ORL-head and neck nursing : official journal of the Society of Otorhinolaryngology and Head-Neck Nurses最新文献

Aims: The Post-extubation Assessment of Laryngeal Symptoms and Severity (PALSS) study systematically evaluates patient symptoms related to endotracheal intubation with mechanical ventilation, assesses laryngeal injury and voice function after extubation, and develops a screening tool to identify patients with clinically important, post-extubation laryngeal injury.

Design: Single-center, prospective observational cohort study conducted in 6 intensive care units (ICU).

Methods: Patients ≥18 years old who are orally intubated and mechanically ventilated in an ICU and meet eligibility criteria will undergo flexible laryngoscopy, with a sample size goal of 300 completed laryngoscopies. Primary outcome measures include signs and symptoms of laryngeal injury, including voice symptoms and alterations in swallowing, measured using the Laryngeal Hypersensitivity Questionnaire-Acute and Voice Symptom Scale questionnaires respectively. Data will be collected within 72 hours post-extubation and at 7-day follow-up or hospital discharge (whichever occurs first). Data will be analyzed using descriptive statistics, regression models, and predictive modeling using machine learning.

Discussion: The findings of this study will describe the clinical signs and symptoms of laryngeal injury post-extubation.

Conclusion: The PALSS study will provide insights for future studies that explore laryngeal injuries using flexible laryngoscopy after endotracheal intubation.

Implications for patient care: Identifying signs and symptoms of laryngeal injury after endotracheal intubation will facilitate the development of a screening tool that will assist in early identification of post-extubation laryngeal injury, and aid in decreasing short- and long-term complications of endotracheal intubation.

Reporting method: SPIRIT.

Patient or public contribution: Patients were study participants; and family members provided informed consent when the patient lacked decision-making capacity.

Mass incarceration in the United States presents major healthcare challenges, and otorhinolaryngology-related needs within carceral settings are underrecognized. Public health crises, as exemplified by the COVID-19 pandemic which led to over 3,000 deaths among incarcerated individuals, can intensify disparities. Both acute otorhinolaryngology conditions, such as craniomaxillofacial trauma, impending airway compromise, and life-threatening infection, as well as more chronic conditions such as cancer, sinusitis, or ear infections can lead to impaired quality of life, disability, or preventable mortality. Incarcerated individuals experience substantial healthcare disparities, which are driven by intrinsic individual and carceral facility factors such as resource scarcity, structural barriers, limited self-advocacy, and social determinants of health, as well as extrinsic factors related to societal misconceptions, inadequate education of healthcare providers on carceral healthcare, and underdeveloped care systems. To address these issues, a comprehensive approach is needed, incorporating experiential learning, bias reduction, and trust building. Early clinical exposure, enhanced public health education, and community outreach efforts are conducive to cultivating structural competence and relevant skills. Carceral health initiatives can thus raise awareness and enhance the healthcare of incarcerated individuals. Healthcare professionals can expand their roles to advocate for equitable care, prioritize rehabilitation over punishment, and support individuals upon reentry into society. Healthcare professionals in otorhinolaryngology, play a pivotal role in addressing the needs of incarcerated individuals, with nurses, physicians, and allied health stakeholders working together. Education, advocacy, and compassionate care provide the basis for a more equitable and humane carceral healthcare system that upholds the dignity and well-being of all individuals.

Clinical practice guidelines (CPG) are developed to inform clinical decision-making and standardize care based on scientific evidence, benefits and harms of treatment, and patient preferences to achieve optimal health outcomes. This survey study explored the level of awareness of otorhinolaryngology (ORL) nurses in using CPGs in clinical practice. The study sought to answer the following: (1) How aware are ORL nurses of CPGs developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF)? (2) Which CPGs are most widely identified by ORL nurses? and (3) Do ORL nurses perceive that AAO-HNSF guidelines can benefit their practice? An online survey was developed, piloted, and launched to all eligible registered nurse SOHN members in October 2015. A total of 146 nurses (29%) completed the survey. Over 60% of respondents were in nursing for more than 20 years, 20% were in ORL for 5 years or less, and 40% worked in the hospital, 25% were aware of one or less of the guidelines, with 75% aware of 2 or more specialty guidelines. Nurses were most aware of the tracheostomy care (64%), tonsillectomy in children (47%), and tympanostomy tubes in children (46%) guidelines. The majority of ORL nurses was aware of specialty CPGs and used them to help guide their clinical practice on a regular basis. They also perceived support by their organizations to engage in evidence-based practice. Increasing nurses' awareness and knowledge of CPGs will likely increase guideline use and advance clinical practices based on these recommendations. Strategies to enhance evidence-based guideline recommendations into practice will also be discussed.

A 13-year-old boy with Down syndrome (DS) presents to the pediatric otolaryngologist after being lost to follow-up for several years. The child is accompanied by his stepmother, who has recently been granted full custody together with his father. The stepmother states that the child's mother was non-compliant with his medical care and now, as she describes it, they are "playing catch-up." According to his stepmother, he has a history of recurrent ear infections and had tympanostomy tubes inserted in the past (date(s) unknown). The child has several other co-morbidities including severe obstructive sleep apnea (OSA), premature ventricular beats and possible hypothyroidism. He receives services in school for his speech and language delays in addition to regular physical and occupational therapy. The child was referred by his pediatrician who initially sent him for an audiological evaluation after failing a hearing test in the office. The child's audiogram is consistent with bilateral, severe mixed sensorineural (SNHL) and conductive hearing loss (CHL) and reveals small canal volumes consistent with bilateral middle ear effusions (MEE). The physical exam also reveals bilateral MEE and possible cholesteatoma in the right ear, consistent with chronic otitis media. This case highlights the need for early education of families in the primary care setting when the diagnosis of DS is made, in order to ensure that the child receives adequate care to maximize developmental potential and quality of life.

The risk of opioid misuse for the treatment of chronic pain requires nurses to understand the societal impact of chronic pain and prescription opioid misuse. Patient safety is imperative while managing pain, including orofacial pain. When opioids are required, identifying risk to the patient through thorough assessment using opioid risk tools, monitoring using toxicology screens, and using state prescription drug monitoring databases, will help reduce risk for misuse or abuse. Treatment plans must be balanced using multimodal and interprofessional approaches in order to capitalize on the diverse knowledge of the healthcare team to provide the best care to patients.

Pain is a prevalent global health concern, and pain assessment and treatment is a patient right. This evidence-based practice project targeted translating pain management interventions into practice for adult and pediatric patients undergoing needle stick procedures in ambulatory settings. Evidence-based interventions should consistently be offered to patients who often experience procedural pain or discomfort. Implementation of the practice change included multiple interactive, reinforcing strategies. Pre/post-implementation evaluation measures included clinician knowledge, perceptions, and current practices. A pain-related question was added to the institution's ambulatory patient satisfaction survey. Ongoing reinfusion efforts are aimed at promoting sustainability and integration of the practice change.

All health care professionals want to provide their patients with the best care possible. In order to accomplish this, the most current research must be incorporated into their daily practice. Many medical specialty societies have developed clinical practice guidelines to help facilitate achievement of safe, high quality patient care. This manuscript highlights the recommendations from the clinical practice guidelines developed and published through the American Academy of Otolaryngology-Head and Neck Surgery Foundation. Dissemination of clinical practice guidelines, to a broad audience, is essential to ensure implementation and adoption into practice. The key action statements and recommendation strength of each from the clinical practice guidelines are highlighted to help achieve these goals.