Hospital infectious disease emergency preparedness: a 2007 survey of infection control professionals.

BACKGROUND: Hospital preparedness for infectious disease emergencies is imperative. METHODS: A 40-item hospital preparedness survey was administered to Association for Professionals in Infection Control and Epidemiology, Inc, members. Kruskal-Wallis tests were used to evaluate the relationship between hospital size and emergency preparedness in relation to various surge capacity measures. Significant findings were followed by Mann-Whitney U post hoc tests. RESULTS: Most hospitals have an infection control professional on their disaster committee, 24/7 infection control support, a health care worker prioritization plan for vaccine or antivirals, and nonhealth care facility surge beds but lack health care worker, laboratory, linen, and negative-pressure room surge capacity. Many hospitals participated in a disaster exercise recently and are stockpiling N95 respirators and medications. Few are stockpiling ventilators, surgical masks, or patient linens; those that are have

Modafinil--medical considerations for use in sustained operations.

An understanding of the consequences of sustained operations involving prolonged sleep deprivation is important to the military. Losses in cognitive performance of the order of 30% after one night and 60% after two nights of sleep loss have been shown to occur in several studies. Napping strategies have been proposed as one coping strategy for these performance decrements. An alternate solution is the use of stimulants. Modafinil may offer a safer alternative to more commonly used psychostimulants. It has been shown to counteract the effects of sleep deprivation with fewer side effects than amphetamine. Recent studies on the effects of modafinil during sleep deprivation are reviewed and compared with those of other stimulants such as amphetamine and caffeine, and to prophylactic naps. Recommendations are proposed for the use of modafinil in sustained military missions. For missions of about 24 h, modafinil is preferable to naps. For longer missions, naps should be considered, along with the concomitant use of modafinil to help maintain performance levels. The authors discuss apparent 'overconfidence' and hyperthermia-inducing effects of modafinil, and advise that these effects be taken into account if modafinil is to be used in any mission conducted in the field or in hot environments. It is also recommended that individual sensitivity to the drug should be tested before any mission of a sustained nature, especially if it involves small operational groups or combat aircrew, where the impact of such effects on individuals would be more critical.

Effect of modafinil on core temperature during sustained wakefulness and exercise in a warm environment.

BACKGROUND: Previous studies have revealed that modafinil elevates resting core temperature during periods of sustained wakefulness. The purpose of this study was to examine the effects of modafinil on core temperature during rest and exercise throughout 40 h of sustained wakefulness in a warm environment. METHODS: Ten males performed a drug session (three 100 mg doses per day) and a placebo session that involved a control day, 40 h of sustained wakefulness, and a recovery sleep. For 38 h of the sustained wakefulness, subjects were exposed to 30 degrees C with 50% relative humidity. During the afternoon of both days of wakefulness and during the early morning of the second day, subjects performed 2 h of exercise at 60% VO2max while exposed to the warm environment. RESULTS: The data revealed that rectal temperature (Tre) was elevated at rest 0.15-0.2 degrees C following modafinil ingestion throughout the period of sustained wakefulness. This increase in body temperature at rest was due to an increase in heat production during the first day of wakefulness followed by a lower evaporative heat loss during the second day. During exercise, an inconsistent effect of the drug on Tre was observed throughout the 38-h period. On the first afternoon, the impact of modafinil on Tre was no longer evident after 20 min of exercise. In contrast, during the early morning and afternoon of the second day, the effects of the drug on Tre at rest remained during exercise. For seven subjects who had Tre data for 80 min during all exercise periods, Tre during the placebo session was 38.9, 38.4, and 38.7 degrees C after 80 min of exercise for periods one, two and three, respectively, whereas the corresponding values during the modafinil session were 38.8, 38.7, and 38.9 degrees C. CONCLUSION: With a greater cumulative dose of the drug, Tre remained elevated throughout the exercise period to an extent similar to the increase observed under resting conditions when compared with the placebo condition.