Closed Drainage System Research Articles

Chronic Subdural Hematoma (CSH) is Still an Important Clinical Problem. Analysis of 700 Consecutive Patients.

BackgroundChronic subdural hematoma (CSH) is still an important neurosurgical problem and the number of patients increases despite the progress in early diagnosis of cerebral lesions.MethodologyWe analyzed a group of 700 consecutive patients treated in neurosurgical departments for CSH. Clinical state on admission was evaluated according to the Markwalder scale, all patients had CT studies and were operated using craniotomy or burr holes with closed system drainage techniques.ResultsMore than 50% had extensive intracranial bleeding, almost half of the patients were treated with oral anticoagulants. The patients with extensive fresh bleeding were in significantly worse states on admission and were treated by craniotomy and external capsulectomy (42%). All the others had burr holes and closed system drainage of the subdural space. Results of treatment were acceptable, 2% died, and 1.5% remained vegetative, due to massive hemorrhage and severe neurological deficits on admission.ConclusionsDespite a progress in diagnosis, CSH still remains an often cause of severe intracranial complications. The rising number of occurrences of this lesion is strictly connected with a wide use of oral anticoagulants. Surgical removal of CSH still remains the best type of treatment for such lesions.

Closed Drain Transfer Pump Failure Analysis using Root Cause Failure Analysis (RCFA) Method

Maintenance is a process carried out to maintain the reliability of individual/group assets. Positive displacement type pumps are commonly used in closed drainage systems as transfer pumps in oil and gas processing plants. However, there are times when the pump fails which requires further effort to prevent the failure from recurring. Efforts that can be made to overcome this are using the method of Analysis of the Root Failure (Root Cause Failure Analysis). The RCFA method uses recollection of evidence related to design, procurement, and operation of a tool to find root causes and latent causes of problems. As a result of gaps found between the design process, procurement which leads to the root cause of pump failure, this study recommends pump-operating companies to pay more attention to piping installation to support pump performance and coordination between owner, design, and procurement to prevent this failure from recurring.

Chronic Subdural Hematoma - A Dilemma to Put Drain

Background: A chronic subdural hematoma (CSDH) is a collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura for more than 21 days. The elderly patients are more likely to develop a subdural hematoma, particularly from trivial trauma. CSDHs have been evacuated by burr holes, twist-drill craniotomies and craniotomies. The treatment of chronic subdural haematoma by burr hole drainage has been performed usually without using a closed drainage system, the problem of intracranial air entrapment still persists and can cause a deterioration in the level of consciousness or seizures in the postoperative period. We wanted to compare the effects of patient with drain and those without drain.
 Objectives: our study is to compare the clinical outcome of CSDH with or without drain.
 Methods: This prospective study was carried out at CMH Dhaka from January 2017 to July 2018; total 70 cases were investigated for the effectiveness of subdural drain. Cases were randomly allocated in two groups. Data were collected by specially designed questionnaire and analyzed by SPSS.
 Results and Observation: 70 patients of CSDH were included in this study out of which 25 underwent burr hole with closed system drainage and 45 underwent burr hole without closed system drainage. They were divided into Group A and B, respectively. Among the total number of patients 14 (20%) had shown recurrence. Out of 14 patients, 12 belong to Group B (86 %) and 2 belong to Group a (14 %).
 Conclusion: It is concluded that, those with a closed system drainage recurrence rate is significantly lower than with burr-hole evacuation alone.
 Bang. J Neurosurgery 2019; 9(1): 26-32

Risk Factors for Recurrence of Chronic Subdural Hematoma: A Single Center Experience

Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a substantial recurrence rate. We aimed to investigate the predictive factors for the postsurgical recurrence of CSDH. We retrospectively reviewed the medical records of patients with CSDH who underwent surgery in West China Hospital between January 2012 and June 2018. Univariate and multivariate analyses were performed to identify the relationships between recurrence of CSDH and factors such as age, sex, history of injury, Markwalder grading, computed tomography findings, surgical methods, and outcomes. A total of 328 patients (281 men and 47 women) aged 22-93 years (mean age, 65.14 ± 13.76 years) were included. Computed tomography findings at admission showed mixed density hematoma in 136 patients, isodensity hematoma in 140, high-density hematoma in 34, and low-density hematoma in 18. The mortality and recurrence rate were 0.30% (1 of 328) and 2.44% (8 of 328), respectively. Six months postoperatively, 327 patients had Markwalder grade 0. Hematoma recurred in 8 patients of which 7 were mixed density hematoma and 1 was isodensity hematoma. Six patients who underwent craniotomy had thickened inner neomembrane that was resected. Univariate and multivariate analyses found mixed density hematoma to be an independent risk factor for the recurrence of CSDH. Burr hole craniostomy with irrigation and closed-system drainage is effective for the surgical treatment of CSDH. Mixed density hematoma is an independent predictor for the recurrence of CSDH. Presence of thick inner neomembrane might be the primary cause of CSDH recurrence.

Volume and Midline Shift as Preoperative Computed Tomography Imaging Predictors of Postoperative Chronic Subdural Hematoma Recurrence: Retrospective Review of 345 Patients With 412 Operative Subdural Sides

Abstract INTRODUCTION The treatment and management of chronic subdural hematoma (cSDH) is highly variable, with recurrent surgery resulting in increased elderly morbidity, and economic burden to patients and the healthcare system. By conducting a retrospective review of patients with cSDH who underwent evacuation, we will provide a better understanding of predictive factors of recurrence, thereby optimizing a surgeon's management and treatment. METHODS We conducted a retrospective review of 345 patients with a total of 412 sides of cSDH, who received either burr-hole craniostomy or a craniotomy with closed system drainage. We reviewed the immediate preoperative and postoperative computed tomography (CT) scan, and defined recurrence as repeat surgical intervention on the side of initial evacuation. We performed a per-patient and per-side analysis of the collected data. RESULTS A total of 49 (11.9%) patients and 51 sides (12.4%) experienced a recurrent cSDH requiring re-evacuation. In the per-patient analysis, the preoperative hematoma volume [CI 1.082 (1.013-1.155)] and midline shift at the third ventricle [CI 1.118 (1.1028-1.215)] were predictors of recurrence. This was also observed in the per-side analysis at CI 1.088 (1.021-1.159) and CI 1.130 (1.045-1.222), respectively. On the per-patient side, comorbidities (diabetes, liver disease, alcohol abuse, antiplatelet/anticoagulant medication) and other demographic factors (gender, age) were not linked to recurrence. If a patient had a bilateral hematoma and both sides were operated on, it was found to be protective of recurrence with a CI of 0.111 (0.025-0.486). CONCLUSION Larger preoperative volumes and a greater midline shift significantly increased the risk of re-evacuation for cSDH, while other demographic and CT characteristics did not. Therefore, this may represent that a high-risk subgroup can be used as a target for preventative therapy.

Randomized Controlled Trial to Reduce Bacterial Colonization of Surgical Drains with the Use of Chlorhexidine-Coated Dressings After Breast Cancer Surgery.

Breast surgery is considered a clean surgery. However, surgical-site infection (SSI) rates are currently higher than predicted. Postoperative drains remain in situ for several days, with inevitable bacterial colonization and increased SSI risk. This randomized controlled trial from October 2016 to January 2018 analyzed patients undergoing breast cancer surgery. The patients were randomized to either the standard drain care group or the antiseptic dressing group (3M® Tegaderm® CHG). Drain samples taken on postoperative days (PODs) 7 and 14 were cultured as standardized in the laboratory. Colonization rates and SSI were compared between the two groups. The study enrolled 104 patients with 167 surgical drains. The patients' clinical characteristics were similar in the two groups, with no statistically significant differences. Bulb fluid cultures at postoperative week (POW) 1 were positive for 42.9% of the control group and 28.9% of the antiseptic group (p = 0.06). Cultures from the POW 2 assessment were positive for 79.7% of the control group versus 54.9% of the antiseptic group (p = 0.001). Cultures from drain tubes were positive for 79.8% of the control group and 50.7% of the antiseptic group (p = < 0.001). In 11 patients, an SSI developed, 3 (5.8%) from the intervention and 8 (15.4%) from the control procedure (p = 0.11). The study findings demonstrated that the use of antiseptics at the drain exit site significantly reduced bacterial colonization of the closed drainage system in breast cancer surgery. Semi-permeable occlusive chlorhexidine-impregnated dressings provide an opportunity to test simple, safe, and low-cost interventions that may reduce drain bacterial colonization and SSI after breast surgery.

Efficacy of Trauma Catheter and Mushroom Tip Catheter in Evacuation of Chronic Subdural Hematoma and Complications of Drain Placement.

ObjectiveThe aim of this study was to assess the efficacy and complications of trauma catheter versus mushroom tip catheter placement in the evacuation of chronic subdural hematoma via twist drill craniostomy with closed system drainage.BackgroundChronic subdural hematoma (cSDH) is one of the most frequent neurosurgical pathologies in patients >70 years of age with an estimated incidence of 8.2 per 100,000 people per year. The most common risk factors for cSDH are advanced age, alcohol abuse, seizures, cerebrospinal fluid (CSF) shunts, coagulopathies, blood thinners, and patients at risk for falling. Twist drill craniostomy can be performed at the bedside under local anesthesia, making it an attractive treatment option, especially in poly-morbid patients who are poor surgical candidates. A closed drainage system is placed at the time of surgery to allow continuous drainage and promote postoperative brain expansion. Despite the increasing prevalence, limited literature exists to guide surgical management, particularly in terms of drain management and selection of catheter. MethodsThis is a retrospective review of 205 patients from January 2007 to May 2017 at two-level high volume centers for the evaluation and treatment of cSDH. Inclusion criteria include patients >18 years of age with the radiographic presence of a subdural hematoma for greater than three weeks. All patients were managed with either a trauma catheter or mushroom tip catheter. All patients received computed tomography (CT) of the head without contrast prior to subdural drain placement and within 24 hours after subdural drain removal. Exclusion criteria include patients <18 years of age and patients with depressed skull fractures, vascular malformations, subdural empyema, subdural hygroma, or who initially underwent open craniotomy or burr-hole craniotomy.ResultsDrain efficiency in evacuating the cSDH was assessed using both radiographic and clinical markers. Analysis of 205 patients treated by twist drill craniostomy and the subsequent closed system drainage utilizing either the mushroom tip catheter or trauma catheter revealed that neither catheter was superior in producing a statistically significant change in the maximum thickness of the cSDH (p = 0.35) and midline shift (p = 0.45). Furthermore, when assessing patients clinically via utilization of the Glasgow Coma Scale (GCS), both the trauma catheter and the mushroom catheter did not show a statistically significant difference in improving GCS after the evacuation of the cSDH (p = 0.35). Neither catheter was associated with an increased incidence of hemorrhage with drain placement requiring open surgery (p = 0.12), need for additional drain placement (p = 0.13) or decline in GCS with intervention (p = 0.065).ConclusionAnalysis of the 205 patients treated by twist drill craniostomy with closed system drainage for the evacuation of chronic subdural hematoma utilizing either the mushroom tip or trauma catheters revealed that neither catheter was statistically significant in radiographic or clinical improvement in evacuating cSDH. Furthermore, neither catheter was found to be associated with an increased complication risk.

Prevention of catheter-associated urinary tract infection in neurological post-operation patients: a best practice implementation project

The objective of this evidence based implementation project was to promote evidence based practice in the prevention of catheter-associated urinary tract infection (CAUTI) in the neurology and neurosurgery units of a Taipei hospital. Catheter-associated urinary tract infection has been associated with increased morbidity, mortality, hospital costs and length of stay. Urinary drainage systems are often reservoirs of infection in patients, thus effective prevention of CAUTI requires an evidence-based approach. The CAUTI incidence in the neurosurgery units of the hospital was 1.86-2.69% urinary catheter days, which ranked as medium when compared to the entire hospital. A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool, based on eight audit criteria that represented best practice recommendations for CAUTI. A baseline audit of the neurology and neurosurgery units was performed, followed by the implementation of multiple strategies throughout a 20-week period. A follow-up audit was undertaken after this to assess changes in practice. The post strategy implementation audit results indicated that compliance with clinical guideline recommendations improved considerably. Proper utilization of an appropriate closed drainage system and training of persons maintaining catheters achieved 100% compliance. The guideline recommendation that catheter and drainage bags be changed only when clinically indicated reached 94% compliance. Catheters removed within 24 hours postoperatively improved by more than 50% compliance. Compliance with systemic antimicrobials being clinically indicated and their use justified improved by 25% and documentation on a clinically appropriate indication for ongoing urinary catheterization improved by almost 33.3%. The implementation project was successful in improving nurses' knowledge and skills related to the prevention of CAUTI. A variety of strategies, such as an education program, simple and clear instruments, collaboration with physicians in caring for patients with a high risk of CAUTI, and multiple educational materials can facilitate implementation of evidence based procedures in clinical practice.

DRESSINGS INDICATED IN THE TREATMENT OF MEDIASTINITIS AFTER CARDIAC SURGERY: INTEGRATIVE REVIEW

ABSTRACT Objective: identify and describe which dressings are recommended in the treatment of mediastinitis after cardiac surgery in adult patients. Method: integrative review held in the databases MEDLINE/PubMed, LILACS, CINAHL, Web of Science, Cochrane, SCOPUS and manual search, between December 2017 and January 2018. It was selected studies on dressings used in the treatment of mediastinitis after cardiac surgery. Results: eight articles were included: three addressed the treatment of negative pressure wounds and reported that most of the patients analyzed were successful in treatment, reducing the need for other interventions; four compared the previous therapy with conventional dressings and concluded that the rates of sternal reinfection and hospital mortality were lower in the first group; and one compared vacuum assisted therapy with a closed drainage system and lower rates of sternal reinfection were seen in the group undergoing vacuum treatment. Conclusion: the evidence indicates that the use of vacuum therapy to treat mediastinitis after cardiac surgery was effective. However, despite the positive outcome, clinical trials with strict methodological description and significant samples are suggested to minimize the risk of bias and to evaluate the impact of dressings in the treatment of mediastinitis.

A Clinical Analysis to Detect Risk Factors of Chronic Subdural Hematoma Recurrence

Introduction: The etiology of recurrence of chronic subdural hematoma (CSDH) after surgical evacuation has not been completely understood until now, but several risk factors for recurrence have been reported. Meanwhile, the definitive risk factors have not been defined until now. Aim of Study: Analyze the potential risk factors, and emphasize preoperative, operative and post-operative ones for CSDH recurrence. Patients and Methods: This study is a prospective randomized clinical trial study including 82 patients with symptomatizing CSDH who underwent burr holes procedure and irrigation with closed system drainage for CSDH at Neurosurgical Department—Assuit University Hospital from July 2016 to July 2018. The possible factor studied for recurrence included age, hypertension, diabetes mellitus, liver diseases, Hemoglobin (Hb) level, prothrombin concentration and time (PC and PT), hematoma thickness and internal architecture, number of burr holes and position of drain, duration of drainage, amount of drainage and presence of postoperative residual hematoma on follow up CT brain. Multiple logistic regression analysis is used to assess the predictors of recurrence. Results: This study included 70 males and 12 females. The mean age was 58.9 years (range 34 - 93 years). 6 patients presented with recurrent CSDH. Age above 60 years, Hypertension, Diabetes mellitus (DM), prolong PT, separated and trabecular internal architecture of hematoma, and the thickness of hematoma more than 20 mm in pre-operative CT and postoperative residual hematoma were statistically significant factors for recurrence of CSDH. Conclusion: This information might be helpful in detecting patients with possible high incidence of recurrence and directing for close follow ups and acts that may reduce the incidence of recurrence.

Burr Hole Drainage versus Small Craniotomy of Chronic Subdural Hematomas.

ObjectiveChronic subdural hematoma drainage is one of the most common procedures performed in neurosurgical practice. Not only burr hole drainage but also small craniotomy (diameter 3–5 cm) is frequently used neurosurgical treatment of chronic subdural hematomas. We assessed to compare the postoperative recurrence rates between burr hole drainage versus small craniotomy with closed-system drainage for chronic subdural hematomas.MethodsFrom January 2016 to December 2018, 75 patients who were treated with burr hole drainage and small craniotomy with closed system drainage for the symptomatic chronic subdural hematoma were enrolled. Pre and postoperative computed tomography (CT) were used for radiologic evaluation. The choice of procedure was decided by preoperative CT images.Results60 patients out of 75 patients underwent burr hole drainage, whereas 15 patients underwent small craniotomy. The overall postoperative recurrence rate was 16%. The recurrence occurred in 8 patients out of 60 patients in burr hole drainage group (13.3%) and 7 patients out of 15 patients in small craniotomy group (46.7%). The number of days of hospitalization was 10.3 days in burr hole drainage group and 15.7 days in small craniotomy group.ConclusionBurr hole drainage would be sufficient to evacuate chronic subdural hematoma with lower recurrence rate, but small craniotomy was also needed in some cases such as hematoma has solid portion or multiple septum.

Sitting position awake craniostomy with drainage for chronic subdural hematoma: A viable alternative?

Background/Aim. Chronic subdural hematoma (CSDH) is one of the most frequent neurosurgical conditions with an overall incidence ranging from 1.72 to 20.6 per 100,000 persons per year. The surgical procedure for CSDH is relatively simple and usually performed in the supine position. Reported reoccurrence rates range from 11.7% to 28%. Postperative pneumocephalus was previously identified as a sole predictor of reoccurrence. The aim of this study was to assess the advantage of the procedure in the sitting position in patients with CSDH and a possible impact on the reoccurrence rate. Methods. The study included 31 patients who underwent awake craniostomy with closed system drainage for CSDH (16 in supine and 15 in sitting position) in our department from December 2016 to March 2018. Results. A total of 22 males and 9 females were included in the study. The overall reoccurrence rate was 19% (22% and 18% in females and males, respectively). The re-occurrence was noted in 5 patients who had undergone surgery in the supine position, and in one case in the sitting position. Our results revealed a lower reoccurrence rate in patients undergoing surgery in the sitting position, although not reaching statistical significance [odds ratio (OR): 0.18, 95% confidence interval: 0.01?1.42, p = 0.172]. Conclusion. Craniostomy in the sitting position under local anesthesia is a safe, simple, and reliable procedure for CSDH treatment. Besides being very comfortable for the patient, according to our initial results, it might also lead to a lower reoccurrence rate, probably due to the better management of the air inflow, and consequent pneumocephalus.

An In Vitro Bladder Model for Studying Catheter-Associated Urinary Tract Infection and Associated Analysis of Biofilms.

Urethral catheters are among the most widely used medical devices, applied to manage a wide range of conditions in hospital, community, and care home settings. In long-term catheterized individuals, infection with Proteus mirabilis frequently complicates the care of patients owing to formation of extensive crystalline biofilms. Here we describe the use of an in vitro bladder model of the catheterized urinary tract and associated analyses to study P. mirabilis crystalline biofilm formation. The model originally described by Stickler et al. (1999, 310:494-501, Methods Enzymol) replicates a complete sterile closed drainage system as used in clinical practice, and permits formation of biofilms directly on catheters under conditions representative of those encountered in vivo. Models may be used to replicate either established infection or early stage colonization, and we describe a range of associated methods for quantification and visualization of biofilms formed on catheters. These methods are also easily adapted to study catheter-associated biofilm formation by other urinary tract pathogens.

The rate of re-operation in patients with chronic subdural hematoma

Background:&#x0D; Chronic subdural hematoma is a collection of liquefied blood between the dura and arachnoid layer of the brain which thought to result from injury to bridging veins crossing the subdural space. Patients with chronic subdural haematomas can present in a variety of ways, and symptom onset and progression may range from days to weeks. Surgical approach with standard methods is still controversial.&#x0D; Objective: to compare patients outcome following two surgical approaches with or without closed system drainge. &#x0D; Patients and methods: The present prospective cohort study included 40 patients with subdural hematoma throughout the period extending from January 2010 to August 2014. Two bur hole craniostomies (12 mm in diameter) were made in each patients; one in front of the coronal suture and the other behind the hematoma and the procedure was done without membranectomy. In 15 cases, closed system drainage was placed into the hematoma cavity for an average of 2 days (1 to 3 days) after irrigation with physiologic saline solution.&#x0D; Results: The outcome after operation was as following: 5 out of 25 patients in the first group needed re-operation accounting for a rate of (20%). The rate was slightly lower in the second group; 2 out of 15 (13.3%). The difference in rate of re-operation was not significant (P&gt; 0.05)&#x0D; Conclusion: The use of subdural closed drainage system is not superior to drainage and simple closure in treatment of chronic subdural hematoma.&#x0D;

Chronic Subdural Hematoma Prognostic Factors for Recurrence

AbstractBackground: Chronic Subdural Hematoma (CSDH) is a common neurologic disease in elderly. It is not always a benign condition because high recurrence rate had been reported. Independent risk factors for CSDH recurrence, especially the surgical and post-operative factors, had not been sufficiently investigated.Aim of Study: To evaluate the outcome of CSDH after burr hole craniostomy and irrigation with closed system drainage, and to analyze the potential risk factors, emphasizing surgical and post-operative ones, for CSDH recurrence and comparing the results to others mentioned in literature.Methods: We retrospectively analysed data of 82 CSDH patients treated by burr hole(s) craniostomy and irrigation with close system drainage CSDH in Assuit University Hospital from July 2015 to July 2016.Results: Of these CSDH patients, the main age was 58.9 years and 85.4% were males. The CSDH recurrence rate after burr-hole craniostomy was 7.3% in our hospital. CSDH recurrence was significantly associated with diabetes mellitus (p=0.027), hypertension (p=0.021) and prolonged PT (p= 0.025). Moreover an increased CSDH recurrence rate was observed in the patient group that had a mixed type (p=0.047), separated (p=0.044), trabecular (p=0.025) and hematoma thickness more than 20mm (p=0.34) of the CSDH in the preoperative diagnostic imaging .Also there were increased recurrence rate in patients group that had postoperative residual hematoma (p<0.001).Conclusion: We found diabetes mellitus, hypertension, prolonged PT, mixed type hematoma, separated, trabecular internal architecture of hematoma, thickness of hematoma 20mm and post-operative residual hematoma independently predict recurrence of CSDH after burr hole(s) craniostomy. The patients with these risk factors may need closer surveil-lance post-operatively.

Chronic Subdural Hematoma: Surgical Management and Outcome in Newly Established Neurosurgical Unit: Experience of 78 Patients Operated over 1 Year

Objective: Chronic subdural hematoma (CSDH) has an increasing incidence and results in high morbidity and mortality. With the increasing age, the number of the elderly patient is coming frequently with symptoms of headache and hemiparesis. We review here the 1-year experience of a single institution and the literature regarding the treatment and major associations of CSDH and some patients with subacute subdural hematomas. Materials and Methods: Analysis of 78 cases of Chronic SDH operated in department of Neurosurgery for a period of one year. Burr-hole evacuation with and without closed system drainage has been the operative technique of the first choice at our institution for 4 consecutive years. Results: Our results indicated that neurological status on admission was the best predictor of outcome. The use of the drain had a significant reduction in the recurrence rates. With regard to the other data, age, brain atrophy, thickness and density of hematoma, subdural accumulation of air, and antiplatelet and anticoagulant therapies were found to correlate significantly with prognosis. Conclusions: Burr-hole evacuation is a relatively safe and effective first-line management option. All cases were operated under local anaesthesia. The patients had excellent recovery postoperatively. The recurrence rate is not associated with the use of a drain after burr-hole evacuation of a CSDH, proper irrigation, and closure reduce complications.

How to Treat Chronic Subdural Hematoma? Past and Now.

Treatment of chronic subdural hematoma (CSDH) is relatively straightforward, however, there is still some debate regarding the best strategy for treatment. The most practical recommendations of up to date were identified by a review of literature. The author reviewed the literature on CSDH management from the past to now to identify the best methods. Till 1970s, craniotomy was the most commonly used method. Burr hole (BH) became the most preferred method from 1980s. In 1977, twist drill (TD) craniostomy was introduced. Closed system drainage after a BH or a TD became the most frequently used surgical method. Although nonsurgical treatment is often successful, trephination has more advantages, such as rapid resolution of the symptoms and short period of hospitalization. Nonsurgical treatment is possible in asymptomatic patients with a small CSDH. For the symptomatic patients with CSDH, trephination is the treatment of choice, either by BH or TD. In gray zone between surgery and medical treatment, shared decision making can be an ideal approach. For the recurrent CSDHs, repeated trephination is still effective for patients with a low risk of recurrence. If the risk of recurrence is high, additional management would be helpful. For the refractory CSDHs, it is necessary to obliterate the subdural space.

Community diagnosis for a slum population under the field practice area of a government medical college, New Delhi: community-oriented primary care exercise for undergraduate students

Background: Rapid urbanization has led to the increase in a group of people called ‘Urban poor’ dwelling as a community in ‘Slums’, worldwide. Slums manifest deprivation that transcends income poverty. Hence, we conducted this Community-oriented primary care (COPC) exercise, to give medical students a greater understanding of the situation of individual patients in the slum and to formulate a community diagnosis.Methods: The current study was done at Tyagaraj Nagar Jhuggi in the South district of New Delhi, during Community-oriented primary care (COPC) exercise of undergraduate medical students in their 4th semester over a period of 20 days, using a predesigned proforma for collecting data on health events and determinants of health, from families. 35 households were chosen by systematic random sampling.Results: Out of 179 community members studied, 33 (18.43%) were afflicted with morbidity, which consists of common cold with cough, generalized body pain and joint pain. The sex ratio was found to be 826, literacy rate was 76.9% in the study area, 44.11% of the households were having sanitary latrines owned by them, 68.6% had a closed drainage system 63% of the families used clean fuel for cooking and unmet need of contraception was 85% among eligible couples.Conclusions: Investments in women’s access to various contraceptive preferences are urgently needed to help increase the contraceptive prevalence rate. Health Education and awareness campaigns on prevention of potential mosquito, fly breeding sites, hand hygiene, avoidance of firewood as fuel, establishing smoke outlet and solid waste management should be arranged.

Drains Are Not Beneficial in Primary Shoulder Arthroplasty.

The purpose of this study was to determine if clinical differences exist between closed drainage use in primary shoulder arthroplasty and postoperative complications. A retrospective review was performed of all primary total shoulder and reverse total shoulder arthroplasty procedures at the authors' institution during a 2-year period. A total of 378 of 636 shoulder arthroplasty patients met inclusion criteria. Drains were used in 111 patients. The authors did not identify a significant relationship between drain use and postoperative complications. When complications were stratified just by the presence or absence of risk factors, irrespective of whether a drain was used, no significant relationship was identified. This study does not support the routine use of closed drainage systems in primary shoulder arthroplasty, including for patients with risk factors for potentially developing postoperative complications. [Orthopedics. 2019; 42(1):e29-e31.].

The effect of daily change of sterile urinary bag on bacteriuria and catheter–associated urinary tract infections

Introduction: One of the major healthcare measures in hospitals, is reducing the risk of infections. Since catheter-associated urinary tract infections (CA-UTIs) occur in 80% of cases, the prevention of these infections plays an important role in reducing infections related to the treatment care. Objectives: The present study aims to determine the effect of daily change of sterile urinary bag on the incidence of bacteriuria and CA-UTIs. Patients and Methods: This quasi-experimental study include all patients referred to the neurology, urology and surgery wards, as well as the ICU and CCU of Hajar and Kashani hospitals, Shahrekord, Iran. A total of 200 patients aged 18-75 years that required insertion of the urinary Foley catheter were divided into two groups: catheterization with the usual method (control group) and catheterization with daily change of sterile urinary bag (case group). In each of the two groups, immediately after insertion and during the removal of urethral catheter, the urine sample was collected using sterile method and was sent to the laboratory to conduct examinations for bacteriuria. The demographic information was prepared and collected using the researcher made questionnaire. Results: In this study, the average age of the patients was 49.81±15.11. The rate of CA-UTI was more in the control group than the case group (29% as compared with 16%) (P=0.04). The average age of patients with infection due to urethral catheterization was found to be higher (55.4±14.52 versus 48.4±14.92) (P<0.001). Conclusion: While a preference for closed drainage system existed, however in the present study, it was found that with daily change of sterile urinary bag even with opening of system, the rate of CA-UTI was reduced