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At least 379 records · Page 21Linked to original sources
PubMed2002

The practice of perioperative antibiotic prophylaxis in eight German hospitals.

BACKGROUND: Although there is consensus in the international literature on the benefits of using perioperative antibiotic prophylaxis (PAP), there is still considerable scope for improving its use in many hospitals. MATERIALS AND METHODS: In this study, data on the practice of PAP were recorded in eight German hospitals within the framework of a prospective controlled interventional study for the surveillance and prevention of nosocomial infections. RESULTS: A total of 627 surgical procedures (appendectomies, other colorectal procedures, total prosthetic hip replacement) were assessed; 397 with PAP and 224 without PAP; six procedures could not be evaluated. Of the 397 PAP recorded, only 180 (45.3%) were performed correctly in accordance with international standards as a preoperative single dose (19/59 PAP in appendectomies, 72/188 PAP in other colorectal procedures, 89/150 PAP in total prosthetic hip replacement). CONCLUSION: There is still great uncertainty regarding the point in time at which PAP should be administered and its duration. Additional efforts are necessary to improve PAP in accordance with published evidence-based guidelines.

Anti-Bacterial Agents↗
PubMed1991

The predictive value of preoperative silent ischemia for postoperative ischemic cardiac events in vascular and nonvascular surgery patients.

Silent ischemia has been shown to be predictive of postoperative cardiac events in vascular surgery patients. However, no controlled data regarding its predictive value in nonvascular surgery patients are available. We studied 67 vascular surgery and 79 nonvascular surgery patients, all of whom had increased risk for cardiac disease, to determine whether the occurrence of preoperative silent myocardial ischemia is predictive of morbid postoperative cardiac events in a diverse surgical group. The presence of preoperative silent ischemia in both nonvascular and vascular surgical patients had similar predictive value (0.38 and 0.38, respectively) for postoperative morbid cardiac events. The absence of preoperative silent ischemia predicted an excellent outcome in patients undergoing nonvascular surgery (0.99), but was a less robust predictor in our vascular patients (0.86). These data suggest that the functional status of the coronary circulation is one of the most important determinants of outcome.

Aged↗
PubMed1990

Extragenital Mycoplasma hominis infections in adults.

PURPOSE: To heighten awareness of the role of Mycoplasma hominis as an extragenital pathogen in adults. PATIENTS AND METHODS AND RESULTS: Patients ranged in age from 14 to 76 years. Thirteen patients were immunosuppressed, including nine organ transplant recipients; three were receiving steroids, and two had an underlying malignancy. The remainder were immunocompetent. Thirteen patients had prior surgery at or near the site of infection. M. hominis was isolated from normally sterile sites such as blood or cerebrospinal, pleural, abdominal and joint fluids, and bone. Non-sterile sites of isolation included surgical wounds and pulmonary secretions. The organism was detected in anaerobic cultures of clinical specimens sent to the laboratory for routine bacteriologic culture. Gram stains of fluids or wound drainage revealed neutrophils but no bacteria. Anti-mycoplasmal therapy was effective in eradicating the organism in 13 of 15 patients who were treated. Of those in whom treatment failed, one patient had an antibiotic-resistant isolate and the other had M. hominis isolated from the lung at postmortem after just 2 days of therapy. CONCLUSION: Our experience suggests that significant infections due to M. hominis, although uncommon, are not rare, and methods to isolate and identify this organism should be available for general adult medical and surgical populations.

Adolescent↗
PubMed1991

Nosocomial infections in surgical patients: developing valid measures of intrinsic patient risk.

For surgeons or hospitals to compare their rates of wound infection meaningfully, the analysis must first control for the mix of intrinsic infection risk of their patients. Research over the past century has led to the development of several intrinsic risk indexes that can be used to stratify the wound infection rates so that valid comparisons can be made within risk strata. For an intrinsic risk index to be useful for comparing rates, it must control for all of the important intrinsic risk constructs; merely being statistically associated with infection rates does not ensure that a risk index will be useful. Understanding how a risk index can be both parsimonious and comprehensive requires consideration of the competing principles of multicollinearity and orthogonality. Various techniques of multivariate analysis are used to develop multivariate risk indexes, but the success of the process depends on having all of the important orthogonal risk constructs represented in the pool of predictor variables available for the analysis, either directly by variables in the pool or by demonstrated multicollinearity. Despite recent advances in risk measurement, many important questions remain.

Cross Infection↗
PubMed1975

Emergency subclavian vein catheterization and intravenous hyperalimentation.

One hundred consecutive subclavian catheter insertions were performed by the surgical house staff of Martland Hospital, Newark, New Jersey, over a ten month period. The only complications were three punctures of the subclavian artery and one systemic infection. The following conclusions were drawn from these data. Maintaining a closed intravenous system with minimal manipulation of the catheter is the most important factor in avoiding infectious complication. Neither the routine use of irrigation of the catheter with amphotericin B nor insertion of the catheter under strict aseptic conditions is necessary to minimize infectious complications. The morbidity related to insertion of the catheter can be kept to a minimum if the catheters are inserted by experienced personnel.

Amphotericin B↗
PubMed1976

Abdominal incision and closure. A systems approach.

The application of systems analysis and flow charting technics to abdominal incision and closure allow a complete display of objectives and alternatives. A route of alternatives has been chosen and supported by the best available principles in the surgical literature. The choices include an unconventional large bite monofilament continuous one-layer closure of the abdominal aponeurosis as well as several less commonly used principles to minimize the risk of wound infection. The process of graphic display of objectives and alternatives in a surgical procedure or disorder allows one to more sharply focus on alternatives at different steps and more rigidly support them by careful analysis of past experience or review of the literature.

Abdomen↗
PubMed1976

Repair of recurrent ventral hernias by an internal "binder".

A technic for the repair of massive recurrent incisional hernia is described. Use of a polypropylene mesh prosthesis as an intraperitoneal "binder" permits reconstruction of the abdominal wall when primary closure is impossible. Intraoperative testing of the repair provides reassurance that unrestricted postoperative activity will not invite recurrence.

Hernia, Ventral↗
PubMed1980

Quality assurance in surgical practice through auditing.

An efficient auditing method is presented which involves objective criteria-based numerical screening of medical process and treatment outcome by paramedical staff and detailed analysis of deviated cases by surgeons. If properly performed it requires the study of no more than 50 cases in a diagnostic category to provide sufficient information about the quality of care. Encouraging points as well as problems are communicated to the surgeons to induce the maintenance or improvement of the standard of care. Graphic documentation of case performance is possible, allowing surgeons to compare results with their colleagues. The general performance level of several consecutive studies can be compared at a glance. In addition, logical education programs to improve the medical process can be designed on the basis of the problems identified. As all the cases with an unacceptable outcome are traceable to inadequate medical process, improvement in this area will decrease outcome defects. With the use of auditing and the follow-up technique described, the quality of care in surgery may be assured.

British Columbia↗