Estimating the cost of health care–associated infections : mind your p’s and q’s

Monetary valuations of the economic cost of health care–associated infections (HAIs) are important for decision making and should be estimated accurately. Erroneously high estimates of costs, designed to jolt decision makers into action, may do more harm than good in the struggle to attract funding for infection control. Expectations among policy makers might be raised, and then they are disappointed when the reduction in the number of HAIs does not yield the anticipated cost saving. For this article, we critically review the field and discuss 3 questions. Why measure the cost of an HAI? What outcome should be used to measure the cost of an HAI? What is the best method for making this measurement? The aim is to encourage researchers to collect and then disseminate information that accurately guides decisions about the economic value of expanding or changing current infection control activities.

'The war of Canudos: a Euclidean interpretation.' [Guerra de Canudos: uma leitura euclidiana]

The publication of the book The interior, in 1902, would change the course of thinking about the War of Canudos, who for many years, had been known simply as' the history of Euclid. President Getulio Vargas became interested in the backwoods bloodbath after reading the book avenger-Euclidean. Liked the work he visited the place of occurrence of war promising enjoy the river poured-Barris with the construction of the weir Cocorobo. Euclides da Cunha lived and produced his work in a time of great change in thought, politics and technology. Despite having worked in the press throughout his life, was best known as an engineer, for having exercised the office during the reconstruction of the bridge, in Sao Jose do Rio Pardo. This article aims to illuminate the event of war in light of the Euclidean work. We will examine the trajectory of Euclides da Cunha in journalism. Your learning process to execute the office newsreader and war correspondent, the newspaper O Estado de S. Paul, as well as their reports and work-monument the hinterlands. Resumo: A publicação da obra Os sertões, em 1902, mudaria os rumos do pensamento sobre a Guerra de Canudos, que, por muitos anos, ficara conhecida, simplesmente, como ‘história de Euclides’. O presidente Getúlio Vargas interessou-se pela hecatombe sertaneja após ter lido o livro-vingador euclidiano. Gostou tanto da obra que visitou o lugar de acontecimento da guerra prometendo aproveitar as águas do rio Vaza-Barris com a construção do açude de Cocorobó. Euclides da Cunha viveu e produziu a sua obra em um momento de grandes transformações no pensamento, na política e na tecnologia. Apesar de ter atuado na imprensa ao longo de toda a sua vida, ficou mais conhecido como engenheiro, por ter exercido o ofício, durante a reconstrução da ponte, em São José do Rio Pardo. O presente artigo visa iluminar o acontecimento da guerra à luz da obra euclidiana. Examinaremos a trajetória de Euclides da Cunha no jornalismo. O seu processo de aprendizagem para exercer o ofício de noticiarista e correspondente de guerra, pelo jornal O Estado de S. Paulo, bem como, as suas reportagens e obra-monumento Os sertões.

Phase III trial comparing paclitaxel poliglumex (CT-2103, PPX) in combination with carboplatin versus standard paclitaxel and carboplatin in the treatment of PS 2 patients with chemotherapy-naïve advanced non-small cell lung cancer

INTRODUCTION: Performance status (PS) 2 patients with non-small cell lung cancer (NSCLC) experience more toxicity, lower response rates, and shorter survival times than healthier patients treated with standard chemotherapy. Paclitaxel poliglumex (PPX), a macromolecule drug conjugate of paclitaxel and polyglutamic acid, reduces systemic exposure to peak concentrations of free paclitaxel and may lead to increased concentrations in tumors due to enhanced vascular permeability. METHODS: Chemotherapy-naive PS 2 patients with advanced NSCLC were randomized to receive carboplatin (area under the curve = 6) and either PPX (210 mg/m/10 min without routine steroid premedication) or paclitaxel (225 mg/m/3 h with standard premedication) every 3 weeks. The primary end point was overall survival. RESULTS: A total of 400 patients were enrolled. Alopecia, arthralgias/myalgias, and cardiac events were significantly less frequent with PPX/carboplatin, whereas grade ≥3 neutropenia and grade 3 neuropathy showed a trend of worsening. There was no significant difference in the incidence of hypersensitivity reactions despite the absence of routine premedication in the PPX arm. Overall survival was similar between treatment arms (hazard ratio, 0.97; log rank p = 0.769). Median and 1-year survival rates were 7.9 months and 31%, for PPX versus 8 months and 31% for paclitaxel. Disease control rates were 64% and 69% for PPX and paclitaxel, respectively. Time to progression was similar: 3.9 months for PPX/carboplatin versus 4.6 months for paclitaxel/carboplatin (p = 0.210). CONCLUSION: PPX/carboplatin failed to provide superior survival compared with paclitaxel/carboplatin in the first-line treatment of PS 2 patients with NSCLC, but the results with respect to progression-free survival and overall survival were comparable and the PPX regimen was more convenient. © 2008International Association for the Study of Lung Cancer.