-
International Wound Journal Jun 2024To assess all published studies which describe what happens to the delivery of pressure ulcer/injury (PI/PU) care pathways as a result of detecting raised sub-epidermal... (Review)
Review
To assess all published studies which describe what happens to the delivery of pressure ulcer/injury (PI/PU) care pathways as a result of detecting raised sub-epidermal moisture (SEM) delta (∆ ≥ 0.6). We undertook a systematic review of the literature, and included original research studies using either a prospective or retrospective study design that report the impact that assessment using SEM assessments have on healthcare practitioners' delivery of PI/PU care pathways in adults at risk of developing PI/PUs. The review protocol was registered on PROSPERO (CRD42023416975). A literature search was conducted in May 2023, using PubMed, CINAHL, Scopus, Cochrane, EMBASE, Web of Science and Science Direct databases. Data were extracted using a data extraction tool including elements such as country, setting, sample size, intervention, control and quality appraisal was undertaken using the Evidence-based Librarianship. We identified nine papers published between 2017 and 2022. The majority of these studies were conducted in England (n = 6; 67%). The systematic review included studies conducted across multiple care settings including acute care, medical-surgical units, and palliative care, highlighting the importance of PI/PU prevention and management across diverse patient populations. The PI/PU care pathways implemented in the studies varied, but commonly included elements such as the application or increased use of pressure-redistributing mattresses/cushions, implementation of repositioning plans, management of incontinence and moisture, regular skin inspection, and assessment of patient mobility. Out of the nine studies identified, seven reported PI/PU incidence. A meta-analysis of seven studies (N = 18 451) demonstrated a statistically significant reduction in visual PI/PU development in favour of SEM-guided care pathways compared to usual care (the odds ratio = 0.36 [95% confidence interval: 0.24-0.53, p < 0.00001]). This systematic review provides evidence that implementing SEM assessments in patients at risk of developing PI/PUs prompts anatomy-specific clinical actions. The subsequent implementation of enhanced and targeted skin care interventions leads to consistent and sustained reductions in hospital-acquired PU incidence. The findings emphasise the importance of incorporating SEM assessments as part of comprehensive PI/PU prevention strategies in all care settings and patient populations. This systematic review is limited by the predominance of observational studies and variable study quality. Future research should focus on randomised trials in different care settings that monitor the efficacy of preventive interventions and their impact in reducing PI/PU incidence when implemented based on SEM assessments.
Topics: Pressure Ulcer; Humans; Male; Female; Middle Aged; Aged; Adult; Aged, 80 and over; Critical Pathways; Delivery of Health Care
PubMed: 38832363
DOI: 10.1111/iwj.14928 -
Cureus May 2024Thyroid abscess is a rare occurrence and is characterized by an accumulation of pus within the thyroid gland. It most commonly forms as a sequela of acute suppurative...
Thyroid abscess is a rare occurrence and is characterized by an accumulation of pus within the thyroid gland. It most commonly forms as a sequela of acute suppurative thyroiditis, and it presents as a painful swelling of the anterior neck with fever. Patients may also develop referred ear pain and compressive symptoms such as difficulty breathing and swallowing as the abscess enlarges. On examination, the swelling is often associated with erythema, local rise of temperature, and tenderness. Laboratory investigations may reveal leukocytosis, elevated acute phase reactants, and an abnormal thyroid function test. Despite advancements in diagnostic modalities and treatment approaches, literature on thyroid abscesses remains limited. We present a unique case of a long-standing thyroid abscess resulting from chronic suppuration which did not exhibit any of the mentioned expected findings seen in other cases. This patient was euthyroid, and laboratory investigations showed no significant abnormality. It was successfully treated with total thyroidectomy and appropriate antibiotics.
PubMed: 38832164
DOI: 10.7759/cureus.59549 -
Urology Jun 2024To present long-term experience with buccal mucosa posterior urethroplasty (BMPU) for refractory posterior urethral stenosis (PUS) or vesicourethral anastomosis stenosis...
Substitution Urethroplasty With Buccal Mucosal Graft in the Management of Stricture of Vesicourethral Anastomosis or Membranous Urethra: Single-institution Long-term Experience With Perineal Approach and Endourethroplasty.
OBJECTIVE
To present long-term experience with buccal mucosa posterior urethroplasty (BMPU) for refractory posterior urethral stenosis (PUS) or vesicourethral anastomosis stenosis (VUAS) either by perineal approach (PA) or by endourethroplasty (EUP).
MATERIALS AND METHODS
A single-center retrospective study of 38 consecutive patients operated on between 1999 and 2022. BMPU consisted of the transfer of onlay or tubular buccal mucosa grafts into dilated and/or incised strictures through an open or endourological approach. If VUAS or PUS recurred with short stenosis within the first 12 months after surgery, it was transected by a cold-knife direct vision internal urethrotomy (DVIU), referred to as an "auxiliary" DVIU. The primary outcome was 3-year stricture recurrence-free survival (SRFS).
RESULTS
BMPU by perineal approach and EUP were performed in 27 (71%) and 11 (29%) patients, respectively. The 3-year SRFS was 65% for the whole cohort, with rates of 63% for the perineal approach and 73% for endourological approach. With permitted auxiliary DVIU, 3-year SRFS for the whole cohort was 81%. De novo incontinence occurred in 2 out of 18 preoperatively continent patients. Limitations include the retrospective nature of the single-center study and a small, heterogenous cohort of patients.
CONCLUSION
We present 2 techniques of substitution urethroplasty with BMG in the management of PUS and VUAS with a low rate of recurrence or de novo incontinence. A novel endourological approach (EUP) is a promising minimally invasive alternative to the perineal approach.
PubMed: 38830554
DOI: 10.1016/j.urology.2024.05.034 -
BMC Musculoskeletal Disorders Jun 2024To develop an AI-assisted MRI model to identify surgical target areas in pediatric hip and periarticular infections.
OBJECTIVE
To develop an AI-assisted MRI model to identify surgical target areas in pediatric hip and periarticular infections.
METHODS
A retrospective study was conducted on the pediatric patients with hip and periarticular infections who underwent Magnetic Resonance Imaging(MRI)examinations from January 2010 to January 2023 in three hospitals in China. A total of 7970 axial Short Tau Inversion Recovery (STIR) images were selected, and the corresponding regions of osteomyelitis (label 1) and abscess (label 2) were labeled using the Labelme software. The images were randomly divided into training group, validation group, and test group at a ratio of 7:2:1. A Mask R-CNN model was constructed and optimized, and the performance of identifying label 1 and label 2 was evaluated using receiver operating characteristic (ROC) curves. Calculation of the average time it took for the model and specialists to process an image in the test group. Comparison of the accuracy of the model in the interpretation of MRI images with four orthopaedic surgeons, with statistical significance set at P < 0.05.
RESULTS
A total of 275 patients were enrolled, comprising 197 males and 78 females, with an average age of 7.10 ± 3.59 years, ranging from 0.00 to 14.00 years. The area under curve (AUC), accuracy, sensitivity, specificity, precision, and F1 score for the model to identify label 1 were 0.810, 0.976, 0.995, 0.969, 0.922, and 0.957, respectively. The AUC, accuracy, sensitivity, specificity, precision, and F1 score for the model to identify label 2 were 0.890, 0.957, 0.969, 0.915, 0.976, and 0.972, respectively. The model demonstrated a significant speed advantage, taking only 0.2 s to process an image compared to average 10 s required by the specialists. The model identified osteomyelitis with an accuracy of 0.976 and abscess with an accuracy of 0.957, both statistically better than the four orthopaedic surgeons, P < 0.05.
CONCLUSION
The Mask R-CNN model is reliable for identifying surgical target areas in pediatric hip and periarticular infections, offering a more convenient and rapid option. It can assist unexperienced physicians in pre-treatment assessments, reducing the risk of missed and misdiagnosis.
Topics: Humans; Male; Female; Magnetic Resonance Imaging; Child; Retrospective Studies; Adolescent; Osteomyelitis; Child, Preschool; Infant; Hip Joint; China; Abscess; ROC Curve
PubMed: 38824518
DOI: 10.1186/s12891-024-07548-1 -
Neurology India Mar 2024
Topics: Humans; Empyema, Subdural; Heart Septal Defects, Ventricular; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 38817191
DOI: 10.4103/neurol-india.Neurol-India-D-24-00165 -
Jornal Brasileiro de Pneumologia :... 2024To identify how pediatric surgeons manage children with pneumonia and parapneumonic pleural effusion in Brazil.
OBJECTIVE
To identify how pediatric surgeons manage children with pneumonia and parapneumonic pleural effusion in Brazil.
METHODS
An online cross-sectional survey with 27 questions was applied to pediatric surgeons in Brazil through the Brazilian Association of Pediatric Surgery. The questionnaire had questions about type of treatment, exams, hospital structure, and epidemiological data.
RESULTS
A total of 131 respondents completed the questionnaire. The mean age of respondents was 44 ± 11 years, and more than half (51%) had been practicing pediatric surgery for more than 10 years. The majority of respondents (33.6%) reported performing chest drainage and fibrinolysis when facing a case of fibrinopurulent parapneumonic pleural effusion. A preference for video-assisted thoracic surgery instead of chest drainage plus fibrinolysis was noted only in the Northeast region.
CONCLUSIONS
Chest drainage plus fibrinolysis was the treatment adopted by most of the respondents in this Brazilian sample. There was a preference for large drains; in contrast, smaller drains were preferred by those who perform chest drainage plus fibrinolysis. Respondents would rather change treatment when facing treatment failure or in critically ill children.
Topics: Humans; Brazil; Cross-Sectional Studies; Drainage; Male; Female; Practice Patterns, Physicians'; Empyema, Pleural; Adult; Child; Surveys and Questionnaires; Thoracic Surgery, Video-Assisted; Middle Aged; Surgeons; Pediatrics
PubMed: 38808824
DOI: 10.36416/1806-3756/e20230318 -
Frontiers in Cellular and Infection... 2024Antibiotic drug combination therapy is critical for the successful treatment of infections caused by multidrug resistant pathogens. We investigated the efficacy of...
Antibiotic drug combination therapy is critical for the successful treatment of infections caused by multidrug resistant pathogens. We investigated the efficacy of β-lactam and β-lactam/β-lactamase inhibitor combinations with other antibiotics, against the hypervirulent, ceftazidime/avibactam resistant Liverpool epidemic strain (LES) B58. Although minimum inhibitory concentrations differed by up to eighty-fold between standard and host-mimicking media, combinatorial effects only marginally changed between conditions for some combinations. Effective combinations were further tested in a chronic, high-density murine infection model. Colistin and azithromycin demonstrated combinatorial effects with ceftazidime and ceftazidime/avibactam both and . Conversely, while tobramycin and tigecycline exhibited strong synergy , this effect was not observed . Our approach of using host-mimicking conditions and a sophisticated animal model to evaluate drug synergy against bacterial pathogens represents a promising approach. This methodology may offer insights into the prediction of combination therapy outcomes and the identification of potential treatment failures.
Topics: Animals; Pseudomonas aeruginosa; Drug Synergism; Anti-Bacterial Agents; Disease Models, Animal; Pseudomonas Infections; Mice; Microbial Sensitivity Tests; Drug Therapy, Combination; Abscess; Drug Combinations; Drug Resistance, Multiple, Bacterial; Female; Ceftazidime; Azithromycin; Azabicyclo Compounds; Colistin
PubMed: 38808066
DOI: 10.3389/fcimb.2024.1352339 -
BMJ Open May 2024Radical mastoidectomy is a common procedure for chronic suppurative otitis media, typically performed under a microscope. The smooth operation is closely related to the...
Efficacy and safety of intravenous tranexamic acid in microscopic modified radical mastoidectomy: a study protocol for a prospective, randomised, double-blind controlled trial.
INTRODUCTION
Radical mastoidectomy is a common procedure for chronic suppurative otitis media, typically performed under a microscope. The smooth operation is closely related to the clarity of the operative field. Our trial is designed to investigate whether the intravenous administration of tranexamic acid (TXA) can improve the clarity of the operative field, reduce the operative time, and increase surgeon satisfaction.
METHODS AND ANALYSIS
This study is a prospective, randomised, double-blinded, controlled trial that aims to investigate the effects of TXA on patients with otitis media. The trial will include patients between the ages of 18 and 65 who will be randomly assigned to either the TXA group or the control group. In the TXA group, patients will receive 1 g of TXA diluted to 20 mL of normal saline before anaesthesia induction while the control group will receive 20 mL of normal saline. The primary outcome measure will be the Modena Bleeding Score, which will assess the clarity of the surgical field. Secondary outcomes will include the surgeon's satisfaction with surgical conditions, operation time, laboratory measurements (prothrombin time, activated partial thromboplastin time, fibrin degradation products, D-dimer) and levels of inflammatory factors (such as IL-6) at 24 hours postoperatively. In addition, the incidence of general adverse reactions such as postoperative nausea, vomiting and dizziness; serious adverse events such as arterial and venous thromboembolism, myocardial infarction and epilepsy within 90 days will be compared between the two groups.
ETHICS AND DISSEMINATION
The protocol was approved by the Ethics Committee of Peking University People's Hospital (2021PHB173-001), on 19 July 2021. The trial results will be submitted for publication in a peer-reviewed journal.
TRIAL REGISTRATION NUMBER
ChiCTR2100049183.
Topics: Humans; Tranexamic Acid; Double-Blind Method; Antifibrinolytic Agents; Prospective Studies; Adult; Administration, Intravenous; Mastoidectomy; Middle Aged; Female; Male; Adolescent; Otitis Media, Suppurative; Young Adult; Randomized Controlled Trials as Topic; Operative Time; Aged
PubMed: 38806427
DOI: 10.1136/bmjopen-2024-087062 -
Proceedings of the National Academy of... Jun 2024
Topics: Humans; Hidradenitis Suppurativa; Transcriptome; Gene Expression Profiling; Bias
PubMed: 38805291
DOI: 10.1073/pnas.2404503121 -
Proceedings of the National Academy of... Jun 2024
Topics: Humans; Hidradenitis Suppurativa; Female; Male; Sex Factors
PubMed: 38805283
DOI: 10.1073/pnas.2405298121