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Patients with candidemia are at risk for other invasive infections, such as methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI).
To identify the risk factors for, and outcomes of, BSI in adults with Candida spp. and MRSA at the same time or nearly the same time.
Population-based cohort study.
Metropolitan Atlanta, March 1, 2008, through November 30, 2012.
All residents with Candida spp. or MRSA isolated from blood.
The Georgia Emerging Infections Program conducts active, population-based surveillance for candidemia and invasive MRSA. Medical records for patients with incident candidemia were reviewed to identify cases of MRSA coinfection, defined as incident MRSA BSI 30 days before or after candidemia. Multivariate logistic regression was performed to identify factors associated with coinfection in patients with candidemia.
Among 2,070 adult candidemia cases, 110 (5.3%) had coinfection within 30 days. Among these 110 coinfections, MRSA BSI usually preceded candidemia (60.9%; n=67) or occurred on the same day (20.0%; n=22). The incidence of coinfection per 100,000 population decreased from 1.12 to 0.53 between 2009 and 2012, paralleling the decreased incidence of all MRSA BSIs and candidemia. Thirty-day mortality was similarly high between coinfection cases and candidemia alone (45.2% vs 36.0%, P=.10). Only nursing home residence (odds ratio, 1.72 [95% CI, 1.03–2.86]) predicted coinfection.
A small but important proportion of patients with candidemia have MRSA coinfection, suggesting that heightened awareness is warranted after 1 major BSI pathogen is identified. Nursing home residents should be targeted in BSI prevention efforts.
Infect. Control Hosp. Epidemiol. 2015;36(11):1298–1304
Recent developments in postgraduate medical education for the training of junior doctors in the UK necessitate changes in all parts of the curriculum, including the assessment system. There is a move away from the limited, traditional one-off assessment towards multidimensional, broader assessments of a doctor's longer-term performance. This is accompanied by the rapid development of assessment tools, collectively termed workplace-based assessments, and is in keeping with an outcome-based approach to medical education and its increasing professionalisation. In addition to clinical skills, other aspects of being a good practitioner are being assessed, including team-working, working with colleagues and patients, probity and communication skills. Using a combination of tools gives the assessment process high validity. Of the many challenges posed by these changes is the need for data on their reliability in psychiatry. There must be a clear process for applying assessments, national standardisation and training for those using asessment tools.
Previous cross-sectional studies have highlighted a number of obstetric
variables that may be associated with the development of broadly defined
puerperal (post-partum) psychosis. These include: (a) primiparity (b)
pregnancy complications, (c) delivery complications, (d) Caesarean
section, (e) female baby and (f) shorter gestation period.
To examine these risk factors in women with well-characterised bipolar
affective puerperal psychosis.
A sample of 129 women with bipolar affective puerperal psychosis were
investigated using a design that takes advantage of within-subject
comparisons of affected and unaffected deliveries.
Two of the variables studied were independently associated with an
episode of puerperal psychosis: primiparity (odds ratio=3.76,
P<0.001) and delivery complications (odds
This study provides further evidence of the association between
primiparity and puerperal psychosis and suggests that complications
during delivery may be associated with a severe post-partum episode.
Recent developments in medical education and in UK government policy for the training and service commitment of junior doctors have highlighted the need to examine clinical teaching. There is growing evidence of the effectiveness of more structured approaches to patient-based teaching. The scope of what can be taught includes the three domains of knowledge, skill and attitudes. There are proven models to deliver teaching not only of patient assessment and management but also of all aspects of the doctor–patient relationship. The application of patient-based teaching is entirely consonant with the rigours of the outcome-based approach to curriculum planning and delivery. The successful, thoughtful adoption of patient-based teaching is part of the ‘professionalisation’ of education in psychiatry that in turn begs questions about the learning, accreditation and reward of those involved as teachers at all levels.
The “new deal” for junior doctors is set to ensure reduction of hours worked to a maximum of 72 per week by the end of 1996. To facilitate this reduction, juniors with a higher workload are being asked to consider alternative working patterns to the traditional “on-call” total system, and either work full shift systems (e.g. as in casualty departments) or a partial shift system that falls between these two extremes.
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