Using Bacterial Fluorescence Imaging and Antimicrobial Stewardship to Guide Wound Management Practices: A Case Series

2018 ◽  
Vol 64 (8) ◽  
pp. 18-28 ◽  
Author(s):  
Rosemary Hill ◽  
Monique Rennie ◽  
Joshua Douglas
Keyword(s):  
Fluorescence Imaging ◽  
Antimicrobial Stewardship ◽  
Management Practices ◽  
Case Series ◽  
Wound Management

scholarly journals Surgical management of Encapsulating Peritoneal Sclerosis (EPS) in children: international case series and literature review

2021 ◽  
Author(s):  
Videha Sharma ◽  
Zia Moinuddin ◽  
Angela Summers ◽  
Mohan Shenoy ◽  
Nicholas Plant ◽  
...  
Keyword(s):  
Case Series ◽  
Wound Management ◽  
Supplementary Information ◽  
Operative Morbidity ◽  
Post Surgery ◽  
Paediatric Patients ◽  
Stoma Formation ◽  
Gut Function ◽  
Health And Development ◽  
Secondary Closure

Abstract Background Encapsulating Peritoneal Sclerosis (EPS) is a rare phenomenon in paediatric patients with kidney failure treated with peritoneal dialysis (PD). This study highlights clinical challenges in the management of EPS, with particular emphasis on peri-operative considerations and surgical technique. Methods Retrospective analysis of all paediatric patients with EPS treated at the Manchester Centre for Transplantation. Results Four patients were included with a median duration of 78 months on PD. All patients had recurrent peritonitis (> 3 episodes), and all had symptoms within three months of a change of dialysis modality from PD to haemodialysis or transplant. In Manchester, care was delivered by a multi-disciplinary team, including surgeons delivering the adult EPS surgical service with a particular focus on nutritional optimisation, sepsis control, and wound management. The surgery involved laparotomy, lavage, and enterolysis of the small bowel + / − stoma formation, depending on intra-abdominal contamination. Two patients had a formal stoma, which were reversed at three and six months, respectively. Two patients underwent primary closure of the abdomen, whereas two patients had re-look procedures at 48 h with secondary closure. One patient had a post-operative wound infection, which was managed medically. One patient’s stoma became detached, leading to an intra-abdominal collection requiring re-laparotomy. The median length of stay was 25 days, and patients were discharged once enteral feeding was established. All patients remained free of recurrence with normal gut function and currently two out of four have functioning transplants. Conclusions This series demonstrates 100% survival and parenteral feed independence following EPS surgery. Post-operative morbidity was common; however, with individualised experience-based decision-making and relevant additional interventions, patients made full recoveries. Health and development post-surgery continued, allowing the potential for transplantation. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

scholarly journals A cross sectional study to assess the knowledge and response to dog bite among the urban and rural population of Hubballi taluk

2019 ◽  
Vol 6 (2) ◽  
pp. 539
Author(s):  
Maneesha Godbole ◽  
Anjana Ramachandra Joshi ◽  
Dattatraya D. Bant
Keyword(s):  
Management Practices ◽  
Cross Sectional Study ◽  
Wound Management ◽  
Economic Losses ◽  
Post Exposure Prophylaxis ◽  
Sectional Study ◽  
Dog Bite ◽  
Cross Sectional ◽  
Canine Rabies ◽  
Rabies Prevention

Background: Rabies is a fatal zoonotic disease of the central nervous system, most commonly caused by the bite of rabid dogs. Globally canine rabies causes 59,000 human deaths, over 3.7 million DALYs and 8.6 billion USD economic losses annually. These losses are due to a lack of knowledge about wound management and post-exposure prophylaxis. The objective of the study was to assess the knowledge and practices following dog bite and its management among the urban and rural population.Methods: A cross-sectional study was conducted in the field practice area of KIMS, Hubli. 120 households of the urban and rural locality were interviewed with a semi-structured pretested questionnaire.Results: Overall 89.16% of the study population was aware that the disease can be prevented by vaccination. 35% of the rural and 28% of the urban population believed that the disease can spread from person to person. The knowledge about the site and the number of doses of vaccine was poor among both the population. The harmful practices for treatment of bite were still prevalent among both rural (25%) and urban (8.3%) population.Conclusions: The knowledge about the dog bite management and Rabies prevention is insufficient among both populations. There are myths and misconceptions about the disease and wound management. Practices like application of harmful substances like lime, turmeric, mud are the problems hindering rabies prevention and control. Proper steps need to be taken up to control the canine rabies.

Open wound management following pull‐through resection for oral cancer: A case series of 14 patients

2021 ◽  
Author(s):  
Atsushi Taguchi ◽  
Tsuyoshi Kojima ◽  
Yusuke Okanoue ◽  
Hiroki Kagoshima ◽  
Koki Hasebe ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Case Series ◽  
Wound Management ◽  
Open Wound ◽  
Pull Through

scholarly journals Incorporating Point-of-Care Bacterial Fluorescence into a Wound Clinic Antimicrobial Stewardship Program

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1010
Author(s):  
Thomas E. Serena
Keyword(s):  
Fluorescence Imaging ◽  
Antimicrobial Stewardship ◽  
Chronic Wounds ◽  
The United States ◽  
Outpatient Setting ◽  
Joint Commission ◽  
World Health ◽  
Evidence Based ◽  
Hospital Inpatient ◽  
Imaging Device

Background: In 2014 the World Health Organization (WHO) warned of an emerging world-wide crisis of antibiotic-resistant microorganisms. In response, government and professional organizations recommended that health care systems adopt antimicrobial stewardship programs (ASPs). In the United States, the Centers for Medicare Services (CMS) mandated antimicrobial stewardship in the hospital inpatient setting. Effective 1 January 2020, the Joint Commission required ambulatory centers that prescribe antibiotics, such as wound centers, to institute an ASP. Chronic wounds often remain open for months, during which time patients may receive multiple courses of antibiotics and numerous antimicrobial topical treatments. The wound clinician plays an integral role in reducing antimicrobial resistance in the outpatient setting: antibiotics prescribed for skin and soft tissue infections are among the most common in an outpatient setting. One of the most challenging aspects of antimicrobial stewardship in treating chronic wounds is the inaccuracy of bacterial and infection diagnosis. Methods: Joint Commission lists five elements of performance (EP): (1) identifying an antimicrobial stewardship leader; (2) establishing an annual antimicrobial stewardship goal; (3) implementing evidence-based practice guidelines related to the antimicrobial stewardship goal; (4) providing clinical staff with educational resources related to the antimicrobial stewardship goal; and (5) collecting, analyzing, and reporting data related to the antimicrobial stewardship goal. This article focuses on choosing and implementing an evidence-based ASP goal for 2020. Discussion: Clinical trials have demonstrated the ability of fluorescence imaging (MLiX) to detect clinically significant levels of bacteria in chronic wounds. Combined with clinical examination of signs and symptoms of infection, the MLiX procedure improves the clinician’s ability to diagnose infection and can guide antimicrobial use. In order to satisfy the elements of performance, the MLiX procedure was incorporated into the annual ASP goal for several wound care centers. Clinicians were educated on the fluorescence imaging device and guidelines were instituted. Collection of antimicrobial utilization data is underway.

scholarly journals Plastic Surgery at War: A Scoping Review of Current Conflicts

2020 ◽  
Author(s):  
Justin P Fox ◽  
Nickolay P Markov ◽  
Alexandra M Markov ◽  
Eamon O’Reilly ◽  
Kerry P Latham
Keyword(s):  
Plastic Surgery ◽  
Scoping Review ◽  
Wound Care ◽  
Critical Role ◽  
Case Series ◽  
The United States ◽  
Lessons Learned ◽  
Plastic Surgeon ◽  
Wound Management ◽  
Search Criterion

Abstract Introduction The scope of military plastic surgery and location where care is provided has evolved with each major conflict. To help inform plastic surgeon utilization in future conflicts, we conducted a review of military plastic surgery-related studies to characterize plastic surgeon contributions during recent military operations. Materials and Methods Using a scoping review design, we searched electronic databases to identify articles published since September 1, 2001 related to military plastic surgery according to a defined search criterion. Next, we screened all abstracts for appropriateness based on pre-established inclusion/exclusion criteria. Finally, we reviewed the remaining full-text articles to describe the nature of care provided and the operational level at which care was delivered. Results The final sample included 55 studies with most originating in the United States (54.5%) between 2005 and 2019 and were either retrospective cohort studies (81.8%) or case series (10.9%). The breadth of care included management of significant upper/lower extremity injuries (40%), general reconstructive and wound care (36.4%), and craniofacial surgery (16.4%). Microsurgical reconstruction was a primary focus in 40.0% of published articles. When specified, most care was described at Role 3 (25.5%) or Roles 4/5 facilities (62.8%) with temporizing measures more common at Role 3 and definite reconstruction at Roles 4/5. Several lessons learned were identified that held commonality across plastic surgery domain. Conclusions Plastic surgeons continue to play a critical role in the management of wounded service members, particularly for complex extremity reconstruction, craniofacial trauma, and general expertise on wound management. Future efforts should evaluate mechanisms to maintain these skill sets among military plastic surgeons.

Complete Abolition of Opioid Prescribing in an Upper Extremity Surgical Practice

Hand ◽  
2020 ◽  
pp. 155894472096671
Author(s):  
Mark Henry
Keyword(s):  
Soft Tissue ◽  
Upper Extremity ◽  
Pain Control ◽  
Case Series ◽  
Similar Efficacy ◽  
Wound Management ◽  
Elbow Fracture ◽  
Level Of Evidence ◽  
Hand Fracture ◽  
Fracture Bone

Background Prescription opioids threaten potential addiction, diversion, and death. Nonopioid regimens have demonstrated similar efficacy for select upper extremity postoperative patients. Methods After adopting a practice policy completely abolishing opioid prescriptions, data were collected on all consecutive surgical cases for the next 6 months, without exclusion. There were 800 cases, 61% male and 39% female, with a mean age of 45. Seventy patients (9%) reported already using prescription medications employed in multimodality regimens; no instruction was given to alter consumption. Patients were divided into 5 groups based on the type of surgery: elective soft tissue (24%), trauma wound management (19%), soft tissue structural repairs (9%), hand fracture/bone procedures (34%), and wrist to elbow fracture/bone procedures (14%). Each group was compared directly to each other group with a 2-tailed t-test, P < .05. Results Patients reported achieving pain control without the need for further medication assistance by a mean of postoperative day 2.7. Times to pain control by group were as follows: 1.5, 3.1, 2.7, 2.9, and 3.6 days respectively. Mean postoperative daily pain scores (using a 10-point visual analog scale) for days 1 to 5 were as follows: 2.8, 2.1, 1.5, 1.0, and 0.6, respectively, with a sum of 8.0. During the 6-month tracking period, the practice only received 4 calls from patients with questions about pain control (0.5% of cases). Conclusions Patients achieved good immediate pain control without opioids and reported rapidly declining pain levels over the next several days to the point of no longer requiring medication. Type of Study/Level of Evidence Prospective cohort case series, therapeutic; Level IV.

scholarly journals Inferior Gluteus Maximus Island Flap for Reconstruction of Ischial Pressure Sores

2017 ◽  
Vol 23 (1) ◽  
Author(s):  
Yawar Sajjad ◽  
Beenish Rahat ◽  
Salman Hameed
Keyword(s):  
Case Series ◽  
Gluteus Maximus ◽  
Wound Dehiscence ◽  
Island Flap ◽  
Wound Management ◽  
Medical Institute ◽  
High Recurrence Rate ◽  
Pressure Sores ◽  
Retrospective Case ◽  
Grade 3

<p>Surgical management of ischial pressure sores has always been a challenge due to high recurrence rate. Ischial pressure sores develop due to unrelieved pressure over the Ischium. Inferior gluteus maximus island flap has been used effectively for coverage of ischial pressure sores.</p><p><strong>Objective:</strong><strong>  </strong>To describe the efficacy of inferior gluteus maximus flap for reconstruction of ischial pressure sores.</p><p><strong>Methods:</strong><strong>  </strong>A retrospective case series, consisted of sample of 17 cases. The study was conducted in the Department of Plastic and Reconstructive Surgery, Post Graduate Medical Institute, Lahore General Hospital Lahore, over a period of 8 years from March 2008 to March 2016. The case series included17 patients with grade 3 and grade 4 ischial pressure sores, comprising 12 male and 5 female, with age range of 28 to 64 (mean = 46 years).Follow-up ranged from 1 to 4 years with a mean of 2.5 years. Inferior gluteus maximus island flap was used for reconstruction of Ischial pressure sores.</p><p><strong>Results:  </strong>In thirteen (76%) of the seventeen patients, wound healed uneventfully without any complication. Partial wound dehiscence was observed in 2 patients (12%). Both of these healed with conservative wound management. Recurrence was seen in 2 patients (12%) after 8 months. These two patients underwent <em>reoperation</em> and gluteus maximus flap was readvanced that resulted in satisfactory wound coverage.</p><p><strong>Conclusion:</strong>  Inferior gluteus maximus island flap can be considered as a reliable option for reconstruction of ischial pressure sores.</p>

Sign in / Sign up

Export Citation Format

Share Document