODS: MEDLINE, CINAHL, EMBASE and PsycINFO databases were searched for articles addressing the treatment of HO after SCI. Studies were selected by two reviewers and were only included for analysis if at least 50% of the subjects had an SCI, there were at least three SCI subjects and if the study subjects participated in a treatment or intervention. Study quality was assessed by two independent reviewers using the Downs and Black evaluation tool for all studies, as well as the PEDro assessment scale for randomized control trials only. Levels of evidence were assigned using a modified Sackett scale. RESULTS: A total of 13 studies met the inclusion criteria. The selected articles were divided into prevention or treatment of post-SCI HO. Nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, and pulse low-intensity electrogmagnetic field (PLIMF) therapy were reviewed as prophylactic measures. Bisphosphonates, radiotherapy and excision were reviewed as treatments of post-SCI HO. CONCLUSIONS: Pharmacological treatments of HO after SCI had the highest level of research evidence supporting their use. Of these, NSAIDs showed greatest efficacy in the prevention of HO when administered early after an SCI, whereas bisphosphonates were the intervention with strongest supportive evidence once HO had developed. Of the non-pharmacological interventions, PLIMF was supported by the highest level of evidence; however, more research is needed to fully understand its role.

Breaking the boundaries: collaborating to develop a model ventilator training program.

Changes in the health care system have created new opportunities for acute care nurses to establish collaborative relationships with their rehabilitation partners. When a rehabilitation facility decided to establish a ventilator weaning rehabilitation program, an acute care facility joined forces with the institution to develop an educational plan for the nursing staff. The development and implementation of the educational program as well as the collaborative relationship established between the two facilities are highlighted in this continuing education article.

Pulmonary lobectomy patient care pathway: a model to control cost and maintain quality.

BACKGROUND: Cost containment is a reality in thoracic surgery. Patient care pathways have proved effective in cardiac surgery to reduce length of stay and control costs. METHODS: A multidisciplinary team formulated a pulmonary lobectomy patient care pathway to standardize care, reduce length of stay and costs, and maintain quality. Variance codes were developed to collect data prospectively on reasons for prolonged stay. A patient satisfaction survey was instituted to learn patients' responses to their hospitalization. RESULTS: One hundred forty-seven patients underwent lobectomy in 1995 before institution of the pathway with a mean length of stay of 10.6 days and a mean cost of $16,063. The lobectomy pathway was instituted at the beginning of 1996. One hundred thirty patients underwent lobectomy in 1996 with a mean length of stay of 7.5 days (p = 0.03) and a mean cost of $14,792 (p = 0.47). Readmission and mortality rates were unchanged. Eighty-eight of 130 patients (68%) were able to be discharged by the target length of stay of 7 days in 1996 as opposed to 76 of 147 patients (52%) in 1995. The most common reason for delayed discharge was inadequate pain control. The majority of patients felt prepared for discharge by the seventh postoperative day (70 of 96 patients, 73%). CONCLUSIONS: The institution of a lobectomy patient care pathway appeared to reduce length of stay and costs. The pathway provided a framework to begin systematic quality control measures to enhance patient care.

Lung volume reduction surgery for emphysema.

This article summarizes the care of patients undergoing bilateral lung volume reduction surgery as a treatment for end-stage emphysema. Surgical removal of emphysematous tissue allows for a reconfiguration of the chest wall and diaphragm, improving pulmonary mechanics. This results in reduced air trapping and improved gas exchange. It is important for nurses caring for these patients to be knowledgeable in the postoperative care of thoracic surgical patients and to have an understanding of the pathophysiology of emphysema, the medical management, and, in particular, the relationship between dyspnea and anxiety. Strategies to assist with airway clearance, control pain, prevent and alleviate dyspnea, reduce and treat anxiety, and ensure nutrition need to be incorporated into the postoperative plan of nursing care.

Managing post-intubation injuries.

Many patients who experience a long, complicated illness require endotracheal intubation and tracheostomy. A few patients develop potentially life-threatening post-intubation injuries. In this overview, common post-intubation injuries, emergency and surgical treatment for these complications, and pre and postoperative nursing management of these patients are discussed.

Eficácia e aderência ao tratamento prolongado com Duovent no broncoespasmo: comparaçäo com Salbutamol / Results obtained longstanding treatment of bronchospasm using Duovent comparasion with Salbutamol

Duovent e salbutamol foram comparados em 15 pacientes com broncoespasmo crônico estabilizado, mas parcialmente reversível, para verificaçäo da persistência do efeito terapêutico, da eficácia broncodilatadora e aderência do paciente no traramento prolongado com essas drogas. Os resultados mostraram: 1) Eficácia clínica: boa proteçäo contra o broncoespasmo. Tosse, dispnéia diurna e noturna e o número de puffs adicionais foram melhor controlados com Duovent; 2) Açäo e eficácia broncodilatadora: a CVF e até mesmo a VEF1 estavam suficientemente estáveis nas condiçöes basais com variaçöes insignificantes nos vários controles com ambas as drogas, embora Duovent tenha sido pouco mais favorável. A eficácia broncodilatadora foi mantida de forma mais significante com Duovent em comparaçäo com o salbutamol mesmo depois de 5h; 3) A aderência dos pacientes foi melhor com Duovent, tanto na opiniäo pessoal do paciente quanto devido ao menor número de administraçöes diárias recebidas pelos pacientes (3 ao invés de 4)

Efficacy and compliance to prolonged Duovent treatment of bronchospasm. Comparison with salbutamol.

Duovent and salbutamol were compared in 15 patients with stabilized, but partially reversible chronic bronchospasm to verify the persistence of therapeutic effect, bronchodilator efficacy and patient compliance to prolonged treatment with these drugs. Results showed: Clinical efficacy; good protection from bronchospasm. Cough, day-time and nocturnal dyspnoea and the number of additional sprays required were better controlled with Duovent. Activity and bronchodilator efficacy: FVC and even more so FEV1 were sufficiently stable in baseline conditions with negligible variations at the various control times with both drugs, although Duovent was slightly more favourable. Bronchodilator efficacy was maintained more significantly with Duovent compared to salbutamol even after 5 h. Patient compliance: this was better with Duovent, both from the patient's personal opinion and because of the fewer number of daily administrations which the patient received (3 instead of 4).

Results of treatment with sodium sulbenicillin in thirty elderly patients with acute bronchopulmonary infection.

Thirty elderly patients with acute bronchopulmonary infections were treated with intravenous sodium sulbenicillin for up to 20 days at a dose of 4-6 g/day. Clinical results were excellent in 19 cases and good in 10 cases. In one case treatment had to be discontinued due to a dermal side-effect. It is concluded that sulbenicillin is a useful therapy for acute bronchopulmonary infections in the elderly.

[Remarks on the use of shortened procedures in evaluating EDTA-induced urinary lead excretion]. / Sull'impiego di procedimenti abbreviati nell prova di piomburia provocata

Urinary lead excretion following EDTA administration was studied in 47 both normal and lead intoxicated subjects, mainly monitoring the rate of excretion through sequential urine samples. Urinary lead excretion patterns proved to be quite different in the examined subjects: in particular, great differences were noted in the onset of lead excretion increase. The six-hr lead excretion resulted to be 60,7% of the total 24-hr excretion, with, however, a very wide range (42% to 83%). Urine flow didn't appear to influence the rhythm of urinary lead excretion. There is sufficient evidence to justify the conclusion that evaluation of EDTA-induced urinary lead excretion on the basis of the first-six-hr results cannot be assumed as a reliable procedure, unless it is used for rough diagnostic screening purposes.