Nosocomial infections and their relationship to non-traditional risk factors in a medical intensive care unit

Background. Nosocomial infections are a source of concern for many hospitals in the United States and worldwide. These infections are associated with increased morbidity, mortality and hospital costs. Nosocomial infections occur in ICUs at a rate which is five times greater than those in general wards. Understanding the reasons for the higher rates can ultimately help reduce these infections. The literature has been weak in documenting a direct relationship between nosocomial infections and non-traditional risk factors, such as unit staffing or patient acuity.^ Objective. To examine the relationship, if any, between nosocomial infections and non-traditional risk factors. The potential non-traditional risk factors we studied were the patient acuity (which comprised of the mortality and illness rating of the patient), patient days for patients hospitalized in the ICU, and the patient to nurse ratio.^ Method. We conducted a secondary data analysis on patients hospitalized in the Medical Intensive Care Unit (MICU) of the Memorial Hermann- Texas Medical Center in Houston during the months of March 2008- May 2009. The average monthly values for the patient acuity (mortality and illness Diagnostic Related Group (DRG) scores), patient days for patients hospitalized in the ICU and average patient to nurse ratio were calculated during this time period. Active surveillance of Bloodstream Infections (BSIs), Urinary Tract Infections (UTIs) and Ventilator Associated Pneumonias (VAPs) was performed by Infection Control practitioners, who visited the MICU and performed a personal infection record for each patient. Spearman's rank correlation was performed to determine the relationship between these nosocomial infections and the non-traditional risk factors.^ Results. We found weak negative correlations between BSIs and two measures (illness and mortality DRG). We also found a weak negative correlation between UTI and unit staffing (patient to nurse ratio). The strongest positive correlation was found between illness DRG and mortality DRG, validating our methodology.^ Conclusion. From this analysis, we were able to infer that non-traditional risk factors do not appear to play a significant role in transmission of infection in the units we evaluated.^

The impact of traditional psychiatric services and case management services on the functioning of people with schizophrenia: A cross-national study in Nova Scotia and Texas

The purpose of this study was to determine the impact of traditional psychiatric services with case management services on the functioning of people with schizophrenia. Traditional services were defined as routine clinic services consisting of medication follow-along, psychotherapy, and support services. Case management consisted of activities involved in linking, planning, and monitoring services for the outpatient client who has schizophrenia. The target population was adult schizophrenics who had been receiving outpatient clinic services for a minimum of six months. Structured interviews were conducted using standardized scales (e.g., Quality of Life, Self-Efficacy, and Brief Symptom Inventory) with 78 outpatient client volunteers from two sites: Nova Scotia (Canada) and Texas (USA). The researcher tested for differences in psychiatric symptomatology, recidivism, and quality of life for persons with schizophrenia receiving traditional psychiatric services in Nova Scotia and traditional plus case management services in Texas. Data were collected from the structured interviews and medical records review forms. Types of services were blocked into low and high levels of Intensity (frequency x minutes) and compared to determine the relative contribution of each. Finally, the role of clients' self-efficacy was tested as an intervening variable. Although the findings did not support the hypotheses in the direction anticipated, there were some interesting and useful results. From the Nova Scotia site, clients who received low levels of services were hospitalized less compared to the Texas site. The more psychotic a patient was the higher their involvement in medication follow-along and the more monitoring they received. The more psychotherapy received, the lower the reported satisfaction with social relationships. Of particular interest is the role that self-efficacy played in improved client outcomes. Although self-efficacy scores were related to improved functioning, the mechanism for this still needs to be clarified through subsequent research. ^

Understanding mental illness in Nigeria: Bringing culture and traditional medicine into mental health policy

One of the major challenges in treating mental illness in Nigeria is that the health care facilities and mental health care professionals are not enough in number or well equipped to handle the burden of mental illness. There are several barriers to treatment for individual Nigerians which include the following: such as the lack of understanding of the root causes of mental illness, lack of financial support to get mental treatment, lack of social support (family, friends, neighbors), the fear of stigmatization concerning being labeled as mentally ill or being in association with the mentally ill, and the consultation of traditional native healers who may be unknowingly prolonging illness, rather than addressing and treating them due to lack of formal education and standardization of their treatments. Another barrier is the non-health nature of the mental health services in Nigeria. Traditional healers are essentially the mental health system. The elderly, women, and children are the most vulnerable groups in times of strife and hardships. Their mental well-being must be taken into account as well as their special needs in times of personal or societal crisis. ^ Nigerian mental health policy is geared toward forming a mental health system, but in actuality only a mental illness care system is the observed result of the policy. The government of Nigeria has drafted a mental health policy, yet its actual implementation into the Nigerian health infrastructure and society waits to be materialized. The limited health legislation or policy implementations tend to favor those who have access to these urban areas and the facilities' health services. Nigerians living in rural areas are at a disadvantage; many of them may not even be aware of services available to help them understand and treat mental illness. Perhaps, government driven health interventions geared toward mental illness in rural areas would reach an underserved Nigerians and Africans in general. Issues with political instability and limited infrastructure often hinder crucial financial resources and legislation from reaching the people that are truly in need of governmental leadership in regards to mental health policy.^ Traditional healers are a severely untapped resource in the treatment of mental illness within the Nigerian population. They are abundant within Nigerian communities and are meeting a real need for the mentally ill. However, much can be done to remove the barriers that prevent the integration of traditional healers within the mental health system and improve the quality of care they administer within the population. Mental illness is almost exclusively coped with through traditional medicine practices. Mobilization and education from each strata of Nigerian society and government as well as input from the medical community can improve how traditional medicine is utilized as a treatment for clinical illness and help alleviate the heavy burden of mental illness in Nigeria. Currently, there is no existing policy making structure for a working mental health system in Nigeria, and traditional healers are not taken into account in any formulation of mental health policy. Advocacy for mental illness is severely inadequate due to fear of stigmatization, with no formally recognized national of regional mental health association.^

Modified 3+3 design for phase I clinical trials

Phase I clinical trial is mainly designed to determine the maximum tolerated dose (MTD) of a new drug. Optimization of phase I trial design is crucial to minimize the number of enrolled patients exposed to unsafe dose levels and to provide reliable information to the later phases of clinical trials. Although it has been criticized about its inefficient MTD estimation, nowadays the traditional 3+3 method remains dominant in practice due to its simplicity and conservative estimation. There are many new designs that have been proven to generate more credible MTD estimation, such as the Continual Reassessment Method (CRM). Despite its accepted better performance, the CRM design is still not widely used in real trials. There are several factors that contribute to the difficulties of CRM adaption in practice. First, CRM is not widely accepted by the regulatory agencies such as FDA in terms of safety. It is considered to be less conservative and tend to expose more patients above the MTD level than the traditional design. Second, CRM is relatively complex and not intuitive for the clinicians to fully understand. Third, the CRM method take much more time and need statistical experts and computer programs throughout the trial. The current situation is that the clinicians still tend to follow the trial process that they are comfortable with. This situation is not likely to change in the near future. Based on this situation, we have the motivation to improve the accuracy of MTD selection while follow the procedure of the traditional design to maintain simplicity. We found that in 3+3 method, the dose transition and the MTD determination are relatively independent. Thus we proposed to separate the two stages. The dose transition rule remained the same as 3+3 method. After getting the toxicity information from the dose transition stage, we combined the isotonic transformation to ensure the monotonic increasing order before selecting the optimal MTD. To compare the operating characteristics of the proposed isotonic method and the other designs, we carried out 10,000 simulation trials under different dose setting scenarios to compare the design characteristics of the isotonic modified method with standard 3+3 method, CRM, biased coin design (BC) and k-in-a-row design (KIAW). The isotonic modified method improved MTD estimation of the standard 3+3 in 39 out of 40 scenarios. The improvement is much greater when the target is 0.3 other than 0.25. The modified design is also competitive when comparing with other selected methods. A CRM method performed better in general but was not as stable as the isotonic method throughout the different dose settings. The results demonstrated that our proposed isotonic modified method is not only easily conducted using the same procedure as 3+3 but also outperforms the conventional 3+3 design. It can also be applied to determine MTD for any given TTL. These features make the isotonic modified method of practical value in phase I clinical trials.^

Administration of misoprostol by trained traditional birth attendants to prevent postpartum haemorrhage in homebirths in Pakistan: a randomised placebo-controlled trial

Gynuity

Modular las voces para llegar a la Historia : Una lectura de 'Bilbao Song', de José Agustín Goytisolo

El artículo se propone a discutir el entrelace entre historia, poesía y ciudad en la obra Taller de arquitectura, de José Agustín Goytisolo, especialmente en su poema 'Bilbao song'. Integrante de la denominada generación de los 50, Goytisolo demostró, frecuentemente, gran preocupación sobre la condición del hombre en la sociedad moderna y su vida en las grandes ciudades. Taller de arquitectura es una obra representativa en el contexto de sus reflexiones sobre el hombre y su entorno. En nuestro texto discutiremos como el poeta articula distintas visiones de la ciudad de Bilbao con los discursos que surgen a lo largo del poema. Para emprender dicha discusión, proponemos un recorrido por la historia política, social y estética del final de los años 60 y principios de los 70 en España, a fin de examinar los procedimientos poéticos utilizados por el autor en la configuración de las relaciones entre historia, poesía y sociedad presentes en 'Bilbao song'. Expondremos como el autor aprehende y modula las voces de 'Bilbao song' utilizándose de la yuxtaposición de imágenes, de historias y de ritmos, para componer un mosaico que revela las diversas caras de la ciudad y de sus gentes bajo el cielo de la dictadura franquista

El aborigen en defensa de su identidad : Análisis de los poemas 'My name' de Magoleng wa Selepe (Sudáfrica) y 'Spiritual song of the aborigine' de Hyllus Maris (Australia)

Fil: Iacoboni, Gabriela N.. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

El aborigen en defensa de su identidad : Análisis de los poemas 'My name' de Magoleng wa Selepe (Sudáfrica) y 'Spiritual song of the aborigine' de Hyllus Maris (Australia)

Fil: Iacoboni, Gabriela N.. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

Modular las voces para llegar a la Historia : Una lectura de 'Bilbao Song', de José Agustín Goytisolo

El artículo se propone a discutir el entrelace entre historia, poesía y ciudad en la obra Taller de arquitectura, de José Agustín Goytisolo, especialmente en su poema 'Bilbao song'. Integrante de la denominada generación de los 50, Goytisolo demostró, frecuentemente, gran preocupación sobre la condición del hombre en la sociedad moderna y su vida en las grandes ciudades. Taller de arquitectura es una obra representativa en el contexto de sus reflexiones sobre el hombre y su entorno. En nuestro texto discutiremos como el poeta articula distintas visiones de la ciudad de Bilbao con los discursos que surgen a lo largo del poema. Para emprender dicha discusión, proponemos un recorrido por la historia política, social y estética del final de los años 60 y principios de los 70 en España, a fin de examinar los procedimientos poéticos utilizados por el autor en la configuración de las relaciones entre historia, poesía y sociedad presentes en 'Bilbao song'. Expondremos como el autor aprehende y modula las voces de 'Bilbao song' utilizándose de la yuxtaposición de imágenes, de historias y de ritmos, para componer un mosaico que revela las diversas caras de la ciudad y de sus gentes bajo el cielo de la dictadura franquista

Modular las voces para llegar a la Historia : Una lectura de 'Bilbao Song', de José Agustín Goytisolo

El artículo se propone a discutir el entrelace entre historia, poesía y ciudad en la obra Taller de arquitectura, de José Agustín Goytisolo, especialmente en su poema 'Bilbao song'. Integrante de la denominada generación de los 50, Goytisolo demostró, frecuentemente, gran preocupación sobre la condición del hombre en la sociedad moderna y su vida en las grandes ciudades. Taller de arquitectura es una obra representativa en el contexto de sus reflexiones sobre el hombre y su entorno. En nuestro texto discutiremos como el poeta articula distintas visiones de la ciudad de Bilbao con los discursos que surgen a lo largo del poema. Para emprender dicha discusión, proponemos un recorrido por la historia política, social y estética del final de los años 60 y principios de los 70 en España, a fin de examinar los procedimientos poéticos utilizados por el autor en la configuración de las relaciones entre historia, poesía y sociedad presentes en 'Bilbao song'. Expondremos como el autor aprehende y modula las voces de 'Bilbao song' utilizándose de la yuxtaposición de imágenes, de historias y de ritmos, para componer un mosaico que revela las diversas caras de la ciudad y de sus gentes bajo el cielo de la dictadura franquista

Farming strategy of African smallholder farmers in transition from traditional to alternative agriculture : the case of the Nupe in central Nigeria

It is worthwhile to understand farming strategies of smallholder farmers in sub-Saharan Africa, especially those of farmers who are in transition from traditional to alternative agriculture in terms of adoption of innovative technologies. In a case study of inland valleys in central Nigeria, we investigated the farming strategy of Nupe farmers who have a long-term tradition of wet rice cultivation and indigenous methods of land preparation for soil, water and weed management. In this region, a new method of land preparation has recently been introduced along with a recommendation to use improved seeds and chemical fertilizers. Our findings reveal that Nupe farmers directly sow traditional seeds and apply a marginal amount of fertilizer to paddy plots prepared by labor-saving methods on drought-prone hydromorphic valley fringes and flood-susceptible valley bottoms, whereas they preferentially transplanted improved seedlings and applied a relatively large quantity of fertilizer to paddy fields prepared by a labor-intensive and mechanized method on a valley position where they can access to optimum water condition (less risky against the drought and flood).