skin-care-1.matches: skin care
Reinforcing organizationwide pressure ulcer reduction on high-risk geriatric inpatient units.

Stier L, Dlugacz YD, O'Connor LJ, Eichorn AM, White M, Fitzpatrick J.

North Shore-Long Island Jewish Health System, Great Neck, NY, USA. lstier nshs.edu

Skin care and pressure ulcer prevention programs abound, although their content varies and their outcomes are often difficult to quantify. This article describes 2 complementary programs, their quality improvement processes, and a variety of ways of measuring their success. The first program was broad in scope, emphasizing system-wide changes in administration and coordination of resources, while the second focused on nursing education on high-risk units. These 2 approaches could be adapted for use in any health care setting.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14740581&dopt=Abstract skin, skin care, skin care medicine skin-care-3.matches: skin care
Systemic candidiasis in extremely low birth weight infants receiving topical petrolatum ointment for skin care: a case-control study.

Campbell JR, Zaccaria E, Baker CJ.

Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, TX 77030, USA. judithc bcm.tmc.edu

BACKGROUND AND OBJECTIVE: An increase in the incidence of systemic candidiasis (SC) followed a change in skin care for extremely low birth weight (ELBW) infants in our neonatal intensive care unit (NICU). We sought to determine whether the use of topical petrolatum ointment (TPO) for skin care of ELBW infants was associated with risk for SC. STUDY DESIGN: Case-control study. SETTING: A 48-bed NICU in a private hospital in Houston, Texas. PATIENTS: Ten ELBW infants with and 30 without SC admitted to the NICU from December 1, 1997 through July 31, 1998. METHODS: ELBW infants with SC were identified using hospital microbiology and infectious disease consultation databases. A case was defined as an infant weighing </=1000 g at birth with Candida spp isolated from a normally sterile body site. Three infants without SC were matched to each case by birth weight, admission date, and survival to the age of SC onset for the case. Data were collected by retrospective medical record review. Molecular analysis of Candida isolates was performed by karyotyping and restriction fragment length polymorphism using pulsed-field gel electrophoresis. RESULTS: Case infants had a mean (+/- standard deviation) age of onset of 21.5 +/- 24 days. Infants with SC and controls did not differ in birth weight, gestational age, or duration of therapy with steroids, antibiotics, insulin, or total parenteral nutrition. Although cases were more likely to be born vaginally and had a longer duration endotracheal intubation than controls, these differences were not significant. The odds ratio for skin care with TPO in case infants versus control infants was 11 (95% confidence interval: 1.9-63). Skin care with TPO was discontinued and the incidence of SC decreased to baseline. Several Candida spp and genetic profiles were identified, suggesting that there was not a common source outbreak. CONCLUSIONS: We conclude that the use of TPO promoted an increase in the incidence of SC in ELBW infants. Additional investigation of potential infectious risks for ELBW infants receiving TPO skin care is warranted.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10790460&dopt=Abstract skin, skin care, skin care medicine skin-care-3.matches: skin care
One year later: did the quality circle of geriatric hip fracture care achieve quality outcomes?

Leininger SM.

Orthopedics and Urology Services, West Penn Allegheny University Hospitals, Pittsburgh, USA.

In 1 year, the Geriatric Orthopaedic Hip Fracture Program saw various positive results. The accomplishments are as follows: Appropriate use of consulting services. Reduction in the mortality rate. Increase in the number of patients (76%) who returned to home versus skilled nursing facilities. Reduction of LOS. Fifty-seven percent of patients are independent with ADLs at 6 months after hip fracture repair. Sixty-four percent remain independent ambulators and use aids on an as needed basis. Our team has learned that we need to improve certain areas of the program. We need to reinforce to the staff the importance of following skin care and toileting guidelines. Other research articles looking at the overall condition of the geriatric patient have used the Apache score or the Anesthesia Rating score and we plan to follow suit. The Apache and Anesthesia ratings have been used to predict outcomes; the higher the score, the less successful the outcome. Within the cost structure, we needed to become more aware of the comorbidity costs and identify opportunities to address these issues.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10855150&dopt=Abstract skin, skin care, skin care medicine skin-care-3.matches: skin care
A nursing protocol for the management of perineal-rectal skin alterations.

Haisfield-Wolfe ME, Rund C.

Perineal-rectal care is defined as skin care to the region between the vulva and anus in the female and scrotum and anus in the male (Costello, 1997). Perineal-rectal care is essential to prevent infection and promote comfort but is complicated by the anatomical location of the perineum and rectum. In addition, no standardized perineal-rectal care approach exists. Patients with cancer are at particular risk for developing perineal-rectal skin breakdown because of immunosuppression, side effects of radiation and chemotherapy, and compromised nutritional status. A perineal-rectal skin-care protocol is presented that incorporates recommendations for routine care as well as recommendations for managing common skin alterations, including erythema, dry and moist desquamation, and infection.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10865579&dopt=Abstract skin, skin care, skin care medicine skin-care-3.matches: skin care
Skin barrier properties in different body areas in neonates.

Yosipovitch G, Maayan-Metzger A, Merlob P, Sirota L.

Department of Dermatology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.

OBJECTIVE: The aim of the study was to investigate skin barrier function in neonates in different anatomic sites during the first 2 days of life. DESIGN: The study population consisted of 44 healthy full-term newborn infants. Transepidermal water loss (TEWL), stratum corneum hydration (SCH), and skin surface pH were measured in different anatomic sites (forehead, flexor part of forearm, upper back, abdomen, inguinal region, palms, and soles) during the first 10 hours of life and 24 hours later. Measurements were recorded with a Tevameter, a Corneometer, and a skin pH meter with a flat glass electrode. Results were compared with those in 20 healthy adults. RESULTS: TEWL was lower in infants than in adults in the forehead, palms, soles, and higher in the forearms. It was significantly higher on day 1 than on day 2 in the soles, palms, and forearms, and in the forearm, palms, and inguinal region compared with the other anatomic sites. SCH was significantly lower in the infants on the forehead, back, and abdomen, and higher on the forearms and palms; it was significantly higher on the first day of life on the forearms and palms, and lower in the inguinal region. Skin surface pH was significantly higher in the infants in all body sites (>6.6 in most measurements). On day 2, it was significantly lower than on day 1, but still higher than in adults. SCH correlated positively with TEWL in the neonates but not in the adults. None of the variables were related to gestational age, sex, mode of delivery, or body weight. CONCLUSIONS: Changes take place in SCH, water loss, and pH in the first 2 days after birth, suggesting that the stratum corneum barrier is still in the process of adapting to extrauterine life. The significant anatomic variability in TEWL and SCH should be taken into account in evaluating the permeation of skin care products and topical medications in newborns.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10878157&dopt=Abstract skin, skin care, skin care medicine skin-care-3.matches: skin care
An overview of aesthetic surgery of the face.

Guthrie PB.

This article explores the interface between the aesthetic aspects of dentistry and complementary cosmetic surgery of the face. Dentists do not often think of facial cosmetic surgery and plastic surgeons do not often think of aesthetic dentistry as being complementary to their endeavours. This paper is designed to help breach this gap. An outline is given of the various cosmetic surgery procedures used on the face with emphasis on those in the perioral region. Procedures discussed include meloplasty, blepharoplasty, laser resurfacing, liposculpture, lip augmentation, rhinoplasty, chin augmentation, correction of prominent ears, and skin care.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10895625&dopt=Abstract skin, skin care, skin care medicine skin-care-3.matches: skin care
Postoperative small bowel fistula: back to basics.

Bissett IP.

Department of Surgery, Western Regional Hospital, Pokhara, Nepal. i.bissett auckland.ac.nz

Twenty-one patients presenting between January 1992 and January 1998 with postoperative small bowel fistula were reviewed and their management and outcome were recorded. There were six jejunal and 15 ileal fistulae. Seven fistulae were low output and 14 high output. The management principles included: (i) initial resuscitation and skin care; (ii) early surgery for sepsis, or for a high-output fistula which showed no signs of decrease by 10 days, or total wound breakdown. Surgery involved, where possible, fistula resection with double enterostomy, a feeding gastrostomy and abdominal drainage; and (iii) enteral feeding with refeeding of enterostomy output into the distal stoma if required to correct fluid and electrolyte imbalance and malnutrition. Five patients died and in the other 16 their fistulae closed and they are alive and well.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10902468&dopt=Abstract skin, skin care, skin care medicine