-
Surgery Journal (New York, N.Y.) Jul 2016Effective preoperative antisepsis is recognized to prevent surgical site infection (SSI), although the definitive method is unclear. Many have compared chlorhexidine...
Effective preoperative antisepsis is recognized to prevent surgical site infection (SSI), although the definitive method is unclear. Many have compared chlorhexidine (CHG) with povidone-iodine (PVI), but there is emerging evidence for combination usage. To conduct a systematic review and meta-analysis to evaluate if combination skin preparation (1) reduces colonization at the operative site and (2) prevents SSI compared with single-agent use. A literature search of MEDLINE, Embase, and Cochrane Database of Clinical Trials was performed. Comparative, human trials considering the combination use of CHG and PVI, as preoperative antisepsis, to single-agent CHG or PVI use were included. Studies were excluded from meta-analysis if the use or absence of alcohol was inconsistent between study arms. The study was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The primary outcome for meta-analysis was surgical site infection. The secondary outcome was colonization at the operative site. Eighteen publications with a combination of CHG and PVI use were identified. Of these, 12/14 inferred promise for combination usage, including four trials eligible for meta-analysis. Only one trial reported SSI as its outcome. The remaining three considered bacterial colonization. Combination preparation had a pooled odds ratio for complete decolonization of 5.62 (95% confidence interval 3.2 to 9.7, < 0.00001). There was no evidence of heterogeneity (Cochran's Q 2.1, 2 , = 0.35). There is emerging, albeit low-quality, evidence in favor of combination CHG and PVI preoperative antisepsis. Further rigorous investigation is indicated.
PubMed: 28824994
DOI: 10.1055/s-0036-1587691 -
Frontiers in Medicine 2019Gathering synovial tissue from any swollen joint especially in early arthritis patients is critical for good quality research and to obtain further insight into the... (Review)
Review
Gathering synovial tissue from any swollen joint especially in early arthritis patients is critical for good quality research and to obtain further insight into the pathophysiology of inflammatory joint diseases. Multiplying biopsy sites is a challenge in terms of the techniques needed for each different joint but also in terms of safety and tolerability. It is important to provide the best care especially in very early arthritis patients who have only had the disease for a few months. This review discusses the minimal requirements applying to antiseptic techniques for the operator's hands, patient preparation, local anesthesia, and post-procedure care.
PubMed: 30723716
DOI: 10.3389/fmed.2019.00001 -
Journal of Global Antimicrobial... Sep 2021Chronic wound infections may delay the healing process and are responsible for a significant burden on healthcare systems. Since inappropriate management may commonly... (Review)
Review
OBJECTIVES
Chronic wound infections may delay the healing process and are responsible for a significant burden on healthcare systems. Since inappropriate management may commonly occur in the care of these patients, this review aims to provide a practical guide underlining actions to avoid in the management of chronic wound infections.
METHODS
We performed a systematic review of the literature available in PubMed in the last 10 years, identifying studies regarding the management of patients with chronic wound infections. A panel of experts discussed the potential malpractices in this area. A list of 'Don'ts', including the main actions to be avoided, was drawn up using the 'Choosing Wisely' methodology.
RESULTS
In this review, we proposed a list of actions to avoid for optimal management of patients with chronic wound infections. Adequate wound bed preparation and wound antisepsis should be combined, as the absence of one of them leads to delayed healing and a higher risk of wound complications. Moreover, avoiding inappropriate use of systemic antibiotics is an important point because of the risk of selection of multidrug-resistant organisms as well as antibiotic-related adverse events.
CONCLUSION
A multidisciplinary team of experts in different fields (surgeon, infectious disease expert, microbiologist, pharmacologist, geriatrician) is required for the optimal management of chronic wound infections. Implementation of this approach may be useful to improve the management of patients with chronic wound infections.
Topics: Anti-Bacterial Agents; Humans; Wound Healing; Wound Infection
PubMed: 34144200
DOI: 10.1016/j.jgar.2021.05.010 -
Journal of Vascular Surgery Nov 2014
Topics: Antisepsis; Catgut; Equipment Design; History, 19th Century; Humans; Ligation; Surgical Wound Infection; Suture Techniques; Sutures; Vascular Surgical Procedures
PubMed: 24833248
DOI: 10.1016/j.jvs.2014.04.005 -
PloS One 2012Skin antisepsis is a simple and effective measure to prevent infections. The efficacy of chlorhexidine is actively discussed in the literature on skin antisepsis.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Skin antisepsis is a simple and effective measure to prevent infections. The efficacy of chlorhexidine is actively discussed in the literature on skin antisepsis. However, study outcomes due to chlorhexidine-alcohol combinations are often attributed to chlorhexidine alone. Thus, we sought to review the efficacy of chlorhexidine for skin antisepsis and the extent of a possible misinterpretation of evidence.
METHODS
We performed a systematic literature review of clinical trials and systematic reviews investigating chlorhexidine compounds for blood culture collection, vascular catheter insertion and surgical skin preparation. We searched PubMed, CINAHL, the Cochrane Library, the Agency for Healthcare Research and Quality website, several clinical trials registries and a manufacturer website. We extracted data on study design, antiseptic composition, and the following outcomes: blood culture contamination, catheter colonisation, catheter-related bloodstream infection and surgical site infection. We conducted meta-analyses of the clinical efficacy of chlorhexidine compounds and reviewed the appropriateness of the authors' attribution.
RESULTS
In all three application areas and for all outcomes, we found good evidence favouring chlorhexidine-alcohol over aqueous competitors, but not over competitors combined with alcohols. For blood cultures and surgery, we found no evidence supporting chlorhexidine alone. For catheters, we found evidence in support of chlorhexidine alone for preventing catheter colonisation, but not for preventing bloodstream infection. A range of 29 to 43% of articles attributed outcomes solely to chlorhexidine when the combination with alcohol was in fact used. Articles with ambiguous attribution were common (8-35%). Unsubstantiated recommendations for chlorhexidine alone instead of chlorhexidine-alcohol were identified in several practice recommendations and evidence-based guidelines.
CONCLUSIONS
Perceived efficacy of chlorhexidine is often in fact based on evidence for the efficacy of the chlorhexidine-alcohol combination. The role of alcohol has frequently been overlooked in evidence assessments. This has broader implications for knowledge translation as well as potential implications for patient safety.
Topics: Alcohols; Anti-Infective Agents, Local; Antisepsis; Blood Specimen Collection; Catheter-Related Infections; Chlorhexidine; Humans; Skin; Surgical Wound Infection; Treatment Outcome; Vascular Access Devices
PubMed: 22984485
DOI: 10.1371/journal.pone.0044277 -
Cardiovascular Therapeutics 2021To observe the effect of nicorandil on septic rats and explore the possible mechanism of its myocardial protection, so as to provide theoretical basis for the treatment...
OBJECTIVE
To observe the effect of nicorandil on septic rats and explore the possible mechanism of its myocardial protection, so as to provide theoretical basis for the treatment of septic cardiomyopathy.
METHODS
Sixty male clean SD rats were selected as the research objects and randomly divided into 3 groups by random number method: sham operation group (sham group), cecal ligation and perforation group (CLP group), nicorandil treatment group (nicorandil+CLP group). After the operation, the nicorandil group was pumped with nicorandil diluent 1 ml/h (2 mg/kg/h) with a micropump for 6 hours. The sham group and CLP group were pumped with the same amount of normal saline 1 ml/h for a total of 6 hours. After 24 hours, the survival of the rats in each group was observed. The expression of troponin I (cTnI), tumor necrosis factor (TNF-), and interleukin-1 (IL-1) in the serum was detected. Then, the ventricle was harvested for the observation of the pathological changes of myocardium. Quantitative real-time polymerase chain reaction and immunostaining were used to detect myocardial tissue apoptosis, and Western blot methods were used to detect protein expression changes in nuclear factor-B (NF-B) pathways.
RESULTS
24 hours after operation, the survival rate of the rats in the CLP group was 60%. There was a large amount of necrosis of myocardial cells and inflammatory cell infiltration. The survival rate of rats in the nicorandil+CLP group was 75%. Compared with the CLP group, the necrosis of myocardial cells was reduced, and there was still a small amount of inflammatory cell infiltration. In the CLP group, myocardial inflammation and apoptosis were significant, and NF-B pathway was activated. On the contrary, the NF-B pathway in the nicorandil+CLP group was inhibited, and the expression of inflammatory factors and apoptosis factors was inhibited.
CONCLUSION
Nicorandil can reduce the release of inflammatory factors in septic rats, improve the inflammatory response, reduce myocardial damage, and play a myocardial protective effect. Its mechanism may be related to the inhibition of the activation of NF-B signaling pathway.
Topics: Animals; Anti-Inflammatory Agents; Antisepsis; Apoptosis; Cardiomyopathies; Male; Nicorandil; Rats; Rats, Sprague-Dawley; Sepsis; Tumor Necrosis Factor-alpha
PubMed: 34950238
DOI: 10.1155/2021/5822920 -
PloS One 2022This paper uses extensive database research, film viewing and literature review to show how the field of surgery was staged in the early days of film history. It can be... (Review)
Review
This paper uses extensive database research, film viewing and literature review to show how the field of surgery was staged in the early days of film history. It can be shown that-although surgical medicine was a subject in transition, and many scientific breakthroughs (anesthesia und antisepsis) made surgery less painful and more complication-free-filmmakers still frequently resorted to horror memories of the past and created a questionable, or ambivalent image of the surgeon, sometimes as extreme as the "lunatic with a scalpel" stereotype, blurring the line between genius and madness. But there were also positive staging's: The surgical intervention was often captured on the screen as a last resort for clinically hopeless cases, with the surgeon often presented as a "deus ex machina", the savior out of nowhere. Other specialties, however, such as plastic surgery, were mostly positively dramatized, which reveals a stark contrast to research about the representation of the field in the sound film era. A view at the fields of neurosurgery and (selectively) opthalmo-surgery rounds out the panorama of forty-one surgical films. In summary, it is shown that the early surgical film depicts the specialty and the surgeon in a highly ambivalent way, from savior to monster thereby reflecting one of the most significant transitions in the history of surgery and showing us what image was presented to the public-and thus to potential patients-in the movie theaters.
Topics: Humans; Medicine; Motion Pictures; Sound; Stereotyping; Surgeons
PubMed: 36542642
DOI: 10.1371/journal.pone.0279422 -
The Chicago Medical Journal and Examiner Oct 1886
PubMed: 37618696
DOI: No ID Found