Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients

AbstractSurgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare services after surgery. We aimed to investigate whether a smartphone-delivered wound assessment tool can expedite diagnosis and treatment of SSI after emergency abdominal surgery. This single-blinded randomised control trial (NCT02704897) enroled adult emergency abdominal surgery patients in two tertiary care hospitals. Patients were randomised (1:1) to routine postoperative care or additional access to a smartphone-delivered wound assessment tool for 30-days postoperatively. Patient-reported SSI symptoms and wound photographs were requested on postoperative days 3, 7, and 15. The primary outcome was time-to-diagnosis of SSI (Centers for Disease Control definition). 492 patients were randomised (smartphone intervention: 223; routine care: 269). There was no significant difference in the 30-day SSI rate between trial arms: 21 (9.4%) in smartphone vs 20 (7.4%, p = 0.513) in routine care. Among the smartphone group, 32.3% (n = 72) did not utilise the tool. There was no significant difference in time-to-diagnosis of SSI for patients receiving the intervention (−2.5 days, 95% CI: −6.6−1.6, p = 0.225). However, patients in the smartphone group had 3.7-times higher odds of diagnosis within 7 postoperative days (95% CI: 1.02−13.51, p = 0.043). The smartphone group had significantly reduced community care attendance (OR: 0.57, 95% CI: 0.34−0.94, p = 0.030), similar hospital attendance (OR: 0.76, 95% CI: 0.28−1.96, p = 0.577), and significantly better experiences in accessing care (OR: 2.02, 95% CI: 1.17−3.53, p = 0.013). Smartphone-delivered wound follow-up is feasible following emergency abdominal surgery. This can facilitate triage to the appropriate level of assessment required, allowing earlier postoperative diagnosis of SSI.

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O8 Tracking wound infection with smartphone technology (twist): a randomised controlled trial in emergency surgery patients

British Journal of Surgery ◽

10.1093/bjs/znab282.013 ◽

2021 ◽

Vol 108 (Supplement_5) ◽

Author(s):

K A McLean ◽

K E Mountain ◽

C A Shaw ◽

T M Drake ◽

Riinu Ots ◽

...

Keyword(s):

Postoperative Period ◽

Emergency Surgery ◽

Standard Care ◽

Primary Outcome ◽

Assessment Tool ◽

Postoperative Wound ◽

Wound Assessment ◽

Significant Difference ◽

Time To Diagnosis

Abstract Introduction Surgical site infections (SSI) complicate 2%–10% of general surgery cases, and represent a significant burden on acute healthcare services. We aim to investigate if a smartphone-delivered wound assessment tool results in earlier treatment. Method This parallel, single-blinded randomised control trial enrolled adult emergency abdominal surgery patients in two tertiary hospitals (ClinicalTrials.gov number, NCT02704897). Patients were randomised (1:1 ratio) between standard postoperative care and additional access to a smartphone-delivered wound assessment tool for 30-days postoperatively. Patients routinely submitted wound questionnaires and photos for surgical review at postoperative days 3, 7, and 15. The primary outcome measure was time-to-diagnosis of SSI (CDC definition) within 30 postoperative days. Result 492 patients undergoing emergency surgery were randomised (smartphone intervention = 223; standard care = 269). There was no significant difference (P = 0.513) in the 30-day SSI rate between trial arms: 21 (9.4%) in smartphone vs 20 (7.4%) in standard care. While the mean time-to-diagnosis of SSI was 9.3 days (SD = 6.3) in the smartphone group, and 11.8 days (SD = 6.7) in the control group, this did not demonstrate a significant difference for the primary outcome (P = 0.255). However, patients in the smartphone group had 3.7-fold higher odds to be diagnosed in first 7 postoperative days (95% CI: 1.02 to 13.51, P = 0.043). Conclusion Digital patient-driven postoperative wound follow-up can be feasibly delivered in a broad cohort of emergency surgery patients. This can facilitate triage of patients to the appropriate level of assessment required, allowing diagnosis of SSI earlier in the postoperative period. Take-home Message Digital patient-driven postoperative wound follow-up can be feasibly delivered in a broad cohort of emergency surgery patients. This can facilitate triage of patients to the appropriate level of assessment required, allowing diagnosis of SSI earlier in the postoperative period.

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Assessing Patient Symptoms Due to Nasal Septal Perforation: Development and Validation of the NOSE-Perf Scale

Otolaryngology ◽

10.1177/0194599821992010 ◽

2021 ◽

pp. 019459982199201

Author(s):

Cullen M. Taylor ◽

Stephen F. Bansberg ◽

Michael J. Marino

Keyword(s):

Nasal Obstruction ◽

Discriminant Validity ◽

Assessment Tool ◽

Tertiary Care ◽

Control Group ◽

Septal Perforation ◽

Specific Symptom ◽

Nose Scale ◽

Nasal Septal Perforation ◽

Patient Reported

Objective Reporting patient symptoms due to nasal septal perforation (NSP) has been hindered by the lack of a validated disease-specific symptom score. The purpose of this study was to develop and validate an instrument for assessing patient-reported symptoms related to NSP. Study Design Validation study. Setting A tertiary care center. Methods The Nasal Obstruction Symptom Evaluation (NOSE) scale was used as an initial construct to which 7 nonobstruction questions were added to measure septal perforation symptoms. The proposed NOSE-Perf instrument was distributed to consecutive patients evaluated for NSP, those with nasal obstruction without NSP, and a control group without rhinologic complaints. Questionnaires were redistributed to the subgroup with NSP prior to treatment of the perforation. Results The study instrument was completed by 31 patients with NSP, 17 with only nasal obstruction, and 22 without rhinologic complaint. Internal consistency was high throughout the entire instrument (Cronbach α = 0.935; 95% CI, 0.905-0.954). Test-retest reliability was demonstrated by very strong correlation between questionnaires completed by the same patient at least 1 week apart ( r = 0.898, P < .001). Discriminant validity was confirmed via a receiver operating characteristic ( P < .001, area under the curve = 0.700). The NOSE-Perf scale was able to distinguish among all 3 study groups ( P < .001) and between NSP and nasal obstruction ( P = .024). When used alone, the NOSE scale could not discriminate between NSP and nasal obstruction ( P = .545). Conclusions The NOSE-Perf scale is a validated and reliable clinical assessment tool that can be applied to adult patients with NSP.

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The role of honey in healing of bedsores in cancer patients

South Asian Journal of Cancer ◽

10.4103/2278-330x.103714 ◽

2012 ◽

Vol 01 (02) ◽

pp. 66-71 ◽

Cited By ~ 12

Author(s):

Aramita Saha ◽

Subrata Chattopadhyay ◽

Md. Azam ◽

Prabir Kr. Sur

Keyword(s):

Wound Healing ◽

Cancer Patients ◽

Assessment Tool ◽

Low Cost ◽

Critical Difference ◽

Visual Analogue Pain ◽

Wound Assessment ◽

Significant Difference ◽

Bacteria And Fungi ◽

And Control

Abstract Bacground: Honey was used to treat infected wounds as long as 2000 years before bacteria were discovered. It has been reported to have inhibitory action to around 50 species of bacteria and fungi (aspergillus, penicillium). Usually, Metronidazole powder is used in our palliative clinic for wound healing due to low cost & effectivity. Honey is cheap, easily available ingredient with high astringent activity. Objective: Objectives of the study were to find out the effectiveness of Honey in terms of rate of wound healing & pain control in bedsores of cancer patients. Materials and Methods: 40 cancer patients with bedsore wounds were randomly assigned (1:1 ratio i.e. 20 in each arm) for Study Arm (Honey plus Metronidazole powder) and Control Arm (only Metronidazole powder), attending Palliative clinic of our department in between July 2010 to September 2011. Washing of the wound with normal saline done daily before application of above medicaments. Change of posture & soft bed were encouraged in both groups. A pre designed interview proforma, standardised Bates Jensen Wound Assessment Tool and Visual Analogue Pain assessment scale were used to collect and assess data. Results: There was significant difference in wound healing status (F value = 6.523; Critical Difference =14.03, P&nit;0.05) from day 10 and pain reduction also (F value = 6.638 and Critical Difference = 1.667, P&nit;0.05) from day 7 in study arm. Conclusion: Application of honey dressing provides a better wound healing, rapid pain relief in cancer patients with bedsores in palliative settings.

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Can a smartphone-delivered tool facilitate the assessment of surgical site infection and result in earlier treatment? Tracking wound infection with smartphone technology (TWIST): protocol for a randomised controlled trial in emergency surgery patients

BMJ Open ◽

10.1136/bmjopen-2019-029620 ◽

2019 ◽

Vol 9 (10) ◽

pp. e029620 ◽

Cited By ~ 2

Author(s):

Kenneth A McLean ◽

Katie E Mountain ◽

Catherine A Shaw ◽

Thomas M Drake ◽

Riinu Ots ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Surgical Site Infection ◽

Postoperative Care ◽

Assessment Tool ◽

Controlled Trial ◽

Secondary Outcome ◽

Site Infection ◽

Wound Assessment ◽

Time To Diagnosis ◽

Randomised Controlled

IntroductionNational data suggest that surgical site infection (SSI) complicates 2%–10% of general surgery cases, although the patient-reported incidence is much higher. SSIs cause significant patient morbidity and represent a significant burden on acute healthcare services, in a cohort predominantly suitable for outpatient management. Over three-quarters of UK adults now own smartphones, which could be harnessed to improve access to care. We aim to investigate if a smartphone-delivered wound assessment tool results in earlier treatment.Methods and analysisThis is a randomised controlled trial aiming to recruit 500 patients across National Health Service (NHS) hospitals. All emergency abdominal surgery patients over the age of 16 who own smartphones will be considered eligible, with the exclusion of those with significant visual impairment. Participants will be randomised in a 1:1 ratio between standard postoperative care and the intervention – use of the smartphone tool in addition to standard postoperative care. The main outcome measure will be time-to-diagnosis of SSI with secondary outcome measures considering use of emergency department and general practitioner services and patient experience. Follow-up will be conducted by clinicians blinded to group allocation. Analysis of time-to-diagnosis will be by comparison of means using an independent two sample t-test.Ethics and disseminationThis is the first randomised controlled trial on the use of a smartphone-delivered wound assessment tool to facilitate the assessment of SSI and the impact on time-to-diagnosis. The intervention is being used in addition to standard postoperative care. The study design and protocol were reviewed and approved by Southeast Scotland Research and Ethics Committee (REC Ref: 16/SS/0072 24/05/2016). Study findings will be presented at academic conferences, published in peer-reviewed journals and are expected in 2020. A written lay summary will be available to study participants on request.Trial registration numberNCT02704897; Pre-results.

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Surgical-site infections in emergency abdominal paediatric surgeries at a tertiary-care hospital in Pakistan

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1107 ◽

2020 ◽

pp. 1-9

Author(s):

Ali Faisal Saleem ◽

Huma Faiz Halepota ◽

Hasaan Omar ◽

Areeba Zain ◽

Muhammad Arif Mateen Khan

Keyword(s):

Abdominal Surgery ◽

Surgical Site Infection ◽

Tertiary Care ◽

Stable Condition ◽

University Hospital ◽

P Value ◽

Care Hospital ◽

Site Infection ◽

Significant Difference ◽

Pathogen Occurrence

Abstract A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the post-operative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chi-square and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status. Pathogen occurrence related to time-trend of 98 paediatric patients who underwent emergency abdominal surgery was plotted. Of the 94 who were discharged in stable condition, it was found that there was no significant difference between pre- and post-surgical pathogens. Escherichia coli (n=10) was found to be the most common pathogen. Contaminated wounds were associated with higher SSI (p=0.036, OR 1.95 95% CI 0.7-5.4). Continuous...

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Validation of a Modern Activity Hand Survey with Respect to Reliability, Construct and Criterion Validity

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193408093810 ◽

2008 ◽

Vol 33 (5) ◽

pp. 653-660 ◽

Cited By ~ 13

Author(s):

M. ALEXANDER ◽

O. I. FRANKO ◽

E. C. MAKHNI ◽

D. ZURAKOWSKI ◽

C. S. DAY

Keyword(s):

Wide Spectrum ◽

Hand Function ◽

Tertiary Care ◽

Criterion Validity ◽

Clinic Visit ◽

Significant Difference ◽

Patient Reported ◽

Validity Criterion ◽

History Of ◽

Test Retest Reliability

This study validates a novel, modern wrist and hand functional assessment: the Modern Activity Subjective Survey of 2007 (MASS07). In total, 326 patients visiting an academic tertiary-care orthopaedic hand clinic (April 2006–April 2007) were recruited to complete the MASS07 questionnaire, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and Patient-Rated Wrist Evaluation (PRWE) to assess construct validity, criterion validity and test–retest reliability of the MASS07. MASS07 correlated strongly with both PRWE (0.81) and DASH (0.85) even when adjusted for age, sex and history of hand problems ( P<0.001). MASS07 scores compared for 42 patients with repeated visits indicated no statistically significant difference between MASS07 scores at the patients’ first and second clinic visit. We conclude that the newly constructed MASS07 instrument is valid and reliable with respect to the outpatient population with a wide spectrum of hand and wrist pathologies for fast and effective assessment of patient-reported hand function during modern daily activities.

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Preoperative serum albumin level as a predictor of surgical complications after emergency abdominal surgery

International Surgery Journal ◽

10.18203/2349-2902.isj20190383 ◽

2019 ◽

Vol 6 (2) ◽

pp. 361

Author(s):

Sharath Kumar V. ◽

Dhruva G. Prakash ◽

Venkatasiva Krishna Pottendla

Keyword(s):

Postoperative Complications ◽

Abdominal Surgery ◽

Serum Albumin ◽

Serum Albumin Level ◽

Tertiary Care ◽

Total Mortality ◽

Albumin Level ◽

Morbidity And Mortality ◽

Preoperative Serum ◽

Emergency Abdominal Surgery

Background: Hypoalbumenia has been shown to be associated with increased morbidity and mortality in acute surgical patients due to increased catabolism. This study intends to correlate between hypoalbumenia and postoperative complications in patients undergoing emergency abdominal surgery.Methods: A prospective study is done in a rural tertiary care centre in a total of 190 patients undergoing emergency abdominal surgery after obtaining ethical clearance. In this study preoperative serum albumin and postoperative complications including death up to postoperative day thirty were recorded and gathered using a checklist designed for the study and analysed. Serum albumin less than 3.5g/dl is considered as hypoalbumenia in this study. The correlation between preoperative serum albumin and postoperative morbidity and mortality is assessed.Results: In a total of 190 patients, 93 (48.9%) patients had morbidity and 27 (14.2%) patients had mortality. Preoperative serum albumin less than 3.5g/dl is found in 120 (63.1%) cases and 70 (36.9%) patients has same or more than 3.5g/dl. Patients with preoperative serum albumin less than 3.5g/dl has morbidity in 87 (45.8%) patients than that of normal preoperative serum albumin level which is 6 (3.1%) cases (p= <0.0001, chi-square =72.31). The total mortality is 27 (14.2%) in which all mortality is found in low albumin group compared to no mortality in patients with normal serum albumin. As the albumin level decreases the risk of morbidity and mortality increases with majority of complication in this study occurring in patients with albumin group less than 2.5g/dl to 3g/dl.Conclusions: Preoperative serum albumin is a good predictor of surgical outcome after emergency abdominal surgery.

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Factors impacting time to diagnosis in pediatric, adolescent and young adult (AYA) patients with solid tumors.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e21515 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e21515-e21515

Author(s):

Elysia Marie Alvarez ◽

Lena Winestone ◽

Jeffrey McPheeters ◽

Diane Puccetti ◽

Jennifer Jill Wilkes ◽

...

Keyword(s):

Medical Care ◽

Germ Cell Tumors ◽

Young Patients ◽

Soft Tissue Sarcomas ◽

Cancer Type ◽

Factors Associated ◽

Significant Difference ◽

Patient Reported ◽

Time To Diagnosis ◽

Delays In Diagnosis

e21515 Background: While cancer is the leading cause of non-accidental death in children and AYAs, factors associated with delays in diagnosis in young patients with cancer are poorly understood; we sought to fill this knowledge gap. Methods: Using the OptumLabs Data Warehouse’s claims data for commercially insured enrollees in a large US health plan—we identified pediatric [0-14 years (y)] and AYA (15–39 y) patients diagnosed with soft tissue sarcomas (STS), bone tumors (BT) and germ cell tumors (GCT) during 2001–17 and continuously enrolled 6 months prior to diagnosis. Time to diagnosis was calculated as days between first medical encounter associated with a possible cancer symptom and diagnosis date. Median times from first symptom to diagnosis were compared using Wilcoxon Rank Sum test. Multivariable logistic regression identified sociodemographic and clinical factors associated with longer time ( > 3 months) from symptom to diagnosis. Results: Of the 11,395 patients, 86% presented to medical care with symptoms prior to diagnosis [STS: 2,228 (89%); BT: 1,565 (87%); GCT: 5,904 (84%)]. The most common symptoms were pain and swelling. STS had the longest median days to diagnosis (92), followed by BT (91) and GCT (49). There was a significant difference (p < 0.001) in median days to diagnosis by age for BT (0–14y: 69; 15–21y: 77; 22–39y: 105) and GCT (0–14y: 96; 15–21y: 34; 22–39y: 49), but not for STS. Patients in households with ≥ a college degree (OR 1.96, 95% CI 1.06–3.64, vs < high school) and seeing a specialist (excluding oncologists) (OR 2.54, CI 2.03–3.19, vs primary care) at first symptom presentation was associated with a longer delay, while older age (22–39y: OR 0.77, CI 0.63–0.94, vs 0-14y) and male sex (OR 0.58, CI 0.51–0.66) were associated with a shorter delay in diagnosis. Conclusions: This study demonstrates that, in a commercially insured population, time to diagnosis varies by cancer type and is impacted by clinical and sociodemographic factors. Shorter time to diagnosis may represent delays in presenting to medical care or more acute presentations of symptoms, therefore patient-reported symptoms and barriers to care data should be collected to better define strategies to reduce delays in diagnosis.

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Effect of Hyaluronic Acid Cream in Management of Maxillofacial Wounds

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i4.3672 ◽

2020 ◽

Vol 11 (4) ◽

pp. 6892-6896

Author(s):

Divya Sanjeev ramakrishnan ◽

Sudarssansubramaniam gouthaman ◽

Senthilnathan Periasamy

Keyword(s):

Wound Healing ◽

Hyaluronic Acid ◽

Assessment Tool ◽

Control Group ◽

Study Group ◽

Tissue Formation ◽

Granulation Tissue Formation ◽

Wound Assessment ◽

Significant Difference ◽

Daily Application

The present study aims to determine the efficacy of hyaluronic acid cream in the management of maxillofacial wounds. Total of twenty-five patients who were randomly assigned to study group, was admitted in for trauma management with facial lacerations was administered hyaluronic acid cream 0.5% (BIONECT) for one week twice daily application on the wounds .the wounds were then assessed with PWAT (photographic wound assessment tool) at 3rd day, 5th day, 7th day respectively. The control group (n=25) was administered with povidone-iodine cream. The study group showed a statistically significant difference (p<0.005) in wound healing earlier than the control group at 7th day. Patient compliance was higher in the study group than the control group. Hyaluronic acid has been proven to be shown in involvement in various stages of wound healing from promoting initial inflammation, granulation tissue formation tissue, keratinocyte migration and proliferation. The hyaluronic acid cream can be utilised as an alternative to promote ideal healing by protecting the wound from detrimental changes, providing or maintaining a damp environment and remarkably reducing microbial load .hence from our study, the hyaluronic acid cream benefits in the healing of acute maxillofacial wounds.

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The impact of delayed mobilization on post-discharge outcomes after emergency abdominal surgery: A prospective cohort study in older patients

PLoS ONE ◽

10.1371/journal.pone.0241554 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241554 ◽

Cited By ~ 1

Author(s):

Jenelle L. Pederson ◽

Raj S. Padwal ◽

Lindsey M. Warkentin ◽

Jayna M. Holroyd-Leduc ◽

Adrian Wagg ◽

...

Keyword(s):

Abdominal Surgery ◽

Tertiary Care ◽

Functional Decline ◽

Surgical Patients ◽

Care Needs ◽

Post Discharge ◽

Clinical Frailty Scale ◽

Increased Risk ◽

The Impact ◽

Emergency Abdominal Surgery

Surgeons are increasingly treating seniors with complex care needs who are at high-risk of readmission and functional decline. Yet, the prognostic importance of post-operative mobilization in older surgical patients is under-investigated and remains unclear. Thus, we evaluated the relationship between post-operative mobilization and events after hospital discharge in older people. Overall, 306 survivors of emergency abdominal surgery aged ≥65y who required help with <3 activities of daily living were prospectively followed at two Canadian tertiary-care hospitals. Time until mobilization after surgery was attained from hospital charts and a priori defined as ‘delayed’ (≥36h) or ‘early’ (<36h). Primary outcomes for 30-day and 6-month all-cause readmission/death after discharge were assessed in multivariable logistic regression. Patients had a mean age of 76 ± 7.7 years, 45% were women, 41% were ‘vulnerable-to-moderately-frail’, according to the Clinical Frailty Scale. Most common reasons for admission were gallstones (23%), intestinal obstructions (21%), and hernia (17%). Median time to post-operative mobilization was 19h (interquartile range 9−35); 74 (24%) patients had delayed mobilization. Delayed mobilization was independently associated with higher risk of 30-day readmission/death (19 [26%] vs. 22 [10%], P<0.001; adjusted odds ratio [aOR] 2.24, 95%CI 0.99–5.06, P = 0.05), but this was not statistically significant at 6-months (38 [51%] vs. 64 [28%], P<0.001; aOR 1.72, 95%CI 0.91−3.25, P = 0.1). One-quarter of older surgical patients stayed in bed for 1.5 days post-operatively. Delayed mobilization was associated with increased risk of short-term readmission/death. As older, more frail patients undergo surgery, mobilization of older surgical patients remains an understudied post-operative factor. Trial registration: clinicaltrials.gov identifier: NCT02233153

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