Dealing with complications in interventional radiology.

It is widely accepted that most misadventures, which lead to harm have not occurred because of a single individual but rather due to a failure of process that results in healthcare workers making mistakes. This failure of process and the pervasiveness of adverse events is just as prevalent in Interventional Radiology (IR) as it is in other specialities. The true prevalence and prevailing aetiology of complications in IR are not exactly known as there is a paucity of investigative literature into this area; especially when compared with other more established disciplines such as Surgery. Some IR procedures have a higher risk profile than others. However, published data suggests that many adverse events in IR are preventable (55-84%) and frequently involve a device related complication such as improper usage or malfunction. This article aims to discuss factors that contribute to complications in IR along with tools and strategies for dealing with them to achieve optimal patient outcomes.

Surgical site infection in posterior spine surgery.

BACKGROUND: Surgical site infections (SSIs) in spine surgery remain a significant cause of morbidity and prolonged hospitalization. Factors affecting SSI includes patient's comorbidities, duration of surgery, type and indication for surgery among others. We intend to document our experience in our center and highlight possible factors influencing SSI in posterior spine surgery. METHODOLOGY: All consecutive patients who had posterior spine surgeries between January 2012 and July 2014 were recruited into the study. All patients who had wound infection were noted and culture sensitivities were documented as well. Results were analysed to get the infection rate, reasons for prolonged stay on admission as well as possible contributing factors to wound infections. RESULTS: A total of 62 patients' records were reviewed with 34 males and 28 females (male:female = 1.2:1). SSI was classified as deep or superficial to the fascia. Ten (16.1%) patients were found to have an SSI with 7 (11.3%) patients having deep infections and 3 (4.8%) had superficial infection. Vertebral level operated, etiology, and diagnosis were not statistically significant for SSI. However, spinal instrumentation, surgery on cervical region and wound inspection on or before postoperative day 5 were associated with an increase in the rate of SSI. Comorbidities such as diabetes mellitus, obesity, and anemia were significant risk factors. The organisms cultured were Pseudomonas and Staphylococcus species. CONCLUSIONS: Wound infection is a significant complication of posterior spine surgery. This causes distress for both patient and surgeons alike. Uncontrolled diabetes, spine instrumentation and long duration of surgery are significant risk factors for SSI. Practices of early wound inspection, frequent wound dressing changes and not keeping to nontouch technique for changing and removing dressings are important risk factors for SSI in posterior spine surgeries that need to be changed to reduce the burden of SSI.

[Difficulties with using morphine in cancer pain management: Ivorian experience]. / Les difficultés de la prise en charge par la morphine de la douleur en cancérologie: expérience ivoirienne.

UNLABELLED: Pain is the most frequent functional aspect found with cancers. Pain leads to incapacity in 69% of cases. However, pain is insufficiently handled, especially in developing countries. Pain considerably affects the quality of life of patients, and it imposes adequate care including the use of morphine when it is necessary. OBJECTIVE: To determine the difficulties to handle pain in particular with the use of morphine in order to propose some solutions. METHODS: Prospective study over six months in the Cancerology Unit of Treichville Training Hospital. It includes 120 patients who had questioning and physical examination including pain evaluation by the VAS. RESULTS: Chronic pain occurred to 96 patients (80%), pain was nociceptive for 48 patients (50%) and 19 patients (20%) had mixed pain. Morphine was relevant in 54 cases but only 27 prescriptions were made. One of the reasons was the fear of some physicians. Only eight prescriptions were respected. Six patients did not respected prescription because of unavailability whereas the remaining mentioned financial reasons as the obstacle. None adverse reaction occurred. CONCLUSION: Morphine represents a major tool to handle pain for a patient suffering of cancer. In Ivory Coast, the development of palliative care enables through national workshop to start a campaign in favor of the availability and easy geographical and financial accessibility of morphine (mainly morphine powder) whenever the prescription is required.