The prevalence and clonal expansion of high-level gentamicin-resistant enterococci isolated from blood cultures in a Dutch university hospital.
(41/2332)
We studied the prevalence and clonality of high-level gentamicin-resistant enterococci (HLGRE) in a Dutch university hospital. Of 238 enterococcal strains isolated from blood cultures between 1991 and 1997, 57 were HLGRE. Genomic analysis of these strains revealed 19 different genotypes, two of which were encountered more frequently [type A (12/57), type B (23/57)]. The spread of these types largely explained the rise in HLGRE incidence from 14% in 1991 to 31% in 1997. However, the contribution of unique strains to the total HLGRE burden also increased from 4% to 16%. We conclude that both clonal expansion and the emergence of unique HLGRE have contributed significantly to the increasing incidence of HLGRE. (+info)
Evaluation of an anesthesiology department newsletter.
(42/2332)
The West Virginia University Department of Anesthesiology has distributed a weekly newsletter to department members for several years. A recent survey and discussion among members found the newsletter to be useful and important in shaping the culture of the department and marketing it. A weekly format of three to five pages was judged best. News about anesthesiology, department policies, and practice management information were most valued. (+info)
Effect of endovascular services and hospital volume on cerebral aneurysm treatment outcomes.
(43/2332)
BACKGROUND AND PURPOSE: Endovascular coil embolization and angioplasty for cerebral vasospasm are offered by some centers for the treatment of unruptured and ruptured cerebral aneurysms. Whether the availability of these therapies improves outcomes at these institutions has not been evaluated. METHODS: We assessed institutional factors in the outcomes of patients treated for cerebral aneurysms in the academic medical centers of the University Health Systems Consortium. In-hospital deaths (primary outcome), length of stay, and hospital charges were evaluated in multivariable models adjusted for age, sex, race, admission source, and admission status. RESULTS: There were 2623 unruptured and 9534 ruptured aneurysm cases treated at 70 centers in the University Health Systems Consortium hospital discharge database during 1994-1997. Patients treated at institutions that more frequently used coil embolization were less likely to die in the hospital (relative risks [RRs] for every 10% of endovascular-treated cases: ruptured aneurysms: RR, 0.91; 95% CI, 0.86 to 0.96; P=0.001; unruptured aneurysms: RR, 0.84; 95% CI, 0.78 to 0.91; P<0.001). Patients treated at institutions that used angioplasty for vasospasm had a 16% reduction in risk of in-hospital death compared with patients treated at other institutions (RR, 0.84; 95% CI, 0.71 to 0.98; P=0.03). Hospital treatment volume was not independently associated with in-hospital death. CONCLUSIONS: Patients treated for cerebral aneurysms at institutions offering endovascular services have lower rates of in-hospital mortality. Whether this is due to improved outcomes with endovascular therapy or is a marker for other aspects of multidisciplinary care cannot be answered in this analysis. (+info)
Endovascular treatment of abdominal aortic aneurysms in Norway: the first 100 patients.
(44/2332)
OBJECTIVES: to present the first 100 consecutive endograft implantations for abdominal aortic aneurysms (AAAs) in Norway. DESIGN: retrospective study of 100 consecutive graft implantations, performed at five University Hospitals during 1995 to 1997. MATERIAL: one hundred patients with a median age of 70 years were included. In all patients the Vanguard modular system (Boston Scientific Corp.) was used. Ninety-four of the 100 patients were treated under regional anaesthesia. A completion angiography was done to evaluate the position of the graft and whether endoleaks were present. RESULTS: two patients died within 30 days, one due to cardiac insufficiency and another due to haemorrhage during the procedure. There were four early conversions to open repair. At discharge eight patients had an endoleak, while retrograde flow into the aneurysmal sac was observed in four patients. During the follow-up period one conversion to open repair became necessary due to graft migration. Four late leaks were all repaired successfully using endovascular techniques. Five cases of retrograde filling were detected and embolisation with coils was performed in two cases, while three were observed. Seven graft-limb occlusions occurred during the follow-up period and four of these required treatment. CONCLUSIONS: endovascular AAA repair should be regarded as an experimental treatment, although the short term results are promising. Close follow-up of patients with CT scans or arteriography is necessary. (+info)
Detection of carbapenemase-producing Acinetobacter baumannii in a hospital.
(45/2332)
Acinetobacter baumannii strains resistant to both imipenem (IPM) and ceftazidime (CAZ) were isolated from 1994 through 1996 at Gunma University Hospital. Nine isolates from different inpatients were examined for carbapenem-hydrolyzing activity and for the carbapemase gene bla(IMP) by the PCR method. All nine isolates were carbapenemase-producing strains that hydrolyzed IPM and that harbored bla(IMP). The bla(IMP) gene was transmissible by conjugation to an IPM-susceptible recipient strain of A. baumannii and conferred resistance to IPM, CAZ, cefotaxime (CTX), ampicillin (AMP), and piperacillin (PIP). Either intermediate or high-level resistance to amikacin (AMK) was transferred from two and five strains, respectively, concomitantly with bla(IMP), and gentamicin (GEN) resistance was also transferred in one instance of high-level AMK resistance. Comparative examination of clinical isolates for resistance patterns to nine drugs, IPM, CAZ, CTX, aztreonam, AMP, PIP, AMK, GEN, and norfloxacin, in addition to pulsed-field gel electrophoresis patterns with NotI-digested genomic DNA, confirmed nosocomial transmission of infections involving carbapenemase-producing A. baumannii strains. (+info)
Heterogeneous vancomycin resistance in methicillin-resistant Staphylococcus aureus strains isolated in a large Italian hospital.
(46/2332)
Of 179 methicillin-resistant Staphylococcus aureus strains isolated from 1997 to 1998, two strains (1.1%) gave subclones for which the vancomycin MICs were 8 mg/liter. Pulsed-field gel electrophoresis showed identical restriction patterns for both isolates, suggesting transfer of a single clone between two different patients. (+info)
AIDS incidence and survival in a hospital-based cohort of asymptomatic HIV seropositive patients in Sao Paulo, Brazil.
(47/2332)
BACKGROUND: In spite of the high incidence of AIDS in Brazil, few studies have tried to evaluate the prognosis of asymptomatic HIV seropositive Brazilian patients. METHODS: A hospital outpatient facility-based cohort of HIV seropositive asymptomatic subjects was followed to determine their probability of remaining AIDS-free at 2 and 4 years of follow-up, as well as the one-year estimated cumulative probability of survival for the AIDS incident cases. The cohort was made up of all asymptomatic HIV seropositive subjects referred to the Immunology Branch of a large university hospital in Sao Paulo, Brazil, between 1985 and June 1997. RESULTS: The cumulative probability of remaining free from AIDS was 79% (+/- 3.7% SE) at 2 years, and 64.4% (+/- 5.1% SE) at 4 years after first known positive anti-HIV serology. Women had a marginally significant better probability of remaining AIDS-free after both 2 and 4 years of known seropositivity, as compared with men. There were no significant differences in the prognosis of the infection by age; the only single parameter associated with better prognosis was an initial CD4+ count > or =350/microl. The probability of survival one year after the diagnosis of AIDS was 78%, and the 50% estimated probability of survival was 19 months. Older patients (aged > or =35 years) had a better prognosis, as suggested by their longer survival estimates (P = 0.06). CONCLUSIONS: The probability of survival with AIDS observed in this study was higher than in the few previously published estimates for Brazil. However, since the time frame was so wide, it may not be entirely comparable with earlier studies. Some likely explanations for this possibly better prognosis could include more efficient prophylaxis for opportunistic diseases, as well as an increase in the availability of anti-retroviral drugs. The 8% incidence of AIDS at 2 years observed in this study for those individuals whose initial CD4+ count was > or =350/ml was close to that found in a large international epidemiological study of seroconverters. (+info)
Attitudes toward managed care and cost containment among primary care trainees at 3 training sites.
(48/2332)
OBJECTIVE: To study the attitudes of entering first year (Y1) and graduating third year (Y3) primary care physician trainees from 3 different training program sites (a university hospital system site [UHS], a large staff-model health maintenance organization managed care system site [MCS], and a large public hospital system site [PHS]) toward selected aspects of managed care. DESIGN: A self-administered questionnaire was used in a cross-sectional study. PARTICIPANTS AND OUTCOME MEASURES: Participants were all Y1 and Y3 primary care trainees in internal medicine, pediatrics, and family medicine programs from 3 training program sites. Survey questions dealt with attitudes toward health services, managed care cost containment, and the role of the physician in society. RESULTS: Of eligible primary care trainees (n = 218), 91% completed the instrument. Trainees at the MCS generally held more positive views of managed care systems than trainees at the UHS or PHS. Internal medicine trainees held more negative attitudes towards managed care systems than trainees in pediatrics or family medicine. UHS and PHS trainees more often thought that managed care systems interfere with the doctor-patient relationship and that these systems are more concerned with economics than in providing quality patient care. Approximately one quarter of the Y1 trainees at all sites thought that reducing the cost of healthcare is beyond the control of doctors. No Y3 trainee at the PHS believed that reducing costs was beyond the control of doctors. The majority of trainees endorsed routine peer review of clinical decisions to control healthcare costs. Most trainees believed that managed care systems will eventually predominate and that physician independence is being impaired. CONCLUSION: The data suggest that attitudes of internal medicine, family medicine, and pediatric trainees toward various aspects of managed care vary not only by their year of training but also by their training environment. Thus, managed care educational programs for trainees should consider both the baseline attitudes of trainees and characteristics of the training site itself. (+info)