Effect of Preoperative Skin Preparation Methods on Sternotomy Surgical Site Infection Rates: A Quasi-Experimental Study

BACKGROUND: A surgical site infection (SSI) reduces patient quality of life, increases morbidity and mortality rates, and increases health care costs. Results of studies comparing the effects of preoperative skin preparations are contradictory. PURPOSE: This study aimed to determine the effect of different preoperative skin preparation methods on the rate of SSIs in patients undergoing sternotomy. METHODS: A quasi-experimental study was conducted among 96 male patients undergoing sternotomy. The control group (CG) (n = 34) received routine care consisting of shaving body hair with a razor blade followed by instructions to take a bath or shower. In the intervention groups, patients received education about SSI prevention and body hair was removed with an electric clipper, followed by bathing with daphne soap containing olive oil (IG-1) (n = 31) or 2% chlorhexidine solution (IG-2) (n = 31). Patient demographic, medical history, surgical, and wound assessment variables were obtained. Potential SSI signs and symptoms were assessed for up to 90 days following surgery. RESULTS: Patient demographic, medical history, and surgical variables did not differ among the 3 groups. Sternal SSI occurred in 10.4% of all study patients; 8.8% of the CG patients, 12.9% of the IG-1 patients, and 9.7% of the IG-2 patients developed an SSI (P > .05). CONCLUSION: There were no significant differences in the rate of sternotomy SSI among the 3 groups. Randomized controlled trials with large samples are needed to compare these methods to determine optimal and affordable preoperative skin preparation methods.

Humanist Chaplains Entering Traditionally Faith-Based NHS Chaplaincy Teams

Healthcare chaplaincy in the National Health Service (NHS) has rapidly changed in the last few years. Research shows a decline of people belonging to traditional faith frameworks, and the non-religious patient demographic in the NHS has increased swiftly. This requires a different approach to healthcare chaplaincy. Where chaplaincy has originally been a Christian profession, this has expanded to a multi-faith context. Over the last five years, humanists with non-religious beliefs have entered the profession for the first time, creating multi-faith and belief teams. As this is a very new development, this article will focus on literature about humanists entering traditionally faith-based NHS chaplaincy teams within the last five years in England. This article addresses the question “what are the developments resulting from the inclusion of humanist chaplains in healthcare chaplaincy?” Topics arising from the literature are an acknowledgement of a changing healthcare chaplaincy field, worries about changing current practices and chaplaincy funding, the use of (Christian) language excluding non-religious people and challenging assumptions about those who identify as non-religious.

The Clinicopathologic Evaluation of Eosinophilic Cholecystitis: A Retrospective Observational Study in a Tertiary Care Center

Background: Eosinophilic cholecystitis (EC) is a rare form of cholecystitis that is diagnosed histopathologically. The aim of this study to evaluate the patient demographic features, laboratory findings and histopathologic characteristics of EC. The aim of this study to evaluate the patient demographic features, laboratory findings and histopathologic characteristics of EC. Design and setting: Retrospective observational study conducted in Erzurum, Turkey. Methods: Between June 2014 and June 2017 3,178 cholecystectomy specimens were reviewed retrospectively. Nineteen EC cases were included to the study. Parameters such as sex, age, clinical information, laboratory findings were obtained from information system of hospital. And the data of EC group were compared with a control group of 50 non-specific chronic cholecystitis patients (CC). Result: Out of 3,178 cholecystectomy specimens, 19 cases were diagnosed as EC (0.59%). Patients’ age ranged from 22-84 years and female to male ratio was 1.7:1. The average eosinophil count was 139.7 U/L in EC group. 11.7% of EC group had high level for eosinophils. In the EC group there were statistical significances between high eosinophil percentages and aspartate transaminase (AST), alkaline phosphatase (ALP) values (P<0.05, P<0.05). The EC group eosinophil levels were slightly higher than CC. Histopathologically, dense, severe infiltrates composed of eosinophils were seen. Conclusion: EC is a rare entity that can only diagnosed by histopathology. There were certain high levels in liver function tests and eosinophils in correlation with non-specific cholecystitis. Although the presentation may be similar to non-specific cholecystitis, if a postoperative histopathological diagnosis of EC is made, then the patient must be investigated thoroughly to rule out other associated disease conditions.

Confusion and a cough: an experience of COVID-19 in dementia patients

AimsTo assess the clinical presentation and outcomes of COVID-19 positive patients with dementia and to evaluate the suitability of the “4C mortality score.” Older adults with dementia are a vulnerable patient group therefore it was predicted that this patient demographic would have poorer outcomes and high mortality rates. Ward 24 is an organic old age psychiatry ward in University Hospital Monklands, Lanarkshire for patients with advanced dementia. Older adults have been found to have atypical presentations and non-specific symptoms in COVID-19, however given COVID is still a new and evolving disease, little is known about the impact on dementia patients. The 4C mortality score was designed to predict in-hospital mortality for hospitalised COVID-19 patients using a number of clinical parameters.MethodData were collected retrospectively from all inpatients on ward 24 testing positive for COVID-19 between October and December 2020. Data were collected using online MIDIS entries, paper notes, NEWS charts and Clinical Portal. A 4C mortality score was calculated for each patient using an online calculator based on the data collected.Result15 patients tested positive for COVID-19; 47% male and 53% female, age range between 64 and 92 years old. 67% of patients had 3 or more comorbidities and 89% had either a high or very high 4C mortality score. Mortality from COVID-19 was 13% and 20% of patients required oxygen. 27% of patients were asymptomatic, these patients also had the lower risk mortality scores. 67% presented with pyrexia, 33% had a cough and 13% had breathlessness. Non-specific symptoms were also seen; 53% had fatigue, 20% had diarrhoea and 20% had unresponsive episodes. Post COVID delirium was seen in 20% of patients.ConclusionMortality rates were lower than expected, indicating that the 4C mortality score might not be appropriate to use in this patient demographic due to confounding factors. Atypical symptoms were common in patients, with a variability of clinical presentations within the patient demographic. These findings suggest the importance of having a low threshold for COVID-19 infection even in the absence of typical symptoms. Development of an alternative risk stratification tool would be beneficial for this patient group, with further studies needed on a larger scale to facilitate this.

Prediction of neonatal morbidity and very preterm delivery using maternal steroid biomarkers in early gestation

Background Preterm delivery is a common pregnancy complication that can result in significant neonatal morbidity and mortality. Limited tools exist to predict preterm birth, and none to predict neonatal morbidity, from early in pregnancy. The objective of this study was to determine if the progesterone metabolites 11-deoxycorticosterone (DOC) and 16-alpha hydroxyprogesterone (16α-OHP), when combined with patient demographic and obstetric history known during the pregnancy, are predictive of preterm delivery-associated neonatal morbidity, neonatal length of stay, and risk for spontaneous preterm delivery prior to 32 weeks’ gestation. Methods and findings We conducted a cohort study of pregnant women with plasma samples collected as part of Building Blocks of Pregnancy Biobank at the Indiana University School of Medicine. The progesterone metabolites, DOC and 16α-OHP, were quantified by mass spectroscopy from the plasma of 58 pregnant women collected in the late first trimester/early second trimester. Steroid levels were combined with patient demographic and obstetric history data in multivariable logistic regression models. The primary outcome was composite neonatal morbidity as measured by the Hassan scale. Secondary outcomes included neonatal length of stay and spontaneous preterm delivery prior to 32 weeks’ gestation. The final neonatal morbidity model, which incorporated antenatal corticosteroid exposure and fetal sex, was able to predict high morbidity (Hassan score ≥ 2) with an area under the ROC curve (AUROC) of 0.975 (95% CI 0.932, 1.00), while the model without corticosteroid and fetal sex predictors demonstrated an AUROC of 0.927 (95% CI 0.824, 1.00). The Hassan score was highly correlated with neonatal length of stay (p<0.001), allowing the neonatal morbidity model to also predict increased neonatal length of stay (53 [IQR 22, 76] days vs. 4.5 [2, 31] days, above and below the model cut point, respectively; p = 0.0017). Spontaneous preterm delivery prior to 32 weeks’ gestation was also predicted with an AUROC of 0.94 (95% CI 0.869, 1.00). Conclusions Plasma levels of DOC and 16α-OHP in early gestation can be combined with patient demographic and clinical data to predict significant neonatal morbidity, neonatal length of stay, and risk for very preterm delivery, though validation studies are needed to verify these findings. Early identification of pregnancies at risk for preterm delivery and neonatal morbidity allows for timely implementation of multidisciplinary care to improve perinatal outcomes.