Evaluation of Patient Information Material in the Consent Process for Surgical Stabilization of Rib Fractures.

BACKGROUND: Surgical stabilization of rib fractures is a procedure carried out in most trauma centers; however, data on evaluation of patient information material regarding this procedure are limited. The trauma service at our hospital implemented slide presentation as an adjunct tool to the consenting process for patients undergoing this procedure. OBJECTIVE: The aim was to evaluate information material for patients undergoing surgical stabilization of rib fractures procedure and subjective outcomes from education on components of knowledge, emotion, and behavior for patients undergoing this procedure. METHODS: A one-group posttest prospective design study was conducted over 18 months at a Level I trauma center. Supplementary visual material was provided as an adjunct to the consent process of surgical rib fixation. Evaluation from the patient's perspective was undertaken utilizing the usefulness scale for patient information material. This tool was based on a tripartite model of reading, evaluating, and responding to patient information material. RESULTS: Over the period of 18 months, 60 patients underwent surgical stabilization of rib fractures. Fifty-two (91.7%) patients reviewed the information material, and 41 (78.8%) patients completed the feedback. The results reflect that the majority of patients perceived positive responses in emotional support (M = 8.42, SD = 6.6); behavioral motivation (M = 8.57, SD = 6.4); and education on knowledge (M = 9.09, SD = 4.6). CONCLUSION: In this novel study, visual aids as an adjunct to the informed consent process augmented patient knowledge regarding surgical stabilization of rib fractures and received positive subjective patient feedback on knowledge about the procedure.

Therapeutic drug monitoring of beta-lactam antibiotics in burns patients--a one-year prospective study.

BACKGROUND: Beta-lactams are first-line antibiotics for the management of superficial infections due to burn injury. There is sparse data available on therapeutic drug monitoring (TDM) in patients with burns in a ward setting. This study was conducted to evaluate the utility of a beta-lactam TDM program in a cohort of burn injury patients in a ward environment. METHODS: Steady-state blood samples were collected immediately before a scheduled dose. The therapeutic concentration targets assessed were (1) free antibiotic concentrations exceeding the minimum inhibitory concentration (MIC; fT > MIC) and (2) free concentrations ≥4× MIC of the known or suspected pathogen (fT > 4× MIC). The duration of therapy was also assessed. RESULTS: A total of 50 patients were included for TDM over a 12-month period. The mean (±SD) age was 49 ± 16 years. The mean percent total body surface area burn was 17 ± 13%. The mean serum creatinine concentration was 86 ± 20 µmole/L. Sixty percent of the patients did not achieve fT > MIC, and only 18% achieved the higher target of fT > 4× MIC. Although all the patients achieved a positive clinical outcome, the duration of antibiotic treatment was shorter in patients who achieved fT > MIC compared with those who did not (4.2 ± 1.1 versus 5.3 ± 2.3 days; P = 0.03). CONCLUSIONS: We found TDM to be a reliable intervention for burn injury patients in a ward environment. This study supports pharmacokinetic data that burns patients may be at risk of subtherapeutic dosing, which may prolong the duration of antibiotic therapy.

Characteristics of bloodstream infections in burn patients: An 11-year retrospective study.

AIMS: The principal aim of this study was to describe infection related characteristics of blood stream infections (BSI) in patients with burns. We sought to determine the organisms that caused BSI and factors that could predict the outcome of BSI. METHODS: Data was collected on admitted patients with burns from January 1998 to December 2008. Selected information from databases was analysed using SPSS version 17 (SPSS Inc., Chicago). Descriptive, univariate and multivariate analysis was undertaken to determine factors predictive of clinical outcome. The factors analysed by univariate analysis were selected on clinical plausibility. Multivariate analysis used a crosstabs procedure initially to estimate maximum likelihood. Factors that were associated with a p value <0.15 were entered into a binary logistic regression to detect which factors were independent predictors of mortality in BSI and outcome according to specific organisms. RESULTS: Ninety-nine out of 2364 (4%) patients developed 212-documented BSI. The median time from burn to BSI was 7 (interquartile range 3-16) days. Gram-positive organisms, in particular Methicillin resistant Staphylococcus aureus and Coagulase negative Staphylococci, were the most common bacteria associated with BSI in the first week of hospital admission. The mortality rate for all admissions over the data collection period was 3%. Of the 99 patients with BSI, 13 died giving a mortality rate, in the presence of BSI, of 13%. Univariate analysis found that the factors predictive of P. aeruginosa mortality were inhalational injury, higher total body surface area burns, total days of antibiotic treatment and elevated Acute Physiological and Chronic Health Evaluation (APACHE) II scores. Multivariate analysis identified inhalational injury to be the only factor associated with BSI-related mortality. CONCLUSION: Whilst the overall mortality in our cohort was low, the presence of BSI increased this four-fold. Whilst infections caused by Gram-positive pathogens occurred earlier in the patient stay than Gram-negative organisms, the highest mortality was associated with P. aeruginosa infections. This study highlights the negative effects of BSI on clinical outcomes in burn patients.