Counseling Patients with Implanted Cardiac Devices: the Nurse???s Role

Patients with implanted cardiac devices constitute a growing segment of the contemporary healthcare practice. Taking care of such a rapidly growing patient population constitutes a challenge for all health care providers working in a cardiology ward, operating or procedure room, or primary care practice. Nurses among them have a unique role by being the most appropriate persons to provide in-hospital and long-term health care, education and psychological support to these patients. In-hospital and long-term care will ensure an uneventful procedure and a safe discharge as well as early detection of device malfunction and late complications. Education of the patient will prevent any self or environmental interactions which can adversely affect proper device function and will increase his or her adherence to the follow-up treatment. Finally, by providing psychosocial and emotional support the nursing staff can address the immediate concerns of the patient and help him or her cope successfully with the new life situation. Continuing education is extremely important for nurses counselling patients with implanted devices in order to play successfully their role as the continuous link to the multidisciplinary team of professionals that guide the oftentimes forgotten humanistic care of these patients

Subacute Rumen Acidosis in Greek Dairy Sheep: Prevalence, Impact and Colorimetry Management

Subacute rumen acidosis (SARA) is a current issue in intensive livestock farming, and it is particularly associated with feeding high-concentrate diets. This study investigated the prevalence and impact of SARA in forty-two Greek dairy sheep flocks by recording rumen pH, milk composition, and milk yield over a period of nine months. Moreover, it explored the use of computerized rumen colorimetry as a management and diagnostic tool for SARA in dairy sheep. In culled ewes, computerized rumen mucosal colorimetry was applied, and rumen wall samples taken for histological examination. SARA cases were identified in 19 farms (45%, n = 42). Farms with SARA cases had lower milk fat levels, while milk yield and milk protein levels did not differ based on the SARA status of the farms. In culled ewes, rumen color was significantly associated with the flock’s SARA status, and affected ewes showed increased thickness in non-keratinized and total epithelial layers. It was concluded that computerized rumen mucosal colorimetry in aged, culled ewes shows promise as an indicator, post mortem, of SARA present in dairy sheep flocks whose impact can be minimized by making significant changes in dietary management

The Use of Stromal Vascular Fraction in Long Bone Defect Healing in Sheep

The objectives of the present study were to evaluate (a) the feasibility of using stromal vascular fraction (SVF) and nanocrystalline hydroxyapatite (nHA) paste in combination for the treatment of segmental bone defect, (b) the quality of the callus produced, (c) the potential improvement of the autograft technique, and (d) the direct comparison of the biomaterial to the use of autogenous cancellous bone. Unilateral, segmental mid-diaphyseal bone defect was created on the right metatarsus of skeletally mature sheep animals (n = 24) under anesthesia (D0). Residual segments were stabilized by stainless-steel plates and appropriate screws. Defects were managed as follows: group A: use of nHA paste to filling, group B: use of autogenous bone graft mixed with nHA bone paste, placed in defect, group C: use of SVF mixed with nHA bone paste injected into defect, group D: use of bone graft and SVF with nHA paste before apposition in bone defect. SVF had been previously isolated from adipose tissue of the animals intra-operatively after digestion with collagenase solution and neutralization. Animals were evaluated clinically and by X-raying and ultrasonographic examination of the defect, at regular intervals, until D90. Ultrasonographic assessment performed along the length of the defect included calculation of the length of the bone defect and assessment of vascularization. SVF was successfully isolated from group C and D animals, with the average yield being 1.77 × 106 cells. The comparison of clinical scores (based on the ‘Kaler scale’) on each post-operative day indicated significant differences between the four groups on D1 to D30 (p p = 0.07) and 0 (p = 0.033). Differences in radiographic assessment scores were significant for scores obtained on D60 (p = 0.049) and D90 (p = 0.006). There was a significant difference between the four groups in the length of the bone defect, as assessed ultrasonographically, for the entire length of the study; median values were 8, 8.5, 6, and 8 mm for groups A, B, C, and D, respectively (p = 0.008). There was a significance in the differences between median scores obtained during the histopathological examination: 2, 11, 13.5, and 12 for group A, B, C, and D (p = 0.022). There was an inverse correlation between the overall scores of histopathological evaluations and the length of the bone defect (observed on D90) (p p < 0.0001). This is the first study in which the efficacy of fresh autologous Stromal Vascular Fraction (SVF) from adipose tissue in enhancing bone healing in a long, weight-bearing, diaphyseal bone was evaluated. It is concluded that the lumbosacral region was an attractive site for harvesting adipose tissue, the use of SVF contributed to faster rehabilitation post-operatively, and SVF significantly enhanced bone formation; in general, the results indicated an osteogenic potential of SVF comparable to the gold standard autologous bone graft