Assessment of central venous catheter-associated infections using semi-quantitative or quantitative culture methods

Semiquantitative (Maki) and quantitative (Brun- Buisson) culture techniques were employed in the diagnosis of catheter-related bloodstream infections (CRBSI) in patients who have a short-term central venous catheter (inserted for 30 days). The diagnosis of CRBSI was based on the results of semiquantitative and quantitative culture of material from the removed catheters. Catheter tips (118) from 100 patients were evaluated by both methods. Semiquantitative analysis revealed 34 catheters (28.8%) colonized by ≥15 colonyforming units (cfu), while quantitative cultures (34 catheters, 28.8%) showed the growth of ≥103 cfu/mL. Bacteremia was confirmed in four patients by isolating microorganisms of identical species from both catheters and blood samples. Using the semiquantitative culture technique on short-term central venous catheter tips, we have shown that with a cut-off level of ≥15 cfu, the technique had 100.0% sensitivity, specificity of 68.4%, 25.0% positive predictive value (PPV) and 100.0% negative predictive value (NPV), efficiency of 71.4% and a prevalence of 9.5%. The quantitative method, with a cut-off limit of ≥103 cfu/mL, gave identical values: the sensitivity was 100.0%, specificity 68.4%, positive predictive value (PPV) 25.0%, negative predictive value (NPV) 100.0%, efficiency 71.4% and prevalence 9.5%. We concluded that the semiquantitative and quantitative culture methods, evaluated in parallel, for the first time in Brazil, have similar sensitivity and specificity. Keywords: central venous catheter; semi-quantitative culture; quantitative culture; catheter-related bacteremia.

Comparative study of ultrasonographic methods for assessment of pregnancy age in bitches

Compared with human beings, the application of ultrasound in estimating fetal age in bitches is limited due to the large variation of breed and size in this species. Several formulas were developed to calculate the gestational age and to provide the date of birth in dogs, but the efficacy of these formulas on the different gestational stages and dog breeds is unknown. The aim of this study was to compare sonographic methods for assessment of gestational age and days before parturition in dogs with different body weights and pregnancy stages. Twenty seven bitches of several sizes were examined and divided into three groups according to the initial body weight (A: <10kg; B: 10.1 - 20kg; C: >20.1kg); then each group was divided into three subgroups according to pregnancy stage (1st: 18 to 30 days; 2nd: 31 to 40 days; 3rd: >40 days) estimated according to the first day of copulation. Ultrasonography was performed weekly from the first stage of pregnancy. In the first and second stage the following formulas were applied: GA = (6XGSD) + 20; DBP = 65 - IG; by Nyland & Matton (2002); GA: gestational age; DBP: days before parturition; DSG: gestational sac diameter; in the third stage: DBP = 61,2 - (24,6 X BD); DBP = 43,5 - (10,9 X CD); by Burk & Ackerman (1996); BD: biparietal diameter; CD: body diameter, and: GA = (15 X BD) + 20; GA = (7 X CD) + 29; GA = (6 X BD) + (3 X CD) + 30; DBP = 65 - GA; by Nyland & Matton (2002). Results were compared statistically. The equations proposed by Nyland & Matton (2002), were more accurate in all pregnancy stages, with a margin of error of only three days, regardless of the size of the animal; therefore these methods are the best option in veterinary practice.

Reliability of marginal microleakage assessment by visual and digital methods

The aim of this study was to investigate the reliability of visual and digital methods to assess marginal microleakage in vitro. Materials and Methods: Typical Class V preparations were made in bovine teeth and filled with composite resin. After dye penetration (0.5% basic fuchsin), teeth were sectioned and the 53 obtained fragments were assessed according to visual (stereomicroscope) and digital methods (Image Tool Software ® -ITS) (University of Texas Health Science Center-San Antonio Dental School, USA). Two calibrated examiners (A and B) evaluated dye penetration, by means of a stereomicroscope with ×20 magnification (scores), and by the ITS (millimeters). The intra- and inter-examiner agreement was estimated according to Kappa statistics (κ), and intraclass correlation coefficient (ρ). Results: In relation to the visual method, the intra-examiner agreement was almost perfect (κA = 0.87) and substantial (κB = 0.76), respectively to the examiner A and B. The inter-examiner agreement showed an almost perfect reliability (κ = 0.84). For the digital method, the intra-examiner agreement was almost perfect for both examiners and equal to ρ = 0.99, and so was the inter-examiner agreement value. Conclusion: Visual (stereomicroscope) and digital methods (ITS) showed high levels of intra- and inter-examiner reproducibility when marginal microleakage was assessed.

Spatial Assessment of Indices for Characterizing the Erosive Force of Rainfall in El Salvador Republic

Soil erosion data in El Salvador Republic are scarce and there is no rainfall erosivity map for this region. Considering that rainfall erosivity is an important guide for planning soil erosion control practices, a spatial assessment of indices for characterizing the erosive force of rainfall in El Salvador Republic was carried out. Using pluviometric records from 25 weather stations, we applied two methods: erosivity index equation and the Fournier index. In all study area, the rainiest period is from May to November. Annual values of erosivity index ranged from 7,196 to 17,856 MJ mm ha(-1) h(-1) year(-1) and the Fournier index ranged from 52.9 to 110.0 mm. The erosivity map showed that the study area can be broadly divided into three major erosion risk zones, and the Fournier index map was divided into four zones. Both methods revealed that the erosive force is severe in all study area and presented significant spatial correlation with each other. The erosive force in the country is concentrated mainly from May to November.

Assessment of informatization for the dispensing of medications at a university hospital

INTRODUCTION: Informatics and automation are important tools for the reduction of work, errors and costs in a hospital pharmacy. OBJECTIVES: To describe the structuring and function of an informatized system for the dispensing of medications and to assess its effect on nursing and pharmacy services during the period from 1997 to 2003. MATERIALS and METHODS: In this descriptive and retrospective study, we performed an analysis of documents addressing the structuring and implementation of the informatized medication dispensing system. In addition, we analyzed the perceptions of nurses, pharmacists and pharmacy assistants who participated in the structuring phase of the system when interviewed about the effect of informatization on administrative aspects (e.g., requisition of medications, presentation of the dispensed medication and system operationalization). RESULTS: The major advantages provided by the new system were 1) the elimination of manual transcripts for prescribed medications, 2) increased speed, 3) better identification of the doses prescribed by physicians, 4) medication labels containing all necessary identification and 5) practicality and safety of optical bar code-based verification of the requested and dispensed medications. CONCLUSIONS: The great majority of the interviewees considered the informatized medication supply system to be of good quality. Analysis of the data provided information that could contribute to the expansion and refinement of the system, provide support for studies regarding the utilization of medications and offer new perspectives for work and productivity.

Safety Assessment of Potentially Inappropriate Medications (PIM) use in Older People and the Factors Associated with Hospital Admission

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Assessment of a high-order finite difference upwind scheme for the simulation of convection-diffusion problems

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)