No abstract

we report the first Belgian outbreak of CA-MRSA USA300 in this article. A strict search and destroy strategy and continued surveillance are required in the management of CA-MRSA USA300.

While surgery is gaining in efficiency it is equally getting more and more complex. Meanwhile patients are getting more and more demanding. In the past decades, safety and quality have become prominent criteria by which surgical care is evaluated. Several important factors can be identified which are influencing the quality of surgical care, in our view these factors can be classified into four major groups: the team of caretakers, the patient, the material, and the procedure. For all of these factors, a high level of knowledge and optimal communication is crucial to guarantee a high standard of care and minimize the chance of complications. Different quality assessment tools are currently used in surgery. Databases of surgical procedures have the potential to offer an enormous amount of information on the quality of care. However, the implementation of comprehensive databases is difficult and expensive, while its value is overshadowed by possible underreporting. Introducing surgical checklists is a cheap yet efficient way to increase both the safety and the quality of surgical care. Nevertheless, its implementation is sometimes opposed since they slow down the patient flow. The risk of complications tends to increase when a new technique is introduced. Therefore, quality assurance (QA) programs have to be implemented. Surgical simulation training is rapidly becoming a necessary adjunct to traditional patient-based training models. Finally, key performance indicators (KPI) can be used for measuring the success of medical interventions such as surgery. For the near future, the introduction of one comprehensive medical file per patient could be a major step in increasing the safety and efficiency of our medical deeds. In parallel, a nationwide prospective registry for surgical interventions should be introduced. Postgraduate surgical training should be organized by the national professional groups and should be adapted to the local needs. A system of accreditation for specific interventions should be introduced guaranteeing their state-of-the-art application.

No abstract

Premenopausal dysfunctional bleeding (PDB) is a common medical problem. Surgery is typically performed after the failure of a medical approach. Surgical options include endometrial ablation techniques or a hysterectomy. The aims of our study are to measure the outcome parameters of firstgeneration endometrial ablations (fgEA) and to identify patient-related prognostic factors. We included all fgEAs performed between September 2001 and December 2011 at the General Hospital of Turnhout, Belgium (n=218). The outcome was defined by the need for a postoperative therapy (group 1-no therapy; group 2-therapy, but no hysterectomy; group 3-hysterectomy). We also rated postoperative amenorrhea and patient satisfaction. The prognostic factors examined were associated dysmenorrhea, a history of cesarean section, preoperative duration of blood loss, age, parity, and a history of tubal ligation sterilization. We used Excel 2011, Version 14.0.0, and Statplus Mac LE 2009 for our statistical analysis. The hysterectomy rate post-fgEA was 10 % (22/ 218). The rate of amenorrhea (defined as cessation of bleeding from 3 months postprocedure until the moment the patient was interviewed) was 76 % (165/218). Ninety-two percent (202/218) of patients were either satisfied or very satisfied with the procedure and outcome. The only significant prognostic factor was the age of the patient at the time of the fgEA (p=0.0004 for mean age at time of fgEA and p=0.0433 for comparison pre-versus perimenopausal age). The outcome of this fgEA technique is often underestimated and can still result in a high amenorrhea and satisfaction rate and low postoperative hysterectomy rate.