A probable case of human neurotrichinellosis in the United States.
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Human neurotrichinellosis is seldom reported. This is likely the result of the low incidence of parasites from the genus Trichinella in the United States domestic food supply, as well as difficulties in diagnosing the disease, especially when neither the organism nor the source of the infection are readily available. Although trichinellosis from domestic food supplies has been decreasing for many years, a resurgence has occurred in cases derived from the consumption of wild game. We report a rare case of neurotrichinellosis in the United States and implicate wild game as the source of the infection. These results suggest that clinicians should consider the potential for Trichinella infection in cases where wild game is common in the diets of the patients. (+info)
Ocular and respiratory illness associated with an indoor swimming pool--Nebraska, 2006.
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On December 26, 2006, the Nebraska Department of Health and Human Services (NDHHS) received a report of a child hospitalized in an intensive care unit for severe chemical epiglottitis and laryngotracheobronchitis after swimming in an indoor motel swimming pool. The pool was inspected the same day and immediately closed by NDHHS because of multiple state health code violations. NDHHS initiated an outbreak investigation to identify additional cases and the cause of the illness. This report describes the results of that investigation, which indicated that 24 persons became ill, and the outbreak likely was the result of exposure to toxic levels of chloramines that had accumulated in the air in the enclosed space above the swimming pool. This outbreak highlights the potential health risks from chemical exposure at improperly maintained pools and the need for properly trained pool operators to maintain water quality. (+info)
Bupropion and nicotine patch as smoking cessation aids in alcoholics.
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This is a double-blind placebo-controlled study of sustained-release bupropion as a smoking cessation aid in alcoholics undergoing treatment for their alcoholism. Participants (N=58) were enrolled within 1 week of entry into alcohol treatment from community and Veterans Affairs Substance Use Disorder programs. All participants received nicotine patch and were invited to attend a smoking cessation lecture and group. Cigarette smoking and alcohol outcomes were measured at 6 months. Bupropion when added to nicotine patch did not improve smoking outcomes. One third of participants on bupropion reported discontinuing the drug during weeks 1-4. Participants reported cigarette outcomes with nicotine patch that are similar to those seen in the general population. All study participants significantly reduced cigarette use. Comorbid affective disorder or antipersonality disorder did not affect outcomes. Alcohol outcomes were improved in those who discontinued cigarettes. (+info)
An efficiency evaluation of protocols for tight glycemic control in intensive care units.
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BACKGROUND: The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals. OBJECTIVES: To evaluate the efficiency of protocols for tight glycemic control used in intensive care units. METHODS: Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses. RESULTS: Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason. CONCLUSIONS: Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed. (+info)
Design and implementation of a rule based system for ambulatory nursing data management.
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In order to effectively organize the use of nursing time during clinic check-in, we designed a forward chaining rule based program for nursing history taking, problem tracking, and documentation. The program consists of a medical logic module trigger engine which identifies relevant rules for nursing history, an interactive question manager for nursing history taking, and a rule generation shell implemented within a specially designed Medical Query Language (MQL) shcema. At clinic check-in, the engine refreshes the rule set for the patient from interaction with the computerized medical record. The interaction driver assists the nurse with tracking of elapsed time, and allows him/her to pursue questions, record data, and create or complete nursing interventions. Nursing question sets and interventions are maintained longitudinally to assure continuity of care. Nursing problems are created on the problem list within the computerized record as the rule system identifies their existence. (+info)
Increasing physician acceptance and use of the computerized ambulatory medical record.
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Because physicians have been reluctant to accept computerized medical records systems, we sought to identify the barriers to acceptance and redesigned our ambulatory records system accordingly. We identified several problems physicians encounter in using our computerized medical record system (COSTAR), including physicians' hesitation to use a computer in front of their patients, physicians' poor keyboard skills, and the structural organization of the computerized medical record. We formed a users group to educate users and the group has helped identify solutions to these problems. We equipped the exam room terminals with a user-friendly, patient-specific menu. We created a new physician interface for COSTAR that was organized to function similarly to a patient's chart and features user-friendly menus that provide cues to the unsophisticated user. Physician use of exam room terminals tripled after the installation of the exam room menu. The new physician interface doubled physician use of COSTAR's scheduling features. Acceptance of the new interface as gauged by a user survey was excellent, with the majority stating it improved their patient care. (+info)
Information management in ambulatory care: the nurse and computerized records.
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The ambulatory office setting is increasingly becoming a central focus of patient care. The nursing staff are integral to patient care management in this environment. They are frequently the heaviest users of medical records and are generally early advocates of well designed computer records systems. As our implementation of a Computer Stored Ambulatory Record (COSTAR V) has grown in complexity and utility, reorganization of the record and development of new features to support nursing has become critical. This demonstration will show how nursing information management has changed using a variety of computer record tools, including features of exam room data entry, specialized nursing displays and problem based patient summaries. Specific items for demonstration will include: nursing check-in module, rule driven nursing history program, prescription refill functions, documentation and billing for nursing procedures, nursing telephone management functions, a module for management of anticoagulation and document retrieval and display utilities. (+info)
Statewide annual hospital charges for acute care of traffic injuries: Nebraska, 2004.
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Case-based hospital billing data from the Health Care Utilization Partnership was used to calculate annual statewide hospital charges for the acute care of traffic injuries in Nebraska. E-codes 810.0 through 819.9 identified traffic injury cases. Admissions and emergency department (ED)-only visits for traffic injuries accrued significantly higher charges than other types of care. Statewide, hospital charges for the acute care of traffic injury totaled more than U.S.dollars 63.8 million in 2004. Of this, 23.2% was charged to public payers (Medicare or Medicaid) and 5.5% was charged to self-pay (generally accepted as bad debt absorbed by the hospital system). (+info)