hospital protocol
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Author(s):  
Anders Granholm ◽  
Olav Lilleholt Schjørring ◽  
Aksel Karl Georg Jensen ◽  
Benjamin Skov Kaas‐Hansen ◽  
Marie Warrer Munch ◽  
...  

2021 ◽  
Vol 14 ◽  
pp. 240-242
Author(s):  
Justin Cline ◽  
Jack Nolte ◽  
Gregory Mendez ◽  
Jordan Willis ◽  
Andrew Bachinskas ◽  
...  

Introduction.Skeletal traction use generally has decreased over generations and is used most often for temporary fracture stabilization. Proper nursing management of patients in skeletal traction is crucial. A hospital protocol was created and implemented to educate and direct registered nurses (RNs) in the care of patients requiring skeletal traction. Method.A skeletal traction management protocol was drafted and implemented as hospital policy. Twenty-nine RNs from an orthopaedic unit at a level 1 trauma center attended a financially compensated, 45-minute, in-person, off-shift educational session. An anonymous pre-test utilizing a 5-point Likert scale was completed to assess RN knowledge and comfort regarding the following topics of traction care: pin care, manual traction, frame assembly, weight application and removal, skin evaluation, neurovascular checks, and reporting issues. The RNs were provided with a copy of the new hospital policy and key points were highlighted and demonstrated. After the demonstration, the RNs were given a post-test to assess their perceived knowledge and comfort with traction care. Results.Statistically significant improvements in RN knowledge and comfort were seen in six of the seven evaluated topics. The greatest increase was seen in the manual traction topic. No significant change regarding neurovascular checks was observed with this topic having the highest pre-test scores. Conclusion. A hospital protocol was created successfully and implemented that significantly improved the level of RN knowledge and comfort with the management of patients requiring skeletal traction. Future studies should assess the effectiveness of annual education regarding the traction policy.


Author(s):  
Emanuel Kolanko ◽  
Tomasz Senderek ◽  
Anna Prokop-Staszecka ◽  
Aleksandra Kruk ◽  
Elżbieta Broniatowska ◽  
...  

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S161-S161
Author(s):  
R Alkhateb ◽  
V Prajapati ◽  
J Daniels ◽  
L Greebon

Abstract Introduction/Objective Preventing allomiunization from D-mismatched transfusions, i.e., transfusion RhD positive (RhD+) red blood cells (RBC) to an RhD negative (RhD–) individual, is not well established. We describe our hospital protocol and experiences managing RhD– young women who received emergency release D-mismatched transfusions. Methods/Case Report The pathologists evaluate all patients who received D-mismatched blood transfusions. The inclusion criteria for alloimmunization prophylaxis protocol include: RhD– females; <50 years old; No current or historical Anti-D; and received ≥1 unit of RhD+ blood. The prophylaxis protocol depends on the RBC volume (RBCV) transfused. Patients who receive RBCV <20% of their total blood volume (TBV) are eligible to receive high dose RhIg, calculated based on the volume transfused. Those who received RBCV ≥20% of TBV would be eligible for red cell exchange (RBCX) followed by RhIg. Results (if a Case Study enter NA) Since 2016, four eligible patients received RhIg prophylaxis protocol and none met the criteria for RBCX. All the patients started the prophylaxis protocol within 24 hours of transfusion and completed it within 72 hours. One patient developed post treatment hemolysis and significant drop in hemoglobin requiring blood transfusion. Passive anti-D post treatment was confirmed in three patients, and one had passive anti C. Three of the four patients had follow up antibody screens >6 months post treatment that were negative for RhD alloimmunization. Conclusion Our therapeutic plan, the first well established protocol, involves identifying eligible patients based on set criteria and protocols. Our experience demonstrates that this protocol is effective in reducing/preventing RhD alloimmunization.


2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Zaid Saffo ◽  
Weixia Guo ◽  
Kylie Springer ◽  
Kathleen Maksimowicz-McKinnon ◽  
Vivek Kak ◽  
...  

Abstract Context Tocilizumab (TCZ), an interleukin-6 (IL-6) receptor antagonist, has been approved for use in rheumatoid arthritis and cytokine storm syndrome (CSS) associated with chimeric antigen receptor T cells treatment. Although TCZ is currently utilized in the treatment of critically ill coronavirus 2019 (COVID-19) patients, data on survival impact is minimal. Objectives To assess the mortality rate of patients presenting with COVID-19 who received TCZ for suspected CSS. Methods This retrospective cohort study was conducted at Henry Ford Health System between March 10, 2020 and May 18, 2020. Data collection began in May 2020 and was completed in June 2020. Patients included in the study required hospital admission and had positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction on nasopharyngeal swab. Eligibility criteria to receive TCZ, per hospital protocol, included any of the following: persistent fever, defined as 38.0 °C for at least 6 hours; a diagnosis of the acute respiratory distress syndrome (ARDS); serum ferritin ≥1,000 (ng/mL) or doubling within 24 hours; D-Dimer ≥ 5 (mg/L); serum lactate dehydrogenase ≥500 (IU/L); or interlukin-6 level ≥5 times the upper limit of normal. Dosing was initially determined by weight, then changed to a fixed 400 mg per hospital protocol. A comparator cohort was created from patients with COVID-19 and ARDS who did not receive TCZ. Patient survival was analyzed using the Kaplan–Meier method and compared by log rank test. A multivariable cox regression was applied to evaluate the association between TCZ and mortality. Results One hundred and thirty patients were evaluated in the study, 54 (41.5%) of whom received TCZ. Patients who received TCZ were younger (mean age, 63.8 vs. 69.4 years; p=0.0083) and had higher body mass indices (mean, 33.9 vs. 30.4; p=0.005). Of the comorbid conditions evaluated, heart disease was more common in the comparator group than the TCZ group (27 patients [35.5%] vs. 10 patients [18.5%]; p=0.034). A Kaplan–Meier survival curve demonstrated no difference in survival between TCZ and comparator patients (log rank p=0.495). In the multivariable Cox regression model for mortality at 30 days, treatment with TCZ was not associated with decreased mortality (hazard ratio, 1.1; 95% confidence interval, 0.53–2.3; p=0.77). Lower mean C-reactive protein (CRP) levels were demonstrated within 48 hours of disposition in the TCZ group (mean TCZ, 4.9 vs. mean comparator, 13.0; p=<0.0001). Conclusions In this cohort study, no difference in survival was observed in critically ill patients treated with TCZ.


2021 ◽  
Vol 15 (6) ◽  
pp. 1407-1410
Author(s):  
A. Adam ◽  
A. Z. K. Chachar ◽  
M. Haider ◽  
N. Yaqoob ◽  
M. Asif ◽  
...  

Background: Chronic hepatitis C is a common entity which is frequently associated with depression. Aim: To determine the frequency of depression in patients of chronic hepatitis C who had not yet received treatment. Settings: Department of Gastroenterology and Medicine at Fatima Memorial Hospital Lahore, Pakistan. Study design: Cross sectional Descriptive study Methods: Total 217 patients were enrolled. Each patient was interviewed and then marked down by the doctor himself. Patient Health Questionnaire (PHQ 9) (annexure 2 attached) was applied to determine the presence of depression. Depression was managed as per hospital protocol. The study was conducted from 10th April, 2018 to 9th October, 2018 Results: In this study mean age was 45 years with standard deviation ± 11.33. 62% patients were male, 38% patients were female. More over 57% patients had depression while 43% patients didn’t have depression. Conclusion: Our study concluded that there was a significant association between depression and chronic hepatitis C patients before they have started their treatment, in tertiary care hospital. Keywords: Depression, chronic, hepatitis C


Dermatology ◽  
2021 ◽  
pp. 1-3
Author(s):  
Brent J. Doolan ◽  
Michelle Weaich ◽  
Joanne Mamo ◽  
Monisha Gupta

Autologous non-cultured epidermal cellular grafting is the treatment of choice for patients with stable refractory vitiligo. Recently, studies have shown cost-effective alternatives for this procedure, superseding previous techniques that required large research facilities or expensive pre-packaged kits. We provide modifications to current techniques, including the use of individual Petri dishes to allow for processing larger skin grafts, hyfrecation instead of conventional manual dermabrasion of the recipient site to reduce scar formation as well as better margin delineation, and an intravenous giving set with a filter for improved filtration of the mixed cell population. These modifications facilitated sufficient skin repigmentation in a cost-effective outpatient setting.


2021 ◽  
Vol 3 (3) ◽  
pp. 862-869
Author(s):  
Ibrahim A. Abdelazim ◽  
Mohannad Abu-Faza ◽  
Soud Al-Ajmi ◽  
M. Farghali ◽  
Svetlana Shikanova

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110008
Author(s):  
Mark S Whiteley ◽  
Laura K Taylor ◽  
Julie C King ◽  
Brittany E Hughes

A 48-year-old woman attended to discuss a dilemma. She had suffered a cardiac arrest immediately following microsclerotherapy of leg telangiectasia with 0.3% aethoxysklerol. She had successful defibrillation and been transferred to hospital. In hospital, despite normal cardiac tests, she was diagnosed as having idiopathic cardiac arrest. The exposure to aethoxysklerol was discounted by her cardiologists as a cause of her arrest. Following the hospital protocol, she was strongly advised to have an implantable defibrillator. Cardiac arrest and myocardial infarction are documented after aethoxysklerol injection with proposed mechanisms being anaphylaxis, direct cardiotoxicity or endothelin-1 release. Before consenting to an implantable defibrillator, which may have its own complications in the long term, doctors and the patient need to be certain that this arrest was not due to a reaction to aethoxysklerol.


2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Maria A. Montoya-Giraldo ◽  
Luisa F. Díaz ◽  
Ubier E. Gómez ◽  
Juliana Quintero ◽  
Andres F. Zuluaga

Abstract Background Acute paraquat ingestion remains a leading cause of mortality in developing countries. There is currently no evidence that treatment with high-dose immunosuppressants and antioxidants improves survival in patients with paraquat poisoning, and better options are urgently needed. Here, we describe the unexpected survival and recovery of a patient with a potentially fatal paraquat poisoning. Case presentation After ingesting 28 mL of paraquat (20% ion w/v), confirmed by a deep blue color in the urine dithionite test (UDT), a 17-year-old Hispanic Colombian boy was treated according to the hospital protocol with cyclophosphamide, methylprednisolone, N-acetylcysteine, vitamin E and propranolol. Gastrointestinal endoscopy showed extensive ulceration and necrosis. As a novelty, enoxaparin at a single dose of 60 mg was added to his treatment. Despite the evidence of severe mucosal burns in the gastrointestinal tract and high paraquat concentrations found in the UDT, the clinical condition began to improve after 1 day of treatment, with full recovery and discharge from hospital after 21 days. Conclusions Although the amount of paraquat ingested by the patient was large and the UDT indicated severe poisoning with a somber prognosis, unexpected survival of the patient was observed, and the addition of enoxaparin was the only change from the standard treatment.


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