887 resultados para Oak Park (Ill.)
Resumo:
Background. Invasive Candida infection among nonneutropenic, critically ill adults is a clinical problem that has received increasing attention in recent years. Poor performance of extant diagnostic modalities has promoted risk-based, preemptive prescribing in view of the poor outcomes associated with inadequate or delayed antifungal therapy; this risks unnecessary overtreatment. A rapid, reliable diagnostic test could have a substantial impact on therapeutic practice in this patient population.
Methods. Three TaqMan-based real-time polymerase chain reaction assays were developed that are capable of detecting the main medically important Candida species, categorized according to the likelihood of fluconazole susceptibility. Assay 1 detected Candida albicans, Candida parapsilosis, Candida tropicalis, and Candida dubliniensis. Assays 2 and 3 detected Candida glabrata and Candida krusei, respectively. The clinical performance of these assays, applied to serum, was evaluated in a prospective trial of nonneutropenic adults in a single intensive care unit.
Results. In all, 527 specimens were obtained from 157 participants. All 3 assays were run in parallel for each specimen; they could be completed within 1 working day. Of these, 23 specimens were obtained from 23 participants categorized as having proven Candida infection at the time of sampling. If a single episode of Candida famata candidemia was excluded, the estimated clinical sensitivity, specificity, and positive and negative predictive values of the assays in this trial were 90.9%, 100%, 100% and 99.8%, respectively.
Conclusions. These data suggest that the described assays perform well in this population for enhancing the diagnosis of candidemia. The extent to which they may affect clinical outcomes, prescribing practice, and cost-effectiveness of care remains to be ascertained.
Resumo:
Background
Over the past ten years MRSA has become endemic in hospitals and is associated with increased healthcare costs. Critically ill patients are most at risk, in part because of the number of invasive therapies that they require in the intensive care unit (ICU). Washing with 5% tea tree oil (TTO) has been shown to be effective in removing MRSA on the skin. However, to date, no trials have evaluated the potential of TTO body wash to prevent MRSA colonization or infection. In addition, detecting MRSA by usual culture methods is slow. A faster method using a PCR assay has been developed in the laboratory, but requires evaluation in a large number of patients.
Methods/Design
This study protocol describes the design of a multicentre, phase II/III prospective open-label randomized controlled clinical trial to evaluate whether a concentration of 5% TTO is effective in preventing MRSA colonization in comparison with a standard body wash (Johnsons Baby Softwash) in the ICU. In addition we will evaluate the cost-effectiveness of TTO body wash and assess the effectiveness of the PCR assay in detecting MRSA in critically ill patients. On admission to intensive care, swabs from the nose and groin will be taken to screen for MRSA as per current practice. Patients will be randomly assigned to be washed with the standard body wash or TTO body wash. On discharge from the unit, swabs will be taken again to identify whether there is a difference in MRSA colonization between the two groups.
Discussion
If TTO body wash is found to be effective, widespread implementation of such a simple colonization prevention tool has the potential to impact on patient outcomes, healthcare resource use and patient confidence both nationally and internationally.
Trial Registration
[ISRCTN65190967]
Resumo:
The reduction of forest floor ground cover and litter layers by prescribed fires may alter the morphology (field and micro) and physical properties of surface horizons. This study determined long-term (35 yr) changes in surface horizon bulk density, organic matter concentration and content, and morphology in response to periodic (5 yr) and annual (1 yr) prescribed fires. Soils were fine-silty, siliceous, thermic Glossic Fragiuldults, supporting mixed oak vegetation in middle Tennessee. Upper mineral soils (0- to 2-cm and 0- to 7.6-cm depths) were sampled and detailed field descriptions made. Periodic and control plots had a thin layer of Oi, Oe, and Oa horizons 5 yr after the 1993 burn, whereas on annual burn plots a 1- to 2-cm charred layer was present. Significant reductions in organic matter concentration and mean thickness of the A horizon were found from burning (A horizons thicknesses were 6.4, 4.6, and 2.9 cm in control, periodic, and annual plots, respectively). Periodic burns did not significantly alter the organic matter and bulk density of the upper 7.6 cm of mineral soil; however, annual burns did result in significantly higher bulk densities (1.01, 1.07, and 1.29 Mg m-3 in control, periodic, and annual plots, respectively) and lower organic matter concentrations and contents. Microscopic investigations confirmed that compaction was increased from annual burning. Thin sections also revealed that the granular structure of the A horizons in control and periodic plots resulted from bioterbation of macro and mesofauna, fungi, and roots. Long-term annual burning greatly affected surface soil properties, whereas periodic burning on a 5-yr cycle had only limited effects.
