S Saint

..We were also curious whether lead infection preventionist certification in infection prevention and control (CIC) correlated with perceptions of the evidence...

..The objective of this study was to evaluate the results of a statewide quality improvement effort to reduce inappropriate urinary catheter use...

..We conducted a national study to examine the current practices used by hospitals to prevent hospital-acquired UTI...

..Physicians are often unaware that their patients have a urinary catheter, and these "forgotten" catheters are frequently unnecessary...

..Therefore, how hospitals and physicians respond to the CMS rule changes must be monitored closely...

..We thus conducted a multicenter study to understand better how US hospitals approach the prevention of hospital-acquired UTI...

..We describe here the results of our multimodal intervention intended to improve levels of healthcare worker hand hygiene...

..Just as healthcare epidemiology has emerged as a paradigm for patient safety, infection prevention may serve as a clinical model for implementation researchers...

..Because preliminary data indicated that hospital leadership played an important role, we sought better to understand which behaviors are exhibited by leaders who are successful at implementing HAI prevention practices in US hospitals...

..Therefore, learning how to implement these findings is critically important to promoting high-quality care and a safe health care environment...

..A recent meta-analysis concluded that silver alloy catheters reduce the incidence of UTI by 3-fold; however, clinicians must decide whether the efficacy of such catheters is worth the extra per unit cost of $5.30...

..Health care payers increasingly expect that the results of evidence-based economic evaluations will guide practitioners in their choice of cost-effective interventions...

..We explored the types and numbers of champions who lead efforts to implement best practices to prevent hospital-acquired infection in US hospitals...

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..The slight increase in infectious risk when using multilumen catheters is likely offset by their improved convenience, thereby justifying the continued use of multilumen vascular catheters...

..We sought to determine the beliefs of both older male patients and nursing staff about the relative merits and problems of condom and indwelling catheters...

..However, the benefits expected from lowering homocyst(e)ine levels with folic acid and vitamin B(12) supplementation have yet to be demonstrated in clinical trials...

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..In this article, we provide an overview of the development of S pneumoniae resistance to commonly used antibiotics and discuss the implications of the development of resistance on treatment decisions...

..Using these methods, urinary catheter-associated UTI can often be prevented for weeks, but not longer terms...

..We conclude by providing guidance on the appropriate use of summary measures derived from meta-analyses for cost-effectiveness studies...

..To examine the extent to which US acute care hospitals have adopted recommended practices to prevent central venous catheter-related bloodstream infections (CR-BSIs)...

..We found no clear evidence to suggest which antiseptic should be used to prevent false-positive results. Studies suggest, however, a possible benefit from the use of prepackaged skin antiseptic kits and alcohol-containing antiseptics...

..Explanations for this sex difference are controversial. The objective of this study was to assess whether infection contributes to the increased risk of mortality in women...

..A synopsis of comments made during the morning practice panel and empirical support for the themes and subthemes identified by panelists are provided in this article...

..We evaluated whether physician profiling affects physician satisfaction and hospital length of stay, and assessed physicians' views concerning hospital cost containment and the quality of care they provide...

..To examine the extent to which elderly individuals use various skilled care facilities after coronary artery bypass grafting (CABG)...

..To compare condom and indwelling urinary catheters in terms of infection risk and patient satisfaction...

..Catheter-related bloodstream infections are common, costly, and morbid. Randomized controlled trials indicate that antiseptic-coated central venous catheters reduce infection rates...

..We also summarize the most recent data on how to prevent hospital-acquired infection, in general, and nosocomial pneumonia, in particular...

..Risk factors for bacteremia in patients with hospital-acquired bacteriuria are largely unknown. Given the morbidity and costs associated with nosocomial bacteremia, determining risk factors could enhance the safety of hospitalized patients...

..In addition, we hope that this article will stimulate increased interest and research in identifying strategies that will successfully move evidence from the peer-reviewed literature to the patient's bedside...

..This systematic review is intended to provide clinicians with an overview of the incidence, etiology, and outcome of hospital-acquired fever...

..At community hospitals and less research-oriented AMCs, hospital medicine programs may soon be ready to become separate divisions...

..Attention toward prevention of CAUTI will likely increase as Center for Medicare and Medicaid Services and other third-party payers no longer reimburse for hospital-acquired UTI...

..Moreover, our findings provide important insights about how and why different quality improvement strategies might perform across organizations with differing contextual characteristics...

..To summarize the effect of urinary catheter reminder systems on the rate of CAUTI, urinary catheter use, and the need for recatheterization, we performed a systematic review and meta-analysis...

..To assess the knowledge of recommended urinary catheter care practices among nursing home (NH) healthcare workers (HCWs) in southeast Michigan...

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..To examine the results of a multi-institution, hospitalist-centered consortium designed to disseminate knowledge of best practices relevant to patient safety and to facilitate institutional innovation around such practices...

..Concomitant with this re-examination have been reports showing variability in the use of specific blood components. This investigation was designed to assess hospital variation in blood use and outcomes in cardiac surgery patients...

..A qualitative study was conducted to determine the barriers to implementing evidence-based practices to prevent HAI, with a specific focus on the role played by hospital personnel...

..We also were curious whether variability would exist in the hand hygiene rates despite the close proximity of the units...

..Strategies to optimize antibiotic use for such patients are discussed and include implementing a process whereby a urine culture is automatically performed if a urinalysis result suggests infection...

..Many hospitalizations for residents of skilled nursing facilities are potentially avoidable. Factors that could prevent hospitalization for urinary tract infection (UTI) were investigated, with focus on patient mobility...

..Leadership support and staff receptivity play a significant role in its adoption...

..Information regarding the incidence of antibiotic-resistant infection in residents of skilled nursing facilities is lacking...

..To determine what practices are used by hospitals to prevent ventilator-associated pneumonia (VAP) and, through qualitative methods, to understand more fully why hospitals use certain practices and not others...

..Ideally, a successful hospital-based clinical research program will need to partner hospitalists with specialists...

..To assess use of urinary collection devices (external, intermittent, and indwelling catheters; pads or briefs) and examine predictors of indwelling catheters in skilled nursing facilities (SNFs)...

..Future research should focus on additional methods for preventing this common infection...

..To examine the effects of internal medicine specialty and physician experience on inpatient resource use and clinical outcomes on an academic general medicine service...

..e., internists who spend less than 50% of their clinical time caring for inpatients), what effect does time spent in the hospital have on physician satisfaction, stress, and burnout?"..

..More than 80% of hospitals in the United States use critical pathways for at least some of their patients. Unfortunately, critical pathway effectiveness in improving clinical efficiency is unclear...

..To obtain nationally representative estimates of the additional time, and related cost, of unpaid family caregiving (informal caregiving) associated with chronic lung disease among older Americans...

..Results of recent studies from high-volume academic centers suggest that coronary artery bypass grafting (CABG) is becoming safer to perform in octogenarians. Similar data from community-based facilities do not exist...

..The group also includes a consumer representative. Critical issues are addressed through rigorous case discussion, literature review, and expert consultation...

..To obtain nationally representative estimates of the additional time, and related cost, of informal caregiving associated with urinary incontinence in older individuals...

..We assessed (1) whether in-hospital mortality rates differ across lower- and higher-volume hospitals by expected surgical risk and (2) whether high-risk patients are more likely to undergo CABG at low-volume centers...

..Identifying children at risk for readmission is challenging. Children who did not require supplemental oxygen may be at greater risk because they are progressing in their illness...

..Although previous meta-analyses have concluded that acetylcysteine is beneficial, the recent availability of additional trials calls for reassessment of current evidence...

..If this strategy is effective, similar strategies can be studied and implemented for other high-risk groups...

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..The goal of this study was to determine whether outcomes of nonemergent coronary artery bypass grafting (CABG) differed between low- and high-volume hospitals in patients at different levels of surgical risk...

..While the efficacy and safety of coronary artery bypass grafting (CABG) has been established in several clinical trials, little is known about its outcomes in Native Americans...

..In this article, Drs Flaherty, Saint, Fendrick, and Martinez discuss how an evidence-based approach to treatment may help ensure that efficacious therapy is available in the future...

..Before its clinical use is justified, however, the overall accuracy of EBCT must be better defined...

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..4, p = 0.003). Community-acquired bacteremia is often device-related and may be preventable. Strategies that have been successful in preventing nosocomial device-related bacteremia should be adapted to the outpatient setting...

..We conclude that internists, regardless of training in epidemiology, rely heavily on abstracts and prescreening of articles by editors...

..Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in critically ill patients. The clinical and economic consequences of VAP are unclear, with a broad range of values reported in the literature..

..Interventions beneficial to the prevention of ventilator-associated pneumonia would therefore have a significant impact on the care of these patients...

..It remains unclear whether minocycline/rifampin catheters are cost-effective for all high-risk patients or only those requiring longer-term catheterization...

..Use of chlorhexidine gluconate is a simple and effective means of reducing vascular catheter-related infections...

..While we believe the available evidence does support the use of maximal sterile barriers during routine insertion of central venous catheters, prospective studies and economic analyses would better clarify its value...