A Model Infectious Disease Curriculum for Fourth Grade Students: Integrating Prevention and Education Concepts in the Classroom

Despite the significant need for prevention education and updated disease curricula in elementary schools, there is a deficit of model units, lesson plans, and activities at the fourth grade level. An infectious disease and prevention teaching unit has been developed, following guidelines specified by the Centers for Disease Control and Prevention and a format consistent with proven pedagogical methods. This curriculum was tested in five classrooms with a total of 94 students.Prior to implementation, an assessment of all fourth grade teachers in the district examined their perceived knowledge of infectious diseases and their perceived self-efficacy in teaching such content. Evaluation of student progress included student pre and post-tests to assess changes in knowledge. Upon completion of the unit, teachers evaluated the unit to determine its relevance, effectiveness, and ease of implementation, and completed a post-test on their own knowledge and efficacy.Results indicate that the unit was effective in increasing student comprehension and interest in infectious disease prevention, and teacher efficacy in delivery of the material. This model curriculum can serve as a foundation to increase school health education in critical public health areas such as infectious diseases and preparedness, and provide an early introduction to public health careers

Diffuse descending necrotizing mediastinitis: surgical therapy and outcome in a single-centre series

OBJECTIVES Descending necrotizing mediastinitis (DNM) is a rare but rapidly progressing disease with a potentially fatal outcome, originating from odontogenical or cervical infections. The aim of this article was to give an up-to-date overview on this still underestimated disease, to draw the clinician's attention and particularly to highlight the need for rapid diagnosis and adequate surgical treatment. METHODS We present a retrospective analysis of 17 patients diagnosed and treated for advanced DNM between 1999 and 2011 in a tertiary referral medical centre. Hence, this is one of the largest single-centre studies in recent years concerning the diffuse form (i.e. extending into the lower mediastinum) of DNM. Subsequently, we analysed and compared the international literature with our data, with the focus on surgical management and outcome. RESULTS In our series of 17 adult patients, 16 were surgically treated by median sternotomy (n=8) or the clamshell (n=8) approach for diffuse DNM. One patient, referred with septic shock, died 2 days after surgery. The median interval from diagnosis of DNM by cervicothoracic computed tomography scan and thoracic surgery was 6h (range 1-24h) in all but the one patient with fatal outcome (48h). Concomitant cervicotomy was performed in 11 patients (65%) and tracheotomy in 9 (53%). The median duration of hospitalization was 16 days (range 4-50 days), including an intensive care unit stay of 4 days (range 1-50 days). CONCLUSIONS For DNM limited to the upper part of the mediastinum, which applies to the majority of cases, a transcervical approach and drainage may be sufficient. In advanced disease, extending below the tracheal carina, an immediate and more aggressive surgical approach is required to combat a much higher morbidity and mortality in this subset of patients. A timely situational approach via median sternotomy or a clamshell incision allowed us to maintain a very low morbidity, mortality and rate of reoperations, without major complications due to the surgical approach itsel

Challenging Diagnosis of Severe Bilateral Cervicofacial Subcutaneous Emphysema following Root Perforation in a Maxillary Lateral Incisor: A Case Report

Cervicofacial subcutaneous emphysema (CFSE) is a rare complication. CFSE may happen following some dental procedures including root canal therapy and is caused by unintentional entry of air into potential spaces of head and neck. In the current report, a case of extensive bilateral subcutaneous emphysema -following the root perforation of a maxillary anterior tooth- is presented. A 26-year-old woman was referred for further consultation concerning her right maxillary lateral incisor; for which a poor prognosis was considered following an endodontic treatment. There was a history of sudden facial swelling during root canal therapy. With the exacerbation of the problem and experiencing other symptoms, she was hospitalised. CT scan showed bilateral extension and penetration of air into submandibular, peri-orbital and parapharyngeal spaces. Clinical and radiographic evaluations of the maxillary lateral incisor revealed mid-root perforation on its buccal side, which was sealed by MTA. Eventually, the tooth was successfully restored.Keywords: Necrotizing Fasciitis; Root Perforation; Subcutaneous Emphysem

Mortality and outcome of patients with necrotizing fasciitis and Fournier‘s gangrene with and without hyperbaric oxygen therapy: a retrospective study

Hintergrund: Nekrotisierende Fasziitis (NF) und Fournier-Gangrän (FG) sind nekrotisierende Weichteilinfektionen (NSTI) mit einer hohen Mortalität. Die Standardtherapie umfasst frühzeitiges radikales Debridement, intravenöse Breitspektrum-Antibiose und intensivmedizinische Behandlung. Hyperbare Sauerstofftherapie (HBOT) ist eine adjuvante Therapieoption, die in spezialisierten Zentren routinemäßig eingesetzt wird, für deren Nutzen jedoch wenig Evidenz vorliegt. Ziel der Arbeit war es, Mortalität und Outcome einer Patientenkohorte mit NF und FG über 10 Jahre retrospektiv zu untersuchen und den Einfluss der HBOT auf diese Parameter zu ermitteln. Methoden: Patienten-, Krankheits- und Therapiemerkmale aller Fälle mit NF und FG, die vom 01.01.2010 bis 01.10.2020 im Zentrum für Wundmedizin des Klinikums im Friedrichshain behandelt wurden, wurden aus den Patientenakten extrahiert. Primäre Outcome-Parameter waren die Mortalität in der Gesamtkohorte und in drei Subgruppen bzgl. HBOT, von denen die erste Patienten ohne Indikation für eine HBOT, die zweite Patienten mit HBOT und die dritte Patienten, bei denen eine HBOT aufgrund von Kontraindikationen nicht realisierbar war, umfasste. Subgruppenanalysen zur Prüfung von Einflussfaktoren auf Mortalität wurden mit Chi2- Test, exaktem Fisher-Test, Mann-Whitney-U-Test und Kruskal-Wallis-Test durchgeführt. Zusätzlich wurden multivariate Regressionsmodelle mit Mortalität als Regressand erstellt. Kumulative Überlebenszeiten von Patienten ohne HBOT, mit HBOT und ohne Option für HBOT wurden mit Kaplan-Meier-Analysen verglichen. Ergebnisse: 192 Patienten, darunter 79,7% mit NF und 20,3% mit FG, wurden eingeschlossen. Die Krankenhausmortalität betrug 27,6%. Höheres Alter (Odds Ratio (OR)=1,03, p=0,017), Problemlokalisation der NSTI (OR=2,88, p=0,003), fehlende Option einer HBOT (OR=8,59, p=0,005), Erregernachweis in Blutkulturen (OR=3,36, p=0,002), Komplikationen (OR=10,35, p<0,001) und Sepsis/Organdysfunktion (OR=19,58, p<0,001) waren mit einem höheren Mortalitätsrisiko assoziiert, größere Anzahl an Debridements, Unterdruckwundtherapie, Defektrekonstruktion und längerer Krankenhausaufenthalt mit besserem Überleben. 43,2% der Patienten erhielten eine HBOT, bei 51,0% war diese nicht indiziert und bei 5,7% nicht durchführbar. Die Überlebensraten waren in den ersten beiden Subgruppen vergleichbar (73,5% vs. 75,5%), in der letzten Gruppe jedoch signifikant geringer (36,4%; p=0,022). Ein Vergleich der klinischen und laborchemischen Parameter bei Aufnahme ergab eine höhere Krankheitsschwere in den Gruppen mit HBOT und ohne Option einer HBOT. Schlussfolgerungen: Die hier identifizierten Prognosefaktoren bei NF und FG sind teilweise im Einklang mit der Literatur, teilweise erweitern sie den Forschungsstand. Die Ergebnisse weisen auf einen positiven Effekt der HBOT bei NF und FG hin, da Patienten mit HBOT trotz ungünstigerer Ausgangsbedingungen eine ähnliche Mortalität wie Patienten ohne Indikation für eine HBOT aufwiesen.Background: Necrotizing fasciitis (NF) and Fournier’s gangrene (FG) are necrotizing soft tissue infections (NSTI) with high mortality. Standard therapy includes early radical debridement, intravenous broad-spectrum antibiosis and intensive care treatment. Hyperbaric oxygen therapy (HBOT) represents an adjuvant treatment option which is regularly applied in specialized centers; however, scientific evidence in support of its use is scarce. The objective of the study was to analyze mortality and outcome of a patient cohort with NF and FG retrospectively over 10 years and to determine the impact of HBOT on these parameters. Methods: Patient, disease and treatment characteristics of all cases of NF and FG treated in the Center of Wound Medicine of the Vivantes Klinikum im Friedrichshain from 01 January 2010 to 01 October 2020 were extracted from the patient records. Primary outcome parameters were mortality in the whole cohort and in three subgroups according to HBOT, the first of which contained patients without the indication for HBOT, the second patients with HBOT and the third patients in whom HBOT was not practicable because of contraindications. Subgroup analyses to assess impact factors on mortality were performed with Chisquared test, Fisher’s exact test, Mann-Whitney-U test and Kruskal-Wallis test. Additionally, we generated multivariate logistic regression models with mortality as a regressand. Cumulative survival times of patients without HBOT, with HBOT and without the option for HBOT were compared with Kaplan-Meier analyses. Results: 192 patients, among them 79.7% with NF and 20.3% with FG, were included. In-hospital mortality was 27.6%. Higher age (odds ratio (OR)=1.03, p=0.017), problem localization of the NSTI (OR=2.88, p=0.003), lack of option for HBOT (OR=8.59, p=0.005), pathogen detection in blood cultures (OR=3.36, p=0.002), complications (OR=10.35, p<0.001) and sepsis/organ dysfunction (OR=19.58, p<0.001) were associated with a higher risk of mortality, higher number of debridements, negative pressure wound therapy, defect reconstruction and a longer hospital stay with improved survival. 43.2% of the patients received HBOT, in 51.0% HBOT was not indicated and in 5.7% not practicable. Survival rates were comparable in the first two subgroups (73.5% vs. 75.5%), but significantly lower in the last group (36.4%; p=0.022). A comparison of clinical and laboratory parameters at admission showed a higher disease severity in the groups with HBOT and without the option for HBOT. Conclusions: The prognostic factors for NF and FG identified here are partly in line with the literature and partly expand the state of research. The results point to a positive effect of HBOT in NF and FG, because patients with HBOT had similar mortality as patients without the indication for HBOT despite less favorable initial conditions

Anorectal emergencies: WSES-AAST guidelines.

Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies.The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process

Early detection, prevention and management of bacterial infections in the intensive care unit

Bacterial infections occur frequently in intensive care units (ICU) across the world. Their prevalence has relevant impacts on diagnostic approaches, patient treatment concepts and subsequent patient outcomes. In this habilitation, the role and manifestation of bacterial surface and device contamination potentially affecting critically ill patients with coronavirus disease 2019 (COVID-19) as well as appropriate diagnostic and management strategies with hospital epidemiological consequences during a novel pandemic are discussed. The work demonstrates that bacterial superinfections in critically ill COVID-19 patients with acute respiratory distress syndrome are frequent and commonly associated with longer duration of invasive mechanical ventilation. It highlights the substantial potential of structured microbiological sampling procedures and thorough antibiotic stewardship, in order to prevent the spread of multidrug resistant bacteria. Furthermore, potential benefits of the application of intravenous immunoglobulins as an early management strategy to treat necrotizing soft tissue infections (NSTI) are analyzed in a structured ICU patient cohort with a rare bacterial disease. To analyze a further specific management and prevention approach, this work characterizes the visual behaviour of critical care nurses while identifying drug labels of relevant ICU medications in a setting where performing under time pressure and the avoidance of medication errors - such as in patients with bacterial infections - are key. Together, the results of the presented work demonstrate the importance of accurate diagnostic, prevention and treatment strategies in the vulnerable collective of ICU patients with bacterial infections

Publication status and reporting quality of case reports on acupuncture-related adverse events: A systematic reviews of case studies

Introduction: Case reports on acupuncture-related adverse events (AEs) have been consistently published in the literature. This review aims to assess the current publication status of case reports on acupuncture-related AEs and evaluate their reporting quality in order to identify areas for improvement. Methods: This study is a systematic review (SR) of case reports. Studies describing cases for acupuncture-related AEs between 2010 and 2023 (until July) were searched in PubMed, Embase, and local databases (China and Korea), as well as by hand-searching references included in published relevant SRs. A bibliometric analysis was conducted to examine the publication trends of the included literature. The appropriateness of the acupuncture described in the cases, the causality assessment between AEs and acupuncture treatment, and the presence of necessary items from the CAse REport guidelines (CARE) checklist were narratively analyzed. Results: A total of 169 case reports were included in this review. Over the past decade, an average of 12 case reports on acupuncture-related AEs were published annually. However, only 38.2% of the articles provided sufficient information to determine the appropriateness of the acupuncture treatment used in the reported cases, and considerable numbers of the included case reports did not suggest enough information for the assessment of a causal relationship. The majority of cases did not report the timeline (n =164), patient perspectives (n =157), and informed consent (n = 121) items from the CARE checklist. Discussion: Acupuncture-related AEs persist in being frequently reported in the literature. Nonetheless, the information concerning acupuncture and causality assessment within these publications is still found to be insufficient. The development of reporting guidelines for future case reports on acupuncture-related AEs is anticipated to promote an academic environment conducive to more comprehensive reporting.publishedVersio

Adverse effects of delayed antimicrobial treatment and surgical source control in adults with sepsis: results of a planned secondary analysis of a cluster-randomized controlled trial

BACKGROUND: Timely antimicrobial treatment and source control are strongly recommended by sepsis guidelines, however, their impact on clinical outcomes is uncertain. METHODS: We performed a planned secondary analysis of a cluster-randomized trial conducted from July 2011 to May 2015 including forty German hospitals. All adult patients with sepsis treated in the participating ICUs were included. Primary exposures were timing of antimicrobial therapy and delay of surgical source control during the first 48 h after sepsis onset. Primary endpoint was 28-day mortality. Mixed models were used to investigate the effects of timing while adjusting for confounders. The linearity of the effect was investigated by fractional polynomials and by categorizing of timing. RESULTS: Analyses were based on 4792 patients receiving antimicrobial treatment and 1595 patients undergoing surgical source control. Fractional polynomial analysis identified a linear effect of timing of antimicrobials on 28-day mortality, which increased by 0.42% per hour delay (OR with 95% CI 1.019 [1.01, 1.028], p ≤ 0.001). This effect was significant in patients with and without shock (OR = 1.018 [1.008, 1.029] and 1.026 [1.01, 1.043], respectively). Using a categorized timing variable, there were no significant differences comparing treatment within 1 h versus 1–3 h, or 1 h versus 3–6 h. Delays of more than 6 h significantly increased mortality (OR = 1.41 [1.17, 1.69]). Delay in antimicrobials also increased risk of progression from severe sepsis to septic shock (OR per hour: 1.051 [1.022, 1.081], p ≤ 0.001). Time to surgical source control was significantly associated with decreased odds of successful source control (OR = 0.982 [0.971, 0.994], p = 0.003) and increased odds of death (OR = 1.011 [1.001, 1.021]; p = 0.03) in unadjusted analysis, but not when adjusted for confounders (OR = 0.991 [0.978, 1.005] and OR = 1.008 [0.997, 1.02], respectively). Only, among patients with septic shock delay of source control was significantly related to risk-of death (adjusted OR = 1.013 [1.001, 1.026], p = 0.04). CONCLUSIONS: Our findings suggest that management of sepsis is time critical both for antimicrobial therapy and source control. Also patients, who are not yet in septic shock, profit from early anti-infective treatment since it can prevent further deterioration. Trial registration ClinicalTrials.gov (NCT01187134). Registered 23 August 2010, NCT01187134 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-03901-9

Infections in Surgery

Infections in surgery, commonly known as surgical site infections (SSIs), are complications that may occur after a surgical procedure. SSIs represent a serious problem leading to increased morbidity, mortality, and healthcare costs, highlighting the need for continued efforts to improve surgical practices and reduce their incidence. Several factors can contribute to the development of SSIs: patient-related factors (such as obesity, advanced age, diabetes, immunosuppression, pre-existing infections etc.); preoperative preparation-related factors (such as incomplete skin antisepsis or failure to administer appropriate antibiotic prophylaxis); microbial contamination (despite sterile techniques, microorganisms can infect the surgical site); surgical procedure-related factors (duration and complexity of the surgeries); postoperative care-related factors (such as inadequate wound care or infection control measures). To prevent SSIs, healthcare facilities implement various strategies, including: optimization of patients’ conditions before surgery; preoperative antibiotic prophylaxis; strict sterile technique; postoperative wound care; surveillance and monitoring to identify and address SSIs early, preventing their spread and complications. Despite the evidence supporting the effectiveness of best practices, many clinicians fail to implement them, and evidence-based practices that optimize both the prevention and treatment of SSIs tend to be underused, highlighting the importance of ongoing research and improvement in surgical techniques and infection control practices. This open access book provides a practical toolkit for surgeons and intensivists to improve their daily clinical practices in order to reduce the risk of SSIs