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1.
Eur Rev Med Pharmacol Sci ; 25(2): 609-619, 2021 01.
Article in English | MEDLINE | ID: mdl-33577014

ABSTRACT

OBJECTIVE: To analyze the available evidence comparing the clinical and functional outcomes of physiotherapy vs. surgical repair in the management of degenerative rotator cuff tears (RCTs), and to perform a meta-analysis to clarify the possible superiority of one approach vs. the other. MATERIALS AND METHODS: A literature search was carried out on the PubMed, Scopus and Web of Science databases on May 30th, 2020, to identify all the randomized trials comparing surgery to conservative management of degenerative rotator cuff tears. The following data were extracted from each included study: patients' demographics, study design and level of evidence, follow-up times, treatment groups, evaluation scores adopted, overall clinical findings. The quality of the trials was assessed using the Cochrane Risk of Bias Assessment. RESULTS: A total of 7 studies, including 326 patients and dealing with conservative treatment vs. surgical repair for rotator cuff tears, were included in this study. Although surgery provided superior results both in terms of VAS (p=0.017) and Constant score (p<0.0001) compared to conservative management at 1 year follow-up, this superiority did not reach the "minimal clinical important difference". Otherwise, a few data are available about long-term outcomes, thus there is insufficient evidence about the role of surgery to prevent the progression of tendon wear. CONCLUSIONS: A proper rehabilitation program is able to provide similar results compared to surgery at a short term follow-up in degenerative RCTs. Further long term data are necessary to understand if tendon repair might have a protective role towards worsening of degeneration thus providing better clinical outcome than conservative management.


Subject(s)
Conservative Treatment , Rotator Cuff Injuries/surgery , Humans , Randomized Controlled Trials as Topic , Rotator Cuff Injuries/metabolism
2.
Infect Control Hosp Epidemiol ; 22(2): 120-4, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11232875

ABSTRACT

Establishing a clinical diagnosis of infection in residents of long-term-care facilities (LTCFs) is difficult. As a result, deciding when to initiate antibiotics can be particularly challenging. This article describes the establishment of minimum criteria for the initiation of antibiotics in residents of LTCFs. Experts in this area were invited to participate in a consensus conference. Using a modified delphi approach, a questionnaire and selected relevant articles were sent to participants who were asked to rank individual signs and symptoms with respect to their relative importance. Using the results of the weighting by participants, a modification of the nominal group process was used to achieve consensus. Criteria for initiating antibiotics for skin and soft-tissue infections, respiratory infections, urinary infections, and fever where the focus of infection is unknown were developed.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Communicable Diseases/drug therapy , Drug Utilization/standards , Residential Facilities/standards , Aged , Centers for Disease Control and Prevention, U.S. , Drug Resistance, Microbial , Fever/drug therapy , Hospitals, Chronic Disease/standards , Hospitals, Veterans/standards , Humans , Nursing Homes/standards , Practice Guidelines as Topic , Respiratory Tract Infections/drug therapy , Skin Diseases, Infectious/drug therapy , United States , Urinary Tract Infections/drug therapy
3.
Infect Control Hosp Epidemiol ; 21(8): 537-45, 2000 Aug.
Article in English | MEDLINE | ID: mdl-10968724

ABSTRACT

There is intense antimicrobial use in long-term-care facilities (LTCFs), and studies repeatedly document that much of this use is inappropriate. The current crisis in antimicrobial resistance, which encompasses the LTCF, heightens concerns of antimicrobial use. Attempts to improve antimicrobial use in the LTCF are complicated by characteristics of the patient population, limited availability of diagnostic tests, and the virtual absence of relevant clinical trials. This position paper recommends approaches to management of common infections in LTCF patients and proposes minimal standards for an antimicrobial review program. In developing these recommendations, the position paper acknowledges the unique aspects of provision of care in the LTCF.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Infection Control/methods , Long-Term Care , Aged , Drug Resistance, Microbial , Guidelines as Topic , Health Policy , Humans , Medical Audit
4.
J Hosp Infect ; 43 Suppl: S9-18, 1999 Dec.
Article in English | MEDLINE | ID: mdl-10658754

ABSTRACT

Long term care facilities (LTCFs) include a variety of different types of healthcare settings, each with their own unique infectious disease problems. This report focuses on the epidemiological considerations, risk factors and types of infections that occur in elderly patients institutionalized in nursing home settings. In the US, the number of patients in nursing homes continues to grow as the population ages. Today, patients in nursing homes have more complicated medical conditions than they did five years ago as they become even more elderly and the trend continues towards shorter and shorter hospital stays in acute care facilities. The patient population in nursing homes is uniquely susceptible to infections because of the physiological changes that occur with ageing, the underlying chronic diseases of the patients and the institutional environment within which residents socialize and live. In addition, in nursing home settings, problems with infections may be more difficult to diagnose because of their subtle presentations, the presence of co-morbid illnesses which obscure the symptoms of infection and the lack of on site diagnostic facilities. Delays in diagnosing and treating infections allow transmission to occur within the facility. Both endemic and epidemic infections occur relatively commonly in nursing homes. The incidence of endemic infections, such as catheter-associated urinary tract infections, lower respiratory infections and skin infections, is influenced by the debility level of the patients. Calculations of infection rates are influenced by the intensity of surveillance methods at each institution. Many endemic infections are unpreventable. Epidemic infections account for 10-20% of nursing home infections. These include clusters of upper or lower respiratory infections, gastroenteritis, diarrhoea, and catheter-associated UTI's. Epidemic infections are potentially preventable with sound infection control practices. Special attention must be paid to promote universal precautions and give certain patients, such as those with known infection or colonization with Clostridium difficile, MRSA or VRE, special consideration. The potential for epidemic infections with antibiotic-resistant organisms is real. In the nursing home setting, attention must be given to develop and support strong infection control programmes that can monitor the occurrence of institutionally-acquired infections and initiate control strategies to prevent the spread of epidemic infections. Education in infection control issues and attention to employee health is essential to enable staff to care appropriately for today's nursing home population and to prepare them for the even more complicated patients who will be cared for in this type of setting in future.


Subject(s)
Cross Infection/epidemiology , Homes for the Aged , Nursing Homes , Aged , Cross Infection/prevention & control , Drug Resistance, Multiple , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/microbiology , Humans , Respiratory Tract Infections/epidemiology , Risk Factors , Skin Diseases, Infectious , United States/epidemiology , Urinary Tract Infections/epidemiology
5.
Infect Control Hosp Epidemiol ; 19(2): 114-24, 1998 Feb.
Article in English | MEDLINE | ID: mdl-9510112

ABSTRACT

The scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have developed a wide variety of useful recommendations and guidelines for infection control, and apart from general guidance provided by the Joint Commission on Accreditation of Healthcare Organizations, there are surprisingly few recommendations on infrastructure and essential activities for infection control and epidemiology programs. In April 1996, the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panel's best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee.


Subject(s)
Cross Infection/prevention & control , Hospital Administration/standards , Infection Control/methods , Infection Control/organization & administration , Accreditation , Cost-Benefit Analysis , Data Collection , Evidence-Based Medicine , Humans , Occupational Health , Organizational Objectives , Organizational Policy , Personnel, Hospital/education , United States
6.
Am J Infect Control ; 26(1): 47-60, 1998 Feb.
Article in English | MEDLINE | ID: mdl-9503113

ABSTRACT

The scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have developed a wide variety of useful recommendations and guidelines for infection control, and apart from general guidance provided by the Joint Commission on Accreditation of Healthcare Organizations, there are surprisingly few recommendations on infrastructure and essential activities for infection control and epidemiology programs. In April 1996, the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panel's best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee.


Subject(s)
Cross Infection/prevention & control , Hospital Administration/standards , Infection Control/methods , Infection Control/organization & administration , Accreditation , Cost-Benefit Analysis , Data Collection , Evidence-Based Medicine , Humans , Occupational Health , Organizational Objectives , Organizational Policy , Personnel, Hospital/education , United States
8.
Infect Control Hosp Epidemiol ; 17(2): 119-28, 1996 Feb.
Article in English | MEDLINE | ID: mdl-8835449

ABSTRACT

There is intense antimicrobial use in long-term-care facilities (LTCF), and studies repeatedly document that much of this use is inappropriate. The current crisis in antimicrobial resistance, which encompasses the LTCF, heightens concerns of antimicrobial use. Attempts to improve antimicrobial use in the LTCF are complicated by characteristics of the patient population, limited availability of diagnostic tests, and virtual absence of relevant clinical trials. This article recommends approaches to management of common LTCF infections and proposes minimal standards for an antimicrobial review program. In developing these recommendations, the article acknowledges the unique aspects of provision of care in the LTCF.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Cross Infection/prevention & control , Drug Utilization Review , Nursing Homes/standards , Cross Infection/diagnosis , Cross Infection/microbiology , Cross Infection/therapy , Drug Resistance, Microbial , Humans , Long-Term Care , Practice Guidelines as Topic , United States
9.
Clin Microbiol Rev ; 9(1): 1-17, 1996 Jan.
Article in English | MEDLINE | ID: mdl-8665472

ABSTRACT

Infections occur frequently in nursing home residents. The most common infections are pneumonia, urinary tract infection, and skin and soft tissue infection. Aging-associated physiologic and pathologic changes, functional disability, institutionalization, and invasive devices all contribute to the high occurrence of infection. Antimicrobial agent use in nursing homes is intense and usually empiric. All of these factors contribute to the increasing frequency of antimicrobial agent-resistant organisms in nursing homes. Programs that will limit the emergence and impact of antimicrobial resistance and infections in nursing homes need to be developed.


Subject(s)
Bacterial Infections/prevention & control , Drug Resistance, Microbial , Nursing Homes , Aged , Aging/immunology , Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Disease Outbreaks , Female , Humans , Infection Control , Male
10.
Infect Control Hosp Epidemiol ; 16(6): 348-53, 1995 Jun.
Article in English | MEDLINE | ID: mdl-7657988

ABSTRACT

Although patients in long-term-care facilities are at increased risk of infection, little is known about how to practice infection control in this setting. This article reviews risk factors for infection, the components of an infection control program, and particular infections that are important in long-term-care facilities. In addition, special characteristics of long-term-care facilities that challenge the individuals charged with conducting effective infection control programs will be discussed.


Subject(s)
Infection Control/methods , Nursing Homes/statistics & numerical data , Humans , Infections/etiology , Long-Term Care/statistics & numerical data , Risk Factors
11.
Ann Intern Med ; 121(2): 117-23, 1994 Jul 15.
Article in English | MEDLINE | ID: mdl-8017725

ABSTRACT

OBJECTIVE: The In-Training Examination in Internal Medicine (ITE-IM) has been offered to internal medicine trainees annually since 1988 as an instrument for self-assessment. This report outlines the manner in which the test is prepared, reviews the results of annual examinations, and analyzes trends during the past 6 years. DESIGN: Results of each examination were reviewed with regard to the demographic characteristics of persons taking the test, their previous medical training, and their present program affiliations. RESULTS: Then number of residents participating in the ITE-IM has increased steadily over the past 6 years. In 1993, more than 12,000 residents from more than 90% of internal medicine training programs in the United States participated in the examination; the percentage of international medical school graduates taking the examination increased from 27% in 1988 to 47% in 1993. Statistical analyses of each examination have shown it to be reliable, internally consistent, and discriminating. Over the past 6 years, graduates of U.S. medical schools have scored consistently higher than those of international medical schools and schools of osteopathic medicine on all annual examinations. However, in 1993, for residents at all levels of training, the differences in scores between graduates of U.S. medical schools and graduates of international medical schools narrowed substantially. From 1988 to 1993, there has been a trend toward lower scores by every cohort on each subsequent examination. The decreases in scores are most pronounced for graduates of U.S. medical school and those of schools of osteopathic medicine. The lower scores may be caused by either an increased level of difficulty in the examination or decreased knowledge among examinees. CONCLUSIONS: The ITE-IM is a useful instrument to assess the knowledge base of residents and program directors with a reliable evaluation of themselves and their programs in comparison to their national peer groups. It also provides objective data to monitor trends over time in residents' scores and relates them to the changing demographic characteristics of trainees and to innovations in the clinical curricula of internal medicine training programs.


Subject(s)
Educational Measurement , Internal Medicine/education , Clinical Competence , Humans , United States
12.
Clin Infect Dis ; 18(6): 1004-6, 1994 Jun.
Article in English | MEDLINE | ID: mdl-8086528

ABSTRACT

Leptospirosis, severe infection due to Leptospira interrogans, is a potentially lethal disease that causes multiple organ failure. In addition to hepatic, renal, and CNS involvement, which are classic complications of leptospirosis, the disease may also be complicated by adult respiratory distress syndrome. Treatment with penicillin may precipitate a severe Jarisch-Herxheimer reaction. The mechanisms of Leptospira-induced toxicity remain obscure. We report a near-fatal case of leptospirosis in a patient who developed a JHR and respiratory failure immediately after initiation of therapy.


Subject(s)
Drug Eruptions/etiology , Leptospira interrogans , Leptospirosis/complications , Respiratory Distress Syndrome/etiology , Humans , Leptospirosis/drug therapy , Male , Middle Aged , Penicillins/adverse effects , Penicillins/therapeutic use
13.
J Gerontol ; 48(6): M266-71, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8227997

ABSTRACT

BACKGROUND: There has been disagreement over the significance of bacteriuria in nursing home residents. METHODS: During an 18-month period, the risks and consequences of bacteriuria (BU) in 195 residents of a skilled nursing facility without indwelling catheters were examined. Clinical and epidemiologic data and urine for culture were collected every 2 weeks to identify risk factors, symptoms, and occurrences of BU. A mean of 23 cultures per resident was collected. RESULTS: Forty-three percent of the study population (35% of men; 47% of women) had "persistent BU" defined as > 10(5) cfu/ml of urine on > 25% of an individual's collected cultures. Women with persistent BU more frequently were incontinent of bowel and bladder (OR 5.3, 6.3, respectively), more likely to be functionally disabled (OR 3.2), to carry a diagnosis of dementia (OR 2.4), and less likely to have suffered a stroke (OR 0.40). Cancer (OR 6.5) was the only risk factor for persistent BU in men. The number of antibiotic courses prescribed, frequency of hospitalizations, and mortality rates were not significantly different between the two BU groups in either men or women. CONCLUSIONS: Persistent BU is common in nursing home residents. The association of bowel and bladder incontinence and functional disability with persistent bacteriuria suggests that treatment or prevention of these risk factors may prevent or decrease the incidence of bacteriuria. There was no evidence of significant adverse outcomes resulting directly from the bacteriuric state. Higher mortality in the bacteriuric group was the result of underlying functional debility and severity of illness rather than the presence or persistence of BU.


Subject(s)
Bacteriuria , Nursing Homes , Urinary Catheterization , Aged , Aged, 80 and over , Bacteriuria/complications , Bacteriuria/etiology , Bacteriuria/microbiology , Dementia/complications , Fecal Incontinence/complications , Female , Humans , Length of Stay , Male , Neoplasms/complications , Odds Ratio , Urinary Catheterization/adverse effects , Urinary Incontinence/complications
14.
Am J Med ; 91(3B): 158S-163S, 1991 Sep 16.
Article in English | MEDLINE | ID: mdl-1928157

ABSTRACT

During a 4-year period, we collected prospective epidemiologic data and intraoperative wound cultures from 1,852 surgery patients at a university-affiliated community hospital in order to identify the critical risk factors for postoperative wound infections and study the impact of perioperative antibiotics on the bacteriology of infected wounds. Stepwise logistic regression analysis revealed four risk factors that were independent of each other and highly predictive for subsequent wound infection. These were the surgical wound class, American Society of Anesthesiologists physical status grouping, duration of surgery, and results of intraoperative cultures. Addition of other variables to our model did not increase the predicted probability of infection. Even though patients with positive intraoperative cultures had an increased rate of infection, this information had limited clinical utility. The predictive value of a positive culture was low (32%), false-positive rate was high (82%), and concordance with isolates from infected wounds was low (41% when both cultures were positive). Patients who had received perioperative antibiotics and who developed infections were frequently infected with organisms that were resistant to the perioperative drug regimen, compared with patients who had not received antibiotics. A better understanding of the variables that affect the epidemiology and pathogenesis of postoperative wound infection will enable us to make more valid comparisons of rates among hospitals, help us to develop more effective infection control strategies and provide us with more effective treatments.


Subject(s)
Infections , Postoperative Complications , Adult , Aged , Bacteria/isolation & purification , Drug Resistance, Microbial , Female , Humans , Infections/epidemiology , Infections/microbiology , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/microbiology , Risk Factors , Severity of Illness Index , Surgical Procedures, Operative
16.
J Hosp Infect ; 18 Suppl A: 289-98, 1991 Jun.
Article in English | MEDLINE | ID: mdl-1679795

ABSTRACT

During a 4-year period, we collected prospective epidemiological data and intraoperative wound cultures from 1852 surgery patients at a university-affiliated community hospital in order to identify the critical risk factors for postoperative wound infections and study the impact of perioperative antibiotics on the bacteriology of infected wounds. Stepwise logistic regression analysis revealed four risk factors that were independent of each other and highly predictive for subsequent wound infection. These were the surgical wound class, American Society of Anesthesiology (ASA) physical status grouping, duration of surgery and results of intraoperative cultures. Addition of other variables to our model did not increase the predicted probability of infection. Even though patients with positive intraoperative cultures had an increased rate of infection, this information had limited clinical utility because of its low predictive value, high false-positive rate and poor concordance with isolates from infected wounds. Patients who had received perioperative antibiotics and who developed infections were frequently infected with organisms that were resistant to the perioperative drug regimen, compared with patients who had not received antibiotics.


Subject(s)
Intraoperative Complications/epidemiology , Surgical Wound Infection/epidemiology , Anesthesiology , Female , Health Status , Hospitals, Community , Hospitals, University , Humans , Intraoperative Complications/classification , Intraoperative Complications/microbiology , Logistic Models , Male , Predictive Value of Tests , Prospective Studies , Risk Factors , Surgical Wound Infection/classification , Surgical Wound Infection/microbiology , Time Factors
17.
Bol Chil Parasitol ; 45(3-4): 83-5, 1990.
Article in Spanish | MEDLINE | ID: mdl-2152365

ABSTRACT

A prospective study was carried out in 229 chronic patients (of both sexes) from the Psychiatric Hospital of Putaendo, in order to find out the frequency of intestinal parasites and/or commensals in the period 1987-1989. One hundred and ninety four (84.7%) out of the 229 studied patients were infected by parasites and/or commensals. The high prevalence of commensals Entamoeba coli (55.0%) and Endolimax nana (50.5%) became more evident. Among the parasites, the most frequent was Trichuris trichiura (41.5%). The presence of Pediculus humanus capitis and lesions suggestive of those produced by Sarcoptes scabiei were detected in 7.2 and 0.6 of the examined patients. The results obtained show the high frequency of intestinal infections by parasites and commensals in the patients of the studied hospital.


Subject(s)
Ectoparasitic Infestations/epidemiology , Intestinal Diseases, Parasitic/epidemiology , Nematode Infections/epidemiology , Protozoan Infections/epidemiology , Adolescent , Adult , Aged , Child , Chile/epidemiology , Chronic Disease , Feces/parasitology , Female , Food Parasitology , Hospitals, Psychiatric , Humans , Male , Middle Aged , Nematode Infections/transmission , Prevalence , Prospective Studies , Protozoan Infections/transmission , Rural Population
20.
Pediatrics ; 82(6): 909-13, 1988 Dec.
Article in English | MEDLINE | ID: mdl-3186383

ABSTRACT

Of 849 CSF cultures done at Hartford Hospital, nine were positive for nonanthrax Bacillus species. Differentiation of true nonanthrax Bacillus species infection from contamination requires careful consideration of the clinical findings, the clinical course, and the laboratory data. In seven patients the nonanthrax Bacillus species represented contamination. In two patients the nonanthrax Bacillus species represented true infection. In one of these infected patients, nonanthrax Bacillus species complicated a cranial gun shot wound. Bacillus cereus meningitis developed in the second patient, a premature infant, following sepsis from a contaminated IV catheter. Nonanthrax Bacillus species, especially B cereus, can be resistant to penicillins and cephalosporins when nonanthrax Bacillus species infections are being treated, susceptibility testing should always be performed.


Subject(s)
Bacillus/isolation & purification , Meningitis/cerebrospinal fluid , Adult , Aged , Bacillus/classification , Cerebrospinal Fluid Shunts , Child, Preschool , Female , Humans , Infant, Newborn , Male , Middle Aged , Retrospective Studies
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