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Cosmetic Dermatology

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Principles of Neurosurgery

 

Principles of Neurosurgery give a broad overview of the subject to medical students e junior house officers in the clinical neurosciences. The chapter topics chosen cover core areas of neurosurgery...excellent!!! 1000 pages, thousand of pictures, tables and ilustrations... 

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Principles of Neurosurgery

 

Reproductive endocrinology and infertility

More than 30 years after the birth of Louise Brown, the first child born as a result of in vitro fertilization, the practice of reproductive medicine has grown and evolved in a dramatic and profound fashion.
The advances made in the treatment of infertility have made the care of infertile patients more successful, rewarding, and exciting. However, management of the modern reproductive
endocrinology and infertility clinic has become very complex.
This book was developed to assist the practicing reproductive endocrinologist and/or laboratory director by providing an overview of relevant scientific, medical, and management issues in a single volume. While no book can cover everything associated with managing a reproductive endocrinology clinic and laboratory, we have enlisted experts from all relevant areas to provide concise, practical, and evidence based summaries of relevant topics. It is our hope that this resource will be of assistance to physicians and scientists engaged in this exciting field of medicine.

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Surgical Site Infections

Primitive ancestors of Homo sapiens and their colonizing bacteria have coevolved for approximately 500,000 years; some experts estimate that the total number of human cells is 1013 and the total number of colonizing microbes is 1014. Despite this 10-to-1 inequity, the balance of power is influenced by an intact human immune system and the integrity of the skin and mucous membranes. Operative procedures disrupt this balance, resulting in a risk of surgical-site infections from endogenous flora, including colonizing strains of Staphylococcus aureus.

The Centers for Disease Control and Prevention (CDC) term for infections associated with surgical procedures was changed from surgical wound infection to surgical site infection in 1992 . These infections are classified into incisional, organ, or other organs and spaces manipulated during an operation; incisional infections are further divided into superficial (skin and subcutaneous tissue) and deep (deep soft tissue-muscle and fascia). These definitions should be followed universally for surveillance, prevention, and control of surgical site infections.

Surgical site infections (SSIs) initiated during invasive procedures can require additional and/or extended treatment. Despite the best efforts of healthcare facilities to maintain safe surgical environments, surgical site infections result in up to $10 billion in treatment costs every year in the U.S. alone.
* 780,000 out of 30 million surgical procedures performed annually in the U.S. result in SSI.1
* In the United Kingdom, the estimated direct costs for a patient who has developed a surgical site infection are between €2,265 and €2,518.2
* According to a study in the Netherlands, SSIs result in 5.8 to 17 extra days of hospitalization.3
* In France, approximately 11% of surgical patients acquire a surgical site infection.4

Some common causes of SSI are:
* Complications from surgical hypothermia
* Contamination of the incision area by skin flora
* Bacterial cross–contamination
* Surgical instrument contamination

The pathogens isolated from infections differ, primarily depending on the type of surgical procedure. In clean surgical procedures, in which the gastrointestinal, gynecologic, and respiratory tracts have not been entered, Staphylococcus aureus from the exogenous environment or the patient's skin flora is the usual cause of infection. In other categories of surgical procedures, including clean-contaminated, contaminated, and dirty, the polymicrobial aerobic and anaerobic flora closely resembling the normal endogenous microflora of the surgically resected organ are the most frequently isolated pathogens

The most critical factors in the prevention of postoperative infections, although difficult to quantify, are the sound judgment and proper technique of the surgeon and surgical team, as well as the general health and disease state of the patient. Other factors influence the development of postoperative wound infection, especially in clean surgical procedures, for which the infection rate (<3%) is generally low. Infections in these patients may be due solely to airborne exogenous microorganisms

Article taken from:
http://www.cdc.gov/ncidod/eid/vol7no2/nichols.htm
http://www.nejm.org/doi/full/10.1056/NEJMe0908753
http://www.haiwatch.com/SSI.aspx?Region=UK

Hospital acquired infections

When someone develops an infection at a hospital or other patient care facility that they did not have prior to treatment, this is referred to as a healthcare-associated (sometimes hospital-acquired) infection (HAI).

Healthcare-associated infections (HAIs) are a global crisis affecting both patients and healthcare workers.

According to the World Health Organization (WHO), at any point in time, 1.4 million people worldwide suffer from infections acquired in hospitals.

A Centers for Disease Control (CDC) report published in March-April 2007 estimated the number of U.S. deaths from healthcare asociated infections in 2002 at 98,987.

The risk of acquiring healthcare-associated infections in developing countries is 2-20 times higher than in developed countries.

Afflicting thousands of patients every year, HAI often leads to lengthening hospitalization, increasing the likelihood of readmission, and adding sizably to the cost of care per patient.

Financially, HAIs represent an estimated annual impact of $6.7 billion to healthcare facilities, but the human cost is even higher.

Until recently, a lack of HAI reporting requirements for healthcare facilities has contributed to less-than-optimal emphasis being placed on eliminating the sources of healthcare associated infections. However, growing public anxiety regarding the issue and resulting legislation on state and local levels demanding accountability is serving to accelerate initiatives to combat HAIs.

To learn more about the impact of healthcare-associated infections for both medical professionals and patients, please visit www.haiwatch.com.
Grabbed from:
http://haiwatchnews.com/