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To describe interfacility transfer communication (IFTC) methods for notification of multidrug-resistant organism (MDRO) status in a diverse sample of acute-care hospitals.
Hospitals within the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN).
SRN members completed an electronic survey on protocols and methods for IFTC. We assessed differences in IFTC frequency, barriers, and perceived benefit by presence of an IFTC protocol.
Among 136 hospital representatives who were sent the survey, 54 (40%) responded, of whom 72% reported having an IFTC protocol in place. The presence of a protocol did not differ significantly by hospital size, academic affiliation, or international status. Of those with IFTC protocols, 44% reported consistent notification of MDRO status (>75% of the time) to receiving facilities, as opposed to 13% from those with no IFTC protocol (P = .04). Respondents from hospitals with IFTC protocols reported significantly fewer barriers to communication compared to those without (2.8 vs 4.3; P = .03). Overall, however, most respondents (56%) reported a lack of standardization in communication. Presence of an IFTC protocol did not affect whether respondents perceived IFTC protocols as having a significant impact on infection prevention or antimicrobial stewardship.
Most respondents reported having an IFTC protocol, which was associated with reduced communication barriers at transfer. Standardization of protocols and clarity about expectations for sending and receipt of information related to MDRO status may facilitate IFTC and promote appropriate and timely infection prevention practices.
Current surveillance for healthcare-associated (HA) urinary tract infection (UTI) is focused on catheter-associated infection with hospital onset (HO-CAUTI), yet this surveillance does not represent the full burden of HA-UTI to patients. Our objective was to measure the incidence of potentially HA, community-onset (CO) UTI in a retrospective cohort of hospitalized patients.
Retrospective cohort study.
Academic, quaternary care, referral center.
Hospitalized adults at risk for HA-UTI from May 2009 to December 2011 were included.
Patients who did not experience a UTI during the index hospitalization were followed for 30 days post discharge to identify cases of potentially HA-CO UTI.
We identified 3,273 patients at risk for potentially HA-CO UTI. The incidence of HA-CO UTI in the 30 days post discharge was 29.8 per 1,000 patients. Independent risk factors of HA-CO UTI included paraplegia or quadriplegia (adjusted odds ratio [aOR], 4.6; 95% confidence interval [CI], 1.2–18.0), indwelling catheter during index hospitalization (aOR, 1.5; 95% CI, 1.0–2.3), prior piperacillin-tazobactam prescription (aOR, 2.3; 95% CI, 1.1–4.5), prior penicillin class prescription (aOR, 1.7; 95% CI, 1.0–2.8), and private insurance (aOR, 0.6; 95% CI, 0.4–0.9).
HA-CO UTI may be common within 30 days following hospital discharge. These data suggest that surveillance efforts may need to be expanded to capture the full burden to patients and better inform antibiotic prescribing decisions for patients with a history of hospitalization.
Concerns relating to increased use of psychotropic medication contrast with those of under-treatment and under-recognition of common mental disorders in children and young people (CYP) across developed countries. Little is known about the indications recorded for antidepressant prescribing in primary care in CYP.
This was an electronic cohort study of routinely collected primary-care data from a population of 1.9 million, Wales, UK. Poisson regression was undertaken to model adjusted counts of recorded depression symptoms, diagnoses and antidepressant prescriptions. Associated indications were explored.
3 58 383 registered patients aged 6–18 years between 1 January 2003 and 31 December 2013 provided a total of 19 20 338 person-years of follow-up. The adjusted incidence of antidepressant prescribing increased significantly [incidence rate ratio (IRR) for 2013 = 1.28], mainly in older adolescents. The majority of new antidepressant prescriptions were for citalopram. Recorded depression diagnoses showed a steady decline (IRR = 0.72) while depression symptoms (IRR = 2.41) increased. Just over half of new antidepressant prescriptions were associated with depression (diagnosis or symptoms). Other antidepressant prescribing, largely unlicensed, was associated with diagnoses such as anxiety and pain.
Antidepressant prescribing is increasing in CYP while recorded depression diagnoses decline. Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose. Unlicensed antidepressant prescribing is associated with a wide range of diagnoses, and while accepted practice, is often not supported by safety and efficacy studies. New strategies to implement current guidance for the management of depression in CYP are required.
Our knowledge of the universe comes from recording the photon and particle fluxes incident on the Earth from space. We thus require sensitive measurement across the entire energy spectrum, using large telescopes with efficient instrumentation located on superb sites. Technological advances and engineering constraints are nearing the point where we are recording as many photons arriving at a site as is possible. Major advances in the future will come from improving the quality of the site. The ultimate site is, of course, beyond the Earth’s atmosphere, such as on the Moon, but economic limitations prevent our exploiting this avenue to the degree that the scientific community desires. Here we describe an alternative, which offers many of the advantages of space for a fraction of the cost: the Antarctic Plateau.
Selective serotonin reuptake inhibitor use is associated with increased risk of suicidal ideation in adolescent humans, yet the neuropharmacological basis of this phenomenon is unknown. Consequently, we examined the behavioural and neurochemical effects of chronic paroxetine (PRX) treatment in adult and adolescent rats. Rats received PRX in their drinking water (target dose 10 mg/kg) for 22 d, during which time they were assessed for depression- and anxiety-like behaviours. Subsequent ex-vivo analyses examined serum PRX concentrations, striatal neurotransmitter content, and regional serotonin and dopamine transporter (SERT, DAT) binding density. After 11–12 d treatment, PRX-treated adolescent rats showed a significant inhibition of social interaction while adults were unaffected. After 19–20 d treatment, adolescents failed to show an antidepressant-like effect of PRX treatment on the forced swim test (FST), while PRX-treated adults showed a typical decrease in immobility and increase in swimming. Two PRX-treated adolescents died unexpectedly after the FST suggesting a compromised response to physical stress. Despite their greater apparent adverse reaction to the drug, adolescents had significantly lower plasma PRX than adults at day 22 of treatment. Chronic PRX treatment had similar effects in adults and adolescents on striatal 5-HT (unchanged relative to controls) and 5-HIAA levels (decreased), while markers of dopaminergic function (DOPAC, HVA, DA turnover) were increased in adults only. SERT density was up-regulated in the amygdala in PRX-treated adolescents only while DAT density in the nucleus accumbens was down-regulated only in PRX-treated adults. These data suggest that the immature rat brain responds differently to PRX and that this might be of use in modelling the atypical response of human adolescents to antidepressants. The age-specific PRX-induced changes in dopaminergic markers and SERT and DAT binding provide clues as to the neural mechanisms underlying adverse PRX effects in adolescent humans.
To quantify the value of performing active surveillance cultures for detection of methicillin-resistant Staphylococcus aureus (MRSA) on intensive care unit (ICU) discharge.
Prospective cohort study.
Medical ICU (MICU) and surgical ICU (SICU) of a tertiary care hospital.
We analyzed data on adult patients who were admitted to the MICU or SICU between January 17, 2001, and December 31, 2004. All participants had a length of ICU stay of at least 48 hours and had surveillance cultures of anterior nares specimens performed on ICU admission and discharge. Patients who had MRSA-positive clinical cultures in the ICU were excluded.
Of 2,918 eligible patients, 178 (6%) were colonized with MRSA on ICU admission, and 65 (2%) acquired MRSA in the ICU and were identified by results of discharge surveillance cultures. Patients with MRSA colonization confirmed by results of discharge cultures spent 853 days in non-ICU wards after ICU discharge, which represented 27% of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.
Surveillance cultures of nares specimens collected at ICU discharge identified a large percentage of MRSA-colonized patients who would not have been identified on the basis of results of clinical cultures or admission surveillance cultures alone. Furthermore, these patients were responsible for a large percentage of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.
Two patients (G01, J02) with chronic nonfluent aphasia and sentence
production deficits received syntactic mapping treatment to improve
sentence production. The patients had dramatically different outcomes in
that improved syntax production generalized to nontreatment tasks for G01,
but not for JO2. To learn how treatment influenced the neural substrates
for syntax production, both patients underwent pre- and posttreatment
functional magnetic resonance imaging (fMRI) of sentence generation. G01
showed more robust activity posttreatment than pretreatment in
Broca's area; ventral temporal activity decreased slightly from pre-
to posttreatment. Comparison of J02's pretreatment and posttreatment
images revealed little change, although activity was more diffuse pre-
than posttreatment. Findings suggest that for G01, rehabilitation led to
engagement of an area (Broca's area) used minimally during the
pretreatment scan, whereas for J02, rehabilitation may have led to more
efficient use of areas already involved in sentence generation during the
pretreatment scan. fMRI findings are discussed in the context of
sentence-production outcome and generalization. (JINS, 2006,
Four years after the occurrence of an outbreak of hepatitis B and HIV infection among
injecting drug user inmates at Her Majesty's Prison Glenochil in Scotland, a study design was
developed to complete the epidemiological account of the HIV outbreak. Our aim was to
identify potential cases of (1) HIV transmission not diagnosed during the original outbreak
investigation and (2) the source(s) of the outbreak. Scotland's HIV positive case register was
searched for matches to a soundexed list of 636 Glenochil inmates imprisoned during
January–June 1993. Eight HIV infections that may have been acquired in Glenochil and four
possible sources of the outbreak were identified. The second stage of follow-up – molecular
epidemiological techniques used on stored sera samples from identified individuals – is
described in the companion paper. Without breach of medical or prisoner confidentiality,
indirect and anonymous follow-up has proved possible for the Glenochil inmates.
This data linkage study examined the extent of hepatitis B transmission
and co-infection with
HIV among 636 former inmates of Glenochil prison, Scotland, during an outbreak
bloodborne diseases in 1993 which was related to needle sharing. Eleven
during the first half of 1993 presented with hepatitis B infection, of
whom co-infection with
HIV was detected in six. Based on dates of test results in relation to
time of imprisonment,
seven definitely acquired their hepatitis B infection within the
prison. Only two infections were
reported to Scotland's hepatitis B register and neither could be
prison-linked. This outbreak of
hepatitis B is the first of its kind to be reported but not the
first to have occurred. It not only
highlights the urgency for measures to prevent further spread of infection
among prisoners but
also illustrates the need for comprehensive surveillance of hepatitis B
infection, and the need
for a protocol on how to manage such outbreaks and on how to establish
the extent of
transmissions when acute hepatitis B occurs in prison.
Let denote a subring of the complex field that contains 1 and is closed under complex conjugation. It is shown that, with respect to the involution induced by word-reversal, the algebra over of a free monoid admits a trace and a separating family of star matrix representations. From the existence of a trace it is deduced that the aforementioned involution is special, in the sense of Easdown and Munn. Similar results hold for the algebra over of a free monoid with involution.
The effects of mild to moderate infections of Trichuris trichiura on cognitive functions were investigated in Jamaican children aged 7 to 10 years. In all, 189 infected children and 100 uninfected classmates were studied. The infected children were randomly assigned to receive treatment (albendazole) or a placebo. All children were given cognitive tests on enrolment and 14 weeks later. These included verbal fluency (generation of ideas), digit span (working memory), number choice (speed of processing of visual stimuli), visual search (sustained attention) and a French Vocabulary test (paired-associate learning). At baseline, the infected children had lower scores than the uninfected ones in fluency (P = 0·01), search (P = 0·02) and French (P = 0·01). Treatment effects were examined among infected children and there was no significant treatment effect for any of the tests. However, there was a significant treatment by weight-for-age interaction in fluency (P < 0·05). The children with low weight-for-age (Z-score < – 1) improved with treatment while there was no improvement with treatment among the other children. We concluded that treatment of children with mild to moderate T. trichiura infections using albendazole produces little benefit in cognition if they are adequately nourished; however, undernourished children are more likely to benefit.
The relationship between varying intensities of Trichuris trichiura infection and iron status was examined in Jamaican schoolchildren, aged 7 to 11 years. A total of 409 children was identified with T. trichiura (epg > 1200). A control group comprised 207 uninfected children who were matched by school and class to every pair of infected subjects. Blood samples were obtained from 421 children: 264 infected and 157 controls. Compared to the rest of the children, those with heavy infections (epg > 10 000) had significantly lower (P < 0·05) Hb (11·5 ± 1·3 vs. 12·1 ± 1·1 g/dl), MCV (78·6 ± 6·3 vs. 81·2 ± 5·5 fl), MCH (26·2 ± 2·9 vs. 27·5 ± 2·5 pg) and MCHC (33·2 ± 1·5 vs. 33·9 ± 1·4 g/dl). Similarly, the prevalence of anaemia (Hb < 11·0 g/dl) amongst heavily infected children (33%) was significantly higher (P < 0·05) than the rest of the sample (11%). These differences remained significant after controlling for confounding variables including socio-economic status, age, gender, area of residence and the presence of Ascaris infections. Differences in red cell count, ferritin, and free erythrocyte protoporphyrin were not statistically significant and showed no association with the infectious load. These results suggest that in the Jamaican children studied, iron deficiency anaemia is associated with Trichuris infections over 10 000 epg, but not with less intense infections.
A double-blind placebo trial was conducted to determine the effect of moderate to high loads of Trichuris trichiura (whipworm) infection on the cognitive functions of 159 school children (age 9–12 years) in Jamaica. Infected children were randomly assigned to Treatment or Placebo groups. A third group of randomly selected uninfected children were assigned to a Control for comparative purposes. The improvement in cognitive function was evaluated using a stepwise multiple linear regression, designed to control for any confounding variables. The expulsion of worms led to a significant improvement in tests of auditory short-term memory (P < 0.02; P < 0.01), and a highly significant improvement in the scanning and retrieval of long-term memory (P < 0.001). After 9 weeks, treated children were no longer significantly different from an uninfected Control group in these three tests of cognitive function. The removal of T. trichiura was more important than Ascaris lumbricoides in determining this improvement. The results suggest that whipworm infection has an adverse effect on certain cognitive functions which is reversible by therapy.
Pre-Anglian terrace stages of the proto-Thames system are traced from the present middle Thames area into Essex and south East Anglia. Gravel composition indicates that each of the main terrace stages is associated with an influx of far-travelled material, probably signifying at least three phases of pre-Anglian glaciation in the south Midlands. Gravel composition also indicates the occurrence of major changes during Early and Middle Pleistocene times in the extent of the Thames catchment, and in the disposition of the main drainage lines. The important role of the Goring Gap in the development of the drainage system is noted, and the nature and distribution of Anglian fluvioglacial gravels are described.