Intensive care unit nurse staffing and the risk for complications after abdominal aortic surgery.
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CONTEXT: We previously found that length of stay in the intensive care unit (ICU) after abdominal aortic surgery increased when fewer ICU nurses were available per patient. We hypothesized that having fewer nurses increases the risk for medical complications. OBJECTIVE: To evaluate the association between nurse-to-patient ratio in the ICU and risk for medical and surgical complications after abdominal aortic surgery. DESIGN: Observational study. SETTING: All nonfederal acute care hospitals in Maryland. DATA SOURCES: Information about patients came from hospital discharge data on all patients in Maryland with a principal procedure code for abdominal aortic surgery from 1994 through 1996 (n = 2606). The organizational characteristics of ICUs were obtained by surveying ICU medical and nursing directors in 1996 at the 46 Maryland hospitals that performed abdominal aortic surgery. Thirty-nine of the ICU directors (85%) completed the survey. EXPOSURE: Surgery in hospitals with fewer ICU nurses (in which each nurse cared for three or four patients) compared with hospitals with more ICU nurses (in which each nurse cared for one or two patients). OUTCOME: Proportion of patients who developed postoperative complications. RESULTS: Seven hospitals with 478 patients had fewer ICU nurses, and 31 hospitals with 2128 patients had more ICU nurses. Patients in hospitals with fewer nurses were more likely than patients in hospitals with more nurses to have complications: 47% vs. 34% had any complication, 43% vs. 28% had any medical complication, 24% vs. 9% had pulmonary insufficiency after a procedure, and 21% vs. 13% were reintubated (P < 0.001 for all comparisons). After adjustment for patient, hospital, and surgeon characteristics, having fewer versus more ICU nurses was associated with an increased risk for any complication (relative risk, 1.7 [95% CI, 1.3 to 2.4]), any medical complication (relative risk, 2.1 [CI, 1.5 to 2.9]), pulmonary insufficiency after procedure (relative risk, 4.5 [CI, 2.9 to 6.9]) and reintubation (relative risk, 1.6 [CI, 1.1 to 2.5]). CONCLUSION: Having fewer ICU nurses per patient is associated with increased risk for respiratory-related complications after abdominal aortic surgery. (+info)
Risk of Lyme disease: perceptions of residents of a Lone Star tick-infested community.
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BACKGROUND: Lone Star ticks (Amblyomma americanum) have been suggested as a vector of the agent of Lyme disease (Borrelia burgdorferi sensu lato) in the USA, based on associations with an infection manifesting mainly as erythema migrans. In laboratory experiments, however, they failed to transmit B. burgdorferi sensu stricto. METHODS: In this study, carried out from 1994 to 1996, we determined the seroprevalences of B. burgdorferi (1.2%), Ehrlichia chaffeensis (7%), E. phagocytophila (0%), Rickettsia rickettsii (0%), R. typhi (0%), Coxiella burneti (0%), Francisella tularensis (0%), and Babesia microti (0%) by standard serological methods for 325 residents (97% of the total population) of Gibson Island, coastal Maryland, USA, where 15% of the residents reported having had Lyme disease within a recent 5-year span. FINDINGS: Of the 167 seronegative individuals who were followed up prospectively for 235 person-years of observation, only 2 (0.85%) seroconverted for B. burgdorferi. Of 1556 ticks submitted from residents, 95% were identified as Lone Star ticks; only 3% were deer ticks (Ixodes dammini), the main American vector of Lyme disease. B. burgdorferi s.s. infected 20% of host-seeking immature deer ticks, and borreliae ("B. lonestari") were detected in 1-2% of Lone Star ticks. Erythema migrans was noted in 65% of self-reports of Lyme disease, but many such reports indicated that the rash was present while the tick was still attached, suggesting a reaction to the bite itself rather than true Lyme disease. Sera from individuals reporting Lyme disease generally failed to react to B. burgdorferi or any other pathogen antigens. CONCLUSION: The residents of Gibson Island had an exaggerated perception of the risk of Lyme disease because they were intensely infested with an aggressively human-biting and irritating nonvector tick. In addition, a Lyme disease mimic of undescribed etiology (named Masters' disease) seems to be associated with Lone Star ticks, and may confound Lyme disease surveillance. The epidemiological and entomological approach used in this study might fruitfully be applied wherever newly emergent tickborne zoonoses have been discovered. (+info)
Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001.
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Since October 3, 2001, CDC and state and local public health authorities have been investigating cases of bioterrorism-related anthrax. This report updates previous findings, provides new information on case investigations in two additional areas, presents the susceptibility patterns of Bacillus anthracis isolates, and provides interim recommendations for managing potential threats and exposures and for treating anthrax. (+info)
Prevalence of Campylobacter spp., Escherichia coli, and Salmonella serovars in retail chicken, turkey, pork, and beef from the Greater Washington, D.C., area.
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A total of 825 samples of retail raw meats (chicken, turkey, pork, and beef) were examined for the presence of Escherichia coli and Salmonella serovars, and 719 of these samples were also tested for Campylobacter spp. The samples were randomly obtained from 59 stores of four supermarket chains during 107 sampling visits in the Greater Washington, D.C., area from June 1999 to July 2000. The majority (70.7%) of chicken samples (n = 184) were contaminated with Campylobacter, and a large percentage of the stores visited (91%) had Campylobacter-contaminated chickens. Approximately 14% of the 172 turkey samples yielded Campylobacter, whereas fewer pork (1.7%) and beef (0.5%) samples were positive for this pathogen. A total of 722 Campylobacter isolates were obtained from 159 meat samples; 53.6% of these isolates were Campylobacter jejuni, 41.3% were Campylobacter coli, and 5.1% were other species. Of the 212 chicken samples, 82 (38.7%) yielded E. coli, while 19.0% of the beef samples, 16.3% of the pork samples, and 11.9% of the turkey samples were positive for E. coli. However, only 25 (3.0%) of the retail meat samples tested were positive for Salmonella. Significant differences in the bacterial contamination rates were observed for the four supermarket chains. This study revealed that retail raw meats are often contaminated with food-borne pathogens; however, there are marked differences in the prevalence of such pathogens in different meats. Raw retail meats are potential vehicles for transmitting food-borne diseases, and our findings stress the need for increased implementation of hazard analysis of critical control point (HACCP) and consumer food safety education efforts. (+info)
Geographic, demographic, and seasonal differences in penicillin-resistant Streptococcus pneumoniae in Baltimore.
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We examined the epidemiology of invasive penicillin-resistant Streptococcus pneumoniae (PRSP) infections among residents of the Baltimore metropolitan area from 1995 through 1997. During this period, the proportion PRSP cases increased 42%, from 5.7% to 8.1% of cases. PRSP rates were highest among persons aged <5 and > or =65 years, black patients, and urban dwellers. However, the proportion of PRSP cases was higher among white persons (10%) than it was among black persons (5%) and among residents of suburban counties (10%) versus urban counties (6%). PRSP cases were more common in November-April (8%) than they were in May-October (5%), particularly for persons aged > or =65 years (10% vs. 1%). By use of logistic regression, white race, suburban residence, and winter respiratory season were found to be independent predictors of infection with PRSP. The incidence of PRSP is increasing in Baltimore, and the seasonality of PRSP suggests that recent antibiotic use, which is more common in winter months, may rapidly affect the prevalence of resistant pneumococcal infections. (+info)
Relationship of milk consumption to blood glucose rise in lactose intolerant individuals.
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Lactose intolerant populations are heterogeneous with respect to their milk-drinking habits. A gradation of lactase activity in the intolerant population may result in sufficient lactose hydrolysis to obviate symptoms and lead to continued milk consumption. This paper reports on differences in maximum blood sugar rise in lactose intolerant children who are observed to consume or reject milk. Of the 89 black elementary school children, 48 (54 per cent) evidenced a flat lactose tolerance curve. Twenty-eight of these 48 children (58 per cent) were defined as nonmilk drinkers. The maximum blood sugar rise was 12.3 mg/100 in the 20 lactose malabsorbers who were defined as milk drinkers. It appears that some lactose malabsorbing children may have sufficient, albeit lower, levels of lactase to hydrolyze moderate amounts of milk. (+info)
A description of the catalog division project at the College of Physicians of Philadelphia Library.
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This paper describes the procedures used at the Library of the College of Physicians of Philadelphia to divide its ninety-year-old dictionary card catalog. The division was necessitated by overcrowding, obsolete subject headings, and lack of a complete authority list which resulted in like materials being scattered throughout the catalog under several headings. Two catalogs were created: the historical-biographical catalog, representing all works published before 1950 and all works of historical or biographical nature; and the current catalog, containing all works published from 1950 on, excepting historical or biographical materials. The 1950- catalog was further divided into name and subject catalogs, and the subject section was revised according to MeSH. The project was completed in about two years. As a result, searching time has been much reduced, and the library is able to take advantage of the annual revisions of MeSH to update the subject catalog. (+info)
Coronary heart disease trends in four United States communities. The Atherosclerosis Risk in Communities (ARIC) study 1987-1996.
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OBJECTIVE: The objective of this paper is to report trends in mortality due to coronary heart disease (CHD), rates of first and recurrent hospitalized myocardial infarction, and survival after myocardial infarction in the Atherosclerosis Risk in Communities (ARIC) Study from 1987 through 1996. METHOD: The ARIC study used retrospective community surveillance to monitor admissions to acute care hospitals and deaths due to CHD (both in- and out-of-hospital) among all residents 35-74 years of age. The surveillance areas included over 360 000 men and women in four communities: Forsyth County, North Carolina; the city of Jackson, Mississippi; eight northern suburbs of Minneapolis, Minnesota; and Washington County, Maryland. RESULTS: The annual age-adjusted mortality rate of CHD fell 3.2% (95% CI: 2.0, 4.3) among men and 3.8% (95% CI: 1.9, 5.6) among women. The greater part of the decline took place between 1987 and 1991. Significant declines were observed for both in-hospital and out-of-hospital CHD death. Significant improvements in case-fatality were also observed. Recurrent hospitalized myocardial infarction event rate fell an average of 1.9% per year among men (95% CI: 0.7, 3.1) and 2.1% (95% CI: 0.3, 3.9) among women. Average annual per cent change in incident hospitalized myocardial infarction was not statistically significant, except in blacks where there was evidence of an increase over time. CONCLUSION: Factors associated with the occurrence of recurrent hospitalized myocardial infarction, as well as those creating a better chance of survival after an event (including reductions in sudden death), were likely the prominent components in the recent decline in CHD mortality in ARIC communities. (+info)