Annotated bibliography PLEASE HELP ME THIS ASSINGMENT…. Th

Annotated bibliography PLEASE HELP ME THIS ASSINGMENT…. This… Annotated bibliography PLEASE HELP ME THIS ASSINGMENT….This assessment requires you to explore the literature. Using the PICOT you developed at the beginning of the course, search the literature (library database) to find 2 research articles that are examples of 2 different levels on the levels of evidence hierarchy. The pyramid that illustrates the levels of hierarchy is provided in instructional materials. Please read about the levels of evidence to ensure you understand them before selecting your picois Does administration of prophylactic antibiotic therapy (I) reduce the cases of post-operative infections (O) for patients (P) compared (C) to those who do not receive antibiotic treatment when undergoing surgery?Develop your title pagePage 1: Provide your APA 7th edition reference for your 1st article at the top of the page.In paragraph 1, identify the level of evidence on the hierarchy, summarize the design, sample, hypothesis/researchand any other components of the study itselfIn paragraph 2, discuss the findings and the relevance/importance of the study to nursing practice (ie. why is this information important to know?)Adequacy of antibiotic prophylaxis and incidence of surgical site infections in neck surgeryM. Alonso-García,A. Toledano-Muñoz,J. M. Aparicio-Fernández,F. M. De-la-Rosa-Astacio,D. Rodríguez-Villar,A. Gil-de-Miguel,M. Durán-Poveda &G. Rodríguez-CaravacaScientific Reports volume 11, Article number: 16413 (2021) Cite this article MetricsdetailsAbstractHealth care-related infections are frequent and among them surgical site infection (SSI) are the most frequent in hospitals. The objective was to evaluate the adequacy of antibiotic prophylaxis in patients undergoing neck surgery and its relationship with the incidence of surgical site infection (SSI). Prospective cohort study. The adequacy of antibiotic prophylaxis in patients undergoing neck surgery was evaluated. Antibiotic prophylaxis was considered adequate when it conformed to all items of the protocol (antibiotic used, time of administration, administration route, dose and duration). The cumulative incidence of SSI was calculated, and the relationship between SSI and antibiotic prophylaxis adequacy was determined using adjusted relative risk (RR). Antibiotic prophylaxis was administered in 63 patients and was adequate in 85.7% (95% CI 75.0-92.3) of them. The cumulative incidence of SSI was 6.4% (95% CI 3.4-11.8). There was no significant relationship between antibiotic prophylaxis inadequacy and the incidence of SSI (RR = 2.4, 95% CI 0.6-10.6). Adequacy of antibiotic prophylaxis was high and it did not affect the incidence of SSIs.IntroductionSurgical site infection (SSI) is the most common healthcare-associated infection (HAI)1,2. The incidence of SSI depends on variables that are both intrinsic (sex, age, comorbidities, etc.) and extrinsic (duration and type of surgery, surgeon experience, preoperative preparation of the patient, etc.) to the patient3,4 and ranges from 1 and 20% depending on the type of surgical procedure5.Neck surgery is one of the most important types of otorhinolaryngological surgery. Specific studies that estimate the incidence of SSI in neck surgery report incidences of less than 1% when the surgery is clean6,7 and between 25 and 85% when the surgery is clean-contaminated8,9. These types of infections are of great health importance because they increase the average length of hospital stay, morbidity and mortality, and the healthcare cost per patient10,11.One of the most effective measures for reducing SSI is antibiotic prophylaxis, which is indicated in clean-contaminated and contaminated surgeries and in clean surgeries in which an implant is placed, the operative time is prolonged, the patient is immunosuppressed or that are performed on a specific site12,13. The purpose of preoperative prophylaxis is for the antibiotic to reach an optimal concentration in the tissue during the surgical procedure and in the hours immediately following the closure of the incision. The choice of antibiotic will depend on the typical flora of each healthcare centre, the resistance map and the surgical site. For long surgeries, when the duration exceeds twice the half-life of the antibiotic, the dose should be repeated14,15.The use of antibiotic prophylaxis protocols facilitates adequacy, and in our hospital, we have a protocol that is periodically updated based on the recommendations in the literature. The protocol is reviewed and updated every two years by the infections commission.The objective of our study was to evaluate the adequacy of the antibiotic prophylaxis to our protocol in patients undergoing neck surgery and the relationship between the adequacy of antibiotic prophylaxis and the incidence of SSI.MethodsA prospective cohort study was conducted from January 2011 to December 2019. Consecutive patients over 18 years old who underwent neck surgery at the Alcorcón Foundation University Hospital (Hospital Universitario Fundación Alcorcón—HUFA) were sampled. Patients who at the time of surgery had an active infection or were receiving antibiotic treatment were excluded. The study was approved by the Ethics and Clinical Research Committee of HUFA (number 9/14).The sample size was calculated for an estimated proportion of compliance with the antibiotic prophylaxis protocol of 85%, a confidence level of 95%, an accuracy of 10% and considering losses of 5%. Thus, it was considered necessary to include 52 patients.Sociodemographic variables (age, sex), patient comorbidities (cancer, diabetes, chronic obstructive pulmonary disease (COPD), obesity, liver cirrhosis, malnutrition, addiction to parenteral drugs, neutropenia, kidney failure, immunodeficiency), surgical risk according to the American Society of Anaesthesiologists (ASA) classification, surgery-related variables (type of surgery, duration, International Classification of Diseases (ICD-9-CM) diagnosis, drainage, shaving or transfusion), antibiotic prophylaxis-related items (election, time of administration, administration route, dose, duration), compliance with the protocol and SSI-related variables (diagnosis of infection, microorganism and location) were considered. Antibiotic prophylaxis stated in the hospital protocol is shown in Table 1 and it was prescribed for all otorhinolaryngological surgery undergoing laryngectomy or oral or pharyngeal mucosal incision, either in clean, clean-contaminated or contaminated surgery. Antibiotic prophylaxis was considered adequate when it conformed to all items of the protocol. In case of protocol inadequacy, the reason for inadequacy was recorded as follows: time of administration (the dose was not administered 30-60 min before surgery), election (the antibiotic administered differed from that specified in the protocol), duration (prophylaxis was prescribed more than 24 h), administration route (administered by a route other than intravenous) or dose (the dose was different from that described in the protocol). Compliance was defined as the percentage of antibiotic prophylaxis administered when indicated. The diagnosis of SSI was made based on the Centres for Disease Control and Prevention (CDC) criteria16 and was evaluated jointly by the Preventive Medicine Unit and the Otorhinolaryngology Service. The surgical procedures included are shown in Table 2 and ICD-9-CM codes 30.22, ‘Vocal cordectomy’, and 31.45, ‘Open biopsy of the larynx and trachea’, were classified as clean surgeries.Table 1 Antibiotic prophylaxis protocol in otorhinolaryngological surgery.Full size tableTable 2 Distribution of surgical interventions.Full size tableClinical follow-up of patients was performed from the time of surgery to 30 days after, which is the maximum incubation period for SSIs in surgeries not involving implant placement. They were actively monitored from the time of surgery until discharge and data were collected using an ad hoc form from the following data sources: hospital electronic medical records for surgery and hospital stay-related variables, in-hospital readmission, outpatients’ revision and care provided in the hospital’s emergency department. HORUS, the clinical history platform of the Community of Madrid for primary health-care was also used, which allowed follow-up through primary care visits from discharge to the end of the incubation period.Statistical analysisA descriptive analysis of the quantitative variables was performed using the mean and standard deviation or the median and interquartile range (IQR) if the variables were not normally distributed; these variables were compared using Student’s t test or the Mann-Whitney test in cases of nonnormality. Qualitative variables were described using frequency distributions and percentages and were compared using the Pearson ?2 test or Fisher’s exact test, as appropriate. The cumulative incidence of SSI was calculated, as was the relationship between SSI and antibiotic prophylaxis adequacy using the relative risk (RR). Statistical analysis was performed in SPSS 23.0, and a p-value < 0.05 was considered statistically significant.Informed consentThis study was done in accordance with the strengthening the reporting of observational studies in epidemiology (STROBE) statement. Informed consent was obtained from all subjects.ResultsDuring the study period, 140 patients were included in the sample and all of the patients completed the 30-day follow up. The mean age was 65.8 ± 12.4 years. A total of 81.4% of the patients were male. Table 2 shows the surgical interventions performed and their distribution frequency. The demographic and clinical characteristics of the patients are summarized in Table 3. The median length of hospital stay was 3 days (IQR 1-14 days), and discharges were almost completely due to cure (97.9%).                      Health Science Science Nursing NRSE 4550

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