An antibiotic formulary for a tertiary care foot clinic: admission avoidance using intramuscular antibiotics for borderline foot infections in people with diabetes.

AIMS: To develop an antibiotic foot formulary for the empirical treatment of diabetes-related foot infections presenting to our service. Subsequently, to asses costs associated with the introduction of our protocol, in particular to assess the effect on admissions avoidance and any cost savings achieved. METHODS: We reviewed several existing antibiotic protocols. We analysed data on costs related to treatment and admission rates prior to and after the introduction of the protocol. RESULTS: We rationalized our antibiotic protocol and adapted the Infectious Disease Society of America guideline by introducing a category of 'moderate infection-borderline admission' to our classification. This enabled the administration of outpatient intramuscular antibiotics. After introducing the rationalized protocol, our average antibiotic prescribing costs for a 3-week course of treatment fell from £17.12 to £16.42. Over 22 months of follow-up, 26 episodes were eligible for treatment with intramuscular antibiotics. Over the same time period, 121 people were admitted directly from the foot clinic. The costs saved as a result of avoided or delayed admission for those 26 episodes was over £76 000. For 12 people who required subsequent admission, their length of hospital stay was significantly shorter than those admitted directly [9.25 days (range 2-25) vs. 16.11 (2-64), P = 0.045]. CONCLUSIONS: By modifying the Infectious Disease Society of America classification and adopting a protocol to administer outpatient oral and intramuscular antibiotics, we have led to substantial cost savings, shorter hospital admissions and also have developed a successful admissions avoidance strategy.

Computer-aided, case-based diagnosis of mammographic regions of interest containing microcalcifications.

RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate the effectiveness of a mapped-database diagnostic system in reducing the incidence of benign biopsies and misdiagnosed cancers among mammographic regions of interest (ROIs). MATERIALS AND METHODS: A novel neural network was devised (a) to respond to a query ROI by recommending to biopsy or not to biopsy and (b) to map each ROI in the database as a dot on a computer screen. The network was designed so that clusters in the array of dots help the radiologist to find proved ROIs visually similar to the query ROI. This mapped-database diagnostic system was restricted to ROIs with visible microcalcifications. The neural network was trained with a stored database of 80 biopsy-proved ROIs. RESULTS: Four radiologists acting independently on 100 ROIs recommended biopsies for 18, 15, 28, and 18 benign ROIs and misdiagnosed cancers in 11, 12, 7, and eight ROIs, respectively. Interaction with the mapped-database system reduced the numbers of benign biopsies to 11, eight, 18, and 10 cases and of misdiagnosed cancers to eight, seven, four, and three cases, respectively. Statistical analysis indicated that three radiologists achieved significant improvements at P < or = .02 and the fourth achieved a substantial improvement at P < or = .07. CONCLUSION: By using a mapped database of proved mammographic ROIs containing microcalcifications, radiologists may statistically significantly reduce the numbers of benign biopsies and misdiagnosed cancers.

Get patient information anytime, anywhere.

In a hospital faced with rapidly changing community needs, system integration will unite data from beside monitors and ancillary equipment with the hospital's information system. The technology enables faster, easier, and fewer patient transfers, flexible monitor use, continuous monitoring, and remote access of patient information.

Transurethral ultrasound-guided laser-induced prostatectomy: National Human Cooperative Study results.

Between November 1990 and March 1992, 150 patients at 10 United States institutions were treated with transurethral ultrasound-guided laser-induced prostatectomy (TULIP) for the relief of bladder outlet obstruction secondary to benign prostatic hypertrophy. The TULIP system incorporates ultrasound visualization with a 90-degree angle, side-firing laser to effect coagulation necrosis of prostate tissue. The overall preoperative prostate volume in this TULIP study was 40 cc and all types of prostatic enlargement, including median lobe obstruction, were treated. There were no intraoperative complications, with no hemorrhage or post-transurethral resection syndrome, and no blood transfusions were required. Hospital stay averaged 1.7 days and 83% of the patients went home after a 1-night stay. We evaluated 63 patients at 6 months after the TULIP procedure. Mean symptom scores decreased from 18.8 to 6.1, for a 68% improvement. The mean peak flow increased from 6.7 ml. per second preoperatively to 11.9 ml. per second, for a 78% improvement. Overall, 87% of the patients exhibited at least 50% improvement in either the symptom score or peak flow parameter, while 49% of the patients demonstrated at least a 50% improvement in both parameters.

Intraoperative use of ureterorenoscope.

A new intraoperative use of the ureterorenoscope is described for open stone surgery. A mid ureteral stone that had moved back into the kidney was retrieved successfully through a ureterotomy incision, avoiding further procedures.

The management of ureteral calculi during pregnancy.

During the past seven years, 14 pregnant patients were admitted to our hospital for treatment of ureteral calculus. During this same period, 22,495 deliveries were performed, for an incidence of one calculus per 1,600 pregnancies. Eleven patients spontaneously passed the calculus, ten prior to delivery and one patient postpartum. Three patients required an operation, two antepartum and one patient postpartum. No maternal or fetal complications occurred. Management of urinary calculi during pregnancy must be individualized and should be based upon location of the stone, degree of obstruction, presence or absence of infection, general condition of the patient and stage of pregnancy. Surgical intervention to remove obstructing calculi is not contraindicated during pregnancy.