Biomedical subjects
Publications and source records attributed to D Wasson.
The nurse plays an important part in the preoperative and postoperative management of the patient with a urinary diversion. Although urinary diversion as a surgical alternative has been performed since the mid 1800s, improvements in technique and management over the past 10 years warrant discussion. Three types of urinary diversion procedures are discussed along with suggestions for optimal nursing management during the postoperative period.
Containing health care costs is essential in providing nursing care. This study examined the cost effectiveness and ease of use of two methods to secure tracheostomy tubes. The findings supported using Velcro devices to reduce total procedure costs per patient.
The purpose of this descriptive study is to determine whether self-esteem differs between chemically dependent adolescents and adolescents from the general high school population. The Self-Esteem Inventory (Coopersmith, 1987) was completed by 119 adolescents (31 inpatient, 31 aftercare, and 57 general high school students) aged 13 to 18. Findings suggest that inpatient, chemically dependent adolescents have lower self-esteem than the other two groups. For the chemically dependent adolescent, nursing case management with communication among and between health care providers, school professionals, and family may facilitate successful, long-term recovery. For adolescents at risk for development of chemical dependence, nursing health promotion behaviors, such as early assessment and implementation of self-esteem-building activities, may assist in prevention of chemical dependency.
BACKGROUND: Melanoma of the foot is often discussed as an uncommon tumor which, when it occurs, presents in nonwhite races. STUDY DESIGN: The tumor registry of a 650 bed community teaching hospital and the Connecticut Tumor Registry were retrospectively reviewed for the nine-year period from July 1980 to July 1989. Patient age, race, sex, incidence of misdiagnosis, and delay until definitive therapy were recorded. Tumor location, size, staging, follow-up, recurrence, and disease-free survival rates were also recorded and correlated with initial disease, stage, and misdiagnosis or delay. RESULTS: Twenty-six cases were identified at Bridgeport Hospital, and 140 cases were identified in the Connecticut Tumor Registry. Significant delay in diagnosis occurred in 68 percent of the cases from the hospital and at least 16 percent of the cases in the state tumor registry. Regardless of stage, melanoma of the foot had a worse prognosis than melanoma of the thigh and lower leg. Delays in diagnosis had no demonstrable effect on clinical outcome. CONCLUSIONS: Melanoma of the foot is not as rare as commonly suspected, and constituted 3 percent of the 4,562 melanomas reported in the state tumor registry for the nine-year period. The majority were in fair-skinned individuals, and misdiagnosis was common. It is the inherent aggressiveness of the tumor rather than the delay in diagnosis that accounts for the poor clinical outcome.
Agenesis of the gallbladder, with normal bile ducts, is a rare congenital condition occurring in 13 to 65 per 100,000 population, probably from failure of the gallbladder bud to develop or vacuolize in utero. Adults are usually asymptomatic. We report a 40-year-old woman with gallbladder agenesis, found at operation for presumed gallbladder disease. We review 44 similar cases: dyspepsia was the predominant symptom in 15 of 44 patients (34%); 24 of 44 (54%) had symptoms suggestive of biliary colic, and 12 of 44 (27%) had jaundice. Common duct stones were found in eight of 12 patients who were jaundiced, but not in any other. A familial tendency was reported in five series. Our patient and one other had another congenital anomaly. Ultrasound was performed on five patients: three had a small, shrunken gallbladder and in two the gallbladder was absent. Ultrasound may suggest the diagnosis if absence of the gallbladder is demonstrated in conjunction with another congenital anomaly.
A 75-year-old black man came to the emergency room because of nausea, vomiting, abdominal pain, and distension and obstipation. An abdominal radiograph revealed a sigmoid volvulus. This was nonoperatively reduced in the emergency room. Following a mechanical and antibiotic bowel preparation, the patient underwent elective exploration. We report, for the first time, operative treatment of sigmoid volvulus with a laparoscopic-assisted sigmoid colectomy and primary anastomosis. Because of dense fibrous scarring of the sigmoid mesentery produced by chronic mesosigmoiditis, the redundant sigmoid was exteriorized and resected extracorporeally. A stapled, side-to-side, functional end-to-end anastomosis was constructed. The patient experienced little postoperative pain and virtually no postoperative ileus. We believe that laparoscopic-assisted sigmoid resection may offer distinct advantages for the treatment of the typically elderly, debilitated patient in whom sigmoid volvulus develops. Furthermore, because of the characteristic mesosigmoiditis associated with sigmoid volvulus, we suspect that exteriorization and extracorporeal resection may prove the easiest and most rapid laparoscopic approach to this disease.
For years, nurse educators' approach to curriculum building has been one entrenched in the behaviourist school of thinking. The outcome for nursing was a graduate who could function well in a predictable environment. However, as nursing practice is becoming increasingly complex, nurse educators feel more and more disenchanted with this approach and are turning to orientations which support a professional model of education. Shifting orientation to a paradigm for professional education requires that educators change their views and practices to reflect the assumptions underlying the new paradigm. This paper examines the process involved in shifting orientations to curriculum development and proposes strategies to mobilise educators in their own resocialisation to their new roles as educators and learners.
With the increasing number of older patients and the decreased length of hospital stays, nurses are faced with the challenge of ensuring that the patient or caregiver can manage care after discharge. Patient education facilitates the maintenance and promotion of self-care behaviors. Health-care trends, educational materials, costs and reimbursements, and innovative methods for education all affect the future of hospital-based patient education.