Surgical infections
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Surgical infections · Oct 2009
ReviewNonoperative management of blunt abdominal trauma: have we gone too far?
The paradigm shift in the management of blunt abdominal trauma has been to become less invasive with both diagnostic tools and management. Avoidance of a laparotomy with its short-term and long-term risks is of obvious benefit to the patient. ⋯ Safe nonoperative management requires adherence to cardinal surgical principles, examination and re-examination of the patient, and fastidious clinical judgment.
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Surgical infections · Oct 2009
The development of a regional system for care of the burn-injured patients.
In the mid-20th century, it was recognized that patients with major burn injury required a dedicated, multidisciplinary team approach to receive optimal care. In the subsequent years, regionalized systems of care were developed to provide this level of care to the entire populations. There have been no reports on how an individual regional system evolved and the impact it had on the delivery of care for burn-injured patients. ⋯ Although there has been a significant decrease in the number of patients requiring hospitalization for burn injuries, there are still a large number of patients who suffer these injuries. Regionalization of burn care has been associated with care for patients in designated facilities in over 75% of the cases and a reduction in mortality by almost 50%.
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Surgical infections · Aug 2009
ReviewHas mortality from sepsis improved and what to expect from new treatment modalities: review of current insights.
The incidence of sepsis is increasing continuously, making mortality rate reduction through improved intensive care unit (ICU) care and new treatment modalities a pressing issue. This study aimed to provide insight into the effects of modern ICU care on mortality trends from severe sepsis and to provide a quantitative review of the relative effectiveness of new treatment modalities in reducing deaths. ⋯ The mortality rate from severe sepsis has decreased significantly with modernization of ICU care. New therapeutic strategies may reduce further the mortality rate. However, focused implementation of these new strategies in accordance with their relative effectiveness is needed before we can expect to see their true effect on mortality rates.
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Surgical infections · Aug 2009
Surgical site infections: does inadequate antibiotic therapy affect patient outcomes?
Complicated skin/skin structure infections involve deeper soft tissues and include surgical site infections (SSIs). Inadequate antibiotic therapy (IAT) has been associated with adverse outcomes in respiratory and blood stream infections, but is seldom evaluated in SSIs. This study assessed the impact of IAT on primary outcomes of length of stay (LOS) and costs in complicated SSIs; identifying risk factors associated with receiving IAT was a secondary objective. ⋯ Inadequate antibiotic therapy is associated with longer LOS and higher costs in complicated SSIs. Risk factors for IAT include prior antibiotic therapy, polymicrobial infection, infection with P. aeruginosa or Enterococcus spp., and abdominal incisions.
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Silver has been used extensively throughout recorded history for a variety of medical purposes. ⋯ Silver was the most important antimicrobial agent available before the introduction of antibiotics.