Increasing healthcare workers' compliance with hand hygiene guidelines remains a challenge to the clinical community. In order to reduce healthcare-associated infections, it is important to educate student nurses to comply with the guidelines during clinical placements. Identifying student nurses' hand hygiene performance is the first step towards developing teaching methods to improve and sustain their overall and moment-specific compliance. As a measure to ensure student compliance during clinical placements, mentors should be aware of their influence on students' performance, act as hand hygiene ambassadors, encourage students to comply with established guidelines and provide regular feedback.
The purpose of this article is to report whether combined open and endovascular treatment could be applied in patients with complex aortic disease. A retrospective study including four patients with complex aortic disease was undertaken. In all patients, extra-anatomic bypass to the visceral arteries was made through a laparotomy while the aortic lesion was repaired by stent grafting. One patient died on the first postoperative day and another died 3 months after treatment from a myocardial infarction. The other two patients were alive 13 and 34 months after treatment, respectively. However, a patient treated for a ruptured thoracoabdominal type 2 aneurysm on the basis of a dissection suffers from postoperative paraplegia. The combination of open surgery with extra-anatomic bypass to visceral arteries and stent grafting could be an option for the treatment of patients with complex aortic disease, especially in high-risk cases in which more extensive open surgery is contraindicated.
Aim of the Study: In the clinical situation there is discrepancy between various investigations regarding the cardiac response of thoracic aortic cross-clamping. The aim was therefore to investigate the hemodynamic response and blood gases during proximal aortic cross-clamping (XC) in patients operated for descending thoracic and thoracoabdominal aortic aneurysm without circulatory support. Patients and Methods: Altogether 51 patients operated on for thoracoabdominal (n = 31) or descending thoracic aortic aneurysm (n = 20) were included in the investigation. All patients were operated with aortic XC, but no circulatory support was applied. Hemodynamic variables and blood gases were recorded before and during XC. Results: A significant increase in cardiac output during XC from 4.7 to 6.0 liters/min was observed (p < 0.01). There was a similar percentual increase in heart rate and also the proximal systolic blood pressure increased. A metabolic acidosis occurred during XC. Conclusion: Cardiac output was significantly increased during XC in patients operated on for thoracoabdominal or descending thoracic aneurysm using direct aortic XC without circulatory support. Simultaneously, the heart rate was increased and there was a hyperdynamic circulatory state proximal to the aortic clamp. Redistribution of the blood volume in addition to catecholamine release may be responsible for the observed changes. These observations may influence the selection of operative strategy for some of these patients.
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