Introduction: Surgery in patients with head and neck cancers is frequently complicated by multiple stages of procedure that includes significant surgical removal of all or part of an organ with cancer, tissue reconstruction, and extensive neck dissection. Postoperative wound infections, termed ‘surgical site infections’ (SSIs) are a significant impediment to head-and-neck cancer surgery and recovery, and need to be addressed.
Areas covered: Approximately 10–45% of patients undergoing head-and-neck cancers surgery develop SSIs. SSIs can lead to delayed wound healing, increased morbidity and mortality as well as costs. Consequently, SSIs need to be avoided where possible, as even the surgery itself impacts on patients’ subsequent activities and their quality of life, which is exacerbated by SSIs. Several risk factors for SSIs need to be considered to reduce future rates, and care is also needed in the selection and duration of antibiotic prophylaxis.
Expert commentary: Head and neck surgeons should give personalized care especially to patients at high risk of SSIs. Such patients include those who have had chemoradiotherapy and need reconstructive surgery, and patients from lower and middle-income countries and from poorer communities in high income countries, who often have high levels of co-morbidity because of resource constraints. 相似文献
Bulletin of Environmental Contamination and Toxicology - The residual activity of herbicides may be detrimental to the environment, requiring analysis of the persistent residues in the soil and... 相似文献
Background: Elevated serum transaminases that are often observed in critically ill children are frequently attributed to liver injury. Indeed, hypoperfused or hypoxemic livers will produce sudden and marked elevations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The aim of this study was to determine the frequency and consequences of elevated serum transaminases in children following cardiac surgery. Methods: Charts of all children admitted to the Pediatric Intensive Care Unit following cardiac surgery over a 10‐year period were retrospectively analyzed. Results: Of the 384 children studied, 46 (11.9%) had elevated transaminases. Extreme ALT and AST levels (≥20‐fold elevations over the upper limit of normal) were found in 3.4% and 4.7% of the children, respectively. Tetralogy of Fallot and double outlet right ventricle were significantly more common (P < 0.001) among the elevated transaminases group (26% and 13% vs 17% and 2.5%, respectively). A significant difference (P < 0.001) was noted between overall mortality among 384 patients studied: 15.8%, versus a mortality of 43.4% among children who manifested elevated transaminases levels following cardiac surgery. AST, ALT and lactate dehydrogenase peak levels were significantly higher in the group of children who died in comparison to the survivors (P < 0.05). Kaplan–Meier survival analysis demonstrated lower survival among the patients who had extreme ALT elevations (P < 0.05). Conclusions: Elevation of transaminases following cardiac surgery occurs more frequently than previously reported, particularly in the setting of right‐sided heart failure. Extreme elevation of ALT, AST and lactate dehydrogenase correlated with decreased postoperative survival and places these children in a high‐risk category, requiring closer, more stringent monitoring. 相似文献
To evaluate the impact of opioid controlled substance agreements (CSAs) enrollment on health care utilization.
Patients and Methods
We retrospectively evaluated health care utilization changes among 772 patients receiving long-term opioid therapy for chronic noncancer pain enrolled in a CSA between July 1, 2015, and December 31, 2015. We ascertained patient characteristics and utilization 12 months before and after CSA enrollment. Decreased utilization was defined as a decrease of 1 or more hospitalizations or emergency department visits and 3 or more outpatient primary and specialty care visits. Multivariate modeling assessed demographic characteristics associated with utilization changes.
Results
The 772 patients enrolled in an opioid CSA during the study period had a mean ± SD age of 63.5±14.9 years and were predominantly female, white, and married. The CSA enrollment was associated with decreased outpatient primary care visits (odds ratio [OR], 0.16; 95% CI, 0.14-0.19) and increased diagnostic radiology services (OR, 1.22; 95% CI, 1.02-1.47). After CSA enrollment, patients with greater comorbidity (Charlson Comorbidity Index score >3) were more likely to have reduced hospitalizations (adjusted OR, 2.8; 95% CI, 1.3-6.0; P=.008), reduced outpatient primary care visits (adjusted OR, 2.0; 95% CI, 1.2-3.2; P=.005), and reduced specialty care visits (adjusted OR, 2.0; 95% CI, 1.2-3.3; P=.006).
Conclusion
For patients receiving long-term opioid therapy for chronic noncancer pain, CSA enrollment is associated with reductions in primary care visits and increased radiologic service utilization. Patients with greater comorbidity were more likely to have reductions in hospitalizations, outpatient primary care visits, and outpatient specialty clinic visits after CSA enrollment. The observational nature of the study does not allow the conclusion that CSA implementation is the primary reason for these observed changes. 相似文献
Opinion statement Patients with hepatitis C virus (HCV) infection have a higher prevalence of psychiatric illness compared with the general
US population, and the prevalence of HCV infection in patients with severe mental illness ranges between 8% and 19%, which
is four to nine times that of the general US population (1.8%). Given the association between HCV infection and psychiatric
illness, gastroenterologists are on the front line of identifying comorbid psychiatric and substance use disorders and conducting
a psychosocial pretreatment risk-benefit assessment for HCV infection. The use of interferon-α (IFN)-based therapies in combination
with ribavirin (RBV) to eradicate HCV has been associated with frequent neuropsychiatric adverse effects (eg, affective, anxiety,
cognitive, and psychotic symptoms) that compromise the management of both HCV patients with and those without a preexisting
history of psychiatric illness. Consequently, gastroenterologists have been reluctant to engage patients with HCV and comorbid
psychiatric illness in antiviral treatment due to concerns about exacerbating or precipitating neuropsychiatric symptoms.
Despite the clinical challenge that HCV treatment of patients with comorbid HCV and psychiatric illness presents, recent research
indicates that HCV treatments can be safely administered to patients with psychiatric illness provided that there is a comprehensive
pretreatment assessment, a risk-benefit analysis, and ongoing follow-up of neuropsychiatric symptoms during antiviral therapy.
The process of pretreatment assessment involves screening patients for psychiatric and substance use disorders, educating
patients about the treatment process, and addressing available psychosocial support. Most psychotropic medications (antidepressants,
mood stabilizers, antipsychotics, and neuroleptics) are thought to be safe to use in the management of patients with HCV and
psychiatric illness and for the management of IFN- and RBV-induced neuropsychiatric adverse effects. Nonetheless, the prophylactic
use of psychotropic medications to prevent IFN- and RBV-induced neuropsychiatric adverse effects remains a controversial topic.
The use of IFN and RBV in patients with HCV and severe mental illness can be done safely with expert psychiatric follow-up.
In this review, we discuss the process of pretreatment assessment of patients with HCV and psychiatric illness and specifically
address IFN- and RBV-induced depression in patients receiving HCV treatment. 相似文献