Perioperative Contamination of Orthopaedic Polyethylene Implants, Targeting Devices and Arthroscopes. Experts' Decision Tree and Literature Review.

Introduction Sterility errors during orthopaedic procedures can be stressful for the surgeon or scrub nurse and lead to devastating infectious complications and liability issues. This paper aims to review orthopaedic surgeon practices and propose possible attitudes to adopt. Methods Out of 1023 questionnaires sent, 170 orthopaedic surgeons answered a Volunteer Feedback Template (multiple-choice test) by SurveyMonkey® (San Mateo, CA, USA) anonymously. The survey questioned surgeon's response to a sterility mistake during a standard total knee joint replacement, trauma surgery and arthroscopic procedure. Those "sterility mistake" situations occurred when there was contamination of 1) a sterile polyethylene (PE) 2) a sterile targeting device, and 3) an arthroscope. Results When the definitive PE is contaminated, and if a new definitive PE will only be available 2 hours later, 52% of surgeons would wait for the new definitive PE (p<0.001). In the same situation, if a new PE will only be available in 4 hours, the results showed a significant difference favoring two other options: "putting a definitive PE one size smaller or bigger with balance adjustment" (31%); and "leaving the provisional PE in the joint, closing the wound and re-operating the patient in the coming days when the definitive PE arrives" (29%) (p<0.001). When the new PE is only available 24 hours later results were 34% and 31%, respectively (p<0.001). In the case of a surgical procedure for a classic intertrochanteric fracture, if the carbon fiber targeting device is contaminated, most surgeons (50%) chose to put the nail without the targeting device and finish the surgery (p<0.001). When the arthroscope is desterilized, 39% of participants would wait until the arthroscope has been sterilized again (approximately 2 hours), while 24% would use another procedure (p<0.001). Sixty-two percent of surgeons would adapt their strategy. No clear trend could be identified in terms of antibiotic treatment following a sterility error. Conclusions There are no established guidelines on how to deal with sterility breaches during surgery and on the antibiotic strategy following the prolonged surgical time resulting from the delay for a new implant. The most common course of action chosen by participating surgeons is detailed in our expert decision tree - if another sterile component is not available within 2 hours - : insertion of another PE size, rescheduling the operation, adapting the surgical technique (for trauma procedures), or soaking the arthroscope in disinfectant solution. As instances of contamination cannot be avoided, it is recommended to have a minimum of two copies of sterile PE implants, arthroscopes or targeting devices readily available before surgery begins-

Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study.

Pelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding. Our aim was to assess the association of the pelvic fracture pattern according to the Tile classification system with transfusion requirements and mortality rates, and to evaluate the correlation between the use of pelvic binders and arterial angio-embolization and the mortality of patients with pelvic fractures. Single-center retrospective cohort study including all consecutive patients with a pelvic fracture from January 2008 to June 2015. All radiological fracture patterns were independently reviewed and grouped according to the Tile classification system. Data on patient demographics, use of pelvic binders and arterial angio-embolization, transfusion requirements and mortality were extracted from the institutional trauma registry and analyzed. The present study included 228 patients. Median patient age was 43.5 years and 68.9% were male. The two independent observers identified 105 Tile C (46.1%), 71 Tile B (31.1%) and 52 Tile A (22.8%) fractures, with substantial to almost perfect interobserver agreement (Kappa 0.70-0.83). Tile C fractures were associated with a higher mortality rate (p = 0.001) and higher transfusion requirements (p < 0.0001) than Tile A or B fractures. Arterial angio-embolization for pelvic bleeding (p = 0.05) and prehospital pelvic binder placement (p = 0.5) were not associated with differences in mortality rates. Tile C pelvic fractures are associated with higher transfusion requirements and a higher mortality rate than Tile A or B fractures. No association between the use of pelvic binders or arterial angio-embolization and survival was observed in this cohort of patients with pelvic fractures

Vegetatiezones van de wereld : klimatologische en bodemkundige achtergronden

De vegetatietypen van de wereld zijn in te delen in zones die Wa1ter (14) zonobiomen noemt. De vegetatiesamenstelling en -structuur binnen de zones worden bepaald door diverse milieuomstandigheden. De meest belangrijke hiervan zijn het klimaat en de bodem. Het klimaat heeft invloed op de vegetatie via neerslag, instraling van zonne-energie en temperatuur. Ook beïnvloed het klimaat de bodemvorming en hierdoor voor de vegetatie belangrijke bodemeigenschappen, zoals vochtcapaciteit, poriënvolume, doorluchting en voedselrijkdom. Een belangrijke factor in deze materie is het water. Water is voor de plant van levensbelang. Iedere plant moet een bepaalde hoeveelheid water op kunnen nemen om te kunnen groeien en zich voort te planten. Toch heeft ieder gebied, hoe droog of hoe nat het ook is, zijn eigen, aan dat milieu aangepaste soorten. In de bodem zorgt het water voor verwering, uitloging en uitspoeling, diverse erosie- en sedimentatieprocessen en voor het transporteren van voedingselementen naar de plant. We zien dat er een evenwicht is tussen klimaat, bodem en vegetatie. Door onzorgvuldig ingrijpen van de mens in de laatste eeuwen is dit evenwicht echter op vele plaatsen verstoord. Soms reversibel, maar soms ook definitief.

Een onderzoek van bodem en vegetatie in de Madeveengronden van het Peizerdiep

In dit verslag wordt ingegaan op de voedselrijkdom van madeveengronden en de mogelijke relatie met de vegetatie in het stroomdal van het Peizerdiep. De onderzoeksgebieden zijn de ‘Hazematen’ en de ‘Broeklanden’ beide in beheer bij S.B.B. In de middenloop van het Peizerdiep komt potklei, een glimmerrijke smeltwaterafzetting, aan en/of onder het oppervlak voor. Glimmers zijn rijk aankalium, dat bij verwering vrij kan komen. In de onderzoeksgebieden zijn grondmonsters genomen, vegetatieopnamen gemaakt en grondwaterbuizen geplaatst. Met behulp van de verkregen gegevens is getracht een effect van potklei op de voedselrijkdom van de bodem aan te tonen. Dit effect is echter niet aantoonbaar gebleken aangezien de bodem een overmaat aan nutriënten bevat, voor zover dit N, P en K betreft. Een duidelijke relatie tussen de vegetatie en de bodem is niet aangetoond in deze onderzoeksgebieden. De vegetatie blijkt grotendeels bepaald te worden door de kwaliteit en stand van het grondwater.

Strategies for multi-site GLP studies

A GLP study can be performed at more than one site. This is called a multi-site study. Although, the study is performed at different sites, it is still one study and must completely comply with the GLP principles. The fact that different activities are conducted at different sites implies that the planning, the organization and the communication are crucial for the success of the study. This means that all the staff involved should know their responsibilities and should have the knowledge and skills to realize all the phases of the study according to the GLP principles. To achieve a well managed multi-site study, several strategies for setting up such a study can be followed. This paper focuses on the responsibilities, communication, and collaboration of the personnel, which are involved in a multisite study. Several case studies are highlighted, and we concluded that the basic communication triangle in a single-site GLP study between test facility management, study director, and the quality assurance unit should be extended to the communication among test facility and test site management,study director, principle investigator(s), and the quality assurance units at the test sites</p