Combined aortic root replacement and heart transplantation in a patient with dilated cardiomyopathy and aortic root aneurysm

Concomitant replacement of the ascending aorta and heart transplantation are an infrequent procedure. This procedure was most often performed in patients with Marfan syndrome, however, it has its own technical difficulties. Hereby, we report on combined heart transplantation and aortic root replacement using donor's ascending aorta in a 25-year-old man diagnosed with dilated cardiomyopathy and ascending aorta aneurysm. This procedure was successful and beneficial to patients with aortopathy who are candidates for heart transplantation. © 2018, Iranian Society for Organ Transplantation

The prevalence of pain at pressure areas and pressure ulcers in hospitalised patients.

Background: Patients with pressure ulcers (PUs) report that pain is their most distressing symptom, but there are few PU pain prevalence studies. We sought to estimate the prevalence of unattributed pressure area related pain (UPAR pain) which was defined as pain, soreness or discomfort reported by patients, on an " at risk" or PU skin site, reported at a patient level.Methods: We undertook pain prevalence surveys in 2 large UK teaching hospital NHS Trusts (6 hospitals) and a district general hospital NHS Trust (3 hospitals) during their routine annual PU prevalence audits. The hospitals provide secondary and tertiary care beds in acute and elective surgery, trauma and orthopaedics, burns, medicine, elderly medicine, oncology and rehabilitation. Anonymised individual patient data were recorded by the ward nurse and PU prevalence team. The analysis of this prevalence survey included data summaries; no inferential statistical testing was planned or undertaken. Percentages were calculated using the total number of patients from the relevant population as the denominator (i.e. including all patients with missing data for that variable).Results: A total of 3,397 patients in 9 acute hospitals were included in routine PU prevalence audits and, of these, 2010 (59.2%) patients participated in the pain prevalence study. UPAR pain prevalence was 16.3% (327/2010). 1769 patients had no PUs and of these 223 patients reported UPAR pain, a prevalence of 12.6%. Of the 241 people with pressure ulcers, 104 patients reported pain, a UPAR pain prevalence of 43.2% (104/241).Conclusion: One in six people in acute hospitals experience UPAR pain on 'at risk' or PU skin sites; one in every 8 people without PUs and, more than 2 out of every five people with PUs. The results provide a clear indication that all patients should be asked if they have pain at pressure areas even when they do not have a PU

The development of the Glamorgan paediatric pressure ulcer risk assessment scale.

OBJECTIVE: To develop a predictive pressure ulcer risk assessment scale based on patient data. METHOD: Detailed questionnaires, based on a review of the paediatric and adult literature and discussion with paediatric nurses with expertise in this area, were used to obtain data on patient characteristics from 265 inpatients in a children's hospital and 54 children with pressure ulcers and 17 children without pressure ulcers from 11 hospitals. These data were then combined to compare the characteristics of children with and without pressure ulcers (using the chi-square test). RESULTS: The Glamorgan paediatric pressure ulcer risk assessment scale was developed, based on the significance values identified by the statistical analysis. Variables that were significantly (p<0.01) associated with pressure ulceration included: difficult to position, anaemia, equipment pressing or rubbing against skin, reduced mobility for age, prolonged surgery and persistent pyrexia. The sensitivity, specificity and predictive validity of the Glamorgan scale was found to be greater than those for the Braden Q scale, which is widely used to assess pressure ulcer risk in children in the US. CONCLUSION: Using patient data from children and young people in the development of risk assessment tools for this age group may be preferable to modifying existing adult tools

The development of the Glamorgan paediatric pressure ulcer risk assessment scale

While there are many paediatric pressure ulcer risk assessment scores, none had been validated. Working with colleagues in Glamorgan and New York an evidence based pressure ulcer risk assessment score has been validated. This is the first such quantitative validation in the world

A comparison of Braden Q, Garvin and Glamorgan risk assessment scales in paediatrics.

Aims and Objectives: To compare three risk assessment scales with respect to predictive validity Background: In paediatrics there are several competing scales and at least ten published paediatric pressure ulcer risk assessment scales have been identified. However there are few studies exploring the validity of such scales, and none identified that compares paediatric risk assessment scales. Design: Cross sectional study Methods: Three risk assessment scales, Braden Q, Garvin and Glamorgan, were compared. The total scores and sub-scores were tested to determine if children with pressure ulcers were significantly different from those with no pressure ulcer. Logistic regression was conducted to determine if the probability of developing a pressure ulcer was a better predictor of development of pressure ulcer compared with the total score of each scale. Receiver operating characteristic curves were computed and the area under the curve used to compare the performance of the risk assessment scales. Results: Data from 236 children were collected. 71 were from children in eleven hospitals who were asked to provide data on children with pressure ulcers (although seventeen did not have a pressure ulcer) of whom five were deep (grade 4). A sample of 165 were from one hospital, of which seven had a pressure ulcer, none grade four. The Glamorgan risk assessment scale had a higher predictive ability than either the Braden Q or Garvin. The mobility sub-score of each of the risk assessment scales was the most predictive in each case. Conclusions: The Glamorgan scale is the most valid of the three paediatric risk assessment scales studied in this population. Mobility alone may be as effective as employing the more complex risk assessment scale. Relevance to clinical practice: If a paediatric risk assessment scale is employed to predict risk, then unless it is valid, it may identify children who are not at risk and waste resources, or fail to identify children at risk possibly resulting in adverse health outcomes

Surgical management of iatrogenic occluded left pulmonary artery

A 4-year-old boy developed dyspnea 18 months after attempted surgical patent ductus arteriosus closure using a clip that was inadvertently placed on the left pulmonary artery, followed by reoperation to repair the left pulmonary artery with a patch and re-close the ductus. Computed tomography angiography confirmed a large patent ductus arteriosus, left pulmonary artery occlusion, and patent left pulmonary veins. Therefore, a third surgery was performed for suture closure of the ductus and left pulmonary artery repair with an interposition tube graft. Follow-up by transthoracic echocardiography and computed tomography angiography showed good flow in the left and right pulmonary arteries. © The Author(s) 2018