Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Consensus evidence-based clinical practice recommendations for the diagnosis and treat-to-target management of osteoporosis in chronic kidney disease stages G4-G5D and post-transplantation: An initiative of Egyptian Academy of Bone Health

The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts' suggestions, and the percent agreement was calculated. Statements receiving rates of 7-9 by more than 75% of experts' votes were considered as achieving consensus. The surveys were sent to an expert panel ( = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7-9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management. [Abstract copyright: Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.

Effect of a Planned Health Teaching on Improving Knowledge and Competence of Home Care Practice of Post Stroke Patient Among Caregivers' Achievement

Background: Stroke is one of the major healthcare challenges, being one of the leading causes of death, disability, and dependency in the activity of daily living worldwide Homecare of stroke patients is having a great role in the patient recovery. Patient family caregivers and relatives can play an important role in the care of patients. But how to continue proper care of the patient at home after discharge, they don't know what to do and don't have practice as well. In this view, the researcher believes that it might be a great help for caregivers and the patients to teach theirs about stroke and home care of stroke patients. Objective: The study aims to evaluate the effectiveness of a planned health teaching on the caregiver's knowledge and competence of home care of stroke patients. Therefore, improve the patients' functional ability. Methods: The two group pre and post-test, quasi-experimental design was conducted among 50 caregivers of stroke patients, assigned to 25 caregivers as a control group and 25 caregivers as an experimental group. The study was done in the university hospital at El Fayoum city from 1st March 2019 to 31st August 2019. Four tools were used for data collection after reviewing relevant data as the following; a structured interviewing questionnaire, caregiver's knowledge questionnaire regarding stroke, caregiver's practices regarding bed position, Position Change and Transfer, and Range of Motion Exercises, and patient function ability assessment according to Barthel index. Results: revealed that there was a poor score level of knowledge and competence of home care practices before the intervention. However, there was an improvement of score level in the control and experimental group post-intervention, but the higher score was observed in the experimental group. The mean score level of patient functional ability in the experimental group improved than the control group through follow up. Highly statistical significance was found between control and experimental group post-intervention related to knowledge and practices. A positive significant correlation between caregiver's practices and patients function ability in the experimental group was found. Conclusion: planned health teaching is important after patients discharge to increase the caregiver's knowledge and competence of home care practices of post-stroke patients; resulting in improved patient functional ability.</jats:p

Enhancing nursing practice through patient outcome measures: a framework for optimizing care in intracranial surgery

Abstract Background The nursing practices are evidence-based and have not been systematically applied to patients undergoing intracranial surgeries, which is one of the most critical procedures for treating brain diseases. Nursing care prevents complications, minimizes infections, and ensures a healthy, speedy recovery across preoperative, intraoperative, and postoperative phases. Aim This study aimed to evaluate the enhancement of nursing practice through patient outcome measures for optimizing care in intracranial surgeries. Method A quasi-experimental design was utilized in this study. The study was conducted at the neurosurgery unit at the Mansoura University Hospital with 50 nurses and 100 patients, 50 for each control and intervention group. The patients were divided into study groups in which the trained nurses applied to nursing practices, and the control group received only their usual care. Tools Four tools were used, including a structured interview questionnaire sheet. Nurses’ knowledge and nursing practices for patients undergoing intracranial surgeries, patients’ outcomes, and observational performance checklist. Statistical analysis A one-way analysis of variance (ANOVA) test, which is a statistical test used to analyze the difference between the means of more than two groups. The chi-square, SD (standard deviation), MH (marginal homogeneity test), and t (paired t-test) have been involved in the study. Results Nurses’ knowledge improved from 42.9% fair pre-application to 54% good post-application (P < 0.001). Pre- and postoperative practices also showed marked progress, with satisfactory practice levels rising from 66% to 72% in second observations, respectively (P < 0.001). Patient outcomes improved, with 62% of the study group showing moderate positive outcomes compared to 92% negative in the control group (P < 0.001). Patient satisfaction scores rose significantly, from a mean of 25.3 pre-application to 83.9 post-application (P < 0.001). Conclusion The study demonstrated significant improvements in nurses’ knowledge, practices, and patient outcomes following the implementation of the nursing practices. Recommendations Implement the nursing practices as a standard protocol to enhance nursing practices, improve patient recovery, and reduce complications in neurosurgical care