Recent social influence research utilizing psychological reactance theory (J. W. Brehm, 1966) has focused on how reactance motivates message rejection due to threats to perceived freedoms posed by controlling language. Although reactance has been shown to increase message rejection and source derogation, persuasive appeals employing alternative forms of restoration of freedom, as suggested by the theory, have received little if any empirical scrutiny. The present study manipulated the levels of controlling language and lexical concreteness within health messages targeting a young adult population. Results show a number of negative outcomes associated with the use of controlling language but suggest more positive outcomes associated with the use of restoration postscripts. Findings also indicate that relative to abstract language, messages using concrete language receive more attention, are viewed as more important, and generate more positive assessments of the source.

QUESTION ASKED: What is the real rate of surgical site infection (SSI) after surgery for gynecologic malignancy and benign gynecologic disease?SUMMARY ANSWER: Overall SSI rates differed greatly between the University HealthSystem Consortium (UHC), National Surgical Quality Improvement Program (NSQIP) and National Healthcare Safety Network (NHSN) (1.5%, 8.8%, and 2.8% respectively, P , .001) due to wide variation in reporting methodology. Variation was notable among deep (UHC, 0.7%; NSQIP, 4.7%; NHSN, 1.3%; P , .001) and organ space infections (UHC, 0.4%; NSQIP, 4.4%; NHSN, 1.4%; P , .001) as well as when the reporting agencies were compared with institutional chart review by the authors. Also, because of differences in reporting methodology, only 19 cases (24.4%) were included in more than one database and only one case was included in all three databases (1.3%).WHAT WE DID: We compared SSI rates after gynecologic surgery obtained from the UHC, NSQIP and NHSN databases and the reporting methodologies used by these agencies among themselves. We also compared the SSI rates reported by these agencies to the SSI rate obtained from chart review.WHAT WE FOUND: There was significant variation in the rate of SSI after gynecologic surgery reported by national reporting agencies. Variations in reporting methodology also resulted in limited overlap between reporting agencies in identification of cases with SSI. BIAS, CONFOUNDING FACTORS, DRAWBACKS:A limitation of this analysis is that these data are from a single institution and relate to SSI after surgery for gynecologic malignancy and benign gynecologic disease. Results may not be generalizable for the rate of SSI after surgery in other institutions or specialties. Finally, care must be taken when comparing the reported rates of SSI across agencies as there is variation in the denominators on the basis of the differing inclusion and exclusion criteria. REAL-LIFE IMPLICATIONS:There is discordance among national reporting agencies tracking the rate of SSI. Adopting standardized metrics across agencies could improve consistency and accuracy in assessing SSI rates. When planning an initiative to improve SSI rates and patient outcomes, it is important to assess which metric and reporting method will be most useful and appropriate (Fig). AbstractPurpose Surgical site infections (SSIs) are associated with patient morbidity and increased health care costs. Although several national organizations including the University HealthSystem Consortium (UHC), the National Surgical Quality Improvement Program (NSQIP), and the National Healthcare Safety Network (NHSN) monitor SSI, there is no standard reporting methodology.

Background-Surgical site infections (SSI) lead to increased patient morbidity and healthcare costs. Our objective was to decrease the SSI rate following gynecologic surgery.

Background Surgical site infections (SSI) lead to increased patient morbidity and healthcare costs. Our objective was to decrease the SSI rate following gynecologic surgery. Methods Adult patients undergoing abdominal surgery for gynecologic malignancy or benign disease received the following: patient education; preoperative antibacterial soap; appropriate antibiotic prophylaxis; change of gloves and use of clean instruments at surgical closure; surgical dressing for 48 hours; and a post-discharge phone call. The baseline SSI rate was determined retrospectively (4/1/14–6/30/14) while the post-intervention SSI rate was determined prospectively (2/16/15–10/15/15). The main outcome was the overall SSI rate with secondary outcomes including the rate of superficial, deep, incisional and organ space infection as well as the bundle’s cost-effectiveness. Results A total of 232 baseline and 555 post-intervention patients were included. There were no differences between baseline and post-intervention groups with regard to median BMI, surgical approach, receipt of preoperative chemotherapy and/or radiation therapy and cases including bowel surgery. Overall SSI rate decreased significantly from baseline (12.5%) to post-intervention (7.4%) (OR 0.56 [0.37–0.85]; p=0.01). A 40% decrease was noted in the rate of superficial and deep infections (9.5% vs. 5.9%; OR 0.60 [0.38–0.97]; p=0.04) and SSI after open surgery (21.4% vs. 13.2%; OR 0.56 [0.34–0.92]; p=0.03). The estimated cost of the intervention was $19.26/case and the net total amount saved during the post-intervention period was $65,625/month. Conclusions This bundled intervention led to a significant decrease in the overall SSI rate and was cost-effective. The largest decreases in SSI were in incisional infections and following open surgery.

ResumenLas investigaciones recientes sobre la influencia social utilizando la teoría de reactancia psicológica (Brehm, 1966) se han concentrado en cómo la reactancia motiva el rechazo de mensajes debido a las amenazas a las libertades percibidas planteadas por un lenguaje