Patient Care Problems Research Articles

Patient-Reported Symptoms in the Hematologic Malignancies

BACKGROUND: In patients with hematologic malignancies symptoms related to the disease and its treatment remain a major problem in patient care. With the advent of new treatment including immunotherapy and targeted therapies the potential for prolonged life and additional treatment is increasing. Patient self-reported symptom burden during periods of observation and treatment are infrequently reported but highly relevant to patient care. Assessment of patient-reported outcomes may allow for improvement in the management of symptoms and communication with providers.The Symptom Inventory Tool (SIT) is an assessment tool that captures patient's perceived symptom burden for real-time clinical intervention, taken at baseline and every 21 days or greater. It is comprised of 19 questions from the validated M.D. Anderson SIT (MDASI) (Cleeland CS, Cancer 2013.) and 8 additional questions added by CTCA for additional evaluation of patient symptoms.PATIENTS & METHODS:Patients reported symptoms intensity using the SIT: 19-item MDASI and 8 additional questions added by CTCA (constipation, swelling, mouth soreness, bleeding, sexual interest, family, hope & overall QOL). Symptoms were rated "at the worst" on an 11-point numeric scale ranging from 0 (’none present") to 10 ("as bad as you can imagine") in the previous 24 hours. SIT became an integral part of patient care at CTCA beginning in 2012.RESULTS: From 2012 to 2016, a total of 230 patients diagnosed with hematologic malignancies were evaluated at CTCA-ERMC. 108 patients that had two or more SIT data points were selected for analysis. A total of 830 assessments were analyzed. The assessments consisted of 108 completed at baseline, 107 completed at the 2nd follow-up, and 613 at 3rd follow-up or greater. Median age was 51 years (range, 18-78). Race: white (65%) black (32%) and other (2%). The average time since diagnosis was 41 months, and 32% of the patients had received prior systemic therapy. Table 1 shows the 5 most reported symptoms of entire sample with approximately 30% reported improvement from the baseline to the second assessment. Table 2 shows a subset of 35 patients that reported severe scores of > 8 for five symptoms that had clinically significant improvement from baseline to 2nd assessment.CONCLUSIONS: The SIT was successful in identifying symptom burden and interference with life issues in patients with hematologic malignancies. Early identification of patient symptom burden may allow for faster intervention and improvement in patient outcomes. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

A pilot study exploring the relationship between lifelong learning and factors associated with evidence-based medicine.

ObjectivesTo explore possible relationships between residents’ lifelong learning orientation, skills in practicing evidence-based medicine (EBM), and perceptions of the environment for learning and practicing EBM. MethodsThis was a pilot study with a cross-sectional survey design. Out of 60 residents in a medical residency program, 29 participated in the study. Data were collected using a survey that comprised three sections: the JeffSPLL Scale, EBM Environment Scale, and an EBM skill questionnaire. Data were analyzed using SPSS and were reported with descriptive and inferential statistics (mean, standard deviation, Pearson’s correlation, and a two-sample t-test). ResultsMean scores on the JeffSPLL Scale were significantly correlated with perceptions of the EBM Scale and use of EBM resources to keep up to date or solve a specific patient care problem. There was a significant correlation between mean scores on the EBM Scale and hours per week spent in reading medical literature to solve a patient care problem. Two-sample t-tests show that residents with previous training in research methods had significantly higher scores on the JeffSPLL Scale (p=0.04), EBM Scale (p=0.006), and self-efficacy scale (p =0.024). ConclusionsGiven the fact that physicians are expected to be lifelong learners over the course of their professional career, developing residents’ EBM skills and creating interventions to improve specific areas in the EBM environment would likely foster residents’ lifelong learning orientation.

A pilot programme of clinical practice improvement for future consultant doctors.

To provide junior doctors with tools to improve patient care in their workplace, a partnership was developed between the Clinical Excellence Commission (CEC) and the Royal Australasian College of Physicians (RACP) to help trainee consultants carry out clinical practice improvement (CPI) projects during clinical work. Based on a patient-care problem they wished to resolve, trainee consultants attended a 2-day face-to-face workshop to learn quality-improvement methods, describe their proposals and refine them using CPI methodology. They were provided with continuing supervision, participated in a mid-point review and were responsible for driving their projects. Trainee consultants attended a 2-day face-to-face workshop to learn quality-improvement methods RESULTS: Examples of five projects are: reducing mislabelled specimens leaving an emergency department, from 82 in the baseline period to 18 following the intervention; creating a multidisciplinary team to reduce hypoglycaemic episodes on a diabetic ward, from 23 episodes at baseline to three episodes over the same time period after the intervention; establishing an acute paediatric review clinic that reduced avoidable admissions of pneumonia by 74percent; providing 100percent of patients in a palliative care unit with an effective pain-management plan; developing an education package to increase staff confidence in recognising and responding to anaphylaxis in children, producing an increase in confidence from 51percent at baseline to 100percent after the intervention. Involving a learned college such as the RACP in patient-care improvement, with educational input from a partner organisation, shows how junior staff can become effective leaders in improving patient care.

A cross-sectional assessment of stress, coping, and burnout in the final-year medical undergraduate students.

Background:Medical students undergo significant stress during training which may lead to own suffering or problem in patient care. High level of burnouts and depression is also not uncommon. The transition from preclinical to clinical training has been regarded as crucial to student in relation to the stress.Methodology:An assessment of perceived stress and its relation to general psychopathology, the pattern of coping, and burnout in the final-year medical student was done to bring out clear nature, pattern, and extent of the problem.Results:Perceived stress had statistically significant association with general psychopathology and depressive-anxiety component of burnout. Acceptance, positive reframing, humor, planning, and active coping correlated with lower score on perceived stress.Conclusion:Higher score on perceived stress was associated with higher scores on general psychopathology and burnout. Age of joining MBBS course and doctor in the family did not affect the stress significantly. People who displayed positive coping strategies had lesser stress and general psychopathology.

Reconstruction of facial defects with local flaps--a training model for medical students?

IntroductionThe lack of surgeons will be a future major problem in patient care for multifaceted reasons. Niche specialties such as OMFS face an additional drawback because of the need for dual qualification. Special surgical training that gives students the opportunity to gain experience in the techniques of plastic-reconstructive surgery (PRS) has therefore been established to promote interest in OMFS.MethodsTwo hands-on courses with 8 modules of 2 h for 10 students were established. Course modules included surgical techniques of PRS, such as local flaps in a complex facial defect on pig heads, and were supervised by two OMFS surgeons. The identical initial and final tests examined theoretical knowledge and practical skills. Questionnaires concerning basic demographic data, future career goals, and perception of surgical disciplines before and after the completion of the course were handed out.ResultsThe 19 participating students (12 female, 7 male; median age 24 ± 2.24) were in their 8.31 ± 1.20 semester. Results of the tests showed improvement in knowledge following the courses (before 52.68 ± 12.64 vs. after 77.89 ± 11.37; p < 0.05). Based on the Likert scale, an increase in interest in a career in OFMS was observed (3.90 ± 1.18 vs. 2.72 ± 1.33; p < 0.05), but this was not so marked with regard to a career in a surgical discipline in general (1.93 ± 1.30 vs. 1.62 ± 1.19; p > 0.05). Perception of OMFS as a surgical discipline changed (3.68 ± 1.09 vs. 1.80 ± 0.64; p < 0.05). The following values also changed: students´ perception of PRS in OMFS (14 (74.68 %) vs. 5 (25.32 %); 19 (100 %) vs. 0 (0 %)), evaluation of PRS as a study subject for medical students (7 (36.84 %) vs. 12 (63.16 %); 19 (100 %) vs. 0 (0 %)), and the interest in an OMFS elective subject (6 (31.58 %) vs. 13 (68.42 %); 18 (94.74 %) vs. 1 (5.26 %)) and as a final clinical year subject (4 (21.05 %) vs. 15 (78.95 %); 14 (73.68 %) vs. 5 (26.32 %)).ConclusionsHands-on courses with complex facial defects can be used to gain new professionals, even in niche specialties such as OMFS. Moreover, a hands-on course design, including innovative teaching methods and structured objective tests combined with a close student-teacher relationship and motivated instructors, is able to promote complex surgical skills in PRS.

Implementation of a Nursing Peer-Review Program in the Hospital Setting.

Nursing peer review (NPR), a formal process by which nurses are referred for peer evaluation when patient care problems are identified, has gained acceptance as a method to improve nursing quality and safety. This article describes the development of a formal NPR program for acute care nurses, intended to validate and improve nursing practice. Nursing peer review is a systematic process of assessing and evaluating nursing care by peers against professional practice standards. The purpose of an NPR program is to provide a pathway whereby peers hold one another accountable for practice. Accountability is an important demonstrator of professionalism. Because nursing is a trusted profession, it is imperative that it demonstrate accountability. The NPR program was developed and implemented by a clinical nurse specialist. A literature review was conducted to assist program development including the processes of building an NPR committee and nurses for review. To trigger referrals to the NPR system, nursing indicators were identified. To diminish fear among nurses, education for staff members focused on the purpose and importance of the NPR process and the intent to strengthen practice. Nursing peer review committee members were also educated in the use of NPR principles including just culture, appreciative inquiry, and confidentiality. Upon implementation, nearly 200 referrals were received within the first 14 months; 85% met criteria for review. Nursing practice was identified as appropriate (ie, nursing actions were consistent with good practice) in 66% of the reviews. Trends in individual and system processes were identified for improvement. The clinical nurse specialist's role as NPR program coordinator provided an innovative way to impact nursing and organizational spheres of influence through program development and implementation. Future goals include sustaining/improving nursing awareness of the NPR process and identification of additional indicators to trigger review.

Managing uncertainty in diagnostic practice.

In spite of the large medical literature devoted to a discussion of the topic, uncertainty, particularly in diagnostic practice, is sometimes mishandled by clinicians. This, I will argue, can in turn lead to medical and ethical problems in patient care. Via the analysis of two recent case studies, I will propose an explanation for why this kind of uncertainty is sometimes not appropriately dealt with during the process of differential diagnosis in the clinic. Furthermore, I will also give recommendations for improving diagnostic practice by highlighting some representative elements of diagnostic uncertainty and reminding clinicians to be aware of the tendency to overlook this uncertainty in routine clinical cases.

Thinking outside the box.

By taking a fresh approach to a patient care problem, this nurse found an effective way to promote drainage of aspirated fluid.

Patient vignette #1 answer analysis.

One of the regular features of this section will be a review of the responses to the vignettes from the previous issue. Available from: http://surgicalneurologyint.com/downloadpdf.asp?issn=2152-7806;year=2014;volume=5;issue=14;spage=493;epage=495;aulast=Stecker;type=2 The following is the analysis of responses to the questions posed in Vignette #1: Unrecognized Seizure: The key elements of making the diagnosis. Question 1: When the readers of the vignette were asked about possible diagnoses; syncope, seizure, stroke, arrhythmia, and orthostatic hypotension were all considered likely according to the respondents. All of the respondents appropriately felt that there was an incomplete history and that obtaining a history from the patient's family members could add significant value to the care of the patient Question 4: When the respondents were asked what would be the most important additional piece of history obtained from the patient's sister, some respondents wanted more information about allergies and medications while others wanted more information about whether the patient had previously had a similar episode. The question posed a difficult one in that there is so much unavailable information that could be critically important. However, it is important to establish an exact description of what happened to the patient at what time. It is very often true that the initial description of what happened to the patient is conveyed as “I passed out” or by the family as “he had a seizure;” but accepting these short statements is tantamount to allowing the patient or family to make the diagnosis instead of the clinician. It is very important to get a good timeline of when the patient was last seen normal, what the initial symptoms were, how the symptoms progressed and how long the symptoms lasted. At a later time, the patient could, conceivably provide information on past medical history, medications and previous events; but the clinical scenario describes the patient as being unconscious during the event that brought them into the emergency room (ER) and so it is unlikely the patient will be sure of all the details. In fact, patients often confabulate a history that seems rational to them, but in reality, is incorrect. For example, many patients who have seizures say that they were awake during the event while people who witness the event all confirm that the patient was unresponsive Question 6: The respondents did feel that additional information was very helpful but not everyone would document the information, nor would they inform the physician of the new information. Once it is found that this information is important, it is vital to the care of the patient to both document and to let a physician know of the additional information. It is important to do both because it is highly likely that the source of the information may not be available when the physician comes to obtain a history Question 7: All the respondents felt appropriately that if the intern cannot be reached and the information is important then that information should be escalated to the resident or the ER physician. Inadequate communication is one of the most frequent sources of problems in patient care. In particular, the ability to communicate information like this may be lost if the nurse is distracted by another pressing issue. It is important to have a rigorous handoff process that will make sure that important information is captured even if the nurse is unable to provide this information immediately Question 9: A number of respondents felt that seizure was a more likely diagnosis, however, some respondents still felt syncope could also be in the differential diagnosis. In this case, syncope would be more unlikely since syncope does not occur in bed and rarely causes the patient to fall—the authors agree that stroke/TIA should also be considered in the differential diagnosis Question 11: After the event, most respondents wanted q1hr neuro checks. Frequency of neuro checks can be an issue since in many telemetry units; there is not enough staffing for this and so there is pressure to say that a longer interval might be acceptable. Neuro checks every hour is in fact the optimal answer; and if necessary, the patient should transferred to a location where the frequency of the neuro checks can be carried out such as an intensive care unit Question 12: Most respondents answered that the patient should be transferred and the authors agree with this response Question 13: Escalation as suggested by the respondents is appropriate for this question, but is often forgotten if more pressing issues are present Question 15: The respondents realized the importance of communication initially and agreed that the final diagnosis was pulmonary embolus.

Application of“high quality nursing service demonstration project”in nursing management

Objective To explore the application effect of “high quality nursing service demonstration project” in nursing management .Methods This study was a non-experimental design using data analysis method.The total of 262 clinical nurses and 10 000 patients with their permission were included in this research.The Nurses Job Satisfaction Scale （NJSS）, Chinese Nurse Job Stressors Questionnaire （CNJSQ）, and Self-Rating Anxiety Scale （ SAS ） were collected from the nurses whereas Patient Satisfaction Questionnaire （ PSQ） was collected from the patients at pre and post of the administration of the “high quality nursing service demonstration project”.Results After carried out the “Quality care demonstration project”, the patient satisfaction increased from 84.2%to 95.6%.There was significant difference （χ2 =2.14,P〈0.05）.Positive evaluation was above 90%.Nurse job satisfaction scores, wages, benefits, rewards approach, the relationship between colleagues, work nature, desire to communicate were significantly improved （t =2.99,2.18,3.24, 2.44,2.41,2.25, respectively;P〈0.05）.Nurse job stress scores, nursing profession and work issues, time allocation and workload issues , working conditions and equipment problems , patient care problems caused by stress were significantly reduced （t=2.65,3.17,1.75,3.36, respectively;P〈0.05）.After the intervention, the mean score of positive assessment of SAS , negative assessment of SAS and the total score were significantly decreased （t=1.15,1.73,1.24, respectively;P〈0.05）.Conclusions Evidence from the study suggests the meaningful effectiveness of the “Quality care demonstration project” and there is a strong need of continuous promotion based on the research outcomes . Key words: Nursing management; Patients’ satisfaction; Work stress; Anxiety; High quality nursing service demonstration project

Clinical ethics in psychiatry: state of the art

Overview on Clinical Ethics Consultation in Psychiatry. Systematic literature search in data bases (PubMed, Web of Knowledge, SpringerLink, PubPsych, PsychSpider und PsycINFO) against the background of practical experiences with pilot model of implementation of Ethics Consultation in one psychiatric university hospital. Reports on Ethics Consultation in Psychiatry were published only sporadically. This is contrasted by recent experiences showing considerable needs for ethics support in Child and Adolescent Psychiatry, Adult as well as Forensic Psychiatry. This somewhat "late" development of Ethics Consultation in Psychiatry (compared with somatic medicine) might have structural reasons (lacking resources), be related to strong compensatory competencies of psychiatric staff, esp. regarding communication or legal knowledge, but could also relate to an under-estimation ("under-diagnostic") of ethical problems in psychiatric patient care - both, in the eyes of psychiatric insiders, as well as seen from the outside. Needs for model projects and accompanying research on Ethics Consultation in Psychiatry. Proved in practice: patient- as well as team-oriented ethics support.

The effect of raloxifene hydrochloride for the prevention of health care problems of patients who underwent surgeries for endometrial cancer: A multicenter clinical trial.

5602 Background: The removal of ovaries is necessary at the surgery for endometrial cancer. However, since the loss of ovaries cause several health problems in patients, the establishment of the pr...

ABSTRACT 927

Background and aims: To provide evidence on establishment of nurse specialist in our hospital. Aims: To understand the PICU nurse specialist medical staff awareness, expectations of the current situation in order to explore the necessity and feasibility of jobs created for PICU nurse specialist. Methods: Questionnaire to survey the understanding of nurse specialist in PICU medical staff. Results: Generally, medical staff thought nurses to perform advanced practice were nurse specialists (97.97%), expected their qualifications at bachelor and above, with good communication skills, ability of teamwork, research skills. Nurse specialist can expect to solve difficult patient care problems and guide the work of nurses in clinical practice, have the power and responsibility only next to nurse, and should have beds distribution rights, responsible for the overall management, no specific charge of beds. Conclusions: On current situation it's necessary to setup nurse specialist related system such as accreditation of qualification, standardization and standardized training system, job evaluation system to ensure the credibility and effectiveness of the system of specialist nurses in clinical practice.

CP-062 Subcutaneously implanted port-chamber central venous catheters: prevention and care of occlusion

BackgroundOcclusion of subcutaneously implanted port-chamber central venous access devices (CVAD) is a commonly occurring problem in cancer patient care. A change of port-chamber catheter model in our institution was the...

Request for ethics support in healthcare practices. Reasons and characteristics of Ethics Consultation Service users.

Ethical problems in healthcare practices are increasing. Therefore, healthcare professionals encounter difficult ethical problems more frequently in their professional activities. For this reason, in several countries Ethics Consultation Services have been created, and a debate concerning their role and organization model has developed. Despite the great interest of healthcare professionals in ethics support, Ethics Consultation Services are scarcely diffused in Italy. A survey was conducted to identify the levels of the nurses' experience and knowledge in the field of ethics and to assess their willingness to use a consultation service to approach ethical issues in healthcare. A questionnaire was administered and completed personally by 374 nurses appropriately instructed beforehand on its use. They were recruited from post-basic training courses at the Faculty of Medicine and Surgery of the University of L'Aquila. The willingness to recur to an ethical consultation, indicated by 90.3% of respondents, would confirm the hypothesis that the increasing ethical difficulties encountered in healthcare activities determined a greater interest towards this kind of service. The results of the study underline both the need and expectations the nurses have for ethics consultation and support to face ethical difficulties in patient care, and describe the characteristics of potential users. In our country the delay in approaching such problems is in contrast with the marked interest the healthcare professionals have for a possible request for support to face ethical problems in patient care. The study shows the respondents' high degree of appreciation of the contents of an ethics consultation activity and, consequently, it is desirable that the creation of an Ethics Consultation Service takes into consideration the indications given by the potential users, in addition to the experiences coming from other countries.

Communication Commentary: It Takes a Village: Effective Interprofessional Collaboration in Health Care Teams

Health care is changing. The technologies available for diagnostics are improving. The methods of acquiring and sharing information are burgeoning with the advent of the electronic medical record and information technology. Care is expected to be patient-centered, ensuring that the patient and familyunderstandtheoptionsavailable for treatment and are the decision-makers guiding care. In addition, health care is increasingly team-based. A broadly accepted definition of team-based health care is “the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—to accomplish shared goals within and across settings to achieve coordinated, high-quality care” (1). “The high-performing team is now widely recognized as an essential tool for constructing a more patient-centered, coordinated, and effective health care delivery system” (2, p. 3). With the literature burgeoning with new research findings, and with the research evidence that serves as the metric for quality of care continually changing, no single physician can absorb all of this information. Physicians must rely on specialists in other fields. Patient consumers are frequent utilizers of physician services. For example, the “typical Medicare beneficiary visits two primary care clinicians and five specialists per year,” as well as utilizing the ancillary services of diagnostic radiology, laboratory testing, pharmacy, and other services (3). Individuals suffering frommultiple

Improving physiological and psychological status in a hemodialysis patient: a nursing experience using an exercise training program

Exercise training during hemodialysis has been found to improve functional capacity, nutritional status, cardiovascular risk factors, depression, and well being in hemodialysis patients. This report describes a nursing experience that applied exercise training to improve activity intolerance, powerlessness, and ineffective health maintenance in a hemodialysis patient. The care period was from May 11 to July 27, 2012. The author collected information using observation, interview, physical examination, and medical record review and identified patient care problems including activity intolerance, powerlessness, and ineffective health maintenance. In addition to providing individual nursing interventions, the author designed a stationary bicycle installed at the end of the bed. The patient was asked use the bicycle to exercise 30 mins per time, three times per week for a period of 12 weeks during the patient's hemodialysis period. Before and after a 12-week of exercise training, collected the 6-minute walk test (6MWT), self-perceived improvement, and self-reported depression scales were performed prior to and after completion of the intervention. Hematological triglyceride, albumin, and hemoglobin data were collected each week. Heart rate, blood pressure, and oxygen saturation were examined prior to and after the intervention to ensure patient safety. After the 12-week intervention, the average heart rate achieved 40-60% of the maximum heart rate and the heart rate peaked between 85 and 121 bpm. Moreover, the 6MWT distance increased from 210 m to 255 m, triglyceride decreased from 622 mg/dL to 173 mg/dL, and self-perceived fatigue and depression markedly improved. This nursing experience is shared with nurses caring for patients with similar conditions.

Nursing competences and basic education: descriptive study on new-graduate nurses

The pressing need by the health organizations of new-graduate nurses immediately able to take full charge of the ward, together with the radical changes of nursing education, led the professional community to discuss the education of new-graduate nurses. To describe if new-graduate nurses at the Nursing Degree Course in Reggio Emilia, have the competences adequate to the demands of the health care organizations. Fifty ward Nursing Manager of a National health Service, where new-graduate nurses of the 2009-2010 academic year were emploied by at least one month were interviewed by phone. A list of 34 competences were identified and grouped into six skill areas (taking care, technical, managerial, communication, professional ethics, education and professional updating); for each, respondents had to rank the level of compentence on a Likert scale from 1 not able to 5 fully able. According to Nursing Managers new-graduate nurses are able to identify the patient care problems (mean score 4.1+0.8), to perform nursing techniques (mean score 4.4+0.7) and to meet the deadlines of the organizations (mean score 4.2+0.8). All Nursing Managers agree that new-graduate nurses have required skills and knowledge to work in their units. The level of expertise of by new-graduates in the areas investigated appears adequate to fulfill the role of nurse in health care organizations after a short period of coaching by a senior nurse.

Development of assessments for use on advanced pharmacy practice experiences

ObjectiveTo develop two comprehensive assessments related to common disease states seen in both inpatient and outpatient clinical settings. MethodsSyllabi from the didactic therapeutics sequence were reviewed to identify topics on which the Advanced Pharmacy Practice Experience (APPE) student pharmacists were previously assessed. ResultsFifteen major system and patient-care problem areas were identified as the most commonly experienced by APPE student pharmacists during an Ambulatory Care or Acute Care/General Medicine rotation. Nine content experts were invited to write ten multiple-choice questions in his/her designated content area(s) with an even distribution of inpatient and outpatient emphasis questions, practitioner role questions, and the preferred 7:3 ratio of application to analysis questions. ConclusionsThese assessments will be utilized as pre- and post-rotation quizzes to assess student learning on APPEs. Using these assessments, students may be able to self-assess and preceptors may be able to determine how well their rotation educates student pharmacists.

Model development for determining the efficacy of a combination coating for the prevention of perioperative device related infections: A pilot study

Antibiotic resistant bacterial infections are a growing problem in patient care. These infections are difficult to treat and severely affect the patient's quality of life. The goal of this translational experiment was to investigate the antimicrobial potential of cationic steroidal antimicrobial-13 (CSA-13) for the prevention of perioperative device-related infections in vivo. It was hypothesized that when incorporated into a polymeric device coating, the release of CSA-13 could prevent perioperative device-related infection without inhibiting skeletal attachment. To test this hypothesis, 12 skeletally mature sheep received a porous coated titanium implant in the right femoral condyle. Group 1 received the titanium implant and an inoculum of 5 × 10(8) CFU of methicillin-resistant Staphylococcus aureus (MRSA). Group 2 received a CSA-13 coated implant and the MRSA inoculum. Group 3 received only the CSA-13 coated implant and Group 4 received only the implant-without the CSA-13 coating or MRSA inoculum. In conclusion, the CSA-13 combination coating demonstrated bactericidal potential without adversely affecting skeletal attachment. The CSA-13 containing groups exhibited no evidence of bacterial infection at the conclusion of the 12 week study and established skeletal attachment consistent with Group 4. In contrast, all of the Group 1 animals became infected and required euthanasia within 6-10 days. The significance of this finding is that this combination coating could be applied to implanted devices to prevent perioperative device-related infections. This method may facilitate significantly reduced incidences of device-related infections as well as a new method to treat and prevent resistant strain bacterial infections.