The Experts below are selected from a list of 318 Experts worldwide ranked by ideXlab platform
A P R Wilson - One of the best experts on this subject based on the ideXlab platform.
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AGE, ASA AND BMI AS RISK FACTORS FOR SURGICAL SITE INFECTION MEASURED USING Asepsis IN TRAUMA AND ORTHOPAEDIC SURGERY
2012Co-Authors: Elizabeth Ashby, A P R Wilson, M.j. Davies, Fares S. HaddadAbstract:There is mixed evidence in the literature regarding increasing age, ASA and BMI as risk factors for surgical site infection in orthopaedic surgery. To investigate the matter further, we examined 1055 wounds in 1008 patients in the Department of Trauma and Orthopaedic Surgery at University College London Hospital between 2000 and 2006. All patients with a minimum two-night stay were included. Data was collected by four designated research nurses. The age, height, weight and ASA status of each patient was recorded. All wounds were classified using Asepsis. This is a quantitative wound scoring method which is a summation of scores calculated from visual wound characteristics and the clinical consequences of infection. Our results showed a strong linear association between age and Asepsis scores. Single variable regression analysis showed a t value of 3.32 and p value of 0.001. A similar linear association was seen between ASA grading and Asepsis scores. Single variable regression analysis showed a t value of 2.75 and p value of 0.006. The association between BMI and Asepsis scores was markedly different from that seen with age and ASA. The graph was U-shaped with patients with a BMI of 25-30 having the lowest average Asepsis scores. Patients with a lower and a higher BMI had higher average Asepsis scores. Single variable regression analysis was not significant since the relationship between BMI and Asepsis scores is not linear. In conclusion, there are clearly defined patient groups who are at increased risk of developing a surgical site infection: older patients, patients with a higher ASA, and patients with both a low and high BMI. These patients should be targeted to reduce overall infection rates. This can be achieved by ensuring adequate antibiotic prophylaxis, having a low threshold to treat suspected infection and arranging regular follow-up.
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ORTHOPAEDIC WOUND SURVEILLANCE USING Asepsis
2009Co-Authors: Elizabeth Ashby, A P R Wilson, M.j. Davies, Fares S. HaddadAbstract:Aims: To determine the rate of orthopaedic wound infection using Asepsis and compare this to the rate of infection as defined by the US Centres for Disease Control (CDC) and the UK Surgical Site Infection Surveillance Service (SSISS). Background: It is a common misconception that reported rates of orthopaedic wound infection are accurate, reliable and reproducible. Most definitions of infection, including CDC and SSISS, are subjective and depend on the interpretation of the surgeon. Asepsis1 is a method of wound scoring which grades wounds as uninfected, disturbed healing, minor infection, moderate infection and severe infection. Asepsis scoring has been proven to be both objective and repeatable2. Method: Over 4 years, 1113 orthopaedic wounds were prospectively evaluated using the CDC definition for surgical site infections, the SSISS definition and the Asepsis scoring method. Patients were seen pre-operatively and at 3 and 5 days post-operatively. They also completed a wound surveillance questionnaire at 2 months post-discharge. Results: The overall infection rates were 8% as defined by CDC, 4% as defined by SSISS and 3% as defined by Asepsis. Further classification of the wounds as defined by Asepsis revealed that 91% of wounds showed no evidence of infection (score 40). Conclusion: This study illustrates that accurate wound surveillance is not simple. Different wound infection definitions give very different rates of infection and make comparisons between surgeons and hospitals impossible. We propose that Asepsis provides the most accurate and reproducible results and also provides more information with the grading of wound infection. The overall rate of orthopaedic wound infection using the Asepsis method is 3%. If all hospitals used this scoring method, more accurate comparisons of infection rates could be made.
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the use of the wound scoring method Asepsis in postoperative wound surveillance
Journal of Hospital Infection, 1990Co-Authors: A P R Wilson, C Weavill, J Burridge, M C KelseyAbstract:Abstract For the purposes of wound surveillance programmes and clinical trials, a wound scoring method, Asepsis, makes assessment of wound sepsis more objective and reproducible by allotting points both for the appearance of the wound in the first week and for the clinical consequences of infection. Asepsis was compared with other definitions of wound infection in 1029 surgical patients and its suitability for surveillance and detection of risk factors were examined. Satisfactory healing was recorded in 867 patients, disturbance of healing in 74 and minor, moderate and severe wound infection in 41, 24 and 23 patients respectively. An Asepsis score over 20 points was more sensitive and as specific as the presence of pus as an indicator of changes in management resulting from infection. Multiple regression analysis of Asepsis scores indicated that operation type, ward, degree of contamination, age, body mass index, and preoperative stay in hospital were significant risk factors. In matching 52 infected patients with uninfected controls, any wound score over 10 points was associated with a significant delay in discharge from hospital (median 3 days, P
M C Kelsey - One of the best experts on this subject based on the ideXlab platform.
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the use of the wound scoring method Asepsis in postoperative wound surveillance
Journal of Hospital Infection, 1990Co-Authors: A P R Wilson, C Weavill, J Burridge, M C KelseyAbstract:Abstract For the purposes of wound surveillance programmes and clinical trials, a wound scoring method, Asepsis, makes assessment of wound sepsis more objective and reproducible by allotting points both for the appearance of the wound in the first week and for the clinical consequences of infection. Asepsis was compared with other definitions of wound infection in 1029 surgical patients and its suitability for surveillance and detection of risk factors were examined. Satisfactory healing was recorded in 867 patients, disturbance of healing in 74 and minor, moderate and severe wound infection in 41, 24 and 23 patients respectively. An Asepsis score over 20 points was more sensitive and as specific as the presence of pus as an indicator of changes in management resulting from infection. Multiple regression analysis of Asepsis scores indicated that operation type, ward, degree of contamination, age, body mass index, and preoperative stay in hospital were significant risk factors. In matching 52 infected patients with uninfected controls, any wound score over 10 points was associated with a significant delay in discharge from hospital (median 3 days, P
J Burridge - One of the best experts on this subject based on the ideXlab platform.
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the use of the wound scoring method Asepsis in postoperative wound surveillance
Journal of Hospital Infection, 1990Co-Authors: A P R Wilson, C Weavill, J Burridge, M C KelseyAbstract:Abstract For the purposes of wound surveillance programmes and clinical trials, a wound scoring method, Asepsis, makes assessment of wound sepsis more objective and reproducible by allotting points both for the appearance of the wound in the first week and for the clinical consequences of infection. Asepsis was compared with other definitions of wound infection in 1029 surgical patients and its suitability for surveillance and detection of risk factors were examined. Satisfactory healing was recorded in 867 patients, disturbance of healing in 74 and minor, moderate and severe wound infection in 41, 24 and 23 patients respectively. An Asepsis score over 20 points was more sensitive and as specific as the presence of pus as an indicator of changes in management resulting from infection. Multiple regression analysis of Asepsis scores indicated that operation type, ward, degree of contamination, age, body mass index, and preoperative stay in hospital were significant risk factors. In matching 52 infected patients with uninfected controls, any wound score over 10 points was associated with a significant delay in discharge from hospital (median 3 days, P
Asad U Khan - One of the best experts on this subject based on the ideXlab platform.
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comparison of single and double layered saphenectomy wound closure techniques in coronary artery bypass graft surgery cabg using Asepsis wound score
Pakistan Heart Journal, 2018Co-Authors: Firdous Perveen, Riffat Tanveer, Asad U KhanAbstract:Objective: To compare the mean Asepsis wound scores in single-layer versusdouble-layer closure of below-knee saphenectomy wound at 5 postoperativeday in coronary artery bypass graft surgery patients. Methodology: This randomized controlled trial was conducted at Department ofCardiac Surgery, Dow University of Health Sciences and Civil Hospital Karachifrom January to June 2017. Patients of either gender with age of 50-60 yearshaving multi-vessel coronary artery disease undergoing elective, isolated CABGwith ejection fraction greater than 40% and controlled diabetes and hypertensionfor more than 5 years were included in the study . Patients were randomlyassigned to two groups (Single layer closure and Double layer closure).Woundswere examined and scored (using Asepsis scoring system) by consultant on 5postoperative day. Results: A total of 80 patients were included in the study . Patients were divided intwo groups (S= Single layer closure and D= Double layer closure ) having 40patients each. The mean age was 54.9 3.31 years. About 77.5% of patientswere males. Mean Asepsis score in group S was 3.10 1.02 while in group Dwas 5.68 1.30 (p<0.05). Conclusion: Compared with double-layer, single-layered technique has lowermean Asepsis score in saphenectomy wounds of CABG surgery patients andhence is more suitable modality of saphenectomy wound closure. Key Words: Saphenectomy, wound closure, coronary artery bypass graftsurgery (CABG).
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COMPARISON OF SINGLE AND DOUBLE LAYERED SAPHENECTOMY WOUND CLOSURE TECHNIQUES IN CORONARY ARTERY BYPASS GRAFT SURGERY (CABG) USING Asepsis WOUND SCORE
Pakistan Heart Journal, 2018Co-Authors: Firdous Perveen, Riffat Tanveer, Asad U KhanAbstract:Objective: To compare the mean Asepsis wound scores in single-layer versusdouble-layer closure of below-knee saphenectomy wound at 5 postoperativeday in coronary artery bypass graft surgery patients. Methodology: This randomized controlled trial was conducted at Department ofCardiac Surgery, Dow University of Health Sciences and Civil Hospital Karachifrom January to June 2017. Patients of either gender with age of 50-60 yearshaving multi-vessel coronary artery disease undergoing elective, isolated CABGwith ejection fraction greater than 40% and controlled diabetes and hypertensionfor more than 5 years were included in the study . Patients were randomlyassigned to two groups (Single layer closure and Double layer closure).Woundswere examined and scored (using Asepsis scoring system) by consultant on 5postoperative day. Results: A total of 80 patients were included in the study . Patients were divided intwo groups (S= Single layer closure and D= Double layer closure ) having 40patients each. The mean age was 54.9 3.31 years. About 77.5% of patientswere males. Mean Asepsis score in group S was 3.10 1.02 while in group Dwas 5.68 1.30 (p
T Hong - One of the best experts on this subject based on the ideXlab platform.
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randomized double blind placebo controlled trial of 40 mg day of atorvastatin in reducing the severity of sepsis in ward patients Asepsis trial
Critical Care, 2012Co-Authors: Jaimin M Patel, Catherine Snaith, D R Thickett, Teresa Melody, P Hawkey, Alan Jones, Lucie Linhartova, Anthony H Barnett, T HongAbstract:Introduction: Several observational studies suggest that statins modulate the pathophysiology of sepsis and may prevent its progression. The aim of this study was to determine if the acute administration of atorvastatin reduces sepsis progression in statin naive patients hospitalized with sepsis. Methods: A single centre phase II randomized double-blind placebo-controlled trial. Patients with sepsis were randomized to atorvastatin 40 mg daily or placebo for the duration of their hospital stay up to a maximum of 28-days. The primary end-point was the rate of sepsis progressing to severe sepsis during hospitalization. Results: 100 patients were randomized, 49 to the treatment with atorvastatin and 51 to placebo. Patients in the atorvastatin group had a significantly lower conversion rate to severe sepsis compared to placebo (4% vs. 24% p = 0.007.), with a number needed to treat of 5. No significant difference in length of hospital stay, critical care unit admissions, 28-day and 12-month readmissions or mortality was observed. Plasma cholesterol and albumin creatinine ratios were significantly lower at day 4 in the atorvastatin group (p < 0.0001 and p = 0.049 respectively). No difference in adverse events between the two groups was observed (p = 0.238). Conclusions: Acute administration of atorvastatin in patients with sepsis may prevent sepsis progression. Further multi-centre trials are required to verify these findings.
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atorvastatin for preventing the progression of sepsis to severe sepsis Asepsis trial a randomised double blind placebo controlled trial isrctn64637517
Critical Care, 2011Co-Authors: Jaimin M Patel, Catherine Snaith, D R Thickett, L Linhortova, Teresa Melody, P Hawkey, T Barnett, Alan Jones, T Hong, Gavin D PerkinsAbstract:Statins have pleiotrophic effects independent of their lipid-lowering properties and may modulate the pathophysiology of sepsis, prevent sepsis progression and improve outcomes [1]. This study evaluated the acute use of Atorvastatin in reducing sepsis progression compared with placebo in statin-naive individuals.
