A Delphi Consensus to Identify Perioperative Antibiotic Prescribing Best Practices in Mohs Surgery

Abstract: Surgical site infections (SSI) make a significant global contribution to morbidity, mortality, and cost while remaining one of the most preventable causes of healthcare-associated infection. Perioperative antibiotics are a mainstay of prevention, but antibiotics are also associated with cost, risk, and increasing resistance. Dermatology is responsible for more oral antibiotic prescriptions than any other discipline. Despite a trend toward conservative prescribing practices and antibiotic stewardship in dermatology overall, antibiotic prescriptions in dermatologic surgery continue to increase, with a notable rise in short-term perioperative prescribing. There is currently a lack of evidence-based perioperative antibiotic prescribing guidelines within the dermatology literature. Evidence supports the need for specific, up-to-date recommendations regarding antibiotic management in the setting of dermatologic surgery. This QI project aims to review and synthesize current recommendations in the literature and identify best practices for developing standardized, appropriate use criteria for perioperative use of antibiotics in dermatologic surgery

Examining the Experience of Teen-to-Teen Crisis Line Work for Adolescent Volunteers: A Pilot Study

Suicidal thoughts and behaviors are high and increasing among youth. Crisis lines are one of the oldest downstream approaches for suicide prevention, which have demonstrated effectiveness for adults and preliminary effectiveness for youth. Teen-to-teen (t2t) crisis lines are a unique resource where adolescent volunteers help their similarly aged peers (through texts, chats, calls, and emails). However, no research to date has examined the impacts of t2t crisis line volunteering on the youth. The goal of this pilot study is to begin to evaluate the experience of t2t crisis lines for the youth volunteers. Adolescent (n=20, ages 15-20) volunteers were recruited from two of the largest crisis lines in the U.S. – Teen Line and YouthLine. Enrolled volunteers were administered surveys assessing positive/helpful experiences, negative/unhelpful experiences, and motivations for joining the t2t crisis line. Volunteers were assessed up to five times over the course of one year; once at baseline and then every three months for up to one year (baseline, 3-month follow-up, 6-month follow-up, 9-month follow-up, 12-month/1-year follow-up). Direct content analysis was used to examine the experiences and motivations of volunteering on the crisis line. Preliminary results indicate that all volunteers reported some positive aspects of the t2t line experience, and many reported some negative aspects as well.https://digitalcommons.odu.edu/gradposters2023_sciences/1011/thumbnail.jp

Choledochoduodenal fistula presenting with pneumobilia in a patient with gallbladder cancer: a case report

<p>Abstract</p> <p>Introduction</p> <p>Spontaneous biliary tract fistulas are rare entities. Most of them are associated with long-standing gallstones (especially common bile duct stones, or recurrent biliary tract infections), some with more uncommon diseases such as gallbladder cancer. Some authors believe that back flow from fistulas predisposes patients to gallbladder cancer and some believe that cancer causes necrosis and fistula formation. Gallbladder cancer has a dismal prognosis and 85% of patients are dead within a year of diagnosis. A common complication of gallbladder cancer is obstruction of the common bile duct, which may produce multiple intra-hepatic abscesses in or near the tumor-laden gallbladder. Fistula formation may further complicate the clinical picture.</p> <p>Case presentation</p> <p>We present a case of choledochoduodenal fistula in a 60-year-old diabetic African-American woman with gallbladder cancer. The initial clinical presentation was confusing and complex. Our patient was also found to have a gallbladder fossa abscess that was drained percutaneously as another complicating factor relating to her cancer. She developed myocardial infarction, massive upper gastrointestinal bleeding and respiratory arrest during her stay in hospital. Computed tomography was very helpful in assessing our patient and we discuss how, in a patient with pneumobilia, it can be helpful for detecting fistula, air in bile ducts or to show contractions of the gallbladder.</p> <p>Conclusions</p> <p>We believe this case merits reporting as it shows an entity that is not frequently thought of, is hard to diagnose and can be fatal, as in our patient. Careful evaluation, and computed tomography studies and endoscopic retrograde cholangio-pancreatography are helpful in early diagnosis and finding better management options for these patients.</p

A Rapid-ACCE review of CYP2C9 and VKORC1 alleles testing to informwarfarin dosing in adults at elevated risk for thrombotic events to avoid serious bleeding,”

Purpose: Summarize evidence regarding genetic testing in adults to inform warfarin dosing to reduce adverse drug events such as serious bleeding. Methods: Review published (and selected gray) literature using the Rapid-ACCE structure that addresses analytic validity, clinical validity, clinical utility, and ethical, legal, and social implications. Results: Preliminary data suggest overall analytic sensitivity and specificity will be 98% or higher for CYP2C9 genotyping, but strength of evidence for analytic validity is low, especially for VKORC1 testing. Strength of evidence is high for the clinical validity of both genes in predicting stable warfarin dose, an intermediate outcome, but is low for the association between CYP2C9 testing and severe bleeding events (clinical sensitivity 46% (95% CI 32-60%); specificity 69% (95% CI 62-75%) and absent for bleeding events associated with VKORC1 testing. No data are available to document clinical utility of genotyping before warfarin dosing. Conclusions: The most important gaps identified are: which variants should be included in a testing panel, lack of data from external proficiency testing, lack of validated dosing algorithm incorporating genetic and nongenetic factors, evidence of clinical utility, reliable economic analyses, and methods to address several ethical, legal, and social implications issues. Genet Med 2008:10(2):89 -98

Multicolour correlative imaging using phosphor probes

Correlative light and electron microscopy exploits the advantages of optical methods, such as multicolour probes and their use in hydrated live biological samples, to locate functional units, which are then correlated with structural details that can be revealed by the superior resolution of electron microscopes. One difficulty is locating the area imaged by the electron beam in the much larger optical field of view. Multifunctional probes that can be imaged in both modalities and thus register the two images are required. Phosphor materials give cathodoluminescence (CL) optical emissions under electron excitation. Lanthanum phosphate containing thulium or terbium or europium emits narrow bands in the blue, green and red regions of the CL spectrum; they may be synthesised with very uniform-sized crystals in the 10- to 50-nm range. Such crystals can be imaged by CL in the electron microscope, at resolutions limited by the particle size, and with colour discrimination to identify different probes. These materials also give emissions in the optical microscope, by multiphoton excitation. They have been deposited on the surface of glioblastoma cells and imaged by CL. Gadolinium oxysulphide doped with terbium emits green photons by either ultraviolet or electron excitation. Sixty-nanometre crystals of this phosphor have been imaged in the atmospheric scanning electron microscope (JEOL ClairScope). This probe and microscope combination allow correlative imaging in hydrated samples. Phosphor probes should prove to be very useful in correlative light and electron microscopy, as fiducial markers to assist in image registration, and in high/super resolution imaging studies