Reducing Pediatric Sternal Wound Infections: A Quality Improvement Project.

OBJECTIVES: To evaluate whether a quality improvement intervention reduces sternal wound infection rates in children after cardiac surgery. DESIGN: This is a pre- and postintervention quality improvement study. SETTING: A 16-bed cardiac ICU in a university-affiliated pediatric tertiary care children's hospital. PATIENTS: All patients undergoing cardiac surgery via median sternotomy from January 2010 to December 2014 are included. The sternal wound infection rates for primary closure and delayed sternal closure are reported per 100 sternotomies. The hospital-acquired infection records were used to identify preintervention cases, while postintervention cases were collected prospectively. INTERVENTION: Implementation of a sternal wound prevention bundle during the preoperative, intraoperative, and postoperative periods for cardiac surgical cases. MEASUREMENTS AND MAIN RESULTS: During the preintervention period, 32 patients (3.8%) developed sternal wound infection, whereas only 19 (2.1%) developed sternal wound infection during the postintervention period (p = 0.04). The rates of sternal wound infection following primary closure were not significantly different pre- and postintervention (2.4% vs 1.6%; p = 0.35). However, patients with delayed sternal closure had significantly lower postintervention infection rates (10.6% vs 3.9%; p = 0.02). CONCLUSIONS: Implementation of a sternal wound prevention bundle during the perioperative period was associated with lower sternal wound infection rates in surgeries with delayed sternal closure.

Rollovers during play: Complementary perspectives.

In this commentary, we compare and contrast Norman et al.s' findings on rollovers during dog play (Norman et al., 2015; the "target article") with our work on dog play fighting (Bauer and Smuts, 2007; Ward et al., 2008). We first review our major findings and then correct some errors in the target article's descriptions of our work. We then further explore the concept of "defensive" rollovers proposed in the target article. We conclude that a combination of the target article's approach and ours should inform future investigations of dog rollovers.

Quantity-based judgments in the domestic dog (Canis lupus familiaris).

We examined the ability of domestic dogs to choose the larger versus smaller quantity of food in two experiments. In experiment 1, we investigated the ability of 29 dogs (results from 18 dogs were used in the data analysis) to discriminate between two quantities of food presented in eight different combinations. Choices were simultaneously presented and visually available at the time of choice. Overall, subjects chose the larger quantity more often than the smaller quantity, but they found numerically close comparisons more difficult. In experiment 2, we tested two dogs from experiment 1 under three conditions. In condition 1, we used similar methods from experiment 1 and tested the dogs multiple times on the eight combinations from experiment 1 plus one additional combination. In conditions 2 and 3, the food was visually unavailable to the subjects at the time of choice, but in condition 2, food choices were viewed simultaneously before being made visually unavailable, and in condition 3, they were viewed successively. In these last two conditions, and especially in condition 3, the dogs had to keep track of quantities mentally in order to choose optimally. Subjects still chose the larger quantity more often than the smaller quantity when the food was not simultaneously visible at the time of choice. Olfactory cues and inadvertent cuing by the experimenter were excluded as mechanisms for choosing larger quantities. The results suggest that, like apes tested on similar tasks, some dogs can form internal representations and make mental comparisons of quantity.