220 results on '"Wound classification"'
Search Results
2. Multi‐Wound Classification: Exploring Image Enhancement and Deep Learning Techniques
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Prince Odame, Maxwell Mawube Ahiamadzor, Nana Kwaku Baah Derkyi, Kofi Agyekum Boateng, Kelvin Sarfo‐Acheampong, Eric Tutu Tchao, Andrew Selasi Agbemenu, Henry Nunoo‐Mensah, Dorothy Araba Yakoba Agyapong, and Jerry John Kponyo
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capsule networks ,deep learning ,telemedicine ,wound classification ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Electronic computers. Computer science ,QA75.5-76.95 - Abstract
ABSTRACT Wounds contribute to 30%–42% of hospital visits and 9% of deaths but remain underreported in Africa. Diseases and surgeries increase wound prevalence, especially in rural areas where 27%–82% of people live, and health facilities are poor or non‐existent. This research aims to design a disease‐related wound classification model for online diagnosis and telemedicine support for traditional health practitioners and village health workers. This paper focuses on wounds from diabetic ulcers, pressure ulcers, surgery, and venous ulcers. The approaches used included Contrast Limited Adaptive Histogram Equalization (CLAHE) with machine and deep learning models, Discrete Wavelet Transformations (DWT) with a novel Gated Wavelet Convolutional Neural Network (CNN) model, and FixCaps, an improved version of Capsule Networks utilizing Convolutional Block Attention Module (CBAM) to reduce spatial information loss. The performance metrics showed similar results for the first two approaches, but FixCaps was the most proficient, with accuracy, precision, recall, and F‐score of 93.83%, 95.41%, 88.63%, and 90.93% respectively. FixCaps had trainable parameters of about 8.28 MB compared with the 195.64 MB of the Gated Wavelet CNN Model.
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- 2025
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3. Comparing surgical infections in National Surgical Quality Improvement Project and an Institutional Database
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Selby, Luke V., Sjoberg, Daniel D., Cassella, Danielle, Sovel, Mindy, Weiser, Martin R., Sepkowitz, Kent, Jones, David R., and Strong, Vivian E.
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- 2015
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4. Automated wound segmentation and classification of seven common injuries in forensic medicine.
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Zimmermann, Norio, Sieberth, Till, and Dobay, Akos
- Abstract
In forensic medical investigations, physical injuries are documented with photographs accompanied by written reports. Automatic segmentation and classification of wounds on these photographs could provide forensic pathologists with a tool to improve the assessment of injuries and accelerate the reporting process. In this pilot study, we trained and compared several preexisting deep learning architectures for image segmentation and wound classification on forensically relevant photographs in our database. The best scores were a mean pixel accuracy of 69.4% and a mean intersection over union (IoU) of 48.6% when evaluating the trained models on our test set. The models had difficulty distinguishing the background from wounded areas. As an example, image pixels showing subcutaneous hematomas or skin abrasions were assigned to the background class in 31% of cases. Stab wounds, on the other hand, were reliably classified with a pixel accuracy of 93%. These results can be partially attributed to undefined wound boundaries for some types of injuries, such as subcutaneous hematoma. However, despite the large class imbalance, we demonstrate that the best trained models could reliably distinguish among seven of the most common wounds encountered in forensic medical investigations. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Classification and a decade-long follow-up of rat bite injuries in the nasal region
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Chu-Hsin Chen, Yahong Chen, Peng Xu, and Kai Liu
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Rat bite ,Wound classification ,Nasal reconstruction ,Surgery ,RD1-811 - Abstract
Background: Nasal defects due to rat bites are frequently encountered in rural regions of China. In addition to serving as disease vectors, rats can also inflict bite injuries. In this study, we delineated the characteristics of rat bite injuries in the nasal region and discussed the clinical features observed during a 10-year follow-up period. Methods: We retrospectively reviewed hospital records for patients admitted due to rat bites. This study outlines the demographics, clinical features, and follow-up outcomes supported by comprehensive photo documentation of the patients’ progress. Results: Twenty-five patients, with a mean age of 29 years, were admitted due to rat bites. Treatment was provided for three distinct types of injuries: nasal tip defect (type I), nasal defect (type II), and full-thickness nasal defect with loss of surrounding tissues (type III). All patients recovered fully. Conclusions: The treatment for rat bites should be based on the wound type. The long-term follow-up outcomes are more favorable when fewer subunits of the nose affected. We recommend early surgical intervention, along with psychological therapy, to prevent interference with growth and development.
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- 2024
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6. Surgical wound classification in otolaryngology: A state‐of‐the‐art review
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Bernstein, Jeffrey D, Bracken, David J, Abeles, Shira R, Orosco, Ryan K, and Weissbrod, Philip A
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Biomedical and Clinical Sciences ,Clinical Sciences ,Patient Safety ,Rare Diseases ,Dental/Oral and Craniofacial Disease ,ENT ,OHNS ,health care spending ,otolaryngology ,quality improvement ,reimbursement ,surgical site infection ,wound classification - Abstract
ObjectiveTo describe the issues related to the assignment of surgical wound classification as it pertains to Otolaryngology-Head & Neck surgery, and to present a simple framework by which providers can assign wound classification.Data sourcesLiterature review.ConclusionSurgical wound classification in its current state is limited in its utility. It has recently been disregarded by major risk assessment models, likely due to inaccurate and inconsistent reporting by providers and operative staff. However, if data accuracy is improved, this metric may be useful to inform the risk of surgical site infection. In an era of quality-driven care and reimbursement, surgical wound classification may become an equally important indicator of quality.
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- 2022
7. A meta‐analysis of the risk factors for surgical site infection in patients with colorectal cancer.
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Chen, Yani, Guo, Hua, Gao, Tian, Yu, Jiale, Wang, Yujia, and Yu, Haiquan
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MEDICAL databases ,ONLINE information services ,SURGICAL therapeutics ,META-analysis ,MEDICAL information storage & retrieval systems ,SYSTEMATIC reviews ,COLOSTOMY ,BLOOD transfusion ,LAPAROSCOPIC surgery ,DIABETES ,SURGERY ,PATIENTS ,RISK assessment ,COLORECTAL cancer ,CANCER patients ,SEX distribution ,SURGICAL site infections ,DIGESTIVE organ surgery ,DESCRIPTIVE statistics ,RESEARCH funding ,ABDOMINAL surgery ,MEDLINE ,ODDS ratio ,BODY mass index ,MICROBIAL contamination ,DISEASE risk factors - Abstract
The purpose of the meta‐analysis was to evaluate and compare the surgical site infection (SSI) risk factors in patients with colorectal cancer (CC). The results of this meta‐analysis were analysed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random or fixed‐effect models. For the current meta‐analysis, 23 examinations spanning from 2001 to 2023 were included, encompassing 89 859 cases of CC. Clean‐contaminated surgical site wounds had significantly lower infections (OR, 0.36; 95% CI, 0.20–0.64, p < 0.001) compared to contaminated surgical site wounds in patients with CCs. Males had significantly higher SSIs (OR, 1.18; 95% CI, 1.12–1.24, p < 0.001) compared to females in patients with CC. American Society of Anesthesiology score ≥3 h had a significantly higher SSI (OR, 1.42; 95% CI, 1.18–1.71, p < 0.001) compared to <3 score in patients with CCs. Body mass index ≥25 had significantly higher SSIs (OR, 1.54; 95% CI, 1.11–2.14, p = 0.01) compared to <25 in patients with CCs. The presence of stoma creation had a significantly higher SSI rate (OR, 2.28; 95% CI, 1.37–3.79, p = 0.001) compared to its absence in patients with CC. Laparoscopic surgery had significantly lower SSIs (OR, 0.68; 95% CI, 0.59–0.78, p < 0.001) compared to open surgery in patients with CC. The presence of diabetes mellitus had a significantly higher SSI rate (OR, 1.24; 95% CI, 1.15–1.33, p < 0.001) compared to its absence in patients with CCs. No significant difference was found in SSI rate in patients with CCs between <3 and ≥3 h of operative time (OR, 1.07; 95% CI, 0.75–1.51, p = 0.72), between the presence and absence of blood transfusion (OR, 1.60; 95% CI, 0.69–3.66, p = 0.27) and between the presence and absence of previous laparotomies (OR, 1.47; 95% CI, 0.93–2.32, p = 0.10). The examined data revealed that contaminated wounds, male sex, an American Society of Anesthesiology score ≥3 h, a body mass index ≥25, stoma creation, open surgery and diabetes mellitus are all risk factors for SSIs in patients with CC. However, operative time, blood transfusion and previous laparotomies were not found to be risk factors for SSIs in patients with CC. However, given that several comparisons had a small number of chosen research, consideration should be given to their values. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Are current wound classifications valid for predicting prognosis in people treated for limb‐threatening diabetic foot ulcers?
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Chang, Ya‐Chu, Huang, Yu‐Yao, Hung, Shih‐Yuan, Yeh, Jiun‐Ting, Lin, Cheng‐Wei, Chen, I‐Wen, Wei, Hung‐Hui, Yang, Hui‐Mei, and Huang, Chung‐Huei
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TRAUMATOLOGY diagnosis ,C-reactive protein ,ALBUMINS ,DIABETIC foot ,MAJOR adverse cardiovascular events ,RISK assessment ,LEG ,HOSPITAL mortality ,LIMB salvage ,RESEARCH funding ,AMPUTATION ,ODDS ratio - Abstract
This study aims to investigate whether the current wound classifications were valid for the treatment prognosis of subjects treated for limb‐threatening diabetic foot ulcers (LTDFU). A total of 1548 patients with LTDFU and infection were studied, with wounds recorded using the Wagner, Texas, PEDIS and WIfI classifications while major lower extremity amputations (LEAs) or in‐hospital mortality incidences were defined as poor outcomes. Among them, 153 (9.9%) patients received major LEAs and 38 (2.5%) patients died. After adjustments, the Wagner classification and Texas stage as well as clinical factors such as comorbidity with major adverse cardiac events (MACE), being under dialysis and having serum levels of C‐reactive protein (CRP) and albumin were independent factors for prognosis. For patients without dialysis, Wagner and Texas stage stood out independently for prognosis. For patients on dialysis, only levels of CRP (odds ratio [OR] = 2.2 in Wagner, OR = 2.0 in WIfI, OR = 2.2 in Texas, OR = 2.3 in PEDIS) and albumin (OR = 0.4 in four classifications) were valid predictors. The Wagner system and Texas stage were valid for predicting prognosis in treatment for LTDFUs, suggesting a role of vascular perfusion. MACE history, levels of CRP and albumin level should assist in prediction; more significantly, only levels of CRP and albumin appeared valid for those subjects undergoing dialysis. [ABSTRACT FROM AUTHOR]
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- 2024
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9. Aetiology, Classification and Advocating for a Holistic, Multidisciplinary Approach
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Michelucci, Alessandra, Granieri, Giammarco, Dini, Valentina, Romanelli, Marco, Maruccia, Michele, editor, Papa, Giovanni, editor, Ricci, Elia, editor, and Giudice, Giuseppe, editor
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- 2023
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10. A Novel Fused Multi-Class Deep Learning Approach for Chronic Wounds Classification.
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Aldoulah, Zaid A., Malik, Hafiz, and Molyet, Richard
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DEEP learning ,CHRONIC wounds & injuries ,WOUND care ,MEDICAL care costs ,CLASSIFICATION ,MEDICAL personnel - Abstract
Chronic wounds affect the lives of millions of individuals globally, and due to substantial medical costs, treating chronic injuries is very challenging for the healthcare system. The classification of regular wound type is essential in wound care management and diagnosis since it can assist clinicians in deciding on the appropriate treatment method. Hence, an effective wound diagnostic tool would enable clinicians to classify the different types of chronic wounds in less time. The majority of the existing chronic wound classification methods are mainly focused on the binary classification of the wound types. A few approaches exist that classify chronic wounds into multiple classes, but these achieved lower performances for pressure and diabetic wound classification. Furthermore, cross-corpus evaluation is absent in chronic wound type classification, in order to better evaluate the efficacy of existing methods on real-time wound images. To address the limitations of the current studies, we propose a novel Swish-ELU EfficientNet-B4 (SEEN-B4) deep learning framework that can effectively identify and classify chronic wounds into multiple classes. Moreover, we also extend the existing Medetec and Advancing the Zenith of Healthcare (AZH) datasets to deal with the class imbalance problem of these datasets. Our proposed model is evaluated on publicly available AZH and Medetec datasets and their extended versions. Our experimental results indicate that the proposed SEEN-B4 model has attained an accuracy of 87.32%, 88.17%, 88%, and 89.34% on the AZH, Extended AZH, Medetec, and Extended Medetec datasets, respectively. We also show the effectiveness of our method against the existing state-of-the-art (SOTA) methods. Furthermore, we evaluated the proposed model for the cross-corpora scenario to demonstrate the model generalization aptitude, and interpret the model's result through explainable AI techniques. The experimental results show the proposed model's effectiveness for classifying chronic wound types. [ABSTRACT FROM AUTHOR]
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- 2023
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11. Classification of Wounds and the Physiology of Wound Healing
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Gupta, Ankit, Kumar, Prasun, editor, and Kothari, Vijay, editor
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- 2021
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12. Optimizing Surgical Outcomes
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Stasko, Thomas, MacFarlane, Deborah F., Ross, Amy S., and MacFarlane, Deborah F., editor
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- 2021
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13. A Novel Fused Multi-Class Deep Learning Approach for Chronic Wounds Classification
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Zaid A. Aldoulah, Hafiz Malik, and Richard Molyet
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chronic wound ,EfficientNet-B4 ,Medetec dataset ,AZH dataset ,wound classification ,Technology ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Biology (General) ,QH301-705.5 ,Physics ,QC1-999 ,Chemistry ,QD1-999 - Abstract
Chronic wounds affect the lives of millions of individuals globally, and due to substantial medical costs, treating chronic injuries is very challenging for the healthcare system. The classification of regular wound type is essential in wound care management and diagnosis since it can assist clinicians in deciding on the appropriate treatment method. Hence, an effective wound diagnostic tool would enable clinicians to classify the different types of chronic wounds in less time. The majority of the existing chronic wound classification methods are mainly focused on the binary classification of the wound types. A few approaches exist that classify chronic wounds into multiple classes, but these achieved lower performances for pressure and diabetic wound classification. Furthermore, cross-corpus evaluation is absent in chronic wound type classification, in order to better evaluate the efficacy of existing methods on real-time wound images. To address the limitations of the current studies, we propose a novel Swish-ELU EfficientNet-B4 (SEEN-B4) deep learning framework that can effectively identify and classify chronic wounds into multiple classes. Moreover, we also extend the existing Medetec and Advancing the Zenith of Healthcare (AZH) datasets to deal with the class imbalance problem of these datasets. Our proposed model is evaluated on publicly available AZH and Medetec datasets and their extended versions. Our experimental results indicate that the proposed SEEN-B4 model has attained an accuracy of 87.32%, 88.17%, 88%, and 89.34% on the AZH, Extended AZH, Medetec, and Extended Medetec datasets, respectively. We also show the effectiveness of our method against the existing state-of-the-art (SOTA) methods. Furthermore, we evaluated the proposed model for the cross-corpora scenario to demonstrate the model generalization aptitude, and interpret the model’s result through explainable AI techniques. The experimental results show the proposed model’s effectiveness for classifying chronic wound types.
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- 2023
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14. The SHID wound classification system for diabetic foot ulcer patients: a validity study.
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Jais, Suriadi, Pratama, Kharisma, Fahrain, Jery, Junaidi, Junaidi, Kardiatun, Tutur, and Kawuryan, Uji
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DIABETIC foot , *PREDICTIVE validity , *NURSING students , *CLASSIFICATION , *PEOPLE with diabetes - Abstract
This study aimed to evaluate the predictive validity of the SHID (Suriadi, Haryanto, Imran dan Defa) wound classification system compared to TU (Texas University) and Wagner wound classification systems in Indonesia. A prospective cohort study included patients with diabetic foot ulcers at Kitamura wound clinic in Indonesia. A total of 111 diabetic foot ulcer patients were assessed with SHID, TU, and Wagner wound classification systems. Two postgraduate nursing students assessed 111 wounds of bedside patients and observed them for 4 weeks. The predictive validity test indicated that the cut-off score of ≤grade 2 for SHID was 74% and 97%, ≤grade IB for TU was 77% and 92%, then ≤grade 2 for Wagner was 84% and 71% for sensitivity and specificity, respectively. The area under the curve (AUC) in SHID, TU, and Wagner tools was 0.90 (95% CI: 0.828-0.950), 0.85 (95% CI: I0.766-0.910), and 0.86 (95% CI: 0.775-0.917), respectively. The Youden index for SHID, TU, and Wagner was 0.72%, 0.70%, and 0.55%, respectively. The wound classification systems are good tools for identifying diabetic foot ulcers. However, the newly developed SHID tool produced the best AUC and Youden Index values compared to the Wagner tool. [ABSTRACT FROM AUTHOR]
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- 2022
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15. Using the Red Cross wound classification to predict treatment needs in children with conflict-related limb injuries: a retrospective database study
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Lisanne van Gennip, Frederike J. C. Haverkamp, Måns Muhrbeck, Andreas Wladis, and Edward C. T. H. Tan
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Global health ,Pediatric surgery ,Wound classification ,Extremity injury ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background The International Committee of the Red Cross (ICRC) implemented the Red Cross wound classification (RCWC) to quickly assess the severity of a wound in conflict settings. A subdivision into wound grades derived from the RCWC consists of grades 1, 2, and 3, and represents low, major, and massive energy transfer, respectively, to the injured tissue. The aim of this observational study is to assess whether the Red Cross wound grade of a pediatric patient’s wound correlates with patient outcomes. Methods All pediatric patients (age < 15 years) treated in an ICRC hospital between 1988 and 2014 for conflict-related penetrating extremity injuries were retroactively included. Correlations were assessed between wound grades and number of surgeries, blood transfusions, days hospitalized, and mortality. Stratification analyses were performed to evaluate potential effect modifiers. Results The study included 2463 pediatric patients. Pediatric patients with a higher wound grade received significantly more surgeries (grade 1 median 2; grade 3 median 3), more blood transfusions (grades 1 and 3 received 33.9 and 72.2 units per 100 patients, respectively), and were hospitalized longer (grade 1 median 15; grade 3 median 40 days). Mortality rates did not significantly differ. Stratification analyses did not reveal effect modifiers for the association between wound grades and patient outcomes. Conclusion The Red Cross wound grade of a pediatric patient’s extremity wound correlates independently with treatment needs. This simple wound grading system could support clinical decision-making and should be integrated into the clinical assessment of weapon-wounded pediatric patients in conflict settings.
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- 2020
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16. Surgical Site Infections: Wound and Stump Infections
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Safdar, Nasia, Zerbel, Sara A. M., Misch, Elizabeth Ann, and Safdar, Amar, editor
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- 2019
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17. Australian guideline on wound classification of diabetes-related foot ulcers: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease.
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Hamilton, Emma J., Scheepers, Joanna, Ryan, Hayley, Perrin, Byron M., Charles, James, Cheney, Jane, and Twigg, Stephen M.
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FOOT ulcers , *FOOT diseases , *MEDICAL personnel , *DIABETIC foot , *WOUNDS & injuries - Abstract
Background: Wound classification systems are useful tools to characterise diabetes-related foot ulcers (DFU) and are utilised for the purpose of clinical assessment, to promote effective communication between health professionals, and to support clinical audit and benchmarking. Australian guidelines regarding wound classification in patients with DFU are outdated. We aimed to adapt existing international guidelines for wound classification to develop new evidence-based Australian guidelines for wound classification in people with diabetes and DFU. Methods: Recommended NHRMC procedures were followed to adapt suitable International Working Group on the Diabetic Foot (IWGDF) guidelines on wound classification to the Australian health context. Five IWGDF wound classification recommendations were evaluated and assessed according to the ADAPTE and GRADE systems. We compared our judgements with IWGDF judgements to decide if recommendations should be adopted, adapted or excluded in an Australian context. We re-evaluated the quality of evidence and strength of recommendation ratings, provided justifications for the recommendation and outlined any special considerations for implementation, subgroups, monitoring and future research in an Australian setting. Results: After the five recommendations from the IWGDF 2019 guidelines on the classification of DFUs were evaluated by the panel, two were adopted and three were adapted to be more suitable for Australia. The main reasons for adapting, were to align the recommendations to existing Australian standards of care, especially in specialist settings, to maintain consistency with existing recommendations for documentation, audit and benchmarking and to be more appropriate, acceptable and applicable to an Australian context. In Australia, we recommend the use of the SINBAD system as a minimum standard to document the characteristics of a DFU for the purposes of communication among health professionals and for regional/national/international audit. In contrast to the IWGDF who recommend against usage, in Australia we recommend caution in the use of existing wound classification systems to provide an individual prognosis for a person with diabetes and a foot ulcer. Conclusions: We have developed new guidelines for wound classification for people with diabetes and a foot ulcer that are appropriate and applicable for use across diverse care settings and geographical locations in Australia. [ABSTRACT FROM AUTHOR]
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- 2021
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18. Wound Classification Score Discordance in Pediatric Operations - A Quality Improvement Study.
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Massoumi, Roxane L., Wertz, Joseph, Anderson, Noah, Barrett, Nathaniel, and Jen, Howard C.
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APPENDECTOMY , *ELECTRONIC health records , *PHYSICIANS , *PEDIATRIC surgeons , *CLASSIFICATION , *CHI-squared test - Abstract
Wound classification scores are used to categorize the risk of postoperative infections. It was noted at our academic institution that wound classifications were often inaccurately recorded in the electronic health record. We thus instituted a quality improvement program, hypothesizing that this would improve charting accuracy. On June 1, 2019, we posted the wound classifications in each pediatric operating room (OR), provided OR nurses with teaching, and began including the classification in the postoperative surgeon debriefing. We performed a retrospective chart review of all general pediatric operations from June 19 to December 19 to compare classifications recorded in the electronic health record to the "correct" classification determined by manual review of operating reports. These data were compared with a similar chart review from 2018. To compare the efficacy of nursing versus physician focused changes, we compared our appendectomy data with a nearby community institution where the same group of surgeons practice. Pearson's Chi-squared test was used to report the significance of the differences observed in the concordance proportion, with 95% confidence intervals calculated using the Clopper-Pearson procedure. Overall, 444 pre- and 179 postpractice change charts were reviewed. There were no significant differences pre or postpractice change. At the community institution, we noted a significant improvement in charting accuracy for appendectomies from 3.33% to 44.83%. Despite implementing nursing and physician focused quality improvement practices, there was not a significant improvement in charting accuracy at the academic institution. However, we did note an improvement at the community facility where our pediatric surgeons also practice. We thus suspect that our nursing focused changes may have been inadequate. Future efforts will focus on providing intensive and sustained OR nurse training to help improve the wound classification charting accuracy. [ABSTRACT FROM AUTHOR]
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- 2021
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19. Evaluation of the effect of triclosan coated sutures in the prevention of surgical site infections in a Spanish hospital setting: A prospective, observational study
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Manuel Bustamante Montalvo, Miguel Cainzos, Luis Prieto Carreiras, Andrea Castiñeira Piñeiro, Adrián García Iglesias, Ana Fernandez Novo, Lara María González Gómez, Ana Flores, Rita Diz Gil, and Carlos Fernández Baltar
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Triclosan-coated suture ,Surgical site infection ,Hospital-acquired infection ,Wound classification ,Class IV wound ,Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Summary: Background: Surgical site infections (SSIs) are one of the most frequently reported types of hospital-acquired infection and are associated with substantial clinical and economic burden. Aim: To assess the incidence of SSIs and analyze contributing risk factors in a real-world Spanish hospital setting before and after the implementation of triclosan-coated sutures (TCS). Methods: A prospective, observational study was conducted at Hospital Clínico Universitario de Santiago de Compostela, Spain. Enrolled patients underwent surgery in the following specialties: general surgery, urology, neurosurgery, gynaecology, and traumatology. The primary outcome of the study was SSI incidence, assessed at a 30-day follow-up. Secondary outcomes were length of hospital stay, and readmission, reintervention, and mortality rates, also at 30 days. Findings: 5,081 patients were included in the study, of which 2,591 were treated using non-coated sutures (NCS) and 2,490 using TCS. After adjusting for potential confounders, TCS significantly reduced SSI rate by 36%, compared with NCS (odds ratio [OR]: 0.64; 95% confidence interval [CI]: 0.48–0.85; P
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- 2021
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20. Wound healing applications of creams and "smart" hydrogels.
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Stan, Diana, Tanase, Cristiana, Avram, Marioara, Apetrei, Roxana, Mincu, Nicolae‐Bogdan, Mateescu, Andreea Lorena, and Stan, Dana
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WOUND healing , *HYDROCOLLOID surgical dressings , *HYDROGELS , *MEDICAL personnel , *PATIENTS' rights , *HEALING - Abstract
Although superficial wounds are often easy to treat for healthy individuals, there are some more severe types of wounds (burns, ulcers, diabetic wounds, etc.) that are a challenge for clinicians. A good therapeutic result is based on the delivery of a treatment at the right time, for the right patient. Our goal was to sum up useful knowledge regarding wound healing and wound treatments, based on creams and hydrogels with various active ingredients. We concluded that both preparations have application in preventing infections and promoting healing, but their efficacy is clearly conditioned by the type, depth, severity of the wound and patient profile. However, due to their superior versatility and capability of maintaining the integrity and functionality of the active ingredient, as well as it is controlled release at site, hydrogels are more suited for incorporating different active ingredients. New wound healing devices can combine smart hydrogel dressings with physical therapies to deliver a more efficient treatment to patients if the indications are appropriate. [ABSTRACT FROM AUTHOR]
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- 2021
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21. Treatment of Ulcerations and Wounds
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Tiede, Regina, Emmert, Steffen, Isbary, Georg, Metelmann, Hans-Robert, editor, von Woedtke, Thomas, editor, and Weltmann, Klaus-Dieter, editor
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- 2018
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22. Wound prevalence survey in a regional integrated care organisation in the midwest of Ireland.
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Meagher, Helen, Keane, Niamh, Egan, Siobhan, Sheikhi, Ali, Moloney, Michael A., and Kavanagh, Eamon
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Background/aims: The aim of this clinical audit was to determine the point prevalence of wounds over a 1-week period during April 2019 in the midwest Regional Integrated Care Organisation (RICO), which has a population of 379 452. The RICO consists of six hospitals, a public health nursing service across three counties, community residential settings, nine older person's service sites, community health centres and one prison. Method: A peer-reviewed, purpose-designed data collection tool was used to gather demographic and wound data on each patient with a wound in the midwest RICO. Anonymised data were collected by the nurse undertaking routine wound care on one occasion during the 1-week study period. There were no exclusion criteria for this study; all patients with a wound were eligible for inclusion. Ethical approval was obtained. Results: Completed data collection forms were returned for 791 patients who had a combined total of 1164 wounds. Data were analysed using SPSS version 21 to produce descriptive statistics. A point prevalence of 0.2% of the total RICO population had a wound, with a mean of 1.47 wounds per patient. Some 51% of the cohort was female. The median age was 75 years (range 3–101 years, standard deviation=19.881). Leg ulcers were the most common wound type, with a prevalence of 0.07% (33.7% of the cohort). Conclusions: This clinical wound prevalence audit supports previous studies in relation to wound statistics in Ireland and will be useful for resource planning in an ageing population. [ABSTRACT FROM AUTHOR]
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- 2021
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23. Rat bite injuries in children: description of a novel classification.
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Ngwenya, R. E., Khulu, B. L., Karusseit, V. O. L., and Mokoena, T.
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WOUND care , *RATS , *TREATMENT effectiveness , *SKIN grafting , *WOUNDS & injuries , *SKIN ulcers - Abstract
Purpose: Rats are common intruders into human settlements. Apart from their role as disease vectors, they can also cause bite injuries. We describe the clinical course of a series of children with rat bites, and characterise the injures. Methods: A retrospective review of hospital records of children admitted for rat bites in a large regional hospital was undertaken. The demographics, wound characteristics, treatment given and clinical outcome of the patients are described. Results: Fifty-nine children, with a mean age of 3.7 years, were admitted for rat bites. Three distinct types of wounds were treated: superficial scratches (Type I), deeper bites often with infection and ulceration (Type II) and full-thickness with loss of skin or underlying soft tissues (Type III). Few wounds displayed signs of inflammation. Only some Type II injuries required urgent local surgery in the form of drainage and debridement. Type III wounds required a skin graft. All patients recovered. Conclusion: We suggest that treatment of rat bites should be based on the wound type. Most patients do not require hospital admission or antibiotic treatment. Treatment should be mostly conservative wound care management. Surgery is only indicated for drainage of pus, debridement, skin graft or rarely reconstruction. [ABSTRACT FROM AUTHOR]
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- 2021
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24. Surgical Antibiotic Prophylaxis: Incidence and Risk of Surgical Site Infection.
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B., Fadzwani, A. R., Raha, M. N., Nadia, W. M., Wan Rahiza, J., Razman, and A. J., Nordiah
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SURGICAL site infections , *ANTIBIOTIC prophylaxis , *BREAST surgery - Abstract
Introduction: This prospective cross sectional study assessed surgical antibiotic prophylaxis (SAP) practice, the incidence of surgical site infection (SSI) and its associated risks in Universiti Kebangsaan Malaysia Medical Centre. Methods: Patients for elective colorectal, hepatobiliary, upper gastrointestinal, breast and endocrine surgery, who received SAP were included and followed up until day-30 postoperatively. Types of antibiotic, preoperative-dose timing, intraoperative re-dosing and its duration were recorded. The incidence of SSI was calculated and its associated risks expressed in odds ratio. Results: Out of 166 patients recruited, 121 (72.89%) patients received SAP preoperatively, and 91 (75.21%) of them were prescribed the appropriate antibiotic as per our institutional guideline. Three patients who continued to receive therapeutic antibiotic postoperatively were excluded from statistical analysis. Eleven (9.10%) patients received SAP beyond the preoperative-dose timing of 60 minutes (p=0.001), which was an independent risk factor for SSI (adjusted OR 4.527, 95% CI; 1.058-19.367, p=0.042). The risk of SSI also remained in patients who continued to receive SAP beyond 24 hours (OR 4.667, 95% CI; 1.527-14.259, p=0.007). The overall rate of SSI was 17.18%. Conclusion: We found that the choice of antibiotic prescribed for SAP was in accordance to institutional guideline and the relatively high SSI incidence was similar to a recent local report. Although the number of patients receiving preoperative dose-timing of > 60 minutes was low, it was nonetheless an independent risk factor for SSI. The postoperative continuation of SAP for more than 24 hours showed no benefit in reducing SSI. [ABSTRACT FROM AUTHOR]
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- 2020
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25. Management of Infected Mesh in Ventral Hernias
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Itani, Kamal M. F., Siegert, C. Jeff, and Novitsky, Yuri W., editor
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- 2016
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26. Infecciones postoperatorias en ginecología y obstetricia
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Guamancela Auquilla, Christian Geovanny, Sandoval Benalcázar, Diana Carolina, Medina Jadan, Erika Janeth, Dávila Flores, Johnny X., Guamancela Auquilla, Christian Geovanny, Sandoval Benalcázar, Diana Carolina, Medina Jadan, Erika Janeth, and Dávila Flores, Johnny X.
- Abstract
In the department of Gynecology and Obstetrics, surgical infections are very common. Infections are basically caused by the germs of the normal flora of the vagina and perineum. Additionally, the conditions of the surgical site, the socioeconomic level of the woman, her immunological status, the type of surgery performed and the characteristics of the surgical technique, are factors that affect the presence of infections, increasing the degree of contamination that It can appear in the wound. Antibiotic prophylaxis is used to reduce the risks of infection, however, it has not been able to completely eliminate them. In this sense, the use of broad-spectrum antibiotics should be indicated immediately once a postoperative infection has been diagnosed. Most patients respond to treatment within 24 to 48 hours when the appropriate antibiotics are selected. Postoperative infections include vaginal cuff cellulitis, pelvic cellulitis, adnexal infection, ovarian abscess, pelvic abscess, abdominal wound infection, and toxic shock syndrome. With the following bibliographical review, relevant information is provided about the most frequent postoperative infections in gynecology and obstetrics., En el departamento de Ginecología y Obstetricia las infecciones quirúrgicas son muy comunes. Las infecciones están causadas básicamente por los propios gérmenes de la flora normal de la vagina y perineal. Adicionalmente, las condiciones del sitio quirúrgico, el nivel socioecnomico de la mujer, su estado inmunológico, el tipo de cirugía que se practica y las características de la técnica quirúrgica, son factores que inciden en la presencia de infecciones, incrementando el grado de contaminación que puede presentarse en la herida. La profilaxis antibiótica es utilizada para disminuir los riesgos de infección, sin embargo, no ha logrado eliminarlos por completo. En tal sentido, el uso de antibióticos de amplio espectro deben ser indicados de manera inmediata una vez se ha diagnosticado una infección postoperatoria. La mayoría de los pacientes responden al tratamiento dentro de las 24 a 48 horas cuando se seleccionan los antibióticos apropiados. Las infecciones postoperatorias incluyen la celulitis del manguito vaginal, la celulitis pélvica, la infección anexial, el absceso ovárico, el absceso pélvico, la infección de la incisión abdominal y el síndrome de shock tóxico. Con la siguiente revisión bibliográfica, se brinda información relevante acerca de las infecciones postoperatorias más frecuentes en ginecología y obstetricia
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- 2023
27. Perioperative complications of complex abdominal wall reconstruction with biologic mesh: A pooled retrospective cohort analysis of 220 patients from two academic centers.
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Latifi, Rifat, Samson, David J., Gogna, Shekhar, and Joseph, Bellal A.
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ABDOMINAL surgery ,ACADEMIC medical centers ,SURGICAL complications ,PLASTIC surgery ,RETROSPECTIVE studies ,SURGICAL meshes - Abstract
Background: Perioperative outcomes in patients who undergo complex abdominal wall reconstruction (CAWR) may be associated with severe complications, mainly when these procedures are done urgently or emergently. This study aims to identify perioperative predictors of outcomes after CAWR with biologic mesh (BM).Materials and Methods: In a retrospective study, perioperative complications (length of hospital stay, ventilator support, surgical site infection, need for wound VAC, reoperation, total complications, and mortality), were analyzed in all patients who underwent open CAWR with BM over six years in two academic centers. Furthermore, we examined the effect of cardiac disease, BMI, diabetes, COPD, case mixed index, hernia size, wound classification, mesh technique, the setting of surgery, on perioperative complications. Multivariable linear and logistic regression analyses were performed.Results: There were 220 patients: 134 patients from center A and 86 patients from center W Mean age was 54.9 ± 14.8 years, 47.7% were females, 33.8% of the patients had BMI ≥30 kg/m2 and median hospital length of stay was 7 days. Center W patients had increased need for mechanical ventilation (10.5% vs. 3%, p = 0.02) and higher need for wound VAC (19.8% vs. 6.7%, p = 0.003). On multivariable linear regression, independent patient predictors of increased hospital length of stay (HLO) were: urgent/emergent surgery (β 6.93, 95% CI 1.65-12.22, p = 0.01), cardiac disease (β 7.84, 95% CI 1.23-14.46, p = 0.02) and epigastric defect (β 13.68, 95% CI 0.29-27.06, p = 0.045). Addition-ally, urgent/emergent setting (OR 3.06, 95% CI 1.69-5.55, p < 0.001) and cardiac disease (OR 2.15, 95% CI 1.03-4.50, p = 0.042) were independently associated with increased odds for perioperative complications.Conclusions: Perioperative complications of patients undergoing CAWR are considerable and depend on defect complexities, the setting of surgery, comorbidities, wound classification, procedural factors, and case-mix index. Prospective studies on perioperative complications are needed. [ABSTRACT FROM AUTHOR]- Published
- 2020
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28. Assessing the assumptions of classification agreement, accuracy, and predictable healing time of sea lamprey wounds on lake trout
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Jean V. Adams, Gregory Fischer, Cheryl A. Murphy, Ted Treska, and Tyler J. Firkus
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0106 biological sciences ,Potential impact ,Wound classification ,integumentary system ,Ecology ,biology ,Wound status ,010604 marine biology & hydrobiology ,Lamprey ,High variability ,Healing time ,010501 environmental sciences ,Aquatic Science ,biology.organism_classification ,01 natural sciences ,Fishery ,Trout ,Fisheries management ,Ecology, Evolution, Behavior and Systematics ,0105 earth and related environmental sciences - Abstract
Sea lamprey control in the Laurentian Great Lakes relies on records of sea lamprey wounds on lake trout to assess whether control efforts are supporting fisheries management targets. Wounding records have been maintained for 70 years under the assumption that they are a reliable and accurate reflection of sea lamprey damage inflicted on fish populations. However, two key assumptions underpinning the use of these data need thorough evaluation: sea lamprey wounds follow a predictable healing progression, and individuals classify wounds accurately and reliably. To assess these assumptions, we conducted a workshop where experienced professionals examined lake trout with known sea lamprey wounds. For most lake trout, pictures were taken at regular intervals during the healing process. Our evaluation of wound pictures found high variability in healing times and wound progressions that did not conform to the currently used classification system. Participants’ wound classification agreement and accuracy were low and misclassification rates were high for most wound types. Training provided during the workshops did not markedly improve these metrics. We assessed wound classification accuracy for the first time and found assumptions of high accuracy and agreement are not met. We recommend misclassification rates be incorporated into models using wound data, sensitivity analyses be conducted to assess the potential impact of wound misclassification on estimates of key metrics (such as sea lamprey-induced mortality for lake trout), and alternative biomarkers be developed to quantify wound status with greater accuracy and precision.
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- 2021
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29. Improvement of surgical wound classification following a targeted training program at a children's hospital.
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Butler, Marilyn W., Zarosinski, Sandy, and Rockstroh, Dagmar
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Abstract Background Inaccurate assignment of surgical wound class (SWC) remains a challenge in perioperative documentation. The purpose of our intervention was to increase the accuracy of SWC through a targeted training program directed toward pediatric surgeons and nurses. Methods A retrospective electronic medical record (EMR) chart review of 400 operations was performed according to NSQIP criteria during specified periods in 2014 and 2017, assessing SWC errors before and after a training program and posting of reference materials in operating rooms at a 165-bed children's hospital. After each operation, nurses confirmed SWC with the surgeon before recording the value in the EMR. Differences in proportions of misclassified SWC were evaluated with a chi-square test. Results Following the educational program, misclassified SWC improved from 70/200 (35.0%) to 18/200 (9.0%), p < 0.001. Misclassified SWC for appendectomies improved from 46/95 (48.4%) to 12/108 (11.1%), p < 0.001. Conclusions Accurate SWC assignment in the EMR was improved by an educational program and posting of materials to aid assignment, as well as enhanced communication between surgeons and nurses at the conclusion of each operation. We present the first known attempt to list all pediatric surgery procedures according to SWC. Accurate SWC allows stratification of risks and more effective targeted interventions. Level of evidence Level III. [ABSTRACT FROM AUTHOR]
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- 2018
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30. Contaminated or dirty wound operations and methicillin-resistant Staphylococcus aureus (MRSA) colonization during hospitalization may be risk factors for surgical site infection in neonatal surgical patients.
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Inoue, Mikihiro, Uchida, Keiichi, Ichikawa, Takashi, Nagano, Yuka, Matsushita, Kohei, Koike, Yuhki, Okita, Yoshiki, Toiyama, Yuji, Araki, Toshimitsu, and Kusunoki, Masato
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METHICILLIN-resistant staphylococcus aureus , *SURGICAL site infections , *NEONATAL surgery , *TRAUMA surgery , *INJURY complications , *DISEASE risk factors , *HOSPITAL care , *NEONATAL intensive care , *STAPHYLOCOCCAL diseases , *NEONATAL intensive care units , *RETROSPECTIVE studies - Abstract
Purpose: Establishment of evidence-based best practices for preventing surgical site infection (SSI) in neonates is needed. SSI in neonates, especially those with a low birth weight, is potentially life-threatening. We aimed to identify risk factors associated with SSI in neonates.Methods: A retrospective review was performed using 2007-2016 admission data from our institution. Neonatal patients who were admitted to the neonatal intensive care unit and underwent surgery were evaluated for a relationship between development of SSI and perinatal or perioperative factors and methicillin-resistant Staphylococcus aureus (MRSA) colonization during hospitalization.Results: One hundred and eighty-one patients were enrolled in this study. Overall SSI incidence was 8.8%. Univariate analysis showed that SSI was significantly more frequent in both patients with contaminated or dirty wound operations and patients with MRSA colonization during hospitalization. Both of these factors were identified as independent risk factors for SSI by multivariate analysis [hazard ratio (HR): 6.1, 95% confidence interval (CI) 2.0-19.9; HR: 3.3, 95% CI 1.1-10.4, respectively].Conclusions: This study identified contaminated or dirty wound operations and MRSA colonization during hospitalization as risk factors for SSI in neonates. MRSA colonization may be a preventable factor, unlike previously reported risk factors. [ABSTRACT FROM AUTHOR]- Published
- 2018
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31. Orthopaedic surgical dressings
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Adam Bitterman, Kanwarpaul S. Grewal, Tyler J. Tantillo, Michael Wilson, Brandon Klein, and Nicholas A. Sgaglione
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Dressings ,Orthopedic surgery ,medicine.medical_specialty ,Wound classification ,integumentary system ,business.industry ,Combined use ,Orthopaedics ,Wound care ,Regimen ,Medicine ,Surgical dressing ,Medical history ,business ,Intensive care medicine ,SURGICAL DRESSINGS ,RD701-811 ,Earth-Surface Processes - Abstract
The choice of which surgical dressing to use is an important step in the postoperative care of orthopaedic patients. This decision is influenced in part by the patient's level of activity prior to surgery, medical history, wound classification, and cost. As orthopaedic wounds are inherently complex, often overlying bony prominences, it is imperative that orthopaedic providers are aware of the dressings available and how best to deploy them. Classified into three categories (passive, active, and interactive), orthopaedic surgical dressings can vary based upon their mechanism of action, absorptive capacity, and ability to provide wound protection. Through the activation or promotion of one of the four stages of wound healing, orthopaedic surgical dressings act to optimize postoperative wound care, leading to improved patient outcomes and a decrease in associated complications. The combined use of multiple dressings, with varying attributes, provides the ultimate method for obtaining the ideal orthopaedic surgical dressing. Choosing the appropriate dressing and subsequent care regimen can prevent unnecessary hospitalizations and additional costs associated with complex wound care. Future prospective trials aimed at evaluating specific dressings and their utility in orthopaedics is warranted.
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- 2021
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32. Wound prevalence survey in a regional integrated care organisation in the midwest of Ireland
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Eamon G. Kavanagh, Siobhan Egan, Niamh Keane, Ali Sheikhi, Michael A. Moloney, and Helen Meagher
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Clinical audit ,medicine.medical_specialty ,Wound classification ,business.industry ,Prevalence ,Surgical wound ,Prevalence survey ,Integrated care ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Family medicine ,medicine ,030212 general & internal medicine ,business - Abstract
Background/aims: The aim of this clinical audit was to determine the point prevalence of wounds over a 1-week period during April 2019 in the midwest Regional Integrated Care Organisation (RICO), which has a population of 379 452. The RICO consists of six hospitals, a public health nursing service across three counties, community residential settings, nine older person's service sites, community health centres and one prison. Method: A peer-reviewed, purpose-designed data collection tool was used to gather demographic and wound data on each patient with a wound in the midwest RICO. Anonymised data were collected by the nurse undertaking routine wound care on one occasion during the 1-week study period. There were no exclusion criteria for this study; all patients with a wound were eligible for inclusion. Ethical approval was obtained. Results: Completed data collection forms were returned for 791 patients who had a combined total of 1164 wounds. Data were analysed using SPSS version 21 to produce descriptive statistics. A point prevalence of 0.2% of the total RICO population had a wound, with a mean of 1.47 wounds per patient. Some 51% of the cohort was female. The median age was 75 years (range 3–101 years, standard deviation=19.881). Leg ulcers were the most common wound type, with a prevalence of 0.07% (33.7% of the cohort). Conclusions: This clinical wound prevalence audit supports previous studies in relation to wound statistics in Ireland and will be useful for resource planning in an ageing population.
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- 2021
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33. Incision Classification Accuracy: Do Residents Know How to Classify Them?
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Goodwin, Jessica, Womack, Pepper, Moore, Billy, Laureano Phillips, J., and Duane, Therese
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MEDICAL personnel , *SURGICAL complications , *OPERATIVE surgery , *CRITICAL care medicine , *SURGICAL site ,SERVICES for - Abstract
Background: It is unclear whether surgical residents understand how to classify incisions, which may impact how closure is handled in the operating room. We hypothesized that surgical residents define incision class (IC) accurately compared with an attending NSQIP surgeon champion (SC).Methods: We evaluated our NSQIP database from April 1, 2015, to December 31, 2016, including cases in which a resident was present and IC was documented. Cases in which the resident, circulator, or surgical clinical rater disagreed on the IC were then reviewed by a blinded SC.Results: Residents were correct in 83.6% of the cases, with PGY 5 persons having the lowest accuracy. Class 3 incisions were most often misclassified (36%). A disproportionate number of misclassifications by PGY4 and PGY5-7 residents occurred in incision classes 2 and 3. Surgical site infections occurred in 7.4% of cases, ranging from 2.4% in IC 1 to 15.7% in IC 4 cases.Conclusions: Although overall accuracy appears reasonable, it is of concern that incisions at higher risk of infection (contaminated) were least likely to be classified appropriately. Chief residents, who often are making the decisions on incision closure, were the least accurate in determining IC. This may have a deleterious impact on incision management, suggesting a need for directed resident education on IC and further investigation to determine its impact on site infection risk and patient outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2017
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34. The role of simultaneous abdominal surgery and wound classification in ventriculoperitoneal shunt complication.
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Miyata, Shin, Golden, Jamie, Lebedevskiy, Olga, Stein, James, Bliss, David, Stein, James E, and Bliss, David W
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SURGICAL anastomosis , *OPERATIVE surgery , *ABDOMINAL surgery , *SURGICAL site infections , *PERITONEUM , *SURGICAL complications , *CEREBROSPINAL fluid shunts , *DATABASES , *RETROSPECTIVE studies - Abstract
Purpose: To evaluate whether simultaneous abdominal surgery or wound contamination at the time of ventriculoperitoneal (VP) shunt placement are associated with increased shunt complications.Methods: Pediatric patients who underwent VP shunt placement were identified using the National Surgical Quality Improvement Program Pediatric database. VP shunt complication rates were compared between patients who underwent simultaneous abdominal surgeries at the time of VP shunt placement vs those who did not and between those with clean/clean-contaminated and contaminated/dirty wound classifications. Adjusted analysis was performed using 1:5 case-control matching.Results: Among 2715 patients who underwent VP shunt placement, 21 had simultaneous abdominal procedures and were matched with 105 control patients. No significant difference was found in overall (34.3 vs 14.3%, p = 0.07), infectious (8.6 vs 4.8%, p = 1.000), or non-infectious (25.7 vs 9.5%, p = 0.156) shunt complications in the simultaneous vs non-simultaneous group, respectively. In a separate analysis of wound classification, 12 patients with contaminated/dirty wounds were matched with 60 patients with clean/clean-contaminated wounds. The rates of shunt infections for clean/clean-contaminated and contaminated/dirty cases were 10.0 and 16.7%, respectively (p = 0.613).Conclusion: In our matched case-control study, neither simultaneous abdominal surgery nor wound contamination at the time of VP shunt placement demonstrated significant increased risk of 30-day post-operative complication. [ABSTRACT FROM AUTHOR]- Published
- 2017
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35. A meta-analysis of the risk factors for surgical site infection in patients with colorectal cancer.
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Chen Y, Guo H, Gao T, Yu J, Wang Y, and Yu H
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The purpose of the meta-analysis was to evaluate and compare the surgical site infection (SSI) risk factors in patients with colorectal cancer (CC). The results of this meta-analysis were analysed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random or fixed-effect models. For the current meta-analysis, 23 examinations spanning from 2001 to 2023 were included, encompassing 89 859 cases of CC. Clean-contaminated surgical site wounds had significantly lower infections (OR, 0.36; 95% CI, 0.20-0.64, p < 0.001) compared to contaminated surgical site wounds in patients with CCs. Males had significantly higher SSIs (OR, 1.18; 95% CI, 1.12-1.24, p < 0.001) compared to females in patients with CC. American Society of Anesthesiology score ≥3 h had a significantly higher SSI (OR, 1.42; 95% CI, 1.18-1.71, p < 0.001) compared to <3 score in patients with CCs. Body mass index ≥25 had significantly higher SSIs (OR, 1.54; 95% CI, 1.11-2.14, p = 0.01) compared to <25 in patients with CCs. The presence of stoma creation had a significantly higher SSI rate (OR, 2.28; 95% CI, 1.37-3.79, p = 0.001) compared to its absence in patients with CC. Laparoscopic surgery had significantly lower SSIs (OR, 0.68; 95% CI, 0.59-0.78, p < 0.001) compared to open surgery in patients with CC. The presence of diabetes mellitus had a significantly higher SSI rate (OR, 1.24; 95% CI, 1.15-1.33, p < 0.001) compared to its absence in patients with CCs. No significant difference was found in SSI rate in patients with CCs between <3 and ≥3 h of operative time (OR, 1.07; 95% CI, 0.75-1.51, p = 0.72), between the presence and absence of blood transfusion (OR, 1.60; 95% CI, 0.69-3.66, p = 0.27) and between the presence and absence of previous laparotomies (OR, 1.47; 95% CI, 0.93-2.32, p = 0.10). The examined data revealed that contaminated wounds, male sex, an American Society of Anesthesiology score ≥3 h, a body mass index ≥25, stoma creation, open surgery and diabetes mellitus are all risk factors for SSIs in patients with CC. However, operative time, blood transfusion and previous laparotomies were not found to be risk factors for SSIs in patients with CC. However, given that several comparisons had a small number of chosen research, consideration should be given to their values., (© 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)
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- 2023
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36. Risk prediction analysis for post-surgical complications in cardiothoracic surgery
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Pereira, Catarina, Guede Fernández, Federico, and Vigário, Ricardo
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Wound classification ,Machine learning ,Deep learning ,Engenharia e Tecnologia::Outras Engenharias e Tecnologias [Domínio/Área Científica] ,Cardiothoracic surgery ,Surgical site infections ,Wound segmentation - Abstract
Cardiothoracic surgery patients have the risk of developing surgical site infections (SSIs), which causes hospital readmissions, increases healthcare costs and may lead to mortality. The first 30 days after hospital discharge are crucial for preventing these kind of infections. As an alternative to a hospital-based diagnosis, an automatic digital monitoring system can help with the early detection of SSIs by analyzing daily images of patient’s wounds. However, analyzing a wound automatically is one of the biggest challenges in medical image analysis. The proposed system is integrated into a research project called CardioFollowAI, which developed a digital telemonitoring service to follow-up the recovery of cardiothoracic surgery patients. This present work aims to tackle the problem of SSIs by predicting the existence of worrying alterations in wound images taken by patients, with the help of machine learning and deep learning algorithms. The developed system is divided into a segmentation model which detects the wound region area and categorizes the wound type, and a classification model which predicts the occurrence of alterations in the wounds. The dataset consists of 1337 images with chest wounds (WC), drainage wounds (WD) and leg wounds (WL) from 34 cardiothoracic surgery patients. For segmenting the images, an architecture with a Mobilenet encoder and an Unet decoder was used to obtain the regions of interest (ROI) and attribute the wound class. The following model was divided into three sub-classifiers for each wound type, in order to improve the model’s performance. Color and textural features were extracted from the wound’s ROIs to feed one of the three machine learning classifiers (random Forest, support vector machine and K-nearest neighbors), that predict the final output. The segmentation model achieved a final mean IoU of 89.9%, a dice coefficient of 94.6% and a mean average precision of 90.1%, showing good results. As for the algorithms that performed classification, the WL classifier exhibited the best results with a 87.6% recall and 52.6% precision, while WC classifier achieved a 71.4% recall and 36.0% precision. The WD had the worst performance with a 68.4% recall and 33.2% precision. The obtained results demonstrate the feasibility of this solution, which can be a start for preventing SSIs through image analysis with artificial intelligence. Os pacientes submetidos a uma cirurgia cardiotorácica tem o risco de desenvolver infeções no local da ferida cirúrgica, o que pode consequentemente levar a readmissões hospitalares, ao aumento dos custos na saúde e à mortalidade. Os primeiros 30 dias após a alta hospitalar são cruciais na prevenção destas infecções. Assim, como alternativa ao diagnóstico no hospital, a utilização diária de um sistema digital e automático de monotorização em imagens de feridas cirúrgicas pode ajudar na precoce deteção destas infeções. No entanto, a análise automática de feridas é um dos grandes desafios em análise de imagens médicas. O sistema proposto integra um projeto de investigação designado CardioFollow.AI, que desenvolveu um serviço digital de telemonitorização para realizar o follow-up da recuperação dos pacientes de cirurgia cardiotorácica. Neste trabalho, o problema da infeção de feridas cirúrgicas é abordado, através da deteção de alterações preocupantes na ferida com ajuda de algoritmos de aprendizagem automática. O sistema desenvolvido divide-se num modelo de segmentação, que deteta a região da ferida e a categoriza consoante o seu tipo, e num modelo de classificação que prevê a existência de alterações na ferida. O conjunto de dados consistiu em 1337 imagens de feridas do peito (WC), feridas dos tubos de drenagem (WD) e feridas da perna (WL), provenientes de 34 pacientes de cirurgia cardiotorácica. A segmentação de imagem foi realizada através da combinação de Mobilenet como codificador e Unet como decodificador, de forma a obter-se as regiões de interesse e atribuir a classe da ferida. O modelo seguinte foi dividido em três subclassificadores para cada tipo de ferida, de forma a melhorar a performance do modelo. Caraterísticas de cor e textura foram extraídas da região da ferida para serem introduzidas num dos modelos de aprendizagem automática de forma a prever a classificação final (Random Forest, Support Vector Machine and K-Nearest Neighbors). O modelo de segmentação demonstrou bons resultados ao obter um IoU médio final de 89.9%, um dice de 94.6% e uma média de precisão de 90.1%. Relativamente aos algoritmos que realizaram a classificação, o classificador WL exibiu os melhores resultados com 87.6% de recall e 62.6% de precisão, enquanto o classificador das WC conseguiu um recall de 71.4% e 36.0% de precisão. Por fim, o classificador das WD teve a pior performance com um recall de 68.4% e 33.2% de precisão. Os resultados obtidos demonstram a viabilidade desta solução, que constitui o início da prevenção de infeções em feridas cirúrgica a partir da análise de imagem, com recurso a inteligência artificial.
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- 2022
37. A call for a standardized definition of perforated appendicitis.
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Rogers, Andrew P., Zens, Tiffany J., Leys, Charles M., Nichol, Peter F., and Ostlie, Daniel J.
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Background Abscess rates have been reported to be as low as 1% and as high as 50% following perforated appendicitis (PA). This range may be because of lack of universal definition for PA. An evidence-based definition (EBD) is crucial for accurate wound classification, risk-stratification, and subsequent process optimization. ACS NSQIP-Pediatric guidelines do not specify a definition of PA. We hypothesize that reported postoperative abscess rates underrepresent true incidence, as they may include low-risk cases in final calculations. Methods Local institutional records of PA patients were reviewed to calculate the postoperative abscess rate. The ACS NSQIP-Pediatric participant use file (PUF) was used to determine cross-institutional postoperative abscess rates. A PubMed literature review was performed to identify trials reporting PA abscess rates, and definitions and rates were recorded. Results 20.9% of our patients with PA developed a postoperative abscess. The ACS NSQIP-Pediatric abscess rate was significantly lower (7.61%, p < 0.001). In the eighteen published studies analyzed, average abscess rate (14.49%) was significantly higher than ACS NSQIP-Pediatric (p < 0.001). There was significantly more variation in trials that do not employ an EBD of perforation (Levene's test F-value = 6.980, p = 0.018). Conclusions A standard EBD of perforation leads to lower variability in reported postoperative abscess rates following PA. Nonstandard definitions may be significantly altering the aggregate rate of postoperative abscess formation. We advocate for adoption of a standard definition by all institutions participating in ACS NSQIP-Pediatric data submission. Level of evidence III. [ABSTRACT FROM AUTHOR]
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- 2017
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38. An Inexpensive Modified Primary Closure Technique for Class IV (Dirty) Wounds Significantly Decreases Superficial and Deep Surgical Site Infection.
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Kim, Bradford, Aloia, Thomas, Kim, Bradford J, and Aloia, Thomas A
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SURGICAL site , *MEDICAL care costs , *DERMATOMYCOSES , *SURGICAL complications , *HEALTH outcome assessment , *DISEASES - Abstract
Despite the creation of several programs to decrease the incidence of surgical site infection, it remains a common complication that has a significant impact on patient recovery and medical costs. The following is a description and brief outcome report of a modified primary closure technique used for dirty (Class IV) wounds. There were 14 consecutive patients who had a laparotomy with Class IV wounds treated by a single surgeon (TAA) from 2011 to 2015. All patients had a history of cancer and either showed signs suggestive for an acute abdomen and required an emergent exploratory laparotomy or were found to have purulent intraabdominal infection at the time of elective surgery. The operation and "modified primary closure" technique (subcutaneous wound wicks with stapled skin closure) were performed in every case. The modified primary closure technique was utilized in 14 patients with a Class IV wound. There were no 30-day mortalities or readmissions. Wound wicks were slowly advanced out over a 7-day period, and only one patient required subsequent wound packing of a single-wicked area. There were no superficial or deep surgical site infections, or wound dehiscence during the hospital course, or 30-day postoperative period. The modified primary closure technique is efficient and inexpensive and was effective in a series of 14 patients with wounds classified as dirty. [ABSTRACT FROM AUTHOR]
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- 2016
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39. Operative wound classification: an inaccurate measure of pediatric surgical morbidity.
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Gonzalez, Katherine W., Dalton, Brian G., Kurtz, Brendan, Keirsey, Michael C., Oyetunji, Tolulope A., and St. Peter, Shawn D.
- Abstract
Background Wound classification has catapulted to the forefront of surgical literature and quality care discussions. However, it has not been validated in laparoscopy or children. We analyzed pediatric infection rates based on wound classification and reviewed the most common noninfectious complications which could be a more appropriate measure for quality assessment. Methods We performed a retrospective review of 800 patients from 2011 to 2014 undergoing common procedures at a tertiary pediatric hospital. Demographics, procedure, wound classification and complications were analyzed using descriptive statistics. Results Infection rates were in the expected low range for clean procedures. However, 5% of pyloromyotomy patients required readmission and 10% of circumcision patients developed penile adhesions; 2% required reoperation. Ostomy reversal, a clean contaminated case, had 17% wound infections, whereas acute appendicitis, a contaminated case had only a 4% infection rate. Laparoscopic cholecystectomy (clean-contaminated or contaminated depending on inflammation) had 2% postoperative infections. Perforated appendicitis, a dirty procedure had an 18% infection rate, below the expected > 27% for dirty cases in adults. Conclusions Current wound classifications do not accurately approximate the risk of surgical site infections in children, particularly for laparoscopic procedures. It would be more appropriate to grade hospitals based on disease and procedure specific complications. [ABSTRACT FROM AUTHOR]
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- 2016
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40. A multicenter, pediatric quality improvement initiative improves surgical wound class assignment, but is it enough?
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Putnam, Luke R., Levy, Shauna M., Blakely, Martin L., Lally, Kevin P., Wyrick, Deidre L., Dassinger, Melvin S., Russell, Robert T., Huang, Eunice Y., Vogel, Adam M., Streck, Christian J., Kawaguchi, Akemi L., Calkins, Casey M., St. Peter, Shawn D., Abbas, Paulette I., Lopez, Monica E., and Tsao, KuoJen
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Background/Purpose Surgical wound classification (SWC) is widely utilized for surgical site infection (SSI) risk stratification and hospital comparisons. We previously demonstrated that nearly half of common pediatric operations are incorrectly classified in eleven hospitals. We aimed to improve multicenter, intraoperative SWC assignment through targeted quality improvement (QI) interventions. Methods A before-and-after study from 2011–2014 at eleven children’s hospitals was conducted. The SWC recorded in the hospital’s intraoperative record (hospital-based SWC) was compared to the SWC assigned by a surgeon reviewer utilizing a standardized algorithm. Study centers independently performed QI interventions. Agreement between the hospital-based and surgeon SWC was analyzed with Cohen’s weighted kappa and chi square. Results Surgeons reviewed 2034 cases from 2011 (Period 1) and 1998 cases from 2013 (Period 2). Overall SWC agreement improved from 56% to 76% (p < 0.01) and weighted kappa from 0.45 (95% CI 0.42–0.48) to 0.73 (95% CI 0.70–0.75). Median (range) improvement per institution was 23% (7–35%). A dose-response-like pattern was found between the number of interventions implemented and the amount of improvement in SWC agreement at each institution. Conclusions Intraoperative SWC assignment significantly improved after resource-intensive, multifaceted interventions. However, inaccurate wound classification still commonly occurred. SWC used in SSI risk-stratification models for hospital comparisons should be carefully evaluated. [ABSTRACT FROM AUTHOR]
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- 2016
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41. May the drain be a way in for microbes in surgical infections?
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Barbadoro, Pamela, Marmorale, Cristina, Recanatini, Claudia, Mazzarini, Giorgia, Pellegrini, Ilaria, D'Errico, Marcello M., and Prospero, Emilia
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Background Surgical site infection (SSI) is among the most frequent hospital-acquired infections occurring in surgical patients and leads to increased morbidity, mortality, and costs. We aimed to identify risk factors for SSI in patients undergoing surgical procedures, with a particular attention to the use of drains. Methods This study includes all patients undergoing abdominal surgical procedures in 2 surgical wards in a teaching hospital in central Italy. Collected data included patient's demographic and clinical characteristics, procedure characteristics, administration of perioperative antibiotic prophylaxis, and microorganism isolated. The outcome of interest was SSI. Findings A total of 872 abdominal surgery procedures were surveyed during the study period. Drains were placed in 37.0% of cases. SSI rate was 6.4% globally and 13.6% among the patients with drains, versus 2.4% in those without a drain ( P < .001). In 72.1% of cases antibiotic prophylaxis was administered. The logistic regression analysis ( P < .001) shown insertion of a drain (odds ratio [OR], 5.14; 95% confidence interval [CI], 2.63-10.08), prolonged surgery (OR, 1.98; 95% CI, 1.09-3.59), and American Society of Anesthesiologists score equal to 3 (OR, 6.13; 95% CI, 2.33-16.11) as independent risk factors for SSI, whereas antibiotic prophylaxis was protective (OR, 0.53; 95% CI, 0.29-0.99). Conclusion This study revealed surgical drains as a risk factor for SSI, pointing out the need of a clearer understanding of drain role in the dynamics of SSI occurrence, with the purpose of decreasing infection risk through targeted preventive interventions. [ABSTRACT FROM AUTHOR]
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- 2016
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42. Sensor-Based Upper-Extremity Frailty Assessment for the Vascular Surgery Risk Stratification
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Federico J. Yanquez, Nima Toosizadeh, Anna Peterson, Craig Weinkauf, Kaoru R. Goshima, Hossein Ehsani, Wei Zhou, and Jane Mohler
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Male ,Reoperation ,Weakness ,medicine.medical_specialty ,Time Factors ,Logistic regression ,Risk Assessment ,Wearable Electronic Devices ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Elbow ,medicine ,Humans ,Hospital Mortality ,Prospective Studies ,Adverse effect ,Aged ,Wound classification ,Frailty ,business.industry ,Length of Stay ,Middle Aged ,Vascular surgery ,Frailty assessment ,030220 oncology & carcinogenesis ,Risk stratification ,Physical therapy ,Female ,030211 gastroenterology & hepatology ,Surgery ,medicine.symptom ,business ,Vascular Surgical Procedures ,Body mass index - Abstract
Available methods for determining outcomes in vascular surgery patients are often subjective or not applicable in nonambulatory patients. The purpose of the present study was to assess the association between vascular surgery outcomes and a previously validated upper-extremity function (UEF) method, which incorporates wearable motion sensors for the physical frailty assessment.Patients (≥50 y old) undergoing vascular surgery were recruited. Participants performed the 20-s UEF test, which involved rapid elbow flexion. This technology quantifies physical frailty features including slowness, weakness, exhaustion, and flexibility, which allows grouping individuals into nonfrail, prefrail, and frail categories. Surgical outcomes included length of hospital stay, discharged disposition, and 30-d mortality, complications, readmission, and reintervention(s). Associations between outcomes and frailty were assessed using nominal logistic regression models, adjusted for age, gender, body mass index, and wound classification.Thirty-seven participants were recruited: eight nonfrail (age = 62.0 ± 10.6); 22 prefrail (age = 65.6 ± 11.6); and seven frail (age = 68.0 ± 8.0). Significant associations were observed between frailty and length of hospital stay (three times longer among frail participants, P = 0.03), mortality after surgery (two incidents among frail participants, P 0.01), and adverse discharge disposition (all nonfrail patients were discharged home, whereas only 43% of frail patients discharged home, P = 0.01).This is the first study to validate the utility of UEF among patients undergoing any vascular surgery. Findings suggest that UEF may provide an objective and simple approach for assessing frailty to predict adverse events after vascular surgery, especially for nonambulatory patients.
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- 2020
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43. Factors Affecting Vascular Clogging, Wound Status and Bacterial Culture in Diabetic Foot Ulcers
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Jin Yong Shin, Si-Gyun Roh, Suk Choo Chang, Nae-Ho Lee, and Jong-Lim Kim
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Wound classification ,medicine.medical_specialty ,Microbiological culture ,Diabetic foot ulcer ,Wound status ,business.industry ,Internal medicine ,medicine ,medicine.disease ,business ,Diabetic foot - Published
- 2019
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44. Factors Predictive of Reoperation After Pancreaticoduodenectomy for Pancreatic Cancer
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Bradley R. Hall, Harlan Sayles, Lynette M. Smith, Richard Sleightholm, and Chandrakanth Are
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medicine.medical_specialty ,Wound classification ,Pancreatic ductal adenocarcinoma ,business.industry ,medicine.medical_treatment ,Wbc count ,medicine.disease ,Pancreaticoduodenectomy ,Logistic regression ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Oncology ,Surgical oncology ,030220 oncology & carcinogenesis ,Pancreatic cancer ,medicine ,Original Article ,030211 gastroenterology & hepatology ,Pancreas ,business - Abstract
While mortality is low, morbidity remains high for patients undergoing pancreas resections, especially for those who return to the operating room (RTOR). The aim of this study is to identify risk factors for RTOR following pancreaticoduodenectomy (PD) for ductal adenocarcinoma. Logistic regression models were constructed using the 2014 and 2015 National Surgical Quality Improvement Program (NSQIP) Pancreas Targeted database. Preoperative and procedure-related risk factors predictive of RTOR for patients undergoing either classic or pylorus-preserving pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) were identified. A total of 1736 patients were included. Multivariable analysis of patients undergoing classic PD demonstrated that an abnormally low preoperative WBC count was significantly associated with RTOR (OR 2.78, 95% CI 1.27–6.06, p = 0.010). For patients who underwent pylorus-preserving PD, the wound classification (OR 3.99, 95% CI 1.75–9.11, p = 0.001) and arterial resection (OR 26.3, 95% CI 7.96–87.20, p
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- 2019
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45. Evaluation of the effect of triclosan coated sutures in the prevention of surgical site infections in a Spanish hospital setting: A prospective, observational study
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Carlos Fernández Baltar, Rita Diz Gil, Andrea Castiñeira Piñeiro, Miguel Cainzos, Ana Fernandez Novo, Lara María González Gómez, Ana Flores, Luis Prieto Carreiras, Manuel Bustamante Montalvo, and Adrián García Iglesias
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Triclosan-coated suture ,medicine.medical_specialty ,business.industry ,Wound classification ,Incidence (epidemiology) ,Mortality rate ,fungi ,Traumatology ,Infectious and parasitic diseases ,RC109-216 ,Odds ratio ,medicine.disease ,Hospital-acquired infection ,Confidence interval ,Internal medicine ,medicine ,Class IV wound ,Observational study ,Neurosurgery ,Original Research Article ,Public aspects of medicine ,RA1-1270 ,business ,Surgical site infection - Abstract
Summary: Background: Surgical site infections (SSIs) are one of the most frequently reported types of hospital-acquired infection and are associated with substantial clinical and economic burden. Aim: To assess the incidence of SSIs and analyze contributing risk factors in a real-world Spanish hospital setting before and after the implementation of triclosan-coated sutures (TCS). Methods: A prospective, observational study was conducted at Hospital Clínico Universitario de Santiago de Compostela, Spain. Enrolled patients underwent surgery in the following specialties: general surgery, urology, neurosurgery, gynaecology, and traumatology. The primary outcome of the study was SSI incidence, assessed at a 30-day follow-up. Secondary outcomes were length of hospital stay, and readmission, reintervention, and mortality rates, also at 30 days. Findings: 5,081 patients were included in the study, of which 2,591 were treated using non-coated sutures (NCS) and 2,490 using TCS. After adjusting for potential confounders, TCS significantly reduced SSI rate by 36%, compared with NCS (odds ratio [OR]: 0.64; 95% confidence interval [CI]: 0.48–0.85; P
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- 2021
46. Hyperspectral imaging-based cutaneous wound classification using neighbourhood extraction 3D convolutional neural network.
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Cihan M and Ceylan M
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- Hyperspectral Imaging, Neural Networks, Computer
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Objectives: Hyperspectral imaging is an emerging imaging modality that beginning to gain attention for medical research and has an important potential in clinical applications. Nowadays, spectral imaging modalities such as multispectral and hyperspectral have proven their ability to provide important information that can help to better characterize the wound. Oxygenation changes in the wounded tissue differ from normal tissue. This causes the spectral characteristics to be different. In this study, it is classified cutaneous wounds with neighbourhood extraction 3-dimensional convolutional neural network method., Methods: The methodology of hyperspectral imaging performed to obtain the most useful information about the wounded and normal tissue is explained in detail. When the hyperspectral signatures of wounded and normal tissues are compared on the hyperspectral image, it is revealed that there is a relative difference between them. By taking advantage of these differences, cuboids that also consider neighbouring pixels are generated, and a uniquely designed 3-dimensional convolutional neural network model is trained with the cuboids to extract both spatial and spectral information., Results: The effectiveness of the proposed method was evaluated for different cuboid spatial dimensions and training/testing rates. The best result with 99.69% was achieved when the training/testing rate was 0.9/0.1 and the cuboid spatial dimension was 17. It is observed that the proposed method outperforms the 2-dimensional convolutional neural network method and achieves high accuracy even with much less training data. The obtained results using the neighbourhood extraction 3-dimensional convolutional neural network method show that the proposed method highly classifies the wounded area. In addition, the classification performance and the2computation time of the neighbourhood extraction 3-dimensional convolutional neural network methodology were analyzed and compared with existing 2-dimensional convolutional neural network., Conclusions: As a clinical diagnostic tool, hyperspectral imaging, with neighbourhood extraction 3-dimensional convolutional neural network, has yielded remarkable results for the classification of wounded and normal tissues. Skin color does not play any role in the success of the proposed method. Since only the reflectance values of the spectral signatures are different for various skin colors. For different ethnic groups, The spectral signatures of wounded tissue and the spectral signatures of normal tissue show similar spectral characteristics among themselves., (© 2023 Walter de Gruyter GmbH, Berlin/Boston.)
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- 2023
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47. Risk factors for surgical site infection in a teaching hospital: a prospective study of 1,138 patients.
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Keping Cheng, Jiawei Li, Qingfang Kong, Changxian Wang, Nanyuan Ye, and Guohua Xia
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- *
SURGICAL complications , *PEOPLE with diabetes , *SURGICAL site , *TEACHING hospitals , *CONFIDENCE intervals , *MULTIVARIATE analysis - Abstract
Background: The purpose of this study was to identify risk factors for surgical site infection (SSI) in a teaching hospital. Methods: A prospective study was initiated to investigate risk factors for SSI at a universityaffiliated tertiary care center from July 2013 to December 2014. The chi-square test for categorical variables was used to determine the significance of association, whereas the multivariate logistic regression model was used to examine independent risk factors for SSI. Results: A total of 1,138 patients met the inclusion criteria, in whom 36 cases of infection occurred during the hospitalization period and two cases occurred after discharge. Univariate analysis showed that SSI was associated with the type of operation, wound classification, volume of blood loss, blood transfusion, American Society of Anesthesiology score before surgery, risk index, duration of surgery, diabetes, cancer, gastrointestinal catheter, urinary catheter, postoperative drainage, and preprocedural white blood cell count. Multivariate analysis identified six independent parameters correlating with the occurrence of SSI: diabetes (odds ratio [OR] 6.400; 95% confidence interval [CI] 2.582-15.866; P=0.000); cancer (OR 2.427; 95% CI 1.028-5.732; P=0.043); preprocedural white blood cell count more than 10×109/L (OR 6.988; CI 3.165-15.425; P=0.000); wound classification (clean contaminated [OR: 7.893; CI: 2.244-27.762; P=0.001]; contaminated [OR: 7.031; CI: 1.652-29.922; P=0.008]; dirty [OR: 48.778; CI: 5.418-439.164; P=0.001]); operative duration more than 120 minutes (OR 4.289; CI 1.773-10.378; P=0.001); and postoperative drainage (OR 3.957; CI 1.422-11.008; P=0.008). Conclusion: Our data suggest that all these risk factors could be regarded as potential indicators of SSI and that relevant preventive measures should be taken to reduce SSI and improve patient outcomes. [ABSTRACT FROM AUTHOR]
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- 2015
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48. Surgical wound classification for pediatric appendicitis remains poorly documented despite targeted interventions.
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Putnam, Luke R., Levy, Shauna M., Holzmann-Pazgal, Galit, Lally, Kevin P., Lillian S., Kao, and Tsao, KuoJen
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Background/Purpose Surgical wound class (SWC) is used to risk-stratify surgical site infections (SSI) for quality reporting. We previously demonstrated only 8% agreement between hospital-based SWC and diagnosis-based SWC for acute appendicitis. We hypothesized that education and process-based interventions would improve hospital-based SWC reporting and the validity of SSI risk stratification. Methods Patients (< 18 years old) who underwent appendectomies for acute appendicitis between January 2011 and December 2013 were included. Interventions entailed educational workshops regarding SWC for perioperative personnel and inclusion of SWC as a checkpoint in the surgical safety checklist. Thirty-day postoperative SSIs were recorded. Chi-square, Fisher’s exact test, and kappa statistic were utilized. Results 995 cases were reviewed (pre-intervention = 478, post-intervention = 517). Weighted interrater agreement between hospital-based and diagnosis-based SWC improved from 50% to 81% (p < 0.01), and weighted kappa increased from 0.16 (95% CI 0.004–0.03) to 0.29 (95% CI 0.25–0.34). Hospital-based dirty wounds were significantly associated with SSI in the post-intervention period only (p < 0.01). Conclusions Agreement between hospital-based SWC and diagnosis-based SWC significantly improved after simple interventions, and SSI risk stratification became consistent with the expected increase in disease severity. Despite these improvements, there were still substantial gaps in SWC knowledge and process. [ABSTRACT FROM AUTHOR]
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- 2015
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49. Australian guideline on wound classification of diabetes-related foot ulcers: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease
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Byron Perrin, James Charles, Hayley Ryan, Stephen M. Twigg, Australian Diabetes-related Foot Disease Guidelines Pathways, Emma J. Hamilton, Jane Cheney, and Joanna Scheepers
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Clinical audit ,medicine.medical_specialty ,Evidence-based practice ,Health Personnel ,Context (language use) ,Diseases of the musculoskeletal system ,Audit ,Guidelines ,Documentation ,Adopt ,Diabetes Mellitus ,medicine ,Humans ,Orthopedics and Sports Medicine ,Foot Ulcer ,Uncategorized ,Evidence-Based Medicine ,Wound classification ,business.industry ,Diabetes-related foot ulcers ,Methodology ,Australia ,Adapt ,Guideline ,Benchmarking ,medicine.disease ,Diabetic foot ,Diabetic Foot ,RC925-935 ,Family medicine ,business - Abstract
Background Wound classification systems are useful tools to characterise diabetes-related foot ulcers (DFU) and are utilised for the purpose of clinical assessment, to promote effective communication between health professionals, and to support clinical audit and benchmarking. Australian guidelines regarding wound classification in patients with DFU are outdated. We aimed to adapt existing international guidelines for wound classification to develop new evidence-based Australian guidelines for wound classification in people with diabetes and DFU. Methods Recommended NHRMC procedures were followed to adapt suitable International Working Group on the Diabetic Foot (IWGDF) guidelines on wound classification to the Australian health context. Five IWGDF wound classification recommendations were evaluated and assessed according to the ADAPTE and GRADE systems. We compared our judgements with IWGDF judgements to decide if recommendations should be adopted, adapted or excluded in an Australian context. We re-evaluated the quality of evidence and strength of recommendation ratings, provided justifications for the recommendation and outlined any special considerations for implementation, subgroups, monitoring and future research in an Australian setting. Results After the five recommendations from the IWGDF 2019 guidelines on the classification of DFUs were evaluated by the panel, two were adopted and three were adapted to be more suitable for Australia. The main reasons for adapting, were to align the recommendations to existing Australian standards of care, especially in specialist settings, to maintain consistency with existing recommendations for documentation, audit and benchmarking and to be more appropriate, acceptable and applicable to an Australian context. In Australia, we recommend the use of the SINBAD system as a minimum standard to document the characteristics of a DFU for the purposes of communication among health professionals and for regional/national/international audit. In contrast to the IWGDF who recommend against usage, in Australia we recommend caution in the use of existing wound classification systems to provide an individual prognosis for a person with diabetes and a foot ulcer. Conclusions We have developed new guidelines for wound classification for people with diabetes and a foot ulcer that are appropriate and applicable for use across diverse care settings and geographical locations in Australia.
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- 2021
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50. Classification and management of acute wounds and open fractures.
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Lee, Noel and Di Mascio, Livio
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Abstract: Acute traumatic wounds and open fractures potentially cause significant morbidity and loss of function. Much of the management of these types of injuries has been developed from the experience of military surgeons during times of armed conflict. The approach to management should start on initial assessment using trauma resuscitation protocols. Once life-threatening injuries have been managed, the wound should be thoroughly debrided and the skeleton stabilized. In the presence of heavy contamination, the wound must be re-inspected after 48 hours to evaluate whether further debridement is necessary and plans for soft tissue coverage can be made. The approach to management of open fractures should be systematic, involving both orthopaedic surgeons and plastic surgeons from the outset. [Copyright &y& Elsevier]
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- 2014
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