A new job can be stimulating, but it can also be stressful. Not only will you have new responsibilities, but you’ll also have a new setting, new leaders, and new colleagues. And the quicker you can figure out who’s who and what’s what—without stepping on anyone’s toes—the better off you’ll be.
But establishing positive relationships while performing your new job well can be tricky. And early missteps can have a lasting effect on your working relationships and your effectiveness. That’s why I recommend using the four tactics below, starting on day one. (more…)
Achieving excellent wound care outcomes can be challenging, given the growing number of high-risk patients admitted to healthcare facilities today. Many of these patients have comorbidities, such as obesity, diabetes, renal disease, smoking, chronic obstructive pulmonary disease, and poor nutritional status. These conditions reduce wound-healing ability. (more…)
Most of the wounds in the 154,644 patients were diabetic foot ulcers, venous leg ulcers, and pressure ulcers. The study authors note that debridement is a “key process” in wound bed preparation and starting the healing process.
The findings are congruent with previous studies and are based on an analysis of the largest wound data set to date. (more…)
Colleen Jackson recently was promoted to a manager position on her unit. At first, she was thrilled with the opportunity to advance her leadership skills, but now she’s having second thoughts. She doesn’t feel confident in her new role and worries how her team views her. She confesses to her manager, “I keep thinking someone will figure out how much I really don’t know and question whether I should’ve been given the position. Sometimes I feel like an imposter. When I mention this to my friends, they tell me to ‘fake it until you make it.’ But I’m not so sure about that!”
Colleen isn’t alone in feeling like an imposter. In imposter syndrome, a person doesn’t feel good enough, is unsure of what she’s doing, and feels she can’t live up to others’ expectations. She may be afraid she’ll be found out as an imposter at any moment. The syndrome is most common among women leaders who feel they don’t deserve the success they’ve achieved despite external evidence of their competence. It’s more likely in perfectionists who constantly compare themselves to others.
Certain situations, such as taking on a new role, can lead to imposter syndrome. For instance, Colleen may think that because she was seen as qualified for her new role, others expect her to immediately have expert knowledge. If, like Colleen, you feel you don’t deserve the career success you’ve had, you may experience deep feelings of inauthenticity and fear you’ll be found out as a fake. (See Inside the imposter syndrome.)
In small doses, feelings of inadequacy may not be a bad thing, because they remind us to work on building our competency. But people with imposter syndrome feel a level of self-doubt that can lead to overwork and a paralyzing fear of failure. The fear of being unmasked causes incredible stress. Colleen and others like her may have unrealistic expectations of themselves in a new role—expectations that can compromise their success.
Overcoming imposter syndrome
For people with imposter syndrome, the response to their success may rest too heavily on others’ approval, recognition, and opinions. A wise mentor once told me we can easily overestimate how much time others spend thinking about us and our behaviors. Most people, she observed, are self-absorbed. This is important to consider, because the idea that Colleen is an imposter probably has never crossed her team members’ minds.
Imposter syndrome can create performance anxiety and lead to perfectionism, burnout, and depression. So learning how to manage these feelings is important. Cathy Robinson-Walker, MBA, MCC, who coaches nurse leaders, provides advice to help cope with imposter syndrome. Her recommendations include the six actions steps below.
Discuss your feelings with a trusted mentor.
Sharing your insecurities with someone you trust and respect can help you separate what’s real from your perceptions of insecurity. A trusted mentor might inform Colleen she’s making good progress as a beginning leader and that no one expects her to be an expert at this point. The mentor can provide guidance about specific areas where Colleen might need additional growth and how to best go about this.
Pay attention to your own self-talk and consider whether your thoughts are empowering or disabling.
Do you often say to yourself, “I achieved this only because I work harder than anyone else, not because I’m more competent”? Valerie Young, author of The Secret Thoughts of Successful Women: Why Capable People Suffer from the Impostor Syndrome and How to Thrive in Spite of It, makes a strong case that your internal script is a well-rehearsed pattern that serves as a key to feelings of being an imposter. She cautions that individuals with imposter syndrome may sabotage themselves as a way of holding back, due to feelings of being a fraud.
Instead, choose a different script and talk yourself down during times of self-doubt. Instead of thinking, “I’m the wrong person for this job,” retrain yourself to say, “I have a lot to offer in this position.”
Make of list your strengths.
Take the time to make a written list your strengths and what you contribute. Ask others for input, and refer to the list in times of self-doubt. If you’re in a new role, remember that you were chosen for a reason. In Colleen’s case, her supervisor saw her leadership potential. Also realize that most people overestimate their abilities; people with imposter syndrome underestimate theirs.
Accept that perfection is unrealistic and costly.
Trying to be perfect and feeling you need to “know it all” is unrealistic and can be costly on a personal level. Perfectionists typically believe anything short of a flawless performance all the time is unacceptable. But none of us can live a mistake-free life; we all make errors. Those with imposter syndrome hold themselves to impossibly high standards and feel shame, insecurity, and low self-esteem when they don’t meet their own expectations. But progress, not perfection, is what really matters.
Know you’ll need to develop your competencies at certain times in your career.
Throughout your career, you’ll go through periods when you’re on a steep learning curve and will need to further develop your competencies. You may feel like a novice and have to work hard to build new competencies.
Be honest about what you know and don’t know, and seek advice from experts on your unit or in your organization. The simple act of saying, “This is new for me, and I’m working hard to learn this role” can be empowering. Colleen, for instance, might be surprised at others’ reactions to hearing this from her. They might perceive her as a more authentic leader.
Be willing to be uncomfortable and move through your fear.
In Fear of Flying, author Erica Jong urges readers engaging in new experiences to feel the fear and do it anyway. Fear is a useful emotion, as long as it doesn’t escalate to the level of paralyzing behaviors. Practice and preparation can help ease new leaders’ fears. The fear of new challenges will never truly go away, but it can be managed.
Building competence leads to competency
People with imposter syndrome generally are intelligent, thoughtful, and capable but lack self-confidence. Over time, clinicians like Colleen will grow out of feeling like an imposter as they build their competency and become more comfortable in their roles. Eleanor Roosevelt said, “I believe that anyone can conquer fear by doing the things he fears to do, provided he keeps doing them until he gets a record of successful experience behind him.” If you feel like an imposter, this is good advice to ponder.
Selected references
Clance PR, Imes S. The imposter phenomenon in high achieving women: dynamics and therapeutic intervention. Psycho Theor, Res and Prac.1978;15(3):241-7.
Jong E. Fear of Flying. Austin, TX: Holt, Reinhart & Winston; 1973.
Robinson-Walker C. The imposter syndrome. Nurs Leader. 2011;9(4):12-13.
Young V. The Secret Thoughts of Successful Women: Why Capable People Suffer from the Impostor Syndrome and How to Thrive in Spite of It. New York: Crown Business; 2011.
Rose O. Sherman is an associate professor of nursing and director of the Nursing Leadership Institute at the Christine E. Lynn College of Nursing at Florida Atlantic University in Boca Raton. You can read her blog at www.emergingrnleader.com.
Critical limb ischemia may not increase mortality risk in patients with diabetes
Diabetic patients with critical limb ischemia (CLI) who are assessed quickly and treated aggressively do not have an increased risk of long-term cardiac mortality, according to a study in Diabetes Care.(more…)
The ability to understand or “read” lower-extremity redness in your patient is essential to determining its cause and providing effective treatment. Redness can occur in multiple conditions—hemosiderin staining, lipodermatosclerosis, venous dermatitis, chronic inflammation, cellulitis, and dependent rubor. This article provides clues to help you differentiate these conditions and identify the specific cause of your patient’s lower-extremity redness. (more…)
Study finds less-invasive method for identifying osteomyelitis is effective
Researchers have found that using hybrid 67Ga single-photon emission computed tomography and X-ray computed tomography (SPECT/CT) imaging combined with a bedside percutaneous bone puncture in patients with a positive scan is “accurate and safe” for diagnosing osteomyelitis in patients with diabetes who have a foot ulcer without signs of soft-tissue infection.
The new method, which avoids an invasive bone biopsy, has a sensitivity of 88% and a specificity of 93.6%. In the study of 55 patients, antibiotic treatment was avoided in 55% of suspected cases.
MRSA strains will likely continue to coexist in hospitals and communities
The strains of methicillin-resistant Staphylococcus aureus (MRSA) differ in the hospital and community settings, and both are likely to coexist in the future, according to a study in PLOS Pathogens.
C. difficile prevention actions fail to stop spread
Despite increasing activities to prevent the spread of Clostridium difficile, infection from C. difficile remains a problem in healthcare facilities, according to a survey of infection preventionists by the Association for Professionals in Infection Control and Epidemiology (APIC).
The survey found that 70% of preventionists have adopted additional interventions in their healthcare facilities since March 2010, but only 42% have seen a decline in C. difficile infection rates; 43% saw no decline.
A total of 1,087 APIC members completed the survey in January 2013. The survey also found that more than 92% of respondents have increased emphasis on environmental cleaning and equipment decontamination practices, but 64% said they rely on observation, rather than more accurate and reliable monitoring technologies, to assess cleaning effectiveness.
In addition, 60% of respondents have antimicrobial stewardship programs at their facilities, compared with 52% in 2010. Such programs promote the appropriate use of antibiotics, which can help reduce the risk of C. difficile infection.
Mast cells may not play significant role in wound healing
“Evidence that mast cells are not required for healing of splinted cutaneous excisional wounds in mice,” published in PLOS One, analyzed wound healing in three types of genetically mast-deficient mice and found they reepithelialized their wounds at rates similar to control mice. At the time of closure, the researchers found that scars in all the mice groups were similar in both “quality of collagen deposition and maturity of collagen fibers.” The findings fail to support the previously held belief that mast cells are important in wound healing.
Study identifies effective casting for diabetes-related plantar foot ulcers
Nonremovable casts that relieve pressure are more effective than removable casts or dressings alone for the treatment of plantar foot ulcers caused by diabetes, according to an analysis of clinical trials.
The authors of “Pressure-relieving interventions for treating diabetic foot ulcers,” published by The Cochrane Library, reviewed 14 randomized clinical trials that included 709 participants. Nonremovable pressure-relieving casts were compared to dressings alone, temporary therapeutic shoes, removable pressure-relieving devices, and surgical lengthening of the Achilles tendon.
The study also notes that when combined with Achilles tendon lengthening, nonremovable devices were more successful in one forefoot ulcer study than the use of a nonremovable cast alone.
Most studies were from the United States (five) and Italy (five), with Germany, the Netherlands, Australia, and India each contributing one study.
Prescriber preference drives use of antibiotics in long-term care
The study of 66,901 patients from 630 long-term care facilities found that 77.8%
received a course of antibiotics. The most common length (41%) was 7 days, but the length exceeded 7 days in 44.9% of patients. Patient characteristics were similar among short-, average-, and long-duration prescribers.
The study authors conclude: “Future trials should evaluate antibiotic stewardship interventions targeting prescriber preferences to systematically shorten average treatment durations to reduce the complications, costs, and resistance associated with antibiotic overuse.”
Electrophysical therapy may be helpful for diabetic foot ulcers
The authors of the study in International Wound Journal reviewed eight trials with a combined total of 325 patients. Five studies were on electrical stimulation, two on phototherapy, and one on ultrasound. Because of the small number of trials, the possibility of harmful effects can’t be ruled out, and the authors recommend “high-quality trials with larger sample sizes.”
Significant geographic variations in spending, mortality exist for diabetic patients with foot ulcers and amputations
The study in Journal of Diabetes and Its Complications found that higher spending wasn’t associated with a significant reduction in 1-year patient mortality. In addition, rates of hospital admission were associated with higher per capita spending and higher mortality rates for patients.
Home-based exercise program improves life for lymphedema patients
An individualized, home-based progressive resistance exercise program improves upper-limb volume and circumference and quality of life in postmastectomy patients with lymphedema, according to a study published in the Journal of Rehabilitation Research and Development.
The elevator door opens and you step in to find yourself face to face with the important person you’ve wanted to meet to discuss your promising idea. It’s the chance you wouldn’t want to miss. But that chance lasts only as long as the elevator ride. You have less than a minute to make an impression. Do you have an elevator speech ready?
What’s an elevator speech?
An elevator speech is any short speech that sells an idea, promotes a business, or markets an individual. It’s a short summary, or pitch, that quickly describes the value of a service, product, or organization. The term is a metaphor for unexpected access to someone to whom you’d like to sell an idea or proposal. It derives from the early days of the Internet boom when web development companies needed venture capital. Firms were swamped with applications for funding, and in many cases, the companies that won the cash were those whose reps had a simple pitch and could explain a business proposal in an elevator in the time it took to ride to their floor.
A great elevator speech describes and sells an idea in less than a minute. Of course, it’s not restricted to elevators. It comes in handy any time and anywhere you need to give a concise presentation to capture someone’s interest so you can move to the next step—a follow-up call, a referral, a meeting, or a partnership.
Why clinicians need an elevator speech
You need to be able to describe what you do, what you’re interested in doing, and how you can be a resource to someone. The ability to sum up a unique aspect of your service or expertise in a way that excites others is a fundamental skill. Doing this in a brief, persuasive manner is an asset for any professional. A good elevator speech should grab one’s attention in a few words and make that person want to know more about you. Here are examples where a good elevator speech would be helpful:
• Thomas goes to a recruitment fair hoping to get an interview at a certain hospital.
• Mary is finishing her master of science degree and is interested in a position in a new wound care clinic.
• Caroline has written a book on grant writing and would like to present her ideas at a conference.
• Brian is interested in research and would like to join the research team.
• Mindy is trying to expand her wound consultation business.
You can use an elevator speech when you want to grab someone’s attention at a meeting, convention, or other social situation. In such situations, people typically ask, “What do you do?” A well-planned elevator speech can make the listener’s ears perk up and want to know more.
How to prepare an elevator speech
Before you can write an elevator speech, you need to know yourself, what you can offer, what problems you can solve, and what benefits you can bring to the prospective contact. For example, you may be an expert in professional communication and know strategies you can teach other staff to promote a better workplace environment.
You also need to know your audience. Will you direct your pitch to an administrator, a unit manager, or staff? You’re more likely to succeed if your elevator speech is targeted to a specific audience and you adjust it to that audience. Try to prepare different pitches for different audiences; a generic pitch is almost certain to fail. (See Key elements of a good elevator speech by clicking the PDF icon above.)
In today’s busy world, clinicians must be able to communicate in a succinct, persuasive manner. Your elevator speech is your introduction to others. It has to be good. Keep practicing it and perfecting it so you can speak with poise and polish. The more often you give it, the better it will become. It’s a great way to put your best foot forward when you have only a small window of opportunity to make a good impression.
Sjodin T. Small Message, Big Impact: The Elevator Speech Effect. New York, NY: Portfolio; 2012. Sprung S, Giang V. 6 keys to delivering a powerful elevator pitch. Business Insider Web site. www .businessinsider.com/terri-sjodin-how-to-deliver- an-elevator-speech-2012-10. October 26, 2012. Accessed October 26, 2012.
Kathleen D. Pagana is a keynote speaker and professor emeritus at Lycoming College in Williamsport, Pennsylvania. She is the author of The Nurse’s Communication Advantage and The Nurse’s Etiquette Advantage. She is also the coauthor of Mosby’s Diagnostic and Laboratory Test Reference, 11th ed. To contact her, visit www.KathleenPagana.com.
As clinicians, we’re proud of the expert care we provide patients. But we also know that just doing our job isn’t enough to advance our careers. Mastering good communication skills is essential for all clinicians at all career stages—especially with today’s flatter organizational structures and more participatory management styles. Knowing how to communicate in a professional manner can give you the edge you need for career advancement.
Opportunity rarely knocks any more. Instead it may present as a phone call, voice mail, e-mail, or text message. Be sure to use proper etiquette with all communication forms.
Speaking with managers
When dealing with your manager, use a solution-focused approach. Don’t be a complainer. Some communication experts point out that people complain about things they can do something about—not things they have no power over. For example, they don’t complain about their foot size because there’s nothing they can do about it. Yet people often complain about their jobs because they’re unwilling to take the risk of making a change.
We need to take charge of our lives. We can accept the fact—without complaining—that we’re making the choice to stay where we are. Or we can make a request or take action to achieve a desired outcome. Suppose you work on a clinical unit and disagree with the way your manager makes clinical assignments. You have several options:
Complain to coworkers and make the workplace miserable for others.
Speak with your manager and make suggestions for improvement.
Leave your job and go elsewhere if you can’t work with your manager to make things better.
If you decide to stay in your job, accept the fact that you’ve made that choice. Take responsibility for it and stop complaining.
Speaking on the phone with physicians
For clinicians who are not physicians, the key to effective communication with physicians is to remember you’re an important member of the healthcare team. An effective way to guide your communication with physicians and other colleagues is to use a tool such as SBAR (Situation, Background, Assessment, Recommendation). Say, for instance, you want to suggest the doctor order an anxiolytic for your patient. Here’s how you might do it using SBAR:
Situation: “Mrs. Smith is complaining of severe anxiety.” Background: “She is 1 day post-op from a lumbar laminectomy.” Assessment: “She is alert and oriented and her vital signs are stable. She has no numbness or tingling in her extremities.” Recommendation: “She said she takes lorazepam 2 mg orally at when she’s anxious. Would you like to order something for her?”
Before ending the conversation, repeat and clarify the medication order (if the doctor gives one).
Telephone
The sound of your voice and your manners are essential components of phone etiquette. Smile—the smile on your face comes through in your voice. Here are five more tips:
Get yourself organized before placing the call.
Minimize background noise.
Immediately identify yourself. Don’t assume the recipient will recognize your voice.
Concentrate on listening and avoid multitasking.
Schedule phone conversations to avoid playing phone tag.
Voice mail
Voice mail is an efficient way to communicate. Again, five tips:
Always be prepared to leave a message. Jot down your key message points before you call, to avoid stuttering and stammering.
Be concise and to the point.
State your name and the date, time, and purpose of your call.
Enunciate clearly and speak slowly.
State your name and phone number twice at the end of the message so the recipient doesn’t need to replay your message.
E-mail
In many business settings, e-mail has almost replaced letters and memos. In many cases, an e-mail is a recipient’s first impression of you, so follow these tips:
Make the subject line specific. This helps the reader prioritize the message and file it for easy retrieval.
Use a greeting and a close. It’s more polite and less impersonal.
Keep your message concise.
Keep your tone polite and businesslike.
Use your e-mail signature function, which provides several ways to contact you.
Text messages
This form of communication can be the most challenging and unpredictable. Some people send text messages routinely, while others may be unfamiliar with this method. You can’t go too far wrong if you take this advice:
Get to the point quickly. No one wants to read a long message on a mobile phone.
Don’t text during meetings. It’s rude to do so, and others can hear you clicking away or see the light from your screen.
Consider the recipient before using text abbreviations. Some people may not understand text lingo.
Consider the time when sending a text. Although you may be awake at 5 a.m., the sound of your incoming message might disturb a sleeping recipient.
Don’t expect an immediate response to your text. If the message is time sensitive, pick up the phone instead.
Improving the way we speak with managers and physicians can go a long way toward career advancement and professional satisfaction. Common courtesy is just as essential in e-mail, voice mail, and text messages as in face-to-face communication. When you follow the guidelines I’ve given, you’ll elevate your professional communications a few notches.
Selected references
Canfield J, Switzer J. The Success Principles: How to Get from Where You Are to Where You Want to Be. New York, NY: Morrow; 2006.
Kramer M, Schmalenberg, C. Confirmation of a healthy work environment. Crit Care Nurse. 2008 Apr;28(2):56-63.
Pagana K. The Nurse’s Communication Advantage: How Business Savvy Communication Can Advance Your Nursing Career. Indianapolis, IN: Sigma Theta Tau International; 2011.
Pagana K. The Nurse’s Etiquette Advantage: How Professional Etiquette Can Advance Your Nursing Career. Indianapolis, IN: Sigma Theta Tau International; 2008.
A keynote speaker, Kathleen D. Pagana is a professor emeritus at Lycoming College in Williamsport, Pennsylvania, and president of Pagana Keynotes and Presentations. She is the author of The Nurse’s Communication Advantage and The Nurse’s Etiquette Advantage. To contact her, visit www.KathleenPagana.com.
Most of us have had days when we jump from meeting to meeting and at the end of the day wonder, “Did I get anything accomplished or am I more behind than ever?”
Many clinicians tell me that although their wound team meets regularly, the meetings aren’t meaningful enough, leaving the team still facing issues with their wound care program. As a consultant, when I review the wound team agenda, it’s typically missing one or more of four key ingredients:
appropriate member representation
proactive approach that highlights prevention
review of the plan of care and update of the medical record
review of supplies and products. Here’s a closer look at each of these ingredients.
Build a top team
Having the appropriate members on the wound care team is the first ingredient for success. A comprehensive, interdisciplinary team approach is the key to preventing skin breakdown and ensuring good clinical outcomes for residents with skin breakdown. Teams should include representation from nursing, dietary, and physical and occupational therapy, as well as a nurse practitioner or physician.
Nursing representation should include nurses from all three shifts and nursing assistants, who are too often missing from the team. Keep in mind that when it comes to preventing pressure ulcers, nursing assistants carry out most of interventions (for example, turning, incontinence management, heel lift). Even when a patient has a wound, the only intervention carried out by the nurses is the topical treatment; nursing assistants perform all other interventions necessary to ensure healing. Clinicians who empower nursing assistants to have a strong influence with the wound care team—and the program—tend to have very successful prevention programs and good clinical outcomes.
Think prevention
The second key ingredient is prevention. Most wound team meetings only discuss the patients with wounds, missing the bigger goal of preventing wounds in the first place. Once the patients with wounds are discussed, the team should review all high-risk patients to ensure proper preventative measures are in place and care planned. All patients should be quickly reviewed for evidence of:
decline or change in mobility and activity
new onset or change in continence status
decline in nutritional status
decline or change in cognition.
Any triggers in these areas should prompt a review of the plan of care to ensure they are being effectively addressed.
Review and update the plan
The third key ingredient for success is to use meeting time to review and update the plan of care. I’ve observed highly productive meetings and great discussions of the care the facility is providing. Then I review the medical record and discover that none of the interventions discussed are on the plan of care. Always review the patient’s plan of care to ensure it’s accurate, reflects all interventions, and is up to date. This will give you peace of mind that the medical record reflects all the good work you’re doing and helps make the team meetings feel productive.
Discuss products and supplies
The fourth key ingredient is to take the time to quickly discuss current wound care supplies and products with the team. Ask the team if the current supplies are user-friendly, are adequate, provide good outcomes, and are in good working condition.
Many times staff will not say how they’re struggling with, modifying, or not using something until they’re asked. Remember that the most expensive product is the one that doesn’t work or doesn’t get used.
A recipe for success
Using these four key ingredients will lead you to a successful wound team meeting—and a successful program. The mix may not solve your too-many-meetings days, but will give you peace of mind that at least one meeting is productive.
Jeri Lundgren is director of clinical services at Pathway Health in Minnesota. She has been specializing in wound prevention and management since 1990.
The number of people with diabetes who are meeting the ABC goals—hemoglobin A1C, blood pressure, and LDL cholesterol—has risen significantly in recent years, according to a study published by Diabetes Care. Patients meeting all three goals rose from about 2% in 1988 to about 19% in 2010.
Gains were made in each of the ABC goals, based on 2007 to 2010 data: 53% of patients met A1C goals, compared to 43% in 1988 to 1994 data; 51% met blood pressure goals, compared to 33%; and 56% met LDL goals, compared to 10%.
Younger people were less likely to meet A1C and cholesterol goals. Compared with non-
Hispanic whites, Mexican Americans were less likely to meet A1C and LDL goals and non-Hispanic blacks were less likely to meet blood pressure and LDL goals.
The researchers analyzed data from the National Health and Nutrition Examination Surveys from 1988–1994, 1999–2002, 2003–2006, and 2007–2010. Nearly 5,000 people age 20 or older participated.
Although progress had been made, the researchers conclude, “Despite significant improvement during the past decade, achieving the ABC goals remains suboptimal among adults with diabetes, particularly in some minority groups.”
Daily bathing with chlorhexidine-impregnated washcloths reduces infection risk
A study in The New England Journal of Medicine reports that daily bathing with chlorhexidine-impregnated washcloths reduces the risk of becoming infected with multidrug-resistant organisms and subsequent development of hospital-acquired bloodstream infections in intensive care unit patients.
“Effect of daily chlorhexidine bathing on hospital-acquired infection” included 7,727 patients in nine intensive care and bone marrow units in six hospitals. The units were randomly assigned to bathe patients with either no-rinse 2% chlorhexidine-impregnated washcloths or nonantimicrobial washcloths for 6 months; then, the units switched to the opposite product for 6 months.
The rate of infection with multidrug-resistant organisms was 23% lower in the chlorhexidine group and the rate of hospital-acquired bloodstream infection was 28% lower in the chlorhexidine group.
Patients tend not to wear custom-made footwear for preventing diabetic foot ulcers
Adherence to wearing prescription custom-made footwear was low among patients with diabetes, neuropathy, and a recently healed plantar foot ulcer, according to a study in Diabetes Care. The low adherence was particularly notable at home, where patients did the most walking.
Factors associated with higher adherence included lower body mass index, more severe foot deformity, and more appealing footwear.
Tedizolid works as well as linezolid in patients with acute bacterial skin infections
A JAMA study says that a 200-mg once-daily dose of oral tedizolid phosphate over 6 days was as effective as 600 mg of oral linezolid every 12 hours for 10 days in patients with acute bacterial skin and skin-structure infections, including cellulitis or erysipelas, major cutaneous abscesses, and wound infections.
A shorter course of tedizolid may be a “reasonable alternative” to linezolid for treating acute bacterial skin and skin-structure infections, the study concludes.
Water-based exercise improves ROM in patients with long-term arm lymphedema
A study of breast cancer survivors (median 10 years after surgery) with lymphedema found that a water-based exercise program improved shoulder range of motion (ROM).
The program consisted of at least twice-weekly water-based exercise for 8 weeks. At first, participants were supervised, but later they exercised independently. Although lymphedema status didn’t change, those who performed water-based exercise had an increase in ROM, showing improvement years after surgery.
Dehydrated amniotic membrane allograft possible option for treating chronic wounds
A dehydrated amniotic membrane allograft (EpiFix) was used to treat four patients whose wounds hadn’t closed after conservative and advanced measures and who had been referred for plastic procedures. A variety of wounds healed (located on the elbow, knee, hand, and ankle) after one to three applications of the amniotic material, which patients tolerated well. The wounds remained closed several months later.
Study casts doubt on MLD’s role in breast cancer–related lymphedema
A meta-analysis published in the World Journal of Surgical Oncology found the “current evidence” from randomized clinical trials “does not support” the use of manual lymphatic drainage (MLD) in preventing or treating lymphedema in patients with breast cancer.
The authors analyzed 10 randomized clinical trials with 566 patients.
CDC issues additional prevention steps for carbapenem-resistant Enterobacteriaceae
On Feb. 14, the Centers for Disease Control and Prevention (CDC) issued additional prevention steps for carbapenem-resistant Enterobacteriaceae (CRE). Increased reports of CRE prompted the action: Of the 37 unusual forms of CRE reported in the U.S., the last 15 have been reported since July 2012.
• When a CRE is identified in a patient with a history of an overnight stay in a healthcare facility (within the last 6 months) outside the U.S., send the isolate to a reference laboratory for confirmatory susceptibility testing and test to determine the carbapenem resistance mechanism.
• For patients admitted to healthcare facilities in the U.S. after recently being hospitalized (within the last 6 months) in countries outside the U.S., consider performing rectal screening cultures to detect CRE colonization, and place patients on contact precautions while awaiting the results.
Examples of Enterobacteriaceae include Klebsiella species and Escherichia coli. CRE are Enterobacteriaceae with high levels of resistance to antibiotics, including carbapenems. CRE infections most commonly occur among patients who are receiving antibiotics and significant medical treatment for other conditions.
Guidelines for managing prosthetic joint infections released
The Infectious Diseases Society of America has released guidelines for diagnosing and managing prosthetic joint infections.
“Diagnosis and management of prosthetic joint infection: Clinical practice guidelines by the Infectious Diseases Society of America,” published in Clinical Infectious Diseases, notes that of the 1 million people each year who have their hips or knees replaced, as many as 20,000 will get an infection in the new joint.
The guidelines describe the best methods for diagnosing these infections, which are not easy to identify. Specifically, infection should be suspected in a patient who has any of the following: persistent wound drainage in the skin over the joint replacement, sudden onset of a painful prosthesis, or ongoing pain after the prosthesis has been implanted, especially if there had been no pain for several years or if there is a history of prior wound healing problems or infections.
Guidelines for treating infections are included and note that 4 to 6 weeks of I.V. or highly bioavailable oral antibiotic therapy is almost always necessary to treat prosthetic joint infections.
A decade of TIME
The TIME acronym (tissue, infection/inflammation, moisture balance, and edge of wound) was first developed more than 10 years ago to provide a framework for a structured approach to wound bed preparation and a basis for optimizing the management of open chronic wounds healing by secondary intention. To mark the event, the International Wound Journal has published “Extending the TIME concept: What have we learned in the past 10 years?”
The review points out four key developments:
• recognition of the importance of biofilms (and the need for a simple diagnostic)
• use of negative-pressure wound therapy
• evolution of topical antiseptic therapy as dressings and for wound lavage (notably, silver and polyhexamethylene biguanide)
• expanded insight into the role of molecular biological processes in chronic wounds (with emerging diagnostics).
The authors conclude, “The TIME principle remains relevant 10 years on, with continuing important developments that incorporate new evidence for wound care.”
Bed alarms fail to reduce patient falls
A study in Annals of Internal Medicine found that the use of bed alarms had no statistical or clinical effect on falls in an urban community hospital.
The 18-month trial included 16 nursing units and 27,672 inpatients. There was no difference in fall rates per 1,000 patient-days, the number of patients who fell, or the number of patients physically restrained on units using bed alarms, compared with control units.
Authors of “Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: A cluster randomized trial” speculate the lack of response may be related to “alarm fatigue.”
Drug for HIV might help in Staph infections
A study in Nature reports that the drug maraviroc, used to treat HIV, might be useful for treating Staphylococcus aureus infections.
“CCR5 is a receptor for Staphylococcus aureus leukotoxin ED” found that the CCR5 receptor, which dots the surface of immune T cells, macrophages, and dendritic cells, is critical to the ability of certain strains of Staph to specifically target and kill cells with CCR5, which orchestrate an immune response against the bacteria. One of the toxins the bacterium releases, called LukED, latches on to CCR5 and subsequently punches holes through the membrane of immune cells, causing them to rapidly die.
When researchers treated cells with CCR5 with maraviroc and exposed the cells to the Staph toxin, they found maraviroc blocked toxic effects.
Dog able to sniff out C. difficile
A 2-year-old beagle trained to identify the smell of Clostridium difficile was 100% successful in identifying the bacteria in stool samples, and correctly identified 25 of 30 cases of patients with C. difficile, according to a study in BMJ.
“Using a dog’s superior olfactory sensitivity to identify Clostridium difficile in stools and patients: Proof of principle study” discusses how the dog was trained to detect C. difficile and concludes that although more research is needed, dogs have the potential for screening for C. difficile infection.
After-hours access to providers reduces ED use
Patients who have access to their primary healthcare providers after hours use emergency departments (EDs) less frequently, according to a study in Health Affairs.
“After-hours access to primary care practices linked with lower emergency department use and less unmet medical need” found that 30.4% of patients with after-hours access to their primary care providers reported ED use, compared with 37.7% of those without this access. In addition, those with after-hours access had lower rates of unmet needs (6.1% compared to 12.7%).
The findings come from the 2010 Health Tracking Household Survey of the Center for Studying Health System Change. The total sample included 9,577 respondents.
Neuropathic pain in patients with DPN might contribute to risk of falling
The presence of neuropathic pain in patients with diabetic peripheral neuropathy (DPN) contributes to gait variability, which could in turn contribute to the risk of falling, according to “Increased gait variability in diabetes mellitus patients with neuropathic pain.”
The study, published in the Journal of Diabetes and Its Complications, compared patients with at least moderate neuropathic pain with those who had no pain. Researchers used a portable device to measure gait parameters, such as step length and step velocity.
Amputation rates decrease significantly in patients with PAD
“Temporal trends and geographic variation of lower-extremity amputation in patients with peripheral artery disease (PAD): Results from U.S. Medicare 2000–2008” found that amputation rates have decreased significantly, but that significant patient and geographic variations remain.
The study, published in the Journal of the American College of Cardiology, found that among 2,730,742 older patients with identified PAD, the overall rate of lower extremity amputation decreased from 7,258 per 100,000 patients to 5,790 per 100,000. Predictors of lower-extremity amputation included male sex, black race, diabetes mellitus, and renal disease.
