Processes of care in surgical patients who died with hospital-acquired infections in Australian hospitals.

BACKGROUND: Infection may complicate surgical patients' hospital admission. The effect of hospital-acquired infections (HAIs) on processes of care among surgical patients who died is unknown. AIM: To investigate the effect of HAIs on processes of care in surgical patients who died in hospital. METHODS: Surgeon-recorded infection data extracted from a national Australian surgical mortality audit (2012-2016) were grouped into HAIs and no infection. The audit included all-age surgical patients, who died in hospital. Not all patients had surgery. Excluded from analysis were patients with community-acquired infection and those with missing timing of infection. Multivariate logistic regression was used to determine the adjusted effects of HAIs on the processes of care in these patients. Costs associated with HAIs were estimated. FINDINGS: One-fifth of surgical patients who died did so with an HAI (2242 out of 11,681; 19.2%). HAI patients had increased processes of care compared to those who died without infection: postoperative complications [51.0% vs 30.3%; adjusted odds ratio (aOR): 2.20; 95% confidence interval (CI): 1.98-2.45; P < 0.001]; unplanned reoperations (22.6% vs 10.9%; aOR: 2.38; 95% CI: 2.09-2.71; P < 0.001) and unplanned intensive care unit admission (29.3% vs 14.8%; aOR: 2.18; 95% CI: 1.94-2.45; P < 0.001). HAI patients had longer hospital admissions and greater hospital costs than those without infection. CONCLUSION: HAIs were associated with increased processes of care and costs in surgical patients who died; these outcomes need to be investigated in surgical patients who survive.

Value of Neonicotinoid Insecticide Seed Treatments in Mid-South Cotton (Gossypium hirsutum [Malvales: Malvaceae]) Production Systems.

Neonicotinoid insecticides are currently one of two classes of chemicals available as a seed treatment for growers to manage early season insect pests of cotton, Gossypium hirsutum L. (Malvales: Malvaceae), and they are used on nearly 100% of cotton hectares in the midsouthern states. An analysis was performed on 100 seed-treatment trials from Arkansas, Louisiana, Mississippi, and Tennessee to determine the value of neonicotinoid seed treatments in cotton production systems. The analysis compared seed treated with neonicotinoid insecticides seed treatments plus a fungicide with seed only treated with fungicide. When analyzed by state, cotton yields were significantly greater when neonicotinoid seed treatments were used compared with fungicide-only treatments. Cotton treated with neonicotinoid seed treatments yielded 123, 142, 95, and 104 kg ha-1, higher than fungicide only treatments for Arkansas, Louisiana, Mississippi, and Tennessee, respectively. Across all states, neonicotinoid seed treatments provided an additional 115 kg lint ha-1 comparedwith fungicide only treated seed. Average net returns from cotton with a neonicotinoid seed treatment were $1,801 per ha-1 compared with $1,660 per ha-1 for cottonseed treated with fungicide only. Economic returns for cotton with neonicotinoid seed treatments were significantly greater than cottonseed treated with fungicide only in 8 out of 15 yr representing every state. These data show that neonicotinoid seed treatments provide significant yield and economic benefits in Mid-South cotton compared with fungicide only treated seed.

Value of Neonicotinoid Insecticide Seed Treatments in Mid-South Corn (Zea mays) Production Systems.

Neonicotinoid seed treatments are one of several effective control options used in corn, Zea mays L., production in the Mid-South for early season insect pests. An analysis was performed on 91 insecticide seed treatment trials from Arkansas, Louisiana, Mississippi, and Tennessee to determine the value of neonicotinoids in corn production systems. The analysis compared neonicotinoid insecticide treated seed plus a fungicide to seed only with the same fungicide. When analyzed by state, corn yields were significantly higher when neonicotinoid seed treatments were used compared to fungicide only treated seed in Louisiana and Mississippi. Corn seed treated with neonicotinoid seed treatments yielded 111, 1,093, 416, and 140 kg/ha, higher than fungicide only treatments for Arkansas, Louisiana, Mississippi, and Tennessee, respectively. Across all states, neonicotinoid seed treatments resulted in a 700 kg/ha advantage compared to fungicide only treated corn seed. Net returns for corn treated with neonicotinoid seed treatment were $1,446/ha compared with $1,390/ha for fungicide only treated corn seed across the Mid-South. Economic returns for neonicotinoid seed treated corn were significantly greater than fungicide-only-treated corn seed in 8 out of 14 yr. When analyzed by state, economic returns for neonicotinoid seed treatments were significantly greater than fungicide-only-treated seed in Louisiana. In some areas, dependent on year, neonicotinoid seed treatments provide significant yield and economic benefits in Mid-South corn.

Basic skin flaps for the general surgeon: a teaching method.

BACKGROUND: Teaching residents the design and creation of skin flaps is challenging because the use of skin flaps is not common enough during the course of a typical residency to provide a broad experience base. METHODS: A 12 x 12-inch board with a 1/8-inch foam rubber covering was designed to provide for the creation of four flaps and one Z-plasty. A lecture and practical exercise were used to teach basic techniques. Performance was measured by preexamination and postexamination, as well as by a resident satisfaction survey. RESULTS: Mean scores improved by 45%. The resident survey revealed an average subjective rating was 4.7 on a scale of 1 to 5. All residents rated this format superior to traditional lecture instruction. Total cost to provide laboratory experience for 16 residents was $50. Materials can be recovered and reused at a cost of $0.40 each. CONCLUSIONS: The materials developed provided an effective, inexpensive nonbiologic model for teaching preoperative skills.

A quality assurance audit: phase III trial of maximal androgen deprivation in prostate cancer (TROG 96.01).

In 1997 the Trans-Tasman Radiation Oncology Group (TROG) performed a quality assurance (QA) audit of its phase III randomized clinical trial investigating the effectiveness of different durations of maximal androgen deprivation prior to and during definitive radiation therapy for locally advanced carcinoma of the prostate (TROG 96.01). The audit reviewed a total of 60 cases from 15 centres across Australia and New Zealand. In addition to verification of technical adherence to the protocol, the audit also incorporated a survey of centre planning techniques and a QA time/cost analysis. The present report builds on TROG's first technical audit conducted in 1996 for the phase III accelerated head and neck trial (TROG 91.01) and highlights the significant progress TROG has made in the interim period. The audit provides a strong validation of the results of the 96.01 trial, as well as valuable budgeting and treatment planning information for future trials. Overall improvements were detected in data quality and quantity, and in protocol compliance, with a reduction in the rate of unacceptable protocol violations from 10 to 4%. Audit design, staff education and increased data management resources were identified as the main contributing factors to these improvements. In addition, a budget estimate of $100 per patient has been proposed for conducting similar technical audits. The next major QA project to be undertaken by TROG during the period 1998-1999 is an intercentre dosimetry study. Trial funding and staff education have been targeted as the key major issues essential to the continued success and expansion of TROG's QA programme.

Selective removal of plutonium 238 from a canal sediment using a carbonate-chelant soil washing technology (ACT*DE*CON).

The Mound laboratory site in Miamisburg, OH, a former plutonium processing facility, contains approximately 40000 yd(3) (30,580 m3) of plutonium- and thorium-contaminated soils and sediments at levels that require remediation. Existing applicable remediation technologies are unsatisfactory, because they are expensive and do not provide volume reduction. ACT*DE*CON is a chemical soil leaching technology for the treatment of soils that utilizes contaminant dissolution via dilute selective solutions to remove radionuclides. In bench-scale tests, process parameters were developed for the optimal treatment of the Miami Erie Canal soil at the Mound site, combining the maximum plutonium removal with an acceptable amount of soil dissolution and minimizing the costs of reagents. Parameters evaluated included soil to extractant mass ratio, temperature, rinse solution composition, kinetics, and the application of several dewatering aids. Plutonium removal rates of >95% were achieved, and the residual plutonium in the treated soil proved to be very immobile-confirming that the process had removed the most accessible species of the radionuclide. Currently being tested at Mound is an engineering scale-up that includes an attrition scrubber, a counter-current extractor, and a reverse osmosis system. Economic evaluations based on bench-scale results put the treatment cost at US$278/yd(3) (US$364/m3), compared to US$350/yd(3) (US$458/m3) for the 'box-and-bury' baseline alternative treatment system.

The importance of minutes, contracts and agreements.

Hardly a day passes in the office of the RACGP Services Division without an enquiry from a general practitioner about an employment contract. These contracts are as important as our health records but unfortunately are poorly attended to and often missing from the office files. A little attention can save a lot of anguish.

Good systems save costs.

The costs in medical practices are high because of the need for personal contact with patients. It is important, therefore, to minimise other costs by the use of good systems. One such system is the Health Record, which is essential in every practice, and if it is the appropriate system it can significantly reduce ongoing costs. Similarly, good financial and accounting systems and efficient appointment systems can also reduce practice costs.

Are you master or servant of the telephone?

With good organisation, the telephone is a very useful tool in general practice, but if not controlled, it can become master rather than servant. Involvement in its use in your practice is important.

Turn account settlement into a PR exercise.

In general practice it will cost 20 to 25 per cent of the average consultation fee to collect the fee by sending accounts. One might well ask the question: Who can afford to lose that amount of the present consulting fee and still survive economically? At the same time as the fee settlement, the receptionist can help the patient and aid practice efficiency.

Logistics of early management of head and spinal injuries.

The logistics of early management have been studied in a series of 1161 patients with head and/or spinal injuries, who were admitted to hospital in NSW in 1977-78. Special attention has been given to three subgroups: 336 head injuries with records of impaired consciousness before first hospital admission, 355 head injuries later transferred because of deterioration, and 202 serious spinal injuries. It was found that in at least 18% of unconscious head injuries, and a similar percentage of spinal injuries, first aid and transport to hospital were provided by ambulances recorded to have only one trained staff member. In country areas, 41% of unconscious head injuries reached hospital after periods of time exceeding 1 h. For administrative as well as geographic reasons, more than 80% of initially unconscious head injuries and spinal injuries were first admitted to hospitals without neurosurgical and/or spinal services; the majority of cases in both groups, therefore, had to be transferred to other hospitals, often within 6 h of first admission. In the subgroup of cases transferred because of deterioration, mortality increased with distance from a neurosurgical unit. These findings are related to the concept of an integrated regional trauma service.

Epidemiology and clinical outcomes of neurotrauma in New South Wales.

This study of 1161 neurotrauma patients in New South Wales hospitals was designed to examine the role of preventable causes of death and disability in cases of spinal injury, extradural, subdural and multiple intracranial haematomas in order to make recommendations for improvements in accident, emergency, ambulance and hospital services. Methods have been developed for standardizing diagnosis in different classes of hospital for the assessment of severity in terms of the patient's age, sex, physical signs, head and spine injuries and other injuries. Estimates have been made of the number of preventable deaths by a case control study of each category of neurotrauma under study.