Changing epidemiology of methicillin-resistant Staphylococcus aureus colonization in paediatric intensive-care units

Community-associated methicillin-resistant S. aureus (CA-MRSA) accounts for a growing proportion of hospital-onset infections, and colonization is a risk factor. This study aimed to determine changes in the prevalence of CA-MRSA colonization in paediatric intensive-care units (ICUs). A total of 495 paediatric patients colonized with MRSA from neonatal, medical, surgical, and cardiac ICUs between 2001 and 2009 were identified. Isolates were characterized by spa type, staphylococcal cassette chromosome (SCC) mec type and the presence of the genes encoding Panton–Valentine leukocidin (PVL). The proportion of patients colonized with MRSA remained stable (average 3·2%). The proportion of isolates with spa type 1, SCCmec type IV and PVL increased over time to maximums in 2009 of 36·1% (P < 0·001), 54·2% (P = 0·03) and 28·9% (P = 0·003), respectively. Antibiotic susceptibility patterns showed increasing proportions susceptible to clindamycin, gentamicin, tetracycline and trimethoprim-sulfamethoxazole (P values <0·001). In conclusion, the proportion of MRSA-colonized children in ICUs with CA-MRSA increased significantly over time

Accidental Needlestick Exposures linked to the Administration of Local Anesthesia by Healthcare Workers

The Massachusetts Department of Public Health mandates that all Massachusetts hospitals maintain an active log to track sharps injuries due to the health risks related to such injuries. These logs are used to guide continuous quality improvement activities aimed at preventing sharps injuries. A review of sharps injuries at UMass Memorial Medical Center (UMMMC) in 2013 showed a seemingly high incidence occurring among healthcare workers who were administering local anesthesia. We undertook an investigation of the relative rate of needlesticks associated with local anesthesia administration compared to the rate of all sharps injuries over a 10-year period

REABILITAÇÃO NA SÍNDROME PATELOFEMORAL EM ATLETAS

As lesões podem ser consideradas como o principal fator de afastamento deum atleta de sua modalidade esportiva. Esse afastamento é prejudicial, pois influenciadiretamente no seu desempenho físico e técnico, além dos possíveis prejuízospsicológicos, já que a recuperação pode ser demorada, exigindo muita paciência ecautela para voltar à atividade, e conseqüentemente a equipe também é prejudicada. Adisfunção patelofemoral causa dor na região anterior do joelho e é uma das patologiasdesta região que mais acomete os atletas, podendo ser causado devido a umtraumatismo, ou de inicio insidioso, e é mais freqüente em mulheres, relacionada aoaumento na tração lateral exercida pelo mecanismo quadricipital. O objetivo desseartigo foi mostrar protocolo de fisioterapia para tratamento da síndrome patelofemoralem atletas de ginástica rítmica, mostrando a importância dos exercícios específicos defortalecimento e alongamento

Effects of Naltrexone Treatment for Alcohol-Related Disorders on Healthcare Costs in an Insured Population

To determine the impact of treatment with oral naltrexone on healthcare costs in patients with alcohol-related disorders.Using data from the MarketScan Commercial Claims and Encounters Database for 2000–2004, we identified a naltrexone group (with an alcohol-related diagnosis and at least one pharmacy claim for oral naltrexone) and two control groups. Alcohol controls had an alcohol-related diagnosis and were not prescribed an alcoholism treatment medication. Nonalcohol controls had no alcohol-related diagnosis and no prescription for an alcoholism treatment medication. The control groups were matched three to one to the naltrexone group on demographic and other relevant measures. Healthcare expenditures were calculated for the 6-month periods before and after the index naltrexone drug claim (or matched date for controls). Univariate and multivariate analyses were used to compare the groups on key characteristics and on healthcare costs.Naltrexone patients ( n  = 1,138; 62% men; mean age 45 ± 11 years) had significantly higher total healthcare expenditures in the pre-index period than either of the control groups. In the postindex period, naltrexone patients had a significantly smaller increase than alcohol controls in total alcohol-related expenditures. Total nonalcohol-related expenditures also increased significantly less for the naltrexone group than for the alcohol control group. Multivariate analyses showed that naltrexone treatment significantly reduced alcohol-related, nonalcohol-related, and total healthcare costs relative to alcohol controls.Although prior to treatment patients with alcohol-related disorders had higher healthcare costs, treatment with oral naltrexone was associated with reductions both in alcohol-related and nonalcohol-related healthcare costs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79389/1/j.1530-0277.2010.01185.x.pd

Características sociodemográficas del corredor popular veterano español

En las últimas décadas ha aumentado el número de participantes en carreras populares de resistencia, sobre todo, de atletas veteranos. El objetivo de este estudio es determinar las características sociodemográficas del atleta veterano en relación a variables personales, de entrenamiento y lesión. Se elaboró un cuestionario ad hoc con estas variables. El perfil del corredor veterano es un varón en torno a los 40 años, con estudios universitarios, que trabaja y vive en pareja, que entrena 4 días a la semana y recorre sobre 50 kilómetros semanales. Se destaca la alta prevalencia de lesiones en esta población y el único factor que predispone a la lesión es el número de sesiones semanales de entrenamiento

A point-of-care clinical trial comparing insulin administered using a sliding scale versus a weight-based regimen

Background Clinical trials are widely considered the gold standard in comparative effectiveness research (CER) but the high cost and complexity of traditional trials and concerns about generalizability to broad patient populations and general clinical practice limit their appeal. Unsuccessful implementation of CER results limits the value of even the highest quality trials. Planning for a trial comparing two standard strategies of insulin administration for hospitalized patients led us to develop a new method for a clinical trial designed to be embedded directly into the clinical care setting thereby lowering the cost, increasing the pragmatic nature of the overall trial, strengthening implementation, and creating an integrated environment of research-based care