• Oh Miranda posted an update 2 months ago

    Research specifically addressing implementation strategies regarding nursing guidelines is limited. The objective of this review was to provide an overview of strategies used to implement nursing guidelines in all nursing fields, as well as the effects of these strategies on patient-related nursing outcomes and guideline adherence. Ideally, the findings would help guideline developers, healthcare professionals and organizations to implement nursing guidelines in practice.

    Systematic review. PROSPERO registration number CRD42018104615.

    We searched the Embase, Medline, PsycINFO, Web of Science, Cochrane, CINAHL and Google Scholar databases until August 2019 as well as the reference lists of relevant articles.

    Studies were included that described quantitative data on the effect of implementation strategies and implementation outcomes of any type of a nursing guideline in any setting. No language or date of publication restriction was used. The Cochrane Effective Practice and Organisation of Care taxonomy nursing guidelines. Overall, thirty-six studies (68%) reported a positive significant effect of the implementation of guidelines on patient-related nursing outcomes or guideline adherence. Future studies should use a standardized reporting checklist to ensure a detailed description of the used implementation strategies to increase reproducibility and understanding of outcomes.

    Low self-efficacy affects new mothers’ ability to sustain breastfeeding. Interventions that increase self-efficacy could improve sustained breastfeeding.

    To develop an integrated breastfeeding education program based on self-efficacy theory, and evaluate the effect of the intervention on first-time mothers’ breastfeeding self-efficacy and attitudes.

    A single-blind, randomised controlled trial.

    A prenatal clinic of a teaching hospital.

    First-time mothers with a singleton pregnancy (12-32 weeks’ gestation) and their support partners were selected by convenience sampling (N=104) and allocated by block-randomization to an intervention or control group.

    A 3-week breastfeeding intervention program was developed based on self-efficacy theory. The intervention group received the breastfeeding program; the control group received standard care. Data between groups were compared for scores on breastfeeding self-efficacy, infant feeding attitude, and breastfeeding practice, which were assessed using the Breasp (MD from 3.5~7.4, p < .05). Rates for exclusive and predominant breastfeeding postpartum were significantly higher for the intervention group vs control (p < .02) at 1-week (98% vs. 86%), 1-month (100% vs. 90.7%), and 3-months (94% vs. 76.7%). Odds ratio (OR) postpartum for exclusive and predominant breastfeeding was greater for the intervention group at 3-months (OR=4.7, 95% Confidence interval (CI), 1.2 -18.6; p=.05) and for exclusive breastfeeding at 6-months (OR 2.82, 95% CI 1.0-8.1; p=.05).

    The breastfeeding education intervention improved breastfeeding self-efficacy, infant feeding attitudes, and exclusive breastfeeding rates. find more The breastfeeding education program could be effective for sustaining breastfeeding in new mothers.

    Registered with http://www.clinicaltrials.gov (NCT03807726).

    Registered with http://www.clinicaltrials.gov (NCT03807726).

    Secondary Raynaud’s is a manifestation that can present in CREST syndrome as a variant of five different diseases Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. Secondary Raynaud’s presents as a result of an imbalance between vasoconstriction and vasodilation potentially leading to tissue ischemia. The mainstay treatment is medical while surgery treatment preserved as a last resort.

    A 28-year-old female presented with secondary Raynaud’s and was subsequently diagnosed with CREST syndrome. The patient failed to respond to medical treatment, and gangrene of the right fourth distal phalanx developed. Stellate ganglion block was successfully used as a bridge to surgery. Uniportal video-assisted thoracoscopic surgery (VATS) sympathectomy was performed via a 2-cm incision, the sympathetic ganglia were identified and transected by cauterization at the level of the 3rd, 4th, and 5th intercostal spaces extending for a distance of 5 cm to ensure that the nerve of Kuntz was transected. The postoperative outcome was satisfactory, and the condition of the patient improved in a few months.

    Different management modalities have been used to relieve the symptoms of secondary Raynaud’s. The treatment ranges from lifestyle modification, medical treatment, and lastly surgical intervention. Sympathectomy has been suggested for the management of refractive secondary Raynaud’s owing to its considerable clinical response.

    The use of uniportal VATS sympathectomy results in favorable cosmetic and clinical outcomes including reduced length of hospital stay and postoperative pain.

    The use of uniportal VATS sympathectomy results in favorable cosmetic and clinical outcomes including reduced length of hospital stay and postoperative pain.

    Paget’s disease is an intraepithelial invasion by a malignant tumour and is characterised by erythema and inflammation. It can manifest as mammary or extramammary Paget’s disease (EMPD), with the latter often developing in the perianal area. Anorectal cancer can cause transepithelial invasion into the epidermis, resulting in an appearance similar to that of EMPD. This is called pagetoid spread (PS), which is completely different from EMPD. These two conditions are difficult to differentiate because of the nature of intricacy and requirements of histopathology.

    We present a case in which differential diagnosis between these two conditions was not possible during the preoperative examination, resulting in difficulties in treatment. The patient was a 70-year-old woman who experienced pain in the anus since the previous month and presented with red, flat and elevated lesions.

    Treatment for dermatitis was ineffective, and endoscopic examination did not indicate rectal or anal cancer. However, immunohistochemical examination of the biopsy specimen suggested PS. Thus, two-stage operation was planned. Transanal surgery was performed to confirm the diagnosis of PS and intersphincteric resection was allowed as a radical surgery.

    Thus, when differentiation between EMPD and PS is intricacy, two-stage operation is useful in selecting an appropriate radical surgery method, leading to preservation of anal function.

    Thus, when differentiation between EMPD and PS is intricacy, two-stage operation is useful in selecting an appropriate radical surgery method, leading to preservation of anal function.

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