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Although influenza vaccination of healthcare workers reduces influenza-like illness and overall mortality among patients, national rates of vaccination for healthcare providers are unacceptably low. We report the implementation of a new mandatory vaccination policy by means of a streamlined electronic enrollment and vaccination tracking system at the National Institutes of Health (NIH) Clinical Center.
To evaluate the outcome of a new mandatory staff influenza vaccination program.
A new hospital policy endorsed by all the component NIH institutes and the Clinical Center departments mandated that employees who have patient contact either be vaccinated annually against influenza or sign a declination specifying the reason(s) for refusal. Those who fail to comply would be required to appear before the Medical Executive Committee to explain their rationale. We collected in a database the names of all physician and nonphysician staff who had patient contact. When a staff member either was vaccinated or declined vaccination, a simple system of badge scanning and bar-coded data entry captured essential data. The database was continuously updated, and it provided a list of noncompliant employees with whom to follow up.
By February 12, 2009, all 2,754 identified patient-care employees either were vaccinated or formally declined vaccination. Among those, 2,424 (88%) were vaccinated either at the NIH or elsewhere, 36 (1.3%) reported medical contraindications, and 294 (10.7%) declined vaccination for other reasons. Among the 294 employees without medical contraindications who declined, the most frequent reason given for declination was concern about side effects.
Implementation of a novel vaccination tracking process and a hospital policy requiring influenza vaccination or declination yielded dramatic improvement in healthcare worker vaccination rates and likely will result in increased patient safety in our hospital.
Case management has become the statutory basis of community care in the UK for people with long-term mental disorders, although a randomised controlled trial found no important improvements over standard care. Here we compare the costs and cost consequences of this intervention with standard care.
Resource-use data were collected over a six-month baseline period and for 14 months after randomisation on all patients in the trial.
At 14 months the ratio of control group to treatment group weekly costs was 1.09 (95% CI 0.86–1.38) for total costs; 1.12 (0.76–1.65) for state benefits, and 1.21 (0.61–2.42) for health care costs. Costs were thus lower in the treatment group, but these differences were not significant.
Retrospective power calculations indicated that the trial could have detected differences of 30% in total cost, but would have required 700 patients per arm to detect a 20% difference in health care costs. Hence this study, which had adequate power to detect clinically meaningful differences, was found to be far too small to detect large differences in costs. Funding agencies increasingly request that clinical trials include economic alongside clinical end-points: these findings may have important lessons for that policy.
Awareness of the risk of spinal-cord damage in moving an unconscious person with a suspected neck injury into the “lateral recovery position,” coupled with the even greater risk of inadequate airway management if the person is not moved, has resulted in a suggested modification to the lateral recovery position for use in this circumstance.
It is proposed that the modification to the lateral recovery position reduces movement of the neck. In this modification, one of the patient's arms is raised above the head (in full abduction) to support the head and neck. The position is called the “HAINES modified recovery position.” HAINES is an acronym for High Arm IN Endangered Spine.
Neck movements in two healthy volunteers were measured by the use of video-image analysis and radiographic studies when the volunteers were rolled from the supine position to both the lateral recovery position and the HAINES modified recovery position.
For both subjects, the total degree of lateral flexion of the cervical spine in the HAINES modified recovery position was less than half of that measured during use of the lateral recovery position (while an open airway was maintained in each).
An unconscious person with a suspected neck injury should be positioned in the HAINES modified recovery position. There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.
This study analysed factors associated with unintended pregnancy among adolescent and young adult women in Santiago, Chile. Three variations of a behavioural model were developed. Logistic regression showed that the effect of sex education on unintended pregnancy works through the use of contraception. Other significant effects were found for variables reflecting socioeconomic status and a woman's acceptance of her sexuality. The results also suggested that labelling affects measurement of ‘unintended’ pregnancy.
It is proved that if G is any compact connected Hausdorff group with weight w(G)≦c, ℝ is the topological group of all real numbers and n is a positive integer, then the topological group G × ℝn can be topologically generated by n + 1 elements, and no fewer elements will suffice.
It is proved that if G is a compact connected Hausdorff group of uncountable weight, w(G), then G contains a homeomorphic copy of [0, 1]w(G). From this it is deduced that such a group, G, contains a homeomorphic copy of every compact Hausdorff group with weight w(G) or less. It is also deduced that every infinite compact Hausdorff group G contains a Cantor cube of weight w(G), and hence has [0, 1]w(G) as a quotient space.
A topological space is said to be locally dyadic if every neighbourhood of a point contains a dyadic neighbourhood of that point. It is proved here that every locally compact Hausdorff topological group is locally dyadic.
Using the Iwasawa structure theorem for connected locally compact Hausdorff groups we show that every locally compact Hausdorff group G is homeomorphic to Rn × K × D, where n is a non-negative integer, K is a compact group and D is a discrete group. This makes recent results on cardinal numbers associated with the topology of locally compact groups more transparent. For abelian G, we note that the dual group, Ĝ, is homeomorphic to This leads us to the relationship card G = ω0(Ĝ) + 2ω0(G), where ω (respectively, ω0) denotes the weight (respectively local weight) of the topological group. From this classical results such as card G = 2 card Ĝ for compact Hausdorff abelian groups, and ω(G) = ω(Ĝ) for general locally compact Hausdorff abelian groups are easily derived.
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