Surgery Ward Research Articles

Cognizance of patients’ rights towards health in a teaching hospital in Sindh, Pakistan: A comparative study

Objectives The objective of this study is to compare cognizance of patients’ rights among patients and doctors. Material and Methods The comparative cross-sectional study was undertaken in various wards of a teaching hospital in Sindh, Pakistan to explore cognizance of patients’ rights among patients and doctors. A total of 390 patients and 417 doctors were selected from the general medicine and general surgery wards of a teaching hospital in Sindh, Pakistan, from December 01, 2021 to February 28, 2022, through convenience sampling. A validated, pre-guided questionnaire was used for data collection. SPSS version 26.0 was used for analysis. The cumulative and segregated analysis of mean ± standard scores of patients’ and doctors’ cognizance regarding patients’ rights were assessed using an independent t-test. Result The segregated analysis of the mean scores of cognizance of patients’ rights among patients and doctors revealed that the majority of associations were statistically significant (p < 0.05), with a few exceptions. These included the right to receive the best available care and respect (p = 0.29), the right to know about their treatment in an understandable language (p = 0.23), and the right to receive healthcare in a hygienic, clean, and safe environment (p = 0.79). Conclusion There is a significant difference in the levels of cognizance regarding patients’ rights between patients and doctors.

WOUND DRESSINGS FOR SORPTION THERAPY IN THE TREATMENT OF PURULENT WOUNDS: a review article

Surgical infections remain one of the most challenging and urgent issues in modern medicine, reaching a socio-ecological scale of significance nationwide. Despite advances in treating purulent wounds, the prevalence of patients with purulent surgical infections remains high. According to both domestic and international sources, surgical patients with purulent-inflammatory conditions comprise 35–45% of the total patient population in general surgery wards. In some cases, purulent infections become acute and can lead to the generalization of the purulent process, resulting in sepsis and even death. Mortality rates from acute surgical infections range from 19% to 70% within surgical hospitals. Additionally, there has been an increase in the transition of acute purulent processes to chronic stages, which prolongs the treatment duration for these patients. The prevention and treatment of surgical infections are therefore of paramount importance, representing one of the core challenges in surgical care. Optimal local treatment of purulent wounds requires adherence to essential principles, including active surgical intervention, antibiotic therapy throughout the wound healing stages, and local wound management under bandages. An analysis of the literature reveals that sorption-application therapy is gaining prominence in modern surgical practice for local wound management. This approach, which utilizes advanced interactive wound dressings with combined adsorption, osmotic, and necrolytic effects, has shown significant improvements in the effectiveness of purulent wound treatment.

Prevalence and genetic diversity of optrA-positive enterococci isolated from patients in an anorectal surgery ward of a Chinese hospital

Linezolid-resistant enterococci have increased in recent years due to the worldwide spread of acquired resistance genes (cfr, optrA, and poxtA) in clinical, animal, and environmental settings. This study investigated the carriage of optrA-positive enterococci among patients in the anorectal surgery ward in Hangzhou, China, and characterized the genetic context of optrA. A total of 173 wound secretion samples were obtained to screen optrA-positive enterococci. Of the 173 samples, 15 (8.67%) were positive for optrA, including 12 Enterococcus faecalis, two E. faecium, and one E. hirae. Multilocus sequence type analysis revealed that 12 optrA-positive E. faecalis isolates belonged to eight different sequence types (STs), of which ST16 was the main type. Eight optrA variants were identified, whose optrA flanking regions with a fexA gene downstream were bounded by different mobile genetic elements. Furthermore, the optrA gene in 8 out of 15 optrA-positive enterococci could be successfully transferred through conjugation. The findings revealed a high carriage rate of optrA in enterococci from one anorectal surgery ward in China. The dissemination of optrA-positive enterococci isolates in clinical settings should be continually monitored.

Promoting application of enhanced recovery after surgery protocols during perioperative localized abdominal and thoracic neuroblastomas.

To investigate the safety and efficacy of the application of enhanced recovery after surgery (ERAS) protocols in the perioperative period of abdominal and thoracic localized neuroblastomas (NBs). In this retrospective study, 68 children with NBs who underwent surgical resection of the tumor were enrolled. The ERAS protocols for NB excision were implemented in the ERAS group (n = 39) and the consequences were compared with children treated with traditional care (n = 29, TRAD group). The main outcomes of our interest included the incidence of surgery-related complications, the postoperative length of stay (LOS), and the Face/Legs/Activity/Cry/Consolability (FLACC) quantitative table from postoperative days (POD) 1-5. We also evaluated the median intraoperative fluid volume and anesthesia recovery time; blood glucose levels at the beginning of anesthesia, POD1, and 3; WBC counts, CRP values, and the concentration of plasma nutritional indicators on POD1 and 3; time of early ambulation, first anal exhaust, total enteral nutrition (TEN), and discontinue intravenous infusion postoperatively; usage proportion and duration of abdominal and thoracic drainages, nasogastric decompression tubes and urinary catheters; cost of hospitalization, parental satisfaction rate, and readmission rate of surgery ward within 30days. Compared to the TRAD group, the ERAS group had lower surgery-related complications, albeit not significantly (P > 0.05); the median postoperative LOS decreased from 11.0 to 8.0days (P < 0.001), the LOS of abdominal NB was significantly shortened (P < 0.001) compared to thoracic NB (P = 0.07) between the two groups; the FLACC scores decreased significantly from POD1-5 (all P < 0.01). The ERAS group had an improved median intraoperative infusion speed (5.0mL/kg/h vs 8.0mL/kg/h), time of early ambulation (1.0days vs 3.0days), first anal exhaust (2.0days vs 2.0days), TEN (5.0 vs 7.0days), discontinuation of intravenous infusion (5.0days vs 8.0days), and total cost of hospitalization (33,897.2 Yuan vs 38,876.3 Yuan); (all P < 0.01). The usage proportion and duration of surgical drainages and tubes were apparently reduced. The mean blood glucose level was higher at the beginning of anesthesia but lower on POD1 and 3 in the ERAS group (P < 0.01). No statistically significant difference was detected in WBC counts and concentrations of hemoglobin and albumin between the two groups of patients (P > 0.05), while the concentrations of prealbumin on POD3 were higher and the CRP level on POD1 was lower in the ERAS group than the TRAD group (P < 0.01). The satisfaction rate of parents was only slightly higher, but the difference was not statistically significant (P = 0.730). No obvious differences were observed in the aspects of NB resection (P = 0.462) and 30-day readmissions of surgery ward (P = 1.000). The application of ERAS protocols has a significant potential to accelerate perioperative rehabilitation in children undergoing abdominal and thoracic NBs' surgical resection.

The effect of caregivers’ health literacy levels on the quality of life and self-care of patients with heart failure

BackgroundThe aim of this study is to examine the effects of health literacy levels of caregivers on the self-care behaviors and quality of life of patients aged 65 years and older with heart failure. MethodsThe study was conducted in a university hospital in Erzincan, Türkiye between November 4, 2023, and February 12, 2024, on patients hospitalized in internal medicine, cardiology, and cardiovascular surgery wards and their caregivers (n = 206 pairs). ResultsAs a result of the multivariate regression analysis, it was determined that the access, appraisal, and application sub-dimensions of the health literacy of the caregivers positively affected the self-care behaviors and quality of life levels of the patients. ConclusionsThese results reveal the significant effect of the health literacy levels of the caregivers in the management process of heart failure disease. Healthcare providers -especially nurses- can improve patient outcomes of patients with heart failure by considering the health literacy level of their caregivers and using innovative educational methods that can improve the health knowledge and skills of caregivers.

Inappropriate ceftriaxone utilization and predictor factors in Ethiopia: a systematic review and meta-analysis

Ceftriaxone stands as a cornerstone in global antibiotic therapy owing to its potent antibacterial activity, broad spectrum coverage, and low toxicity. Nevertheless, its efficacy is impeded by widespread inappropriate prescribing and utilization practices, significantly contributing to bacterial resistance. The aim of this study is to determine the overall national pooled prevalence of inappropriate ceftriaxone utilization and its predictor factors in Ethiopia. A systematic search was conducted across multiple databases including, PubMed, Science Direct, Hinari, Global Index Medicus, Scopus, Embase, and a search engine, Google Scholar, to identify relevant literatures that meet the research question, from March 20 to 30, 2024. This meta-analysis, which was conducted in Ethiopia by incorporating 17 full-text articles, unveiled a national pooled inappropriate ceftriaxone utilization of 55.24% (95% CI, 42.17%, 68.30%) with a substantial heterogeneity index (I2 = 99.24%, p value < 0.001). The review has also identified predictive factors for the inappropriate use of ceftriaxone: empiric therapy (AOR 21.43, 95% CI; 9.26–49.59); multiple medication co-prescription (AOR: 4.12, 95% CI; 1.62–8.05). Emergency ward (AOR: 4.22, 95% CI; 1.8-12.24), surgery ward (AOR: 2.6, 95% CI; 1.44–7.82) compared to medical ward, prophylactic use (AOR: 500, 95% CI; 41.7–1000), longer hospital stay-8-14 Days; (AOR: 0.167, 95% CI; 0.09–0.29), > 14 days; (AOR: 0.18, 95% CI; 0.1–0.32). The study reveals a high national pooled prevalence of inappropriate ceftriaxone utilization, standing at 55.24%, highlighting a significant hazard in the use of this antibiotic. This could be attributed to instances of overuse, misuse or prescription practices that deviates from established guidelines. This eminent challenge can lead to the development of antibiotic resistance, increased healthcare costs, adverse drug reactions, and treatment failures, necessitating multifaceted approach such as improved antibiotic stewardship, better adherence to guidelines, and enhanced clinician education on appropriate antibiotic use.

"Doctor, would it surprise you if there were prescribing errors in this patient's medication?" Identifying eligible patients for in-hospital pharmacotherapeutic stewardship: A matched case-control study.

Evaluating a patient's medication list is critical to reduce prescribing errors (PEs), but is a labour- and time-intensive process. Identification of patients at risk of PEs could improve the allocation of scarce time and resources, but currently available prediction tools are not effective. To investigate whether ward doctors can identify patients at risk of PEs. This prospective matched case-control study was conducted on three clinical wards in an academic hospital. Otolaryngology and oncology ward doctors used clinical intuition to select patients requiring a clinical medication review (CMR) (cases). These patients were then matched 1:1 on age (±10years) and number (±1) of prescriptions with patients not selected for CMRs on the internal medicine and upper gastrointestinal surgery ward (controls). A multidisciplinary in-hospital pharmacotherapeutic stewardship team assessed the prevalence of PEs. A total of 387 patients with 5191 prescriptions were included. Overall, 799 PEs affecting 279 patients (72.1%) were identified. Most PEs (58.8%) occurred during hospitalization. There were no significant differences in age, number of prescriptions, sex, renal function or documented allergies or intolerances between the cases and controls or between controls and other patients who did not receive a CMR. The incidence of PEs was higher in cases than in controls (97.5% vs 72.5%, odds ratio= 14.8, 95% confidence interval [CI] 1.8-121.1, P= .002)). The rate of PEs was three times higher in cases than in controls (incidence rate ratio=3.0, 95% CI 2.3-4.0, P< .001). Ward doctors can effectively identify patients with PEs, and thus at risk of medication-related harm, using clinical intuition.

The relationship between moral distress and clinical care quality among nurses: an analytical cross-sectional study

BackgroundNurses constitute the largest group of service providers in the healthcare system and significantly influence the quality of healthcare services. Factors such as ethical considerations may be related to the quality of care. This study aimed to determine the relationship between moral distress and the quality of clinical care among nurses working in Gonabad, Iran.MethodsAn analytical cross-sectional study was conducted on 252 nurses working in emergency, internal medicine, surgery, psychiatry, critical care and maternity wards at Allameh Bohlool Hospital from May to July 2023. This research used demographic information questionnaire, the revised Moral Distress Scale (MDS-R), and the Quality Patient Care Scale (QUALPAC). The significance level for the study was set at p < 0.05.ResultsThere was a significant relationship between the frequency of moral distress and the quality of clinical care (p = 0.032), as well as between the intensity of moral distress and the quality of clinical care (p = 0.043). Nurses who experienced moral distress more frequently and intensely provided better quality care. However, there was no significant relationship between the effect of moral distress and the quality of clinical care (r = 0.032, p = 0.619). Additionally, a significant statistical relationship was found between the intensity of moral distress and the physical dimension of clinical care quality (r = 0.171, p = 0.007), indicating that increased moral distress intensity was associated with higher quality of physical care.ConclusionsNurses who experience higher levels of moral distress, both in terms of frequency and intensity, perform better in the care they provide and deliver it in the best possible manner, particularly in the physical dimension of care.

Virtual reality for preoperative patient education: Impact on satisfaction, usability, and burnout from the perspective of new nurses.

Traditional paper-based preoperative patient education is a struggle for new nurses and requires extensive training. In this situation, virtual reality technology can help the new nurses. Despite its potential benefits, there are studies on patient satisfaction but there is limited information on the usability of virtual reality (VR) technology for new nurses in giving preoperative education to patients. To investigate the impact on satisfaction, usability, and burnout of a system using VR technology in preoperative patient education. The study involved 20 nurses from the plastic surgery ward and 80 patients admitted between April and May 2019. Each nurse taught four patients: Two using traditional verbal education and two using virtual reality. The System Usability Scale, After-Scenario Questionnaire, and Maslach Burnout Inventory (MBI) were employed to evaluate the impact of these education methods. The VR education groups showed a statistically higher satisfaction than the traditional verbal education groups. Among the three subscales of the MBI, emotional exhaustion and personal accomplishment improved statistically significantly. VR was also better in terms of usability. This study suggests VR enhances usability and reduces burnout in nurses, but further research is needed to assess its impact on depersonalization and objective measures like stress and heart rate.

Screening for Psychiatric Disorders in Chronic Rhinosinusitis Patients Waiting for Surgery: A Prospective Cross-Sectional Study.

To assess the prevalence of depression, anxiety, insomnia and somatic symptom disorder (SSD) in chronic rhinosinusitis (CRS) patients who were waiting for surgery and to predict these psychiatric disorders using the 22-item Sinonasal Outcome Test (SNOT-22). A prospective cross-sectional study. The rhinology ward at our institution, a tertiary hospital. Adult patients (> 18 years) diagnosed with CRS who were admitted to the rhinology ward for endoscopic sinus surgery and were able to understand and complete the study questionnaires. Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7), Insomnia Severity Index (ISI), Patient Health Questionnaire-15 (PHQ-15) and SNOT-22. Of the 159 participants recruited, 58 were at risk of depression (defined by PHQ-9 > 4, while 25 with PHQ-9 > 9), 49 were at risk of anxiety (defined by GAD-7 > 4, while 25 with GAD-7 > 9), 81 were at risk of insomnia (defined by ISI > 7, while 51 with ISI > 14) and 69 were at risk of SSD (defined by PHQ-15 > 4, while 24 with PHQ-15 > 9). The SNOT-22 score was closely correlated with the scores of psychometric tests and was an independent predictor of these psychiatric disorders. Patients with a high SNOT-22 score (> 30) are likely to be affected by comorbid psychiatric disorders and should be further evaluated by otolaryngologists. Depression, anxiety, insomnia and SSD are prevalent in CRS patients. Otolaryngologists should have a low threshold to ask the patient about psychiatric symptoms, especially for patients with an SNOT-22 score > 30.

How Much is Too Much? Evaluation of the Clinical Relevance of Routine Preoperative Investigations in American Society of Anaesthesiologist (ASA) Grades I and II Patients Undergoing Minor to Intermediate Elective Surgeries at Tertiary Care Teaching Hospital - Influence on Change in the Surgical Plan and Outcome

Abstract Background: In recent decades, experts have questioned the necessity of routine preoperative investigations due to their limited influence on perioperative management, higher expenses, postponed surgical procedures, patient anxiety resulting from false-positive results for minor operations and increased workload for laboratories. Objective: Our objective was to systematically evaluate the impact of pre-operative investigations on the treatment of patients opting for elective procedures. The study aimed to evaluate the impact of pre-operative investigations and peri-operative management on elective surgeries of the American Society of Anesthesiologists (ASA) physical status classification grades I and II, identifying common inappropriate investigations and assessing the impact of abnormal results on patient management. Materials and Methods: We conducted a prospective, cross-sectional, clinical, observational, single-centre study from February 2020 to March 2021 on 500 cases in the General Surgery Department of Tertiary Care Teaching Hospital. This study assessed the importance of pre-operative investigations in low-risk patients undergoing low-grade elective general surgical procedures. We recruited consecutive patients from the surgery wards of the institute, who fulfilled the inclusion criteria and obtained informed written consent for anaesthesia, surgery and participation in the study. Demographic data, the type of investigation conducted and test results were noted. We followed up with patients who had abnormal test results to record the consequences of the abnormality, such as the postponement of surgery and the requirement for additional investigations. Pre-operative transfusion, change in the management plan and change in the anaesthesia plan were recorded. Results: In the current study, the age of the patients ranged from 20 years to 45 years, and the mean age of the patients was 32.208 ± 9.16. The age group of 20–30 years was the commonest, being 158 (31.6%) patients. Out of 500 patients, 296 (59.2%) patients were males and the remaining 204 (40.8%) were female patients. Out of 500 tests, 44 (8.8%) had abnormal results. Most of the changes in our study were based on abnormal ECG findings. Out of a total of 500 surgical procedures performed, 497 (99.4%) were carried out without any difficulty, with two (0.4%) postponed due to abnormality in the pre-operative investigations and one (0.2%) cancelled. A total of 490 (98%) patients did not have any post-operative complications. Only ten (2%) patients developed post-operative complications, and out of those, only one (0.1%) had some abnormality in the pre-operative investigations. Conclusion: Preoperative laboratory investigations do not significantly influence the surgical outcome of the patients belonging to ASA grades I and II.

A pilot survey of dietitian services carried out in a vascular surgery ward in Helsinki University Hospital

A pilot survey of dietitian services carried out in a vascular surgery ward in Helsinki University Hospital

The effect of surgical inguinal hernia repair on testicular blood supply: A prospective superb microvascular imaging ultrasonography study.

In this study, we aimed to evaluate the differences in vascularity between the testis on the inguinal hernia (IH) side and the contralateral healthy testis by performing preoperative and postoperative (first month) examinations with superb microvascular imaging ultrasonography (SMI USG), and to compare results with power Doppler (PD) USG. In this prospective cohort study, 35 patients diagnosed with IH between April 2023 and July 2023 who were hospitalized in the general surgery ward of a tertiary hospital for IH surgery were evaluated. The postoperative vascular index (VI) values obtained by SMI were found to be significantly lower than preoperative VI values in both operated and non-operated testes (p < 0.001). The VI values obtained with PD in the postoperative period were significantly lower in the operated and nonoperated testes on both sides compared with the VI values obtained in the preoperative period (p < 0.001 and p = 0.029, respectively). There was a significant difference between preoperative and postoperative VI difference values obtained by SMI and PD on the operated side (p = 0.015). In our study examining patients who had undergone IH surgery, testicular vascularity was assessed more precisely with the SMI USG method compared with the PD method.

WP7.2 - The Role of a Frailty Team to improve Perioperative Care for ELLSA Patients

Abstract Aim Frailty assessment amongst emergency laparotomy patients is essential. The 8th NELA report highlighted that only 31.8% of patients who were frail and over 65 years received geriatrician input. Within our organisation, patients who undergo emergency laparotomy are included in the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). The consultant geriatrician led Surgical Acute Frailty Team (SAFT) works collaboratively with the emergency general surgery team and ELLSA specialist nurse to review ELLSA patients within our hospital. Our aim was to establish outcomes of ELLSA patients reviewed by SAFT. Methods Data collected routinely via Redcap as part of our organisation’s ELLSA was reviewed. All ELLSA patients aged ≥65 years admitted between November 2022 and November 2023 were included. Data included frailty assessment, discharge destination and 30 day mortality. Results 152 patients aged ≥ 65 years underwent operative intervention as defined by ELLSA. 100% of patients had a documented Clinical Frailty Scale (CFS) score. 72 patients (47.4%) had a pre-operative frailty review. 68.4% of patients had their initial frailty assessment by a consultant geriatrician. 19.7% of patients were reviewed by frailty ANPs or clinical fellow. Only 7.9% of patients required care support on discharge. 30 day mortality was 17.1%. Conclusions Embedding a dedicated frailty team within our general surgery wards has been incredibly successful; frailty assessment is significantly above that of the 8th NELA report. The majority of ELLSA patients aged ≥65 years are discharged home independently. Collaborative working and early identification of frailty in ELLSA patients is essential to improve patient outcomes.

Study on the application of segmented nursing pathway in daytime anorectal surgery patients.

Standardised management of day surgery for haemorrhoids and achieving standardised nursing in the painless ward of colorectal surgery are important. To explore the role of segmented nursing pathways in patients undergoing day surgery for anorectal procedures and to provide theoretical and practical guidance for day surgery nursing. A total of 146 patients undergoing anorectal surgery in our day surgery ward between April 2023 and July 2023 were selected as the study participants, with 74 patients in the control group receiving routine nursing and 72 patients in the experimental group receiving segmented nursing. The preoperative preparedness, preoperative anxiety, complication rate, discharge preparedness and nursing satisfaction were compared between the two groups. The experimental group had higher rates of admission before 8:30 am (77.78% vs 45.95%), awareness of the day surgery process (63.89% vs 24.32%), completion rate of preoperative preparation (81.94% vs 59.46%), satisfaction with preoperative preparation (94.44% vs 74.32%), discharge preparedness (112.42 ± 3.28 vs 95.82 ± 3.41) and nursing satisfaction (97.22% vs 70.27%) compared with the control group (P< 0.05). After the intervention, the self-rating anxiety scale score (43.14 ± 12.44 vs 52.51 ± 13.21) and the self-rating depression scale score (45.03 ± 11.37 vs 55.37 ± 10.14) were lower in the experimental group than in the control group (P< 0.05). Segmented nursing pathways can improve the preoperative preparedness of patients undergoing day surgery for anorectal procedures, alleviate patient anxiety, enhance discharge preparedness, improve the quality of nursing care and increase nursing satisfaction.

VALIDAÇÃO DE WEBSITE PARA IMPLANTAÇÃO DO PROTOCOLO PERIOPERATÓRIO NA PROFILAXIA DE TROMBOEMBOLISMO VENOSO

Introduction: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the leading cause of preventable postoperative deaths. Identifying risk factors based on Virchow’s Triad (blood stasis, hypercoagulability, and endothelial injury) is crucial. Approximately 20% of surgical patients develop VTE, with 7% resulting in fatal PE. The Caprini risk score, used to assess VTE risk, is complex and has limited adherence despite its validation across various specialties. Methodology: The applied research developed the application of a perioperative protocol for VTE prophylaxis in the Vascular Surgery ward of the Hospital Municipal de Marabá. The descriptive and quantitative study was structured via website. The 2013 version of the Caprini score was adopted for risk stratification. Validation of the tool involved 16 experts with inclusion criteria focused on doctors and nurses with experience in the area, where everyone responded to the Likert scale that evaluated 2 major domains of the tool: usability and functionality. Results: Among the 16 evaluators, 56,3% were male and 43,8% female, with an average age of 32,4 years and 7,6 years of experience. The system’s functionality received 97,5% approval, 96,3% of reliability, and 91,3% regarding interface and usability. The utility was well-rated, with 98,8% approving the professional facilitation. Chi-square tests indicated that functionality perception did not vary between physicians and nurses, but utility was significantly influenced by profession. Cronbach’s alpha coefficients indicated high internal consistency: 0,85 for functionality and 0,77 for utility. Discussion: The diverse profiles of the evaluators enriched the website’s validation. Functionality was consistently positively rated, while utility varied by professional role. High internal consistency suggests that the questionnaire is reliable for measuring website performance perceptions. Conclusion: The inclusion of the Caprini protocol in the Tupan Health website demonstrated good performance and high reliability among professionals, facilitating protocol adherence and the prevention of perioperative complications.

The Management and Outcomes of Septic Shock Among Surgical Patients at the Jimma University Medical Center, Jimma, Ethiopia: A Prospective Study.

Background and objective Sepsis and septic shock are major healthcare issues in surgical patients admitted to the surgery ward or ICU, affecting millions of people worldwide annually, with a mortality rate between one in three and one in six of those affected.The incidence and mortality of sepsis vary greatly by region, with the highest prevalence in Sub-Saharan Africa, Oceania, South Asia, East Asia, and Southeast Asia. Of all sepsis cases in 2017, 33.1 million people suffered from ill health due to underlying infectious diseases, and 15.8 million suffered from underlying injuries or non-communicable diseases. Methods This prospective observational study was conducted at the Jimma University Medical Centre (JUMC) in Jimma town in southwest Ethiopia, from April 2023 to October 2023. Allsurgical patients aged ≥15 years who presented with or developed septic shock at the Jimma University Medical Centre were included. Results The study involved a total of 61 patients. The median age of the patients was 45 years [interquartile range (IQR): 40-60years], and 77% (n=47) of the patients were male. The most frequent source of infection in this study was community-acquired infection (83.3%, n=49). The most common focus of sepsis was the intra-abdominal infection of the digestive system (82%, n=50). Lactate level testing and blood cultures before administering antibiotics were not done for all septic shock patients. Source control surgery was performed in 52.5% (n=32) of patients after developing septic shock, and 84.4% (n=27) of surgeries were performed within 24 hours. The 30-day mortality rate was 80.3%, with an ICU mortality rate of 78.94%. The median length of stay in the ICU was three days (IQR: 1-5 days), and the median length of hospital stay was six days (IQR: 2-15 days). Conclusions The mortality rate in our cohort washigher compared to that in studies from high-income and low-income countries. There was poor adherence and compliance with the Surviving Sepsis Campaign (SSC) (the one-hour bundle) guidelines. The length of stay in hospitals and ICUs was lower compared to studies from high-income countries due to the high early mortality rates.

Effect of Perioperative Blood Transfusion on Complications Following Emergency Non-trauma Laparotomy in Mulago Hospital: A Prospective Cohort Study.

Background Although blood transfusion may be required during emergency non-trauma laparotomy, several retrospective cohort studies have identified blood transfusion as a significant predictor of postoperative infections and mortality. However, no study has explored such an association in a resource-limited setting. This study aims to determine the effect of perioperative blood transfusion on the 30-day risk of surgical site infections (SSIs) and mortality among patients undergoing emergency non-trauma laparotomy in a large urban tertiary hospital in a resource-limited setting. Methodology In this prospective, single-center, cohort study, we recruited 160 consecutive adult patients admitted to the general surgery wards 48 hours after emergency non-trauma laparotomy. We grouped them based on transfusion exposure status. Transfusion exposure and possible confounders were recorded on entry, while the presence or absence of SSIs and mortality were obtained over 30 days of follow-up. The data were analyzed using Epi Info version 7 and Stata version 14. P-values <0.05 indicated statistical significance. Results All 160 participants recruited, 28 (17.5%) transfusion-exposed and 132 (82.5%) non-exposed, were included in the final analysis. Transfusion exposure (relative risk = 8.16; 95% confidence interval (CI) = 2.73-24.37; p < 0.001) was an independent risk factor for SSI after multivariate logistic regression analysis adjusted for confounders. Inverse probability weighting with regression adjustment (IPWRA) revealed that transfusion exposure significantly increased the incidence of SSI by 36.2% (95% CI = 14.2%-58.2%; p = 0.001). Furthermore, transfusion exposure (hazard ratio (HR) = 3.62; 95% CI = 1.28-10.27; p = 0.015) and age ≥60 years (HR = 5.97; 95% CI = 1.98-18.01; p = 0.002) were independent risk factors for 30-day mortality after multivariate Cox regression analysis adjusted for confounders. IPWRA revealed that transfusion exposure significantly increased the incidence of mortality by 17.6% (95% CI = 1.4%-33.8%; p = 0.033). Conclusions This study suggests an independent association between perioperative blood transfusion and the occurrence of SSIs and mortality among patients undergoing emergency non-trauma laparotomy. A larger multicenter prospective cohort study considering more confounders and the use of established restrictive transfusion protocols is recommended.

Evaluation of the Adherence to the Antimicrobial Prophylaxis Guidelines before Cardiac Surgeries in a Specialized University Hospital: A Unicenter Cross-Sectional Study from Iran

Background: Surgical site infection (SSI) is the most common reason for patient readmission after surgery. Because most cases of surgical site infection are preventable with antimicrobial prophylaxis, adherence to appropriate guidelines is critical. The aim of this study was to evaluate adherence to guideline recommendations for antimicrobial prophylaxis of surgical site infections at Shahid Chamran Heart Hospital, Isfahan, Iran. Methods: This cross-sectional observational study was conducted using prospective data collected from December 2021 to June 2022 in the cardiac surgery ward of Chamran Hospital. Adherence to "Clinical practice guidelines for antimicrobial prophylaxis in surgery (2013)" was assessed using data from patient records regarding the type, dosage, timing, and duration of antimicrobial prophylaxis. Results: A total of 363 patients were included in this study. The compliance rate with the guideline in terms of the type, dosing, initiation time, redosing and duration of the antimicrobial agent was 99.72%, 1.6%, 98.8%, 29.28%, and 0% respectively. Conclusion: The present study revealed relatively low adherence to the guidelines in terms of dosing, re-dosing and duration of antimicrobial prophylaxis at Chamran Heart Hospital. Based on the results, developing a local guideline is highly recommended.

Analysis of risk factors related to chronic non-healing wound infection and the construction of a clinical prediction model.

This study is aimed to analyse the risk factors associated with chronic non-healing wound infections, establish a clinical prediction model, and validate its performance. Clinical data were retrospectively collected from 260 patients with chronic non-healing wounds treated in the plastic surgery ward of Shanxi Provincial People's Hospital between January 2022 and December 2023 who met the inclusion criteria. Risk factors were analysed, and a clinical prediction model was constructed using both single and multifactor logistic regression analyses to determine the factors associated with chronic non-healing wound infections. The model's discrimination and calibration were assessed via the concordance index (C-index), receiver operating characteristic (ROC) curve and calibration curve. Multivariate logistic regression analysis identified several independent risk factors for chronic non-healing wound infection: long-term smoking (odds ratio [OR]: 4.122, 95% CI: 3.412-5.312, p < 0.05), history of diabetes (OR: 3.213, 95% CI: 2.867-4.521, p < 0.05), elevated C-reactive protein (OR: 2.981, 95% CI: 2.312-3.579, p < 0.05), elevated procalcitonin (OR: 2.253, 95% CI: 1.893-3.412, p < 0.05) and reduced albumin (OR: 1.892, 95% CI: 1.322-3.112, p < 0.05). The clinical prediction model's C-index was 0.762, with the corrected C-index from internal validation using the bootstrap method being 0.747. The ROC curve indicated an area under the curve (AUC) of 0.762 (95% CI: 0.702-0.822). Both the AUC and C-indexes ranged between 0.7 and 0.9, suggesting moderate-to-good predictive accuracy. The calibration chart demonstrated a good fit between the model's calibration curve and the ideal curve. Long-term smoking, diabetes, elevated C-reactive protein, elevated procalcitonin and reduced albumin are confirmed as independent risk factors for bacterial infection in patients with chronic non-healing wounds. The clinical prediction model based on these factors shows robust performance and substantial predictive value.