Prevention of hospital-acquired transnasal tube-related pressure injuries: a quality improvement project.

BACKGROUND: Nurses certified in wound, ostomy, and continence (WOC) monitored an increasing incidence of hospital-acquired transnasal tube-related pressure injuries (TTPIs) in a tertiary hospital. Hospital-acquired pressure injuries are one of the most common preventable complications of hospitalization; however, the significance of TTPI prevention must be considered alongside the safety of tube fixation to prevent unplanned extubations (UEs), which are serious adverse events. Thus, exploring a quality improvement (QI) project to effectively reduce the risk of TTPIs while safeguarding tube safety is urgently needed. PURPOSE: To decrease the incidence of TTPIs. METHODS: Inpatients from 2017 to 2018 were set as the control group, using routine precautions. Inpatients from 2019 to 2020 were set as the experimental group, and a bundle of training and clinical practice interventions was implemented to compare the incidence of TTPIs and UEs between the 2 groups. RESULTS: After improvement, the incidence of TTPIs reduced from 1.20% to 0.69%, the incidence of UEs reduced from 2.40% to 1.63%, and the differences were both statistically significant (P < .05). CONCLUSION: The QI project reduced the incidence of TTPIs and UEs, thereby protecting the nasal skin/mucosal surfaces, safeguarding tube fixation, and ultimately improving the quality of clinical care.

Subarachnoid hemorrhage following wasp stings.

Three days after being stung by wasps in a rural area, a 60-year-old man was admitted to the emergency department with headaches. The physical examination showed that the patient was conscious, had moderate pain, had four head and back stings with local edema and erythema around the wounds, and had a stiff neck. Brain computed tomography upon admission revealed no abnormalities. Following lumbar puncture, the patient was diagnosed with subarachnoid hemorrhage (SAH) induced by wasp stings. No obvious aneurysms were found by either computed tomography angiography or three-dimensional rotational angiography. He received symptomatic treatment including antiallergy medication (chlorpheniramine and intravenous hydrocortisone), nimodipine for possible vasospasm, fluid infusion, and mannitol for intracranial pressure reduction and was discharged on the 14th day. This case of wasp sting-induced SAH is being reported to improve doctors' diagnostic abilities when encountering patients with wasp stings. It is important for emergency physicians to be aware that patients stung by wasps may develop rare complications such as SAH. Hymenoptera-induced SAH is an example of such a case.

Acute myocardial infarction with no chest pain following a Trimeresurus stejnegeri snakebite: a case report.

A 74-year-old female was bitten by a Trimeresurus stejnegeri, which is an unusual but dangerous type of snakebite. After the snakebite, the patient developed oedema, pain and numbness in the injured limb, and acute myocardial infarction, but no chest pain. The patient received base treatment, including anti-venom serum, statins and wound cleaning. After treatment, the pain in the injured limb disappeared and the swelling decreased. The patient underwent a coronary angiogram the next day, and severe stenosis of the anterior descending branch of the left coronary artery was found. She was given coronary stent implantation. After surgery, she was treated with anticoagulants, and antiplatelet medication and was discharged from the hospital on the sixth day after the condition improved. This case report of myocardial infarction-related snake envenomation aims to increase the awareness that snakebites may cause AMI and therefore, multidisciplinary management particularly from emergency physicians and cardiologists may be necessary.

Factors influencing adjustment to a colostomy in Chinese patients: a cross-sectional study.

PURPOSE: We evaluated persons living with a colostomy in order to characterize and describe relationships among adjustment, self-care ability, and social support. SUBJECTS AND SETTING: One hundred twenty-nine colostomy patients from 5 hospitals in Guangzhou, capital city of the Guangdong province, were recruited by convenience sampling. INSTRUMENTS: Cross-sectional data were collected from a survey that included demographic and pertinent clinical data related to their ostomy. The survey also incorporated Chinese language versions of the Ostomy Adjustment Scale, Exercise of Self-Care Agency Scale, and Perceived Social Support Scale. These scales were used to measure the levels and degrees of adjustment, self-care ability, and social support of colostomy patients. METHODS: Respondents completed the survey during outpatient clinics visit after creation of a colostomy. RESULTS: Scores from the Ostomy Adjustment Scale revealed that 96.9% of colostomy patients reported low to moderate adjustment (128.6 ± 19.38) to their stoma. Self-care ability and social support of patients were positively correlated with the adjustment level (R = 0.33, R = 0.21). Several factors, including being a housewife, paying medical expense by oneself, inability to manage the ostomy without assistance, and not participating in an ostomy support group, were associated with a lower level of adjustment (P < .05). Worries about odor and antipathy toward the ostomy significantly contributed to lower levels of adjustment to the stoma (P < .01). CONCLUSION: Overall adjustment to a colostomy was moderate. Self-care ability and social support associated with having a colostomy positively influenced adjustment. Adjustment was also influenced by occupation, health insurance provider, and ability to care for the stoma without requiring assistance.

[Cause of failure and false negative result in sentinel lymph node biopsy through vital blue injection in breast carcinoma].

OBJECTIVE: To investigate the cause of sentinel lymph node biopsy failure and false negative result in vital blue injection for breast cancer. METHODS: Eight-four female breast cancer patients were injected with vital blue to find the sentinel lymph nodes during operation. All patients were treated by the traditional radical or modified radical mastectomy with axillary dissection after sentinel node biopsy. All sentinel nodes, axillary lymph nodes and dissected specimens were submitted separately to pathological examination. RESULTS: Sentinel node was not identified at the time of operation in 11 patients, giving a failure rate of 13.1%. In 73 patients in whom sentinel nodes were identified, 32 (43.8%) revealed cancer invasion. Postoperative axillary node pathology showed cancer metastasis in all of them. Two patients who showed uninvaded sentinel nodes were demonstrated to have axillary node metastasis. These were the two false negative patients. Therefore, the prediction of axillary metastasis by the sentinel node biopsy showed a sensitivity of 90.4%, a specificity of 100% and a false negative rate of 2.7%. CONCLUSION: Failure in identifying the sentinel nodes in vital blue injection is related to the degree of mastering the technique and the method of injection. The cause of false negative result is due to an extensive primary tumor and the variation in the position of the sentinel lymph nodes.

Purification of the 28 kD Protein from Maize Pollen and Studies on Its Properties.

A novel protein with ATPase activity was purified from the cytoplasmic extracts of maize pollen by acetone precipitation, ammonium sulfate fractionation, followed by DEAE-Sephadex A(50) and Mono S ion-exchange chromatography. The molecular weight was about 28 kD as determined by SDS-PAGE and the isoelectric point was pH 8.3 by IEF-PAGE. Western blotting analysis showed the 28 kD protein had no specific immuno-reactions with the anti-kinesin monoclonal or the anti-dynamin polyclonal antibodies. The maximum ultraviolet absorbance was at 278 nm, CD spectrum analysis showed the that 28 kD protein with the feature of a globulin. Pharmacological studies indicated that the enzyme activity was strongly inhibited by Na(3)VO(4) but insensitive to NEM. It was inhibited about 50% by NaF. Oligomycin, KNO(3) and ouabain had no effects on its ATPase activity.