Sputum smear-positive pulmonary tuberculosis: Is sputum smear examination required to discontinue airborne precautions?

OBJECTIVE: Our aim was to evaluate the criteria required to discontinue airborne precautions for patients presenting with sputum smear-positive pulmonary tuberculosis as the need for sputum smear examinations is still a matter of debate. METHOD: We conducted a retrospective study in the University Hospitals of Strasbourg (France) from July 2011 to July 2013. Our aim was to describe the results of sputum smear examinations and cultures obtained from treated patients presenting with drug-sensitive pulmonary tuberculosis. We included 97 patients in the study. CONCLUSION: Nearly half of patients for whom a sputum smear examination was performed had a negative sputum direct examination but a positive culture. According to the literature, those patients are still likely to be contagious. This questions the safety of discontinuing airborne precautions in this situation. We also observed a great disparity in physicians' behaviors. Only half of them waited to get a negative sputum direct examination before discontinuing airborne precautions.

Alternative agendas. System priorities for the 1990s will differ from those of the last decade.

The Sisters of Charity Health Care Systems (SCHCS) was established in 1979 in response to changes in the U.S. healthcare system and to new needs of sponsors and Catholic healthcare facilities. However, the agenda that SCHCS leaders (and leaders of other systems) set at that time must now give way to an agenda that will address the new challenges and responsibilities facing the Catholic healthcare ministry in the 1990s. In its first decade of existence, SCHCS established and fulfilled a number of goals: It strengthened governance relationships, helped systems and sponsors better identify with local communities, enabled facilities to steward resources more effectively, and facilitated members' understanding of mission and sponsorship values. In the 1990s, however, systems will have to create more opportunities for regional, collaborative, and networking relationships among member facilities and between members and non-members. To achieve this, they will have to reevaluate their structures, find ways to faciliatate collaboration, make resources available to institutions outside the system, and develop an overall philosophy that enhances both the fiscal and spiritual well-being of member facilities.

United they thrive: merger of two healthcare systems.

On March 15, 1987, the Sisters of St. Francis of Perpetual Adoration of Colorado Springs and the Sisters of Charity of Cincinnati agreed to consolidate. It marked the culmination of years of building mutual trust and months of intense negotiations. The Sisters of St. Francis realized in 1983 that some major decisions had to be made regarding the future direction of its healthcare ministry because of rapid changes within the healthcare industry and declining numbers of Franciscan sisters working in healthcare. In January 1986 leaders of the two institutes and their healthcare systems sat down for the first time to discuss issues surrounding the collaborative effort and to recommend a list of objectives, including joint ventures in various areas. Other recommendations included the formation of a joint steering council to direct the collaborative effort and the formation of a Colorado Springs Task Force to end the rivalry existing between two local hospitals--one Franciscan-sponsored, the other Charity-sponsored. Additional hurdles included finding an affiliation model that all parties would accept (the one endorsed allows the Sisters of St. Francis to continue to exercise substantial control over the future of its healthcare institutions but gives the Sisters of Charity Health Care System much of the operational control); due diligence reviews of legal and financial documents; canonical review; detailed financial analysis; review of all state and federal regulatory requirements, including antitrust; and educating and preparing members of the Franciscan Healthcare Corporation.

CHA Evaluative Criteria: strengthening commitment to the apostolate.

CHA's Evaluative Criteria helps facilities determine the breadth of their Catholic focus and character. It is the best response Catholic health care facilities can make to the issue of quality of care.