Laboratory investigation of Acanthamoeba lugdunensis from patients with keratitis.
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PURPOSE: Species of four Acanthamoeba isolates (KA/E2, KA/E12, KA/E15, and KA/E16) from the cornea of patients with keratitis were identified and their molecular characteristics compared with those of other strains. METHODS: Morphologic features of amebic cysts were evaluated with a microscope with differential interference contrast (DIC) optics. Restriction fragment length polymorphisms (RFLP) of mitochondrial DNA (mtDNA), riboprinting of small subunit ribosomal RNA gene (18S rDNA), and DNA sequences of 18S rDNA were analyzed. mtDNA and PCR-amplified 18S rDNA of the ocular isolates were digested with restriction enzymes, and the restriction patterns were compared with those of reference strains purchased from American Type Culture Collection (ATCC, Manassas, VA). PCR products of 18S rDNA were cloned and subjected to sequencing. The complete sequence of approximately 2300 bp obtained from the isolates and reference strains were compared with each other and those registered in GenBank. RESULTS: Three ocular isolates (KA/E2, KA/E12, and KA/E16) of Acanthamoeba revealed the identical mtDNA RFLPs and riboprint patterns with Acanthamoeba L3a, the type strain of A. lugdunensis. The other isolate (KA/E15) had riboprint patterns very similar to A. lugdunensis L3a but quite different mtDNA RFLP patterns from those of all the other strains. A dendrogram based on the riboprint data showed that three ocular isolates were identified as A. lugdunensis and the other isolate was very closely related to this species. Identification of the isolates as A. lugdunensis was confirmed by 18S rDNA sequence analysis. The sequence differences of the four isolates from A. lugdunensis L3a was 0.1% to 0.4% (3 to 8/2284 bp) and 1.2% to 1.5% from A. castellanii Castellani. CONCLUSIONS: This is the first report of Acanthamoeba keratitis in Korea caused by A. lugdunensis, which was originally isolated from a freshwater pool in France. Riboprinting can be used as a simple and rapid tool for putative identification of unknown Acanthamoeba ocular isolates. (+info)
Replacement of expensive, disposable instruments with old-fashioned surgical techniques for improved cost-effectiveness in laparoscopic hysterectomy.
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OBJECTIVE: Patients demand that health care and procedures in rural areas be provided by ambulatory surgery centers close to home. However, the reimbursement rate for such procedures in ambulatory centers is extremely low, so a standard classic intrafascial supracervical hysterectomy procedure needs to be more cost effective to be performed there. Instruments and disposable devices can make up > or = 50% of hospital costs for this procedure, so any cost reduction has to focus on this aspect. METHODS: We identified the 3 most expensive disposable devices: (1) an Endostapler, 498 US dollars and 3 staple reloads, 179 US dollars each; (2) a calibrated uterine resection tool 15 mm for encoring of the endocervical canal, 853 US dollars; and (3) a serrated edged macro morcellator for intraabdominal uterus morcellation, 321 US dollars, and substituted them using classic conservative surgical techniques. RESULTS: From September 2001 to September 2002, we performed 26 procedures with this modified technique at an ambulatory surgery center with a follow-up of 6.7 (2 to 14) months. This modified operative technique was feasible; no conversions were necessary, and no complications occurred. Cost savings were 2209 US dollars per procedure; additional costs were 266.33 US dollars for suture material and an Endopouch, resulting in an overall savings of 50 509.42 US dollars. The disadvantage was an increase in operating room time of about 1 hour 20 minutes per case. CONCLUSION: These modifications in the classic intrafascial supracervical hysterectomy technique have proven to be feasible, safe, and highly cost effective, especially for a rural ambulatory surgery center. Long-term follow-up is necessary to further evaluate these operative modifications. (+info)
Comparison of traditional and disposable bed baths in critically ill patients.
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BACKGROUND: For bedridden patients unable to perform personal hygiene measures because of acute illness or chronic debilitation, the bed bath, with either the traditional basin or, more recently, disposable baths, has long been a measure for improving hygiene and costs. OBJECTIVE: To compare the traditional basin bed bath with a prepackaged disposable bed bath in terms of 4 outcomes: time and quality of bath, microbial counts on the skin, nurses' satisfaction, and costs. METHODS: Forty patients in surgical, medical, or cardiothoracic intensive care units received both types of bath on different days. Baths were observed, timed, and scored for quality. Cultures of the peri-umbilicus and groin were obtained before and after each bath. At the end of the study, nurses were interviewed about their preferences. RESULTS: Neither total quality scores nor microbial counts differed significantly between the 2 bath types. Significantly fewer products (P < .001) and less time were used, cost was lower, and nurses' ratings were significantly better with the disposable bath. CONCLUSION: The disposable bath is a desirable form of bathing for patients who are unable to bathe themselves in critical care and long-term care settings, and it may even be preferable to the traditional basin bath. (+info)
Ophthalmic drug delivery through contact lenses.
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PURPOSE: Currently available ophthalmic drug delivery systems are inefficient and may lead to side effects. To increase efficiency and reduce side effects, the authors propose disposable particle-laden soft contact lenses for ophthalmic drug delivery. METHODS: The essential idea is to encapsulate the ophthalmic drug formulations in nanoparticles and to disperse these drug-laden particles in the lens material, such as poly-2-hydroxyethyl methacrylate (p-HEMA) hydrogels. The drug-laden p-HEMA hydrogels were synthesized by free radical solution polymerization of the monomers in presence of nanoparticles. The particle-laden hydrogels were characterized by light-transmission and electron microscopy studies. Release profiles of lidocaine, a model hydrophobic drug, were measured by UV-Vis spectrophotometry. RESULTS: Microemulsions of hexadecane in water stabilized with a silica shell around the particles produced transparent hydrogels. Contact lenses made with particle-laden hydrogels released therapeutic levels of drug for a few days. CONCLUSIONS: Particle-laden hydrogels are promising candidates for ophthalmic drug delivery. They are transparent and can release drugs for extended periods. The drug delivery rates can be controlled by varying the loading of nanoparticles in the gel. (+info)
What's in the doctor's bag?
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BACKGROUND: A doctor's bag is invaluable when you need to take part of the practice to the patient, or in the case of an emergency. OBJECTIVE: This article aims to help new general practice registrars and experienced general practitioners consider what they may need in their doctor's bag. DISCUSSION: The doctor's bag needs to be personalised to the requirements of each GP and their patient population. Decisions need to be made about the type of bag, stationery, equipment and medications carried. Some possible additions for a rural doctor's bag are included, as well as some general tips. (+info)
Cost efficiency analysis of modern cytocentrifugation methods versus liquid based (Cytyc Thinprep) processing of urinary samples.
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BACKGROUND/AIMS: Liquid based cytology (LBC) was developed as a replacement for cytocentrifugation in the treatment of cell suspensions. Because accurate data comparing the quality and total cost of modern cytocentrifugation methods versus LBC in non-gynaecological samples are not available, this study was designed to investigate these issues. METHODS: The study comprised 224 urine samples treated with the Thermo Shandon Cytospin 4 using reusable TPX chambers, disposable Cytofunnels for samples up to 0.5 ml, and disposable Megafunnels for samples up to 6 ml. Each method was compared with the Cytyc Thinprep processing of a paired sample. Quality was assessed by scoring cellularity, fixation, red blood cells, leucocytes, abnormalities of urothelial cells, and suitability for molecular studies. Wage costs, investment, and consumables allowed a "total cost" to be calculated on the basis of 200 specimens/month. Total cost and quality combined were used to calculate an index of total quality (ITQ). RESULTS: Cytocentrifugation with disposable chambers resulted in a global quality superior to that of Cytyc Thinprep LBC. Preparation and screening times were 2.25 and 1.33-2 times greater when using LBC compared with cytocentrifugation. The total cost each month reached 1960.23 $ to 2833.43 $ for cytocentrifugation methods and 5464.95 $ for Cytyc Thinprep LBC (92.8-178.8% increased cost). ITQ of cytocentrifugation with disposable chambers surpassed that of Cytyc Thinprep LBC (37.25/32.08 and 9.98, respectively). CONCLUSION: Cytyc Thinprep LBC and cytocentrifugation are both appropriate methods for cytology based molecular studies, but cytocentrifugation remains the quality standard for current treatment of urinary samples because of its lower cost. (+info)
Safe inoculation of blood and bone marrow for liquid culture detection of mycobacteria.
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BACKGROUND: Needlestick injuries confer an unnecessary risk of occupational bloodborne infections such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. After an accidental needlestick injury, procedures for inoculation of liquid culture media for rapid detection of Mycobacterium tuberculosis complex and other mycobacteria from blood and bone marrow specimens were reviewed. AIM: To identify a safer transfer device, which could replace the ordinary syringe in inoculation of liquid culture vials. METHODS: We identified a transfer device to transfer blood or bone marrow specimens from bedside tubes into liquid culture vials. CONCLUSION: The changed procedure will reduce the risk of needlestick accidents and be of benefit to other microbiological laboratories using the same or similar inoculation techniques. (+info)
Evaluation of 16 adult disposable manual resuscitators.
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INTRODUCTION: Disposable manual resuscitators are commonly used to ventilate patients during cardiopulmonary resuscitation, suctioning, and intrahospital transport, and their clinical performance is critical. METHODS: We bench-tested 16 adult disposable manual resuscitators from 9 different manufacturers. We performed a series of tests and made observations using testing industry standards as a guideline. Each resuscitator was tested for fraction of delivered oxygen (FDO2), tidal volume delivery, drop test, and patient valve lock-up. We also made observations about reservoir style, ease or difficulty of attaching the positive end-expiratory pressure valve, size, texture, carbon dioxide detector, and if the resuscitator was labeled "latex free." RESULTS: Reservoir style and manufacturer design significantly affected FDO2. In general, the resuscitators with reservoir bags provided better FDO2 than did the resuscitators with tubing reservoirs (large-bore or small-bore). Delivered tidal volumes were acceptable for all the resuscitators tested. All the resuscitators passed a standard drop test. None of the resuscitators had a patient valve lock up at high flow. With all but one resuscitator, attaching the positive end-expiratory pressure valve was easy and the valve attached securely. Most resuscitators were average in size and had good texture, but some were large, somewhat slippery, and difficult to handle. Only 2 resuscitators came with carbon dioxide detectors already attached. All but one of the resuscitators were labeled "latex free," and the one that was not was found not to contain latex proteins. CONCLUSIONS: Resuscitator reservoir style and manufacturer design significantly affect FDO2. Some resuscitator models may not deliver adequate oxygen in certain clinical circumstances. Each institution should evaluate and choose the resuscitator that best fits its needs, while meeting established performance criteria. (+info)