BackgroundSurgical‐site infection (SSI) is a potentially serious complication following colorectal surgery. The present systematic review and meta‐analysis aimed to investigate the effect of preoperative oral antibiotics and mechanical bowel preparation (MBP) on SSI rates.MethodsA systematic review of PubMed, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials was performed using appropriate keywords. Included were RCTs and observational studies reporting rates of SSI following elective colorectal surgery, in patients given preoperative oral antibiotic prophylaxis, in combination with intravenous (i.v.) antibiotic prophylaxis and MBP, compared with patients given only i.v. antibiotic prophylaxis with MBP. A meta‐analysis was undertaken.ResultsTwenty‐two studies (57 207 patients) were included, of which 14 were RCTs and eight observational studies. Preoperative oral antibiotics, in combination with i.v. antibiotics and MBP, were associated with significantly lower rates of SSI than combined i.v. antibiotics and MBP in RCTs (odds ratio (OR) 0·45, 95 per cent c.i. 0·34 to 0·59; P < 0·001) and cohort studies (OR 0·47, 0·44 to 0·50; P < 0·001). There was a similarly significant effect on SSI with use of a combination of preoperative oral aminoglycoside and erythromycin (OR 0·40, 0·25 to 0·64; P < 0·001), or preoperative oral aminoglycoside and metronidazole (OR 0·51, 0·39 to 0·68; P < 0·001). Preoperative oral antibiotics were significantly associated with reduced postoperative rates of anastomotic leak, ileus, reoperation, readmission and mortality in the cohort studies.ConclusionOral antibiotic prophylaxis, in combination with MBP and i.v. antibiotics, is superior to MBP and i.v. antibiotic prophylaxis alone in reducing SSI in elective colorectal surgery.

Cognitive side effects of anticholinergic medications in older adults are well documented. Whether these poor cognitive outcomes are observed in children has not been systematically investigated. We aimed to conduct a systematic review and meta-analysis on the associations between anticholinergic medication use and cognitive performance in children. Systematic review was conducted using Medline, PsychInfo, and Embase, identifying studies testing cognitive performance relative to the presence versus absence of anticholinergic medication(s) in children. We assessed effects overall, as well as relative to drug class, potency (low and high), cognitive domain, and duration of administration. The systematic search identified 46 articles suitable for meta-analysis. For the most part, random effects meta-analyses did not identify statistically significant associations between anticholinergic exposure and cognitive performance in children; the one exception was a small effect of anticholinergic anti-depressants being associated with better cognitive function (Hedges’ g = 0.24, 95% CI 0.06–0.42, p = 0.01). Anticholinergic medications do not appear to be associated with poor cognitive outcomes in children, as they do in older adults. The discrepancy in findings with older adults may be due to shorter durations of exposure in children, differences in study design (predominantly experimental studies in children rather than predominantly epidemiological in older adults), biological ageing (e.g. blood brain barrier integrity), along with less residual confounding due to minimal polypharmacy and comorbidity in children.

Background: Biopsychosocial approaches to understanding behavioural and psychological (otherwise known as "non-cognitive" or "neuropsychiatric") symptoms of dementia tend to be conducted by specialist psychology professionals. To increase service users' access to these approaches, healthcare professionals from nursing and allied health disciplines are being trained to use them. However, little is known about healthcare professionals' experiences of implementing biopsychosocial approaches in everyday practice.Objectives: To explore nursing and allied healthcare professionals' views of using the "Newcastle Model," which is a biopsychosocial approach to understanding behavioural and psychological symptoms of dementia.Method: Thirteen community mental healthcare professionals from nursing, social work and occupational therapy backgrounds were interviewed about their views and experiences of using the Newcastle Model to understand and work with behavioural and psychological symptoms of dementia. Data were analysed using thematic analysis.Results: Five themes were identified. The first theme reflected the perceived positive value of taking a more psychosocial approach to understanding behavioural and psychological symptoms of dementia. The second theme reported participants' expressions of low confidence in using the approach, as well as their reported difficulties in prioritising it. The third theme highlighted the perceived time-consuming nature of the approach, and the adaptations that some staff made to increase its practicality. The fourth theme highlighted the importance of working in collaboration with those who provided direct care and support to the person with dementia. The final theme reflected participants' positive view of the effectiveness of the approach for delivering person-centred care Conclusion: Community healthcare professionals valued the integration of a biopsychosocial approach into their practice, although identified key implementation barriers.

Introduction Surgical site infections (SSI) are responsible for one third of all inpatient infections and are associated with increased morbidity and extended hospital stay. The colorectal department at Glasgow Royal Infirmary introduced the Jubilee dressing method in August 2019 with the aim of reducing SSI incidence. Method Closed loop audit of all elective colorectal laparotomies at Glasgow Royal Infirmary pre- and post-introduction of Jubilee dressing method (March – July & August – December 2019). Literature reviews informed selection of baseline characteristics relevant to SSI. Analysis by logistic regression of SSI incidence by characteristic and Jubilee dressing use. Results A total of 193 patients were included. There was 52% uptake of Jubilee dressing method in the implementation phase and reduction in total SSI rate from 18.25% to 14.93%. Operation duration and smoking history were the only significant factors at univariate analysis and were put forward to multivariate analysis. Of these, only operation duration made a significant contribution to SSI incidence. Conclusions Jubilee dressing use did not make a significant difference to SSI incidence in this sample. This intervention is likely to have small effect size and there were probable confounding factors. Multifactorial influence in SSI incidence suggests larger datasets are required to isolate independent factors.