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At least 595 records · Page 33Linked to original sources
PubMed1999

[Evidence-based medicine in antimicrobial surgical prophylaxis].

INTRODUCTION: The main objective of antibiotic prophylaxis in surgery is to reduce morbidity and mortality associated with wound infection, which has a favorable impact on quality of care and overall health-care costs. The bases of antibiotic prophylaxis have been known for decades, but the appearance of new pharmacological agents, alternative routes of administration, modern surgical procedures, and previously unknown antimicrobial resistances involve the need for reviewing these bases. OBJECTIVE: To re-evaluate some of the general principles of the use of antibiotic prophylaxis in surgery and highlight the quality of the evidence supporting our clinical decisions found in the literature. METHOD: Review of the literature with special attention to prospective, randomized, evidence-based clinical trials on the need for antibiotic prophylaxis in surgery, mainly general surgery. RESULTS: The method for demonstrating the effectiveness of an antibiotic in prophylaxis continues to be the prospective, randomized clinical trial. Evidence of the need for antibiotic prophylaxis in clean-contaminated surgery and when prosthetic materials are used is good. CONCLUSIONS: Most studies on the general principles of prophylaxis have been carried out in general surgery and it is difficult to extrapolate their results to other fields or surgical specialties. Therefore, new clinical trials in each specialty are needed to establish specific recommendations. However, the standardization of aseptic, antiseptic, and technical procedures in surgery has produced a notable decrease in the wound infection rate compared to historical controls, so now it is difficult to demonstrate significant differences in the results of clinical trials. Finally, the response to the fundamental question of "What do we propose to prevent and to what degree?" with which the antibiotic era began is either difficult to formulate or described ambiguously when referring to advanced procedures, such as endoprostheses, endoscopic retrograde cholangiography, or dental implants.

Abdominal Injuries↗
PubMed1975

[Selection of pancreato-intestinal anastomosis in pancreatoduodenal resection].

41 pancreatoduodenal resections with 11 lethal issues (26.8 plus or minus 7%) were analysed. In 21 cases an end-to-end pancreatointestinal anastomosis was employed, in 12 cases an end-to-side one with peritonization of a suture line with the jejunal wall after the A. A. Shalimov technic, but in 8 cases- the technic of pancreatojejunostomy elaborated by the author, an end-to-end side type enveloping the anastomosis with a cecal segment of the jejunum. This method of peritonization does not impede passage of the intestinal content, thus rendering unnecessary the production of enteroenterostomy. Suture divergency of the end-to-end pancreatointestinal anastomosis was noted postoperatively in 6 of 21 patients (28.6 plus or minus 10%). Whereas, among 20 pancreatojejunostomies with peritonization of sutures by the jejunal wall after the A. A. Shalimov technic or in the author's modification this complication was noted only in 2 cases (10 plus or minus 7%).

Duodenum↗
PubMed2001

[The approaches to factors which cause medication error--from the analyses of many near-miss cases related to intravenous medication which nurses experienced].

Given the complexity of the intravenous medication process, systematic thinking is essential to reduce medication errors. Two thousand eight hundred cases of 'Hiyari-Hatto' were analyzed. Eight important factors which cause intravenous medication error were clarified as a result. In the following I summarize the systematic approach for each factor. 1. Failed communication of information: illegible handwritten orders, and inaccurate verbal orders and copying cause medication error. Rules must be established to prevent miscommunication. 2. Error-prone design of the hardware: Look-alike packaging and labeling of drugs and the poor design of infusion pumps cause errors. The human-hardware interface should be improved by error-resistant design by manufacturers. 3. Patient names similar to simultaneously operating surgical procedures and interventions: This factor causes patient misidentification. Automated identification devices should be introduced into health care settings. 4. Interruption in the middle of tasks: The efficient assignment of medical work and business work should be made. 5. Inaccurate mixing procedure and insufficient mixing space: Mixing procedures must be standardized and the layout of the working space must be examined. 6. Time pressure: Mismatch between workload and manpower should be improved by reconsidering the work to be done. 7. Lack of information about high alert medications: The pharmacist should play a greater role in the medication process overall. 8. Poor knowledge and skill of recent graduates: Training methods and tools to prevent medication errors must be developed.

Communication↗
PubMed1975

Treatment of surgical infections with tobramcin.

A survey of the safety and effectiveness of tobramycin, a newly developed aminoglycoside antibiotic, was assessed in 116 septic surgical patients. For comparison, the final 52 cases were randomized with 51 similarly infected patients who were treated with gentamicin. The two antibiotics gave equally good results when evaluated bacteriologically and clinically. Nevertheless, gram-negative infections appeared more likely to be susceptible to tobramycin than to gentamicin. No toxicity to the liver or bone marrow was observed. Although there were 13 cases of nephrotoxicity and 4 of ototoxicity, only one instance of such an adverse drug reaction could be attributed to parenterally administered aminoglycoside alone. In fact, topical neomycin and established renal damage caused by prior episodes of shock or dehydration appeared to be significantly more responsible for such adverse effects.

Adolescent↗
PubMed2001

Comparison of three methods in surgical treatment of pilonidal disease.

BACKGROUND: The present study was designed to compare three methods that are still used for the surgical treatment of pilonidal disease: marsupialization, primary midline closure and skin flaps. METHODS: One hundred and one out of a total of 203 pilonidal disease patients underwent excision and marsupialization, while 82 patients had excision and primary closure and the remaining 20 were treated with excision and skin flaps. The minimum and maximum follow-up periods for the aforementioned surgical methods were 4 and 5 years, respectively. All patients were reviewed for in-hospital stay, return to work, wound infection and recurrence rates. Student's t-test and Fisher's exact test were used for statistical analysis. RESULTS: Average hospital stays for marsupialization, primary closure and skin flaps were 2.84 +/- 0.13, 2.62 +/- 0.12 and 5.95 +/- 0.52 days, respectively. Hospital stay for the skin flaps method was longer than that for the other two methods. The average time to return to work after marsupialization was 5.42 +/- 0.08 weeks; but the time needed to return to work after undergoing the primary closure or the skin flaps methods was much shorter: 2.15 +/- 0.05 and 2.90 +/- 0.20 weeks, respectively (P < 0.001). There was no difference in wound infection rate (P = 1.000) or recurrence rates. CONCLUSION: The fact that there were no differences in terms of wound infection or recurrence rates between the three groups, and the relatively shorter period for returning to work, emphasize the usefulness of the excision and repair techniques in the surgical treatment of pilonidal disease.

Adolescent↗
PubMed1979

[Epidemiology of Hospital-acquired infections in surgery (author's transl)].

The incidence of hospital-acquired infections in surgery fluctuates between 1.5 and 29%, the average infection is 5%. The most frequent hospital infections are: urinary tract infections, wound infections, respiratory tract infections, sepsis and infections of the skin. Escherichia coli and Staphylococcus aureus are most commonly isolated from the nosocomial infections. Hospital infections in surgery are of endogenous origin, i.e. from the organisms of the body itself (e. g. wound infections after intestinal interventions) or exogenous from direct or indrect contact. The most frequent route of transmission is by hands. Almost half of all hospital-acquired infections have their origin in surgery. Standards of prevention of hospital-acquired infections in surgery departments are described.

Cross Infection↗
PubMed2002

[The retained surgical sponge, an ongoing surgical problem].

The retained surgical sponge seems to be an ongoing problem. Despite the fact that reports of retained surgical sponges are comparatively rare, this problem seems to be more prevalent than is generally appreciated. Even though counting sponges is a tedious task, it should nonetheless be performed with the utmost attention. Although the presence of radiopaque wires in the sponges is helpful in locating these, it does not prevent surgical sponges from being forgotten. These retained sponges can result in serious conditions such as septic complications or pseudo-tumour formation, which in turn might lead to extensive diagnostic and secondary surgical procedures.

Foreign Bodies↗
PubMed1975

An antibiotic policy for surgical patients.

This paper offers guidance on antibiotic usage in surgical patients. A policy is outlined rather than the comprehensive coverage of every surgical situation. The principles of antibiotic prescribing are given. The antibiotics available and their routes of administration are reviewed. Indications for the prophylactic and therapeutic use of antibiotics are discussed. Factors causing the failure of antibiotic therapy are considered in brief.

Anti-Bacterial Agents↗