Kidney biopsy findings in a critically ill COVID-19 patient with dialysis-dependent. acute kidney injury: a case against \u201cSARS-CoV-2 nephropathy

NO abstract available- Case repor

Effect of structured education programmes on home care nursing of chronic disease: an italian experience (2008-2012)

Background The growing number of patients with chronic illness led to new models of carewhere patients and caregivers take a more active role. We developed a project focused on patient empowerment and family coaching. Theaim was toincrease appropriateness, efficiencyand quality ofhome care services. Methods The study was designed during 2007 by Alta Val d’Elsa‘s (one of the four areas of Siena Health Unit – Tuscany, Italy) primary care nurses using auditing techniques. An epidemiological analysis was performed to assess healthcare needs of the population. Structured training programmes for different pathologies were developed. Sentinel events were established for every disease. Each patient was assigned to a nurse case manager available by phone when on duty and responsible for training and verifying learning. We identified two outcome indicators:the reduction of percentage of low-complexity home care nursing interventions (HCNI), considered at high risk of inappropriateness, and the growth of high-complexity HCNI. The complexity of all possible interventions was established by Local Health Unit management. The project started in January 2008. A satisfaction survey (a one to ten scale, the higher the value, the better) was given to patients and caregivers. Results From 2008 through 2012, 20044 training activities were done for 3667 patients and caregivers. The overall number of interventions increased from 46 456 in 2007 to 52 767 in 2012. The percentage of low-complexity HCNI decreased from 57.5% in 2007 to 51.4% in 2012 while in the other three areasof the Local Health Unit decreased from 61.2% in 2007 to 59.6% in 2012. The number of high-complexity HCNI rose from 11 295 (24.3% of interventions) in 2007 to 17 662 in 2012 (33.5% of interventions); the mean percentage of high-complexity HCNI of the other three areas remained 21.3%. The level of satisfaction, evaluated only in 2008-09, was high: 9.35 for patients and 9.1 for caregivers. Conclusions Our findings suggest that structured educationprogrammes for patients and caregivers allow nurses to dedicate themselves to more complex and appropriate tasks and lead to an increase of number and quality of home care nursing interventions

Sacral nerves reconstruction after surgical resection of a large sacral chordoma restores the urinary and sexual function and the anal continence

Objective: Chordomas are slow-growing tumors, with a high tendency to local relapse. En bloc resection is related to the most favorable outcome in terms of survival but is frequently associated with permanent neurological deficits involving sphincters and sexual functions. In the present article, we describe an innovative technique of en bloc resection followed by reconstruction of the sacral nerves with nerve grafts. Methods: The chordoma was excised through a posterior approach after dividing the proximal and distal sacral nerves using the established technique. After that, a microsurgical S2-S3-S4 nerve reconstruction was performed connecting the proximal and distal stumps with sural nerve grafts withdrawn from both lower limbs. Results: Immediately after surgery, the patient experienced complete impairment of sexual function and sphincters with urinary and fecal incontinence. After 6 months, there was a progressive recovery of sexual function and sphincter control. One year after the operation, the patient achieved an adequate sexual life (erection and ejaculation) and complete control of the bladder and anal sphincter. Conclusion: Reconstruction of nerves sacrificed during sacral tumor removal has been shown to be effective in restoring sphincter and sexual function and is a promising technique that may significantly improve patients' quality of life