Accuracy of clinical indicators of the nursing diagnosis of dysfunctional gastrointestinal motility in infants

This study aimed to analyze the accuracy of the clinical indicators of the nursing diagnosis of dysfunctional gastrointestinal motility in infants from neonatal units and identify their association with clinical variables. This is a study of the diagnostic accuracy of clinical indicators of the diagnosis of dysfunctional gastrointestinal motility, with a cross-sectional design, performed on 228 hospitalized infants in neonatal units. A high prevalence of dysfunctional gastrointestinal motility was identified in the studied population. Regarding accuracy measures, clinical indicators such as increased gastric residual, changes in bowel sounds, bile-colored gastric residual, regurgitation, absence of flatus, and hard and formed stool were useful to discriminate between infants with and without dysfunctional gastrointestinal motility. The findings can help nurses during the diagnostic process, as they identify which defining characteristics can be used to confirm or rule out the probability of occurrence of the diagnosis.

Has UTI and Clostridioides difficile Testing and Treatment Stewardship Diffused Into Oregon Hospitals? A Survey of the Current State

Background: Urinary tract infection (UTI) and Clostridioides difficile infection (CDI) both pose significant diagnostic challenges. Excess testing has implications for hospital-associated infection surveillance and may also lead to overtreatment and associated patient risk. Accurate diagnosis requires stewardship efforts to ensure that the correct patients are tested appropriately. In coordination with clinicians and microbiology labs, hospital infection prevention departments can aid diagnostic stewardship efforts by creating policies for order indications and proper test collection methods and by developing electronic medical record (EMR) support for diagnostic and treatment algorithms. The prevalence of these practices in Oregon, however, is unknown. Methods: We deployed a web-based survey to infection preventionists at all 61 acute-care hospitals in Oregon in January 2019. Responses were collected through April 2019, and a subset of applicable questions were analyzed. Results: Of 61 acute-care hospitals, 58 (95%) responded. A response from a single long-term acute-care hospital was excluded. For urinary tract infections (UTIs), a minority of hospitals reported having policies requiring annual sterile urine collection training for registered nurses (n = 7, 12%), annual observation of the RN sterile urine collection procedure (n = 1, 2%), or use of boric acid containers for urine collection (n = 10, 17%). UTI testing and treatment algorithms embedded in the electronic medical record (EMR) were more common (Fig. 1). Regarding urine culture reflex policies, 39 facilities (68%) reported reflexing abnormal urinalyses to culture only if ordered, whereas 14 respondents (25%) reported automatically reflexed all abnormal urinalyses to culture. For Clostridioides difficile infection (CDI), respondents reported using a variety of methods to discourage inappropriate testing (Fig. 2). Although almost all facilities (n = 53, 93%) reported having a policy to reject formed stool, less than half (n = 27, 47%) reported having a policy to reject stool in patients receiving laxatives. Furthermore, 74% of respondents (n = 42) had a published testing algorithm, more than twice the 18 (32%) hospitals that reported having a comparable UTI algorithm. Conclusions: Infection prevention departments in Oregon acute-care hospitals utilize a variety of tools to contribute to diagnostic and treatment stewardship for UTI and CDI. Our survey revealed many opportunities for improvement in UTI and C. difficile testing and treatment stewardship in Oregon hospitals. For example, although most hospitals reject formed stool for CDI testing, policies for other diagnosis and treatment stewardship techniques were much less commonly employed. Future work will compare the results of this survey to a set of similar questions on a statewide microbiology laboratory survey, assess best practices, and form consensus recommendations on stewardship practices for the state.Funding: NoneDisclosures: None

Nonemetic Effects of Ipecac Syrup

The aftereffects of home-induced emesis with ipecac syrup were determined by telephone interviews of callers to a poison center. During the 12-week study, the presence of any symptoms at follow-up in 146 patients was compared with findings in 99 callers to the poison center who did not receive ipecac. Within four hours after ipecac-induced emesis, 33.6% had no symptoms and 17.1% experienced protracted emesis. In the ipecac-treated group the incidences of one formed stool (4.1%) and lethargy during a typical sleeping time (42.5%) were not significantly different from the incidences in patients not receiving ipecac syrup. The incidences of diarrhea (13.0%) and atypical lethargy (11.6%) were higher (P < .025 and P < .05, respectively) after ipecac-induced emesis than in patients not receiving ipecac syrup. There was no significant statistical association between the propensity of the ingested toxin to produce diarrhea or lethargy and the occurrence of diarrhea or atypical lethargy. Because ipecac-induced emesis can produce diarrhea and lethargy, these side effects should be noted and differentiated from normal conditions when ipecac syrup is administered.

Laxoberal - sodium picosulphate

Sodium picosulphate is the active ingredient of Laxoberal (WBP), a recently introduced liquid laxative. It belongs to the phenylmethane group of laxatives of which phenolphthalein BP and bisacodyl BP (Dulcolax) are examples. The preparation contains no other active ingredient and is promoted for any form of constipation in both children and adults; it is claimed to produce a soft but formed stool in 10–14 hours. It is produced by a subsidiary of Boehringer (who make Dulcolax) and is therefore an example of unacknowledged within-company competition.

Colostomy belts

The special purpose of a colostomy belt is to hold a light dressing over the stoma and to support the weakened abdominal wall. A colostomy bag is useful immediately after surgery but undesirable in the management of an established colostomy: it may predispose to incisional hernia and soreness, and is inappropriate for collecting a formed stool.