Reducing Surgical Site Infections: A Comparison of Surgical Skin Preparations

Surgical site infections are one of the most common healthcare-associated infections among surgical patients. The use of surgical site preparations can prevent this problem. A literature review was conducted to examine the existing studies in an attempt to determine which surgical site preparation yielded the lowest surgical site infection rate postoperatively. The preparations examined in these studies were parachoroxylenol (PCMX), povidone-iodine, combination povidone-iodine and isopropyl alcohol, chlorhexidine gluconate (CHG), chlorhexidine-alcohol, combination povidone-iodine and CHG, and povidone-iodine with industrial methylated spirit. It was concluded that none of these preparations proved to be superior in all surgeries or facilities. Patient allergies, comorbidities, surgical site, surgeon preference, and availability are some factors that affect the types of preparations used. In order to determine which surgical site skin preparation is superior in reducing infection, more studies on these preparations will need to be conducted

[SADE] A Maple package for the Symmetry Analysis of Differential Equations

We present the package SADE (Symmetry Analysis of Differential Equations) for the determination of symmetries and related properties of systems of differential equations. The main methods implemented are: Lie, nonclassical, Lie-B\"acklund and potential symmetries, invariant solutions, first-integrals, N\"other theorem for both discrete and continuous systems, solution of ordinary differential equations, reduction of order or dimension using Lie symmetries, classification of differential equations, Casimir invariants, and the quasi-polynomial formalism for ODE's (previously implemented in the package QPSI by the authors) for the determination of quasi-polynomial first-integrals, Lie symmetries and invariant surfaces. Examples of use of the package are given

Reducing surgical site infections: a comparison of surgical skin preparations

Surgical site infections are one of the most common healthcare-associated infections among surgical patients. The use of surgical site preparations can prevent this problem. A literature review was conducted to examine the existing studies in an attempt to determine which surgical site preparation yielded the lowest surgical site infection rate postoperatively. The preparations examined in these studies were parachoroxylenol (PCMX), povidone-iodine, combination povidone-iodine and isopropyl alcohol, chlorhexidine gluconate (CHG), chlorhexidine-alcohol, combination povidone-iodine and CHG, and povidone-iodine with industrial methylated spirit. It was concluded that none of these preparations proved to be superior in all surgeries or facilities. Patient allergies, comorbidities, surgical site, surgeon preference, and availability are some factors that affect the types of preparations used. In order to determine which surgical site skin preparation is superior in reducing infection, more studies on these preparations will need to be conducted.Student Showcase of Research & Engagement 201

Exploring experiences of and attitudes towards mental illness and disclosure amongst health care professionals:a qualitative study

Background: The literature suggests that many health professionals hold stigmatising attitudes towards those with mental illness and that this impacts on patient care. Little attention has been given to how these attitudes affect colleagues with a mental illness. Current research demonstrates that stigma and discrimination are common in the UK workplace and impact on one’s decision to disclose mental illness. Aims: This study aims to explore health professionals’ experiences of and attitudes towards mental illness and disclosure in the workplace. Methods: This qualitative study involved semi-structured interviews with 24 health professionals employed by an NHS (National Health Service) trust. 13 of these worked in mental health, and 11 in other health fields. Interviews were transcribed and thematic analysis was used to identify themes. Results: Five key themes were identified from the data: personal experiences and their effect in changing attitudes; perceived stigmatising views of mental illness in other staff members; hypothetical disclosure: factors affecting one’s decision; attitudes towards disclosure; support in the workplace after disclosure; and, applying only to those working outside of the mental health field, mental illness is not talked about. The results indicated that participants had a great deal of experience with colleagues with a mental illness and that support in the workplace for such illnesses is variable. Attitudes of participating health professionals towards colleagues with a mental illness appeared to be positive, however, they did report that other colleagues held negative attitudes. Deciding to disclose a mental illness was a carefully thought out decision with a number of advantages and disadvantages noted. In particular, it was found that health professionals’ fear stigma and discrimination from colleagues and that this would dissuade participants from disclosing a mental illness. Conclusion: In many respects, this research supports the findings in other workplaces. Such findings need to be investigated further to identify the degree to which these experiences and attitudes can be applied to other health professionals in other healthcare settings to determine what intervention is necessary. Importantly, this study has also indicated that the level of support available to NHS health professionals with a mental illness is variable, suggesting the need to identify and replicate positive practice.</p

A Cephalometric Study of the Maxillofacial Structure in Obstructive Sleep Apnoea

Sleep is essential for life. We spend somewhere between one quarter and one third of our lives sleeping, depending upon our sleep pattern. Sleep is a normal physiological process, and as with all such processes there are some differences between individuals that are simply variations of normal. Likewise sleep may be associated with variations that are deemed to be outside the boundaries of those considered normal and is therefore considered pathologic. The investigation of a known abnormality of sleep, namely Obstructive Sleep Apnoea (OSA) syndrome, forms the basis of this thesis and an understanding of normal sleep physiology is essential prior to considering the alterations in normal sleep architecture exhibited in this condition. Chapter 1 considers the definition of normal sleep, the diagnosis of pathologic sleep and the characteristic alterations in sleep and wakefulness demonstrated in a person suffering from obstructive sleep apnoea. Obstructive Sleep Apnoea syndrome is a medical condition that has been intensively studied by investigators in various fields of medicine and dentistry since being characterized by Guilleminault et al (1976). The classical description of patients with this syndrome was made by Burwell et al (1976). These patients were said to be obese, suffering from hypersomnolence, periodic breathing with hypoventilation and cor pulmonale. Pickwickian syndrome was the term used in 1918 by Sir William Osler when describing patients with a similar clinical presentation. The research into obstructive sleep apnoea syndrome has revealed pathophysiologic alterations in a variety of bodily systems in these people when compared to non-apnoeic people. These pathophysiologic findings are discussed in Chapter 2. Assessment of the upper airway may be performed clinically, endoscopically, radiographically or using other imaging modalities such as magnetic resonance imaging or manometry. The assessment method evaluated in this thesis is lateral cephalometric radiography. In selecting a method of imaging, it is necessary to have a thorough understanding of the anatomy of the region under examination. Chapter 3 of this thesis outlines the pertinent anatomy of the upper airway and an overview of the available methods of imaging is given. Lateral cephalometric assessment of the upper airway is discussed in particular because it was the modality under investigation. Chapter 4 reviews the literature with respect to known errors using this technology. Although only recently used in relation to obstructive sleep apnoea, lateral cephalometric radiographs have long been utilised by orthodontists and oral and maxillofacial surgeons in the diagnosis and treatment planning of people with malocclusion. Despite a large number of studies reported in the literature regarding lateral cephalometric radiographs and OSA direct comparison between studies is often difficult. Many studies purport to measure the same parameters e.g. pharyngeal airway width but use different landmarks. Some studies use control subjects who are age and/or weight matched, other studies use controls not matched for these parameters. Yet other studies use no control subjects at all. Chapter 5 and Chapter 6 of this thesis provide a review of the literature where lateral cephalometric radiographs have been used to assess subjects with obstructive sleep apnoea syndrome. The imaging of the upper airway is obviously no treatment in itself. One of the problems as with many medical conditions, is the cure may not be acceptable to the patients with the condition. In the case of obstructive sleep apnoea syndrome tracheostomy will cure the patient of the upper airway obstruction however at a personal cost not accepted by most patients. The standard treatment for obstructive sleep apnoea syndrome since 1981 has been nasal continuous positive airway pressure ventilation, reported by Sullivan et al (1981). This modality is reported in the literature to be efficacious however compliance remains an issue. Chapter 7 considers the non-surgical treatment modalities that have been and are used in the treatment of obstructive sleep apnoea syndrome. Surgical treatment for obstructive sleep apnoea syndrome, apart from tracheostomy, has been reported in the literature since 1981 when Fujita reported uvulopalatopharyngoplasty as a surgical technique for the treatment of snoring and obstructive sleep apnoea syndrome. Since that time a number of surgical procedures have been reported with varying degrees of success. These surgical modalities reported in the literature are considered in Chapter 8. On the basis of the literature review, several aims were established using material from the Oral and Maxillofacial Surgery unit, The University of Adelaide and the Thoracic Medicine Unit, The Royal Adelaide Hospital. The objectives of the study were to: 1. Acquire cephalometric data on I 00 consecutive patients undergoing a polysomnographic overnight sleep study for investigation of a suspected sleep breathing disorder as assessed by a thoracic medicine physician. 2. Quantify the airway dimensions of this series of patients using measurements previously reported in the literature. 3. Establish whether BMI has any predictive value for OSA. 4. Establish whether neck circumference is related to BMI or the incidence of OSA. 5. Establish whether age or sex has any influence on the incidence of OSA. 6. Compare airway dimensions measured from the lateral cephalometric radiograph and the severity of OSA to determine if any measurement is predictive for the presence of OSA. 7. Compare airway dimensions measured from lateral cephalometric radiograph and quantify any differences between the study population of OSA patients and simple snorers compared with comparable results reported in the literature. 8. Investigate the sources of error in cephalometry and quantify the error associated with the present study. 9. Quantify the error associated with selected cephalometric variables used in this study. 10. Determine if lateral cephalometric radiographs are a useful adjunct to treatment planning for patients with OSA. Chapter 9 and Chapter 10 report the methodology used in order to achieve the aims of the study. Chapter 11 reports the results of this study. The linear and angular variables measured from the lateral cephalometric radiographs was initially assessed with respect to body mass index (BMI) and respiratory disturbance index (RDI). Subjects were then divided upon the basis of RDI into groups of "snorers" and "obstructive sleep apnoeics". Further statistical evaluation was then performed on the groups. To allow comparison with other results from the literature, the division by RDI was performed three times, at an RDI 10, 15 and 20 events per hour. These results are discussed and compared with the findings in the literature in Chapter 12. Chapter 13 summarises the key findings of this thesis and suggests areas of future investigation to further our understanding of the upper airway changes reported in obstructive sleep apnoeic subjects. A glossary of terms is provided at Chapter 14. The Appendix is a copy of the consent and patient information given to participants prior to their enrolment in this study.Thesis (MDS) -- University of Adelaide, Dept. of Oral and Maxillofacial Surgery, 200

Exploring stakeholders\u27 perceptions of the acceptability, usability, and dissemination of the australian 24-hour movement guidelines for the early years

Background: Australian 24-Hour Movement Guidelines for the Early Years were recently developed. To maximize the uptake of the guidelines, perceptions of key stakeholders were sought. Methods: Thirty-five stakeholders (11% Aboriginal or Torres Strait Islander descent) participated in focus groups or key informant interviews. Stakeholders included parents of children aged 0-5 years, early childhood educators, and health and policy professionals, recruited using convenience and snowballing techniques. Focus groups and interviews were audio-recorded and transcribed verbatim. Data were analyzed inductively using thematic analysis. Results: There was general acceptance of the Movement Guidelines. The stakeholders suggested that the Guidelines were highly aspirational and needed to be carefully messaged, so parents did not feel guilty if their child was not meeting them. Stakeholders identified that the messaging needed to be culturally appropriate and visually appealing. Dissemination strategies differed depending on the stakeholder. Conclusion: Seeking stakeholder perceptions is an important process in the development of national Movement Guidelines. This study successfully examined stakeholders\u27 perceptions regarding the acceptability, usability, and dissemination of the Australian 24-Hour Movement Guidelines. Effective and innovative strategies for maximizing compliance and uptake of the Guidelines should be prioritized

Ensino de microbiologia por meio de ação de extensão para professores de biologia e ciências biológicas

Practical lessons are essential for the student’s learning process. However, teachers face numerous difficulties that prevent these classes from taking place, such as lack of essential materials due to the high cost of products, or even lack of teacher knowledge to perform practices. As teacher training is one of the most important missions of an educational institution and extension activities are one of the three pillars of the university, in order to minimize the obstacles described above, a training course was offered to school teachers, entitled "Microbiological Techniques Using Alternative Low-cost Conditions for Teaching Practices”. During the training course, two lectures were presented: Fundamentals of Microbiology and Biosafety in a Microbiology Laboratory Four practical workshops were also performed: 1 - Comparison of the efficiency of the pressure cooker, stove oven and autoclave in sterilization; 2 - Development of alternative culture media from agro-industrial residues; 3 - Evaluation of the efficiency of alternative culture media in the growth of bacteria and yeasts; 4 - Evaluation of the efficiency of alternative culture media in alcoholic fermentation by Saccharomyces cerevisiae; 5 - Microculture. Workshops were carried out using a variety of alternative materials in order to enable the future replication of these practices in schools. It is possible to suggest greater effectiveness in the teaching-learning process through teacher training to apply a differentiated methodological approach. Within this context, practical activities in the teaching of microbiology can be advantageous for the acquisition of knowledge by students of basic education.Las clases prácticas para la enseñanza de la Biología y las Ciencias Biológicas son fundamentales para el aprendizaje de los estudiantes de educación básica. Sin embargo, los docentes encuentran numerosos obstáculos que impiden que estas clases se lleven a cabo, como, por ejemplo, la falta de materiales esenciales debido al alto costo de los productos, o incluso la falta de capacitación docente para llevar a cabo estas clases prácticas. Siendo la formación docente una de las misiones más importantes de una Institución de Educación Superior, y la extensión uno de los trípodes de la Universidad, con el fin de minimizar los obstáculos descritos anteriormente, se ofreció un curso de formación en clases prácticas a Profesores de Ciencias y Biología de la escuelas públicas de Barra do Bugres titulado “Técnicas microbiológicas utilizando condiciones alternativas de bajo costo para prácticas docentes”. Durante el curso de capacitación, se presentaron dos conferencias: Fundamentos de Microbiología y Bioseguridad en el Laboratorio de Microbiología, así como cuatro talleres prácticos: 1 - Comparación de la eficiencia de la olla a presión, estufa horno y autoclave en esterilización. 2 - Elaboración de medios de cultivo alternativos a partir de residuos agroindustriales; 3 - Evaluación de la eficacia de medios de cultivo alternativos sobre el crecimiento de bacterias y levaduras; 4 - Evaluación de la eficiencia de medios de cultivo alternativos en la fermentación alcohólica por Saccharomyces cerevisiae; 5 Microcultivo. Los talleres se realizaron utilizando varios materiales alternativos para permitir la futura replicación de estas prácticas en las escuelas. Con base en los resultados, es posible sugerir que existe una mayor efectividad en el proceso de enseñanza-aprendizaje, a través de la formación de los docentes para aplicar un enfoque metodológico diferenciado, a través de clases prácticas sobre la enseñanza de la microbiología. En este contexto, las actividades prácticas en la enseñanza de la Biología y las Ciencias Biológicas pueden ser muy importantes para la construcción del conocimiento por parte de los estudiantes de educación básica.As aulas práticas são essenciais para o aprendizado dos alunos. Porém, os professores encontram inúmeros obstáculos que impedem que essas aulas ocorram como, por exemplo, falta de materiais essenciais devido ao alto custo dos produtos, ou até mesmo falta de capacitação do professor para execução de práticas. Como a formação docente é uma das missões mais importantes de uma instituição de ensino e a extensão é um dos tripés da universidade, a fim de minimizar os empecilhos descritos acima, foi ofertado um curso de capacitação aos docentes das escolas intitulado “Técnicas microbiológicas utilizando condições alternativas de baixo custo para práticas de ensino”. Durante o curso de capacitação foram apresentadas duas palestras:&nbsp; Fundamentos da Microbiologia e Biossegurança em Laboratório de Microbiologia e oficinas práticas: 1 - Comparação da eficiência da panela de pressão, forno de fogão e autoclave na esterilização. 2 - Elaboração de meios de culturas alternativos a partir de resíduos agroindustriais; 3 - Avaliação da eficiência dos meios de culturas alternativos no crescimento de bactérias e leveduras; 4 - Avaliação da eficiência dos meios de cultura alternativos na fermentação alcoólica por Saccharomyces cerevisiae; 5 Microcultivo. As oficinas foram conduzidas utilizando diversos materiais alternativos para possibilitar a futura replicação dessas práticas nas escolas. É possível sugerir maior eficácia no processo ensino aprendizagem por meio da capacitação docente para aplicação de uma abordagem metodológica diferenciada.&nbsp; Dentro deste contexto as atividades práticas no ensino de microbiologia podem se apresentar vantajosas para a aquisição de conhecimento pelos estudantes do ensino básico

Congenital Syringocystadenoma Papilliferum

O siringocistoadenoma papílifero é uma neoplasia anexial benigna incomum, que se localiza preferencialmente no couro cabeludo e face, e está associado ao nevo sebáceo em 40% dos casos. Embora rara, a transição para carcinoma basocelular e carcinoma ductal pode ocorrer. Os autores descrevem o caso de um paciente do sexo masculino, de 7 anos de idade, com dermatose papulosa linear do pescoço desde o nascimento. Apresentava, no exame dermatológico, pápulas eritematosas, crateriformes, confluentes, dispostas em faixa, de 3 x 2 cm na região cervical. Foi realizada a exérese da lesão e o exame histopatológico demonstrou invaginação cística epidérmica e projeções papilares revestidas por epitélio glandular, com secreção de decapitação e infiltrado linfo-plasmocitário abundante. Os achados clínicos e histológicos foram compatíveis com o diagnóstico de siringocistoadenoma papílifero. Apesar da variabilidade clínica desta entidade, a histopatologia é característica e o tratamento consiste na exérese da lesão.Papillary syringocystoadenoma is an uncommon benign adnexal neoplasm, which is preferentially located on the scalp and face, and is associated with sebaceous nevus in 40% of cases. Although rare, its transition to basal cell carcinoma and ductal carcinoma may occur. The authors describe the case of a 7-year-old male patient with a linear papular dermatosis in the neck from birth. Dermatological examination showed erythematous, crateriform, confluent papules, arranged in a band, 3 x 2 cm in the cervical region. The lesion was excised for therapeutic and diagnostic purposes. Histopathology demonstrated epidermal cystic invagination and papillary projections surface by glandular epithelium, with decapitation secretion and abundant lymphoplasmocytic infiltrate. The clinical and histological findings were compatible with the diagnosis of papillary syringocystoadenoma. Despite the clinical variability of this entity, the histopathology is characteristic and the treatment consists in the excision of the lesion

Fluid management and active fluid removal practices: a global survey of paediatric critical care physicians

Aims Fluid accumulation (FA) in critically ill children is associated with poor clinical outcomes. While conservative fluid management has been proposed, evidence to guide practice is scarce. We surveyed paediatric critical care (PCC) physicians worldwide regarding their perceptions of FA, active fluid removal (AFR) practices, safety parameters, and willingness to participate in a clinical trial on the topic. Methods Cross-sectional international electronic survey of PCC physicians, distributed through research networks worldwide. Results A total of 409 PCC physicians from 48 countries participated in the survey; 40% (164/409) cared for cardiac patients. The majority believed FA was a modifiable source of morbidity (88%, 359/407) and expressed support for a trial on conservative fluid management trial (94%, 383/407). Restriction of maintenance fluid was more commonly practiced (87%, 335/387) than resuscitation fluid (54%, 210/387), with variability observed among individuals and patient categories. AFR was widely practiced (93%, 361/387), yet significant differences existed in patient selection, timing, modality, and rate. The most common reported time for starting AFR was 48 h (49%, 172/384), with most respondents (92%, 355/385) comfortable doing so in the setting of catecholamine infusions. While most respondents would continue diuretics with mild electrolyte or acid–base disturbances, 52% (179/342) would withhold them in cases of mild hypotension. Conclusions Fluid accumulation remains a significant concern among paediatric intensivists. The observed practice variability underscores the challenges in establishing evidence-based guidelines. Our survey highlights an urgent need for randomized trials in this field and provides valuable insights to inform the design of such future studies

Longitudinal cohort study investigating neurodevelopmental and socioemotional outcomes in school-entry aged children after open heart surgery in Australia and New Zealand: the NITRIC follow-up study protocol

Introduction: Despite growing awareness of neurodevelopmental impairments in children with congenital heart disease (CHD), there is a lack of large, longitudinal, population-based cohorts. Little is known about the contemporary neurodevelopmental profile and the emergence of specific impairments in children with CHD entering school. The performance of standardised screening tools to predict neurodevelopmental outcomes at school age in this high-risk population remains poorly understood. The NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC) trial randomised 1371 children <2 years of age, investigating the effect of gaseous nitric oxide applied into the cardiopulmonary bypass oxygenator during heart surgery. The NITRIC follow-up study will follow this cohort annually until 5 years of age to assess outcomes related to cognition and socioemotional behaviour at school entry, identify risk factors for adverse outcomes and evaluate the performance of screening tools. Methods and analysis: Approximately 1150 children from the NITRIC trial across five sites in Australia and New Zealand will be eligible. Follow-up assessments will occur in two stages: (1) annual online screening of global neurodevelopment, socioemotional and executive functioning, health-related quality of life and parenting stress at ages 2–5 years; and (2) face-to-face assessment at age 5 years assessing intellectual ability, attention, memory and processing speed; fine motor skills; language and communication; and socioemotional outcomes. Cognitive and socioemotional outcomes and trajectories of neurodevelopment will be described and demographic, clinical, genetic and environmental predictors of these outcomes will be explored. Ethics and dissemination: Ethical approval has been obtained from the Children’s Health Queensland (HREC/20/QCHQ/70626) and New Zealand Health and Disability (21/NTA/83) Research Ethics Committees. The findings will inform the development of clinical decision tools and improve preventative and intervention strategies in children with CHD. Dissemination of the outcomes of the study is expected via publications in peer-reviewed journals, presentation at conferences, via social media, podcast presentations and medical education resources, and through CHD family partners.Trial registration numberThe trial was prospectively registered with the Australian New Zealand Clinical Trials Registry as ‘Gene Expression to Predict Long-Term Neurodevelopmental Outcome in Infants from the NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC) Study – A Multicentre Prospective Trial’. Trial registration: ACTRN12621000904875