scholarly journals Carbapenem Resistant Enterobacteriaceae infections in Houston, Texas: An outline

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Hafeez Rehman ◽  
Imran Shaikh ◽  
Kasimu Muhetaer ◽  
Salma Khuwaja
Keyword(s):  
Health Care ◽  
Disease Surveillance ◽  
Age Groups ◽  
Acute Care Hospital ◽  
Resistant Bacteria ◽  
Care Hospital ◽  
Term Care ◽  
Health Care Settings ◽  
Disease Surveillance System ◽  
Enterobacteriaceae Infections

ObjectiveTo examine demographic as well as clinical characteristics of theCarbapenam Resistant Enteriobacteriacae (CRE) Organisms cases inHouston, Texas, 2015-2016IntroductionAccording to CDC, CRE is used to describe bacteria that are non-susceptible to one or more carbapenems; doripenem, meropenemor imipenem and resistant to third generation cephalosporins likeceftriaxone, cefotaxime and ceftazidime. These organisms causeinfections that are associated with high mortality rates and they havethe potential to spread widely. Antibiotic resistant bacteria causemore than 2 million illnesses and at least 23,000 deaths each year inUnited States. CREs are found in many health care settings like acutecare hospitals, long term care facilities, nursing homes, rehabilitationfacilities and other health care settings. Although CREs includes anumber of species, reporting in State of Texas is limited to CRE-Klebsiellaspecies and CRE-E.coli.MethodsPopulation-based surveillance data was generated from Houston’selectronic disease surveillance system reported to Houston HealthDepartment (HHD) from October 2015 to July 2016. Descriptiveanalysis was performed to examine demographic and clinicalcharacteristics across different age groups, gender and race/ethnicity.HHD has received a total of 463 CRE cases during the time period,out of which 72 were non-reportable and did not meet the casecriteria, 187 were out of jurisdiction. The remaining 204 cases wereincluded in this study.ResultsOut of a total of 204 cases, males and females were representedequally (50% each). The mean age of the cases was 67 years(age ranges from 22-98). Majority of the cases were in the older agegroup, 70 years and above 53 (26%), followed by 48 (24%) in agegroup 80 and above years. Among the different race/ethnic groups,African-Americans comprised of 82 (40%), followed by Whites67 (33%) and Hispanics 33 (16%). Out of 204 cases, 156 (76%)were hospitalized, which included acute care hospital, long-termacute care or nursing home. Out of 156 hospitalized cases, 71 (34%)were in Intensive Care Unit (ICU) and 136 (67%) had an invasiveor indwelling device. Of all the cases, 80% had CREKlebsiellapneumoniae, followed by 11% who had CRE- E coli. The cases weredistributed evenly across the city when plotted on ArcGIS with theirresidential addresses.ConclusionsCRE cases are found to be more common among older age groups,African American population and in hospitalized patients. CRE canbe a ground for increasing infectious diseases in the community andone of the reason may be unnecessary use of antimicrobial agents.This study provides a glimpse into the number of CRE cases reportedin Houston since CREs are classified a separate disease in Texas.Further studies are needed to explore the occurrence of anti-microbialdrug resistance among the specific population groups and how thecase investigation efforts can be targeted to enhance prevention.

A Severity Index Designed as an Indicator of Acuity in Palliative Care

1993 ◽  
Vol 9 (4) ◽  
pp. 11-15 ◽  
Author(s):  
Linda Strause ◽  
Laurel Herbst ◽  
True Ryndes ◽  
Mary Callaghan ◽  
Lawrence Piro
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Cancer Patients ◽  
Terminal Illness ◽  
Acute Care Hospital ◽  
Severity Index ◽  
Care Hospital ◽  
Outpatient Services ◽  
Advanced Cancer Patients ◽  
Health Care Settings

Patients who are facing terminal illness frequently experience changes in health care settings which are necessitated by acute events during palliative care. This pilot study evaluates the reliability, criterion validity, and appropriateness of the San Diego Severity Index (SDSI) in a population of advanced cancer patients in different care settings. The SDSI includes diagnostic, acuity, and psychosocial assessments. Cancer patients were evaluated in an outpatient oncology clinic (SCRF), a hospice home care (HC) program, and an acute care hospital/hospice centre (ACC). Scores were lowest for SCRF (9.51 ± 3.7), HC was intermediate (24.04 ± 8.8), while patients at the ACC scored the highest (29.33 ± 7.0). Patients admitted to the ACC were significantly more acute, as assessed by the SDSI, than those utilizing outpatient services. This instrument may be useful as an indicator of appropriate transitions between health care settings.

The Long-Term Acute Care Hospital: A New Option for Ventilator-Dependent Individuals

1990 ◽  
Vol 1 (2) ◽  
pp. 280-288 ◽  
Author(s):  
Jennifer A. Lundberg ◽  
Mary Lou Noll
Keyword(s):  
Health Care ◽  
Acute Care ◽  
Negative Impact ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Health Care Environment ◽  
Term Care ◽  
Care Environment ◽  
Effective Manner

Improved health care and sophisticated medical technology have improved the outcome for many people who suffer a critical illness. One group of people who have benefited are ventilator-dependent individuals (VDIs), as evidenced by the increased number of children and adults requiring long-term mechanical ventilation. Significant changes in this nation’s health care reimbursement structure have made a substantial negative impact on the availability of traditional long-term care options for these patients. In response, a new health care environment has emerged. Now available are specialty hospitals providing general hospital services, which allow for long-term acute care intervention. The Vencor Corporation has successfully established this innovative care environment in a cost-effective manner. There are currently nine Vencor hospitals specializing in providing long-term acute care to VDIs and other catastrophically ill patients

Evaluation of Ceiling Lifts in Health Care Settings

AAOHN Journal ◽  
2009 ◽  
Vol 57 (9) ◽  
pp. 374-380 ◽  
Author(s):  
Hasanat Alamgir ◽  
Olivia Wei Li ◽  
Erin Gorman ◽  
Catherine Fast ◽  
Shicheng Yu ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Pressure Ulcer ◽  
Care Facility ◽  
Care Quality ◽  
Patient Perceptions ◽  
Term Care ◽  
Health Care Settings ◽  
The Relationship

Ceiling lifts have been introduced into health care settings to reduce manual patient lifting and thus occupational injuries. Although growing evidence supports the effectiveness of ceiling lifts, a paucity of research links indicators, such as quality of patient care or patient perceptions, to the use of these transfer devices. This study explored the relationship between ceiling lift coverage rates and measures of patient care quality (e.g., incidence of facility-acquired pressure ulcers, falls, urinary infections, urinary incontinence, and assaults [patient to staff] in acute and long-term care facilities), as well as patient perceptions of satisfaction with care received while using ceiling lifts in a complex care facility. Qualitative semi-structured interviews were used to generate data. A significant inverse relationship was found between pressure ulcer rates and ceiling lift coverage; however, this effect was attenuated by year. No significant relationships existed between ceiling lift coverage and patient outcome indicators after adding the “year” variable to the model. Patients generally approved of the use of ceiling lifts and recognized many of the benefits. Ceiling lifts are not detrimental to the quality of care received by patients, and patients prefer being transferred by ceiling lifts. The relationship between ceiling lift coverage and pressure ulcer rates warrants further investigation.

scholarly journals In-Home Telerehabilitation for Post-Knee Arthroplasty: A Pilot Study

2009 ◽  
Vol 1 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Michel Tousignant ◽  
Patrick Boissy ◽  
Hélène Corriveau ◽  
Hélène Moffet ◽  
François Cabana
Keyword(s):  
Health Care ◽  
Pilot Study ◽  
Acute Care ◽  
Knee Arthroplasty ◽  
Health Care Professionals ◽  
Acute Care Hospital ◽  
Rehabilitation Services ◽  
Control Group ◽  
Care Hospital ◽  
Post Discharge

The purpose of this study was to investigate the efficacy of in-home telerehabilitation as an alternative to conventional rehabilitation services following knee arthroplasty. Five community-living elders who had knee arthroplasty were recruited prior to discharge from an acute care hospital. A pre/post-test design without a control group was used for this pilot study. Telerehabilitation sessions (16) were conducted by two trained physiotherapists from a service center to the patient’s home using H264 videoconference CODECs (Tandberg 550 MXP) connected at 512 Kb\s. Disability (range of motion, balance and lower body strength) and function (locomotor performance in walking and functional autonomy) were measured in face-to-face evaluations prior to and at the end of the treatments by a neutral evaluator. The satisfaction of the health care professional and patient was measured by questionnaire. Results are as follows. One participant was lost during follow-up. Clinical outcomes improved for all subjects and improvements were sustained two months post-discharge from in-home telerehabilitation. The satisfaction of the participants with in-home telerehabilitation services was very high. The satisfaction of the health care professionals with the technology and the communication experience during the therapy sessions was similar or slightly lower. In conclusion, telerehabilitation for post-knee arthroplasty is a realistic alternative for dispensing rehabilitation services for patients discharged from an acute care hospital.Keywords: Telerehabilitation, Physical Therapy, Total Knee Arthroplasty, Videoconferencing

scholarly journals Challenges Facing the Chinese Health Care System

2020 ◽  
pp. 101053952096846
Author(s):  
Kaixuan Hu
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Disease Surveillance ◽  
World Health ◽  
Outbreak Response ◽  
The Past ◽  
Disease Surveillance System ◽  
Rural And Urban ◽  
Health Organization ◽  
Care System

The purposes of this article are to explore the challenges the Chinese health care system will be facing in the next decade. The recent outbreak of coronavirus disease (COVID-19) having infected more than 90 000 persons in China (Source: World Health Organization, WHO Coronavirus Disease Dashboard) again reveals the weaknesses of the fragmental health care system. Over the past 3 decades, increasing out-of-pocket spending on health care, increasing mortality rate of chronic disease, growing disparities between rural and urban populations, the defectiveness of disease surveillance system, and disease outbreak response system have been pressing Chinese authorities for action. As this country has experienced an unprecedented economic growth along with an unparalleled development of health care system in the past 3 decades, the challenges ahead are unavoidably numerous and complex.

scholarly journals 1442. Effect of Reflex Urine Culturing on Rates of Cultures and Infections in an Acute Care Hospital, Emergency Department, and Two Long-Term Care Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S526-S526
Author(s):  
Chelsea Lynch ◽  
Andrea Appleby-Sigler ◽  
Jacqueline Bork ◽  
Rohini Dave ◽  
Kimberly C Claeys ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Long Term Care ◽  
White Blood Cells ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Post Intervention ◽  
Term Care ◽  
Absolute Increase

Abstract Background Urine cultures are often positive in the absence of urinary tract infection (UTI) leading to unnecessary antibiotics. Reflex culturing decreases unnecessary urine culturing in acute care settings but the benefit in other settings is unknown. Methods This was a quasi-experimental study performed at a health system consisting of an acute care hospital, an emergency department (ED), and two long-term care (LTC) facilities. Reflex urine criterion was a urine analysis with > 10 white blood cells/high-power field. Urine cultures performed per 100 bed days of care (BDOC) were compared pre- (August 2016 to July 2017) vs. post-intervention (August 2017 to August 2018) using interrupted time series regression. Catheter-associated UTI (CAUTI) rates were reviewed to determine potential CAUTIs that would have been prevented. Results In acute care, pre-intervention, 894 cultures were performed (3.6 cultures/100 BDOC). Post-intervention, 965 urine cultures were ordered and 507 cultures were performed (1.8 cultures/100 BDOC). Reflex culturing resulted in an immediate 49% decrease in cultures performed (P < 0.001). The CAUTI rate 2 years pre-intervention was 1.8/1000 catheter days and 1.6/1000 catheter days post-intervention. Reflex culturing would have prevented 4/14 CAUTIs. In ED, pre-intervention, 1393 cultures were performed (5.4 cultures/100 visits). Post-intervention, 1959 urine cultures were ordered and 917 were performed (3.3 cultures/100 visits). Reflex culturing resulted in an immediate 47% decrease in cultures performed (P = 0.0015). In LTC, pre-intervention, 257 cultures were performed (0.4 cultures/100 BDOC). Post-intervention, 432 urine cultures were ordered and 354 were performed (0.5 cultures/100 BDOC). Reflex culturing resulted in an immediate 75% increase in cultures performed (P < 0.001). The CAUTI rate 2 years pre-intervention was 1.0/1000 catheter days vs. 1.6/1,000 catheter days post-intervention. Reflex culturing would have prevented 1/13 CAUTIs. Conclusion Reflex culturing canceled 16%-51% of cultures ordered with greatest impact in acute care and the ED and a small absolute increase in LTC. CAUTI rates did not change although reflex culturing would have prevented 29% of CAUTIs in acute care and 8% in LTC. Disclosures All authors: No reported disclosures.

scholarly journals Preventing Transmission of Multidrug-Resistant Bacteria in Health Care Settings: A Tale of Two Guidelines

2006 ◽  
Vol 42 (6) ◽  
pp. 828-835 ◽  
Author(s):  
L. J. Strausbaugh ◽  
J. D. Siegel ◽  
R. A. Weinstein ◽  
R. A. Weinstein
Keyword(s):  
Health Care ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Health Care Settings

Consensus guideline on parenteral methadone use in pain and palliative care

2008 ◽  
Vol 6 (2) ◽  
pp. 165-176 ◽  
Author(s):  
Lauren Shaiova ◽  
Ann Berger ◽  
Craig D. Blinderman ◽  
Eduardo Bruera ◽  
Mellar P. Davis ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Pain Management ◽  
Hospice Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Chronic Pain Management ◽  
Consensus Guideline ◽  
Term Care ◽  
Line Therapy

ABSTRACTOnce used only as third-line therapy for chronic pain management, methadone is now being used as first- and second-line therapy in palliative care. The risks and stigma associated with methadone use are known, but difficulties with dosing methadone and lack of an established conversion protocol from other opiates have limited the access for patient populations who could potentially benefit from this medication. For palliative care patients, the benefits of methadone can far outweigh its risks. This article provides an overview and specific recommendations on the use of parenteral methadone in pain and palliative care, with a focus on the transition from hospital to home/hospice care. The goal of this consensus guideline is to assist clinicians who are providing chronic pain management in acute care hospital and nonhospital settings (i.e., hospice, long-term care facilities, and community) for patients with life-limiting illnesses, where the goals of care are focused on comfort (i.e., palliative care). The recommendations in this article intend to promote a standard of care involving the use of intravenous methadone with the aim of reaching a broader population of patients for whom this drug would provide important benefits.

Sign in / Sign up

Export Citation Format

Share Document