Implications of laparoscopic cholecystectomy for surgical residency training.
(9/2332)
BACKGROUND: Widespread adoption of minimal access techniques forced a generation of abdominal surgeons to re-learn many standard abdominal procedures. This threatened to reduce the pool of suitable "training" operations for surgical residents. METHODS: Operator grade, duration of operation, acute/elective operation, conversion rate, complications, and postoperative stay were recorded prospectively on all laparoscopic cholecystectomies (LC) since 1992. This data was evaluated to determine how the introduction of LC affected residents' training. RESULTS: The percentage of LCs performed by residents increased progressively to reach 58%. Operating time was longer for trainee surgeons, particularly for acute cases (145+/-50 minutes vs 111+/-54 minutes, p<0.05); however, conversion rate, incidence of complications, and postoperative stay were no different. CONCLUSIONS: LC can be performed by surgical trainees with similar complication rates and outcomes as those of qualified surgeons. Once institutional experience has accumulated, this procedure can be integrated into residency training. (+info)
Density and molecular epidemiology of Aspergillus in air and relationship to outbreaks of Aspergillus infection.
(10/2332)
After five patients were diagnosed with nosocomial invasive aspergillosis caused by Aspergillus fumigatus and A. flavus, a 14-month surveillance program for pathogenic and nonpathogenic fungal conidia in the air within and outside the University Hospital in Rotterdam (The Netherlands) was begun. A. fumigatus isolates obtained from the Department of Hematology were studied for genetic relatedness by randomly amplified polymorphic DNA (RAPD) analysis. This was repeated with A. fumigatus isolates contaminating culture media in the microbiology laboratory. The density of the conidia of nonpathogenic fungi in the outside air showed a seasonal variation: higher densities were measured during the summer, while lower densities were determined during the fall and winter. Hardly any variation was found in the numbers of Aspergillus conidia. We found decreasing numbers of conidia when comparing air from outside the hospital to that inside the hospital and when comparing open areas within the hospital to the closed department of hematology. The increase in the number of patients with invasive aspergillosis could not be explained by an increase in the number of Aspergillus conidia in the outside air. The short-term presence of A. flavus can only be explained by the presence of a point source, which was probably patient related. Genotyping A. fumigatus isolates from the department of hematology showed that clonally related isolates were persistently present for more than 1 year. Clinical isolates of A. fumigatus obtained during the outbreak period were different from these persistent clones. A. fumigatus isolates contaminating culture media were all genotypically identical, indicating a causative point source. Knowledge of the epidemiology of Aspergillus species is necessary for the development of strategies to prevent invasive aspergillosis. RAPD fingerprinting of Aspergillus isolates can help to determine the cause of an outbreak of invasive aspergillosis. (+info)
Survey of extended-spectrum beta-lactamases in clinical isolates of Escherichia coli and Klebsiella pneumoniae: prevalence of TEM-52 in Korea.
(11/2332)
Two hundred ninety isolates of Escherichia coli were investigated for the production of extended-spectrum beta-lactamases (ESBLs). Fourteen (4.8%) of the 290 strains were found to produce ESBLs. Each of the 14 strains produced one or two ESBLs, as follows: 10 strains produced TEM-52, 1 strain produced SHV-2a, 1 strain produced SHV-12, 1 strain produced a CMY-1-like enzyme, and 1 strain expressed SHV-2a and a CMY-1-like enzyme. Another two strains for which the MICs of ceftazidime and cefoxitin were high, were probable AmpC enzyme hyperproducers. Because of the high prevalence of TEM-52 in E. coli isolates, we further investigated the TEM-type ESBLs produced by Klebsiella pneumoniae in order to observe the distribution of TEM-52 enzymes among Enterobacteriaceae in Korea. All TEM enzymes produced by 12 strains of K. pneumoniae were identified as TEM-52. To evaluate the genetic relatedness among the organisms, ribotyping of TEM-52-producing E. coli and K. pneumoniae was performed. The ribotyping profiles of the organisms showed similar but clearly different patterns. In conclusion, TEM-52 is the most prevalent TEM-type ESBL in Korea. (+info)
The clinical characteristics of pulmonary alveolar proteinosis: experience at Seoul National University Hospital, and review of the literature.
(12/2332)
Pulmonary alveolar proteinosis is such an extremely rare disease in Korea, that only a few cases have been reported. Meanwhile five cases were experienced at Seoul National University Hospital over ten years since 1987. We summarized the clinical characteristics and courses of them. Seven cases reported in the literature were included to add data about clinical characteristics and courses although only a few case reports mentioned patient's course. Middle aged male patients were mainly affected. No association with particular environmental or occupational exposure was identified. Dyspnea on exertion was the main symptom. Bilateral crackles were consistent, and bilateral parahilar hazy infiltrations on plain chest radiograph and ground glass opacity on high-resolution CT were characteristic. Superimposed infection was not identified in any patient at the time of diagnosis. Decreased diffusing capacity and hypoxia were present in almost every case. Whole lung lavage proved to be an effective therapeutic measure. The response to treatment was good. Long-term course of the disease, e.g. recurrence rate, is not yet known. (+info)
Trends in costs of percutaneous transluminal coronary angioplasty.
(13/2332)
OBJECTIVE: To evaluate recent trends in the cost of percutaneous transluminal coronary angioplasty (PTCA), particularly the impact of newer technology and changing patient profile. STUDY DESIGN: Retrospective study with a 6-month follow up. PATIENTS AND METHODS: We compared the data on two groups of 100 consecutive patients admitted for elective PTCA at Yale-New Haven Hospital in 1995 and 1996. Hospital records, cineangiograms, and hospital cost accounting system were reviewed, and 6-month clinical outcomes were obtained from telephone interviews and medical chart review. RESULTS: Demographic and clinical characteristics did not differ between the 1995 and 1996 groups of patients, nor was a difference detected in in-hospital and 6-month clinical outcomes between 1995 and 1996. Angiographic features of treated lesions were different between the two groups, with a significantly higher frequency of type C and totally occluded lesions in 1996 (p = 0.002 and p = 0.04, respectively). The total hospital costs were higher in 1996 compared with 1995 ($11,799 +/- $6189 vs $10,087 +/- $5608; p = 0.04). This difference persisted after adjustment for changes in patient population. The major factor responsible for escalating costs was a 45% increase in catheterization laboratory costs ($8575 +/- $4524 in 1996 vs $5916 +/- $3030 in 1995; P < 0.0001). In contrast, the noncatheterization costs decreased substantially during this period, largely as a result of an approximately 33% decrease in length of stay (3.75 +/- 2.66 days in 1995 vs 2.57 +/- 1.99 days in 1996; P = 0.0005). In a multiple linear regression model, the most important determinants of cost were lesion characteristics, stent use, and radiographic contrast volume. CONCLUSIONS: Despite cost reduction efforts, the costs of PTCA are rising because of increased consumption of resources in the catheterization laboratory. (+info)
Application of data mining to intensive care unit microbiologic data.
(14/2332)
We describe refinements to and new experimental applications of the Data Mining Surveillance System (DMSS), which uses a large electronic health-care database for monitoring emerging infections and antimicrobial resistance. For example, information from DMSS can indicate potentially important shifts in infection and antimicrobial resistance patterns in the intensive care units of a single health-care facility. (+info)
The process of converting to a near filmless operation at the University of Utah, Department of Radiology.
(15/2332)
The Department of Radiology at the University of Utah Health Sciences Center has made the transition from a traditional film-based department to a near filmless operation. The University of Utah is a large teaching hospital and the transition from film in an educational facility will be discussed. This transition has had its difficulties and its success is dependent on the support of departmental leadership and hospital administration. We have had more than 100 years of experience with film, and current procedures were efficient given the limitations of the medium. While motivated by the traditional reasons for moving to a picture archival and communications system (PACS), such as film savings, unavailable films, and faster reports, we found the intangibles to be the larger issue, as well as a source for the largest benefits. This report will discuss the implementation process and the affect it had on all areas of the hospital, including its impact on hospital physicians, radiologists, file room personnel, and technologists. Procedure changes to the flow of patients, film, and electronic images will also be described. This process cannot be viewed as a one-time change, but must be viewed as a continuous process as areas of improvement are identified and new and improved technologies are developed. (+info)
Migration from hierarchal storage management to ASM storage server: a case study.
(16/2332)
The Department of Radiology at the University of Utah Hospitals and Clinics had to make a change from its current hierarchical storage management (HSM) system. The HSM software is the heart of any near-line data storage system and any change in this software affects all near-line and on-line data storage. In this case, over a terabyte of data had been migrated in more than 2 million files. The traditional method of reading in the old data and then writing it out to the new system was calculated to take more than 60 years. Here, we will examine the reasons for making such a radical change in the HSM used. We will also discuss why ASM (the new HSM software) was selected, and the performance improvements seen. A second, less difficult transition was made a few months later, of upgrading to a newer faster tape technology. The two types of tapes were incompatible, but the storage software and robotics used allowed for a peaceful coexistence during the transition. The transition from HSM to ASM was not a trivial task. It required a reasonable implementation/migration plan, which involved finding the correct resources and thinking outside the norm for solutions. All sites that have any amount of data stored in near-line devices will face similar conversions. This presentation should help in the event that a data conversion plan is not already in place. (+info)