No abstract

Background Teamwork is an essential factor in reducing workflow disruption (WD) in the operating room. Team familiarity (TF) has been recognized as an antecedent to surgical quality and safety. To date, no study has examined the link between team members' role and expertise, TF and WD in surgical setting. This study aimed to examine the relationships between expertise, surgeon-scrub nurse familiarity and WD. Methods We observed a convenience sample of 12 elective neurosurgical procedures carried out by 4 surgeons and 11 SN with different levels of expertise and different degrees of familiarity between surgeons and SN. We calculated the number of WD per unit of coding time to control for the duration of operation. We explored the type and frequency of WD, and the differences between the surgeons and SN. We examined the relationships between duration of WD, staff expertise and surgeon-scrub nurse familiarity. Results 9.91% of the coded surgical time concerned WD. The most frequent causes of WD were distractions (29.7%) and colleagues' interruptions (25.2%). This proportion was seen for SN, whereas teaching moments and colleagues' interruptions were the most frequent WD for surgeons. The WD was less high among expert surgeons and less frequent when surgeon was familiar with SN. Conclusions The frequency of WD during surgical time can compromise surgical quality and patient safety. WD seems to decrease in teams with high levels of surgeon-scrub nurse familiarity and with development of surgical expertise. Favoring TF and giving feedback to the team about WD issues could be interesting ways to improve teamwork.

Conflicts and controls analyzed through verbal reports can be used as relevant indicators to highlight critical moments in decision making that potentially require assistance from information systems.

Purpose Type IIB odontoid fractures (OF) in elderly patients are life-threatening conditions. Optimal treatment of these fractures is still controversial. The aim of this study was to assess the clinical and radiological outcome of surgically treated type IIB OF by anterior screw fixation in octogenarians. Methods Eleven octogenarians with type IIB OF were operated using anterior screw fixation. Follow-up assessment included operative mortality and morbidity rates, long-term functional outcome and fracture union and stability. Results There was neither operative mortality nor morbidity. Five patients had excellent clinical outcome, two good outcome, one fair and three poor. Two patients died of unrelated causes 2 months after surgery. Radiographs showed stable bone union in four patients and stable fibrous union in five patients. Conclusions Given the results in this short series, we suggest that anterior screw fixation of Type IIB OF may be offered as primary treatment in octogenarians.

iHere we report in a human, a renal transplant patient, the first disseminated infection with Nocardia cerradoensis, isolated after a brain biopsy. Species identification was based on 16S rRNA, gyrB, and hsp65 gene analyses. Antibiotic treatment was successful by combining carbapenems and aminoglycosides and then switching to oral trimethoprim-sulfamethoxazole. CASE REPORTA 59-year-old woman with a history of end-stage renal disease, secondary to autosomal-dominant polycystic kidney disease, received a renal transplant in 2010. Her immunosupressive regimen included tacrolimus at 12 mg/day and prednisolone at 7.5 mg/day. Prophylaxis with trimethoprim-sulfamethoxazole (SXT) was given for 6 months after the transplantation and then stopped due to intolerance symptoms. The patient had no history of recent travel. Two weeks before admission, she had had a mild headache with fever and chills and she was empirically treated with amoxicillin and prednisone for 7 days. After a brief improvement, she developed a nonproductive cough with dyspnea. Based on the hypothesis of pneumonia, antibiotic treatment was switched to ceftriaxone combined with aerosol bronchodilators. The patient's pulmonary symptoms rapidly worsened, and in September 2013, she was admitted to the hospital for further investigation.On examination, the patient was awake and complained of inspiratory dyspnea. Diarrhea was noted a few days after the initiation of antibiotic treatment and resolved spontaneously. The patient's temperature was measured at 37.8°C, blood pressure was 150/90 mm Hg, pulse was 97 beats/min, respiratory rate was 36/ min, and oxygen saturation was 97% while she was breathing ambient air. The auscultation evidenced bilateral basal crepitus and no other abnormal sounds. Heart sounds were normal, abdomen was soft, without tenderness, distention, or organomegaly, and neurologic examination was normal. No peripheral lymph nodes were detected. Subcutaneous nodules of the lower extremities appeared a few days after the patient was admitted (Fig. 1A). The white cell count was 18.6 ϫ 10 9 /liter, with 95% neutrophils, and the blood level of C-reactive protein was 159 mg/liter. A chest X-ray and a computed tomography (CT) scan showed wall thickening of the right main bronchus, moderate ground-glass opacities of the right upper lobe, a right hilar lymph node, a small right parenchymal nodule (Ͻ10 mm), and moderate homolateral pleural effusion (Fig. 1B). An abdominal CT scan revealed diffuse peritoneal and right retroperitoneal nodules (Fig. 1C) and a thickening of the cecal wall. Bronchoalveolar lavage (BAL) fluid, bronchial, and subcutaneous biopsy specimens were collected, and examination of stained smears (using Gram, Ziehl-Neelsen, May-Grünwald-Giemsa, Papanicolaou, Perls, and hematoxylin-safranin stains) showed no bacteria or abnormal cells. Cultures for bacteria, fungi, and mycobacteria were all negative. Histological examination of the subcutaneous nodule identified an erythema nodosum. Amplification of bacterial 16S rRNA gene from the c...

In a controlled before-and-after study in a single centre, it was aimed to determine whether identification of Staphylococcus aureus nasal carriers followed by nasal mupirocin ointment and chlorhexidine soap reduced surgical site infections (SSIs) among 182 patients undergoing deep brain stimulation. In all, 119 patients were included in the control group and 63 in the screening group. There was a significant SSI decrease from 10.9% to 1.6% between the two groups (P<0.04; relative risk: 0.13; 95% confidence interval: 0.003-0.922). There were eight SSIs involving S. aureus in the control group, none in the screening group. No specific risk factors for SSI were identified.

The authors present the case of a 13-year-old boy who experienced frequent disabling episodes of typical postural induced headaches, which revealed a Chiari I malformation, syringomyelia and cervical spinal cord edema. This boy had received a valveless lumboperitoneal (LP) shunt at the age of 18 months for macrocephaly. At this time, cranial CT scan showed moderate enlargement of the subarachnoid spaces without hydrocephalus or tonsillar herniation. The LP shunt was clamped but the patient experienced signs of brain stem dysfunction and increased intracranial pressure. Finally, an adjustable valve (110 mm Hg) was inserted and all the symptoms resolved. Although some authors consider LP shunt as a safe and effective procedure even in the pediatric population, our case reminds us that these shunts, especially when valveless, may expose the patient to the risk of symptomatic acquired Chiari I malformation and syringomyelia consecutive to a chronic spinal CSF leakage.

Surgery of ISH provides good QOL and tumoral control except for those located in the medulla oblongata. We recommend considering a careful multimodal therapeutic approach, including radiosurgery for these specific locations.