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https://www.readbyqxmd.com/read/28419812/defining-quality-in-head-and-neck-reconstruction
#1
Peter M Vila, Jason T Rich, Shaun C Desai
Microvascular free flap reconstruction has now become the standard of care in the reconstruction of selected head and neck defects. Although uncommon, flap failure is a catastrophic event that results in significant patient morbidity, extended length of hospitalization, and increased cost. However, there is currently no gold standard for measuring the quality of a reconstructive center. Structure and process outcomes have recently been developed, but outcome measures are still lacking. Areas for future research include preoperative nutrition, preoperative flap planning, intraoperative fluid management, appropriate thromboembolism prophylaxis, consistent perioperative antibiotic regimens, skilled ancillary staff, and clear outcome measures for performance measurement...
April 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28415948/use-of-platelet-rich-plasma-for-regeneration-in-non-vital-immature-permanent-teeth-clinical-and-cone-beam-computed-tomography-evaluation
#2
Adel Alagl, Sumit Bedi, Khalid Hassan, Jehan AlHumaid
Objective This study was performed to assess the clinical and radiological outcomes of a revascularization procedure in immature teeth with apical periodontitis using platelet-rich plasma (PRP). The PRP protocol and conventional revascularization protocol, which used a blood clot as the scaffold, were compared. Methods Thirty non-vital immature permanent teeth were randomly categorized into two groups. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created using either PRP or a blood clot (control) and covered with white mineral trioxide aggregate...
April 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28414168/decompression-alone-versus-fusion-for-pyogenic-spondylodiscitis
#3
Sung Hyun Noh, Ho Yeol Zhang, Hyun Sun Lim, Hyeon Jin Song, Kyung Hwa Yang
BACKGROUND CONTEXT: A spinal infection is a serious problem for a spine surgeon, and there is currently much debate regarding how best to treat pyogenic spondylodiscitis using antibiotics and the instrumentations that have been developed to date. PURPOSE: The purpose of this study was to determine which is better method for treating pyogenic spondylodiscitis. STUDY DESIGN/SETTING: A retrospective chart review was performed. PATIENT SAMPLE: Thirty-one patients with pyogenic spondylodiscitis underwent surgical treatment between 2000 and 2016 at the authors' institution...
April 13, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28405807/management-and-outcomes-of-acute-surgical-patients-at-a-district-hospital-in-uganda-with-non-physician-emergency-clinicians
#4
Caleb Dresser, Usha Periyanayagam, Brad Dreifuss, Robert Wangoda, Julius Luyimbaazi, Mark Bisanzo
INTRODUCTION: Acute surgical care services in rural Sub-Saharan Africa suffer from human resource and systemic constraints. Developing emergency care systems and task sharing aspects of acute surgical care addresses many of these issues. This paper investigates the degree to which specialized non-physicians practicing in a dedicated Emergency Department contribute to the effective and efficient management of acute surgical patients. METHODS: This is a retrospective review of an electronic quality assurance database of patients presenting to an Emergency Department in rural Uganda staffed by non-physician clinicians trained in emergency care...
April 12, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28399047/assessing-quality-and-safety-in-pediatric-supracondylar-humerus-fracture-care
#5
Christopher A Iobst, Matthew Stillwagon, Deidre Ryan, Eric Shirley, Steven L Frick
BACKGROUND: Recently, there has been an emphasis on improving quality, safety, and value in the delivery of health care in the United States. The American Board of Orthopedic Surgery (ABOS) has developed a performance improvement questionnaire (PIQ) for orthopaedic surgeons managing pediatric supracondylar humerus fracture (PSCHF). Using the supracondylar PIQ as a guide, this study evaluates the process of measuring the outcomes and variations in care to PSCHF patients among pediatric orthopaedic surgeons...
April 10, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28396232/treatment-of-osteomyelitis-a-case-for-disruption-of-the-affected-adjacent-periosteum
#6
J W Hudson, Austin P Daly, Michael Foster
PURPOSE: To evaluate the response of mandibular osteomyelitis treated by surgical decortication with disruption of the affected adjacent periosteum in concert with long-term targeted antibiotic therapy. The hypothesis is that, by removing the buccal cortical plate and disrupting the hypertrophically inflamed adjacent periosteum, the medullary bone will be brought in contact with bleeding tissue and circulating immunologic factors and antibiotics, which will promote definitive resolution...
March 18, 2017: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28396114/surgery-related-contact-dermatitis-a-review-of-potential-irritants-and-allergens
#7
Kevin A Cook, John M Kelso
Surgical procedures utilize an increasing number of medical products including antiseptics, anesthetics, gloves, suture materials, tissue adhesives, topical antibiotics, and bandages. Many of these products have irritant potential. Allergic contact dermatitis has also been reported. This review covers preoperative, operative, and postoperative exposures that may result in contact dermatitis. Testing with standard patch panels such as T.R.U.E. Test and the North American Contact Dermatitis Group 65 allergen series does not evaluate for all relevant contactants...
April 7, 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28387071/-pseudotumoral-pelvic-actinomycosis-one-should-think-of-it
#8
A Kakkos, E Gonne, C Coimbra, P Nervo, G Remacle, A Thille, M P Hayette, C Van Linthout, F Kridelka, K Delbecque
Actinomycosis is a rare chronic disease caused by a group of anaerobic Gram positive bacteria. It may mimic a neoplasia at various anatomical levels. A pelvic localization is exceptional but has an increasing incidence since the use of intrauterine devices. In such cases, pelvic actinomycosis may present as a gynecological or a lower colonic malignancy. For all atypical clinical, with a prominent infectious or inflammatory context, the diagnosis of actinomycosis must be suggested and discussed with the pathologist to whom the biopsy will be submitted...
January 2017: Revue Médicale de Liège
https://www.readbyqxmd.com/read/28384465/multicenter-retrospective-study-of-the-risk-factors-of-hemorrhage-after-tooth-extraction-in-patients-receiving-antiplatelet-therapy
#9
Souichi Yanamoto, Takumi Hasegawa, Satoshi Rokutanda, Sayaka Komori, Akira Tachibana, Yuka Kojima, Yoshito Koyama, Yasuyuki Shibuya, Hiroshi Kurita, Takahide Komori, Masahiro Umeda
PURPOSE: To identify the risk factors affecting hemorrhage after tooth extraction in patients receiving antiplatelet therapy, this study investigated the relation between various factors and hemorrhage events after tooth extraction. PATIENTS AND METHODS: The records of 264 patients receiving antiplatelet therapy who underwent tooth extraction were retrospectively reviewed from 6 institutions belonging to the Japanese Study Group of Cooperative Dentistry with Medicine...
March 14, 2017: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28383453/predictors-of-anastomotic-leak-in-elderly-patients-after-colectomy-nomogram-based-assessment-from-the-american-college-of-surgeons-national-surgical-quality-program-procedure-targeted-cohort
#10
Ahmet Rencuzogullari, Cigdem Benlice, Michael Valente, Maher A Abbas, Feza H Remzi, Emre Gorgun
BACKGROUND: Elderly patients undergoing colorectal surgery have increasingly become under scrutiny by accounting for the largest fraction of geriatric postoperative deaths and a significant proportion of all postoperative complications, including anastomotic leak. OBJECTIVE: This study aimed to determine predictors of anastomotic leak in elderly patients undergoing colectomy by creating a novel nomogram for simplistic prediction of anastomotic leak risk in a given patient...
May 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28378083/minor-laparoscopic-liver-resection-toward-1-day-surgery
#11
Nicola de'Angelis, Benjamin Menahem, Philippe Compagnon, Jean Claude Merle, Francesco Brunetti, Alain Luciani, Daniel Cherqui, Alexis Laurent
BACKGROUND: Technical advances in laparoscopy and enhanced recovery after surgery programs have progressively decreased the need for hospitalization. The present study aimed to explore the feasibility and safety of an early discharge protocol after minor laparoscopic liver resection (LLR). METHODS: The study sample consisted of patients with both benign and malignant hepatic lesions involving no more than two hepatic segments who underwent minor LLR and were discharged within 24 h...
April 4, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28371248/randomized-controlled-trial-of-perioperative-antimicrobial-therapy-based-on-the-results-of-preoperative-bile-cultures-in-patients-undergoing-biliary-reconstruction
#12
Kunishige Okamura, Kimitaka Tanaka, Takumi Miura, Yoshitsugu Nakanishi, Takehiro Noji, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano
BACKGROUND: The high frequency of surgical site infections (SSIs) after hepato-pancreato-biliary (HPB) surgery is a problem that needs to be addressed. This prospective, randomized, controlled study examined whether perioperative prophylactic use of antibiotics based on preoperative bile culture results in HPB surgery could decrease SSI. METHODS: Participants comprised 126 patients who underwent HPB (bile duct, gallbladder, ampullary, or pancreatic) cancer surgery with biliary reconstruction at Hokkaido University Hospital between August 2008 and March 2013 (UMIN Clinical Trial Registry #00001278)...
March 29, 2017: Journal of Hepato-biliary-pancreatic Sciences
https://www.readbyqxmd.com/read/28357167/a-case-series-of-bee-sting-keratopathy-with-different-outcomes-in-malaysia
#13
Wen-Jeat Ang, Siti-Zakiah Md Kadir, Abdul-Jalil Fadzillah, Embong Zunaina
We report three patients with corneal bee sting at our tertiary care center in a three-year period starting from 2014 to 2016. All patients sustained a bee sting injury to the cornea. All patients received early preoperative topical antibiotics, topical cycloplegic and intensive topical steroids. However, the timing of the initial presentation, the duration, and the location of the retained stinger differed in each case leading to different postsurgical outcomes.
February 17, 2017: Curēus
https://www.readbyqxmd.com/read/28356079/enterobacteriaceae-producing-extended-spectrum-%C3%AE-lactamases-esbls-colonization-as-a-risk-factor-for-developing-esbl-infections-in-pediatric-cardiac-surgery-patients-retrospective-cohort-study
#14
Amine Cheikh, Bouchra Belefquih, Younes Chajai, Younes Cheikhaoui, Amine El Hassani, Amina Benouda
BACKGROUND: Children with cardiac defects need many hospitalizations and repetitive antibiotic therapies, with an increasing risk of colonization with multidrug-resistant bacteria (MDRB) such as extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) Post-operative infections with these bacteria in paediatric cardiac surgery are life threatening. This article aims to study the prevalence of ESBL colonization among paediatric cardiac surgery patients, and to compare occurrence of post-operative infections with and without ESBL colonization...
March 29, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28350942/prevention-of-surgical-site-infection-in-spine-surgery
#15
Paul A Anderson, Jason W Savage, Alexander R Vaccaro, Kristen Radcliff, Paul M Arnold, Brandon D Lawrence, Mohammed F Shamji
BACKGROUND: Spine surgery is complicated by an incidence of 1% to 9% of surgical site infection (SSI). The most common organisms are gram-positive bacteria and are endogenous, that is are brought to the hospital by the patient. Efforts to improve safety have been focused on reducing SSI using a bundle approach. The bundle approach applies many quality improvement efforts and has been shown to reduce SSI in other surgical procedures. OBJECTIVE: To provide a narrative review of practical solutions to reduce SSI in spine surgery...
March 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28347198/endomyometritis-after-cesarean-delivery-in-the-era-of-antibiotic-prophylaxis-incidence-and-risk-factors
#16
Laura J Moulton, Mark Lachiewicz, Xiaobo Liu, Oluwatosin Goje
PURPOSE: To identify the rate of endomyometritis (PPE) after cesarean delivery (CD) in the era of antibiotic prophylaxis and determine risk factors. METHODS: A single institution retrospective study was performed in women undergoing CD. Data regarding obstetrical and surgical variables were collected. Diagnosis of PPE was made clinically. RESULTS: Among 2419 patients, the rate of PPE was 1.6% (n = 38) and was associated with lower age (27...
March 27, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28344521/timing-of-debridement-and-infection-rates-in-open-fractures-of-the-hand-a-systematic-review
#17
REVIEW
Constantinos Ketonis, Joseph Dwyer, Asif M Ilyas
Background: Literature on open fracture infections has focused primarily on long bones, with limited guidelines available for open hand fractures. In this study, we systematically review the available hand surgery literature to determine infection rates and the effect of debridement timing and antibiotic administration. Methods: Searches of the MEDLINE, EMBASE, and Cochrane computerized literature databases and manual bibliography searches were performed. Descriptive/quantitative data were extracted, and a meta-analysis of different patient cohorts and treatment modalities was performed to compare infection rates...
March 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28342695/in%C3%A2-vivo-serum-concentration-of-vancomycin-in-antibiotic-loaded-acrylic-cement-for-the-treatment-and-prevention-of-periprosthetic-hip-infection
#18
Kenichi Oe, Hirokazu Iida, Narumi Ueda, Tomohisa Nakamura, Naofumi Okamoto, Yusuke Ueda
BACKGROUND: Although antibiotic-loaded acrylic cement (ALAC) is used to prevent and treat periprosthetic hip infection, it is unknown how much antibiotic is deposited in the body in vivo, how high the serum concentration rises, or how long its effects last. The aim of this study was firstly to determine the amount of vancomycin (VCM) deposited as ALAC in the body, and secondly to assess the safety and drug elution profile of VCM in ALAC. METHODS: We administered VCM to prevent infection after total hip arthroplasty (THA) or to treat patients with methicillin-resistant Staphylococcus aureus...
March 22, 2017: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
https://www.readbyqxmd.com/read/28341500/effect-of-2-chlorhexidine-gluconate-impregnated-cloth-on-surgical-site-infections-in-vascular-surgery
#19
John Bak, Jason Le, Toshio Takayama, Angela Gibson, Sara Zerbel, Nasia Safdar, Jon Matsumura
OBJECTIVE: Surgical site infections (SSI) are a significant burden to patients and healthcare systems. This retrospective study evaluates the observed rates of SSI after our institution implemented chlorhexidine gluconate-impregnated (CHG) cloth as a preoperative antiseptic preparation in elective vascular surgery. METHODS: Between March 2011 and January 2012, we reviewed 250 patients who underwent elective vascular surgery who used the CHG cloth preoperatively...
March 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28321988/a-quality-improvement-initiative-to-optimize-dosing-of-surgical-antimicrobial-prophylaxis
#20
Thomas J Caruso, Ellen Wang, Hayden T Schwenk, David Scheinker, Calida Yeverino, Mary Tweedy, Manjit Maheru, Paul J Sharek
BACKGROUND: The risk of surgical site infections is reduced with appropriate timing and dosing of preoperative antimicrobials. Based on evolving national guidelines, we increased the preoperative dose of cefazolin from 25 to 30 mg·kg(-1) . This quality improvement project describes an improvement initiative to develop standard work processes to ensure appropriate dosing. AIMS: The primary aim was to deliver cefazolin 30 mg·kg(-1) to at least 90% of indicated patients...
March 21, 2017: Paediatric Anaesthesia
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