When the library is located in prime real estate: a case study on the loss of space from the Duke University Medical Center Library and Archives.

The Duke University Medical Center Library and Archives is located in the heart of the Duke Medicine campus, surrounded by Duke Hospital, ambulatory clinics, and numerous research facilities. Its location is considered prime real estate, given its adjacency to patient care, research, and educational activities. In 2005, the Duke University Library Space Planning Committee had recommended creating a learning center in the library that would support a variety of educational activities. However, the health system needed to convert the library's top floor into office space to make way for expansion of the hospital and cancer center. The library had only five months to plan the storage and consolidation of its journal and book collections, while working with the facilities design office and architect on the replacement of key user spaces on the top floor. Library staff worked together to develop plans for storing, weeding, and consolidating the collections and provided input into renovation plans for users spaces on its mezzanine level. The library lost 15,238 square feet (29%) of its net assignable square footage and a total of 16,897 (30%) gross square feet. This included 50% of the total space allotted to collections and over 15% of user spaces. The top-floor space now houses offices for Duke Medicine oncology faculty and staff. By storing a large portion of its collection off-site, the library was able to remove more stacks on the remaining stack level and convert them to user spaces, a long-term goal for the library. Additional space on the mezzanine level had to be converted to replace lost study and conference room spaces. While this project did not match the recommended space plans for the library, it underscored the need for the library to think creatively about the future of its facility and to work toward a more cohesive master plan.

Experience and attitudes towards CAM--a survey of internal and psychosomatic patients in a German university hospital

Complementary and alternative medicine (CAM) is popular in Germany. In a consecutive survey the experiences with CAM and the need for a CAM consultation among inpatients of the departments of cardiology (CL), gastroenterology (GE), oncology (OL) and psychosomatics (PS) of the University Hospital Freiburg (FUH) were questionned. Exclusion criteria were inability to understand the questions or a Karnofsky Index < 30%. Four hundred thirty-five patients were included. Three hundred and fifty patients, 100 each in the departments of CL, GE and OL, and 50 in PS answered the questionnaires. Eighty-five patients (20%) refused. Among the 350 patients 26% had previously visited a CAM physician and 19% had visited a CAM therapist (Heilpraktiker). Information about CAM was obtained mainly by television, radio and family members. Frequently used therapies for the current disease were physical training (21%), diet (19%), massage (19%), vitamins/trace elements (19%), herbs (13%), acupuncture (10%) and homeopathy (7%). The highest frequency of CAM use had PS patients, followed by GE, OL and CL patients. High effectivity (> or = 70%) for the current disease, rated on a scale of 4 degrees, had for CL patients physical exercise and massage, for GE patients herbal treatment and for OL patients diet. Physical exercise, diet, massage and herbal treatment generally had better ratings than homeopathy, acupuncture and vitamins. 65% would welcome a CAM center and 53% asked for a consultation about CAM at FUH. OL and GE patients had the strongest (58%), PS patients a lower (52%) and patients with cardiovascular diseases the lowest (43%) interest in a CAM consultation. Twenty-five percent believed, that CAM can help to cope better with their disease. Predictors for a positive attitude towards CAM were young age, aversion to chemical medications (Spearman correlation r = 0.22), desire to participate in therapeutic decisions (r = 0.29), motivation to change, if recommended, the life style (r = 0.31) and desire for a holistic treatment (r = 0.37).

Retrospective analysis of Methicillin-Resistant Staphylococcus Aureus (MRSA) skin and Soft-Tissue Infections (SSTI) in a university hospital emergency department (ED)

Study Objective: Identify the most frequent risk factors of Community Acquired-MRSA (CA-MRSA) Skin and Soft-tissue Infections (SSTIs) using a case series of patients and characterize them by age, race/ethnicity, gender, abscess location, druguse and intravenous drug-user (IVDU), underlying medical conditions, homelessness, treatment resistance, sepsis, those whose last healthcare visit was within the last 12 months, and describe the susceptibility pattern from this central Texas population that have come into the University Medical Center Brackenridge (UMCB) Emergency Department (ED). ^ Methods: This study was a retrospective case-series medical record review involving a convenience sample of patients in 2007 from an urban public hospital's ED in Texas that had a SSTI that tested positive for MRSA. All positive MRSA cultures underwent susceptibility testing to determine antibiotic resistance. The demographic and clinical variables that were independently associated with MRSA were determined by univariate and multivariate analysis using logistic regression to calculate odds ratios (OR), 95% confidence intervals, and significance (p≤ 0.05). ^ Results: In 2007, there were 857 positive MRSA cultures. The demographics were: males 60% and females 40%, with the average age of 36.2 (std. dev. =13) the study population consisted of non-Hispanic white (42%), Hispanics (38%), and non-Hispanic black (18.8%). Possible risk factors addressed included using recreational drugs (not including IVDU) (27%) homelessness (13%), diabetes status (12.6%) or having an infectious disease, and IVDU (10%). The most frequent abscess location was the leg (26.6%), followed by the arm and torso (both 13.7%). Eighty-three percent of patients had one prominent susceptibility pattern that had a susceptibility rate for the following antibiotics: trimethoprim/sulfamethoxazole (TMP-SMX) and vancomycin had 100%, gentamicin 99%, clindamycin 96%, tetracycline 96%, and erythromycin 56%. ^ Conclusion: The ED is becoming an important area for disease transmission between the sterile hospital environment and the outside environment. As always, it is important to further research in the ED in an effort to better understand MRSA transmission and antibiotic resistance, as well as to keep surveillance for the introduction of new opportunistic pathogens into the population. ^

University Hospital (from southwest) 1904

In center: Palmer Ward on front of Nurses Home. Psychopathic hospital at far right, built 1906. On verso: To the left the Homeopathic Hospital; to the right the Allopathic Hospital.

University Hospital (Catherine St. Buildings)

Center building included a nurses home. On verso: U. Hospital. Catherine St. [Street] Hospitals. ?Medical School Dormitories, Catherine St.

The University Hospital

The eastern-most of two similar buildings built in 1891 on Catherine St. The western housed the Homeopathic Hospital from 1891-1900. This building housed the Allopathic Hospital (called Uiversity Hospital) from 1891-1900. (The Homeopathic Hospital had a straight north facade; this building a rounded north facade). From 1900-1925 it housed the Surgical Ward; 1925-1944 the East Convalescent Ward; 1944-1950, the Rapid Treatment Center; 1950-1965, the Institute for Social Research. It was removed in 1965.

The University Hospital

The eastern-most of two similar buildings built in 1891 on Catherine St. The western housed the Homeopathic Hospital from 1891-1900. This building housed the Allopathic Hospital (called Uiversity Hospital) from 1891-1900. (The Homeopathic Hospital had a straight north facade; this building a rounded north facade). From 1900-1925 it housed the Surgical Ward; 1925-1944 the East Convalescent Ward; 1944-1950, the Rapid Treatment Center; 1950-1965, the Institute for Social Research. It was removed in 1965. Heating plant on left. On verso: on the right the Allopathic Hospital.

The University Hospital, Allopathic

The eastern-most of two similar buildings built in 1891 on Catherine St. The western housed the Homeopathic Hospital from 1891-1900. This building housed the Allopathic Hospital (called Uiversity Hospital) from 1891-1900. (The Homeopathic Hospital had a straight north facade; this building a rounded north facade). From 1900-1925 it housed the Surgical Ward; 1925-1944 the East Convalescent Ward; 1944-1950, the Rapid Treatment Center; 1950-1965, the Institute for Social Research. It was removed in 1965. On verso: In the fall of 1897.

University Hospital

The eastern-most of two similar buildings built in 1891 on Catherine St. The western housed the Homeopathic Hospital from 1891-1900. This building housed the Allopathic Hospital (called Uiversity Hospital) from 1891-1900. (The Homeopathic Hospital had a straight north facade; this building a rounded north facade). From 1900-1925 it housed the Surgical Ward; 1925-1944 the East Convalescent Ward; 1944-1950, the Rapid Treatment Center; 1950-1965, the Institute for Social Research. It was removed in 1965.

University Hospital, Catherine St., Allopathic Hospital

The eastern-most of two similar buildings built in 1891 on Catherine St. The western housed the Homeopathic Hospital from 1891-1900. This building housed the Allopathic Hospital (called Uiversity Hospital) from 1891-1900. (The Homeopathic Hospital had a straight north facade; this building a rounded north facade). From 1900-1925 it housed the Surgical Ward; 1925-1944 the East Convalescent Ward; 1944-1950, the Rapid Treatment Center; 1950-1965, the Institute for Social Research. It was removed in 1965.

University Hospital

An outstanding facility, a component part of the famous Medical Center at the University of Michigan.

University Hospital

An outstanding facility and a component part of the famous Medical Center at the University of Michigan in Ann Arbor.

Trends in candidemia and antifungal susceptibility in a university hospital in Northern Ireland 2001-2006

Objectives: To describe the species distribution and antifungal susceptibility trends for documented episodes of candidemia at the Royal Hospitals, Belfast, 2001-2006. Methods: Laboratory-based retrospective observational study of all episodes of candidemia. Results: There were 151 episodes of candidemia. The species recovered were: 96 C. albicans; 26 C. glabrata; 18 C. parapsilosis; five C. tropicalis; four C. guilliermondii; one C. famata and one C. dubliniensis. We separated the data into two periods 2001-2003 and 2004-2006; contrary to the findings of other investigators, there was a notable trends toward increasing frequency of C. albicans and decreasing frequency of non-albicans species over time. Although the proportion of C. albicans, C. parapsilosis and C. tropicalis isolates susceptible to fluconazole was unchanged over time, a trend of decreased susceptibility of C. glabrata to fluconazole was noted over the six-year period. Overall, 73% and 7.7% of C. glabrata isolates had susceptible-dose-dependent and resistant phenotypes, respectively. The percentage of C. glabrata isolates susceptible to fluconazole (MIC