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https://www.readbyqxmd.com/read/29775628/-cost-effectiveness-of-interventions-to-improve-hand-hygiene-in-healthcare-workers-in-middle-income-hospital-settings-a-model-based-analysis
#1
Nantasit Luangasanatip, Maliwan Hongsuwan, Yoel Lubell, Direk Limmathurotsakul, Pramot Srisamang, Nicholas Pj Day, Nicholas Graves, Ben S Cooper
BACKGROUND: Multimodal interventions are effective in increasing hand hygiene (HH) compliance amongst healthcare workers, but it is not known whether such interventions are cost-effective outside high-income countries. AIM: To evaluate the cost-effectiveness of multimodal hospital interventions to improve hand hygiene (HH) compliance in a middle-income country. METHOD: We adopted a conservative approach by developing a model to determine whether reductions in Methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSI) alone would make HH interventions cost-effective in intensive care units (ICUs)...
May 15, 2018: Journal of Hospital Infection
https://www.readbyqxmd.com/read/29772393/unexpected-mechanisms-of-resistance-in-dutch-pseudomonas-aeruginosa-isolates-collected-during-fourteen-years-of-surveillance
#2
P D Croughs, C H W Klaassen, J van Rosmalen, D M Maghdid, S A Boers, J P Hays, W H F Goessens
Pseudomonas aeruginosa is one of the most important causes of infection in the intensive care unit. It is intrinsically resistant to many antibiotics and easily acquires additional resistance genes via horizontal gene transfer of mobile genetic elements. In the present study, 1,528 P. aeruginosa isolates, obtained from a Dutch national surveillance program between the years 1998 and 2011, were analyzed for the presence of Extended Spectrum β-Lactamase (ESBL) genes blaCTX-M , blaSHV , blaTEM , blaBEL , blaPER , blaVEB , blaOXA-10 and metallo-β-Lactamase (MBL) genes blaIMP , blaVIM and blaNDM ...
May 14, 2018: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/29771791/a-successful-model-of-expedited-antiretroviral-therapy-for-clinically-stable-patients-living-with-hiv-in-haiti
#3
Colette Guiteau Moise, Vanessa R Rivera, Kelly A Hennessey, Clovy Bellot, Chris Nicholas, Anna P Fang, Rose Irène Verdier, Patrice Severe, Alix Sainvil, Benedict Charles, Derothy Dorval, Juseline St Amour, Jean W Pape, Serena P Koenig
BACKGROUND: Recommendations for universal antiretroviral therapy (ART) have greatly increased the number of HIV-infected patients who qualify for treatment, particularly with early clinical disease. Less intensive models of care are needed for clinically stable patients. SETTING: A Rapid Pathway (RP) model of expedited outpatient care for clinically stable patients was implemented at the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) Center, Port-au-Prince, Haiti...
April 30, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/29771758/opportunistic-fungal-infection-in-children-and-management
#4
Joseph M Lam
PURPOSE OF REVIEW: An opportunistic mycosis is a fungal agent of low pathogenicity that specifically infects immunocompromised hosts. Advances in transplantation, preterm care, immunosuppressive therapies and intensive care, have lead to the emergence of pediatric patients with serious immunodeficiency who are vulnerable to nonpathogenic fungi. RECENT FINDINGS: The advent of the use of biologic agents in pediatric disease as well as the advances in care of preterm and immunosuppressed patients opens up a new cohort of patients at risk of opportunistic mycotic infections...
May 15, 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29771684/antibiotic-treatment-induced-secondary-iga-deficiency-enhances-susceptibility-to-pseudomonas-aeruginosa-pneumonia
#5
Oliver H Robak, Markus M Heimesaat, Andrey A Kruglov, Sandra Prepens, Justus Ninnemann, Birgitt Gutbier, Katrin Reppe, Hubertus Hochrein, Mark Suter, Carsten J Kirschning, Veena Marathe, Jan Buer, Mathias W Hornef, Markus Schnare, Pascal Schneider, Martin Witzenrath, Stefan Bereswill, Ulrich Steinhoff, Norbert Suttorp, Leif E Sander, Catherine Chaput, Bastian Opitz
Broad-spectrum antibiotics are widely used in patients on intensive care units (ICU), many of which develop hospital-acquired infections with Pseudomonas aeruginosa. Although preceding antimicrobial therapy is known as a major risk factor for P. aeruginosa-induced pneumonia, the underlying mechanisms remain incompletely understood. Here we demonstrate that depletion of the resident microbiota by broad-spectrum antibiotic treatment inhibited TLR-dependent production of a proliferation inducing ligand (APRIL), resulting in a secondary IgA deficiency in the lung in mice and human ICU patients...
May 17, 2018: Journal of Clinical Investigation
https://www.readbyqxmd.com/read/29770791/effects-of-laparoscopic-and-conventional-methods-on-lung-functions-in-colorectal-surgery
#6
Sebahattin Celik, Eyüp M Yılmaz
BACKGROUND We aimed to compare the lung functions, complication rates, and durations of the hospital and intensive care unit stays of patients who had undergone laparoscopic colorectal resection and open colorectal resection. MATERIAL AND METHODS In this study, data were collected prospectively and then evaluated retrospectively. The study was carried out between January 2015 and November 2016 in 2 university hospitals. Pulmonary function tests (PFT) and chest radiography were performed in all patients preoperatively...
May 17, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/29770752/ventilator-bundle-compliance-and-risk-of-ventilator-associated-events
#7
Bryan D Harris, Gale A Thomas, Matthew H Greene, Steven S Spires, Thomas R Talbot
OBJECTIVEVentilator bundles encompass practices that reduce the risk of ventilator complications, including ventilator-associated pneumonia. The impact of ventilator bundles on the risk of developing ventilator-associated events (VAEs) is unknown. We sought to determine whether decreased compliance to the ventilator bundle increases the risk for VAE development.DESIGNNested case-control study.SETTINGThis study was conducted at 6 adult intensive care units at an academic tertiary-care center in Tennessee.PATIENTSIn total, 273 patients with VAEs were randomly matched in a 1:4 ratio to controls by mechanical ventilation duration and ICU type...
June 2018: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29769838/selected-biomarkers-correlate-with-the-origin-and-severity-of-sepsis
#8
Michal Holub, Olga Džupová, Michaela Růžková, Alžběta Stráníková, Eva Bartáková, Jan Máca, Jiří Beneš, Heiko Herwald, Ondřej Beran
The microbial etiology and source of sepsis influence the inflammatory response. Therefore, the plasma levels of cytokines (IL-6, IL-8, and IL-10), chemokines (CCL2/MCP-1, MIP-1 β ), heparin-binding protein (HBP), soluble CD14 (sCD14), and cortisol were analyzed in blood from septic patients obtained during the first 96 hours of intensive care unit hospitalization. The etiology was established in 56 out of a total of 62 patients enrolled in the study. Plasma concentrations of MCP-1, sCD14, IL-6, and IL-10 were significantly higher in patients with community-acquired pneumonia (CAP; n = 10) and infective endocarditis (IE; n = 11) compared to those with bacterial meningitis (BM; n = 18)...
2018: Mediators of Inflammation
https://www.readbyqxmd.com/read/29769151/real-time-automated-detection-of-ventilator-associated-events-avoiding-missed-detections-misclassifications-and-false-detections-due-to-human-error
#9
Erica S Shenoy, Eric S Rosenthal, Yu-Ping Shao, Siddharth Biswal, Manohar Ghanta, Erin E Ryan, Dolores Suslak, Nancy Swanson, Valdery Moura Junior, David C Hooper, M Brandon Westover
OBJECTIVETo validate a system to detect ventilator associated events (VAEs) autonomously and in real time.DESIGNRetrospective review of ventilated patients using a secure informatics platform to identify VAEs (ie, automated surveillance) compared to surveillance by infection control (IC) staff (ie, manual surveillance), including development and validation cohorts.SETTINGThe Massachusetts General Hospital, a tertiary-care academic health center, during January-March 2015 (development cohort) and January-March 2016 (validation cohort)...
May 17, 2018: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29768662/immersion-in-water-during-labour-and-birth
#10
REVIEW
Elizabeth R Cluett, Ethel Burns, Anna Cuthbert
BACKGROUND: Water immersion during labour and birth is increasingly popular and is becoming widely accepted across many countries, and particularly in midwifery-led care settings. However, there are concerns around neonatal water inhalation, increased requirement for admission to neonatal intensive care unit (NICU), maternal and/or neonatal infection, and obstetric anal sphincter injuries (OASIS). This is an update of a review last published in 2011. OBJECTIVES: To assess the effects of water immersion during labour and/or birth (first, second and third stage of labour) on women and their infants...
May 16, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29768249/detection-of-cytomegalovirus-in-saliva-from-infants-undergoing-sepsis-evaluation-in-the-neonatal-intensive-care-unit-the-virion-c-study
#11
Andrea Ronchi, Christopher P Ouellette, Asuncion Mejías, Douglas Salamon, Amy Leber, Lorenza Pugni, Fabio Mosca, Pablo J Sánchez
OBJECTIVE: To determine the frequency of detection of cytomegalovirus (CMV) among infants evaluated for late-onset sepsis in the neonatal intensive care unit (NICU). STUDY DESIGN: This study was a prospective cohort study. RESULTS: During the 13-month study, 84 infants underwent 116 sepsis evaluations, and CMV DNA was detected in saliva in three (4%) infants (median: gestational age 28 weeks, birth weight 950 g), representing 5% (n=6) of all sepsis evaluations...
May 16, 2018: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/29766208/-adequate-anti-infective-treatment-importance-of-individual-dosing-and-application
#12
A Brinkmann, A C Röhr, A Köberer, T Fuchs, W A Krüger, C König, D Richter, M A Weigand, O R Frey
Sepsis-induced changes in pharmacokinetic parameters are a well-known problem in intensive care medicine. Dosing of antibiotics in this setting is therefore challenging. Alterations to the substance-specific kinetics of anti-infective substances have an effect on the distribution and excretion processes in the body. Increased clearance and an increased distribution volume (Vd ) and particularly compromized organ function with reduced antibiotic elimination are often encountered in patients with sepsis. Renal replacement treatment, which is frequently used in intensive care medicine, represents a substantial intervention in this system...
May 15, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29766132/red-cell-distribution-width-predicts-out-of-hospital-outcomes-in-critically-ill-emergency-general-surgery-patients
#13
Joaquim Michael Havens, Anupamaa J Seshadri, Ali Salim, Kenneth B Christopher
Introduction: Red cell distribution width (RDW) is associated with mortality and bloodstream infection risk in critically ill patients. We hypothesized that an increase in RDW at hospital discharge in critically ill patients who received emergency general surgery (EGS) would be associated with increased mortality after hospital discharge. Methods: We performed a two-center observational study of patients treated in medical and surgical intensive care units. We studied 1567 patients, who received critical care between 1998 and 2012 who underwent EGS and survived hospitalization...
2018: Trauma surgery & acute care open
https://www.readbyqxmd.com/read/29764844/second-look-laparostomy-for-perforated-gangrenous-gastric-volvulus-to-prevent-total-gastrectomy
#14
Paul K Okeny, Omar Abbassi, Ali Warsi
A 42-year-old Caucasian woman presented to the emergency department with severe upper abdominal pain and vomiting. Clinically, she was septic, and abdominal examination suggested peritonitis. Following immediate resuscitation, the patient was stabilised and underwent urgent contrast-enhanced CT of the abdomen and pelvis. This revealed a mesenteroaxial gastric volvulus with traction on the mesentery and a small volume of free fluid. She underwent laparotomy revealing gangrenous gastric fundus perforation complicated by persistent intraoperative hypotension...
May 15, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29764558/-progress-of-epidemiology-and-outcome-for-sepsis
#15
Xiaoli He, Deyuan Li, Lina Qiao, Yan Kang
Sepsis is an uncontrolled host's response to infection and leads to life-threatening organ dysfunction. Traditional prognostic indicators for short-term mortality, such as intensive care unit (ICU) mortality, hospital mortality, cannot reveal the real and final outcome of sepsis patients. Sepsis patients remain high mortality even several years after hospital discharge, at the same time the quality of life, and the cognitive function were also damaged at varying degrees. Nowadays, studies about long-term quality of life for sepsis were still sparse and further study was still needed...
May 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29764555/-role-of-noninvasive-mechanical-ventilation-in-patients-with-severe-avian-influenza-a-h7n9-complicated-with-acute-respiratory-distress-syndrome
#16
Haili Luo, Shaohong Wang, Feng Shen, Tongmei Yuan, Xianguo Pan, Jingtao Liu, Ling Yao, Juncheng Wu, Xuemei Long
Human infection with avian influenza A (H7N9) is an acute contagious respiratory disease. Acute respiratory distress syndrome (ARDS) is a common complication in patients with severe avian influenza A (H7N9), for whom mechanical ventilation (MV) is an important supportive method. A patient, suffered from severe avian influenza A (H7N9) and complicated with ARDS, was admitted to the Second Affiliated Hospital of Guizhou Medical University in January 2017. With very intensive care for oxygenation, respiration and consciousness, and monitoring, she was successfully cured by comprehensive managements, among which noninvasive mechanical ventilation (NIV) was the major respiratory support method...
May 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29764273/the-association-between-sequential-organ-failure-assessment-scores-and-mortality-in-patients-with-sepsis-during-the-first-week-the-jseptic-dic-study
#17
Tsuyoshi Nakashima, Kyohei Miyamoto, Toshio Shimokawa, Seiya Kato, Mineji Hayakawa
OBJECTIVE: Predicting prognosis is a complex process, particularly in patients with severe sepsis or septic shock. This study aimed to determine the relationship between the Sequential Organ Failure Assessment (SOFA) scores for individual organs during the first week of admission and the in-hospital mortality in patients with sepsis. METHODS: This study was a post hoc evaluation of the Japan Septic Disseminated Intravascular Coagulation study and included patients admitted to 42 intensive care units in Japan for severe sepsis or septic shock, between January 2011 and December 2013...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29764255/knot-positioning-during-mcdonald-cervical-cerclage-does-it-make-a-difference-a-cohort-study
#18
Hytham Atia, Mohamed Ellaithy, Ahmed Altraigey, Heba Ibrahim
OBJECTIVE: To study the effect of McDonald cerclage knot position on the different maternal and neonatal outcomes. METHODS: This historical cohort study included women with singleton pregnancy who had a prophylactic McDonald cervical cerclage between 1 May 2010 and 31 September 2017. Maternal and neonatal outcome parameters were compared between the anterior and posterior knot cerclage procedures. The primary outcome measure was the rate of term birth. RESULTS: 550 Women had a prophylactic McDonald cervical cerclage, 306 with anterior knot (Group A) and 244 with posterior knot (Group B)...
May 15, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29763777/incorporation-of-point-of-care-ultrasound-into-morning-round-is-associated-with-improvement-in-clinical-outcomes-in-critically-ill-patients-with-sepsis
#19
Zhonghua Chen, Yucai Hong, Junru Dai, Lifeng Xing
OBJECTIVES: Point-of-care ultrasound (POCUS) has been widely used in the intensive care unit (ICU). However, it is largely unknown whether the use of POCUS is associated with improved patient-important outcomes. The study aimed to investigate whether incorporation of POCUS during morning round on a routine basis was able to improve clinical outcomes in critically ill patients with sepsis. DESIGN: It was a prospective observational study. SETTING: A tertiary care emergency intensive care unit...
May 11, 2018: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/29763267/top-20-research-studies-of-2017-for-primary-care-physicians
#20
Mark H Ebell, Roland Grad
Based on systematic surveillance of more than 110 medical journals, 247 studies met criteria as POEMs (patient-oriented evidence that matters) in 2017. Members of the Canadian Medical Association identified 20 of these POEMs as most relevant to practice. This article reviews the clinical questions and bottom-line answers from these studies. Blood pressure should be measured after a period of rest, using a bare arm, and orthostatic blood pressure is more predictive when measured after one minute of standing rather than three minutes...
May 1, 2018: American Family Physician
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