British journal of nursing (Mark Allen Publishing)
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Silver (Ag) has been thought to improve wound healing and reduce instances of associated infections for many years. There are centuries-old records of silver being used in wound treatment, but the past two decades in particular have seen an increasing clinical application of silver-impregnated wound dressings and as such, have seen the number of research articles similarly increase. ⋯ The author also attempts to critically appraise the opposing literature related to the clinical relevance of microbial kill-time and the volume of silver contained in dressings, while investigating the efficacy of silver-impregnated dressings in the management of burns and chronic wounds. In order to collect literature relevant to this review, the author searched CINAHL, Medline, BMJ, Medscape, Journal of Advanced Nursing, the Electronic Medicines Compendium (EMC), and the Cochrane Library, using the terms silver, silver sulfadiazine, impregnated, wound, burn, dressing, review, quantative, efficacy, in vitro, in vivo, nanocrystalline, toxicity, infection, microbial kill-time, and comparison.
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Screening and treatment of latent tuberculosis infection (LTBI) prior to anti-tumour necrosis factor alpha (anti-TNF-alpha) therapy has been shown to decrease the incidence of active tuberculosis (TB) by more than 80%, and is recommended by the British Thoracic Society. In the absence of a gold standard test for LTBI, conventional screening currently involves taking a clinical history of risk factors, a chest X-ray and a tuberculin skin test (TST) which can be difficult to interpret in immunosuppressed patients. Alternative cellular immune-based screening tests have been developed to detect Mycobacterium tuberculosis. ⋯ Tuberculosis resulting from reactivation of latent tuberculosis following treatment with anti-TNF is a continuing problem. Screening reduces the risk but does not eliminate it. Further studies are needed into the cost-effectiveness and sensitivity of ELISpot and the tuberculin skin test in routine clinical practice.
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This literature review reports the effectiveness of two peripheral opioid antagonists to relieve constipation caused by prolonged use of opioids, primarily in patients with advanced cancer. ⋯ The recent development of methylnaltrexone into a commercially-viable drug indicates its effectiveness. It may help patients suffering from the intense discomfort that constipation can cause.
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This article is the first of a two-part review focusing on mechanical ventilation, with particular emphasis on non-invasive ventilation when managing patients suffering from respiratory failure. This article explores the principles underpinning artificial ventilation, explains the difference between positive and negative pressure ventilation, and differentiates between invasive and non-invasive modes of ventilation. ⋯ Optimum ventilatory practice requires knowledge to ensure the choosing of the 'right' ventilator. It ensures informed practice and maintains optimum patient safety.
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In this series of articles, the authors outline what they consider to be essential/core critical care skills that all nurses should possess in order to timely and appropriately assess critically ill patients. It is anticipated that the possession of these core skills will enable nurses to appropriately assess and identify those patients who are at risk of deterioration. ⋯ Having covered respiratory assessment here, in subsequent articles the authors will outline and discuss the following key critical care skills that all nurses should possess: cardiac and circulatory assessment, neurological assessment, hydration status assessment, fluid management and intravenous therapy. In this article the authors discuss the airway, breathing and circulation (ABC) approach to patient assessment and then focus on respiratory assessment and management.