Clare Heal

Does single application of topical chloramphenicol to high risk sutured wounds reduce incidence of wound infection after minor surgery? Prospective randomised placebo controlled double blind trial

Objective To determine the effectiveness of a single application of topical chloramphenicol ointment in preventing wound infection after minor dermatological surgery. Design Prospective randomised placebo controlled double blind multicentre trial. Setting Primary care in a regional centre in Queensland, Australia. Participants 972 minor surgery patients. Interventions A single topical dose of chloramphenicol (n=488) or paraffin ointment (n=484; placebo). Main outcome measure Incidence of infection. Results The incidence of infection in the chloramphenicol group (6.6%; 95% confidence interval 4.9 to 8.8) was significantly lower than that in the control group (11.0%; 7.9 to 15.1) (P=0.010). The absolute reduction in infection rate was 4.4%, the relative reduction was 40%, and the relative risk of wound infection in the control group was 1.7 (95% confidence interval 1.1 to 2.5) times higher than in the intervention group. The number needed to treat was 22.8. Conclusion Application of a single dose of topical chloramphenicol to high risk sutured wounds after minor surgery produces a moderate absolute reduction in infection rate that is statistically but not clinically significant. Trial registration Current Controlled Trials ISRCTN73223053.

Can sutures get wet? Prospective randomised controlled trial of wound management in general practice

Abstract Objective To compare standard management of keeping wounds dry and covered with allowing wounds to be uncovered and wet in the first 48 hours after minor skin excision. Design Prospective, randomised controlled, multicentre trial testing for equivalence of infection rates. Setting Primary care in regional centre, Queensland, Australia. Participants 857 patients randomised to either keep their wound dry and covered (n = 442) or remove the dressing and wet the wound (n = 415). Results The incidence of infection in the intervention group (8.4%) was not inferior to the incidence in the control group (8.9%) (P < 0.05). The one sided 95% confidence interval for the difference of infection rates was ∞ to 0.028. Conclusion These results indicate that wounds can be uncovered and allowed to get wet in the first 48 hours after minor skin excision without increasing the incidence of infection.

Accuracy of clinical diagnosis of skin lesions

Background  Skin cancer is an increasing problem in fair‐skinned populations worldwide. It is important that doctors are able to diagnose skin lesions accurately.

More is not necessarily better. A biomechanical study on distal screw numbers in volar locking distal radius plates.

INTRODUCTION Currently available volar locking plates for the treatment of distal radius fractures incorporate at least two distal screw rows for fixation of the metaphyseal fragment and have a variable-angle locking mechanism which allows placement of the screws in various directions There is, however no evidence that these plates translate into better outcomes or have superior biomechanical properties to first generation plates, which had a single distal screw row and fixed-angle locking. The aim of our biomechanical study was to compare fixed-angle single-row plates with variable-angle multi-row plates to clarify the optimal number of locking screws. MATERIALS AND METHODS Five different plate-screw combinations of three different manufacturers were tested, each group consisting of five synthetic fourth generation distal radius bones. An AO type C2 fracture was created and the fractures were plated according to each manufacturers recommendations. The specimens then underwent cyclic and load-to-failure testing. An optical motion analysis system was used to detect displacement of fragments. RESULTS No significant differences were detected after cyclic loading as well as after load-to-failure testing, neither in regard to axial deformation, implant rigidity or maximum displacement. The fixed-angle single-row plate showed the highest pre-test rigidity, least increase in post-testing rigidity and highest load-to-failure rigidity and least radial shortening. The radial shortening of plates with two distal screw rows was 3.1 and 4.3 times higher, respectively, than that of the fixed-angle single-row plate. CONCLUSION The results of our study indicate that two distal screw rows do not add to construct rigidity and resistance against loss of reduction. Well conducted clinical studies based on the findings of biomechanical studies are necessary to determine the optimal number of screws necessary to achieve reproducibly good results in the treatment of distal radius fractures.

Risk factors for surgical site infection after dermatological surgery

Objectives  Surgical site infection (SSI) following minor surgery contributes to patient morbidity and compromises cosmetic outcomes. The purpose of this study was to determine the incidence of and risk factors for SSI after dermatological surgery in general practice.

Missed opportunities—low levels of chlamydia retesting at Australian general practices, 2008–2009

Objective Chlamydia reinfection is common and increases the risk of reproductive complications. Guidelines for Australian general practitioners recommend retesting 3–12 months after a positive result but not before 6 weeks. The authors describe retesting rates among 16–29-year-old patients diagnosed as having chlamydia at 25 general practice clinics participating in the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance system. Methods The authors calculated annual testing and positivity rates for 16–29-year-olds attending in 2008–2009, re-attendance and retesting rates within <6 weeks, 1.5–4 months and 1.5–12 months of a positive test in 2008–2009 and positivity at retest (where results were available). Results There were 50 408 individuals (60.4% women) who attended in 2008–2009. Annually, 7.4% and 7.3% were tested for chlamydia, of whom 9.1% and 8.0% tested positive, respectively. Within 1.5–4 months of a positive test, 24.6% re-attended and were retested (19% tested positive), 31.6% re-attended and were not retested and 43.9% did not re-attend. Within 1.5–12 months, 40% re-attended and were retested (16% tested positive), 40% re-attended and were not retested and 20% did not re-attend. Of individuals re-attending in 1.5–12 months but not retested, 50% had re-attended three or more times in the period. Within 6 weeks of a positive test, 25% were retested. Discussion A high proportion of 16–29-year-olds re-attended general practices in the recommended retest periods, but retesting rates were low and multiple missed opportunities were common. The findings highlight the need for strategies such as electronic clinician prompts, patient recall systems and promotion of retesting guidelines.

General practitioners' knowledge and attitudes to contact tracing for genital Chlamydia trachomatis infection in North Queensland

Introduction: Most diagnoses of genital chlamydia infection in Queensland are made by general practitioners (GPs). This study aimed to assess GP attitudes to and knowledge of contact tracing in rural North Queensland.

Influence of screw diameter and number on reduction loss after plating of distal radius fractures

Background:  The current options for plate–screw combinations in volar locking distal radius plates used for the treatment of distal radius fractures are either plates with a single distal screw row or plates with multiple distal screw rows. Additionally, the screws themselves may have either fixed angle locking or polyaxial locking mechanisms. To date, there is no evidence or consensus regarding the optimal plate–screw combination. The aim of this study was to assess the biomechanical behaviour of different plate–screw combinations with respect to total distal screw number, number of distal screw rows and screw projection surface area of the most distal row.

A systematic review of patient-related risk factors for catheter-related thrombosis

Abstract To identify patient-related risk factors for venous thrombosis in patients with central venous catheters (CVC) or peripherally inserted central catheters (PICC). We performed a systematic review of the literature assessing patient-related risk factors for thrombosis related to CVC or PICC. The databases PubMed, Ovid and the Cochrane library were searched for observational studies pertaining to patient-related risk factors for CVC and PICC-related thrombosis. The initial search through PubMed, Ovid and the Cochrane library yielded 516 results. After 71 duplicates were removed, 445 articles were assessed for eligibility based on title and abstract. Four hundred and eleven articles were then excluded and 33 full text articles were manually assessed for eligibility. Eight articles were eliminated as they did not contain content relevant to the review. Twenty-five studies were then selected to assess 20 risk factors. There were no consistent significant associations for catheter-related thrombosis across the twenty-five studies. Multiple studies identified age, malignancy, diabetes, obesity, chemotherapy, thrombophilia and a history of thrombosis as significant risk factors for catheter-related thrombosis. Inconsistent findings among studies make it difficult to establish which patient-related risk factors are associated with catheter-related thrombosis. Future studies could include larger sample sizes and more cases of catheter-related thrombosis to produce more significant results. Identification of patient-related risk factors could lead to early recognition of upper limb deep vein thrombosis in patients with catheters, thereby preventing complications.

Agreement between histological diagnosis of skin lesions by histopathologists and a dermato-histopathologist

Background  Skin cancer is an increasing problem in fair‐skinned populations worldwide. It is important that doctors are able to diagnose skin lesions accurately, and this is supported by accurate histological diagnosis.