Impact of the Allergy Clarification for Cefazolin Evidence-based Prescribing Tool on Receipt of Preferred Perioperative Prophylaxis: An Interrupted Time Series Study.

Implementation of a perioperative allergy and antibiotic assessment tool in patients with reported beta-lactam allergy resulted in a pronounced and sustained increase in perioperative cefazolin use. This intervention could result in improved efficiencies surrounding perioperative antibiotic administration and possible reductions in surgical site infection rates.

Self-reported beta-lactam allergy and the risk of surgical site infection: A retrospective cohort study.

OBJECTIVE: To assess whether a self-reported ß-lactam allergy is associated with an increased risk of surgical site infection (SSI) across a broad range of procedures and to determine whether this association is mediated by the receipt of an alternate antibiotic to cefazolin. DESIGN: Retrospective cohort study. PARTICIPANTS: Surgical procedures sampled by an institutional National Surgical Quality Improvement Program database over an 18-month period (January 2017 to June 2018) from 7 surgical specialties. SETTING: Tertiary-care academic hospital. RESULTS: Of the 3,589 surgical procedures included in the study, 369 (10.3%) were performed in patients with a reported ß-lactam allergy. Those with a reported ß-lactam allergy were significantly less likely to receive cefazolin (38.8% vs 95.5%) or metronidazole (20.3% vs 26.1%) and were more likely to receive clindamycin (52.0% vs 0.2%), gentamicin (3.5% vs 0%), or vancomycin (2.2% vs 0.1%) than those without allergy. An SSI occurred in 154 of 3,220 procedures (4.8%) in patients without reported allergy and 27 of 369 (7.3%) with reported allergy. In the multivariable regression model, a reported ß-lactam allergy was associated with a statistically significant increase in SSI risk (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 1.04-2.51; P = .03). This effect was completely mediated by receipt of an alternate antibiotic to cefazolin (indirect effect aOR, 1.68; 95% CI, 1.17-2.34; P = .005). CONCLUSIONS: Self-reported ß-lactam allergy was associated with an increased SSI risk mediated through receipt of alternate antibiotic prophylaxis. Safely increasing use of cefazolin prophylaxis in patients with reported ß-lactam allergy can potentially lower the risk of SSIs.

The importance of tailoring physicians' trauma care training needs in rural environments.

SUMMARY: Gaps in the provision of care exist in the initial evaluation and management of patients first cared for in the most rural settings. We designed a survey to explore what unmet educational needs might exist so as to improve the care of patients before transfer. Here we discuss opportunities for tailored training that will enhance learning capacity, narrow the trauma education gap and improve trauma care, particularly in rural environments.

Nutrition research in the first decade of 21(st) century in Iran: the necessity of road Map.

Due to important role of nutrition research in understanding of relevant health subjects and lack of periodic situation analysis of nutrition articles in Iran, this study was conducted to assess nutrition publications in two time intervals of 2001-2005 and 2006-2010 in Farsi scientific journals. A title to title search was performed in all medical, basic science, agricultural and veterinary journals in a 10-year period. All the article titles were placed in techniques, foods, nutritional biochemistry and physiology, nutrition and health, and clinical nutrition subject headings based on Nutrition Abstracts and Reviews Series A (NARA) database. The publication type and the study design were also determined. Statistical analysis was carried out by chi square to test temporal changes. There were 2127 Farsi publications. The original articles consisted 98.1% of the articles. Interventional and survey articles composed 28.1% and 20.8% of the publication types, respectively. Researchers were mostly interested in descriptive articles. Regarding subject, nutrition and health, and clinical nutrition were of the first and second time period interests, respectively. In comparison between the two time periods, regarding subject heading, the proportion of nutrition and health publications showed a significant decline; while, the proportion of clinical nutrition publication showed a remarkable rise. The publication type, subject and study design of the article do not follow coordinated planning and policy making. Therefore, these researches are not efficient enough to solve nutritional problems in our community properly. Planning of the research priorities in the field of food and nutrition with the agreement and participation of all stakeholders is a necessity.

Designing a model for trauma system management using public health approach: the case of Iran.

Trauma is a leading cause of death and disability around the world. Injuries are responsible for about six million deaths annually, of which ninety percent occur in developing countries. In Iran, injuries are the most common cause of death among age groups below fifty. Trauma system development is a systematic and comprehensive approach to injury prevention and treatment whose effectiveness has been proved. The present study aims at designing a trauma system management model as the first step toward trauma system establishment in Iran. In this qualitative research, a conceptual framework was developed based on the public health approach and three well-known trauma system models. We used Benchmarks, Indicators and Scoring (BIS) to analyze the current situation of Iran trauma care system. Then the trauma system management was designed using the policy development phase of public health approach The trauma system management model, validated by a panel of experts, describes lead agency, trauma system plan, policy-making councils, and data-based control according to the four main functions of management: leading, planning, organizing and controlling. This model may be implemented in two phases: the exclusive phase, focusing on resource integration and the inclusive phase, which concentrates on system development. The model could facilitate the development of trauma system in Iran through pilot studies as the assurance phase of public health approach. Furthermore, the model can provide a practical framework for trauma system management at the international level.

Assessment of severity, causes, and outcomes of hospitalized trauma patients at a major trauma center.

BACKGROUND AND AIM: Trauma is a major cause of hospitalization in both civilians and military personnel (MP). It constitutes one of the most common causes of work layoffs, lowered efficiency, and handicaps in the civilian as well as the military population. Assessment of injury parameters and severity is useful. It allows for grading, grouping, classification, and assessment of outcomes of trauma patients for comparison with world standards. This study aimed to assess the Injury Severity Scores (ISS), recognize the source, and types of injuries leading to hospitalization of civilian and military trauma patients at our trauma center. MATERIALS: During 2004-2005, 1,393 trauma patients were admitted to our trauma center for major injuries. They were divided into three groups (1: ISS < 7; 2: 7 < or = ISS < or = 12; 3: ISS > 12) and assessed via obtaining demographic data, case history, and information relevant to the source of injury and the ISS. The treatment course and outcomes of the patients were followed in a prospective cross-sectional study. RESULTS: Of the 1,393 trauma patients, 721 (51.8%) were civilians and 672 (48.2%) were MPs. With regard to injury severity, 75.7% had an ISS < 7, 18.2% had an 7 < or = ISS < or = 12, and 6.2% had an ISS > 12. The average ISS was 5.2 with an SD of 5 and a median of 4. The average age was 30.5 years +/- 15.9 years with a median of 26.5 years. The average hospital stay was 9.2 days +/- 14.4 days with a median of 5 days. Regarding the mechanism of trauma, overall, 55.8% were traffic crashes, 26.7% falls, 5.9 bullets and shrapnel, and 11.6% altercations and other causes. In the 672 hospitalized MPs, the majority 669 were men (99.6%) and 3 were women (0.4%). Nonpenetrating trauma was prevalent in 71.2% of the MPs. Traffic crashes comprised the most common cause of their admission (36.1%). The average age was 26.6 years +/- 10 years. Fractures were the most common type of injury and this figure was (74%) in MPs. Inability to continue active duty permanently was 9% and mortality was 0.15% (one patient) in this fraction of MP. CONCLUSION: Causes of admission and hospitalization of trauma patients and MPs vary in different societies and nations. The percentage of MPs admitted to our trauma center was almost equal to that of the civilian population. Inquiry into the type and causes of the trauma in each setting constitutes the first step in implementing measures to prevent injuries and handicaps, reduce hospitalization (stay and charges), and cut work layoffs in this patient group. Integrated civilian-military medical systems and, in particular, integrated databases can be helpful in this regard.

Side-to-side arteriovenous fistula at the elbow with perforating vein ligation.

OBJECTIVE: We postulated that ligation of a consistent perforating venous branch at the elbow would improve distention and flow in the superficial veins about the elbow. This would also lesson the likelihood of arterial steal enabling a favorable outcome following a brachial artery medial antecubital or cephalic vein arterio-venous fistula (AVF). METHODS: Pressure measurements were made from the radial artery after side-to-side brachial artery antecubital or cephalic vein AVF in 20 patients. Clamping of the perforating vein increased radial artery pressure significantly indicating that a considerable amount of flow from the side-to-side AVF was diverted into the deep system and away from the accessible superficial veins. Encouraged by this finding, we studied the outcome of brachial cephalic or brachial antecubital AVF with ligation of the deep branch in 134 patients who were not candidates for radio-cephalic AVF. The end point of the study was successful hemodialysis using the fistula. RESULTS: Of the 134 patients treated, 24 died, and 11 were lost to follow-up and were censored from analysis of fistula performance at that time point. The primary fistula success rate was 89.7% +/- 2.66% and 83.7% +/- 3.5% at 1 and 2 years by life table analysis. No patient developed significant arterial steal or venous hypertension. CONCLUSION: We recommend this simple one-stage procedure for patients requiring hemodialysis whose cephalic vein at the wrist is unsuitable.

Pediatric transport related injuries in Tehran: the necessity of implementation of injury prevention protocols.

Prehospital and hospital data was prospectively gathered on all hospitalized trauma patients admitted to six major trauma hospitals in Tehran from August 1999 to September 2000. Data from patients of under 19 years of age was analyzed for this article. From 8000 hospitalized trauma patients, 2354 cases (29%) belonged to this age group. Fall and transport related injuries (TRIs) with 1074 (46%) and 921 (39%) cases respectively, were the most common mechanism of injury. In TRIs, boys were affected 3.5 times as often as girls. Younger children were more prone to pedestrian-related injuries while teenagers were more prone to motorcycle related injuries. Head trauma was the most common cause of death and 28 out of 32 trauma deaths were attributed to this kind of injury. Lower extremity (513) and head injuries (322) were the most common injuries. Only a few of motorcyclists and car passengers used safety devices (helmet and seat belt respectively) at the time of accident.