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The risk of carrying methicillin-resistant Staphylococcus aureus (MRSA) is higher among nursing home (NH) residents than in the general population. However, control strategies are not clearly defined in this setting. In this study, we compared the impact of standard precautions either alone (control) or combined with screening of residents and decolonization of carriers (intervention) to control MRSA in NHs.
Cluster randomized controlled trial
NHs of the state of Vaud, Switzerland
Of 157 total NHs in Vaud, 104 (67%) participated in the study.
Standard precautions were enforced in all participating NHs, and residents underwent MRSA screening at baseline and 12 months thereafter. All carriers identified in intervention NHs, either at study entry or among newly admitted residents, underwent topical decolonization combined with environmental disinfection, except in cases of MRSA infection, MRSA bacteriuria, or deep skin ulcers.
NHs were randomly allocated to a control group (51 NHs, 2,412 residents) or an intervention group (53 NHs, 2,338 residents). Characteristics of NHs and residents were similar in both groups. The mean screening rates were 86% (range, 27%–100%) in control NHs and 87% (20%–100%) in intervention NHs. Prevalence of MRSA carriage averaged 8.9% in both control NHs (range, 0%–43%) and intervention NHs (range, 0%–38%) at baseline, and this rate significantly declined to 6.6% in control NHs and to 5.8% in intervention NHs after 12 months. However, the decline did not differ between groups (P=.66).
Universal screening followed by decolonization of carriers did not significantly reduce the prevalence of the MRSA carriage rate at 1 year compared with standard precautions.
Motor performance and movement quality were quantitatively examined (Zurich Neuromotor Assessment: timed motor performances and associated movements) in 87 prospectively enrolled very-low-birthweight (VLBW; <1250g) children (38 males, 49 females; mean birthweight 1016.2g [SD 141.5]:, range 720–1240g; mean gestational age 28.7wks [SD 2], range 25.7–33.4wks) at 6 years of age. All motor tasks were below the reference population: pure motor (median z-score) –0.46; adaptive fine motor (pegboard) –0.99; adaptive gross motor –0.88; static balance –0.48; and associated movements –1.90. All tasks correlated with the degree of neurological abnormalities (p[les ]0.004). VLBW children with no neurological abnormality also performed below the 10th centile and associated movements occurred more frequently than in the reference population (odds ratio 18, 95% confidence interval 6.7–47.9). Severity of periventricular leukomalacia and intraventricular haemorrhage assessed by ultrasound was associated with adaptive fine and gross motor tasks. We conclude that speed of motor performance and movement quality in particular were substantially impaired in VLBW children and are related to the degree of neurological abnormalities and neonatal cerebral injury.
The over-inhibition of thalamic relay cells by hyperactivity of the internal part of the globus pallidus is a cornerstone of the parkinsonian pathophysiology that leads to a distortion of the thalamocortical dynamics called thalamocortical dysrhythmia (TCD). Here, we present the results of the stereotactic pallidothalamic tractotomy (PTT), which interrupts selectively the enhanced pallidal output to the thalamus in a restricted location in the fields of Forel. This operation represents a reactualization of Spiegel's campotomy. PTT was offered to 41 patients (66.1±8.5 years) suffering from chronic, therapy-resistant Parkinson's disease. It was performed bilaterally in 21 patients. Forty patients displayed mixed, i.e. tremulent and akinetic parkinsonian signs, and seven had drug-induced dyskinesias. One patient had only rest tremor. The evaluation was based on the Unified Parkinson's Disease Rating Scale (UPDRS) scores, comparing the patients' preoperative medicated state with the state at the last postoperative follow-up. We, thus, tested surgical success in terms of superiority to drug treatment. Mean follow-up was 22.4 months with 15 patients followed for >2 years. Mean improvement was 60% (P<0.001) for UPDRS III and 51% (P<0.001) for UPDRS II. Significant improvement (P<0.001) appeared in subscores for tremor (87%), limb akinesia (58%) and axial akinesia (33%). Improvement of postural stability and gait was at the limit of significance (P<0.05). Improvement of hypomimia and hypophonia did not reach statistical significance. Increase of dysarthria was significant (P<0.01). Intake of L-DOPA was reduced significantly and 21 patients were able to stop intake. Median improvement of the Quality of Life score was 67%. Improvement remained, independent of follow-up length. In conclusion, PTT provides a high, stable level of relief to parkinsonian patients whose condition cannot be controlled with pharmacotherapy. The rationale of the surgical therapy is based on a selective extrathalamic regulation of the parkinsonian TCD.
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