Use of diagnosis codes and/or wound culture results for surveillance of surgical site infection after mastectomy and breast reconstruction

We compared surveillance of surgical site infection after major breast operations using a combination of ICD-9-CM diagnosis codes to microbiology-based surveillance. The sensitivity was 87.5% for the coding algorithm and 78.1% for wound cultures. Our results suggest that SSI surveillance can be reliably performed using claims data

An intergenerational transmission of sustainability?:ancestral habitus and food production in a traditional agro-ecosystem of the Upper Guinea Forest, West Africa

The need for sustainable alternatives to industrial farming has led to a revival of interest in traditional agro-ecosystems. Whilst it is well recognised that traditional agro-ecosystems are both social and physical–technical – few case studies have examined interactions between both these dimensions in a single system. For a system to be considered sustainable it needs to be shown to have retained key characteristics over several generations. Case studies therefore demand a location where intergenerational transmission of agro-ecological knowledge and practice is ongoing. This paper examines the intergenerational transmission of social and physical–technical dimensions of a traditional agro-ecosystem of the Loma people in NW Liberia. We engage an innovative interdisciplinary combination of methodologies in analyzing interactions between: (i) energy efficiencies (yield to labour) in 3 different Loma food production systems, using longitudinal quantitative surveys, and, (ii) the social institutions that mediate food production practice, using qualitative methods. Our energy efficiency calculations show that AfDE cultivation is more than twice as efficient at producing calories as either shifting cultivation or forest and river extractivism, yet GPS mapping demonstrates that AfDE cultivation is highly spatially restricted despite clear opportunities for expansion and optimisation. This raises an important question: why have the Loma not expanded AfDE cultivation? We propose that despite being fully aware of the opportunities AfDEs present, a Loma ‘ancestral habitus’ and substantive economic rationality restrict areal expansion and optimisation of AfDE cultivation, curtailing growth and structuring a social-ecological system in dynamic equilibrium. Our findings underline that sustainability is not simply a physio-technical issue; social and belief issues appear to be far more important in framing behaviour in traditional agro-ecosystems

Prevalence and predictors of postdischarge antibiotic use following mastectomy

OBJECTIVESurvey results suggest that prolonged administration of prophylactic antibiotics is common after mastectomy with reconstruction. We determined utilization, predictors, and outcomes of postdischarge prophylactic antibiotics after mastectomy with or without immediate breast reconstruction.DESIGNRetrospective cohort.PATIENTSCommercially insured women aged 18–64 years coded for mastectomy from January 2004 to December 2011 were included in the study. Women with a preexisting wound complication or septicemia were excluded.METHODSPredictors of prophylactic antibiotics within 5 days after discharge were identified in women with 1 year of prior insurance enrollment; relative risks (RR) were calculated using generalized estimating equations.RESULTSOverall, 12,501 mastectomy procedures were identified; immediate reconstruction was performed in 7,912 of these procedures (63.3%). Postdischarge prophylactic antibiotics were used in 4,439 procedures (56.1%) with immediate reconstruction and 1,053 procedures (22.9%) without immediate reconstruction (P&lt;.001). The antibiotics most commonly prescribed were cephalosporins (75.1%) and fluoroquinolones (11.1%). Independent predictors of postdischarge antibiotics were implant reconstruction (RR, 2.41; 95% confidence interval [CI], 2.23–2.60), autologous reconstruction (RR, 2.17; 95% CI, 1.93–2.45), autologous reconstruction plus implant (RR, 2.11; 95% CI, 1.92–2.31), hypertension (RR, 1.05; 95% CI, 1.00–1.10), tobacco use (RR, 1.07; 95% CI, 1.01–1.14), surgery at an academic hospital (RR, 1.14; 95% CI, 1.07–1.21), and receipt of home health care (RR, 1.11; 95% CI, 1.04–1.18). Postdischarge prophylactic antibiotics were not associated with SSI after mastectomy with or without immediate reconstruction (bothP&gt;.05).CONCLUSIONSProphylactic postdischarge antibiotics are commonly prescribed after mastectomy; immediate reconstruction is the strongest predictor. Stewardship efforts in this population to limit continuation of prophylactic antibiotics after discharge are needed to limit antimicrobial resistance.Infect Control Hosp Epidemiol2017;38:1048–1054</jats:sec

Know your HIV epidemic (KYE) report: review of the HIV epidemic in South Africa.

In order to update and consolidate South Africa’s evidence base for HIV-prevention interventions, it was decided by the Government of South Africa to commission a synthesis of the available data on the epidemiology of prevalent and incident HIV infections, and the wider epidemic context of these infections. This know your epidemic (KYE) approach has been successfully implemented in a number of sub-Saharan African countries.2 The process involves a desk review and secondary analysis of existing biological, behavioural and socio-demographic data in order to determine the epidemiology of new HIV infections. KYE reports present key findings and policy and programme recommendations which are grounded in local evidence and aim to support decision-making and improve HIV-prevention results. In 2010, South Africa also conducted a know your response (KYR) review, which critically assessed HIV-prevention policies, programmes and resource allocations. The overall results of this HIV epidemic review and the KYR review will be published in a separate, national KYE/KYR synthesis report

Validation of ICD-9-CM diagnosis codes for surgical site infection and noninfectious wound complications after mastectomy

BACKGROUNDFew studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy.OBJECTIVESTo determine the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in health insurer claims data to identify SSI and noninfectious wound complications, including hematoma, seroma, fat and tissue necrosis, and dehiscence, after mastectomy.METHODSWe reviewed medical records for 275 randomly selected women who were coded in the claims data for mastectomy with or without immediate breast reconstruction and had an ICD-9-CM diagnosis code for a wound complication within 180 days after surgery. We calculated the positive predictive value (PPV) to evaluate the accuracy of diagnosis codes in identifying specific wound complications and the PPV to determine the accuracy of coding for the breast surgical procedure.RESULTSThe PPV for SSI was 57.5%, or 68.9% if cellulitis-alone was considered an SSI, while the PPV for cellulitis was 82.2%. The PPVs of individual noninfectious wound complications ranged from 47.8% for fat necrosis to 94.9% for seroma and 96.6% for hematoma. The PPVs for mastectomy, implant, and autologous flap reconstruction were uniformly high (97.5%–99.2%).CONCLUSIONSOur results suggest that claims data can be used to compare rates of infectious and noninfectious wound complications after mastectomy across facilities, even though PPVs vary by specific type of postoperative complication. The accuracy of coding was highest for cellulitis, hematoma, and seroma, and a composite group of noninfectious complications (fat necrosis, tissue necrosis, or dehiscence).Infect Control Hosp Epidemiol 2017;38:334–339</jats:sec