Quality of life assessment following amputation for septic shock: a long-term descriptive survey after symmetric peripheral gangrene.

PURPOSE: To assess health-related quality of life (HRQOL) following rehabilitation of amputees suffering symmetric peripheral gangrene (SPG) after septic shock. MATERIAL AND METHODS: A retrospective cohort study was conducted in nine French specialized rehabilitation centers. Thirty-two ICU adult patients hospitalized between 2005 and 2015 for septic shock who additionally presented with SPG resulting in at least two major amputations were enrolled. HRQOL was assessed by EQ-5D-3 L questionnaire. RESULTS: All patients (mean ICU length of stay 39 ±â€¯22d, SAPS II 58 ±â€¯18) had both lower limbs amputated and 84% were quadruple amputees. HRQOL, assessed 4.8 ±â€¯2.8 years after amputation, was inferior to the French reference. However, patients' self-rated health status was similar to the reference at the time of HRQOL assessment. The main factor of impaired HRQOL was intense phantom pain, not the mobility or self-care dimensions of EQ-5D. All patients except one preferred to be treated again for SPG despite disability. CONCLUSION: ICU survivors referred to rehabilitation centers after SPG-related amputations had impaired HRQOL. At the time of HRQOL assessment, they considered themselves in good health and preferred to be treated again despite disability. Appraisal of long-term functional outcome should not be used to guide end-of-life decision-making in this situation.

Honey and larvae in the treatment of foot gangrene: a reflection.

With the introduction of the Nursing and Midwifery Council's (NMC) (2015a) revalidation directive, nurses are required to demonstrate an ongoing commitment to providing safe and effective care by continually combining sound empirical evidence with reflective practice ( Sackett et al, 1996 ; Rolfe et al, 2011 ). Using Gibbs' (1998) model, I will reflect on an episode of care undertaken while I was on a recent placement. This reflective account will discuss the clinical use of honey and larvae therapy in the treatment of foot gangrene following meningococcal septicaemia. The psychosocial impact of ill health will also be considered. The use of newly acquired nursing skills and knowledge will be evaluated and the nurse-patient therapeutic relationship explored.

Divertículo de Meckel gigante torsionado. Una presentación inusual / Giant Meckel’s diverticulum torsioned. An unnusual presentation

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