Infections in long-term care institutions in Norway.
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Cross Infection↗
Biomedical subjects
K Crossley
Publications and source records attributed to K Crossley.
Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference.
Establishing a clinical diagnosis of infection in residents of long-term-care facilities (LTCFs) is difficult. As a result, deciding when to initiate antibiotics can be particularly challenging. This article describes the establishment of minimum criteria for the initiation of antibiotics in residents of LTCFs. Experts in this area were invited to participate in a consensus conference. Using a modified delphi approach, a questionnaire and selected relevant articles were sent to participants who were asked to rank individual signs and symptoms with respect to their relative importance. Using the results of the weighting by participants, a modification of the nominal group process was used to achieve consensus. Criteria for initiating antibiotics for skin and soft-tissue infections, respiratory infections, urinary infections, and fever where the focus of infection is unknown were developed.
Aged↗
Long-term care facilities as sources of antibiotic-resistant nosocomial pathogens.
Long-term care facilities house individuals that have usually been transferred from acute-care institutions. For this reason, carriage of methicillin-resistant Staphylococcus aureus (MRSA), resistant Gram-negative bacilli and vancomycin-resistant enterococci (VRE) is relatively frequent. As these patients are readmitted to acute-care institutions, they reintroduce these organisms into those settings. It is notable that studies of these resistant organisms in long-term care facilities demonstrate little transfer between patients. Transmission of these bacteria and the development of infection in nursing homes are both uncommon events. Resources are best devoted to infection-control basics than to isolation of patients colonized or infected with these organisms.
Cross Infection↗
A systematic review of physical interventions for patellofemoral pain syndrome.
OBJECTIVE: Physical interventions (nonpharmacological and nonsurgical) are the mainstay of treatment for patellofemoral pain syndrome (PFPS). Physiotherapy is the most common of all physical interventions and includes specific vastus medialis obliquus or general quadriceps strengthening and/or realignment procedures (tape, brace, stretching). These treatments appear to be based on sound theoretical rationale and have attained widespread acceptance, but evidence for the efficacy of these interventions is not well established. This review will present the available evidence for physical interventions for PFPS. DATA SOURCES: Computerized bibliographic databases (MEDLINE, Current Contents, CINAHL) were searched, including the keywords "patellofemoral," "patella," and "anterior knee pain," combined with "treatment," "rehabilitation," and limited to clinical trials through October 2000. STUDY SELECTION: The critical eligibility criteria used for inclusion were that the study be a controlled trial, that outcome assessments were adequately described, and that the treatment was a nonpharmacological, nonsurgical physical intervention. RESULTS: Of the 89 potentially relevant titles, 16 studies were reviewed and none of these fulfilled all of the requirements for a randomized, controlled trial. Physiotherapy interventions were evaluated in eight trials, and the remaining eight trials examined different physical interventions. Significant reductions in PFPS symptoms were found with a corrective foot orthosis and a progressive resistance brace, but there is no evidence to support the use of patellofemoral orthoses, acupuncture, low-level laser, chiropractic patellar mobilization, or patellar taping. Overall the physiotherapy interventions had significant beneficial effects but these interventions were not compared with a placebo control. There is inconclusive evidence to support the superiority of one physiotherapy intervention compared with others. CONCLUSIONS: The evidence to support the use of physical interventions in the management of PFPS is limited. There appears to be a consistent improvement in short-term pain and function due to physiotherapy treatment, but comparison with a placebo group is required to determine efficacy, and further trials are warranted for the other interventions.
Adolescent↗
Patellar taping: is clinical success supported by scientific evidence?
Patellofemoral pain syndrome (PFPS) is a common condition presenting to physiotherapy and sports medicine practices. Despite its prevalence, the aetiology, pathogenesis, and recommended treatment remain unclear. One component of treatment for PFPS that has been subjected to scrutiny is patellar taping. This taping was designed to realign the patella within the femoral trochlea, thus reducing pain from PFPS and improving both quadriceps and patellofemoral joint function. Clinical and research findings confirm that the pain associated with PFPS is significantly reduced with patellar taping. Therefore, research has aimed at determining the mechanisms of this pain relief. The means by which patellar tape can relieve pain may provide insight into the aetiology and risk factors for PFPS, thus allowing more appropriately designed treatment regimes and preventative strategies. There is evidence to suggest that patellar tape improves patella alignment (measured radiographically) and quadriceps function (torque production and extensor moments). Evidence that patellar tape enhances the activation of individual vastii (magnitude or timing) is limited in quality and quantity, which probably reflects the difficulties inherent in measuring this complex question. There is preliminary evidence for improved knee control during gait in association with patellar tape. This paper critically reviews the studies that have examined the effects of patellar taping and makes informed recommendations for further research and clinical practice.
Arthralgia↗
Ground reaction forces, bone characteristics, and tibial stress fracture in male runners.
PURPOSE: Tibial stress fracture is a common overuse running injury resulting from repetitive mechanical loading. This research project aimed to determine whether runners with a history of tibial stress fracture (TSF) differ in tibial bone geometry, tibial bone mass, and ground reaction force (GRF) parameters during running from those who have never sustained a stress fracture (NSF). METHODS: Forty-six male running athletes (23 TSF; 23 NSF) ranging in age from 18 to 42 yr were recruited for this cross-sectional study. A force platform was used to measure selected GRF parameters (peak and time to peak for vertical impact force, vertical active force, and horizontal braking force) during running at 4.0 m x s(-1). Tibial bone geometry (cross-sectional dimensions and area) was calculated from a computerized tomography (CT) scan at the junction of the middle and distal thirds. Dual energy x-ray absorptiometry (DXA) provided measurements of tibial bone area, bone mineral content (BMC), and bone mineral density (BMD). RESULTS: The TSF group had significantly smaller tibial cross-sectional area (P = 0.02) and DXA tibial bone area (P = 0.02), after adjusting for height and weight, than the NSF group. There were no significant differences between groups for GRF, tibial BMC, or tibial BMD. CONCLUSION: These findings support the contention that bone geometry plays a role in stress fracture development and that male athletes with smaller bones in relation to body size are at greater risk for this bony injury.
Absorptiometry, Photon↗
The oral contraceptive pill: a revolution for sportswomen?
OBJECTIVES: To determine the effects of the oral contraceptive pill (OCP) on skeletal health, soft tissue injury, and performance in female athletes. METHODS: A literature review was performed using literature retrieval methods to locate relevant studies. RESULTS: Most female athletes primarily choose to use the OCP for contraceptive purposes, but cycle manipulation and control of premenstrual symptoms are secondary advantages of its use. The effect of the OCP on bone density in normally menstruating women is unclear, with some studies reporting no effect, others a positive effect, and some even a negative effect. The OCP is often prescribed for the treatment of menstrual disturbances in female athletes, and improvements in bone density may result. Whether the OCP influences the risk of stress fracture and soft tissue injuries is not clear from research to date. Effects of the OCP on performance are particularly relevant for elite sportswomen. Although a reduction in Vo2MAX has been reported in some studies, this may not necessarily translate to impaired performance in the field. Moreover, some studies claim that the OCP may well enhance performance by reducing premenstrual symptoms and menstrual blood loss. A fear of weight gain with the use of the OCP is not well founded, as population studies report no effect on weight, particularly with the lower dose pills currently available. CONCLUSIONS: Overall, the advantages of the pill for sportswomen would appear to outweigh any potential disadvantages. Nevertheless, there is individual variation in response to the OCP and these should be taken into account and monitored in the clinical situation. Women should be counselled as to the range of potential benefits and disadvantages in order to make an informed decision based on individual circumstances.
Athletic Injuries↗
Infections in the elderly--new developments.
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Aged↗
Osteoarthritis of the knee in retired, elite Australian Rules footballers.
OBJECTIVE: To determine the functional and radiological status of knee joints of retired Australian Rules footballers compared with those of active community members. DESIGN: Retrospective cohort study. PARTICIPANTS: Fifty retired elite footballers aged 34-85 years (mean, 53.7 years; SD, 11.4) from four AFL clubs and 50 age-matched controls (35-79 years; mean, 55.7 years; SD, 12.4) who had played no contact sport since their teenage years. MAIN OUTCOME MEASURES: Severity of knee functional osteoarthritis as determined by a questionnaire, and assessment of osteoarthritis by posteroanterior weight-bearing radiographs taken of both knees of each participant in 45-degree flexion. RESULTS: After adjusting for age, height, weight and body mass index, footballers had a significantly greater prevalence (P < 0.0001) and severity (P < 0.05) of functional and radiological osteoarthritis than controls. Footballers with a history of intraarticular ligamentous and/or meniscal injury (Group 1) had a greater risk of functional osteoarthritis (P = 0.002) and radiological (P = 0.067) osteoarthritis than those with a history of collateral ligament injury or no injury (Group 2). Compared with controls, the odds of developing moderate to severe levels of functional and radiological osteoarthritis were 6.9 times (95% CI, 1.6-29.7; P = 0.01) and 105.0 times (95% CI, 11.8-931.8; P < 0.0001), respectively, those in Group 1 footballers and 3.6 times (95% CI, 0.8-16.2; P = 0.10) and 17.7 times (95% CI, 2.2-146.2; P = 0.0075), respectively, those in Group 2 footballers. CONCLUSIONS: Elite Australian Rules footballers have a significant risk of both functional and radiological osteoarthritis, and a history of intra-articular ligament or meniscal injury increases this risk.
Activities of Daily Living↗
Bacterial colonization of nursing home residents on admission to an acute care hospital.
Very little data obtained in a prospective, controlled fashion examines the prevalence of colonization with antibiotic-resistant bacteria and yeast in nursing home residents on admission to acute-care hospitals. We cultured swabs taken from all nursing home patients admitted to a medical center on selected days of the week. Age-matched control patients were also enrolled. Nasal, pharyngeal, and rectal or perineal swabs were done within 24 h of admission. Susceptibility to gentamicin was used as a marker for antibiotic resistance. Most nursing home patients (45/56) were colonized with gentamicin-resistant isolates of coagulase-negative staphylococci; in the control group, 24 patients only carried these organisms (P = 0.0001 chi square). The only resistant Gram-negative bacteria were recovered from control patients (3/56 vs. 0/56 nursing home residents; P = 0.12, Fisher's exact test). Yeast were common colonizers of both nursing home residents and controls but were more frequently recovered from nursing home patients (P = 0.03, chi square). Although colonization by antibiotic-resistant staphylococci of nursing home residents on admission to an acute-care hospital was common, resistant Gram-negative bacilli were not found in this study. Additional investigations are needed to determine the risk of infection/ colonization with resistant organisms in this population.
Aged↗
Stress fractures: a review of 180 cases.
OBJECTIVE: To review the cases of stress fracture seen over a 2-year period at a sports medicine clinic. DESIGN: One hundred and eighty cases diagnosed as stress fractures on the basis of clinical picture and radiological evidence were reviewed. The following features of each stress fracture were noted: age, sex, site, sport/activity. SETTING: A sports medicine centre in Melbourne, Australia. PATIENTS: The average age was 21.8 years. Seventy eight of these stress fractures were seen in women, 102 in men. RESULTS: The most common sites of stress fractures were the metatarsal bones (n = 42), tibia (n = 36), fibula (n = 30), tarsal navicular (n = 26) and pars interarticularis (n = 17). The most common sport was track (n = 54). Other common sports activities were jogging/distance running (n = 35), dance (n = 32) and Australian football (n = 14). The distribution of sites of stress fractures varied from sport to sport. Among the track athletes (n = 54), navicular (n = 19), tibia (n = 14) and metatarsal (n = 9) were the most common stress fracture sites. The distance runners (n = 35) predominantly sustained tibia (n = 15), and fibula (n = 8) stress fractures, while metatarsal stress fractures (n = 18) were the most common among dancers. The distribution of sports varied with the site of the stress fracture. In the metatarsal stress fractures (n = 42), dance was the most common activity. Distance running (n = 15) and track (n = 14) were the most common sports in the group to have sustained tibia stress fractures (n = 36). Track athletes (n = 14) were particularly prevalent in the navicular stress fracture group (n = 26). CONCLUSION: The distribution of sites of stress fractures in this study shows some differences from previously published studies.
Adult↗
Musculoskeletal injuries in track and field: incidence, distribution and risk factors.
This study evaluated the incidence, distribution and types of musculoskeletal injuries sustained by 95 track and field athletes in a 12 month period using a retrospective cohort design, and analysed selected training, anthropometric, menstrual and clinical biomechanical risk factors. Overall, 72 athletes sustained 130 injuries giving an athlete incidence rate of 76% and an injury exposure rate of 3.9 per 1000 training hours. The majority of injuries were overuse in nature and approximately one-third of all injuries were recurrent. The risk of injury was not influenced by gender or event group. The most common sites of injury were the leg (28%), thigh (22%) and knee (16%) with the most common diagnoses being stress fractures (21%) and hamstring strains (14%). Injury patterns varied between event groups with middle-distance and distance runners sustaining more overuse injuries, and sprinters, hurdlers, jumpers and multi event athletes more acute injuries (p < 0.05). Increasing age, greater overall flexibility and a greater prevalence of menstrual disturbances were associated with a greater likelihood of injury. The results of this study show that track and field athletes are at high risk for musculoskeletal injury and that it may be possible to identify those who are more likely to sustain an injury.
Adult↗
State regulations governing infection control issues in long-term care.
OBJECTIVE: To examine states' regulations governing infections and infection control in long-term-care institutions. DESIGN: Collection and examination of relevant documents from all of the states, the District of Columbia, the Joint Commission on Accreditation of Health Care Organizations, and Medicare/Medicaid. MAIN OUTCOME MEASURES: Rules governing (1) admissions of patients with infections, (2) tuberculin testing of residents, (3) employee health, (4) use of immunizations, (5) human immunodeficiency virus (HIV)-infected patients, and (6) infection control were compared. RESULTS: There were wide variations in states' policies in each of these areas and many were inconsistent with current scientific knowledge. CONCLUSION: Uniform federal standards for long-term care would probably provide a better and more economical way to ensure quality of care in these institutions.
Facility Regulation and Control↗
Methicillin-resistant Staphylococcus aureus in Minnesota nursing homes.
OBJECTIVE: To assess the experience of Minnesota nursing homes with methicillin-resistant Staphylococcus aureus (MRSA) and the policies and procedures used for its control. DESIGN: A 12-question survey, with primarily categorical responses, was mailed to the Directors of Nursing of all Minnesota long-term-care facilities. A follow-up mailing was sent to non-responders 5 weeks later. The mailing included a cover letter, a description of the study and its purposes, and a stamped return envelope. Four weeks after the second mailing, all non-responding institutions were contacted by telephone and invited to participated by mail or by completing the survey by telephone. SETTING: All long-term-care facilities in Minnesota licensed for skilled and intermediate care. PARTICIPANTS: The survey was directed to the Directors of Nursing of the long-term-care facilities with the request that, if another individual was better able to complete it, the survey be forwarded to them. RESULTS: Completed responses were obtained from 88% (395/445) of all long-term-care facilities in Minnesota. Forty-eight institutions (12%) had residents colonized or infected with MRSA. Only four (8%) of these facilities stated that MRSA was a problem; however, 33 (69%) of facilities with MRSA had sought outside help or consultation from a variety of sources for its control. Few facilities (7%) had cultured residents specifically for MRSA. Policies regarding the admission of colonized or infected persons were reported by 14% and 21% of facilities, respectively, and over 40% of these policies stated that persons with MRSA would not be accepted. Policies regarding the care of MRSA-colonized or -infected persons were not uniform. Both metropolitan and non-metropolitan facilities had residents with MRSA. CONCLUSIONS: Our results suggest that MRSA in long-term-care facilities may be a widespread and underrecognized problem. There is a need to develop uniform policies for the control of MRSA in nursing homes. These policies should consider the sources and objectives of long-term-care facilities.
Cross Infection↗
Enteral hyperalimentation as a source of nosocomial infection.
Microbial growth in enteral nutrition solutions (ENS) has frequently been documented. To determine the relation of this contamination to nosocomial infection, we prospectively studied 24 intensive care unit patients who received enteral feeding. Cultures of solutions were obtained while refrigerated and during administration as well as pharyngeal and rectal cultures from patients at the start of enteral nutrition and serially during administration. Most patients (10/16, 62.5%) receiving solutions mixed on the ward and 3/14 (21.4%) receiving solutions prepared elsewhere appeared to become colonized (0.05 less than P less than 0.10) by organisms initially isolated from feeds. By antibiotic susceptibility and plasmid analysis, eight patients were found to be colonized by 11 organisms identical to those which were first isolated from ENS. Two of these patients had ENS-associated pneumonias caused by Acinetobacter baumannii. Solutions often contained multiple Gram-negative bacilli similar to those recovered from nurses' hands and blenders, in numbers up to 1 x 10(8) ml-1. We conclude that ENS may be an important source of nosocomial infection. Uniform microbial criteria for ENS should be developed and methods to limit contamination should be utilized.
Adult↗
Needlestick injuries and needle disposal in Minnesota nursing homes.
We examined needle use and disposal, needlestick injuries and their management, and employee education regarding the acquired immunodeficiency syndrome and needle use by means of a questionnaire sent to all long-term care facilities certified for skilled care in Minnesota. Responses were received from 297 of 349 (85.1%) homes. Nearly all homes (271 of 293; 92.5%) provided education for new nursing employees about use and disposal of needles. Disposal of needles and sharps was generally consistent with current recommendations for short-term care hospitals. Needlestick injuries were usually related to recapping and were most common in registered and licensed practical nurses but were infrequent (i.e., less than 1 injury per home per employee-year) probably because parenteral therapy is infrequently used in long-term care settings. Only slightly over half (166 of 286; 58%) of the homes had protocols for management of needlestick injuries. Although Minnesota nursing homes properly dispose of needles and sharps, many of these institutions need to develop policies for management of needlestick injuries that are consistent with current recommendations.
Accidents, Occupational↗
Catheter-related sepsis: prospective, randomized study of three methods of long-term catheter maintenance.
We studied the infectious risk of different methods of managing vascular catheters during long-term use. Consecutive surgical ICU patients requiring triple lumen catheters, pulmonary artery catheters, or arterial catheters for greater than 7 days were prospectively randomized to one of three management groups: a) percutaneous (PERC) puncture with every 7-day catheter change at a new site, b) no weekly change (NWC) with a new site when changed, or c) guidewire exchange (GWX) with every 7-day catheter change at the same site. In all groups, a catheter change was mandatory for a positive blood culture, skin site infection, or sepsis without a likely source. Cultures were obtained when clinically indicated and at the time of every catheter change. Catheter-related sepsis (CRS) was defined as a positive blood culture and catheter culture with the same organism. A total of 112 patients met evaluation criteria. There were no intergroup differences in age, primary diagnosis, severity of injury or illness, number of study days, number of protocol violations, route of catheterization, number of catheters present/patient day, catheter sepsis rate, or bacteremia rate. The NWC group demonstrated an increased number of days/catheter, fewer catheter/subcutaneous tract segment cultures/patient, and a reduced incidence of catheter tip colonization. These results occurred in a setting where the number of CRS episodes/patient was 0.17 for GWX, 0.22 for PERC, and 0.16 for NWC. We conclude that there is no difference in infectious risk between these three methods of long-term catheter management. The method with the least complications and expense should be used.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Educating patients about HIV.
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Acquired Immunodeficiency Syndrome↗