bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tuberculin Positivity and Patient Contact in Healthcare Workers in the Urban United States
Authors: Rattner Susan L. , Fleischer Julie A. , Davidson Bruce L. 
Published: September 2009

AbstractWe performed tuberculin and anergy testing in 91 healthy volunteer employees from the patient transport and housekeeping units at an urban tertiary-care hospital, stratifying results by the risk factor of patient contact. Tuberculin positivity was highly prevalent in this group; patient contact was not a predictor of tuberculosis infection risk, and anergy was rare.
The Analysis of Disease Clusters, Part II: Introduction to Techniques
Authors: Birnbaum David , Jacquez G.M. , Grimson R. , Waller L.A. , Wartenberg D. 
Published: September 2009

AbstractPublic health professionals often are asked to investigate apparent clusters of human health events or “disease clusters.” A cluster is an excess of cases in space (a geographic cluster), in time (a temporal cluster), or in both space and time. This is the second part of an introductory-level review of the analysis of disease clusters for physicians and health professionals concerned with infection surveillance in hospitals. It reviews the status of the field with the hope of expanding the use of cluster analysis methods for the routine surveillance of infectious diseases in the hospital environment.
Implementation and Evaluation of an Algorithm for Isolation of Patients With Suspected Pulmonary Tuberculosis
Authors: Pegues Clare F. , Johnson Douglas C. , Pegues David A. , Spencer Maureen , Hopkins Cyrus C. 
Published: September 2009

AbstractObjective: To implement and evaluate an algorithm designed to assist in the consistent placement of patients with suspected pulmonary tuberculosis into negative-pressure isolation rooms (NPIRs).Design: A standard algorithm was designed for the appropriate room placement of patients with suspected pulmonary tuberculosis using clinical, radiographic, and laboratory criteria and reported risk factors. A case-patient was defined as an inpatient who had at least one Mycobacterium tuberculosis culture-positive respiratory specimen from January 1, 1993, through December 31, 1994. Demographic, clinical, laboratory, case contact, and isolation and room placement data were collected prospectively on all case-patients.Setting: A 900-bed university teaching and referral center.Results: During 1993 and 1994, 69 patients were evaluated for possible pulmonary tuberculosis, and 31 case-patients were identified. Of the 31 case-patients, 26 (84%) were placed on respiratory isolation in NPIRs, including 19 (61%) who were isolated within 24 hours of admission (1993, 14 of 20 [70%]; 1994, 5 of 11 [45%]). Seven case-patients (23%) were isolated in NPIRs following delays that ranged from 2 to 31 days (median, 9 days), and five case-patients (16%) never were isolated during admissions of from 3 to 28 days (median, 4 days). These 12 case-patients contributed a total of 136 patient-exposure days during their hospitalizations. Misclassification of patient risk status by user error delayed isolation of five (42%) of the 12 improperly isolated case-patients.Conclusions: The use of an algorithm incorporating radiographic, laboratory, and clinical criteria and reported risk factors may assist in the rapid isolation of patients with suspected pulmonary tuberculosis.
The Historical Faith of William Tyndale: Non-Salvific Reading of Scripture at the Outset of the English Reformation*
Authors: Baker David Weil 
Published: September 2009

AbstractThis essay argues that for William Tyndale, not only was scripture notsola,but it did not have to be read solely as scripture, that is, the salvific word of God. It could also be read withhistorical faith,a term that Tyndale borrowed from the German Reformer Philip Melanchthon and used to signify “believing in scripture as one would a non-scriptural history.” Tyndale did not exactly advocate this approach to scripture, but he recognized it as having at least some validity, given the role of human agency and authority in the transmission of God's word. More broadly, the notion of historical faith in scripture reflects the Reformation elevation of what John Foxe called the “truth of history” along with that of scripture. In the polemical writings of Tyndale and later English Protestant Reformers, scripture served both as a means of personal salvation and as a source of historical evidence against the Catholic Church. As a source for this kind of evidence, scripture was cited in conjunction with non-scriptural histories and in ways not discernibly different from those in which such histories were cited. Tyndale's historical faith is not, then, as his opponent Thomas More dubbed it, an “evasion” borrowed from Melanchthon, but rather a part of the complex and developing relationship between scripture and history during the English Reformation.
An Outbreak of Fatal Nosocomial Infections Due to Group A Streptococcus on a Medical Ward
Authors: Ramage L. , Green K. , Pyskir D. , Simor A.E. 
Published: September 2009

AbstractGroup A streptococcus is an uncommon but important cause of nosocomial infections. Outbreaks of infection most often have occurred in surgical or obstetrical patients. We describe an outbreak of severe group A streptococcal infections that occurred on a medical unit of a community hospital. Within an 8-day period, three patients developed fatal nosocomial skin and soft-tissue infection due to group A streptococcus. Three nurses who had provided care to one or more of these patients subsequently developed strepto-coccal pharyngitis, and three other nurses were treated with antibiotics for pharyngitis (cultures not obtained). Patient isolates were serotype M-nontypeable, T-11, opacity factor-positive, and shared identical DNA profiles when typed by pulsed-field gel electrophoresis; staff isolates were not available for typing. To prevent further spread of infection, the ward was closed to new admissions, and symptomatic staff were treated with antibiotics and relieved of patient-care duties. This outbreak demonstrates the ability of group A streptococcus to spread rapidly in a hospital setting and to cause severe life-threatening disease in hospitalized patients.
Textual Collaboration and Spiritual Partnership in Sixteenth-Century Italy: The Case of Ortensio Lando and Lucrezia Gonzaga*
Authors: Ray Meredith K. 
Published: September 2009

AbstractThe sixteenth-century writer Ortensio Lando (ca. 1512–ca. 1553) wrote many of his works pseudonymously and borrowed liberally from the works of others. Part of a community of professional writers who experimented with collaborative modes of literary production, Lando was also deeply invested in the currents of religious reform that swept through sixteenth-century Italy. In his extensive literary recourse to female personas, Lando privileged contemporary women who shared his own heterodox religious views. This essay examines Lando's female impersonations with particular attention to his use of Lucrezia Gonzaga da Gazzuolo (ca. 1521–76), whose complex literary relationship with Lando is illustrated by her presence throughout his literary corpus, and by his role in the book ofLetterepublished under her name. It argues that the relationship between these two figures can be best understood as a literary and spiritual partnership, one that meshed Lando's editorial expertise with Gonzaga's fame as a woman of extraordinary virtue and spiritual authority, a reputation that Lando himself helped to create. In an era when print publication by women was still far from common, such collaboration constituted an alternative path to literary expression.
Preventing the Emergence of Multidrug-Resistant Microorganisms Through Antimicrobial Use Controls: The Complexity of the Problem
Authors: Jarvis William R. 
Published: September 2009

AbstractWidespread use of antimicrobials in the inpatient and outpatient setting has been associated with the emergence of multidrug-resistant microorganisms. A variety of methods exist to improve the appropriateness of antimicrobial use in the inpatient setting, including guidelines, antimicrobial use evaluations, microbiology laboratory guidance, formulary development and antimicrobial restriction, use of antimicrobial order or automatic stop order forms, and antimicrobial audits. To decrease the selective pressure that leads to development of pathogen resistance and to reduce antimicrobial expenditures, infectious disease, infection control, pharmacy, and administrative staff need to improve clinician use of antimicrobials through development and implementation of antimicrobial use committees. Through the implementation of a comprehensive, multidisciplinary approach to antimicrobial use and development of clinician education programs, inappropriate antimicrobial use can be reduced, patient care can be improved, and substantial cost savings can be realized.
Methicillin-Resistant Staphylococcus aureus Epidemiology and Control in Belgian Hospitals, 1991 to 1995
Authors: Struelens Marc J. , Ronveaux Olivier , Jans Béatrice , Mertens Raf ,   Groupement pour le Dépistage, l'Etude et la Prévention des Infections Hospitalières
Published: September 2009

AbstractObjectives: To describe the Belgian methicillin-resis-tant Staphylococcus aureus (MRSA) surveillance network, the evolution of methods used in Belgian hospitals for MRSA detection and control, and MRSA incidence from 1994 to1995.Design, Setting, and Participants: Questionnaire surveys; infection control physicians from acute-care hospitals in Belgium.Intervention: Publication of national guidelines for MRSA control in 1993.Results: The participation rate in surveys ranged from 42% to 57% of hospitals. In 1995, 88% of participants detected MRSA strains by disk diffusion tests, with little improvement in standardization since 1991. More centers employed the oxacillin agar screen method (27%), automated systems (29%), or a combination of methods (29%) than in 1991 (P<.005). Between 1991 and 1995, the proportion of hospitals reporting MRSA control measures increased from 68% to 95% (P<.01). Practices that were used increasingly included patient placement in private room (from 50% to 93%, P<.01) and hand decontamination with antiseptic (from 43% to 87%, P<.01). The proportion of centers that reported screening MRSA carriers and treating them topically increased two- and threefold, respectively (P<.05). Surveillance data from 1994 to 1995 showed that MRSA represented a mean of 21.3% of S aureus clinical isolates (range, 1.6% to 62.4%). The median incidence of nosocomial MRSA acquisition was 2.8 per 1,000 admissions, with a wide range (0 to 13.7 per 1,000 admissions) across hospitals of all sizes. The median incidence decreased over the first three semesters of surveillance in hospitals with continuous participation.Conclusion: MRSA detection and control measures have improved in Belgian hospitals after publication of national guidelines. However, MRSA incidence rates show the persistence of nosocomial transmission, with large variations between centers. The national MRSA surveillance network should indicate whether control efforts eventually will curb the problem.
Methicillin-Resistant Staphylococcus aureus Control in Hospitals: The Dutch Experience
Authors: Vandenbroucke-Grauls C.M.J.E. 
Published: September 2009

AbstractThe Netherlands is one of the few countries where methi-cillin-resistant Staphylococcus aureus (MRSA) still is uncommon. In 1988, the Werkgroep Infectie Preventie (Working Party on Infection Prevention) issued guidelines on the control of MRSA that could be applied nationwide. The mainstay of the guideline is that all patients who carry MRSA are strictly isolated in single rooms. In 1989, a surveillance study was started by the National Institute of Public Health and the Environment. This study showed that approximately 200 new cases of MRSA colonization or infection occur each year. Small outbreaks of MRSA occur occasionally in The Netherlands, but the surveillance data confirm the success of the Dutch policy.
How to Limit the Spread of Creutzfeldt-Jakob Disease
Authors: Dormont Dominique 
Published: September 2009

AbstractTransmissible spongiform encephalopathies are rare lethal diseases induced in humans and animals by unconventional agents called transmissible spongiform encephalopathy agents (TSEAs), virions, or prions. Several cases of iatrogenic Creutzfeldt-Jakob disease (CJD) have been reported in the literature after neuro-surgery, treatment with pituitary-derived hormones, corneal grafting, and use of dura mater lyophilisates. In a given infected individual, TSEA-associated infectiousness depends on the nature of the organ: the central nervous system has the highest infectiousness, spleen and lymph nodes a medium infectiousness, and organs such as bone, skin, or skeletal muscles do not harbor any detectable infectiousness in experimental models. Transmissible spongiform encephalopathy/prions have unconventional properties; in particular, they resist almost all the chemical and physical processes that inactivate conventional viruses. Therefore, prevention of CJD agent transmission must be taken into account in daily hospital practice. Efficient sterilization procedures should be determined. In tissue and blood donation, donors with a neurologic history must be excluded, and patients treated with pituitary-derived hormones should be considered potentially infected with TSEA and excluded.
AIDS, Emergency Operations, and Infection Control
Authors: Wittmann Mark Matthias , Wittmann Annemarei , Wittmann Dietmar H. 
Published: September 2009

AbstractAcquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV) may turn out to be the largest lethal epidemic of infection ever. The estimated global number of HIV-infected adults in 1993 was 13 million, with projections of up to 40 million by the year 2000. Human immunodeficiency virus infections and AIDS are relevant to surgeons with respect to the surgical management of AIDS patients in general, the treatment of the increasingly long list of surgical complications specific to AIDS patients in particular, and the risks of patient-to-surgeon and surgeon-to-patient HIV transmission. Because of migration of individuals and populations throughout the world, even surgeons practicing in relatively unaffected regions should be familiar with the potential surgical implications of AIDS. Ethical considerations arise, as well. Are surgeons obliged to operate on HIV-positive or AIDS patients? Some surgeons adhere strictly to the Hippocratic Oath, whereas others reserve the right to be selective on whom they operate, except in emergencies. Other common ethical considerations in the AIDS patient are similar to those arising in the terminal cancer case: whether to operate or not; whether to provide advanced support such as total parenteral nutrition or hemodialysis. Answers are not simple and require close collaboration between the surgeon, the AIDS specialist, and involved members of other specialties. Emergency operations become necessary to treat AIDS independent disease such as acute cholecystitis and appendicitis or AIDS-related life-threatening conditions such as gastrointestinal bleeding, obstruction, perforation, or ischemia complicating Kaposi's sarcoma, lymphoma, and cytomegalovirus or disseminated nontuberculous mycobacterial infections. Delays and errors in diagnosis are frequent. Poor nutritional state with weight loss, low serum albumin, and leukocyte count prevails in most patients requiring emergency operations and account for a high mortality. By applying solid judgment and selecting management appropriately, the surgeon has the ability to prolong life and to improve the quality of life for these unfortunate patients, and to do so with extremely minimal risk to himself and his team.
Initial Worker Evaluation of a New Safety Syringe
Authors: Mulherin Stephanie , Rickman Leland S. , Jackson Marguerite McMillan 
Published: September 2009

AbstractA prospective evaluation of a new safety syringe requiring a one-step activation was carried out at the University of California, San Diego Medical Center. Only 59.5% of 390 syringes were activated, and user acceptance and satisfaction were unfavorable. The development of safety devices should incorporate passive activation and take end-user satisfaction into consideration.
Surgical Outcome Information and the Media
Authors: Lee James T. 
Published: September 2009

AbstractThere is increased media attention to healthcare outcome in the current reform atmosphere. Surgical care is a natural target for both print and electronic coverage. Hospital public relations departments often will be the interface with media representatives. Because surgical care outcome interpretation requires thoughtful evaluation of both single-patient and grouped-patient data, as well as knowledge of realistic risk-benefit ratios, it always is prudent to work with your local surgeon when the request for a story comes to the public relations department.
Effect of a Comprehensive Program to Reduce Needlestick Injuries
Authors: Zafar Abdul B. , Butler R. Christopher , Podgorny Judith M. , Mennonna Patricia A. , Gaydos Larry A. , Sandiford John A. 
Published: September 2009

AbstractThe Arlington Hospital Needlestick Injury (NSI) Prevention Program was created to protect healthcare workers from NSI and to assess the effectiveness of our interventions. Interventions included revising NSI policy and procedures. The average NSI rate dropped from 109 to 43 per year after the interventions, over a period of 4 years.
Respiratory Isolation of Tuberculosis Patients Using Clinical Guidelines and an Automated Clinical Decision Support System
Authors: Knirsch Charles A. , Jain Nilesh L. , Pablos-Mendez Ariel , Friedman Carol , Hripcsak George 
Published: September 2009

AbstractObjective:To evaluate a clinical guideline and an automated computer protocol for detection and respiratory isolation of tuberculosis (TB) patients.Design:An automated computer protocol was tested on a retrospective cohort of adult culture-positive TB patients admitted from 1992 to 1993 to Columbia-Presbyterian Medical Center and evaluated prospectively from July 1995 until July 1996.Setting:A large teaching hospital in New York City.Patients:171 adult patients admitted from 1992 to 1993 and 43 patients admitted between July 1995 and July 1996.Interventions:The 1990 Centers for Disease Control and Prevention guidelines for preventing transmission of TB were adapted to formulate clinical guidelines to ensure early isolation of TB patients at Columbia-Presbyterian Medical Center.Results:Implementation of a clinical respiratory isolation protocol resulted in a significant improvement in TB patient isolation rates, from 45 (51%) of 88 in 1992 to 62 (75%) of 83 in 1993 (P<.001). In testing automated protocols, the theoretical improvement would have identified an additional 27 patients not isolated by clinicians, making the overall isolation rate 134 (78%) of 171.For the prospective evaluation, 30 (70%) of 43 TB patients were isolated by clinicians adhering to the clinical protocol. Four additional patients were identified by the automated TB protocol, making the combined isolation rate 34 (79%) of 43.Conclusions:A clinical policy to isolate TB patients and suspected human immunodeficiency virus-infected patients with cough, fever, or radiographic abnormalities improved isolation of culture-documented TB patients from 1992 to 1993. Automated computer protocols were successful in identifying additional potentially infectious patients that clinicians failed to place on respiratory isolation. Clinical and automated protocols combined resulted in better isolation rates than a clinical protocol alone.
Difference in Incidence and Transmission Mode of Methicillin-Resistant Staphylococcus aureus Among Surgery, Orthopedics, and Pediatrics Wards: A Prospective Study at a University Hospital
Authors: Nishi Jun-Ichiro , Shirao Kazusada , Ito Hiroshi , Yoshinaga Masao , Yoshinaka Heiji , Miyanohara Hiroaki , Hirata Shingo , Ogawa Hiroki , Kitajima Isao , Maruyama Ikuro , Miyata Koichiro , Aiko Takashi , Sakou Takashi 
Published: September 2009

AbstractThe incidence and circumstances of colonization by methicillin-resistant Staphylococcus aureus were prospectively investigated. Among 404 patients, 15 (3.7%) were carriers on admission, and 43 (10.6%) became colonized, mainly after surgical operation. A different mode of transmission was suggested in each ward.
An Outbreak of Burkholderia cepacia With Septicemia on a Cardiology Ward
Authors: van Laer Frank , Raes David , Vandamme Peter , Lammens Christine , Sion Jean Paul , Vrints Chris , Snoeck Jozef , Goossens Herman 
Published: September 2009

AbstractDuring a 3-day period, eight patients developed septicemia with Burkholderia cepacia. Heparin injection was found to be a risk factor. Heparin was diluted with dextrose solution, which was aspirated from a 1-L bag. B cepacia, genotypically identical to the blood isolates, was isolated from this bag.
Hospital Infection Prevention and Control: A Model for Improving the Quality of Hospital Care in Low- and Middle-Income Countries
Authors: Huskins W. Charles , Soule Barbara M. , O'Boyle Carol , Gulácsi László , O'Rourke Edward J. , Goldmann Donald A. 
Published: September 2009

AbstractContinuous quality improvement (CQI) is a powerful methodology for improving clinical outcomes and patient satisfaction while reducing inefficiency and costs. However, most hospitals in low- and middle-income countries have little experience with CQI methods. Hospital infection prevention is an ideal model for nascent efforts to improve the quality of hospital care because of its proven efficacy in reducing the occurrence of infections that compromise patient outcomes and increase costs. This article describes the design and implementation of a demonstration project to reduce the incidence of surgical-site infections (SSIs) for hospitals with little experience with quality-improvement methods. The project has a high likelihood of producing measurable reductions in SSI rates and hospital costs related to inefficient use of perioperative antimicrobial prophylaxis. Moreover, participating staff will gain experience that can be applied to efforts to improve the quality of other aspects of hospital care.
Comparison of Vancomycin and Cefuroxime for Infection Prophylaxis in Coronary Artery Bypass Surgery
Authors: Vuorisalo Sailaritta , Pokela Risto , Syrjälä Hannu 
Published: September 2009

ABSTRACTOBJECTIVE: To investigate clinically significant differences between vancomycin and cefuroxime for perioperative infection prophylaxis in coronary artery bypass surgery.DESIGN: A total of 884 patients were randomized prospectively to receive either cefuroxime (444) or van-comycin (440) and were assessed for infectious complications during hospitalization and 1 month postoperatively.SETTING: A university hospital.RESULTS: The overall immediate surgical-site infection rate was 3.2% in the cefuroxime group and 3.5% in the vancomycin group (difference, −0.3; 95% confidence interval, −2.6-2.1).CONCLUSIONS: The data suggest that vancomycin has no clinically significant advantages over cephalosporin in terms of antimicrobial prophylaxis. We suggest that cefuroxime (or first-generation cephalosporins, which were not studied here) is a good choice for infection prophylaxis in connection with coronary artery bypass surgery in institutions without methicillin-resistant Staphylococcus aureus problems. In addition to the increasing vancomycin-resistant enterococci problem, the easier administration and usually lower price of cefuroxime make it preferable to vancomycin.