Biomedical subjects

Traci L Hedrick

Publications and source records attributed to Traci L Hedrick.

10 recordsLinked to original sources

PubMed2006

Anastomotic leak and the loop ileostomy: friend or foe?

PURPOSE: Anastomotic disruption is an uncommon but morbid complication of colon and rectal surgery. This study was designed to evaluate the use of proximal diversion and surgical drainage as an alternative to anastomotic resection in the operative management of patients with anastomotic complications. METHODS: A retrospective chart review was undertaken of all patients on the colon and rectal surgery service at an academic medical center requiring operative intervention for an anastomotic complication between 1998 and 2005. Demographic data, operative management, morbidity, and mortality were collected and analyzed for each patient. RESULTS: Twenty-seven patients with anastomotic leaks were included in the study. Nineteen patients were managed with proximal diversion and surgical drainage, six patients had resection of their anastomosis and creation of an end colostomy, and two patients were treated by primary reanastomosis. There was 0 percent mortality. Sixty-three percent of the patients treated with proximal diversion had restoration of intestinal continuity vs. 33 percent of the patients who had the anastomosis resected. Of the 13 patients treated with proximal diversion who underwent fluoroscopic evaluation, 92 percent were normal without evidence of persistent leak or stricture. CONCLUSIONS: Based on this retrospective study, proximal diversion without resection of the anastomosis seems to be a safe and effective alternative for the treatment of anastomotic complications. Sepsis is well controlled with limited mortality and there is a high rate of anastomotic salvage. Prospective studies are needed to further delineate the optimal management for this complicated patient population.

Adult↗

PubMed2006

Does enteral glutamine supplementation decrease infectious morbidity?

BACKGROUND: Although some studies have demonstrated lower infectious morbidity in patients receiving supplemental glutamine, there remains no consensus on the utility of such treatment. This study was designed to investigate the effects of supplemental enteral glutamine on the rate and outcomes of infection in critically ill surgical patients. METHODS: All 185 surgical and trauma patients admitted to a single university surgical trauma intensive care unit (STICU) over an approximately three-year period who were to receive enteral nutrition support were assigned sequentially to one of three diets: standard 1-kCal/mL feedings with added protein (Group 1), standard feedings with glutamine 0.6 g/kg per day (Group 2), or immune-modulated feedings with a similar amount of glutamine (Group 3). Group compositions and patient characteristics were similar at baseline. Data were collected prospectively on infections acquired during hospitalization. RESULTS: A total of 119 patients had at least one infection: 59% of the patients in Group 1, 64% of Group 2, and 69% of Group 3 (p = NS). There were no differences among the groups in the mean number of infections. The most common sites in all groups were the lungs, blood, and urine; and the frequencies of these infections did not differ between groups. Minor differences were found between groups in the organisms isolated. Antibiotic usage did not differ. CONCLUSION: Supplemental enteral glutamine in the dose studied does not appear to influence the acquisition or characteristics of infection in patients admitted to a mixed STICU.

Adult↗

PubMed2006

Can we define the ideal duration of antibiotic therapy?

BACKGROUND: Because of the increasing development of antimicrobial resistance, there is a greater responsibility within the medical community to limit the exposure of patients to antibiotics. We tested the hypothesis that shorter courses of antibiotics are associated with similar or better results than longer durations. We also sought to investigate the difference between a fixed duration of therapy and one based on physiologic measures such as fever and leukocytosis. METHODS: All infectious episodes on the general surgery units of the University of Virginia Health System from December 15, 1996, to July 31, 2003, were analyzed retrospectively for the relation between the duration of antibiotic therapy and infectious complications (recurrent infection with the same organism or at the same site). All infections associated with either fever or leukocytosis were categorized into quartiles on the basis of the absolute length of antibiotic administration or the duration of treatment following resolution of fever or leukocytosis. Multivariate logistic regression models were developed to estimate the independent risk of recurrence associated with a longer duration of antibiotic use. RESULTS: Of the 5,561 treated infections, 4,470 were associated with fever (temperature > or =38 degrees C) or leukocytosis (white blood cell count > or =11,000/mm(3)). For all infections, whether analyzed by absolute duration or time from resolution of leukocytosis or fever, the first or second quartiles (0-12 days, 0-9 days, 0-9 days, respectively) were associated with the lowest recurrence rates (14-18%, 17-23%, 18-19%, respectively). Individual analysis of intra-abdominal infections and pneumonia yielded similar results. The fixed-duration groups received fewer days of antibiotics on average, with outcomes similar to those in the physiologic parameters group. CONCLUSIONS: Shorter courses of antibiotics were associated with similar or fewer complications than prolonged therapy. In general, adopting a strategy of a fixed duration of therapy, rather than basing duration on resolution of fever or leukocytosis, appeared to yield similar outcomes with less antibiotic use.

Adult↗

PubMed2006

Prevention of surgical site infections.

In the current era of pay-for-performance standards, the incidence of surgical site infections is increasingly becoming an institutional marker of quality assurance. Surgical site infections lead to increased morbidity and mortality in the surgical population and contribute to an already rising healthcare cost. As a result, the surgical community goes to great lengths to prevent this costly and occasionally lethal complication. Many practices are evidence based, however, many are not. In this article, the most commonly used preventive strategies in practice today and the evidence behind each are reviewed. In addition, an overview of the epidemiology, pathophysiology and microbiology of surgical site infections will be provided.

Anti-Bacterial Agents↗

PubMed2006

Screening practices of patients presenting for resection of a colorectal neoplasm.

Multiple studies demonstrate the efficacy of colorectal cancer (CRC) screening in patients over 50 years of age. However, there is a lack of consensus regarding which screening method to use, and compliance has been poor. The objective of this study was to identify the CRC screening practices at two institutions and determine the relationship between screening and pathologic stage for patients presenting with a colorectal neoplasm. This study, conducted at the University of Virginia (UVA) Health System and the Salem Veterans Affairs Medical Center (VAMC) between October 30, 2000, and September 1, 2004, included 198 patients > or = 50 years who presented for resection of a primary colorectal neoplasm. Pathologic stage and prior screening were identified retrospectively through chart review and patient response to an anonymous survey. Prior screening was demonstrated in 71 per cent of patients. Colonoscopy was the most commonly used modality. There was a higher percentage of CRC screening at VAMC compared with UVA (80% vs 62%, P < 0.0008). Patients at UVA were more likely screened with colonoscopy, whereas fecal occult blood testing (FOBT) was most common at VAMC (P < 0.0001). Prior CRC screening and cancer stage were inversely related. Ninety-one per cent of patients with benign polyps had been screened prior to diagnosis, compared with 72 per cent of patients with stage I and II cancer and 54 per cent of patients with stage III and IV cancer (P < 0.05). Of patients presenting for surgery, 71 per cent underwent CRC screening. Variability exists in the methods employed for CRC screening. CRC screening facilitates diagnosis at an early stage.

Aged↗

PubMed2005

MRI for the diagnosis of blunt abdominal trauma: a case report.

Blunt abdominal trauma is a leading cause of trauma related mortality. Currently, the gold standard in the radiographic evaluation of intra-abdominal injury is computed tomography (CT) with iodinated contrast material. However, in the setting of renal failure or a previous anaphylactic reaction to contrast material, radiographic evaluation of the trauma patient may prove difficult. Without contrast material, the sensitivity of CT in the diagnosis of solid organ injury is diminished. We present a case report and literature review of magnetic resonance imaging in the evaluation of blunt abdominal trauma.

Abdominal Injuries↗

PubMed2005

Health-care-associated infections and prevention.

Health-care-associated infections (HAIs) are an important cause of perioperative morbidity and mortality. Currently, one out of every 10 surgical patients develops an HAI. Causes of HAIs vary, but include the transient immunodeficiency associated with surgery,immobility, and the presence of indwelling devices. With rates of antimicrobial resistance increasing, prevention remains the best solution. The investigators review the most frequently encountered health-care-associated infections with an emphasis on preventative strategies. The article addresses issues related to the diagnosis,treatment, and prevention of health-care-related pneumonia,health-care-associated urinary tract infections, and intravascular-catheter-related infections. The article also discusses the utility of hand hygiene policies.

Anti-Bacterial Agents↗

PubMed2005

Effect of the 80-hour work week on cases performed by general surgery residents.

The Accreditation Council for Graduate Medical Education (ACGME) implemented mandatory work week hours restrictions in 2003. Due to the traditionally long hours in general surgery, the effect of restrictions on surgical training and case numbers was a matter of concern. Data was compiled retrospectively from ACGME logs and operating room (OR) records at a university hospital for 2002 and 2003. Work week restrictions began in January 2003. This data was reviewed to determine resident case numbers, both in whole and by postgraduate year (PGY). Mean case numbers per resident-month in 2002 were 8.8 +/- 8.2 for PGY1s, 16.2 +/- 15.7 for PGY2s, 31.4 +/- 12.9 for PGY3s, 31.5 +/- 17.6 for PGY4s, and 31.5 +/- 17.6 for PGY5s. In 2003, they were 8.8 +/- 5.2 for PGY1s, 16.6 +/- 13.9 for PGY2s, 27.8 +/- 12.5 for PGY3s, 38.2 +/- 18.8 for PGY4s, and 26.1 +/- 9.6 for PGY5s. PGY1s, PGY2s, PGY3s, PGY4s, or all classes were not statistically different. PGY5s did have statistically fewer cases in 2003 (P = 0.03). PGY5s did have statistically fewer cases after the work-hours restriction, which likely represented shifting of postcall afternoon cases to other residents. Comparing other classes and all PGYs, case numbers were not statistically different. Operative training experience does not appear to be hindered by the 80-hour work week.

Burnout, Professional↗

PubMed2004

Impact of immunomodulatory oligodeoxynucleotides on cytokine production in the lipopolysaccharide-stimulated human whole blood model.

BACKGROUND: In studying potential immunotherapeutics for sepsis, we used a lipopolysaccharide (LPS)-stimulated whole blood model to test the immunomodulating capacity of cytosine-phospho-guanine oligodeoxynucleotides (CpG ODNs). We hypothesized that CpG ODNs would have considerable counterinflammatory effects on LPS-induced cytokine production. METHODS: We administered 4 micromol/L of CpG ODNs (2216, D19, 2006, K3, or 1668) or guanine-phospho-cytosine (GpC) ODNs (control D or control K) immediately after LPS (10 ng/mL) stimulation of heparinized human whole blood. Samples were incubated for 1, 3, 6, 12, and 24 hours. Media and LPS were used as negative and positive controls. Cell-free supernatants were obtained and evaluated for interferon gamma (IFN-gamma), interleukin (IL)-12(p40), tumor necrosis factor alpha, IL-6, IL-10, IFN-alpha, IL-8, and IL-1beta by ELISA. RESULTS: Compared to LPS alone, significantly reduced levels of IFN-gamma, IL-12(p40), tumor necrosis factor alpha, and IL-6 were associated with both CpG and GpC ODNs administration to LPS-stimulated whole blood. IL-10 levels were concomitantly increased. However, IFN-alpha generation was CpG specific as was increased IL-8 levels. Lastly, only 2216 was associated with decreased IL-1beta levels. CONCLUSIONS: CpG ODNs and GpC ODNs in the LPS-stimulated whole blood model demonstrate differential counterinflammatory effects, but only CpG ODNs were associated with proinflammatory cytokine production. With further examination, we may find that these observed immunomodulatory differences could potentially be exploited for therapeutic benefit.

Adjuvants, Immunologic↗

PubMedDate not supplied

General surgery morning report: a competency-based conference that enhances patient care and resident education.

PURPOSE: After adopting a night float system, the residency program at the University of Virginia Health System Department of Surgery initiated a daily morning report (MR). The conference was originated to sign out new admissions and consults from the previous day to the services that would assume care. Although initially oriented toward transfer of patient information, MR is also hypothesized to serve as a competency-based resident education tool. METHODS: An anonymous survey was distributed to on-service residents (n = 25). Questions were asked on a 5-point Likert scale. Respondents also ranked the weekly conferences, including MR, in terms of educational benefit derived. RESULTS: Most residents agreed that MR is an efficient method to sign-out patient care [84% stongly agree (SA) or agree (A)] and that it provides an excellent educational experience (88% SA or A). They agreed that it is presented in an evidence-based format (88% SA or A). Regarding the core competencies, residents all asserted that MR addresses "patient care" (100% SA or A) and "medical knowledge" (100% SA or A). Most agreed that it addresses "professionalism" (60% SA or A), "interpersonal skills and communication" (76% SA or A), and "practice-based learning and improvement" (92% SA or A). The 4 most important components identified with respect to continuing to improve both patient care and resident education were the presence of the on-call attending, a review of relevant radiology, provision of follow-up on select cases, and critical review of the literature. On average, MR was seen as the most educational conference, with 52% of residents ranking it first. CONCLUSIONS: Although MR is ubiquitous in most primary care residency programs, such a conference has not typically been held on surgical services. The MR was developed at the University of Virginia Health System Department of Surgery as a necessity for patient sign-out. As this conference has continued to evolve, it has become an excellent tool for resident education. It now serves the purpose of enhancing patient care and medical education and of providing evidence of learning and assessment of the general competencies. The MR provides an example for program directors of how to tailor existing resident work sessions or conferences to meet Accreditation Council for Graduate Medical Education (ACGME) competency requirements.

Clinical Competence↗