Thermal injury destroys the physical skin barrier that normally prevents invasion of microorganisms. This and concomitant depression of local and systemic host cellular and humoral immune responses are important factors that contribute to colonization and infection of the burn wound. One of the most common burn wound pathogens is Staphylococcus aureus. Staphylococcus aureus is both a human commensal and a frequent cause of infections leading to mild to life-threatening diseases. Despite a variety of infection control measures, for example patient cohorting and contact precaution at burn centres, S. aureus is still frequently encountered in burn wounds. Colonization with S. aureus has been associated with delayed wound healing, increased need for surgical interventions, and prolonged length of stay at burn centres. In this minireview, we focus on S. aureus nasal carriage in relation to S. aureus burn wound colonization and subsequent infection, and its impact on strategies for infection control. © 2009 Federation of European Microbiological Societies Published by Blackwell Publishing Ltd.
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A local operating theater ventilation device to specifically ventilate the wound area has been developed and investigated. The ventilation device is combined with a blanket which lies over the patient during the operation. Two configurations were studied: Configuration 1 where HEPA-filtered air was supplied around and parallel to the wound area and Configuration 2 where HEPA-filtered air was supplied from the top surface of the blanket, perpendicular to the wound area. A similar approach is investigated in parallel for an instrument table. The objective of the study was to verify the effectiveness of the local device. Prototype solutions developed were studied experimentally (laboratory) and numerically (CFD) in a simplified setup, followed by experimental assessment in a full scale mock-up. Isothermal as well as non-isothermal conditions were analyzed. Particle concentrations obtained in proposed solutions were compared to the concentration without local ventilation. The analysis procedure followed current national guidelines for the assessment of operating theater ventilation systems, which focus on small particles (<10 mm). The results show that the local system can provide better air quality conditions near the wound area compared to a theoretical mixing situation (proof-of-principle). It cannot yet replace the standard unidirectional downflow systems as found for ultraclean operating theater conditions. It does, however, show potential for application in temporary and emergency operating theaters
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In this chapter, we propose that the democracy we wish to see out in the world is influenced by the quality of our own “inner democracies”—that is: the quality of the democracies among and between the selves or voices in the landscape of the self. We must find ways out of the I-prisons we experience and perpetuate. With this in mind, we propose that ”writing the self,” a method whereby creative, expressive, and reflective writing is used to cultivate an internal dialogue and construct a new identity narrative (Lengelle, 2014), can assist in reshaping our stories about ”the Other and ourselves” and can contribute to personal and cultural healing and reconciliation. The inner dialogue reconciled is foundational for the external dialogue at the heart of global citizenship within education. Indeed, as Schellhammer argues, we must cultivate the self in order to become inter-culturally competent, and this includes facing shadow aspects through truthful dialogues with the self and caring for the self. https://doi.org/10.1007/978-3-319-62861-5_6 LinkedIn: https://www.linkedin.com/in/reinekke-lengelle-phd-767a4322/
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Aim Many long-term ostomates are ‘out-of-sight’ of healthcare, and it is unknown how ostomates deal with ostomy- related problems and how these problems affect their quality of life (QOL). The aim is to examine patient-related studies describing ostomy-related problems and their impact on the perceived QOL of long-term colostomates. Methods The electronic databases PubMed (MEDLINE), CINAHL, Cochrane Library and PsycINFO were systematically searched. All studies were included in which ostomy- specific QOL was measured using validated multidimensional instruments. Results Of the 6447 citations identified, 14 prevailingly descriptive cross-sectional studies were included. Three different validated multidimensional instruments for measuring QOL in ostomates were used (EORTC C30/CR38, MCOHQOLQO, Stoma QOL Questionnaire). All studies demonstrated that living with a colostomy influences the overall QOL negatively. The ostomy-related problems described included sexual problems, depressive feelings, gas, constipation, dissatisfaction with appearance, change in clothing, travel difficulties, feeling tired and worry about noises. Conclusion In conclusion, all 14 studies gave an indication of the impact of ostomy-related problems on the perceived QOL and demonstrated that a colostomy influences the QOL negatively. There is a wide range of ostomyspecific QOL scores, and there seem to be higher QOL scores in the studies where the MCOHQOLQO instrument was used. The MCOHQOLQO and the Stoma QOL Questionnaire gave the most detailed information about which ostomy-related problems were experienced. This review adds knowledge about the impact of stoma-related problems on QOL of long-term ostomates, but more research has to be conducted, to detect ostomy-related problems and especially possible care needs.
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BACKGROUND: Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities. METHODS: We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents' age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed. RESULTS: 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs. CONCLUSIONS: In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was acceptable. No consistent evidence was found for a relationship between the presence of BRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider the mediating and moderating role of staffing-related work processes and ward environment characteristics on quality of care.
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The thoracic and peritoneal cavities are lined by serous membranes and are home of the serosal immune system. This immune system fuses innate and adaptive immunity, to maintain local homeostasis and repair local tissue damage, and to cooperate closely with the mucosal immune system. Innate lymphoid cells (ILCs) are found abundantly in the thoracic and peritoneal cavities, and they are crucial in first defense against pathogenic viruses and bacteria. Nanomaterials (NMs) can enter the cavities intentionally for medical purposes, or unintentionally following environmental exposure; subsequent serosal inflammation and cancer (mesothelioma) has gained significant interest. However, reports on adverse effects of NMon ILCs and other components of the serosal immune systemare scarce or even lacking. As ILCs are crucial in the first defense against pathogenic viruses and bacteria, it is possible that serosal exposure to NMmay lead to a reduced resistance against pathogens. Additionally, affected serosal lymphoid tissues and cells may disturb adipose tissue homeostasis. This review aims to provide insight into key effects of NMon the serosal immune system.
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Most nurse leadership studies have concentrated on a classical, heroic, and hierarchical view of leadership. However, critical leadership studies have argued the need for more insight into leadership in daily nursing practices. Nurses must align their professional standards and opinions on quality of care with those of other professionals, management, and patients. They want to achieve better outcomes for their patients but also feel disciplined and controlled. To deal with this, nurses challenge the status quo by showing rebel nurse leadership. In this paper, we describe 47 nurses’ experiences with rebel nurse leadership from a leadership-as-practice perspective. In eight focus groups, nurses from two hospitals and one long-term care organization shared their experiences of rebel nurse leadership practices. They illustrated the differences between “bad” and “good” rebels. Knowledge, work experience, and patient-driven motivation were considered necessary for “good” rebel leadership. The participants also explained that continuous social influencing is important while exploring and challenging the boundaries set by colleagues and management. Credibility, trust, autonomy, freedom, and preserving relationships determined whether rebel nurses acted visibly or invisibly. Ultimately, this study refines the concept of rebel nurse leadership, gives a better understanding of how this occurs in nursing practice, and give insights into the challenges faced when studying nursing leadership practices.
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This paper describes the participatory development process of a web-based communication system focusing on disease management, particularly infection control of Methicillin-resistant Staphylococcus aureus (MRSA). These infections are becoming a major public health issue; they can have serious consequences such as pneumonia, sepsis or death [1]. This makes it even more important for people to be provided with up-to-date and reliable information. Users of a bilingual communication system (Dutch and German) participated in the development process via a needs assessment, the co-creation of the content and the system via usability tests, and in the summative evaluation of the usage of the system. The system enabled users to search efficiently and effectively for practical and relevant information. Moreover, we found that the participation of the intended users is a prerequisite to create a fit between the needs and expectations of the end-users, the technology and the social context of usage of technology. The summative evaluation showed that the system was frequently used (approximately 11,000 unique visitors per month). The most popular categories include ‘MRSA in general’ (20%, both languages) and ‘Acquiring MRSA’ (17% NL, 13% GER). Most users enter the site using internet search engines (Google) instead of the on-site search engine. When they are on the site, they prefer convenient searching via FAQ or related questions. Furthermore, the results showed that the participation of stakeholders is a prerequisite for a successful implementation of the system. To guide the participation of stakeholders we developed a roadmap that integrates human-centered development with business modelling activities.
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