2009 September 04

Oseltamivir- and amantadine-resistant influenza viruses A (H1N1).

Sep 042009

Oseltamivir- and amantadine-resistant influenza viruses A (H1N1).

Emerg Infect Dis. 2009 Jun;15(6):966-8

Authors: Cheng PK, Leung TW, Ho EC, Leung PC, Ng AY, Lai MY, Lim WW

Surveillance of amantadine and oseltamivir resistance among influenza viruses was begun in Hong Kong in 2006. In 2008, while both A/Brisbane/59/2007-like and A/Hong Kong/2652/2006-like viruses (H1N1) were cocirculating, we detected amantadine and oseltamivir resistance among A/Hong Kong/2652/2006-like viruses (H1N1), caused by genetic reassortment or spontaneous mutation.

PMID: 19523305 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Modelling the impact of an influenza A/H1N1 pandemic on critical care demand from early pathogenicity data: the case for sentinel reporting.

Anaesthesia Start a Discussion »

Sep 042009

Modelling the impact of an influenza A/H1N1 pandemic on critical care demand from early pathogenicity data: the case for sentinel reporting.

Anaesthesia. 2009 Sep;64(9):937-41

Authors: Ercole A, Taylor BL, Rhodes A, Menon DK

Projected critical care demand for pandemic influenza H1N1 in England was estimated in this study. The effect of varying hospital admission rates under statistical uncertainty was examined. Early in a pandemic, uncertainty in epidemiological parameters leads to a wide range of credible scenarios, with projected demand ranging from insignificant to overwhelming. However, even small changes to input assumptions make the major incident scenario increasingly likely. Before any cases are admitted to hospital, 95% confidence limit on admission rates led to a range in predicted peak critical care bed occupancy of between 0% and 37% of total critical care bed capacity, half of these cases requiring ventilatory support. For hospital admission rates above 0.25%, critical care bed availability would be exceeded. Further, only 10% of critical care beds in England are in specialist paediatric units, but best estimates suggest that 30% of patients requiring critical care will be children. Paediatric intensive care facilities are likely to be quickly exhausted and suggest that older children should be managed in adult critical care units to allow resource optimisation. Crucially this study highlights the need for sentinel reporting and real-time modelling to guide rational decision making.

PMID: 19645759 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

What evidence supports the use of computerized alerts and prompts to improve clinicians’ prescribing behavior?

J Am Med Inform Assoc Start a Discussion »

Sep 042009

What evidence supports the use of computerized alerts and prompts to improve clinicians' prescribing behavior?

J Am Med Inform Assoc. 2009 Jul-Aug;16(4):531-8

Authors: Schedlbauer A, Prasad V, Mulvaney C, Phansalkar S, Stanton W, Bates DW, Avery AJ

Alerts and prompts represent promising types of decision support in electronic prescribing to tackle inadequacies in prescribing. A systematic review was conducted to evaluate the efficacy of computerized drug alerts and prompts searching EMBASE, CINHAL, MEDLINE, and PsychINFO up to May 2007. Studies assessing the impact of electronic alerts and prompts on clinicians' prescribing behavior were selected and categorized by decision support type. Most alerts and prompts (23 out of 27) demonstrated benefit in improving prescribing behavior and/or reducing error rates. The impact appeared to vary based on the type of decision support. Some of these alerts (n = 5) reported a positive impact on clinical and health service management outcomes. For many categories of reminders, the number of studies was very small and few data were available from the outpatient setting. None of the studies evaluated features that might make alerts and prompts more effective. Details of an updated search run in Jan 2009 are included in the supplement section of this review.

PMID: 19390110 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Are call light use and response time correlated with inpatient falls and inpatient dissatisfaction?

J Nurs Care Qual Start a Discussion »

Sep 042009

Are call light use and response time correlated with inpatient falls and inpatient dissatisfaction?

J Nurs Care Qual. 2009 Jul-Sep;24(3):232-42

Authors: Tzeng HM, Yin CY

Inpatients use call lights to seek nurses' assistance. Although implied in patient safety, no studies have analyzed data related to the use of or response time to call lights collected by existing tracking mechanisms monitoring nursing practice. This study used archived hospital data to determine the correlation of the call light use rate and the average call light response time with the fall rate, injurious fall rate, and patient satisfaction scores in acute inpatient care settings.

PMID: 19525764 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

It appears to be safe to start chemotherapy on the day of implantation through subcutaneous venous port catheters in inpatient setting.

Support Care Cancer Start a Discussion »

Sep 042009

It appears to be safe to start chemotherapy on the day of implantation through subcutaneous venous port catheters in inpatient setting.

Support Care Cancer. 2009 Apr;17(4):399-403

Authors: Ozdemir NY, Abali H, Oksüzo?lu B, Budako?lu B, Akmangit I, Zengin N

GOALS: It is generally recommended to wait for at least 24 h before starting chemotherapy after implanting venous port catheters (VPC). Our aim was to evaluate whether it is safe to start chemotherapy on the day of implantation. PATIENTS AND METHODS: One hundred eighty patients who had to be given chemotherapy on the day of VPC implantation at our institution from June 2005 to April 2007 were included. MAIN RESULTS: Of patients, 122 were male (67.8%) and median age was 55 years. Majority (133, 72.8%) had colon and gastric adenocancer. Median time to chemotherapy onset from VPC implantation was 102 min (minimum-maximum, 12-402). One hundred sixty-four (91.1%) received prolonged chemotherapy infusions beyond 48 h. No life-threatening acute complications like pneumothorax and hemothorax developed. In one patient extravasation (empty saline extravasation secondary to wrong insertion of the needle), in 17 (9.4%) pain, and in 41 (22.8%) minor bleeding as echymosis were seen. Thrombosis developed in 11 (6.1%). Reasons for VPC removal were thrombosis (2), sepsis (2), cellulitis (1), skin dehiscence (1), and patient will (1). CONCLUSION: Chemotherapy administration immediately after VPC implantation appears safe without increased acute and chronic complications in inpatient setting.

PMID: 18762993 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Emergency department patient preferences for waiting for a bed.

Emerg Med Australas Start a Discussion »

Sep 042009

Emergency department patient preferences for waiting for a bed.

Emerg Med Australas. 2009 Feb;21(1):25-30

Authors: Bartlett S, Fatovich DM

OBJECTIVE: Many EDs have difficulty transferring admitted patients to inpatient beds in a timely manner because of access block. We assessed ED patient preferences for waiting location. METHOD: Admitted ED patients at Royal Perth Hospital, Perth, Western Australia, Australia were surveyed over a 4 week period. Patients were questioned about their preferences for waiting location (ED cubicle, ED corridor, ward corridor, no preference). Patients were also asked what they felt was the maximum acceptable time for waiting for a ward bed. We also assessed if patient expectations were met with regards to their waiting times. RESULTS: A total of 400 patients were surveyed. Of all, 121 patients (30.2%) had no preference for waiting location and 215 patients (53.8%) preferred ED cubicles. If the waiting location option was between EDs and ward corridors, 185 patients (46.2%) had no preference. Of the 215 patients who had a preference, 72.1% preferred to wait in a ward corridor (95% CI 65.5-77.8%) and 27.9% preferred the ED corridor (95% CI 22.1-34.5%). Fifty-seven per cent of patients expected to get to their ward bed within 6 h. Seventy-two point one per cent (95% CI 66.3%-77.2%) of patients did not have their expectations met for bed waiting times. CONCLUSIONS: Patients would prefer to wait in ward corridors for their ward bed if there was no ED cubicle available. Waiting in the ED corridor is their least preferred option. Patients usually expect to get to their ward bed within 3 h. However, with high levels of access block, patient expectations for waiting times for a bed are usually not met. These findings could be used to drive system changes that are more patient-focussed.

PMID: 19254309 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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