Complications associated with clavicular fracture

The objective of our literature review was to inform orthopaedic nurses about the complications of clavicular fracture, which are easily misdiagnosed. For this purpose, we searched MEDLINE (1965-2005) using the key words clavicle, fracture, and complications. Fractures of the clavicle are usually thought to be easily managed by symptomatic treatment in a broad arm sling. However, it is well recognized that not all clavicular fractures have a good outcome. Displaced or comminuted clavicle fractures are associated with complications such as subclavian vessels injury, hemopneumothorax, brachial plexus paresis, nonunion, malunion, posttraumatic arthritis, refracture, and other complications related to osteosynthesis. Herein, we describe what the orthopaedic nurse should know about the complications of clavicular fractures. © 2009 National Association of Orthopaedic Nurses

Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: A randomized placebo-controlled study

Background: Recent studies have indicated that unmanaged pain, both acute and chronic, can affect mental status and might precipitate delirium, especially in elderly patients with hip fractures. The aim of this study was to assess the effectiveness of fascia iliaca compartment block (FICB) for prevention of perioperative delirium in hip surgery patients who were at intermediate or high risk for this complication. Materials and methods: On admission, all included patients were divided into three groups according to low, intermediate or high risk for perioperative delirium. Eligible patients (those classified as at intermediate or high risk for developing delirium) were sequentially randomly assigned to study treatment (FICB prophylaxis or placebo) according to a computer-generated randomization code. The primary outcome was perioperative delirium. Diagnosis of the syndrome was defined using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and Confusion Assessment Method (CAM) criteria. Secondary outcome variables were severity of delirium and delirium duration. Results: Delirium occurred in 33 (15.94%) out of 207 patientsrandomized to FICB prophylaxis or the placebo group. Incidence of delirium in the FICB prophylaxis group was 10.78% (11/102), significantly different from the incidence (23.8%, 25/105) in the placebo group [relative risk 0.45, 95% confidence interval (CI) 0.23-0.87]. Nine of 17 patients with high risk for delirium and included in the FICB prophylaxis group developed delirium, whereas 10 of 16 high-risk patients included in the placebo group became delirious (relative risk 0.84, CI 0.47-1.52). Two of 85 patients with intermediate risk for delirium and included in the FICB prophylaxis group developed delirium, whereas 15 of 89 intermediate-risk patients included in the placebo group became delirious (relative risk 0.13, CI 0.03-0.53). Severity of delirium according to the highest value of the DRSR-98 during an episode with delirium in patients in the FICB prophylaxis group was on average 14.34, versus 18.61 in the placebo group (mean difference 4.27, 95% CI 1.8-5.64, P < 0.001). Mean duration of delirium in the FICB prophylaxis group was significantly shorter than in the placebo group (FICB 5.22 days versus placebo 10.97 days, 95% CI 3.87-7.62, P < 0.001). Conclusion: No significantdifference was found among high-risk patients between FICB prophylaxis and placebo groups in terms of delirium incidence. However, FICB prophylaxis significantly prevented delirium occurrence in intermediate-risk patients. Thus FICB prophylaxis could be beneficial, particularly for intermediate-risk patients. © Springer-Verlag 2009

Sustainable Fertilization in Medicinal and Aromatic Plants

The nutrient level in the soil is one of the most investigated aspects of agricultural research, also including research into Medicinal and Aromatic plants. The effect of fertilization has been studied in detail for many species, with contrasting results as concerns above all the qualitative aspects of production. Generally speaking, an increased level of nutrients induces an enhancement of plant biomass, but when the goal of cultivation is different from herbage yield, i.e. when a special plant part (seeds, or roots, or flowers) is of interest, or when the quality features are especially important, the outcome of fertilization may be dramatically different. A fine-tuned fertilization practice is therefore necessary, and forms, rates and times of distribution of fertilizers must be accurately planned and managed