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Find video protocols related to scientific articles indexed in Pubmed.
Emotion circuits differentiate symptoms of psychosis versus mania in adolescents.
Neurocase
PUBLISHED: 09-30-2014
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The diagnostic boundary between schizophrenia and bipolar disorder can be unclear, particularly with early onset. We assessed if emotion brain circuits differentiate psychosis versus mania symptoms in a series of six early onset patients. Symptoms were dissociated by direction, awareness condition, and brain regions. Greater psychosis symptoms were correlated with greater prefrontal, anterior cingulate, amygdala, and fusiform face area activation during masked fear processing. By contrast, greater mania symptoms were correlated with less amygdala activation during unmasked fear and happy processing. This suggests emotion dysfunction in schizophrenia versus bipolar disorder may arise from partially distinct neural mechanisms of susceptibility.
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Facial emotion identification in early-onset and first-episode psychosis: a systematic review with meta-analysis.
Schizophr. Res.
PUBLISHED: 08-30-2014
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Patients with chronic schizophrenia are characterized by deficits in identifying facial expressions of emotion, and these deficits relate to impaired social and occupational function. It is not yet known if these deficits are trait-like and present at the onset of psychosis, preceding a subsequent diagnosis of schizophrenia. Our objective was to systematically review and analyze the extant literature to assess if there is a consistent profile of emotion identification problems in early-onset and first-episode psychosis.
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Modeling companion diagnostics in economic evaluations of targeted oncology therapies: systematic review and methodological checklist.
Expert Rev. Mol. Diagn.
PUBLISHED: 08-21-2014
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The successful use of a targeted therapy is intrinsically linked to the ability of a companion diagnostic to correctly identify patients most likely to benefit from treatment. The aim of this study was to review the characteristics of companion diagnostics that are of importance for inclusion in an economic evaluation. Approaches for including these characteristics in model-based economic evaluations are compared with the intent to describe best practice methods. Five databases and government agency websites were searched to identify model-based economic evaluations comparing a companion diagnostic and subsequent treatment strategy to another alternative treatment strategy with model parameters for the sensitivity and specificity of the companion diagnostic (primary synthesis). Economic evaluations that limited model parameters for the companion diagnostic to only its cost were also identified (secondary synthesis). Quality was assessed using the Quality of Health Economic Studies instrument. 30 studies were included in the review (primary synthesis n = 12; secondary synthesis n = 18). Incremental cost-effectiveness ratios may be lower when the only parameter for the companion diagnostic included in a model is the cost of testing. Incorporating the test's accuracy in addition to its cost may be a more appropriate methodological approach. Altering the prevalence of the genetic biomarker, specific population tested, type of test, test accuracy and timing/sequence of multiple tests can all impact overall model results. The impact of altering a test's threshold for positivity is unknown as it was not addressed in any of the included studies. Additional quality criteria as outlined in our methodological checklist should be considered due to the shortcomings of standard quality assessment tools in differentiating studies that incorporate important test-related characteristics and those that do not. There is a need to refine methods for incorporating the characteristics of companion diagnostics into model-based economic evaluations to ensure consistent and transparent reimbursement decisions are made.
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Preventing the transmission of multidrug-resistant organisms: modeling the relative importance of hand hygiene and environmental cleaning interventions.
Infect Control Hosp Epidemiol
PUBLISHED: 07-25-2014
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Hand hygiene and environmental cleaning are essential infection prevention strategies, but the relative impact of each is unknown. This information is important in assessing resource allocation.
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Difficulties in demonstrating superiority of an antibiotic for multidrug-resistant bacteria in nonrandomized studies.
Clin. Infect. Dis.
PUBLISHED: 06-30-2014
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The discovery and development of new antimicrobials is critically important, especially as multidrug-resistant bacteria continue to emerge. Little has been written about the epidemiological issues in nonrandomized trials aiming to evaluate the superiority of one antibiotic over another. In this manuscript, we outline some of the methodological difficulties in demonstrating superiority and discuss potential approaches to these problems. Many of the difficulties arise due to confounding by indication, which we define and explain. Epidemiological methods including restriction, matching, stratification, multivariable regression, propensity scores, and instrumental variables are discussed.
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A comparison of glycosaminoglycan distributions, keratan sulphate sulphation patterns and collagen fibril architecture from central to peripheral regions of the bovine cornea.
Matrix Biol.
PUBLISHED: 06-20-2014
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This study investigated changes in collagen fibril architecture and the sulphation status of keratan sulphate (KS) glycosaminoglycan (GAG) epitopes from central to peripheral corneal regions. Freshly excised adult bovine corneal tissue was examined as a function of radial position from the centre of the cornea outwards. Corneal thickness, tissue hydration, hydroxyproline content, and the total amount of sulphated GAG were all measured. High and low-sulphated epitopes of keratan sulphate were studied by immunohistochemistry and quantified by ELISA. Chondroitin sulphate (CS) and dermatan sulphate (DS) distributions were observed by immunohistochemistry following specific enzyme digestions. Electron microscopy and X-ray fibre diffraction were used to ascertain collagen fibril architecture. The bovine cornea was 1021±5.42 ?m thick at its outer periphery, defined as 9-12 mm from the corneal centre, compared to 844±8.10 ?m at the centre. The outer periphery of the cornea was marginally, but not significantly, more hydrated than the centre (H=4.3 vs. H=3.7), and was more abundant in hydroxyproline (0.12 vs. 0.06 mg/mg dry weight of cornea). DMMB assays indicated no change in the total amount of sulphated GAG across the cornea. Immunohistochemistry revealed the presence of both high- and low-sulphated epitopes of KS, as well as DS, throughout the cornea, and CS only in the peripheral cornea before the limbus. Quantification by ELISA, disclosed that although both high- and low-sulphated KS remained constant throughout stromal depth at different radial positions, high-sulphated epitopes remained constant from the corneal centre to outer-periphery, whereas low-sulphated epitopes increased significantly. Both small angle X-ray diffraction and TEM analysis revealed that collagen fibril diameter remained relatively constant until the outer periphery was reached, after which fibrils became more widely spaced (from small angle x-ray diffraction analysis) and of larger diameter as they approached the sclera. Depth-profiled synchrotron microbeam analyses showed that, at different radial positions from the corneal centre outwards, fibril diameter was greater superficially than in deeper stromal regions. The interfibrillar spacing was also higher at mid-depth in the stroma than it was in anterior and posterior stromal regions. Collagen fibrils in the bovine cornea exhibited a fairly consistent spacing and diameter from the corneal centre to the 12 mm radial position, after which a significant increase was seen. While the constancy of the overall sulphation levels of proteoglycans in the cornea may correlate with the fibrillar architecture, there was no correlation between the latter and the distribution of low-sulphated KS.
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Comparative genomics of an IncA/C multidrug resistance plasmid from Escherichia coli and Klebsiella isolates from intensive care unit patients and the utility of whole-genome sequencing in health care settings.
Antimicrob. Agents Chemother.
PUBLISHED: 06-09-2014
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The IncA/C plasmids have been implicated for their role in the dissemination of ?-lactamases, including gene variants that confer resistance to expanded-spectrum cephalosporins, which are often the treatment of last resort against multidrug-resistant, hospital-associated pathogens. A bla(FOX-5) gene was detected in 14 Escherichia coli and 16 Klebsiella isolates that were cultured from perianal swabs of patients admitted to an intensive care unit (ICU) of the University of Maryland Medical Center (UMMC) in Baltimore, MD, over a span of 3 years. Four of the FOX-encoding isolates were obtained from subsequent samples of patients that were initially negative for an AmpC ?-lactamase upon admission to the ICU, suggesting that the AmpC ?-lactamase-encoding plasmid was acquired while the patient was in the ICU. The genomes of five E. coli isolates and six Klebsiella isolates containing bla(FOX-5) were selected for sequencing based on their plasmid profiles. An ? 167-kb IncA/C plasmid encoding the FOX-5 ?-lactamase, a CARB-2 ?-lactamase, additional antimicrobial resistance genes, and heavy metal resistance genes was identified. Another FOX-5-encoding IncA/C plasmid that was nearly identical except for a variable region associated with the resistance genes was also identified. To our knowledge, these plasmids represent the first FOX-5-encoding plasmids sequenced. We used comparative genomics to describe the genetic diversity of a plasmid encoding a FOX-5 ?-lactamase relative to the whole-genome diversity of 11 E. coli and Klebsiella isolates that carry this plasmid. Our findings demonstrate the utility of whole-genome sequencing for tracking of plasmid and antibiotic resistance gene distribution in health care settings.
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Survey of infection prevention informatics use and practitioner satisfaction in US hospitals.
Infect Control Hosp Epidemiol
PUBLISHED: 05-15-2014
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We surveyed hospital epidemiologists and infection preventionists on their usage of and satisfaction with infection prevention-specific software supplementing their institution's electronic medical record. Respondents with supplemental software were more satisfied with their software's infection prevention and antimicrobial stewardship capabilities than those without. Infection preventionists were more satisfied than hospital epidemiologists.
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The evolving landscape of healthcare-associated infections: recent advances in prevention and a road map for research.
Infect Control Hosp Epidemiol
PUBLISHED: 04-09-2014
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This white paper identifies knowledge gaps and new challenges in healthcare epidemiology research, assesses the progress made toward addressing research priorities, provides the Society for Healthcare Epidemiology of America (SHEA) Research Committee's recommendations for high-priority research topics, and proposes a road map for making progress toward these goals. It updates the 2010 SHEA Research Committee document, "Charting the Course for the Future of Science in Healthcare Epidemiology: Results of a Survey of the Membership of SHEA," which called for a national approach to healthcare-associated infections (HAIs) and a prioritized research agenda. This paper highlights recent studies that have advanced our understanding of HAIs, the establishment of the SHEA Research Network as a collaborative infrastructure to address research questions, prevention initiatives at state and national levels, changes in reporting and payment requirements, and new patterns in antimicrobial resistance.
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Neural processing of facial expressions of emotion in first onset psychosis.
Psychiatry Res
PUBLISHED: 03-26-2014
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Schizophrenia is characterized by deficits in face and facial emotion processing. This is the first study using event-related potentials (ERPs) to investigate the corresponding neural activation in first onset psychosis. ERPs for 108 first onset psychosis participants and 108 matched healthy controls were recorded while they viewed facial expressions. Group differences on general (neutral) face processing and emotional valence were examined under both unmasked (conscious) and backward-masked (nonconscious implicit) conditions over frontal and temporo-occipital regions. Clinical significance was assessed by comparing diagnoses and correlating ERPs with symptoms. During general face processing, patients showed reduced activation within 70 ms and exaggerated later processing from 160 ms over the frontal region, with a negative shift in voltage over left temporal and occipital regions across the time course. In addition, from 70 ms onwards, patients showed a positive shift in voltage for disgust whereas controls showed a negative shift in voltage for fear and anger (both compared to happy) over temporo-occipital regions. Effects were related to disorganization and depression symptoms and (preliminarily) were apparent across psychotic diagnoses. These results suggest that first onset psychosis is characterized by general as well as emotion-specific face processing impairments from the earliest, automatic processing period.
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Comparative transcriptomics of early meiosis in Arabidopsis and maize.
J Genet Genomics
PUBLISHED: 03-25-2014
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Though sexually reproductive plants share the same principle and most processes in meiosis, there are distinct features detectable. To address the similarities and differences of early meiosis transcriptomes from the dicot model system Arabidopsis and monocot model system maize, we performed comparative analyses of RNA-seq data of isolated meiocytes, anthers and seedlings from both species separately and via orthologous genes. Overall gene expression showed similarities, such as an increased number of reads mapping to unannotated features, and differences, such as the amount of differentially expressed genes. We detected major similarities and differences in functional annotations of genes up-regulated in meiocytes, which point to conserved features as well as unique features. Transcriptional regulation seems to be quite similar in Arabidopsis and maize, and we could reveal known and novel transcription factors and cis-regulatory elements acting in early meiosis. Taken together, meiosis between Arabidopsis and maize is conserved in many ways, but displays key distinctions that lie in the patterns of gene expression.
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Frequency of Klebsiella pneumoniae carbapenemase (KPC)-producing and non-KPC-producing Klebsiella species contamination of healthcare workers and the environment.
Infect Control Hosp Epidemiol
PUBLISHED: 03-08-2014
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We examined contamination of healthcare worker (HCW) gown and gloves after caring for patients with Klebsiella pneumoniae carbapenemase (KPC)-producing and non-KPC-producing Klebsiella as a proxy for horizontal transmission. The rate of contamination with Klebsiella species is similar to that of contamination with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus, with 31 (14%) of 220 of HCW-patient interactions resulting in contamination of gloves and gowns.
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Variation in definitions and isolation procedures for multidrug-resistant Gram-negative bacteria: a survey of the Society for Healthcare Epidemiology of America Research Network.
Infect Control Hosp Epidemiol
PUBLISHED: 03-08-2014
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To assess definitions, experience, and infection control practices for multidrug-resistant gram-negative bacteria (MDR-GNB), including Enterobacteriaceae, Acinetobacter, and Pseudomonas species, in acute care hospitals.
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Systematic meta-analysis of outcomes associated with psychosis and co-morbid substance use.
Aust N Z J Psychiatry
PUBLISHED: 03-03-2014
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To compare the symptoms and social function of patients with psychosis and current substance use to those with psychosis and no history of substance use.
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A synthesis of drug reimbursement decision-making processes in organisation for economic co-operation and development countries.
Value Health
PUBLISHED: 01-21-2014
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The use of a restrictive formulary, with placement determined through a drug-reimbursement decision-making process, is one approach to managing drug expenditures.
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Prior colonization is associated with increased risk of antibiotic-resistant Gram-negative bacteremia in cancer patients.
Diagn. Microbiol. Infect. Dis.
PUBLISHED: 01-13-2014
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We hypothesized that prior colonization with antibiotic-resistant Gram-negative bacteria is associated with increased risk of subsequent antibiotic-resistant Gram-negative bacteremia among cancer patients. We performed a matched case-control study. Cases were cancer patients with a blood culture positive for antibiotic-resistant Gram-negative bacteria. Controls were cancer patients with a blood culture not positive for antibiotic-resistant Gram-negative bacteria. Prior colonization was defined as any antibiotic-resistant Gram-negative bacteria in surveillance or non-sterile-site cultures obtained 2-365 days before the bacteremia. Thirty-two (37%) of 86 cases and 27 (8%) of 323 matched controls were previously colonized by any antibiotic-resistant Gram-negative bacteria. Prior colonization was strongly associated with antibiotic-resistant Gram-negative bacteremia (odds ratio [OR] 7.2, 95% confidence interval [CI] 3.5-14.7) after controlling for recent treatment with piperacillin-tazobactam (OR 2.5, 95% CI 1.3-4.8). In these patients with suspected bacteremia, prior cultures may predict increased risk of antibiotic-resistant Gram-negative bacteremia.
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The impact of melancholia versus non-melancholia on resting-state, EEG alpha asymmetry: electrophysiological evidence for depression heterogeneity.
Psychiatry Res
PUBLISHED: 01-09-2014
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While depression has been associated with relatively greater right than left frontal cortical activity - a neurophysiological marker reflecting greater activation of the withdrawal system - contradictory findings have been reported. It was hypothesised that melancholia would be associated with relative right frontal activation, in comparison to non-melancholia and controls. We collected 2-min of resting-state, eyes closed, electroencephalographic activity from a total of 237 participants including 117 patients with major depressive disorder (57 with melancholia, 60 with non-melancholia) and 120 healthy controls. In contrast to hypotheses, patients with non-melancholia displayed relative left frontal activation in comparison to controls and those with melancholia. These findings were associated with a small to moderate effect size (Cohen's d=0.30-0.34). Critically, patients with melancholic subtype did not differ from controls despite increased severity - relative to those with non-melancholia - on clinical measures. These results may reflect an increase in approach tendencies in patients with non-melancholia including reassurance seeking, anger or irritable aggression. Findings highlight the need for further research on the heterogeneity MDD.
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Characterization of Klebsiella sp. strain 10982, a colonizer of humans that contains novel antibiotic resistance alleles and exhibits genetic similarities to plant and clinical Klebsiella isolates.
Antimicrob. Agents Chemother.
PUBLISHED: 01-06-2014
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A unique Klebsiella species strain, 10982, was cultured from a perianal swab specimen obtained from a patient in the University of Maryland Medical Center intensive care unit. Klebsiella sp. 10982 possesses a large IncA/C multidrug resistance plasmid encoding a novel FOX AmpC ?-lactamase designated FOX-10. A novel variant of the LEN ?-lactamase was also identified. Genome sequencing and bioinformatic analysis demonstrated that this isolate contains genes associated with nitrogen fixation, allantoin metabolism, and citrate fermentation. These three gene regions are typically present in either Klebsiella pneumoniae clinical isolates or Klebsiella nitrogen-fixing endophytes but usually not in the same organism. Phylogenomic analysis of Klebsiella sp. 10982 and sequenced Klebsiella genomes demonstrated that Klebsiella sp. 10982 is present on a branch that is located intermediate between the genomes of nitrogen-fixing endophytes and K. pneumoniae clinical isolates. Metabolic features identified in the genome of Klebsiella sp. 10982 distinguish this isolate from other Klebsiella clinical isolates. These features include the nitrogen fixation (nif) gene cluster, which is typically present in endophytic Klebsiella isolates and is absent from Klebsiella clinical isolates. Additionally, the Klebsiella sp. 10982 genome contains genes associated with allantoin metabolism, which have been detected primarily in K. pneumoniae isolates from liver abscesses. Comparative genomic analysis of Klebsiella sp. 10982 demonstrated that this organism has acquired genes conferring new metabolic strategies and novel antibiotic resistance alleles, both of which may enhance its ability to colonize the human body.
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A systematic review of cost-sharing strategies used within publicly-funded drug plans in member countries of the organisation for economic co-operation and development.
PLoS ONE
PUBLISHED: 01-01-2014
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Publicly-funded drug plans vary in strategies used and policies employed to reduce continually increasing pharmaceutical expenditures. We systematically reviewed the utilization of cost-sharing strategies and physician-directed prescribing regulations in publicly-funded formularies within member nations of the Organization of Economic Cooperation and Development (OECD).
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Autobiographical and Subjective Memory With Right Unilateral High-Dose 0.3-millisecond Ultrabrief-Pulse and 1-millisecond Brief-Pulse Electroconvulsive Therapy: A Double-blind, Randomized Controlled Trial.
J ECT
PUBLISHED: 11-23-2013
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Shortening the pulse width to 0.3 millisecond holds neurophysiological and clinical promise of making electroconvulsive therapy (ECT) safer by reducing cognitive adverse effects. The exclusive effects of pulse width on autobiographical and subjective memory are largely unstudied. The aim was to principally investigate during the acute ECT course and at 3 months after ECT autobiographical and subjective memory effects of 0.3-millisecond ultrabrief and 1-millisecond brief-pulse ECT.
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Multiomics medicine in oncology: assessing effectiveness, cost-effectiveness and future research priorities for the molecularly unique individual.
Pharmacogenomics
PUBLISHED: 09-13-2013
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The development of genomic technologies has ushered in the era of pharmacogenomics. However, discoveries and clinical use of targeted therapies are still in their infancy. A focus on monogenic pharmacogenetic traits may contribute to this lack of progress. Variation in drug response is likely a complex paradigm involving not only genomic factors but proteomic, metabolomic and epigenomic influences. The incorporation of these omics elements into pharmaceutical development and clinical decision-making will ultimately require the use of methods to determine clinical and economic value. Current methodologies and guidelines for determining clinical effectiveness and cost-effectiveness may have limited applicability to the increasingly personalized nature of omics treatment strategies. Using examples from oncology, this article argues for the adaptation and tailoring of three existing methods for ensuring development and clinical use of multiomics-guided therapies that are effective, safe and offer value for money.
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Effects of contact precautions on patient perception of care and satisfaction: a prospective cohort study.
Infect Control Hosp Epidemiol
PUBLISHED: 08-23-2013
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Contact precautions decrease healthcare worker-patient contact and may impact patient satisfaction. To determine the association between contact precautions and patient satisfaction, we used a standardized interview for perceived issues with care.
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Changes in transfusion practice over time in the PICU.
Pediatr Crit Care Med
PUBLISHED: 08-22-2013
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Recent randomized clinical trials have shown the efficacy of a restrictive transfusion strategy in critically ill children. The impact of these trials on pediatric transfusion practice is unknown. Additionally, long-term trends in pediatric transfusion practice in the ICU have not been described. We assessed transfusion practice over time, including the effect of clinical trial publication.
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Less is more: combination antibiotic therapy for the treatment of gram-negative bacteremia in pediatric patients.
JAMA Pediatr
PUBLISHED: 08-08-2013
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Definitive combination antibiotic therapy with a ?-lactam and an aminoglycoside for the treatment of gram-negative bacteremia is commonly prescribed in pediatric patients; however, its efficacy and toxicity relative to ?-lactam monotherapy are unknown.
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Functional dysconnectivity in schizophrenia and its relationship to neural synchrony.
Expert Rev Neurother
PUBLISHED: 08-01-2013
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Schizophrenia is a debilitating disorder of unknown cause. There is increasing momentum to consider functional dysconnectivity as an endophenotype of schizophrenia, and in particular, how it relates to cognition as a core feature of the disorder. Here, the authors review the conceptual models of functional dysconnectivity in schizophrenia to date, the evidence they are based on and some of the limitations of these models. The authors then propose neural synchrony as a potential mechanism for functional dysconnectivity and review the current state of evidence for a link between neural synchrony and cognition in schizophrenia across behavioral, physiological, brain imaging, neurochemical and neurogenetic units of enquiry. The authors conclude by outlining the unmet needs in this field and give an outlook on how to fill these gaps.
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Comparison of total hospital-acquired bloodstream infections to central line-associated bloodstream infections and implications for outcome measures in infection control.
Infect Control Hosp Epidemiol
PUBLISHED: 07-25-2013
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The validity of the central line-associated bloodstream infection (CLABSI) measure is compromised by subjectivity. We observed significant decreases in both CLABSIs and total hospital-acquired bloodstream infections (BSIs) following a CLABSI prevention intervention in adult intensive care units. Total hospital-acquired BSIs could be explored as an adjunct, objective CLABSI measure.
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Visual Search for Color and Shape: When Is the Gaze Guided by Feature Relationships, When by Feature Values?
J Exp Psychol Hum Percept Perform
PUBLISHED: 07-22-2013
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One of the most widespread views in vision research is that top-down control over visual selection is achieved by tuning attention to a particular feature value (e.g., red/yellow). Contrary to this view, previous spatial cueing studies showed that attention can be tuned to relative features of a search target (e.g., redder): An irrelevant distractor (cue) captured attention when it had the same relative color as the target (e.g., redder), and failed to capture when it had a different relative color, regardless of whether the distractor was similar or dissimilar to the target. The present study tested whether the same effects would be observed for eye movements when observers have to search for a color or shape target and when selection errors were very noticeable (resulting in an erroneous eye movement to the distractor). The results corroborated the previous findings, showing that capture by an irrelevant distractor does not depend on the distractors similarity to the target but on whether it matches or mismatches the relative attributes of the search target. Extending on previous work, we also found that participants can be pretrained to select a color target in virtue of its exact feature value. Contrary to the prevalent feature-based view, the results suggest that visual selection is preferentially biased toward the relative attributes of a search target. Simultaneously, however, visual selection can be biased to specific color values when the task requires it, which rules out a purely relational account of attention and eye movements. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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Does health care role and experience influence perception of safety culture related to preventing infections?
Am J Infect Control
PUBLISHED: 07-02-2013
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Growing evidence reveals the importance of improving safety culture in efforts to eliminate health care-associated infections. This multisite, cross-sectional survey examined the association between professional role and health care experience on infection prevention safety culture at 5 hospitals. The findings suggest that frontline health care technicians are less directly engaged in improvement efforts and safety education than other staff and that infection prevention safety culture varies more by hospital than by staff position and experience.
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The use of cefepime for treating AmpC ?-lactamase-producing Enterobacteriaceae.
Clin. Infect. Dis.
PUBLISHED: 06-11-2013
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?AmpC ?-lactamase-producing organisms are associated with significant morbidity and mortality. Induction of resistance to third-generation cephalosporins after exposure to these agents complicates treatment options and carbapenems are considered optimal therapy. The role of cefepime, however, remains unclear. Our objective was to compare clinical outcomes for patients receiving cefepime compared with meropenem for invasive infections caused by organisms expressing AmpC ?-lactamases. METHODs: ?Hospitalized patients with blood, bronchoalveolar lavage, or intra-abdominal fluid cultures growing Enterobacter spp, Serratia spp, or Citrobacter spp were evaluated using the cefotetan-boronic acid disk test and the cefotetan-cloxacillin Etest to identify organisms with AmpC ?-lactamase production from February 2010 to January 2011. In patients with organisms hyperproducing AmpC ?-lactamases (positive by both methods), clinical outcomes for patients receiving cefepime or meropenem therapy were compared. To minimize the possibility of treatment selection bias, 1:1 nearest neighbor propensity score matching was performed prior to regression analysis.
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Respiratory therapy organizational changes are associated with increased respiratory care utilization.
Respir Care
PUBLISHED: 05-31-2013
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The effect of the respiratory therapist (RT)/patient ratio and RT organizational factors on respiratory resource utilization is unknown. We describe the impact of a multi-component intervention that called for an increase in RT/patient ratio (1:14 to 1:10), improved RT orientation, and formation of a core staffing model on best practice, including spontaneous breathing trials (SBTs) and catheter and bronchoscopically directed lower respiratory tract cultures, or bronchoalveolar lavage (BAL), in both ventilated and non-ventilated patients in the ICU.
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Feature specificity in attentional capture by size and color.
J Vis
PUBLISHED: 05-08-2013
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Top-down guidance of visual attention has classically been thought to operate in a feature-specific manner. However, recent studies have shown that top-down visual attention can also be guided by information about target-nontarget feature relations (e.g., larger, redder, brighter). Here we recommend a minimal set of cues for differentiating between relational and feature-specific attentional guidance and examine contrasting predictions for the guidance of attention by size and color stimuli in a spatial cueing paradigm. In Experiment 1 we demonstrate that in search for size, when both feature-specific and relational strategies are available, participants adopt a relational search strategy. Experiment 2 shows that when feature-specific information is the only reliable information to guide attention to the target, participants are able to adopt a feature-specific set for size information. Finally, in Experiment 3 we extend our paradigm to differentiate between feature-specific and relational strategies in search for color. Together, these experiments help to clarify the conditions under which different attentional guidance strategies will be employed, and demonstrate a useful minimum cue requirement for differentiating between these two forms of top-down guidance. Implications for current theories of attention are discussed.
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Psychiatrists and GPs: diagnostic decision making, personality profiles and attitudes toward depression and anxiety.
Australas Psychiatry
PUBLISHED: 04-25-2013
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The objective of this article is to explore diagnostic decision making around psychological symptoms presenting to general practitioners (GPs) and psychiatrists, identify attitudinal and personality factors of possible relevance in these decisions, and compare GPs and psychiatrists to help identify potential educational targets.
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Accuracy of a radiofrequency identification (RFID) badge system to monitor hand hygiene behavior during routine clinical activities.
Am J Infect Control
PUBLISHED: 04-19-2013
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Hand hygiene (HH) is a critical part of infection prevention in health care settings. Hospitals around the world continuously struggle to improve health care personnel (HCP) HH compliance. The current gold standard for monitoring compliance is direct observation; however, this method is time-consuming and costly. One emerging area of interest involves automated systems for monitoring HH behavior such as radiofrequency identification (RFID) tracking systems.
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A randomized controlled trial of enhanced cleaning to reduce contamination of healthcare worker gowns and gloves with multidrug-resistant bacteria.
Infect Control Hosp Epidemiol
PUBLISHED: 04-11-2013
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OBJECTIVE.?To determine whether enhanced daily cleaning would reduce contamination of healthcare worker (HCW) gowns and gloves with methicillin-resistant Staphylococcus aureus (MRSA) or multidrug-resistant Acinetobacter baumannii (MDRAB). DESIGN.?A cluster-randomized controlled trial. SETTING.?Four intensive care units (ICUs) in an urban tertiary care hospital. PARTICIPANTs.?ICU rooms occupied by patients colonized with MRSA or MDRAB. INTERVENTION.?Extra enhanced daily cleaning of ICU room surfaces frequently touched by HCWs. RESULTS.?A total of 4,444 cultures were collected from 132 rooms over 10 months. Using fluorescent dot markers at 2,199 surfaces, we found that 26% of surfaces in control rooms were cleaned and that 100% of surfaces in experimental rooms were cleaned (P < .001). The mean proportion of contaminated HCW gowns and gloves following routine care provision and before leaving the rooms of patients with MDRAB was 16% among control rooms and 12% among experimental rooms (relative risk, 0.77 [95% confidence interval, 0.28-2.11]; P = .23). For MRSA, the mean proportions were 22% and 19%, respectively (relative risk, 0.89 [95% confidence interval, 0.50-1.53]; P = .16). DISCUSSION.?Intense enhanced daily cleaning of ICU rooms occupied by patients colonized with MRSA or MDRAB was associated with a nonsignificant reduction in contamination of HCW gowns and gloves after routine patient care activities. Further research is needed to determine whether intense environmental cleaning will lead to significant reductions and fewer infections.
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Risk of acquiring extended-spectrum ?-lactamase-producing Klebsiella species and Escherichia coli from prior room occupants in the intensive care unit.
Infect Control Hosp Epidemiol
PUBLISHED: 04-11-2013
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OBJECTIVE.?To quantify the association between admission to an intensive care unit (ICU) room most recently occupied by a patient positive for extended-spectrum ?-lactamase (EBSL)-producing gram-negative bacteria and acquisition of infection or colonization with that pathogen. DESIGN.?Retrospective cohort study. SETTING AND PATIENTS.?The study included patients admitted to medical and surgical ICUs of an academic medical center between September 1, 2001, and June 30, 2009. METHODS.?Perianal surveillance cultures were obtained at admission to the ICU, weekly, and at discharge from the ICU. Patients were included if they had culture results that were negative for ESBL-producing gram-negative bacteria at ICU admission and had an ICU length of stay longer than 48 hours. Pulsed-field gel electrophoresis (PFGE) was performed on ESBL-positive isolates from patients who acquired the same bacterial species (eg, Klebsiella species or Escherichia coli) as the previous room occupant. RESULTS.?Among 9,371 eligible admissions (7,651 unique patients), 267 (3%) involved patients who acquired an ESBL-producing pathogen in the ICU; of these patients, 32 (12%) were hospitalized in a room in which the prior occupant had been positive for ESBL. Logistic regression results suggested that the prior occupants ESBL status was not significantly associated with acquisition of an ESBL-producing pathogen (adjusted odds ratio, 1.39 [95% confidence interval, 0.94-2.08]) after adjusting for colonization pressure and antibiotic exposure in the ICU. PFGE results suggested that 6 (18%) of 32 patients acquired a bacterial strain that was the same as or closely related to the strain obtained from the prior occupant. CONCLUSIONs.?These data suggest that environmental contamination may not play a substantial role in the transmission of ESBL-producing pathogens among ICU patients. Intensifying environmental decontamination may be less effective than other interventions in preventing transmission of ESBL-producing pathogens.
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A comparison of directly elicited and pre-scored preference-based measures of quality of life: the case of adhesive capsulitis.
Qual Life Res
PUBLISHED: 04-10-2013
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To assess the convergent validity and comparative responsiveness in measuring the health-related quality of life associated with adhesive capsulitis of a disease-specific measure (Shoulder Pain and Disability Index), a generic quality of life measure (SF-36), a preference-based multi-attribute utility scale (assessment of quality of life), and two direct patient preference elicitation methods (willingness to pay and time trade-off).
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Using multiple methods to characterize the phenotype of individuals with a family history of major depressive disorder.
J Affect Disord
PUBLISHED: 02-21-2013
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Unaffected relatives (URs) of individuals with major depressive disorder (MDD) are biologically more vulnerable to depression. We compare healthy URs and controls at the level of phenotype (symptoms and functioning) and endophenotype (negative emotion bias), and further investigate the interrelation between these and the contribution of environmental early life stress.
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An open clinical trial assessing a novel training program for social cognitive impairment in schizophrenia.
Australas Psychiatry
PUBLISHED: 02-14-2013
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Social cognition is profoundly impaired in patients with schizophrenia. This study describes Mental-State Reasoning Training for Social Cognitive Impairment (SoCog-MSRT), a 5-week program developed to improve social cognition in patients with schizophrenia. We aimed to investigate the feasibility of implementing SoCog-MSRT in a rehabilitation setting and to evaluate whether our training methods produced improvements. METHOD The feasibility and benefits of SoCog-MSRT were evaluated in an open clinical trial with 14 participants with schizophrenia or schizoaffective disorder. Training comprised 10 twice-weekly sessions, for 5 weeks, with a pre- and post-training assessment.
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Brain imaging predictors and the international study to predict optimized treatment for depression: study protocol for a randomized controlled trial.
Trials
PUBLISHED: 02-04-2013
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Approximately 50% of patients with major depressive disorder (MDD) do not respond optimally to antidepressant treatments. Given this is a large proportion of the patient population, pretreatment tests that predict which patients will respond to which types of treatment could save time, money and patient burden. Brain imaging offers a means to identify treatment predictors that are grounded in the neurobiology of the treatment and the pathophysiology of MDD.
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Depression, anxiety, and moods of hospitalized patients under contact precautions.
Infect Control Hosp Epidemiol
PUBLISHED: 01-23-2013
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To determine the association between contact precautions and depression or anxiety as well as feelings of anger, sadness, worry, happiness, or confusion.
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Do former substance users with psychosis differ in their symptoms or function from non-substance users? A systematic meta-analysis.
Aust N Z J Psychiatry
PUBLISHED: 01-22-2013
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To compare the symptoms and function of patients with psychosis who have ceased using substances to those who have psychosis but do not have a history of substance use.
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Is hand hygiene before putting on nonsterile gloves in the intensive care unit a waste of health care worker time?--a randomized controlled trial.
Am J Infect Control
PUBLISHED: 01-10-2013
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Hand hygiene (HH) is recognized as a basic effective measure in prevention of nosocomial infections. However, the importance of HH before donning nonsterile gloves is unknown, and few published studies address this issue. Despite the lack of evidence, the World Health Organization and other leading bodies recommend this practice. The aim of this study was to assess the utility of HH before donning nonsterile gloves prior to patient contact.
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Acute antidepressant effects of right unilateral ultra-brief ECT: a double-blind randomised controlled trial.
J Affect Disord
PUBLISHED: 01-01-2013
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Shortening the pulse width to 0.3 ms holds neurophysiological and clinical promise of making ECT safer by limiting cognitive side effects. However, the antidepressant effects of right ultra-brief unilateral ECT are under contention. In an acute ECT course, antidepressant equivalence of ultra-brief right unilateral ECT to the high-dose brief pulse right unilateral ECT was investigated.
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Association between contact precautions and delirium at a tertiary care center.
Infect Control Hosp Epidemiol
PUBLISHED: 12-07-2011
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To investigate the relationship between contact precautions and delirium among inpatients, adjusting for other factors.
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Comparison of antidepressant effects between brief and ultrabrief pulse unilateral electroconvulsive therapy: brief report of a randomized double-blind trial.
J ECT
PUBLISHED: 11-30-2011
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Electroconvulsive therapy (ECT) treatments with briefer pulse widths have recently shown promise.
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Environmental contamination because of multidrug-resistant Acinetobacter baumannii surrounding colonized or infected patients.
Am J Infect Control
PUBLISHED: 11-02-2011
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Multidrug-resistant (MDR) Acinetobacter baumannii (MDR-AB) is an important nosocomial pathogen associated with significant morbidity and mortality.
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Web-based training improves knowledge about central line bloodstream infections.
Infect Control Hosp Epidemiol
PUBLISHED: 10-24-2011
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A Web-based training course with embedded video clips for reducing central line-associated bloodstream infections (CLABSIs) was evaluated and shown to improve clinician knowledge and retention of knowledge over time. To our knowledge, this is the first study to evaluate Web-based CLABSI training as a stand-alone intervention.
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Contribution of interfacility patient movement to overall methicillin-resistant Staphylococcus aureus prevalence levels.
Infect Control Hosp Epidemiol
PUBLISHED: 10-03-2011
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The effect of patient movement between hospitals and long-term care facilities (LTCFs) on methicillin-resistant Staphylococcus aureus (MRSA) prevalence levels is unknown. We investigated these effects to identify scenarios that may lead to increased prevalence in either facility type.
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Breaking up is hard to do: the economic impact of provisional funding contingent upon evidence development.
Health Econ Policy Law
PUBLISHED: 08-08-2011
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Funding contingent upon evidence development (FED) has recently been the subject of some considerable debate in the literature but relatively little has been made of its economic impact. We argue that FED has the potential to shorten the lag between innovation and access but may also (i) crowd-out more valuable interventions in situations in which there is a fixed dedicated budget; or (ii) lead to a de facto increase in the funding threshold and increased expenditure growth in situations in which the programme budget is open-ended. Although FED would typically entail periodic review of provisional or interim listings, it may prove difficult to withdraw funding even at cost/QALY ratios well in excess of current listing thresholds. Further consideration of the design and implementation of FED processes is therefore required to ensure that its introduction yields net benefits over existing processes.
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Risk factors for development of intestinal colonization with imipenem-resistant Pseudomonas aeruginosa in the intensive care unit setting.
Infect Control Hosp Epidemiol
PUBLISHED: 06-14-2011
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Risk factors for development of intestinal colonization by imipenem-resistant Pseudomonas aeruginosa (IRPA) may differ between those who acquire the organism via patient-to-patient transmission versus by antibiotic selective pressure. The aim of this study was to quantify potential risk factors for the development of IRPA not due to patient-to-patient transmission.
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Genomic comparison of multi-drug resistant invasive and colonizing Acinetobacter baumannii isolated from diverse human body sites reveals genomic plasticity.
BMC Genomics
PUBLISHED: 06-04-2011
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Acinetobacter baumannii has recently emerged as a significant global pathogen, with a surprisingly rapid acquisition of antibiotic resistance and spread within hospitals and health care institutions. This study examines the genomic content of three A. baumannii strains isolated from distinct body sites. Isolates from blood, peri-anal, and wound sources were examined in an attempt to identify genetic features that could be correlated to each isolation source.
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Outcomes of patients with planned initiation of hemodialysis in the IDEAL trial.
Contrib Nephrol
PUBLISHED: 05-23-2011
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In clinical practice there is considerable variation in the timing of initiation of dialysis. The IDEAL trial (Initiating Dialysis Early and Late study) showed that planned early initiation of dialysis in patients with stage 5 chronic kidney disease (CKD) was not associated with an improvement in clinical outcome, but was associated with increased costs. The predominant dialysis modality worldwide is hemodialysis (HD). This subanalysis of the IDEAL trial examined whether the timing of the initiation of dialysis in those who had chosen HD influenced survival and the occurrence of complications.
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Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial.
BMJ
PUBLISHED: 05-20-2011
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To assess the effect of lateral wedge insoles compared with flat control insoles on improving symptoms and slowing structural disease progression in medial knee osteoarthritis.
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Systematic review of measurement and adjustment for colonization pressure in studies of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and clostridium difficile acquisition.
Infect Control Hosp Epidemiol
PUBLISHED: 04-26-2011
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Colonization pressure is an important infection control metric. The aim of this study was to describe the definition and measurement of and adjustment for colonization pressure in nosocomial-acquisition risk factor studies of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile.
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Comparison of the methicillin-resistant Staphylococcus aureus acquisition among rehabilitation and nursing home residents.
Infect Control Hosp Epidemiol
PUBLISHED: 04-05-2011
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To assess risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition among extended care residents focusing on level of care (residential vs rehabilitation) and room placement with an MRSA-positive resident.
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Comparative effectiveness of nafcillin or cefazolin versus vancomycin in methicillin-susceptible Staphylococcus aureus bacteremia.
BMC Infect. Dis.
PUBLISHED: 03-16-2011
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The high prevalence of methicillin-resistant S. aureus (MRSA) has led clinicians to select antibiotics that have coverage against MRSA, usually vancomycin, for empiric therapy for suspected staphylococcal infections. Clinicians often continue vancomycin started empirically even when methicillin-susceptible S. aureus (MSSA) strains are identified by culture. However, vancomycin has been associated with poor outcomes such as nephrotoxicity, persistent bacteremia and treatment failure. The objective of this study was to compare the effectiveness of vancomycin versus the beta-lactam antibiotics nafcillin and cefazolin among patients with MSSA bacteremia. The outcome of interest for this study was 30-day in-hospital mortality.
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Staphylococcus aureus infections in US veterans, Maryland, USA, 1999-2008.
Emerging Infect. Dis.
PUBLISHED: 03-12-2011
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Trends in Staphylococcus aureus infections are not well described. To calculate incidence in overall S. aureus infection and invasive and noninvasive infections according to methicillin susceptibility and location, we conducted a 10-year population-based retrospective cohort study (1999-2008) using patient-level data in the Veterans Affairs Maryland Health Care System. We found 3,674 S. aureus infections: 2,816 (77%) were noninvasive; 2,256 (61%) were methicillin-resistant S. aureus (MRSA); 2,517 (69%) were community onset, and 1,157 (31%) were hospital onset. Sixty-one percent of noninvasive infections were skin and soft tissue infections; 1,112 (65%) of these were MRSA. Ten-year averaged incidence per 100,000 veterans was 749 (± 132 SD, range 549-954) overall, 178 (± 41 SD, range 114-259) invasive, and 571 (± 152 SD, range 364-801) noninvasive S. aureus infections. Incidence of all S. aureus infections significantly increased (p<0.001), driven by noninvasive, MRSA, and community-onset infections (p<0.001); incidence of invasive S. aureus infection significantly decreased (p<0.001).
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Decreased mortality resulting from a multicomponent intervention in a tertiary care medical intensive care unit.
Crit. Care Med.
PUBLISHED: 03-05-2011
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To evaluate whether a multicomponent intervention, particularly increasing staff, can achieve reductions in patient mortality in an already high-intensity, Leapfrog-compliant medical intensive care unit.
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Activation of the G-protein-coupled receptor 119: a conformation-based hypothesis for understanding agonist response.
J. Med. Chem.
PUBLISHED: 03-01-2011
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The synthesis and properties of the bridged piperidine (oxaazabicyclo) compounds 8, 9, and 11 are described. A conformational analysis of these structures is compared with the representative GPR119 ligand 1. These results and the differences in agonist pharmacology are used to formulate a conformation-based hypothesis to understand activation of the GPR119 receptor. We also show for these structures that the agonist pharmacology in rat masks the important differences in human pharmacology.
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Cost-effectiveness of initiating dialysis early: a randomized controlled trial.
Am. J. Kidney Dis.
PUBLISHED: 02-23-2011
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Planned early initiation of dialysis therapy based on estimated kidney function does not influence mortality and major comorbid conditions, but amelioration of symptoms may improve quality of life and decrease costs.
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Clinical reasoning sessions: back to the patient.
Clin Teach
PUBLISHED: 02-18-2011
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Problem-based learning (PBL) was developed as a facilitated small group learning process based around a clinical problem. Originally designed for pre-clinical years of medical education, its application across all years poses a number of difficulties, including the risk of reducing patient contact, providing a learning process that is skewed towards an understanding of pathophysiological processes, which may not be well understood in all areas of medicine, and failing to provide exposure to clinically relevant reasoning skills.
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The impact of Contact Isolation on the quality of inpatient hospital care.
PLoS ONE
PUBLISHED: 01-31-2011
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Contact Isolation is a common hospital infection prevention method that may improve infectious outcomes but may also hinder healthcare delivery.
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Increased mortality with accessory gene regulator (agr) dysfunction in Staphylococcus aureus among bacteremic patients.
Antimicrob. Agents Chemother.
PUBLISHED: 12-20-2010
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Accessory gene regulator (agr) dysfunction in Staphylococcus aureus has been associated with a longer duration of bacteremia. We aimed to assess the independent association between agr dysfunction in S. aureus bacteremia and 30-day in-hospital mortality. This retrospective cohort study included all adult inpatients with S. aureus bacteremia admitted between 1 January 2003 and 30 June 2007. Severity of illness prior to culture collection was measured using the modified acute physiology score (APS). agr dysfunction in S. aureus was identified semiquantitatively by using a ?-hemolysin production assay. Cox proportional hazard models were used to measure the association between agr dysfunction and 30-day in-hospital mortality, statistically adjusting for patient and pathogen characteristics. Among 814 patient admissions complicated by S. aureus bacteremia, 181 (22%) patients were infected with S. aureus isolates with agr dysfunction. Overall, 18% of patients with agr dysfunction in S. aureus died, compared to 12% of those with functional agr in S. aureus (P = 0.03). There was a trend toward higher mortality among patients with S. aureus with agr dysfunction (adjusted hazard ratio [HR], 1.34; 95% confidence interval [CI], 0.87 to 2.06). Among patients with the highest APS (scores of >28), agr dysfunction in S. aureus was significantly associated with mortality (adjusted HR, 1.82; 95% CI, 1.03 to 3.21). This is the first study to demonstrate an independent association between agr dysfunction and mortality among severely ill patients. The ?-hemolysin assay examining agr function may be a simple and inexpensive approach to predicting patient outcomes and potentially optimizing antibiotic therapy.
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Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol.
BMC Musculoskelet Disord
PUBLISHED: 09-28-2010
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Hip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function.
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Use of gloves and reduction of risk of injury caused by needles or sharp medical devices in healthcare workers: results from a case-crossover study.
Infect Control Hosp Epidemiol
PUBLISHED: 07-28-2010
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Standard precautions are advocated for reducing the number of injuries caused by needles and sharp medical devices ("sharps injuries"), but the effectiveness of gloves in preventing such injuries has not been established. We evaluated factors associated with gloving practices and identified associations between gloving practices and sharps-injury risk.
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Access block and overcrowding in emergency departments: an empirical analysis.
Emerg Med J
PUBLISHED: 06-30-2010
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To quantify the determinants of the duration of time spent in an emergency department (ED) for patients who need admission to hospital.
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.