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van Rossum C, de Bree K, de Jong G, Bartels R, Heeren G, Nabuurs M, Meijer C, Tostmann A, Aquarius R. Usability and outcomes of self-monitored surgical wound healing using a smartphone-based application by patients following neurosurgery. J Hosp Infect 2024; 148:138-144. [PMID: 38554806 DOI: 10.1016/j.jhin.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The Radboudumc developed a smartphone application (WondGezond) to collect surgical wound-healing information provided by the patient. AIM To evaluate usability and outcomes to assess its potential for early surgical site infection (SSI) detection. METHODS Patients surgically treated for degenerative spinal disorders or carpal tunnel syndrome between August 2020 and February 2023 were enrolled one day post surgery and asked to download the app via a quick-response (QR) code. Participants uploaded a photo and answered four questions about their wound daily, for 14 days. Afterwards, participants indicated whether they received treatment for a suspected SSI (participant-reported outcome). Two neurosurgeons independently assessed photos and questionnaire answers for suspected SSIs (physician-assessed outcome). The association between both outcomes was determined by calculating sensitivity, specificity, and positive and negative predictive value (PPV/NPV). FINDINGS After 2009 surgeries, 1695 QR-codes were distributed and 412 (21%) were activated. In all, 232 (56%) participants completed the 14-day period of whom 22 (10%) reported SSI treatment. Physician assessment identified 15 (7%) SSIs. Concordance was reached in 88% of cases. Among 27 discordant cases were 17 false-positives and 10 false-negatives, resulting in low sensitivity (33%) and PPV (23%), but high NPV (95%). CONCLUSION WondGezond provides clinicians with information regarding wound healing and SSIs to follow-up on patients at risk, while possibly also reducing antibiotic (over)treatment and unnecessary visits for patients without issues in wound healing. However, the low participation and false-positive results render the app in its current form unsuitable for surveillance purposes. Further validation of WondGezond is required.
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Affiliation(s)
- C van Rossum
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - K de Bree
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Neurosurgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - G de Jong
- Department of Oral & Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Bartels
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Neurosurgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - G Heeren
- Department of Medical Microbiology and Immunology, Dicoon/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M Nabuurs
- Department of Medical Microbiology and Immunology, Dicoon/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - C Meijer
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A Tostmann
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands; Regional Antimicrobial Resistance and Infection Prevention Network Gelderland, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Aquarius
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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Li C, Meng X. Effective analysis of job satisfaction among medical staff in Chinese public hospitals: a random forest model. Front Public Health 2024; 12:1357709. [PMID: 38699429 PMCID: PMC11063264 DOI: 10.3389/fpubh.2024.1357709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
Objective This study explored the factors and influence degree of job satisfaction among medical staff in Chinese public hospitals by constructing the optimal discriminant model. Methods The participant sample is based on the service volume of 12,405 officially appointed medical staff from different departments of 16 public hospitals for three consecutive years from 2017 to 2019. All medical staff (doctors, nurses, administrative personnel) invited to participate in the survey for the current year will no longer repeat their participation. The importance of all associated factors and the optimal evaluation model has been calculated. Results The overall job satisfaction of medical staff is 25.62%. The most important factors affecting medical staff satisfaction are: Value staff opinions (Q10), Get recognition for your work (Q11), Democracy (Q9), and Performance Evaluation Satisfaction (Q5). The random forest model is the best evaluation model for medical staff satisfaction, and its prediction accuracy is higher than other similar models. Conclusion The improvement of medical staff job satisfaction is significantly related to the improvement of democracy, recognition of work, and increased employee performance. It has shown that improving these five key variables can maximize the job satisfaction and motivation of medical staff. The random forest model can maximize the accuracy and effectiveness of similar research.
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Affiliation(s)
| | - Xuehui Meng
- Department of Health Service Management, Humanities and Management School, Zhejiang Chinese Medical University, Hangzhou, China
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3
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El Barbari JS, Fikuart M, Beisemann N, Müller M, Syrek H, Grützner PA, Franke J, Vetter SY. Improving Medical Photography in a Level 1 Trauma Center by Implementing a Specialized Smartphone-Based App in Comparison to the Usage of Digital Cameras: Prospective Panel Study. JMIR Form Res 2024; 8:e47572. [PMID: 38271087 PMCID: PMC10853857 DOI: 10.2196/47572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Medical photography plays a pivotal role in modern health care, serving multiple purposes ranging from patient care to medical documentation and education. Specifically, it aids in wound management, surgical planning, and medical training. While digital cameras have traditionally been used, smartphones equipped with specialized apps present an intriguing alternative. Smartphones offer several advantages, including increased usability and efficiency and the capability to uphold medicolegal standards more effectively and consistently. OBJECTIVE This study aims to assess whether implementing a specialized smartphone app could lead to more frequent and efficient use of medical photography. METHODS We carried out this study as a comprehensive single-center panel investigation at a level 1 trauma center, encompassing various settings including the emergency department, operating theaters, and surgical wards, over a 6-month period from June to November 2020. Using weekly questionnaires, health care providers were asked about their experiences and preferences with using both digital cameras and smartphones equipped with a specialized medical photography app. Parameters such as the frequency of use, time taken for image upload, and general usability were assessed. RESULTS A total of 65 questionnaires were assessed for digital camera use and 68 for smartphone use. Usage increased significantly by 5.4 (SD 1.9) times per week (95% CI 1.7-9.2; P=.005) when the smartphone was used. The time it took to upload pictures to the clinical picture and archiving system was significantly shorter for the app (mean 1.8, SD 1.2 min) than for the camera (mean 14.9, SD 24.0 h; P<.001). Smartphone usage also outperformed the digital camera in terms of technical failure (4.4% vs 9.7%; P=.04) and for the technical process of archiving (P<.001) pictures to the picture archiving and communication system (PACS) and display images (P<.001) from it. No difference was found in regard to the photographer's intent (P=.31) or reasoning (P=.94) behind the pictures. Additionally, the study highlighted that potential concerns regarding data security and patient confidentiality were also better addressed through the smartphone app, given its encryption capabilities and password protection. CONCLUSIONS Specialized smartphone apps provide a secure, rapid, and user-friendly platform for medical photography, showing significant advantages over traditional digital cameras. This study supports the notion that these apps not only have the potential to improve patient care, particularly in the realm of wound management, but also offer substantial medicolegal and economic benefits. Future research should focus on additional aspects such as patient comfort and preference, image resolution, and the quality of photographs, as well as seek to corroborate these findings through a larger sample size.
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Affiliation(s)
- Jan Siad El Barbari
- Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Maxim Fikuart
- Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Nils Beisemann
- Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | | | | | - Paul Alfred Grützner
- Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Jochen Franke
- Department of Orthopaedics and Traumatology, Tauernklinikum, Zell am See, Austria
| | - Sven Yves Vetter
- Department of Orthopaedics and Traumatology, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany
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Irgang L, Barth H, Holmén M. Data-Driven Technologies as Enablers for Value Creation in the Prevention of Surgical Site Infections: a Systematic Review. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 7:1-41. [PMID: 36910913 PMCID: PMC9995622 DOI: 10.1007/s41666-023-00129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Abstract
Despite the advances in modern medicine, the use of data-driven technologies (DDTs) to prevent surgical site infections (SSIs) remains a major challenge. Scholars recognise that data management is the next frontier in infection prevention, but many aspects related to the benefits and advantages of using DDTs to mitigate SSI risk factors remain unclear and underexplored in the literature. This study explores how DDTs enable value creation in the prevention of SSIs. This study follows a systematic literature review approach and the PRISMA statement to analyse peer-reviewed articles from seven databases. Fifty-nine articles were included in the review and were analysed through a descriptive and a thematic analysis. The findings suggest a growing interest in DDTs in SSI prevention in the last 5 years, and that machine learning and smartphone applications are widely used in SSI prevention. DDTs are mainly applied to prevent SSIs in clean and clean-contaminated surgeries and often used to manage patient-related data in the postoperative stage. DDTs enable the creation of nine categories of value that are classified in four dimensions: cost/sacrifice, functional/instrumental, experiential/hedonic, and symbolic/expressive. This study offers a unique and systematic overview of the value creation aspects enabled by DDT applications in SSI prevention and suggests that additional research is needed in four areas: value co-creation and product-service systems, DDTs in contaminated and dirty surgeries, data legitimation and explainability, and data-driven interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s41666-023-00129-2.
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Affiliation(s)
- Luís Irgang
- School of Business, Innovation and Sustainability - Department of Engineering and Innovation, Halmstad University, Halmstad, Sweden
| | - Henrik Barth
- School of Business, Innovation and Sustainability - Department of Engineering and Innovation, Halmstad University, Halmstad, Sweden
| | - Magnus Holmén
- School of Business, Innovation and Sustainability - Department of Engineering and Innovation, Halmstad University, Halmstad, Sweden
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Xie H, Guo Z, Cao Q, Ye Y, Chen L, Luo N. Effect of individualized comfortable nursing on prognosis of vacuum sealing drainage in patients with orthopedic trauma. Medicine (Baltimore) 2023; 102:e32903. [PMID: 36800609 PMCID: PMC9936052 DOI: 10.1097/md.0000000000032903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
To explore the effect of individualized comfortable nursing on prognosis of vacuum sealing drainage (VSD) in patients with orthopedic trauma. 110 patients with orthopedic trauma VSD were randomly divided into the control group and the observation group, with 55 patients in each group receiving routine care and comfortable care. The wound healing time, visual analog scale, quality of life score, the level of inflammatory factors, the incidence of complications, and patient satisfaction were compared between the 2 groups. The average time of wound healing in the observation group was significantly lower than that in the control group (P < .01). The satisfaction rate in the observation group was significantly higher than that in the control group (P = .029). Meanwhile, the results showed that visual analog scale and quality of life scores in the observation group was significantly improved than that of the control group after receiving intervention (P < .05). After receiving intervention, the levels of TNF-α and IL-6 of patients in both groups were decreased, and the levels of TNF-α and IL-6 in the observation group were significantly decreased than those in the control group. Moreover, the incidence rate of adverse reaction in the observation group was significantly lower than that in the control group (P < .01). Comfortable nursing can reduce the wound healing time, the postoperative pain level, the incidence of complications, and improve patient satisfaction, which is of great significance for the prognosis of VSD in patients with orthopedic trauma.
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Affiliation(s)
- Huifang Xie
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Zhaodi Guo
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Qin Cao
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Yuan Ye
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Li Chen
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Na Luo
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
- * Correspondence: Na Luo, Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei 430200, China (e-mail: )
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Macefield RC, Blazeby JM, Reeves BC, King A, Rees J, Pullyblank A, Avery K. Remote assessment of surgical site infection (SSI) using patient-taken wound images: Development and evaluation of a method for research and routine practice. J Tissue Viability 2023; 32:94-101. [PMID: 36681617 DOI: 10.1016/j.jtv.2023.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/12/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND/AIM Clinical assessment of wounds for surgical site infection (SSI) after hospital discharge is challenging and resource intensive. Remote assessment using digital images may be feasible and expedite SSI diagnosis. Acceptable and accurate methods for this process are needed. This study developed and evaluated the feasibility, acceptability and usability of a method for patients to capture standardised wound images for remote wound assessment to detect SSI. MATERIALS AND METHODS The work was conducted in two phases. Phase I involved: i) a review of literature to identify key components of photography relevant to taking wound images, ii) development of wound photography instructions for patients and a secure process for transmission of images using electronic survey software and iii) pre-testing of the photography instructions and processing method with a sample of 16 patients using cognitive interviews and observations. Phase II involved a prospective cohort study of 89 patients to evaluate the feasibility, acceptability and usability of the remote method following discharge from hospital after surgery. Quality of the images was assessed by three independent clinical reviewers. RESULTS Some 21 key components for photographing wounds were identified from 11 documents. Of these, 16 were relevant to include in instructions for patients to photograph their wounds. Pre-testing and subsequent iterations improved understanding and ease of use of the instructions and the process for transmitting images. Fifty-two of 89 (58.4%) patients testing the method remotely took an image of their wound(s) and 46/52 (88.5%) successfully transmitted images. When it was possible to ascertain a reason for not taking/transmitting images, this was primarily health problems (n = 7) or lack of time/poor engagement with the study (n = 4) rather than problems relating to technology/competency (n = 2) or practical issues relating to the wound itself (n = 2). Eighty-seven (85.3%) of the 102 images received were evaluated to be of high quality and sufficient to remotely assess SSI by at least two independent reviewers. CONCLUSION A simple, standardised and acceptable method for patients to take and transmit wound images suitable for remote assessment of SSI has been developed and tested and is now available for use in routine clinical care and research.
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Affiliation(s)
- Rhiannon C Macefield
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC), Population Health Sciences: Bristol Medical School, University of Bristol, UK.
| | - Jane M Blazeby
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC), Population Health Sciences: Bristol Medical School, University of Bristol, UK
| | - Barnaby C Reeves
- Bristol Trials Centre, Bristol Medical School, University of Bristol, UK
| | - Anni King
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC), Population Health Sciences: Bristol Medical School, University of Bristol, UK
| | - Jonathan Rees
- Hepatobiliary Surgery, University Hospitals Bristol NHS Foundation Trust, UK; Bristol Medical School, University of Bristol, UK
| | | | - Kerry Avery
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC), Population Health Sciences: Bristol Medical School, University of Bristol, UK
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7
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Takahashi EA, Schwamm LH, Adeoye OM, Alabi O, Jahangir E, Misra S, Still CH. An Overview of Telehealth in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e558-e568. [PMID: 36373541 PMCID: PMC11441725 DOI: 10.1161/cir.0000000000001107] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telehealth enables the remote delivery of health care through telecommunication technologies and has substantially affected the evolving medical landscape. The COVID-19 pandemic accelerated the utilization of telehealth as health care professionals were forced to limit face-to-face in-person visits. It has been shown that information delivery, diagnosis, disease monitoring, and follow-up care can be conducted remotely, resulting in considerable changes specific to cardiovascular disease management. Despite increasing telehealth utilization, several factors such as technological infrastructure, reimbursement, and limited patient digital literacy can hinder the adoption of remote care. This scientific statement reviews definitions pertinent to telehealth discussions, summarizes the effect of telehealth utilization on cardiovascular and peripheral vascular disease care, and identifies obstacles to the adoption of telehealth that need to be addressed to improve health care accessibility and equity.
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Nkurunziza T, Williams W, Kateera F, Riviello R, Niyigena A, Miranda E, Bikorimana L, Nkurunziza J, Velin L, Goodman AS, Matousek A, Klug SJ, Gaju E, Hedt-Gauthier BL. mHealth-community health worker telemedicine intervention for surgical site infection diagnosis: a prospective study among women delivering via caesarean section in rural Rwanda. BMJ Glob Health 2022; 7:bmjgh-2022-009365. [PMID: 35902205 PMCID: PMC9341172 DOI: 10.1136/bmjgh-2022-009365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Surgical site infections (SSIs) cause a significant global public health burden in low and middle-income countries. Most SSIs develop after patient discharge and may go undetected. We assessed the feasibility and diagnostic accuracy of an mHealth-community health worker (CHW) home-based telemedicine intervention to diagnose SSIs in women who delivered via caesarean section in rural Rwanda. Methods This prospective cohort study included women who underwent a caesarean section at Kirehe District Hospital between September 2019 and March 2020. At postoperative day 10 (±3 days), a trained CHW visited the woman at home, provided wound care and transmitted a photo of the wound to a remote general practitioner (GP) via WhatsApp. The GP reviewed the photo and made an SSI diagnosis. The next day, the woman returned to the hospital for physical examination by an independent GP, whose SSI diagnosis was considered the gold standard for our analysis. We describe the intervention process indicators and report the sensitivity and specificity of the telemedicine-based diagnosis. Results Of 787 women included in the study, 91.4% (n=719) were located at their home by the CHW and all of them (n=719, 100%) accepted the intervention. The full intervention was completed, including receipt of GP telemedicine diagnosis within 1 hour, for 79.0% (n=623). The GPs diagnosed 30 SSIs (4.2%) through telemedicine and 38 SSIs (5.4%) through physical examination. The telemedicine sensitivity was 36.8% and specificity was 97.6%. The negative predictive value was 96.4%. Conclusions Implementation of an mHealth-CHW home-based intervention in rural Rwanda and similar settings is feasible. Patients’ acceptance of the intervention was key to its success. The telemedicine-based SSI diagnosis had a high negative predictive value but a low sensitivity. Further studies must explore strategies to improve accuracy, such as accompanying wound images with clinical data or developing algorithms using machine learning.
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Affiliation(s)
- Theoneste Nkurunziza
- Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda .,Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, München, Germany
| | - Wendy Williams
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fredrick Kateera
- Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Robert Riviello
- Center for Surgery and Public Health, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Niyigena
- Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Elizabeth Miranda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Vascular Surgery, University of Southern California, Los Angeles, California, USA
| | - Laban Bikorimana
- Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Lotta Velin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Andrea S Goodman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex Matousek
- Northwest Heart and Lung Surgical Associates, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Stefanie J Klug
- Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, München, Germany
| | - Erick Gaju
- eHealth Unit, Republic of Rwanda Ministry of Health, Kigali, Rwanda
| | - Bethany L Hedt-Gauthier
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Herrera Montano I, Presencio Lafuente E, Breñosa Martínez J, Ortega Mansilla A, Torre Díez IDL, Río-Solá MLD. Systematic Review of Telemedicine and eHealth Systems Applied to Vascular Surgery. J Med Syst 2022; 46:104. [PMID: 36471095 PMCID: PMC9734958 DOI: 10.1007/s10916-022-01895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this paper is to review and analyze the current state of telemedicine and ehealth in the field of vascular surgery. METHODS This paper collects the relevant information obtained after reviewing the articles related to telemedicine in vascular surgery, published from 2012 to 2022 contained in scientific databases. In addition, the results obtained are statistically studied based on various factors, such as the year of publication or the search engine. In this way, we obtain a complete vision of the current state of telemedicine in the field of vascular surgery. RESULTS After performing this search and applying selection criteria, 29 articles were obtained for subsequent study and discussion, of which 20 were published in the second half of the decade, representing 70% of the results. In the analysis carried out according to the search criteria used, it can be seen that using the word telemedicine we obtained 69% of the articles while with the criteria mHealth and eHealth we only obtained 22% and 9% of the results, respectively. It can be seen that the filter with the most potential content articles was "vascular surgery AND telemedicine". In the analysis performed according to the search engine, it was observed that the Google Scholar database contains 93% of the articles found in the massive search and the relevant articles contained therein represent 52% of the total. CONCLUSION An upward trend has been observed in recent years, with a clear increase in the number of publications and much lower figures in the first years. One aspect to highlight is that 47.8% of the articles analyzed focus only on postoperative treatment, which may be due to the help provided by telemedicine in detecting surgical site infections by sending images and videos, this being one of the most common postoperative complications. The analyzed works show the importance of telemedicine in vascular surgery and identify possible future lines of research. In the analysis carried out on the origin of the selected relevant papers, an important interest of the US in this topic is demonstrated since more than 50% of the research contains authors from this country, it is also observed that there is no research from Spain, so this research would be an initial step to determine the weaknesses of telemedicine in this field of medicine and a good opportunity to open a research gap in this branch.
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Affiliation(s)
- Isabel Herrera Montano
- grid.5239.d0000 0001 2286 5329Department of Signal Theory and Communications and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, 47011 Valladolid, Spain
| | - Elena Presencio Lafuente
- grid.5239.d0000 0001 2286 5329Department of Signal Theory and Communications and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, 47011 Valladolid, Spain
| | - Jose Breñosa Martínez
- grid.512306.30000 0004 4681 9396Universidad Europea del Atlántico, C / Isabel Torres, 21, 39011 Santander, Spain
| | - Arturo Ortega Mansilla
- grid.512306.30000 0004 4681 9396Universidad Europea del Atlántico, C / Isabel Torres, 21, 39011 Santander, Spain ,grid.441061.60000 0004 1786 8906Universidad Internacional Iberoamericana, Calle 15 Num. 36, between 10 and 12 IMI III, 24560 - Campeche, Mexico City, Mexico
| | - Isabel de la Torre Díez
- grid.5239.d0000 0001 2286 5329Department of Signal Theory and Communications and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, 47011 Valladolid, Spain
| | - María Lourdes Del Río-Solá
- grid.411057.60000 0000 9274 367XVascular Surgery Department, Hospital Clínico Universitario de Valladolid, Ramón y Cajal Ave, nº 3, 47003 Valladolid, Spain
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10
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Bruce J, Knight R, Parsons N, Betteridge R, Verdon A, Brown J, Campolier M, Achten J, Costa ML. Wound photography for evaluation of surgical site infection and wound healing after lower limb trauma. Bone Joint J 2021; 103-B:1802-1808. [PMID: 34847717 DOI: 10.1302/0301-620x.103b12.bjj-2021-0447.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Deep surgical site infection (SSI) is common after lower limb fracture. We compared the diagnosis of deep SSI using alternative methods of data collection and examined the agreement of clinical photography and in-person clinical assessment by the Centers for Disease Control and Prevention (CDC) criteria after lower limb fracture surgery. METHODS Data from two large, UK-based multicentre randomized controlled major trauma trials investigating SSI and wound healing after surgical repair of open lower limb fractures that could not be primarily closed (UK WOLLF), and surgical incisions for fractures that were primarily closed (UK WHiST), were examined. Trial interventions were standard wound care management and negative pressure wound therapy after initial surgical debridement. Wound outcomes were collected from 30 days to six weeks. We compared the level of agreement between wound photography and clinical assessment of CDC-defined SSI. We are also assessed the level of agreement between blinded independent assessors of the photographs. RESULTS Rates of CDC-defined deep SSI were 7.6% (35/460) after open fracture and 6.3% (95/1519) after closed incisional repair. Photographs were obtained for 77% and 73% of WOLLF and WHiST cohorts respectively (all participants n = 1,478). Agreement between photographic-SSI and CDC-SSI was fair for open fracture wounds (83%; k = 0.27 (95% confidence interval (CI) 0.14 to 0.42)) and for closed incisional wounds (88%; k = 0.29 (95% CI 0.20 to 0.37)) although the rate of photographically detected deep SSIs was twice as high as CDC-SSI (12% vs 6%). Agreement between different assessors for photographic-SSI (WOLLF 88%, k = 0.63 (95% CI 0.52 to 0.72); WHiST 89%; k = 0.61 (95% CI 0.54 to 0.69)); and wound healing was good (WOLLF 90%; k = 0.80 (95% CI 0.73 to 0.86); WHiST 87%; k = 0.57 (95% CI 0.50 to 0.64)). CONCLUSION Although wound photography was feasible within the research context and inter-rater assessor agreement substantial, digital photographs used in isolation overestimated deep SSI rates, when compared to CDC criteria. Wound photography should not replace clinical assessment in pragmatic trials but may be useful for screening purposes where surgical infection outcomes are paramount. Cite this article: Bone Joint J 2021;103-B(12):1802-1808.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ruth Knight
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nick Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ria Betteridge
- Tissue Viability Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Amy Verdon
- Tissue Viability Service, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Julie Brown
- Tissue Viability Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Marta Campolier
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Juul Achten
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Matt L Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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11
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Xu X, Sun Y. Nursing countermeasures for VSD treatment of orthopedic trauma and infected wounds. Am J Transl Res 2021; 13:10625-10632. [PMID: 34650735 PMCID: PMC8507021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study intended to investigate the effect of vacuum sealing drainage (VSD) in the treatment of orthopedic trauma and its role in the clinical care. METHODS A total of 104 patients with orthopedic trauma infection admitted to our hospital from January 2019 to January 2020 were divided into control group (n=53, receiving VSD) and study group (n=51, receiving VSD and nursing interventions) by random number table. Surgical outcomes, satisfaction, size of trauma and visual analogue scoring scale (VAS) scores were compared between the two groups. RESULTS The study group had shorter time to achieve granulation tissue coverage of wound base, trauma recovery and hospital stay than the control group (P<0.05). The satisfaction rate in the study group was higher compared with that in the control group (P<0.05). Before intervention, the VAS scores of the two groups and size of trauma were not significantly different (P>0.05). After intervention, VAS scores were significantly lower and trauma area was significantly smaller in both groups, and the difference was more pronounced in the study group compared with that in the control group (P<0.05). Quality of life scores were higher in the study group compared with the control group (P<0.05). Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were lower in the study group compared with those in the control group (P<0.05). Packed cell volume (PCV), plasma viscosity, and low-cut versus high-cut whole blood viscosity were lower in the study group compared with those in the control group (P<0.05). CONCLUSION VSD treatment combined with clinical nursing interventions in patients with orthopedic trauma infection could shorten the time to granulation coverage, wound healing and hospitalization time, and improve indicators of blood rheology. It could also shrink the size of trauma, decrease the level of pain and inflammatory factors, and improve the quality of life, resulting in high satisfaction.
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Affiliation(s)
- Xin Xu
- Department of Orthopedics, Huzhou Cent Hosp, Affiliated Cent Hosp Huzhou University Huzhou 313000, Zhejiang, China
| | - Yanhua Sun
- Department of Orthopedics, Huzhou Cent Hosp, Affiliated Cent Hosp Huzhou University Huzhou 313000, Zhejiang, China
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12
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High incidence of potentially preventable emergency department visits after major elective colorectal surgery. Surg Endosc 2021; 36:2653-2660. [PMID: 33959806 DOI: 10.1007/s00464-021-08514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Emergency department (ED) visits after surgery represent a significant cost burden on the healthcare system. Furthermore, many ED visits are related to issues of healthcare delivery services and may be avoidable. Few studies have assessed the reasons for ED visits after colorectal surgery. The main objectives of this study were to: (1) identify the reasons why patients presented to the ED within 30 postoperative days and (2) determine if these visits were potentially preventable. METHODS A retrospective chart review was conducted on elective major colorectal surgery cases performed in a single center between 01/2017 and 07/2019. Data collected included demographics, medical history, intraoperative details, postoperative complications, ED visits within 30 postoperative days, and readmissions. Each ED visit was assessed by two reviewers and graded on a scale adapted from the New York University ED algorithm. The gradings were: (1) non-emergent, (2) emergent but treatable in an ambulatory setting, (3) emergent/ED-care required but preventable if timely outpatient care was available, and (4) emergent/ED-care required and non-preventable. Grades 1-3 were deemed potentially preventable. Logistic regression identified independent predictors of potentially preventable visits. RESULTS Six hundred and twenty five patients were included in the final analysis. 110 (17.6%) patients presented to the ED within 30 days. The most common cause of ED visit were ileus/small bowel obstruction (SBO) (16.4%), superficial wound infection (15.5%), genitourinary issues (10.9%), and non-infectious gastrointestinal issues (nausea, malnutrition, diarrhea, high output stomas) (10.9%). After review, 51.8% of visits were considered potentially preventable (Grade 1-3). The most common causes of preventable ED visits were superficial wound infection (24.6%), non-infectious gastrointestinal issues (19.3%), and minor bleeding (14.0%). Creation of a new stoma was the only independent risk factor for potentially preventable ED visits (OR 2.14, 95%CI 1.03-4.47). CONCLUSION Approximately half of ED visits within 30 days of discharge were potentially preventable. These findings indicate a need to improve access to outpatient care to reduce preventable ED visits after elective colorectal surgery.
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13
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Pollack AH, Snyder J. Reflecting on patient-generated photographs of the pediatric renal transplant experience. Pediatr Transplant 2021; 25:e13896. [PMID: 33111458 PMCID: PMC8108545 DOI: 10.1111/petr.13896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Poor self-management contributes to reduced renal allograft survival during adolescence and young adulthood. Providing patients with self-reflection tools to help explore the question "Is my experience normal?" may help mitigate these challenges. We explore Photograph-elicitation, a qualitative method where images are used to prompt individuals to talk about their personal experiences and values, engages pediatric transplant recipients and their families to generate insight into their experiences and the challenges they face after transplant. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Pediatric renal transplant recipients and one family member from Seattle Children's Hospital submitted 5 photographs showcasing their transplant story, which were used as prompts during semi-structured interviews. Interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Twenty-four individuals (13 patients: ages 7-21, and 11 parents) completed the study. Conversations generated by the photographs covered topics in more depth than a routine clinical encounter leading to more opportunities for reflection by patients and their family. The photographs generated conversations on four emergent themes: (a) sensemaking; (b) transitions and agency; (c) social interactions and community engagement; and (d) barriers and obstacles. CONCLUSIONS Photograph elicitation generated a rich dataset describing a range of pediatric renal transplant experiences helping physicians gain a rich and nuanced understanding of the daily lives and experiences of their patients outside the clinical setting. Photograph elicitation, as a clinical intervention, may provide new opportunities to address previously unrecognized modifiable risk factors, improving graft survival and health-related quality of life.
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Affiliation(s)
- Ari H. Pollack
- Seattle Children’s Hospital, Seattle, WA, USA,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Jaime Snyder
- Information School, University of Washington, Seattle, WA, USA
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14
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Li C, Liao C, Meng X, Chen H, Chen W, Wei B, Zhu P. Effective Analysis of Inpatient Satisfaction: The Random Forest Algorithm. Patient Prefer Adherence 2021; 15:691-703. [PMID: 33854303 PMCID: PMC8039189 DOI: 10.2147/ppa.s294402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/10/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To identify the factors influencing inpatient satisfaction by fitting the optimal discriminant model. PATIENTS AND METHODS A cross-sectional survey of inpatient satisfaction was conducted with 3888 patients in 16 large public hospitals in Zhejiang Province. Independent variables were screened by single-factor analysis, and the importance of all variables was comprehensively evaluated. The relationship between patients' overall satisfaction and influencing factors was established, the relative risk was evaluated by marginal benefit, and the optimal model was fitted using the receiver operating characteristic curve. RESULTS Patients' overall satisfaction was 79.73%. The five most influential factors on inpatient satisfaction, in this order, were: patients' right to know, timely nursing response, satisfaction with medical staff service, integrity of medical staff, and accuracy of diagnosis. The prediction accuracy of the random forest model was higher than that of the multiple logistic regression and naive Bayesian models. CONCLUSION Inpatient satisfaction is related to healthcare quality, diagnosis, and treatment process. Rapid identification and active improvement of the factors affecting patient satisfaction can reduce public hospital operating costs and improve patient experiences and the efficiency of health resource allocation. Public hospitals should strengthen the exchange of medical information between doctors and patients, shorten waiting time, and improve the level of medical technology, service attitude, and transparency of information disclosure.
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Affiliation(s)
- Chengcheng Li
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, 530021, People’s Republic of China
| | - Conghui Liao
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China
| | - Xuehui Meng
- Department of Health Service Management, Humanities and Management School, Zhejiang Chinese Medical University, Hangzhou, 310000, People’s Republic of China
| | - Honghua Chen
- School of Basic Medicine, Guangxi Medical University, Nanning, 530021, People’s Republic of China
| | - Weiling Chen
- School of Basic Medicine, Guangxi Medical University, Nanning, 530021, People’s Republic of China
| | - Bo Wei
- School of Information and Management, Guangxi Medical University, Nanning, 530021, People’s Republic of China
| | - Pinghua Zhu
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, 530021, People’s Republic of China
- Correspondence: Pinghua Zhu Email
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15
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Kort NP, Barrena EG, Bédard M, Donell S, Epinette JA, Gomberg B, Hirschmann MT, Indelli P, Khosravi I, Karachalios T, Liebensteiner MC, Stuyts B, Tandogan R, Violante B, Zagra L, Thaler M. Resuming elective hip and knee arthroplasty after the first phase of the SARS-CoV-2 pandemic: the European Hip Society and European Knee Associates recommendations. Knee Surg Sports Traumatol Arthrosc 2020; 28:2730-2746. [PMID: 32844246 PMCID: PMC7446739 DOI: 10.1007/s00167-020-06233-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/10/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. METHODS A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. RESULTS The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. CONCLUSION Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe return.
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Affiliation(s)
- N P Kort
- CortoClinics, Schijndel, The Netherlands
| | - E Gómez Barrena
- Department of Orthopaedic Surgery and Traumatology, Hospital La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Bédard
- Département de Chirurgie Orthopédique, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - S Donell
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - J-A Epinette
- Center for Research and Documentation in Arthroplasty, Lille, France
| | - B Gomberg
- OA Centers for Orthopaedics, Portland, ME, USA
| | - M T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - P Indelli
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- International Committee American Academy Hip and Knee Surgeons (AAHKS), Rosemont, IL, USA
| | - Ismail Khosravi
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - T Karachalios
- Orthopaedic Department, University General Hospital of Larissa, School of Health Sciences, Faculty of Medicine, University of Thessaly, Volos, Greece
| | - M C Liebensteiner
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - B Stuyts
- Department of Orthopedic Surgery and Traumatology, GZA Hospitals, Antwerp, Belgium
| | - R Tandogan
- Ortoklinik and Cankaya Orthopedics, Ankara, Turkey
| | - B Violante
- Orthopaedic Department, Istituto Clinico Sant'Ambrogio IRCCS Galeazzi, Milan, Italy
| | - L Zagra
- Hip Department IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - M Thaler
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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16
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McIsaac C, Bolton LL. Reliability and feasibility of registered nurses conducting web-based surgical site infection surveillance in the community: A prospective cohort study. Int Wound J 2020; 17:1750-1763. [PMID: 32761895 DOI: 10.1111/iwj.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 01/22/2023] Open
Abstract
Surgical site infections increase health care costs, morbidity, and mortality in 2% to 5% of surgical patients. Standardised post-surgical surveillance is rare in community settings, causing under-reporting and under-serving of the documented 60% of surgical site infections occurring following hospital discharge. This study evaluated feasibility and concordance (inter-rater reliability) of paired registered nurses using a web-based surveillance tool (how2trakSSI, based on validated guidelines) to detect surgical site infections for up to 30 days after surgery in a cohort of 101 patients referred to Calea Home Care Clinics in Toronto, Canada, March 2015 to July 2016. After paired registered nurse assessors used the tool-less than 10 minutes apart to measure concordance 5 to 7 days postoperatively, they provided feedback on its usefulness at two teleconference discussion groups September 6 to 7, 2016. Overall concordance between assessors was 0.822, remaining consistently above 0.65 across assessor education level and experience, patient age and weight, and wound area. Assessors documented 39.6% surgical site infection prevalence 5 to 7 days after surgery, confirming clinical need, relevance, reliability, and feasibility of using this web-based tool to standardise community surgical site infection surveillance, noting that it was user-friendly, more efficient to use than traditional paper-based tools and useful as a registry for tracking progress.
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Affiliation(s)
| | - Laura L Bolton
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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17
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Cherian T, Hedt-Gauthier B, Nkurunziza T, Sonderman K, Gruendl MA, Nihiwacu E, Ramadhan B, Gaju E, Nahimana E, Habiyakare C, Ntakiyiruta G, Matousek A, Riviello R, Kateera F. Diagnosing Post-Cesarean Surgical Site Infections in Rural Rwanda: Development, Validation, and Field Testing of a Screening Algorithm for Use by Community Health Workers. Surg Infect (Larchmt) 2020; 21:613-620. [PMID: 32423365 DOI: 10.1089/sur.2020.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: We aimed to develop and validate a screening algorithm to assist community health workers (CHWs) in identifying surgical site infections (SSIs) after cesarean section (c-section) in rural Africa. Methods: Patients were adult women who underwent c-section at a Rwandan rural district hospital between March and October 2017. A CHW administered a nine-item clinical questionnaire 10 ± 3 days post-operatively. Independently, a general practitioner (GP) administered the same questionnaire and assessed SSI presence by physical examination. The GP's SSI diagnosis was used as the gold standard. Using a simplified Classification and Regression Tree analysis, we identified a subset of screening questions with maximum sensitivity for the GP and CHW and evaluated the subset's sensitivity and specificity in a validation dataset. Then, we compared the subset's results when implemented in the community by CHWs with health center-reported SSI. Results: Of the 596 women enrolled, 525 (88.1%) completed the clinical questionnaire. The combination of questions concerning fever, pain, and discolored drainage maximized sensitivity for both the GPs (sensitivity = 96.8%; specificity = 85.6%) and CHWs (sensitivity = 87.1%; specificity = 73.8%). In the validation dataset, this subset had sensitivity of 95.2% and specificity of 83.3% for the GP-administered questions and sensitivity of 76.2% and specificity of 81.4% for the CHW-administered questions. In the community screening, the overall percent agreement between CHW and health center diagnoses was 81.1% (95% confidence interval: 77.2%-84.6%). Conclusions: We identified a subset of questions that had good predictive features for SSI, but its sensitivity was lower when administered by CHWs in a clinical setting, and it performed poorly in the community. Methods to improve diagnostic ability, including training or telemedicine, must be explored.
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Affiliation(s)
- Teena Cherian
- Department of Global Health and Social Medicine and Harvard Medical School, Boston, Massachusetts, USA
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine and Harvard Medical School, Boston, Massachusetts, USA.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Kristin Sonderman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Magdalena Anna Gruendl
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Epidemiology, Technical University Munich, Munich, Germany
| | | | | | - Erick Gaju
- Rwanda Ministry of Health, Kigali, Rwanda
| | | | | | | | - Alexi Matousek
- Heart and Lung Institute, Sacred Heart Medical Center, Spokane, Washington, USA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Use of a telehealth follow-up system to facilitate treatment and discharge of emergency department patients with severe cellulitis. Am J Emerg Med 2020; 41:184-189. [PMID: 32081554 DOI: 10.1016/j.ajem.2020.01.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Novel long-acting lipoglycopeptide antibiotics allow for the treatment and discharge of selected emergency department (ED) patients with cellulitis who require intravenous antibiotics. Telehealth systems have shown success in remote management of dermatologic conditions; we implemented a telehealth follow-up program for patients diagnosed with cellulitis in the ED, treated with single-dose dalbavancin, and discharged. METHODS This was a prospective, multi-center observational study. Patients were included based on clinical criteria and ability to complete follow-up using a smartphone and enroll in an online care portal. We examined the rate of successful telehealth follow-up at 24- and 72-hour intervals from discharge. We also examined the ED return rate within 14 days, reviewed any visits to determine cause of return, and for admission. RESULTS 55 patients were enrolled. 54/55 patients completed at least one telehealth follow up encounter (98.2%). 13 patients (23.6%) had a return ED visit within 14 days; no patients required admission for worsening cellulitis. Patient engagement in the telehealth program decreased over time; there was an approximately 11% decrease in engagement between the 24 and 72-hour follow-up call, and a 15% decrease in engagement between the 24 and 72-hour image upload. Patients over 65 had a lower rate of image upload (31%) than younger patients (80.6%). DISCUSSION A telehealth follow-up system for discharged emergency department patients with cellulitis demonstrated high rates of engagement. In these patients who -may have otherwise required admission for intravenous antibiotics, telehealth-facilitated outpatient management resulted in a low ED return rate and no inpatient admissions for cellulitis.
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Stryja J, Sandy-Hodgetts K, Collier M, Moser C, Ousey K, Probst S, Wilson J, Xuereb D. PREVENTION AND MANAGEMENT ACROSS HEALTH-CARE SECTORS. J Wound Care 2020; 29:S1-S72. [DOI: 10.12968/jowc.2020.29.sup2b.s1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jan Stryja
- Vascular Surgeon, Centre of vascular and miniinvasive surgery, Hospital Podlesi, Trinec, The Czech Republic. Salvatella Ltd., Centre of non-healing wounds treatment, Podiatric outpatients’ department, Trinec, The Czech Republic
| | - Kylie Sandy-Hodgetts
- Senior Research Fellow – Senior Lecturer, Faculty of Medicine, School of Biomedical Sciences, University of Western Australia, Director, Skin Integrity Clinical Trials Unit, University of Western Australia
| | - Mark Collier
- Nurse Consultant and Associate Lecturer – Tissue Viability, Independent – formerly at the United Lincolnshire Hospitals NHS Trust, c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9Q
| | - Claus Moser
- Clinical microbiologist, Rigshospitalet, Department of Clinical Microbiology, Copenhagen, Denmark
| | - Karen Ousey
- Professor of Skin Integrity, University of Huddersfield. Institute of Skin Integrity and Infection Prevention, Huddersfield, UK
| | - Sebastian Probst
- Professor of wound care, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Jennie Wilson
- Professor of Healthcare Epidemiology, University of West London, College of Nursing, Midwifery and Healthcare, London, UK
| | - Deborah Xuereb
- Senior Infection Prevention & infection Control Nurse, Mater Dei Hospital, Msida, Malta
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20
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Smith SD, Thompson CE, Sims S. Adapting a Nurse–Managed Mobile Simulation Program to Meet Rural Health Nursing Continuing Education Needs. J Contin Educ Nurs 2020; 51:82-86. [DOI: 10.3928/00220124-20200115-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/04/2019] [Indexed: 11/20/2022]
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21
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Yoo RN, Kim HJ, Lee JI, Kang WK, Kye BH, Kim CW, Bae SU, Nam S, Kang BM. Circular pOlyethylene drape in preVEntion of suRgical site infection (COVER trial): study protocol for a randomised controlled trial. BMJ Open 2020; 10:e034687. [PMID: 31974091 PMCID: PMC7044988 DOI: 10.1136/bmjopen-2019-034687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Surgical site infection (SSI) after abdominal surgery remains a significant cause of morbidity and is associated with an increased socioeconomic burden and a reduced quality of life. Circular wound protectors have been expected to reduce the risk of SSI, but previous studies reported conflicting results on their protective effects. The purpose of this study was to evaluate the efficacy of circular wound protectors in reducing SSI in open abdominal surgery. METHODS AND ANALYSIS The circular pOlyethylen drape in preVEntion of suRgical site infection (COVER) trial investigates whether the application of a dual-ring circular plastic wound protector reduces the rate of SSI in patients undergoing elective or emergent open abdominal surgery related to the gastrointestinal tract, regardless of the type of wound classified by the Centers for Disease Control. The COVER trial is a multicentre, randomised controlled clinical trial with two parallel arms-one using a dual-ring wound protector with circular polyethylene drape and the other using conventional surgical dressing gauze. The primary outcome will measure the rate of SSI within 30 days after surgery in two groups. Statistical analysis of the primary end point will be based on the intention-to-treat population. The sample size was determined to achieve a study power of 80% with 95% two-sided confidence limits. Considering a dropout rate of up to 5%, a total of 458 patients, 229 patients in each group, will be enrolled in this study. ETHICS AND DISSEMINATION The trial protocol and informed consent document have been reviewed and approved by the institutional review board at each participating centre. Written informed consent will be obtained from each study participant. The clinical outcomes of this trial will be submitted to an international peer-reviewed journal and presented at international conferences. TRIAL REGISTRATION NUMBER NCT03170843.
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Affiliation(s)
- Ri Na Yoo
- Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, The Republic of Korea
| | - Hyung Jin Kim
- Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, The Republic of Korea
| | - Jae Im Lee
- Surgery, Uijeongbu St. Mary's Hospital. The Catholic University of Korea, Uijeongbu, The Republic of Korea
| | - Won-Kyung Kang
- Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, The Republic of Korea
| | - Bong-Hyeon Kye
- Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, The Republic of Korea
| | - Chang Woo Kim
- Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, The Republic of Korea
| | - Sung Uk Bae
- Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, The Republic of Korea
| | - Soomin Nam
- Surgery, National Health Insurance Service Ilsan Hospital, Goyang, The Republic of Korea
| | - Byung Mo Kang
- Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, The Republic of Korea
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22
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Kummerow Broman K, Gaskill CE, Faqih A, Feng M, Phillips SE, Lober WB, Pierce RA, Holzman MD, Evans HL, Poulose BK. Evaluation of Wound Photography for Remote Postoperative Assessment of Surgical Site Infections. JAMA Surg 2019; 154:117-124. [PMID: 30422236 DOI: 10.1001/jamasurg.2018.3861] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Surgeons are increasingly interested in using mobile and online applications with wound photography to monitor patients after surgery. Early work using remote care to diagnose surgical site infections (SSIs) demonstrated improved diagnostic accuracy using wound photographs to augment patients' electronic reports of symptoms, but it is unclear whether these findings are reproducible in real-world practice. Objective To determine how wound photography affects surgeons' abilities to diagnose SSIs in a pragmatic setting. Design, Setting, and Participants This prospective study compared surgeons' paired assessments of postabdominal surgery case vignettes with vs without wound photography for detection of SSIs. Data for case vignettes were collected prospectively from May 1, 2007, to January 31, 2009, at Erasmus University Medical Center, Rotterdam, the Netherlands, and from July 1, 2015, to February 29, 2016, at Vanderbilt University Medical Center, Nashville, Tennessee. The surgeons were members of the American Medical Association whose self-designated specialty is general, abdominal, colorectal, oncologic, or vascular surgery and who completed internet-based assessments from May 21 to June 10, 2016. Intervention Surgeons reviewed online clinical vignettes with or without wound photography. Main Outcomes and Measures Surgeons' diagnostic accuracy, sensitivity, specificity, confidence, and proposed management with respect to SSIs. Results A total of 523 surgeons (113 women and 410 men; mean [SD] age, 53 [10] years) completed a mean of 2.9 clinical vignettes. For the diagnosis of SSIs, the addition of wound photography did not change accuracy (863 of 1512 [57.1%] without and 878 of 1512 [58.1%] with photographs). Photographs decreased sensitivity (from 0.58 to 0.50) but increased specificity (from 0.56 to 0.63). In 415 of 1512 cases (27.4%), the addition of wound photography changed the surgeons' assessment (215 of 1512 [14.2%] changed from incorrect to correct and 200 of 1512 [13.2%] changed from correct to incorrect). Surgeons reported greater confidence when vignettes included a wound photograph compared with vignettes without a wound photograph, regardless of whether they correctly identified an SSI (median, 8 [interquartile range, 6-9] vs median, 8 [interquartile range, 7-9]; P < .001) but they were more likely to undertriage patients when vignettes included a wound photograph, regardless of whether they correctly identified an SSI. Conclusions and Relevance In a practical simulation, wound photography increased specificity and surgeon confidence, but worsened sensitivity for detection of SSIs. Remote evaluation of patient-generated wound photographs may not accurately reflect the clinical state of surgical incisions. Effective widespread implementation of remote postoperative assessment with photography may require additional development of tools, participant training, and mechanisms to verify image quality.
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Affiliation(s)
- Kristy Kummerow Broman
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville
| | | | - Adil Faqih
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Feng
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sharon E Phillips
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William B Lober
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle
| | - Richard A Pierce
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael D Holzman
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Benjamin K Poulose
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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23
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Artificial Intelligence Methods for Surgical Site Infection: Impacts on Detection, Monitoring, and Decision Making. Surg Infect (Larchmt) 2019; 20:546-554. [DOI: 10.1089/sur.2019.150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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24
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Sawyer RG, Evans HL, Hedrick TL. Technological Advances in Clinical Definition and Surveillance Methodology for Surgical Site Infection Incorporating Surgical Site Imaging and Patient-Generated Health Data. Surg Infect (Larchmt) 2019; 20:541-545. [PMID: 31460834 PMCID: PMC6823882 DOI: 10.1089/sur.2019.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Surgical site infection (SSI) continues to be a common and costly complication after surgery. The current commonly used definitions of SSI were devised more than two decades ago and do not take in to account more modern technology that could be used to make diagnosis more consistent and precise. Patient-generated health data (PGHD), including digital imaging, may be able to fulfill this objective. Methods: The published literature was examined to determine the current state of development in terms of using digital imaging as an aide to diagnose SSI. This information was used to devise possible methodology that could be used to integrate digital images to more objectively define SSI, as well as using these data for both surveillance activities and clinical management. Results: Digital imaging is a highly promising means to help define and diagnose SSI, particularly in remote settings. Multiple groups continue to actively study these emerging technologies, however, present methods remain based generally on subjective rather than objective observations. Although current images may be useful on a case-by-case basis, similar to physical examination information, integrating imaging in the definition of SSI to allow more automated diagnosis in the future will require complex image analysis combined with other available quantified data. Conclusions: Digital imaging technology, once adequately evolved, should become a cornerstone of the criteria for both the clinical and surveillance definitions of SSI.
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Affiliation(s)
- Robert G. Sawyer
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
- College of Engineering and Applied Sciences, Kalamazoo, Michigan
| | - Heather L. Evans
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Traci L. Hedrick
- Department of Surgery, University of Virginia, Charlottesville, Virginia
- Address correspondence to: Dr. Traci L. Hedrick, Department of Surgery, University of Virginia, PO Box 800709, Charlottesville, VA 22908
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25
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Pollock DA. Digital Platforms as a Method of Invention for Infection Surveillance. Surg Infect (Larchmt) 2019; 20:581-583. [PMID: 31343385 DOI: 10.1089/sur.2019.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: The history of large-scale technological advances, such as the digital revolution in our era, suggests that core technologies yield wide benefits by serving as a method of invention, spawning new tools and techniques that surpass the performance of their predecessors. Methods: Digital platforms provide a method of invention in the health sector by enabling innovations in data collection, use, and sharing. Although wide adoption of computerized information technology in healthcare has produced mixed results, the advent of mobile health (mHealth) creates new opportunities for device-mediated advances in surgical and public health practice. Conclusion: Mobile solutions for collecting, using, and sharing patient-generated health data after surgery can yield important benefits for post-operative monitoring, whether the data are used to evaluate and manage individual patients or track infections and other outcomes in patient populations.
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Affiliation(s)
- Daniel A Pollock
- Surveillance Branch, Division of Healthcare Quality Promotion. National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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26
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Palmgren J, Paoli J, Schmidtchen A, Saleh K. Variability in the diagnosis of surgical-site infections after full-thickness skin grafting: an international survey. Br J Dermatol 2018; 180:1169-1175. [PMID: 30536813 DOI: 10.1111/bjd.17517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diagnosis of a surgical-site infection (SSI) in dermatological surgery can be based entirely on a subjective assessment, according to the fourth criterion of the most common definition of an SSI, which was established by the US Centers for Disease Control and Prevention. OBJECTIVES To investigate the interobserver agreement between dermatologists in their diagnosis of SSI of dermatosurgical wounds. METHODS An international electronic photographic survey with eight photographs of wounds 1 week after full-thickness skin grafting (FTSG) was sent to dermatologists. All wounds were assessed in terms of visual criteria beforehand. Data collected from respondents included physician characteristics and experience, and SSI assessments of all wounds. RESULTS In total, 393 dermatologists from 27 countries enrolled. Most respondents were from the U.S.A. (25%), followed by Sweden (24%) and the U.K. (13%). There was only a slight interobserver agreement on SSI suspicion (κ = 0·19). SSI suspicion was lower for male physicians (P = 0·03), board-certified dermatologists (P = 0·001), physicians regularly assessing surgical wounds (P = 0·03) and physicians performing FTSG (P < 0·001). Swedish physicians diagnosed more SSIs than U.S. physicians (P = 0·002). Erythema was more common in cases with higher SSI suspicion. CONCLUSIONS This study reveals broad inter-rater variability in the diagnosis of SSI, illustrating the need for novel objective diagnostic methods that can better capture the variables that constitute an SSI.
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Affiliation(s)
- J Palmgren
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Tornavägen 10, SE-221 84, Lund, Sweden
| | - J Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Schmidtchen
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Tornavägen 10, SE-221 84, Lund, Sweden.,Copenhagen Wound Healing Center, Bispebjerg Hospital, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,LKCMedicine, Nanyang Technological University, 59 Nanyang Drive, Singapore
| | - K Saleh
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Tornavägen 10, SE-221 84, Lund, Sweden
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27
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Rochon M, Jenkinson S, Ramroop R, Deakin A, Rai P, Healy K, Lukban R, Soppa A, Bhugun K, Lavack C, Fuller N, Morais C, Raja SG. Retrospective analysis of the Photo at Discharge scheme and readmission for surgical site infection following coronary artery bypass graft surgery. J Infect Prev 2018; 19:270-276. [PMID: 38617876 PMCID: PMC11009560 DOI: 10.1177/1757177418780986] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/18/2018] [Indexed: 04/16/2024] Open
Abstract
Background Surgical site infection (SSI) is a costly and devastating complication of surgery. Many cardiac SSIs develop after the patient leaves hospital, but evidence demonstrating the benefit of patient/carer involvement in the process of monitoring and promptly identifying SSI post-discharge is limited. This study estimates the probability of readmission for SSI for coronary artery bypass graft (CABG) patients receiving the Photo at Discharge (PaD). Methods Trained personnel undertook continuous, prospective SSI surveillance using Public Health England protocol between January 2013 and December 2016. Baseline covariables were collected for 1747 CABG-only procedures. As a quasi-randomised design, we adjusted for non-random PaD assignment using retrospective propensity score (PS)-matching based on 12 variables of interest, assessed whether the model had been adequately specified and performed an outcomes analysis. Results A total of 568 patients with PaD were PS-matched with 568 controls. The probabilities of SSI readmission were 0.352 (2/568) and 1.761 (10/568), respectively. The difference in risk of readmission for SSI was significant (relative risk = 0.2, 95% confidence interval = 0.04-0.91; P = 0.04). Conclusion Findings from this single-centre observation study suggest the PaD is associated with a reduction in CABG readmission for SSI and a further study is warranted to verify the efficacy of this strategy.
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Affiliation(s)
- Melissa Rochon
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Sian Jenkinson
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Reeshma Ramroop
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Alexia Deakin
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Padma Rai
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Katie Healy
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Russel Lukban
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Alison Soppa
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Kavita Bhugun
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Cheryl Lavack
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Nikki Fuller
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Carlos Morais
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
| | - Shahzad G Raja
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
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28
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Risk factors and prediction model for inpatient surgical site infection after major abdominal surgery. J Surg Res 2017; 217:153-159. [DOI: 10.1016/j.jss.2017.05.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/27/2017] [Accepted: 05/03/2017] [Indexed: 02/03/2023]
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