Graham E. Wagner

Antibiotic prophylaxis in the placement of totally implanted central venous access ports

BACKGROUND Antibiotic prophylaxis during placement of implanted central venous access ports (CVAP) has not been studied. This retrospective review compared the rate of catheter-related infections (CRIs) with and without perioperative antibiotics. METHODS This was a single-center study that compared patients treated with and without a single dose of antibiotics during CVAP placement. CRIs were defined as a patient treated with antibiotics for port site induration, positive blood cultures, or suspicion of infection that led to port removal within 30 days of placement. RESULTS CVAP were placed in 459 patients, 103 of whom (22.4%) received antibiotic prophylaxis. Surgical technique and patient demographics were similar to those patients not receiving antibiotics (356). All 9 (2%) CRIs occurred in the non-prophylactic antibiotic group (P = .218), with 5 infections resulting in port removal. CONCLUSIONS Single-dose perioperative antibiotics may decrease CVAP infection rates and should be studied further in a prospective randomized trial.

Helmet Use and Risk-taking Behavior Among Skiers and Snowboarders

OBJECTIVE To characterize factors associated with helmet use and risk-taking behavior among recreational skiers and snowboarders. DESIGN Observational study. SETTING Large, western United States mountain resort. PARTICIPANTS 1285 male and female recreational skiers and snowboarders were interviewed during a single winter ski season. INDEPENDENT VARIABLES Helmet use, demographic, and sport-related characteristics. MAIN OUTCOME MEASURES Brief sensation seeking scale (BSSS) as a measure of risk-taking behavior and self-reported risk compensation. RESULTS Of the respondents (N = 1285), 17.5%, 12.5%, and 70.0% reported that they never, sometimes, and always wore a helmet, respectively. Multiple linear regression analysis showed that individuals reporting sometimes wearing a helmet had significantly higher BSSS scores than those reporting never wearing a helmet (P = 0.031) or always wearing it (P = 0.018). Male gender, younger age, snowboarding, higher perceived sport ability, more days per year skiing or snowboarding, and more time spent in the terrain park were significantly associated with higher BSSS scores (P < 0.05). Logistic regression analysis focusing on subgroups of respondents who reported either sometimes or always wearing a helmet indicated that the odds of taking more risks when wearing a helmet for inconsistent helmet users was 75% higher than the odds for those who reported always wearing a helmet (P = 0.06). CONCLUSIONS Inconsistent helmet users have characteristics of risk-taking behavior and risk compensation. Male gender, younger age, snowboarding, higher perceived sport ability, and more time spent on the mountain and in the terrain park are also important determinants of risk-taking behavior.OBJECTIVE To characterize factors associated with helmet use and risk-taking behavior among recreational skiers and snowboarders. DESIGN Observational study. SETTING Large, western United States mountain resort. PARTICIPANTS 1285 male and female recreational skiers and snowboarders were interviewed during a single winter ski season. INDEPENDENT VARIABLES Helmet use, demographic, and sport-related characteristics. MAIN OUTCOME MEASURES Brief sensation seeking scale (BSSS) as a measure of risk-taking behavior and self-reported risk compensation. RESULTS Of the respondents (N = 1285), 17.5%, 12.5%, and 70.0% reported that they never, sometimes, and always wore a helmet, respectively. Multiple linear regression analysis showed that individuals reporting sometimes wearing a helmet had significantly higher BSSS scores than those reporting never wearing a helmet (P = 0.031) or always wearing it (P = 0.018). Male gender, younger age, snowboarding, higher perceived sport ability, more days per year skiing or snowboarding, and more time spent in the terrain park were significantly associated with higher BSSS scores (P < 0.05). Logistic regression analysis focusing on subgroups of respondents who reported either sometimes or always wearing a helmet indicated that the odds of taking more risks when wearing a helmet for inconsistent helmet users was 75% higher than the odds for those who reported always wearing a helmet (P = 0.06). CONCLUSIONS Inconsistent helmet users have characteristics of risk-taking behavior and risk compensation. Male gender, younger age, snowboarding, higher perceived sport ability, and more time spent on the mountain and in the terrain park are also important determinants of risk-taking behavior.