Fracture-Related Infection: a consensus on definition from an international expert group

Fracture-related infection (FRI) is a common and serious complication in trauma surgery. Accurately estimating the impact of this complication has been hampered by the lack of a clear definition. The absence of a working definition of FRI renders existing studies difficult to evaluate or compare. In order to address this issue, an expert group comprised of a number of scientific and medical organizations has been convened, with the support of the AO Foundation, in order to develop a consensus definition. The process that led to this proposed definition started with a systematic literature review, which revealed that the majority of randomized controlled trials in fracture care do not use a standardized definition of FRI. In response to this conclusion, an international survey on the need for and key components of a definition of FRI was distributed amongst all registered AOTrauma users. Approximately 90% of the more than 2,000 surgeons who responded suggested that a definition of FRI is required. As a final step, a consensus meeting was held with an expert panel. The outcome of this process led to a consensus definition of FRI. Two levels of certainty around diagnostic features were defined. Criteria could be confirmatory (infection definitely present) or suggestive. Four confirmatory criteria were defined: Fistula, sinus or wound breakdown; Purulent drainage from the wound or presence of pus during surgery; Phenotypically indistinguishable pathogens identified by culture from at least two separate deep tissue/implant specimens; Presence of microorganisms in deep tissue taken during an operative intervention, as confirmed by histopathological examination. Furthermore, a list of suggestive criteria was defined. These require further investigations in order to look for confirmatory criteria. In the current paper, an overview is provided of the proposed definition and a rationale for each component and decision. The intention of establishing this definition of FRI was to offer clinicians the opportunity to standardize clinical reports and improve the quality of published literature. It is important to note that the proposed definition was not designed to guide treatment of FRI and should be validated by prospective data collection in the future

Terapia comportamental com famílias de crianças agressivas: por que, como e quando

Partindo de três perguntas-chave - por que, como e quando promover uma terapia com famílias de crianças agressivas - este trabalho objetiva demonstrar a relevância de uma intervenção envolvendo pais e crianças com problemas de conduta. É baseado na demanda crescente de atendimento infantil decorrente de dificuldades de natureza interpessoal, bem como na revisão da literatura, que aponta os estressores ambientais sobre a família e a ausência de habilidades cognitivas no repertório da criança como elementos a serem considerados na elaboração de estratégias clínicas. Estas devem ser aplicadas precocemente, a fim de se obter resultados mais eficazes. São descritas as atividades desenvolvidas pelo Programa de Pós-graduação em Psicologia Clínica da Universidade de São Paulo - USP, envolvendo: l) medidas de percepção dos pais e pares; 2) sessões terapêuticas com os pais e com as crianças; 3) análise da interação familiar, gravada em fita-cassete pelos próprios pais. Também são apresentadas as atividades do grupo recreativo infantil desenvolvido na clínica-escola do Instituto de Psicologia da USP durante o processo terapêutico com a família

Germinable soil seedbanks of central Queensland rangelands invaded by the exotic weed Parthenium hysterophorus L.

The germinable soil seedbank was determined at two sites in central Queensland on four separate occasions between February 1995 and October 1996. These sites were infested with parthenium weed (Parthenium hysterophorus L.), a serious invasive exotic weed. During this period, the seedbank varied between 3282 and 5094 seeds m at the Clermont site, and between 20 599 and 44 639 seeds m at the Moolayember Creek site. Parthenium hysterophorus exhibited a very abundant and persistent seedbank, accounting for 47-73% of the seedbank at Clermont and 65-87% of the seedbank at Moolayember Creek. The species richness and species diversity of the seedbank, and the seed abundance of many species, was lower at Moolayember Creek during spring (the time of year when the most dense infestations of the weed originate). Parthenium hysterophorus seedlings also emerged more rapidly from the soil samples than did those of all other species. Hence, it seems that various aspects of the weed's seed ecology, including abundance and the persistence of its seedbank and the rapid emergence of its seedlings, are major factors contributing to its aggressiveness in semiarid rangeland communities in central Queensland. The domination by P. hysterophorus of the seedbanks of these sites suggests that the weed is having a substantial negative impact on the ecology of these plant communities. The diversity of these seedbanks was found to be lower in comparison with that observed in other grassland communities that were not dominated by an invasive weed species. Hence, the prolonged presence of P. hysterophorus may have substantially reduced the diversity of these seedbanks, thereby reducing the ability of some of the native species to regenerate in the future