The validity of adenosine triphosphate measurement in detecting endoscope contamination.

BACKGROUND: Endoscopic procedures are vital to gastrointestinal disease diagnosis and management, but risk infection transmission. In Australia, endoscopes undergo monthly-to-quarterly microbiological testing, to prevent patient infection. Endoscopes are used more frequently, meaning contamination may not be detected by this surveillance before infection transmission occurs. AIM: To evaluate the use of adenosine triphosphate (ATP) measurement, alongside standard microbiological cultures, in detecting endoscope contamination before high-level disinfection. Using these results, we also aimed to confirm the efficacy of manual cleaning in reducing levels of ATP and cfu/mL. METHODS: Seventeen in-clinical-use gastroscopes and 24 in-clinical-use colonoscopes from the Liverpool Hospital Endoscopy unit were sampled across three separate cleaning stages before high-level disinfection. Colony counts and ATP measurements were then performed on these samples. FINDINGS: The correlation between the cfu/mL and RLU of samples collected from colonoscopes was 0.497 (95% confidence interval: 0.28-0.66; P < 0.0001). The correlation between cfu/mL and RLU for samples collected from gastroscopes was 0.377 (0.08-0.61; P = 0.0138). RLU and cfu/mL values were shown to fall significantly (P < 0.005) following precleaning and manual cleaning. CONCLUSION: There was a significant correlation between ATP and cfu/mL measured from samples collected before high-level disinfection. Precleaning and manual cleaning were shown to reduce ATP and microbiological load significantly. ATP measurement can be performed within minutes with little training and produces results that are easy to interpret. These findings warrant further research on the utility of ATP measurement as a screening tool for detecting endoscope contamination after high-level disinfection.

Retrospective review of administration of childhood primary vaccination schedule in an Irish tertiary neonatal intensive care unit.

AIMS: Quantify and evaluate administration of the routine childhood primary vaccination schedule in a tertiary neonatal intensive care unit (NICU). STUDY DESIGN: Retrospective review of paper record of vaccinations administered to inpatients in the NICU from 01/01/2001-30/11/2013. METHODS: Data were extracted from hospital records and institutional databases and analysed using SPSS for Mac version 21. Analysis was made based on gestational age, chronological age at time of administration of vaccine, corrected gestational age at time of vaccine administration and type of vaccine received. RESULTS: For all preterm (gestation < 37 weeks) babies that received the first '6in1' vaccination while an inpatient (n = 344): mean gestational age = 27.3 weeks (sd = 2.6 weeks); mean chronological age at time of vaccination = 9.4 weeks. For all preterm patients that received the second '6in1' vaccination while an inpatient (n = 19): mean gestational age = 25.6 weeks (sd = 1.63); mean chronological age at time of vaccination = 18.4 weeks. For all term (gestation ≥ 37 weeks) patients that received the first '6in1' vaccination while an inpatient (n = 9): mean gestational age = 40.1 weeks (sd = 1.9); mean chronological age at time of vaccination = 9.8 weeks. There were no reported adverse events to any of the vaccinations administered. CONCLUSION: It is safe for premature infants to receive the routine vaccination schedule in a NICU setting.

Interactions between 18-methoxycoronaridine (18-MC) and cocaine: dissociation of behavioural and neurochemical sensitization.

The phenomenon of sensitization has been implicated in various aspects of drug addiction. As such, the present study determined the effects of a potential anti-addictive agent, 18-methoxycoronaridine (18-MC; 40 mg/kg, IP, 19 h earlier), on the expression of sensitization following the repeated administration of cocaine (COC; five once daily injections of 15 mg/kg, IP) or saline. The effects of 18-MC on COC metabolism were also assessed. Compared to vehicle controls, 18-MC significantly enhanced the expression of COC-induced locomotion (0, 10, 20 and 40 mg/kg, IP) in chronic COC treated rats only. In both acute and chronic COC rats, 18-MC potentiated the stereotypy induced by higher COC doses (20 and 40 mg/kg, IP). In contrast, 18-MC abolished the sensitized dopamine (DA) response in the nucleus accumbens (NAC) to COC (20 mg/kg), without altering the DA response of acute COC rats. None of the interactions between 18-MC and COC appear to be related to alterations in COC metabolism as no effect of 18-MC pretreatment was observed on extracellular levels of COC or two of its metabolites, benzoylecogonine and norcocaine. From the present findings, it is concluded that the enhancement of COC-induced behaviour produced by 18-MC pretreatment is independent of effects on either COC pharmacokinetics or COC-induced alterations in DA transmission. However, given that 18-MC decreases the self-administration of COC in laboratory animals, it is proposed that the anti-addictive efficacy of 18-MC might be related to an ability to selectively block the expression of sensitized extracellular levels of DA in the NAC in rats with previous COC experience.

Why managed care needs encounter-based systems.

In the past, hospital information systems were designed and continuously altered to bring greater sophistication and functionality to patient accounting systems activities. Key components were focused on inpatient activities, which accounted to 80 percent or more of the organization's revenues. As a result, much of the information available for an inpatient care record is based on financially-oriented data that was created for reimbursement and charge capture.