[Citizens opinions, experiences and perceptions about waiting lists for elective cataract surgery and hip and knee replacement. ]. / Opiniones, vivencias y percepciones de los ciudadanos en torno a las listas de espera para cirugía electiva de catarata y artroplastia de cadera y rodilla.

OBJECTIVES: The aim of this study is to describe the views, perceptions and personal experience around elective cataract and hip and knee replacement waiting lists in Catalonia in order to improve their management. DESIGN: Qualitative methodology: four focus groups for each procedure. PLACE: Conducted between February-March 2000 at the Catalan Health Services headquarters. PARTICIPANTS: Each focus group included consultants (ophtalmologists, orthopedic surgeons, rheumatologists, rehabilitators, GPs), other related health professionals (nurses, social workers, physiotherapists, opticians/optometrist, GPs), patients and relatives and general population. Participants were selected through researchers and the clinical scientific committees. All of them followed a pre-established inclusion criteria. MAIN MEASURES: The analysis of the information was performed using the content analysis technique (contents of sessions were transcripted and information classified according to themes). RESULTS: Ten themes were identified. Waiting lists were argued to be a consequence of lack of resources, bad management and conflict of interest among consultants. Overall, the health care authority responsibility for the solution was acknowledged, although some participants claim more citizen participation. Among proposed solutions, prevention and education, more resources and improved management were found. Furthermore, a better physician-patient communication was considered essential. All the groups disagreed with the implicit current prioritisation system, however none wanted to assume the responsibility. CONCLUSIONS: Citizen's perceptions and personal experiences point to a multifactorial approach to waiting lists management, which would ameliorate the problem and lead to a better social acceptance.

Rapid identification and antimicrobial susceptibility testing of gram-negative bacilli from blood cultures by the AutoMicrobic system.

A procedure was developed which allows direct identification and antimicrobial susceptibility testing of fermentative and nonfermentative gram-negative bacilli from positive blood cultures. A 10-ml sample was removed from turbid blood culture bottles, and the bacteria were washed and concentrated by centrifugation. The bacterial pellet was used to inoculate an Enterobacteriaceae Plus Identification Card and a Gram-Negative General Susceptibility Card of the AutoMicrobic system. Results with these cards were compared with results obtained with standard technique for 196 blood cultures seeded with recent clinical isolates. Identification of most cultures was available in 8 h, whereas the antimicrobial susceptibility results were available in an average of 4.7 h for all organisms. Direct identification was correct for 95% of the cultures, whereas the antimicrobial susceptibility data had an average agreement of 87% with 3.8% very major and 1.4% major errors. In using this procedure it was possible to provide accurate preliminary identification and results of antimicrobial susceptibility tests for gram-negative bacilli on the same day that a blood culture was determined to be positive.

Pneumococcal infections after human bone-marrow transplantation.

Seven of 26 long-term survivors (greater than 7 months post-transplant) of bone-marrow transplantation developed penicillin-sensitive pneumococcal infections more than 7 months after transplantation. One patient had two infections. Six of eight infections were associated with pneumococcal bacteremia, and Streptococcus pneumoniae type 6A was isolated in three cases. Two infections were fatal. All patients had normal nematopoietic function, and none was receiving immunosuppressive therapy. The development of pneumococcal infection was significantly associated with males and with abnormally low or high serum IGG and IgM levels but not with graft-versus-host disease. Serum opsonic activity for S. pneumoniae type 6A was decreased in six of the seven patients when compared to normal pooled serum in an in-vitro bactericidal assay. Four of the six patients with impaired opsonic activity had low serum antibody levels for S. pneumoniae type 6A capsular polysaccharide, while the other two patients had low serum CH100 complement activity. Bone-marrow transplant recipients have an increased susceptibility to pneumococcal infections and should be evaluated for prophylactic penicillin or pneumococcal vaccination.

Comparison of the Minitek test system with a conventional screening procedure for identification of Enterobacteriaceae.

A Minitek basic 9 disc/11 test system plus arabinose, inositol and rhamnose was compared with a conventional six tube screening system for identification of members of the family Enterobacteriaceae. Correlation varied from 88.3 to 100% with the various substrates when studied against 737 strains of these and other gram-negative bacteria recently isolated in our clinical laboratory. Two discs, citrate and ornithine, which originally gave a correlation of 88.3 and 95.5% respectively were modified so that a final correlation of 99.4 and 96.3% was obtained. The average correlation using the eleven discs was 97%.

In vitro studies with netilmicin compared with amikacin, gentamicin, and tobramycin.

Netilmicin, a new semisynthetic aminoglycoside derived by ethylation of the 1-N position of the deoxystreptamine ring of sisomicin, was tested in vitro with 4,070 strains of gram-negative bacilli isolated at the UCLA Medical Center during 1975 to 1976, using the agar dilution technique and an inoculum of approximately 10(4) organisms. Results were compared with those simultaneously obtained for amikacin, gentamicin, and tobramycin. Using Mueller-Hinton medium, inhibitory concentrations in broth correlated with those obtained by the agar dilution method except for Pseudomonas aeruginosa, where a 2- to 16-fold difference in susceptibility was noted. For most clinically significant Enterobacteriaceae and P. aeruginosa, the activity of netilmicin in vitro was comparable or superior to that of gentamicin, tobramycin, and amikacin with respect to potency by weight and achievable blood levels. Against gentamicin-resistant strains (MIC > 16 mug/ml), the activity of netilmicin paralleled that of amikacin with the exception of Providencia stuartii, which was inhibited by amikacin but not by netilmicin.