Methicillin-resistant Staphylococcus aureus infection in combat support hospitals in three regions of Iraq.

SUMMARYStaphylococcus aureus is a leading cause of infections in deployed service members. Based on a molecular epidemiological study of 182 MRSA isolates from patients in three U.S. Army combat support hospitals in separate regions in Iraq, USA300 clone was the most predominant (80%) pulsotype. This finding suggested that strain carriage from the home country by military personnel is epidemiologically more important than local acquisition.

A high-resolution radiation hybrid map of the human genome draft sequence.

We have constructed a physical map of the human genome by using a panel of 90 whole-genome radiation hybrids (the TNG panel) in conjunction with 40,322 sequence-tagged sites (STSs) derived from random genomic sequences as well as expressed sequences. Of 36,678 STSs on the TNG radiation hybrid map, only 3604 (9.8%) were absent from the unassembled draft sequence of the human genome. Of 20,030 STSs ordered on the TNG map as well as the assembled human genome draft sequence and the Celera assembled human genome sequence, 36% of the STSs had a discrepant order between the working draft sequence and the Celera sequence. The TNG map order was identical to one of the two sequence orders in 60% of these discrepant cases.

The needs assessment checklist: a clinical approach to measuring outcome.

OBJECTIVE: To evaluate the outcome of the Needs Assessment and Goal Planning Programme used in the rehabilitation of people with spinal cord injuries. The Needs Assessment Programme incorporates a behavioural indicator rating scale to detail the individual's progress and rehabilitation needs. This can also be used to evaluate the outcome of the rehabilitation programme in general. The Needs Assessment Checklist (NAC) forms part of the programme and is a tool which is used to evaluate rehabilitation outcome. SETTING: A purpose built, national spinal injuries centre in the United Kingdom. SUBJECTS: 82 patients who had completed the Needs Assessment Checklist, both at the beginning and towards the end of the rehabilitative process. RESULTS: Independence, as measured by the Checklist, was significantly greater in all domains at the time of the second Needs Assessment. CONCLUSIONS: The Needs Assessment and Goal Planning Programme is successful in establishing greater client independence, whether assessed at a verbal or physical level. Team members have used the Needs Assessment Checklist as a behavioural indicator of rehabilitation outcome based on available standards of rehabilitative care. Further development of the Needs Assessment Checklist now needs to focus on establishing concurrent validity and test/retest reliability. The measure developed proved to be a useful, clinically relevant and patient friendly assessment of rehabilitation outcome.

Alterations in self-perceptions following childhood onset of spinal cord injury.

Most research into psychological aspects of spinal cord injury (SCI) has focused on adult onset. This is a retrospective study of self-perceptions following a childhood onset of SCI. Self-esteem, depression and self-perception were examined in 86 people who had a traumatic SCI before the age of 16. Depression was measured using the Beck Depression Inventory, and self-esteem using the Culture-Free Self-Esteem Inventory Self-perception was measured using a scale developed for this study, consisting of 20 adjectives, with participants themselves on dimensions of 'As I am', 'As I would be without the injury', and 'as I would be ideally'. The participants' self perceptions of the injured self and the uninjured self were found to be significantly different on only nine of the 20 adjectives. Low self-perception was found to be associated with low self-esteem and high depression levels, but independent of age at injury, level of injury and gender. The change noted by the participants between how they see themselves now and how they would have been without the injury is not as great as might have been expected.

Psychological impact of the management of methicillin-resistant Staphylococcus aureus (MRSA) in patients with spinal cord injury.

BACKGROUND: Management of MRSA infection includes immediate isolation of the patient. Long periods of isolation are considered to be psychologically detrimental, though little information is available about the impact of isolation as an infection control procedure. The purpose of this study is to examine the psychological well-being of spinal cord injured patients who are isolated as a result of being MRSA positive. METHODS: A cross-sectional matched-control study of MRSA positive patients with MRSA negative patients was carried out at the National Spinal Injuries Centre, Stoke Mandeville Hospital, Bucks, England. Sixteen MRSA positive patients, aged 18 to 65, and their matched controls completed a series of questionnaires to measure aspects of psychological impact. The measures used were functional independence, depression, anxiety, and the affective states of anger, vigour, fatigue and confusion. FINDINGS: The MRSA positive spinal cord injured patients were only significantly more angry than the control group, although these isolated patients scored higher in all measures. INTERPRETATIONS: In this spinal cord injured group the difference between the psychological well-being of isolated MRSA positive patients and non-isolated MRSA negative patients is not as great as might have been expected. Patients feel that rehabilitation is affected, but the situation may be improved by providing more space and a better view onto the ward.

Comparison of auditory brainstem responses and pneumograms in intensive care nursery infants.

Central slowing of auditory brainstem responses (ABRs) and excessive breathing irregularity on pneumogram recordings indicate dysfunction in central auditory pathways and brainstem respiratory control mechanisms, respectively. These centers are anatomically proximate within the brainstem so that ABR slowing and respiratory instability might be expected to occur concomitantly, reflecting overall dysfunction of this part of the central nervous system. To examine the relationship between these two assessments, testing results were compared for 15 infants in the intensive care nursery who had ABRs and 12-hour pneumograms performed at about the same age for separate clinical indications. Wave V latency at 70 dB was found to correlate significantly with three pneumogram measurements of breathing irregularity: the density of short apneas during sleep (p less than 0.01), the number of episodes of periodic breathing per 100 minutes of sleep (p less than 0.05), and the percentage of sleep time spent in periodic breathing (p less than 0.05). Interwave interval I-V correlated significantly with the density of short apneas during sleep (p less than 0.01). The auditory brainstem response and the pneumogram appeared to serve as related indicators of brainstem function in these infants.

Müller curved-stem total hip arthroplasty: long-term follow-up of 185 consecutive cases.

We reviewed 185 consecutive Müller total hip arthoplasties ten to 14 years after operation. Of the 32 patients with 42 arthroplasties who had died within the ten-year period, three had had revisions and five had died of causes related to the operation, including two late infections. Sixty-five hips in 56 living patients were available for clinical and roentgenographic evaluation. An additional 30 hips had been revised for various reasons. When the roentgenographically loose components were combined with the revised ones, the overall incidence of aseptic loosening was 40% for the femoral component and 12.6% for the acetabular component. As previously reported, the combined incidence of loose and revised components at 6 1/2 years was 27.7% for the femoral component and 3.2% for the acetabular component. Therefore, in the intervening five years, the rate of femoral loosening remained about the same, while the rate of acetabular loosening increased. There was a positive correlation between the incidence of loosening of the femoral component and male sex, deficient cementing, and varus position. There was no significant wear of the acetabular component.

UCI total knee replacement. A follow-up study.

Using the UCI (University of California at Irvine) total knee prosthesis, an arthroplasty was performed in ninety-seven patients (121 knees) from 1972 through 1977. I examined eighty of these patients (100 knees) at three to eight years after the operation and it was necessary to either perform or recommend further surgery in twenty-five of them (twenty-seven knees). These results were designated as failures. The knees in valgus angulation that failed typically did so within the first year because of medical instability and patellar dislocation. The knees in varus angulation that failed typically did so one to six years after operation because of loosening of the tibial component. When failure became established, each knee was found to have reverted to its preoperative angular deformity, indicating that deforming factors were still operative. I suspect that ligament imbalance may have contributed to many of these failures. The surface area and stiffness of the 5.0 and 7.5-millimeter-thick tibial components of the original UCI prosthesis were not sufficient to prevent loosening and subsidence. Constraint between the tibial and femoral components was not sufficient to prevent subluxation or dislocation if soft-tissue release was needed for correction of deformity. Prompted by this experience, total knee arthroplasty using the UCI device has been discontinued at the Ochsner Medical Institutions.

Netilmicin use in pediatric patients.

40 newborn infants and children were treated with netilmicin. With a 2-mg/kg dose, the average peak serum concentration was 4.4 microgram/ml. Serum concentrations resulting from the first dose were markedly lower than subsequent doses and therapeutically inadequate. Significant drug accumulation did not occur: peak and trough concentrations on days 2 and 7 were the same in patients with normal renal function. The half-life of netilmicin in infants less than 1 week old was 3.8 h in infants older than 1 week. Infants less than 7 days old require a prolonged dose interval (12 h) to adequately clear the administered dose. Recovery of netilmicin in urine ranged from 50 to 100% and correlated with age and duration of treatment. Elimination of netilmicin was prolonged in newborn infants with renal failure and requires dosage adjustment. Transient change in creatinine clearance occurred in 2 patients (4.6%) and ototoxicity was observed on 2 other patients.

Experience with total hip replacement at Ochsner Clinic.

Eighty-four patients had 97 total hip replacement procedures. Standard Müller components were used in the first 40 operations; the Aufranc-Turner acetabular component was used with the Müller-femoral component in the final 57 procedures. The trochanter was detached only in exceptional circumstances. Seventy-six patients with 87 replacements were followed up for 12 to 34 months. Complications, occasionally multiple, occurred in more than one third of our patients; thromboembolic disease was the most frequent. No significant wound complications occurred; there was no infection. In 71 replacements the results were excellent; in 15, good; and in 1 fair.