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Documentation of prophylactic therapy in surgery

G I Nazarenko, E B Kleymenova, S A Payushik, V A Otdelenov, D A Sychev, L P Yashina
BACKGROUND: Today medicine is facing a "knowledge crisis" in that explosively expanding medical knowledge encounters limited abilities to disseminate new practices [1]. Clinical practice guidelines (CPGs) are intended to promote high standards of care in specific areas of medicine by summarizing best clinical practice based on careful reviews of current research. However, doctors are often short of time to study these documents and check their updates, have little motivation for strict adherence to them...
2015: International Journal of Risk & Safety in Medicine
Davide Ferorelli, Fiorenza Zotti, Silvio Tafuri, Angela Pezzolla, Lidia Dalfino, Nicola Brienza, Alessandro Dell'Erba
This study describes the changes in the performance of health care workers regarding the control of health care-associated infection in a surgical ward of University Hospital Policlinico, Bari, Italy, before and after a training program and adoption of bundles on antibiotic therapy. There were 194 patients recruited (pre: n = 98; post: n = 96), of which 149 (76.8%) had undergone surgery. We documented a change in the proportions of patients who received in-ward prophylactic antibiotics (from 46/98 to 22/96, P < ...
November 2015: American Journal of Infection Control
Margaret I Liang, Adam C ElNaggar, Silpa Nekkanti, David M O'Malley, Erinn M Hade, Larry J Copeland, Jeffrey M Fowler, Ritu Salani, Floor J Backes, David E Cohn
OBJECTIVES: Ovarian cancer quality measures are being developed to improve health care delivery and outcomes. Our objective is to evaluate compliance with 8 quality indicators proposed by the Society of Gynecologic Oncology. METHODS: A review of 123 ovarian cancer patients who underwent primary surgical staging/cytoreduction and chemotherapy from 2010-2012 was undertaken. Medical records were reviewed, and descriptive statistics were performed to determine compliance...
September 2015: Gynecologic Oncology
Bryan Moon, Patrick Lin, Robert Satcher, Justin Bird, Valerae Lewis
BACKGROUND: Intramedullary nailing is the accepted form of treatment for impending or pathologic fractures of the femoral diaphysis. Traditional teaching promotes the use of a cephalomedullary nail so that stabilization is provided for the femoral neck in the event that a future femoral neck metastasis develops. However, that approach may add cost, surgical time, blood loss, and added radiation exposure to staff members, and there is limited evidence in the literature that supports this practice...
April 2015: Clinical Orthopaedics and related Research
Bryson G Richards, William F Schleicher, James E Zins
BACKGROUND: Postoperative pain is a major concern for patients undergoing facial aesthetic surgery. Aggressive efforts to reduce postoperative pain while avoiding adverse sequelae, such as nausea and vomiting, will result in an improved patient experience. Newer pharmaceuticals, medical devices, and longer-acting local anesthetics offer the potential to reduce pain and enhance patient satisfaction. The purpose of this report is to review the options and apply them to 3 specific facial aesthetic procedures: face-lift, brow lift, and blepharoplasty...
October 2014: Plastic and Reconstructive Surgery
Hubert Y Pan, Pamela K Allen, Xin S Wang, Eric L Chang, Laurence D Rhines, Claudio E Tatsui, Behrang Amini, Xin A Wang, Nizar M Tannir, Paul D Brown, Amol J Ghia
PURPOSE/OBJECTIVE(S): To perform a secondary analysis of institutional prospective spine stereotactic body radiation therapy (SBRT) trials to investigate posttreatment acute pain flare. METHODS AND MATERIALS: Medical records for enrolled patients were reviewed. Study protocol included baseline and follow-up surveys with pain assessment by Brief Pain Inventory and documentation of pain medications. Patients were considered evaluable for pain flare if clinical note or follow-up survey was completed within 2 weeks of SBRT...
November 15, 2014: International Journal of Radiation Oncology, Biology, Physics
Lindsay J May, Christopher A Longhurst, Natalie M Pageler, Matthew S Wood, Paul J Sharek, C Michelle Zebrack
OBJECTIVES: The optimal location for postoperative cardiac care of adults with congenital heart disease is controversial. Some congenital heart surgeons operate on these adults in children's hospitals with postoperative care provided by pediatric critical care teams who may be unfamiliar with adult national performance measures. This study tested the hypothesis that Clinical Decision Support tools integrated into the clinical workflow would facilitate improved compliance with The Joint Commission Surgical Care Improvement Project performance measures in adults recovering from cardiac surgery in a children's hospital...
June 2014: Pediatric Critical Care Medicine
Takahiro Fujita, Masahiro Endo, Yoshiaki Gu, Tomoaki Sato, Norio Ohmagari
The characteristics of active tuberculosis in cancer patients in Japan and the effects of this infection on cancer treatment have not yet been clarified. The records of all consecutive patients with microbiologically documented Mycobacterium tuberculosis infection diagnosed between September 2002 and March 2008 at Shizuoka cancer center (a 557-bed tertiary care cancer center in Japan) were reviewed. There were 24 cancer patients with active tuberculosis during the study period. Of these, 23 had solid-organ tumors, and the most common site of the underlying malignancy was the lung...
March 2014: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Z Adamová, R Slováček, J Sankot
INTRODUCTION: Colonic diverticular disease is a common illness, especially in the elderly population. It may be asymptomatic and cause chronic intestinal problems, colonic diverticular bleeding or inflammatory complications with considerable morbidity and mortality. We have attempted at finding factors that would help us identify patients with a higher risk of diverticulitis recurrence as well as patients with a higher likelihood of perforated diverticulitis. MATERIAL AND METHODS: This retrospective study included all patients admitted to our surgical ward for inflammatory complications of diverticular disease between 2000 and 2012: 278 patients, 88 men and 190 women...
October 2013: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Richard M Rosenfeld, Seth R Schwartz, Melissa A Pynnonen, David E Tunkel, Heather M Hussey, Jeffrey S Fichera, Alison M Grimes, Jesse M Hackell, Melody F Harrison, Helen Haskell, David S Haynes, Tae W Kim, Denis C Lafreniere, Katie LeBlanc, Wendy L Mackey, James L Netterville, Mary E Pipan, Nikhila P Raol, Kenneth G Schellhase
OBJECTIVE: Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. Despite the frequency of tympanostomy tube insertion, there are currently no clinical practice guidelines in the United States that address specific indications for surgery. This guideline is intended for any clinician involved in managing children, aged 6 months to 12 years, with tympanostomy tubes or being considered for tympanostomy tubes in any care setting, as an intervention for otitis media of any type...
July 2013: Otolaryngology—Head and Neck Surgery
Ozkan Candan, Nihal Ozdemir, Soe Moe Aung, Cem Dogan, Can Yucel Karabay, Cetin Gecmen, Onur Omaygenç, Ahmet Güler
Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with increased morbidity, mortality, and prolonged hospital stay. Speckle tracking echocardiography (STE) has been applied recently for evaluation of LA function. The purpose of this study was to examine whether left atrial longitudinal strain measured by STE is a predictor for the development of POAF following mitral valve surgery for severe mitral regurgitation. We studied 53 patients undergoing mitral valve surgery in sinus rhythm at the time of surgery...
October 2013: Echocardiography
Jeffrey R Infante, Hendrik-Tobias Arkenau, Johanna C Bendell, Mark S Rubin, David Waterhouse, George Tripp Jones, David R Spigel, Cassie M Lane, John D Hainsworth, Howard A Burris
OBJECTIVES: To evaluate the 6-mo overall survival, safety and tolerability of lenalidomide in combination with standard gemcitabine as first-line treatment for patients with metastatic pancreatic cancer. METHODS: Eligibility included: previously untreated metastatic adenocarcinoma of the pancreas with metastases incurable by surgery/radiation therapy; ECOG PS 0-2; adequate organ function; prophylactic anticoagulation for venous thromboembolic events (VTEs). Patients received lenalidomide 25 mg PO (days 1-21) and gemcitabine 1,000 mg/m ( 2) IV (days 1, 8 and 15) each 28-day cycle, with response evaluations every eight weeks...
April 2013: Cancer Biology & Therapy
Mohammad Taghy, Khorsandi Ashtiani, Mohammad Sadeghi, Babak Saedi, Gilda Givechi
OBJECTIVE: Patients who need major head and neck surgery like laryngectomy are at risk of postoperative wound infection. Although the role of antibiotics in prophylaxis of clean contaminated head and neck surgery has been well documented, controversy exists in the optimal antibiotic regimen. METHODS: In two tertiary referral hospitals (Imam Khomeini and Amir Alam hospital), 90 patients undergoing laryngectomy were prospectively randomized into two groups receiving cefazolin perioperative prophylaxis either for 2 days or for 5 days from June 2004 to March 2006...
January 2010: Indian Journal of Otolaryngology and Head and Neck Surgery
Benjamin E Dillon, Cenk Gurbuz, Philippe E Zimmern
INTRODUCTION: To report the long term result following complications that arose after "prophylactic" placement of midurethral sling (MUS) during prolapse repair. MATERIALS AND METHODS: After institutional review board approval, the records of patients who presented with complications of prophylactic MUS and had a minimum 1 year follow up after repair of their complication were reviewed. Data collected included age, body mass index, operative note documenting primary procedure and type of prophylactic MUS, indication for prophylactic MUS, presenting complaint, duration and severity of symptoms since MUS placement, operative events if any, and outcomes after repair of the complication...
October 2012: Canadian Journal of Urology
S Taneri, A Heiligenhaus
Apart from the classical indication of removing an opaque lens that is compromising vision, extraction of the crystalline lens is gaining increasing importance as a refractive procedure. This literature review which considers the present guidelines of various ophthalmological societies and recently published studies is intended to give an estimate of the incidence of postoperative endophthalmitis and evidence-based recommendations for its prophylaxis, diagnosis, and therapy. The incidence of endophthalmitis after cataract extraction is reported to be 0...
September 2012: Klinische Monatsblätter Für Augenheilkunde
Cassie A Barton, Wesley D McMillian, Bruce A Crookes, Turner Osler, Craig S Bartlett
CONTEXT: Prophylactic antibiotics, paired with wound care and surgical intervention, is considered the standard of care for patients with open fracture. Guidelines from the Eastern Association for the Surgery of Trauma (EAST) recommend specific prophylactic antimicrobial therapy based on the type of open fracture. AIMS: We quantified adherence to EAST guideline recommendations and documented the incidence of infection in patients with open fracture. SETTINGS AND DESIGN: A retrospective, observational study of all patients with open fracture admitted to our facility from January 2004 to December 2008 was conducted...
May 2012: International Journal of Critical Illness and Injury Science
Jennifer Tan, Stephen Lade, Simon Harrison, Stephen Opat, Michael P Mac Manus
AIMS: Primary gastric extramedullary plasmacytoma is an extremely rare condition and there is scant information in the literature concerning its natural history or therapy. There have been anecdotal reports of surgical resection, with or without Helicobacter pylori eradication, but there are no useful reports of the role of radiotherapy. We report the clinicopathologic outcome of radical radiotherapy as a primary treatment modality. METHODS: We identified two patients with biopsy-proven primary gastric extramedullary plasmacytoma...
June 2012: Journal of Medical Imaging and Radiation Oncology
Heyder Omran, Rupert Bauersachs, Siegfried Rübenacker, Franz Goss, Christoph Hammerstingl
Patients who receive long-term oral anticoagulant (OAC) therapy often require interruption of OAC for an elective invasive procedure. Current guidelines allow bridging therapy with either unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH). Apart from the risk of embolism, bleeding is an important complication in this setting and the optimal perioperative management of such patients is still under discussion. The aims of this prospective, observational, multicentre registry of patients treated by cardiologists were: 1) to evaluate current practice of perioperative management of OAC in a large outpatient cohort, 2) to document embolic and haemorrhagic events, and 3) to identify risk factors predicting adverse events...
July 2012: Thrombosis and Haemostasis
G Ormel, L Romundstad, P Lambert-Jensen, A Stubhaug
BACKGROUND: Prophylactic dexamethasone, ondansetron and droperidol have a documented effect on post-operative nausea and vomiting (PONV). Still, there is a lack of studies investigating the effect of adding dexamethasone to ondansetron and droperidol in order to treat established PONV. METHODS: In this double-blind randomised, controlled trial, we compared triple prophylaxis for PONV consisting of dexamethasone 8 mg intravenous (IV), ondansetron 4 mg IV and droperidol 0...
November 2011: Acta Anaesthesiologica Scandinavica
Wei Wang, Hong-Liang Li, Dong-Xin Wang, Xi Zhu, Shuang-Ling Li, Gai-Qi Yao, Kai-Sheng Chen, Xiu-E Gu, Sai-Nan Zhu
OBJECTIVES: To evaluate the efficacy and safety of short-term low-dose intravenous haloperidol for delirium prevention in critically ill elderly patients after noncardiac surgery. DESIGN: Prospective, randomized, double-blind, and placebo-controlled trial in two centers. SETTING: Intensive care units of two large tertiary teaching hospitals. PATIENTS: Four hundred fifty-seven patients 65 yrs or older who were admitted to the intensive care unit after noncardiac surgery...
March 2012: Critical Care Medicine
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