Lack of transmission of mycobacterium abscessus among patients with cystic fibrosis attending a single clinic.
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We retrospectively analyzed 1062 respiratory specimens from 214 patients with cystic fibrosis, of whom 5 patients had 36 cultures positive for M. abscessus. Results of molecular typing demonstrated that each of these 5 patients carried a single unique strain (genotype), which suggests that it may not be necessary to segregate patients with CF who are colonized or infected with M. abscessus from those who are not. (+info)
Hospital preparedness for victims of chemical or biological terrorism.
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OBJECTIVES: This study examined hospital preparedness for incidents involving chemical or biological weapons. METHODS: By using a questionnaire survey of 224 hospital emergency departments in 4 northwestern states, we examined administrative plans, training, physical resources, and representative medication inventories. RESULTS: Responses were received from 186 emergency departments (83%). Fewer than 20% of respondent hospitals had plans for biological or chemical weapons incidents. About half (45%) had an indoor or outdoor decontamination unit with isolated ventilation, shower, and water containment systems, but only 12% had 1 or more self-contained breathing apparatuses or supplied air-line respirators. Only 6% had the minimum recommended physical resources for a hypothetical sarin incident. Of the hospitals providing quantitative answers about medication inventories, 64% reported sufficient ciprofloxacin or doxycycline for 50 hypothetical anthrax victims, and only 29% reported sufficient atropine for 50 hypothetical sarin victims (none had enough pralidoxime). CONCLUSIONS: Hospital emergency departments generally are not prepared in an organized fashion to treat victims of chemical or biological terrorism. The planned federal efforts to improve domestic preparedness will require substantial additional resources at the local level to be truly effective. (+info)
Radiation safety precautions in the management of the hospitalized (131)I therapy patient.
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OBJECTIVES: The patient who has been dosed with therapeutic activities of (131)I for thyroid carcinoma poses a unique set of problems for nuclear medicine technologists in their efforts to reduce personnel exposure and control contamination spread. It is the objective of this article to: (a) review practical radiation safety concerns associated with hospitalized (131)I therapy patients; (b) propose preventative measures that can be taken to minimize potential exposure and contamination problems; and (c) review pertinent federal regulations that apply to patients containing therapeutic levels of radionuclides. (+info)
Medicaid program; use of restraint and seclusion in psychiatric residential treatment facilities providing psychiatric services to individuals under age 21. Health Care Financing Administration (HCFA), HHS. Interim final rule with comment period.
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This interim final rule with comment period establishes a definition of a "psychiatric residential treatment facility" that is not a hospital and that may furnish covered Medicaid inpatient psychiatric services for individuals under age 21. This rule also sets forth a Condition of Participation (CoP) that psychiatric residential treatment facilities that are not hospitals must meet to provide, or to continue to provide, the Medicaid inpatient psychiatric services benefit to individuals under age 21. Specifically, this rule establishes standards for the use of restraint or seclusion that psychiatric residential treatment facilities must have in place to protect the health and safety of residents. This CoP acknowledges a resident's right to be free from restraint or seclusion except in emergency safety situations. We are requiring psychiatric residential treatment facilities to notify a resident (and, in the case of a minor, his or her parent(s) or legal guardian(s)) of the facility's policy regarding the use of restraint or seclusion during an emergency safety situation that occurs while the resident is in the program. We believe these added requirements will protect residents against the inappropriate use of restraint or seclusion. (+info)
Hospital discharge of patients with thyroid carcinoma treated with 131I.
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A dose limit-based criterion was proposed to authorize hospital discharge of thyroid carcinoma patients treated with 131I. Evaluation of accumulated doses to determine the effective half-life, the expected accumulated dose at 1 m, and the hospitalization time was performed to ensure that the dose limit was satisfied for each patient. Situations involving different dose limits and occupancy factors were analyzed. This study dealt only with external exposure; the problem of internal contamination was not considered. METHODS: Fourteen patients treated postoperatively with 131I were studied. The range of activity was 1,110-8,175 MBq. Electronic dosimeters and thermoluminescent dosimeter chips were placed on the left pectoral muscle. Dose was measured for a mean of approximately 2.5 d. The accumulated doses were plotted as a function of time and then fitted using an exponential model to obtain the parameters of total accumulated dose and effective half-life. The doses to the public and relatives at 1 m were calculated with point source approximation and several occupancy factors. RESULTS: The fit function parameters of accumulated doses in the first 36 h predicted the behavior of the total accumulated dose within a 5% error in the parameters. Estimated values of the accumulated dose 1 m from the patient were generally <5 mSv, even for an occupancy factor of 100%. For more restrictive dose constraints, hospitalization times were calculated according to different occupancy factors, as suggested in the European Commission guide. From the fit of the measured data, values of effective half-life for each patient were obtained. CONCLUSION: To apply the dose limit-based criterion, one must calculate the patient-specific parameters, as can be done using the accumulated dose. Knowledge of patient-specific parameters ensures that the patient will not expose any individual to levels greater than the dose limit. The calculated hospitalization times were less than those recommended, especially for countries with more restrictive dose limits. The type of measurements performed in this study reveals more realistic doses for the treatment of thyroid carcinoma with 131I. (+info)
Home care during the pancytopenic phase after allogeneic hematopoietic stem cell transplantation is advantageous compared with hospital care.
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After myeloablative treatment and allogeneic stem cell transplantation (SCT), patients are kept in isolation rooms in the hospital to prevent neutropenic infections. During a 3-year period, patients were given the option of treatment at home after SCT. Daily visits by an experienced nurse and daily phone calls from a physician from the unit were included in the protocol. We compared 36 patients who wished to be treated at home with 18 patients who chose hospital care (control group 1). A matched control group of 36 patients treated in the hospital served as control group 2. All home care patients had hematologic malignancies and 19 were in first remission or first chronic phase. Of the donors, 25 were unrelated. The patients spent a median of 16 days at home (range, 0-26 days). Before discharge to the outpatient clinic after SCT, patients spent a median of 4 days (range, 0-39 days) in the hospital. In the multivariate analysis, the home care patients were discharged earlier (relative risk [RR] 0.33, P =.03), had fewer days on total parenteral nutrition (RR 0.24, P <.01), less acute graft-versus-host disease (GVHD) grades II-IV (RR 0.25, P =.01), lower transplantation-related mortality rates (RR 0.22, P =.04), and lower costs (RR 0.37, P <.05), compared with the controls treated in the hospital. The 2-year survival rates were 70% in the home care group versus 51% and 57% (not significant) in the 2 control groups, respectively (P <.03). To conclude, home care after SCT is a novel and safe approach. This study found it to be advantageous, compared with hospital care. (+info)
Disappearance of leprosy from Norway: an exploration of critical factors using an epidemiological modelling approach.
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BACKGROUND: By the middle of the 19th century, leprosy was a serious public health problem in Norway. By 1920, new cases only rarely occurred. This study aims to explain the disappearance of leprosy from Norway. METHODS: Data from the National Leprosy Registry of Norway and population censuses were used. The patient data include year of birth, onset of disease, registration, hospital admission, death, and emigration. The Norwegian data were analysed using epidemiological models of disease transmission and control. RESULTS: The time trend in leprosy new case detection in Norway can be reproduced adequately. The shift in new case detection towards older ages which occurred over time is accounted for by assuming that infected individuals may have a very long incubation period. The decline cannot be explained fully by the Norwegian policy of isolation of patients: an autonomous decrease in transmission, reflecting improvements in for instance living conditions, must also be assumed. The estimated contribution of the isolation policy to the decline in new case detection very much depends on assumptions made on build-up of contagiousness during the incubation period and waning of transmission opportunities due to rapid transmission to close contacts. CONCLUSION: The impact of isolation on interruption of transmission remains uncertain. This uncertainty also applies to contemporary leprosy control that mainly relies on chemotherapy treatment. Further research is needed to establish the impact of leprosy interventions on transmission. (+info)
An outbreak of Ebola in Uganda.
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An outbreak of Ebola disease was reported from Gulu district, Uganda, on 8 October 2000. The outbreak was characterized by fever and haemorrhagic manifestations, and affected health workers and the general population of Rwot-Obillo, a village 14 km north of Gulu town. Later, the outbreak spread to other parts of the country including Mbarara and Masindi districts. Response measures included surveillance, community mobilization, case and logistics management. Three coordination committees were formed: National Task Force (NTF), a District Task Force (DTF) and an Interministerial Task Force (IMTF). The NTF and DTF were responsible for coordination and follow-up of implementation of activities at the national and district levels, respectively, while the IMTF provided political direction and handled sensitive issues related to stigma, trade, tourism and international relations. The international response was coordinated by the World Health Organization (WHO) under the umbrella organization of the Global Outbreak and Alert Response Network. A WHO/CDC case definition for Ebola was adapted and used to capture four categories of cases, namely, the 'alert', 'suspected', 'probable' and 'confirmed cases'. Guidelines for identification and management of cases were developed and disseminated to all persons responsible for surveillance, case management, contact tracing and Information Education Communication (IEC). For the duration of the epidemic that lasted up to 16 January 2001, a total of 425 cases with 224 deaths were reported countrywide. The case fatality rate was 53%. The attack rate (AR) was highest in women. The average AR for Gulu district was 12.6 cases/10 000 inhabitants when the contacts of all cases were considered and was 4.5 cases/10 000 if limited only to contacts of laboratory confirmed cases. The secondary AR was 2.5% when nearly 5000 contacts were followed up for 21 days. Uganda was finally declared Ebola free on 27 February 2001, 42 days after the last case was reported. The Government's role in coordination of both local and international support was vital. The NTF and the corresponding district committees harmonized implementation of a mutually agreed programme. Community mobilization using community-based resource persons and political organs, such as Members of Parliament was effective in getting information to the public. This was critical in controlling the epidemic. Past experience in epidemic management has shown that in the absence of regular provision of information to the public, there are bound to be deleterious rumours. Consequently rumour was managed by frank and open discussion of the epidemic, providing daily updates, fact sheets and press releases. Information was regularly disseminated to communities through mass media and press conferences. Thus all levels of the community spontaneously demonstrated solidarity and response to public health interventions. Even in areas of relative insecurity, rebel abductions diminished considerably. (+info)