Symptom clusters and related factors in oesophageal cancer patients 3 months after surgery.

AIM: To explore symptom clusters experienced by patients with oesophageal cancer 3 months after surgery and examine whether symptom clusters are related to demographic, clinical and quality of life variables. BACKGROUND: There are multiple symptoms in patients with oesophageal cancer after surgery, which seriously affect their quality of life. Exploring the mechanics of concurrent symptoms such as symptom clusters may facilitate the development of strategies to reduce the impact of these symptoms and improve quality of life. DESIGN: Cross-sectional survey. The STROBE Statement was chosen as the EQUATOR checklist. METHODS: A convenience sample of 128 oesophageal cancer patients was followed up at 3 months after surgery. Participants completed the demographic questionnaire, the M. D. Anderson Symptom Inventory for Gastrointestinal Cancer, the Functional Assessment of Cancer Therapy-General and the Connor-Davidson Resilience Scale. Exploratory factor analysis, stepwise regression and correlation analysis were applied. RESULTS: Four symptom clusters were identified: dysphagia-psychological, chemoradiotherapy side-effect, digestive tract reconstruction and fatigue-sleep. Gender, stage of disease and resilience influenced the dysphagia-psychological symptom cluster. Gender, stage of disease, resilience and treatment were significant factors affecting the chemoradiotherapy side-effect and fatigue-sleep symptom clusters. Gender, stage of disease, resilience and anastomotic position were significant factors influencing the digestive tract reconstruction symptom cluster. The correlations between symptom clusters and quality of life were significant, with the highest correlation between the dysphagia-psychological cluster and quality of life. CONCLUSIONS: Nurses should pay more attention to symptom management in patients with oesophageal cancer 3 months after surgery by focusing on four symptom clusters. It is necessary to implement individualised care depending on the influence factors including gender, stage of disease, resilience, treatment and anastomotic position. RELEVANCE TO CLINICAL PRACTICE: These findings will help develop targeted interventions to facilitate further symptom management for transitional nursing from the peri-operative phase to long-term rehabilitation.

Venous Thromboembolism Prophylaxis in Plastic Surgery: A Literature Review.

Venous thromboembolism (VTE) is a major health concern because it increases morbidity and mortality after a surgical procedure. A number of well-defined, evidence-based guidelines are available delineating suitable use of prophylaxis to prevent deep vein thrombosis and pulmonary embolism. Despite the available literature, there are clear gaps between recommendations and clinical practice, affecting the incidence of VTE. Plastic surgeons underuse the substantiated literature and risk stratification tools that are available to decrease the incidence of VTE in the office-based surgical setting because of fear of bleeding or hematoma complications postoperatively. Venous thromboembolism creates an economic burden on both the patient and the healthcare system. The intent of this literature review is to determine existing VTE risk using assessment models available to aid in the implementation of protocols for VTE prevention, specifically for high-risk cosmetic surgical patients in office-based settings.

Nurses' experiences of leech therapy in plastic and reconstructive surgery.

The aim of this study was to explore nurses' experience of using leech therapy. Leech therapy is useful in promoting revascularisation of skin grafts. Nurse disquiet in their role as leech therapists has been noted. This study explored the experience of Irish nurses. A qualitative design with an interview schedule was used to learn about emotional and practical clinical experiences. Interviews were carried out with seven nurses working with leeches in reconstructive surgery in 2013. These interviews were coded and explored for themes. Results revealed that many nurses feel aversion to the use of leeches. This may be associated with the use of a parasitic organism as treatment in conflict with the nurse's role in cross infection. It was also found that management of a nurse's own and patient's emotional responses is required. In conclusion, preparation for the role of leech therapy beyond the purely practical is necessary, and should explore affective responses of the practitioner and patients.

Congenital Hand Differences.

Congenital hand differences are frequently encountered by pediatric plastic surgeons. These anomalies may cause significant emotional and functional challenges for children. Pediatric plastic surgery nurses should have a basic understanding of common congenital hand differences and related treatment options to facilitate patient education and postoperative care. This article discusses clinical findings and management of 4 of the most common hand anomalies: syndactyly, polydactyly, thumb hypoplasia, and cleft hand. The goals of surgical treatment are to maximize hand function and aesthetics with minimal adverse outcomes.

Endovascular Aortic Repair of Primary Adult Coarctation: Implications and Challenges for Postoperative Nursing.

Endovascular aortic repair is a relatively new surgical technique used to treat a variety of aortic pathologies. Aortic coarctation traditionally has been managed with open surgical repair, involving a large posterolateral thoracotomy, cardiopulmonary bypass, and replacement of the narrowed section of the aorta with a dacron graft. Recent advances in minimally invasive aortic surgery have allowed for repair of the diseased section with an endovascular stent placed percutaneously through the groin under intraoperative fluoroscopic guidance. In this paper, the authors willfocus on the implicationsfor postoperative nursing care after endovascular repair of aortic coarctation using a case study of a 17-year-old male. This novel technique required education of the health care team with respect to implications for practice, understanding potential complications, discharge planning and follow-up. With any new surgical technique there are many questions and challenges that health care professionals raise. The main concerns expressed from the health care team stemmed from a lack of understanding of the disease pathology, and the different risk profile associated with an endovascular repair in contrast to an open repair. The authors will address these concerns in detail.

How to write a journal article for PSN.

Are you considering writing a journal article for Plastic Surgical Nursing? This official journal of the American Society of Plastic Surgical Nurses presents the latest advances in plastic and reconstructive surgical nursing practice. The journal features clinical articles covering a wide variety of surgical and nonsurgical procedures. Patient education techniques and research findings are also included, as well as articles discussing the ethical issues and trends in this expanding clinical nursing specialty. This is a perfect forum to share your knowledge with others in the plastic surgery field, resulting in improved patient care. The editorial board is established and available to assist you in the writing process. It is important to know that you do not have to be an academic scholar to write an article; instead, you have information that you would like to share. This article is intended to provide key points to follow to make sure that writing your article is a positive experience.

An alternative outpatient care model: postoperative guest suite-based care.

BACKGROUND: Patients recovering from outpatient surgery are responsible for managing their pain, managing ambulation, and even implementing thromboembolism prophylaxis after discharge. Because of the importance of postoperative care to prevent complications, a model of care that helps a patient transition to independent self-care could provide optimal results. OBJECTIVES: The authors investigated the safety and morbidity rate for patients who underwent body contouring procedures and overnight care at an attached, nurse-staffed guest suite facility. METHODS: A retrospective review was conducted of 246 patients who underwent major body contouring and who stayed at least 1 night in the guest suite facility. Major complications included a return to the operating room within 48 hours, major wound infection, and unplanned hospitalization within 48 hours. Minor complications included any postsurgical effect necessitating unplanned physician intervention within the first 30 days. Univariate analyses correlating patient characteristics and complication rates were conducted, as well as comparison of complication rates among same procedures reported in the literature. RESULTS: The complication rate (major and minor complications) was 25.20%. Surgical site infection occurred in 8.13% of patients. The most common wound complication was erythema around the incision site (12.20%). Death, deep vein thrombosis, or pulmonary embolism did not occur. Comparison with relevant results reported in the literature indicated a significant reduction in the occurrence of postoperative venous thromboembolism. CONCLUSIONS: Patient education after surgery is essential to healing and adequate care. The guest suite model provides improved care and education for the patient and family postsurgery by addressing some of the known risk factors of plastic surgery. LEVEL OF EVIDENCE: 4.

Current approaches to free flap monitoring.

Postoperative monitoring of free flaps remains an essential component of care in patients undergoing microsurgical reconstructive surgery. Early recognition of vascular problems and prompt surgical intervention improve the chances for flap salvage. Physical examination remains the cornerstone of free flap monitoring, but more recently, additional technologies have been developed for this purpose. In this article, current approaches to free flap monitoring are reviewed.

The art of the aesthetic consultation.

Aging may be one of the most foreseeable facts of life. As aesthetic providers, we routinely hear concerns about facial aging, and it is important that we address these concerns by consistently delivering the best care possible while managing our clients' expectations. How do we set our clients and ourselves up for success by providing superb aesthetic solutions to the age-old challenges we are faced with every day? A thorough Aesthetic Analysis of the clients' needs and an Aesthetic Plan to their specific needs ensure success. An Aesthetic Plan requires a shift from a two-dimensional approach to a three-dimensional approach. Providing safe treatments, establishing trust, producing positive outcomes, and creating engaging experiences will ensure loyalty, future treatments, and continued maintenance.

Nurse education in developing countries--Australian plastics and microsurgical nurses in Nepal.

BACKGROUND: Interplast Australia and New Zealand was established to provide voluntary teams of expertly qualified surgeons, nurses, anesthetists, and allied health care professionals to provide free plastic and reconstructive surgery to the people of neighboring developing countries. Nepal is a developing country that has received overseas assistance for plastic and reconstructive surgery with Interplast since 2007. AIM: The aim of this article was to present three (3) case examples derived from Nepal to illuminate the enhanced capacity of Nepalese plastics and reconstructive health care professionals who have received education facilitated by Interplast METHOD: Case presentations. DISCUSSION: The work performed by Interplast demonstrates that such barriers can be overcome by providing safe, effective, and life-changing plastic surgery to the people of Nepal. Through a collaborative education engagement (described in this article as provided to nursing and other health care workers) volunteers who work with Interplast were able to enable and empower plastics nursing and allied health staff located at the participating site to continue to facilitate complex surgery to the local Nepalese community. Participatory education is an educational approach used by the volunteers working with Interplast CONCLUSION: This collaborative approach offered a means to transfer knowledge into practice for better patient outcomes for nurses and allied health staff in a developing country such as Nepal.

The basics of a health assessment.

Achieving a good aesthetic result begins with a careful preoperative health history and assessment of the patient's desired surgical outcome. Proper interview skills provide the foundation for deciding whether a patient is a good candidate for surgery, identifying risks, and ensuring an optimal surgical experience.

The role of professional nursing organizations in maintaining a healthy workplace.

This article discusses how professional nursing organizations contribute to the goal of a healthy nursing practice environment through offering continuing education, developing practice standards, and promoting nursing competence through certifications.

Hypnosis and relaxation in the context of plastic surgery nursing.

Hypnotic induction and relaxation strategies are discussed as helpful resources for plastic surgery nurses in providing optimal patient care. An overview of the history and context of these strategies is provided along with descriptions of specific techniques to assist patients to relax when receiving potentially painful procedures. The techniques discussed include mindful focus, focused breathing, body scan, progressive relaxation, and guided imagery. Additional resources are provided for nurses seeking further training.

Malignant melanoma.

"Melanoma has become a major public health problem worldwide and its incidence in individuals of European origin continues to rise. Melanoma is the third most common cancer in Australia (in men and women); the fifth in the United States (in men and women); and the 12th in men and the sixth in women in the United Kingdom" (J. G. Thompson, R. A. Scolyer, & R. F. Kefford, 2009, p. 362). The American Cancer Society estimated that about 68,720 new melanomas were diagnosed in the United States during 2009, resulting in about 8,650 deaths. The purpose of this article is to explain the pathophysiologic components of malignant melanoma.

What is new in abdominoplasty?

The purpose of this article is to first review the traditional abdominoplasty procedure. Current studies focused upon improvements in abdominoplasty surgery and results of surgery will then be discussed.Abdominoplasty is a familiar procedure in plastic surgery and has increased in numbers performed by more than 300% in the past decade ((Brauman & Capocci, 2009).

Wound care for the plastic surgery nurse.

The plastic surgery nurse is often confronted with various acute and chronic wounds. Appropriate wound care can facilitate healing, improve quality of life, decrease pain, and improve cosmesis. Yet, with more than 5,000 products on the market today, it can be difficult to choose the appropriate product. This article reviews some of the basic principles of wound healing and patient assessment and then presents a framework from which to develop a plan of care using appropriate wound care products. Appropriate product selection based on patient assessment and clearly defined wound-healing goals can lead to improved healing and saved health care resources.

Nursing monitoring and management of free and pedicled flaps--outcomes of teaching sessions on flap care.

BACKGROUND: Close monitoring is crucial following successful flap surgery because early detection of signs of deterioration can result in a successful intervention and salvage of the flap. An observational audit of practice highlighted short comings in flap monitoring in our Plastic Surgery unit. We created and delivered a teaching session to junior nursing staff with regard the basic principles of flaps and their postoperative care and generated a universal postoperative flap monitoring protocol to help improve and standardize care provision. METHODS: Following a group teaching session, all healthcare providers provided input to create a flap monitoring chart. A cartoon was drawn and placed around the ward to consolidate the ideas generated. RESULTS: The working relationship between doctors and nurses on the ward improved dramatically. Nursing staff felt more confident in their ability to deal with flaps postoperatively and felt more able to contact the surgeons about any concerns or clarifications needed. A re-audit of procedures following these interventions showed improvement in detection of flap ischemia. DISCUSSION: Good patient care within any healthcare system is entirely dependent on the effective function of the multidisciplinary team while maintaining the patient as the focus of care. With both subjective and objective evidences of improvement in the care of flaps in our Plastic Surgery Unit, we can confidently conclude that our teaching program and postoperative flap protocol has been a successful intervention.

Ultralong pedicled superficial temporal fascia island flaps for lower nasal defect.

To explore the method of repairing nose defects of apex, ala, septum, and even opposite ala nasi with ultralong pedicled superficial temporal fascia (STF) island flaps. There were 29 cases with defects of apex nasi, ala nasi, and nasal columella, of which 12 cases were repaired with frontal-branched STF island flaps, 14 cases with apical-branched STF postauricular island flaps, and 3 cases with prefabricated apical-branched STF postauricular island flaps. The flap areas were arranged from 1.2 x 2.3 to 2.0 x 2.8 cm2; the length was more than 15 cm on average. Liners were reconstructed at the stage of prefabricating flaps with free skin graft in the cases of ala nasi defects. The surfaces of wound after flap prefabrications were covered by skin graft as well. Twenty-seven cases were successfully taken without blood circulation blocks; the color, texture, and figure were good, and the outcomes were satisfying. Seven nonprefabricated flap cases have epidermis necrosis because of the lack of artery perfusion pressure and venous return handicap, and the epidermis fell off after 1 month, 2 cases of which required secondary surgery because of partial necrosis. Ultralong pedicled STF island flap is an available way to repair defects of apex nasi, ala nasi, and nasal columella. Prefabricated flaps are with benefits of good blood circulation, primary-made liner, and minute injury of the donor site. It is a good method to repair defects of apex nasi, ala nasi, nasal septum, and opposite ala nasi simultaneously.