Pseudomonas aeruginosa: study of Antibiotic Resistance and Molecular Typing in Hospital Infection Cases in a Neonatal Intensive Care Unit from Rio de Janeiro City, Brazil

This study had the objective of to analyze the demographic and bacteriologic data of 32 hospitalized newborns in an neonatal intensive care unit of a public maternity hospital in Rio de Janeiro city, Brazil, seized by Pseudomonas aeruginosa sepsis during a period ranged from July 1997 to July 1999, and to determine the antimicrobial resistance percentage, serotypes and pulsed field gel electrophoresis (PFGE) patterns of 32 strains isolated during this period. The study group presented mean age of 12.5 days, with higher prevalence of hospital infection in males (59.4%) and vaginal delivery (81.2%), than females (40.6%) and cesarean delivery (18.8%), respectively. In this group, 20 (62.5%) patients received antimicrobials before positive blood cultures presentation. A total of 87.5% of the patients were premature, 62.5% presented very low birth weight and 40.6% had asphyxia. We detected high antimicrobial resistance percentage to b-lactams, chloramphenicol, trimethoprim/sulfamethoxazole and tetracycline among the isolated strains. All isolated strains were classified as multi-drug resistant. Most strains presented serotype O11 while PFGE analysis revealed seven distinct clones with isolation predominance of a single clone (75%) isolated from July 1997 to June 1998.

Report of the National Joint Steering Group on the Working Hours of Non Consultant Hospital Doctors

The introduction of a maximum 48 hour working week for Non Consultant Hospital Doctors by 2010 will have significant implications for both Doctors in training and service delivery in our hospitals. This report focuses on how this reduction in working hours can be achieved and the many directly related issues that need to be addressed Download the Report here

Acute Hospital Bed Capacity - A National Review

The Programme for Prosperity and Fairness outlined the commitment of the Government to a review of hospital bed capacity in both acute and non-acute settings, to be carried out by the Department of Health and Children in conjunction with the Department of Finance and in consultation with the Social Partners. The focus of this report is on bed capacity in publicly-funded acute hospitals in Ireland. The capacity needs of the sub-acute sector have been assessed separately in the context of the Health Strategy, Quality and Fairness: A Health System for You. Download document here

Monaghan General Hospital - Proposals for further and future development

Monaghan General Hospital – Proposals for further and future development The Independent Review Panel recommended a review of the existing protocol for emergency obstetric cases presenting at Hospitals such as Monaghan which have no on-site obstetric expertise, and the implementation of a revised protocol. They also recommended that each maternity incident should be reviewed by a multidisciplinary team from the Cavan Monaghan Group. Click here to download PDF 49kb Appendix PDF 2.5mb

Monaghan General Hospital - Proposals for further and future development

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Estudio de los pacientes con diagn��stico de bronquiectasias, que siguen control en el servicio de neumolog��a del Hospital Son Ll��tzer. Palma de Mallorca

L'objectiu de l'estudi ha estat con��ixer l'etiologia,caracter��stiques cl��niques, tractament i evoluci�� dels pacients diagnosticats de bronquiect��sies i controlats en el Servei de Pneumologia de l'H Ll��tzer. Des de gener 2003 fins juny 2009 s'identifiquen 48 pacients, amb edat mitjana de 60 a. i predomini de dones. L'etiologia m��s freq��ent va ser la post-infecciosa i P. aeruginosa el germen m��s habitual. El patr�� ventilatori dominant va ser el obstructiu. Despr��s de 45 mesos de seguiment no es va apreciar deteriorament de la funci�� pulmonar, probablement relacionat amb el tractament antibi��tic i antiinflamatori en la colonitzaci�� / infecci�� bronquial cr��nica. Paraules clau: bronquiect��sies, Pseudomona aeruginosa, Tomografia computada (TC) de t��rax.

Antecedents of Job Satisfaction, Organizational Commitment and Stress in a Public Hospital: A P-E Fit Perspective

This article tests different P-E fit dimensions in order to assess their impact on three work outcomes: job satisfaction; organizational commitment; and stress perception. Findings shows that P-E fit dimensions have differentiated effects on its dependent variables. This study contributes to several important academic discussions. The first concerns the model tested, which contains several P-E fit dimensions. The second scientific contribution is to consider P-E fit dimensions as antecedents of three job outcomes. The third contribution concerns the development and testing of a new P-E fit dimension called "person-reforms" fit.

Deloitte and Touche Report on AMINCH Hospital

This summary presents the findings, conclusions and recommendations arising from our review of The Adelaide and Meath Hospital, incorporating the National Children,s Hospital (AMINCH). Download the Report here

Non-tuberculous mycobacteria I: one year clinical isolates identification in Tertiary Hospital Aids Reference Center, Rio de Janeiro, Brazil, in pre highly active antiretroviral therapy era

The aim of this study was to determine the prevalence of non-tuberculous mycobacteria (NTM) isolates at University Hospital, Reference Center for Aids in Rio de Janeiro, Brazil, during one year. We used standard biochemical tests for species identification and IS1245 PCR amplification was applied as a Mycobacterium avium specific identification marker. Four hundred and four specimens from 233 patients yielded acid-fast bacilli growth. M. tuberculosis was identified in 85% of the patients and NTM in 15%. NTM disseminated infection was a common event correlated with human immunodeficiency virus (HIV) infected patients and only in HIV negative patients the source of NTM was non sterile site. M. avium complex (MAC) was biochemically identified in 57.8% (49/83) of NTM isolates, most of them from sterile sites (75.5%), and in 94% (46/49) the IS 1245 marker specific for M. avium was present. Twenty NTM strains showed a MAC biochemical pattern with the exception of a urease-positive (99% of MAC are urease-negative), however IS1245 was detected in 96% of the strains leading to their identification as M. avium. In this group differences in NTM source was not significant. The second most frequently isolated NTM was identified as M. scrofulaceum (7.2%), followed by M. terrae (3.6%), M. gordonae (2.4%), M. chelonae (1.2%), M. fortuitum (1.2%) and one strain which could not be identified. All were IS1245 negative except for one strain identified as M. scrofulaceum. It is interesting to note that non-sterile sites were the major source of these isolates (92.8%). Our finding indicated that M. avium is still the major atypical species among in the MAC isolates recovered from Brazilian Aids patients without highty active antiretroviral therapy schema. Some discrepancies were seen between the identification methods and further investigations must be done to better characterize NTM isolates using other phenotypic and genotypic methods.

Listeriosis invasiva en un hospital general: rasgos diferenciales de los pacientes con c��ncer

Aquest estudi es va dissenyar amb l���objectiu de comparar les caracter��stiques dels malalts amb c��ncer respecte als malalts sense c��ncer, amb listeriosis invasiva. No es van detectar diferencies en les caracter��stiques basals dels malalts. La forma de presentaci�� m��s freq��ent en els malalts oncol��gics va ser la bacteri��mia, i en els malalts no oncol��gics, la infecci�� del sistema nervi��s central. El grup de malalts amb c��ncer va tenir un mortalitat superior. Cap de les diferencies va ser estad��sticament significativa, probablement pel baix nombre de malalts, per�� les dades coincideixen amb la literatura.

Estudio cl��nico, observacional, de una nueva modalidad ventilatoria; Ventilaci��n Asistida Proporcional. Hospital de la Santa Creu i Sant Pau, Barcelona, 2010

La ventilaci�� assistida proporcional ��s una modalitat en la que el respirador genera una assist��ncia proporcional a l���esfor�� muscular del pacient. En aquest estudi s���han incl��s vuit malalts en ���weaning��� de la ventilaci�� mec��nica. Es descriu la toler��ncia cl��nica i es quantifica l���esfor�� muscular dels pacients. L���esfor�� muscular va estar sempre dintre de l��mits predefinits de confort. Concloem que la ventilaci�� assistida proporcional d��na una ventilaci�� mec��nica similar a altres modalitats i ��s probablement m��s fisiol��gica.

Premiar y financiar proyectos de calidad revierte positivamente en el paciente y en el hospital: disminuci��n de la infecci��n causada por cat��ter venoso central en pacientes no cr��ticos

Objectiu: Avaluar una intervenci�� dirigida a la reducci�� d���infeccions relacionades amb els cat��ters venosos centrals (IRC). M��todes: Estudi pre-postintervenci��, 2004-2006. Poblaci�� d'estudi: pacients portadors de cat��ter ven��s central (CVC). La intervenci�� va consistir en con��ixer la situaci�� bassal, identificar factors de risc, i en el segon per��ode realitzar diverses intervencions. Resultats: Es van analitzar 175 i 200 CVC en el per��ode pre i postintervenci��, respectivament. Es va observar una incid��ncia de IRC de 20% durant el per��ode preintervenci�� i de 5,5% en el per��ode post-intervenci�� (p&0,001). Conclusi��: La aplicaci�� de mesures de prevenci�� ha aconseguit una disminuci�� d���aquestes del 72,5%.

Estacionalidad de la tuberculosis en el ��rea del Hospital Universitario Dr Peset de Valencia

La tuberculosi (TB) ��s una malaltia infecciosa. Diversos estudis han analitzat l'exist��ncia d'un patr�� estacional en la seva presentaci�� amb resultats discordants. Ens vam proposar con��ixer el patr�� estacional de diagn��stic de la malaltia en l'��rea del nostre hospital. Realitzem un estudi observacional prospectiu de tots els pacients, diagnosticats de TB durant el per��ode 2002-2009 en el nostre Departament. Per a l'an��lisi estad��stica de les dades recollides s'ha utilitzat l'aplicaci�� inform��tica SPSS 15.0. amb un nivell de significaci��: p &0,05. En el nostre medi i clima, el diagn��stic de la tuberculosi pulmonar predomina durant els mesos c��lids. Aquest predomini no s'ha relacionat amb les caracter��stiques socio-demogr��fiques ni cl��niques dels pacients.

Incidenceof out-of-hospital adult nontraumatic cardiac arrest presenting as a convulsion

Introduction: The majority of convulsions are due to an epileptic seizure or a convulsive syncope. The incidence of out-of-hospital cardiac arrest (OH-CA) presenting as a convulsion is unknown. Objective: This study aimed to measure the incidence of adult nontraumatic OH-CA presenting as a convulsion, a rate that has not been published so far, to the best of our knowledge. Methods: We prospectively collected all incoming calls with an out-of-hospital nontraumatic seizure as the chief complaint in patients >18 years old during a 24-month period. Among these calls, we collected cases identified as OH-CA by paramedics. Results: During the 24-month period, the emergency medical services (EMS) dispatch center received 561 calls for an out-of-hospital nontraumatic convulsion in an adult. Twelve cases were ultimately classified as CA. In this group, one bystander spontaneously reported that the patient was known for epilepsy. The incidence of OH-CA presenting as convulsions was therefore 2.1% of all calls for convulsion. Over the same period, the EMS dispatch center received 1,035 calls related to an adult nontraumatic OH-CA. Therefore, the rate of OH-CA presenting as a convulsion represented 1.2% of all adult nontraumatic OH-CA. Conclusion:L Only 12 cases out of the 531 calls for nontraumatic adult convulsions were confirmed OHCA (2.1%). Nevertheless, this unusual presentation of OH-CA must be recognized by dispatchers, even when a patient is reported by bystander as a known epileptic. Dispatchers should keep bystanders on the line or call them back before paramedics' arrival, and have them confirm the progressive return of a normal pat- tern of breathing and state of consciousness; if not, they should encourage the bystander to initiate CPR when necessary. An intervention should be implemented to improve the detection by dispatchers of OH-CA presenting as convulsion by the development of a specific interview and directed observation. For dispatchers, a past medical history of epilepsy should not be regarded as sufficient information to rule out OH-CA. It is mandatory that known epileptic patients should be monitored in the same way as nonepileptic patients.

Utilidad del complejo protromb��nico en el control de la hemostasia en el trasplante cardiaco. experincia en el hospital la fe en el a��o 2009.

Molts dels pacients que van a ser sotmesos a trasplantament card��ac porten tractament amb anticoagulants orals, que cal revertir preoperat��riament. En aquest estudi es pret��n valorar l'efic��cia del complex protromb��nic en la reversi�� de l���anticoagulaci�� oral, realitzant un estudi descriptiu, observacional i retrospectiu dels pacients trasplantats en 2009 en l'Hospital U. La Fe. Resultats: El tractament amb Complex Protromb��nic va ser efectiu per a la reversi�� de l'efecte dels anticoagulants orals, ja que va disminuir el INR (P=0.006) despr��s de la seua administraci��, amb l'avantatge de tenir un efecte r��pid i un esc��s volum.