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

Patients undergoing total laryngectomy face the challenge of an altered anatomy with the resultant changes in quality of life and significant requirements for post-operative care. Increased production of secretions and sputum, the need for ongoing suctioning, and the formation of stomal crusting require meticulous post-operative care. The use of Heat and Moisture Exchange (HME) devices has been shown to decrease the effect of these factors. This article describes the nature of these devices and their use. The literature is reviewed regarding the long term benefits and new data are presented suggesting an immediate post-operative benefit as well. Finally, costs and other considerations for successful use of HME devices are presented.

Objectives: The main aim of the study was to evaluate the effect on subjects' temperature measurement readings when using the infrared tympanic thermometer after correct earphone placement and use, with or without music transmission through the earphone.

Methods: A comparative study design was adopted. A sample of 39 healthy people was randomly divided into three groups. Subjects in all groups used an earphone that had been correctly placed in the right ear only: Group 1: listened to heavy metal music through the earphone (13 participants); Group 2: listened to classical music through the earphone (13 participants); Group 3: no music or sound was transmitted through the earphone (13 participants). Average differences (CI 95%) and Pearson correlations for the temperature measured in the right ear, which was exposed to the different independent variables, and the left ear which was not exposed, were calculated at different times: (1) after 10 minutes compared to the baseline measurement; (2) after 30 minutes compared to the 10 minutes measurement; and (3) after 30 minutes compared to the baseline measurement.

Results: The inter-ear temperature correlation at the baseline was Pearson r .801 (p = .01). There was a significant decrease in the correlations between right and left ear temperatures in Group 1 and in Group 3 which was demonstrated after 10 minutes of earphone use, and reached critical values after 30 minutes of use in all groups. The average warmth in the right ear, as perceived by participants after 20 minutes, was reported. Using the Numerical Rating Score the average was 3.3 +/- 1.3 for Group 1, for Group 2 was 1.9 +/- 1.3 and for Group 3 was 3.3 +/- 1.2 (p = .05).

Conclusion: Within the limitations of the study, which involved a limited number of healthy people the results show that it is best to not measure tympanic temperature in an ear that has very recently had an earphone in place.

A clinical consensus statement (CCS) on tracheostomy care for adults and children was developed to improve care for this patient population. Statements were identified using a modified Delphi method with the goal to reduce practice variations among tracheostomy patients. Integration of these statements into daily practice in the care setting is the next step for information dissemination. The CCS affected current policies, procedures, protocols, staff education, and patient education. The process of updating practice at a large tertiary care center is described using evidence-based implementation strategies.

Objective: To determine parental satisfaction and cost-effectiveness of having a frenotomy performed in the office setting versus in the operating room under general anesthesia.

Method: After obtaining IRB approval at The Children's Hospital of Philadelphia (CHOP), we performed a retrospective chart review of patients having a frenotomy in the office between 2003-2008. 55 patients met the criteria and 25 were consented and their parents interviewed.

Conclusion: All participants reported an improvement in feeding within one day and up to two weeks following the procedure. Parents also reported being somewhat satisfied to very satisfied with having the frenotomy performed in the office versus under general anesthesia. There were no complications reported. Performing the frenotomy in the office provided patients with satisfaction as well as cost savings. The surgical fee for a frenotomy in the office is $850 and is the same as if the procedure is performed in the operating room. Performing a frenotomy under general anesthesia includes extra cost which consists of an anesthesia fee of $500-$900 and hospital charges ranging from $500-$8,000. Performing the frenotomy in the office on our 25 patients has resulted in a cost savings of more than $240,000 and the avoidance of general anesthesia in the first few weeks of life. Office frenotomy should be considered in children with ankyloglossia who present with difficulty nursing in the first week of life.

Background: Tracheostomies are performed to improve health-related quality of life (QOL) in patients requiring prolonged mechanical ventilation. As the lengths of stay in intensive care units (ICU) increase and higher rates of tracheostomies are becoming more prevalent, issues regarding patient perceptions of their own prognoses and outcomes after tracheostomy can considerably impact QOL and in turn their care and recovery. Whether tracheostomy improves QOL, however, has not been studied adequately. Current studies investigating QOL have been limited to pre- and post-ICU admission, have relied on surrogate measures such as clinical outcomes and proxy reports, and have used inadequate instruments, failing to capture all domains of QOL. Studies using a robust instrument to investigate QOL in the ICU before and after tracheostomy are lacking.

Purpose: To explore the feasibility of assessing patient-reported QOL of mechanically ventilated ICU patients with a tracheostomy.

Methods: A prospective longitudinal pilot study was conducted in awake and interactive patients who were mechanically ventilated in an ICU using a modified version of the University of Washington QOL Questionnaire. Data were collected at three measurement time points--Time 0 (T0), Time 1 (T1), and Time 2 (T2)--five days apart. The QOL scores were compared between patients who received a tracheostomy and those who did not, as well as between those who received a tracheostomy before and after ten days of intubation.

Results: The modified University of Washington Quality of Life (UWQOL) questionnaire was easily administered by one person. Patients were able to answer all the questions by writing or pointing at the answer choices with either an endotracheal or a tracheostomy tube in place. The mean time to complete the questionnaire was 7.5 minutes. QOL scores ranging from 0 to 800 were administered. Pain and speech were the most important domains contributing to QOL. The median QOL scores were 242 at T0 and T1, and 383 at T2. There was a significant difference in the median QOL scores between those who received a tracheostomy (458) and those who remained endotracheally intubated (175) at T2. Similarly, patients who received early tracheostomy reached a higher QOL score by T1 compared to those who did not (417 vs. 267).

Conclusions: This pilot study demonstrates that a modified questionnaire to assess QOL in patients with prolonged mechanical ventilation is feasible, and useful in capturing artificial airway-related QOL. Further studies should evaluate the utility of this tool in a larger study.