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Background: The purpose of this prospective study was to determine the effectiveness of targeted interventions to improve compliance with antibiotic prophylaxis guidelines (timing, spectrum, and discontinuation) at 2 university-affiliated hospitals., Methods: Based on barriers identified previously, hospital-specific interventions were developed such as educational conferences, standardized forms, an extended time-out, and feedback. Guideline compliance and surgical site infection (SSI) data were recorded on all patients who underwent elective laparotomies for colorectal procedures, vascular operations, and hysterectomies during four 6-month study periods. Prestudy data from July to December 2006 served as a baseline. One year later, a prospective cohort study was performed. The interventions were introduced to the 2 hospitals in a staggered fashion with 2-month implementation periods before reassessing compliance during the 6-month study periods. General linear modeling was performed (P < .05 significant)., Results: Compliance with all 3 guidelines combined improved during the year preceding the study, after attention only, at both hospitals. Hospital-specific differences were found in the effectiveness of the intervention package on individual guidelines. Hospital 2 but not 1 improved in timing after the interventions; both hospitals improved in spectrum, and neither hospital improved in discontinuation. Overall compliance with all 3 antibiotic prophylactic measures was greater at hospital 1, but hospital 2 had lower SSI rates., Conclusion: Simply increasing attention to a quality problem can result in a significant and sustained improvement. Quality improvement interventions should be evaluated rigorously for effectiveness given hospital-specific differences in effectiveness and for correlation of guideline compliance with outcome., (Copyright 2010 Mosby, Inc. All rights reserved.)

Friction force microscopy was employed for the tribological investigation of human head hair in two different environments: a dry atmosphere and de-ionized water. The fibers were immobilized by embedding them in indium. The effects of bleaching, conditioning, and immersion in methanolic KOH were quantified in terms of the relative coefficient of friction (μ). The virgin fibers were clearly distinguished in terms of friction coefficient from the chemically damaged ones in both environments, while all categories of hair exhibited higher friction coefficients in the aqueous environment. Secondary ion mass spectroscopy was used as a complementary technique to examine the presence of fatty acids on the cuticular surface of the different categories of hair as well as the conditioner distribution. Neither bleaching nor 30 min treatment in methanolic KOH was found adequate to completely remove the fatty acids from the fibers' surface. Conditioner species were detected along the whole cuticular surface.

Background: The aim of this study was to determine if presurgery (T1), post-surgery (T2), or the change in body mass index (BMI) between these time points are useful predictors for predicting longer-term (T3) outcome in gastric bypass surgery., Methods: The sample consisted of 72 gastric bypass surgery patients with an average age of 40.5. The mean presurgery BMI was 54.7 (SD = 8.6). T2 assessments (BMI, depressed mood, binge eating status) occurred on average 21 weeks (SD = 19) after surgery and T3 assessments occurred on average 63 weeks (SD = 34) after surgery., Results: Three separate hierarchical linear regressions were performed to assess the predictive value of (1) BMI at T1, (2) BMI at T2, and (3) change in BMI from T1 to T2 on the dependent variable, BMI at T3, when age, sex, ethnicity, education status, age of overweight, binge eating status, depressed mood, and number of weeks after surgery were controlled for. When these demographic and psychological variables were controlled for, lower BMI at T1 and lower BMI at T2 predicted lower BMI at T3. However, change in BMI from T1 to T2, did not significantly predict BMI at T3 (p < .001)., Conclusions: Higher presurgery BMI and post-surgery BMI predict poorer 1-year follow-up BMI in gastric bypass surgery, and these measures can be used as easy "rules of thumb" for predicting longer term outcome.

Background: One of the greatest challenges facing both practitioners and risk managers is the identification of previously unknown clinical hazards and defects. With the rapid proliferation of new health care services, unknown hazards may propagate as new therapies are integrated into the existing health care system. The main goal of risk analysis is to make these hazards visible by proactively searching and probing the system. Yet, a comprehensive approach by which to safely integrate new therapies into the existing clinical environment has yet to be clearly articulated. Patient care teams can use the proposed framework when introducing new therapies., A Practical Framework: The framework includes a background investigation and literature search; an in situ simulation (in the actual clinical setting used for patients); a Failure Mode and Effects Analysis to determine the severity, probability, and risk of the potential hazards; and a multidisciplinary protocol and safety checklist to standardize practice and ensure provider accountability., Case Examples: Application of this framework to three operative scenarios--intraoperative radiation therapy (IORT), hyperthermic intraperitoneal chemotherapy (HIPEC), and an interventional pulmonology program--demonstrates its flexibility. Its use prospectively identified and mitigated 20 IORT, 5 HIPEC, and 18 interventional pulmonology hazards/defects. Subsequent patient cases were largely uneventful. All cases and patient safety reporting systems are monitored to identify any new defects in an effort to continuously improve patient care., Conclusion: The use of a comprehensive framework to identify and mitigate hazards in an on-site simulated environment promotes safer care for target patient populations; results in familiarity with procedures, amelioration of staff concerns, and standardization of practice; and facilitates teamwork and communication.

Contact granuloma of the vocal cords is a recognised but unusual complication of prolonged endotracheal intubation. The authors have however encountered a case of contact granuloma associated with short-term intubation of just four hours following orthognathic surgery. Here we briefly describe the orthodontic case and orthognathic surgery. We further explain the presenting symptoms and treatment undertaken for the contact granuloma.

This work describes a system for precise re-location of cells within a monolayer after atomic force imaging. As we know little about probe interaction with soft biological surfaces any corroborative evidence is of great importance. For example, it is of paramount importance in living cell force microscopy that interrogated cells can be re-located and imaged by other corroborative technologies. Methodologies expressed here have shown that non-invasive force parameters can be established for specific cell types. Additionally, we show that the same sample can be transferred reliably to an SEM. Results here indicate that further work with live cells should initially establish appropriate prevailing force parameters and that cell damage should be checked for before and after an imaging experiment.