Validation of the surveillance and reporting of central line-associated bloodstream infection denominator data.

BACKGROUND: While the main focus of validating central line-associated infections (CLABIs) has been applying strict definitions to identify cases, assessing the denominator counts has received less attention. This study evaluates the accuracy of the reporting of CLABSI denominator patient-day (PD) and central line-day (CLD) counts to the National Healthcare Safety Network (NHSN) system in one state. METHODS: The Connecticut Department of Public Health (CT DPH) performed a blinded retrospective chart review on the collection of CLABSI PD and CLD on 9 selected days during the fourth quarter of 2009 from 23 acute care hospitals. RESULTS: Overall, 1,988 intensive care unit patient charts were reviewed. Comparison of hospital and CT DPH counts identified over-reporting by 300 PD (17.2%) and 200 CLD (21.7%) with 17 hospitals (74%) collecting data manually. PD manual collection methods were more accurate than electronic methods (P < .01). For CLD, there was no significant difference in collection method (P > .05). Wednesday PD counts were more accurate than Monday (P < .05) or Saturday (P < .05). For CLD counts, there was no significant difference among the 3 days (P > .05). CONCLUSION: Our results provide some evidence for the prerequisite internal validation of denominator data by hospitals before reporting to the national surveillance system.

Estrogen dependent growth inhibitory effects of tamoxifen but not genistein in solid tumors derived from estrogen receptor positive (ER+) primary breast carcinoma MCF7: single agent and novel combined treatment approaches.

While many studies have documented tamoxifen's benefits as an adjuvant therapy in the treatment and prevention of recurrent breast cancer in estrogen receptor positive (ER+) breast carcinoma, this beneficial effect may decrease with long-term tamoxifen use. This experimental study was designed to compare the cytotoxic responses of ER+ primary breast cancer solid tumors derived from the MCF7 cell line to experimental therapeutics, including genistein, tamoxifen, all-trans retinoic acid (ATRA) and parthenolide in the presence and absence of exogenous beta-estradiol. The results of this study suggest that the growth inhibitory effects of tamoxifen, were dependent on beta-estradiol levels. In contrast, the cytotoxic effects of the isoflavone soy derivative, genistein, were observed to be independent of exogenous estrogen. Moreover, combined therapy using tamoxifen and genistein produced enhanced cytotoxic effects also independent of beta-estradiol levels. Additional studies involving the use of the novel agents all trans retinoic acid (ATRA) and parthenolide produced notable tumor responses and combined effects that were also estrogen-independent. Overall, these preclinical research findings suggest possible clinical applications suggesting that genistein might be a useful clinical adjuvant, particularly in post-menopausal women in whom breast cancer occurs more frequently. Moreover, this research suggests that combined treatment approaches involving the use of tamoxifen in conjunction with agents that inhibit NFkappaB pathway signaling, such as parthenolide and genistein, warrant further study.