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Biomedical subjects

P W Smith

Publications and source records attributed to P W Smith.

At least 19 recordsLinked to original sources
PubMed1992

Infection and immune response in the elderly.

A number of immunologic functions have been shown to decline in an age-related fashion, particularly cell-mediated immunity and antibody response to an immunogen. Underlying degenerative diseases and medications further contribute to the immunologic abnormalities noted in the elderly. The elderly in hospitals and nursing homes are a particularly vulnerable subset, with a high incidence of institutionally acquired infection. Aspects of disease prevention in the elderly are discussed.

Aged↗
PubMed1992

Impact on knowledge and practice of a multiregional long-term care facility infection control training program.

BACKGROUND: Few affordable training opportunities are specifically designed for the long-term care facility infection control practitioner. There is also little evidence of the success of training in improving infection control practices. The Nebraska Infection Control Network developed a 2-day basic skills training program for Midwestern long-term care facility infection control practitioners that was later disseminated to eastern and western training sites. In this study we examined the effectiveness of the training program in terms of trainee knowledge and practice. METHODS: From 1986 to 1990, a total of 17 courses conducted at the three sites were attended by a total of 266 infection control practitioners. Trainees completed a 40-item multiple choice test before and after training to evaluate their knowledge gain. Implementation of eight key infection control practices and time devoted to infection control duties were measured before training and at 3 and 12 months after training. Implementation of infection control practices was also evaluated in a second study, with infection control practitioners randomly assigned to trained and wait-control conditions. RESULTS: Significant increases after training were found at each site for both knowledge and implementation measures. These increases were maintained at 12 months follow-up. Time devoted to infection control duties increased significantly at the midwest and western sites but not at the eastern site. In the second study, significant differences were found between the trained and the wait-control group in use of infection control practices, providing evidence for a causal relationship between training and increased use of practices. CONCLUSIONS: The training program was effective in producing improvements in knowledge and implementation of recommended infection control practices in long-term care facilities. These improvements were consistent across three diverse geographic areas. There were some specific geographic differences.

California↗
PubMed1992

Design and dissemination of a multiregional long-term care infection control training program.

Long-term care facilities have only recently begun to receive attention in the area of infection control. A training program was developed in Nebraska to help supply practitioners with knowledge and techniques designed specifically for the long-term care environment. This program's success led to its implementation in other regions. The regional extensions of the program were designed to operate with independent faculty but standardized course materials.

Cross Infection↗
PubMed1992

Advances in hospital infection control programs.

The past decade in infection control has seen remarkable growth of both practitioners and the basic infection control program. Technical advances led to more sophisticated data collection, analysis, and strategies. Health care is being streamlined to be highly effective and efficient. It is easy to become enchanted with new, exciting, and high-tech aspects of disease prevention and control, but we must all remember that the basics of a good program from 10 years ago are still applicable today.

Cross Infection↗
PubMed1991

Current status of nosocomial infection control in extended care facilities.

The 1980s saw the birth and growth of the distinct field of infection control in the extended care facility (ECF). Major advances in the field during the last decade have been surveys documenting the magnitude of the problem of ECF nosocomial infections, descriptive studies of ECF nosocomial infections, descriptive studies of ECF epidemics, development of ECF infection control programs, and recognition of the unique problems of the ECF infection control program. As the field matures, areas that should receive additional attention during the upcoming decade include: analysis of the risk factors and consequences of ECF nosocomial infections; analysis of resident and institutional variables that predict nosocomial infection; and studies on the efficacy of both infection control programs and specific infection control measures. ECF infection control programs have benefited a great deal from hospital infection control, but ECF infection control problems are quite different and demand unique solutions.

Cross Infection↗
PubMed1991

A microbiologic survey of long term care urinary catheters.

Culture and sensitivity data were collected on over 500 isolates from indwelling urinary catheters in 23 Nebraska long-term care facilities. Four percent of all nursing home patients had indwelling urinary catheters. The prevalence of bacteriuria in catheterized patients was 79%., and the most frequent isolates were E. coli, Proteus mirabilis, and Enterococcus species. Thirteen percent of catheterized patients were receiving systemic antibiotics, and 85% had at least one urinary bacterial isolate resistant to the antibiotic being administered. Antibiotic resistance correlated positively with a number of factors in the long-term care institutions, including size and skill level.

Aged↗
PubMed1990

Current trends in suture fixation of posterior chamber intraocular lenses.

Corneal surgeons were surveyed with regard to their technique of suture fixation of posterior chamber intraocular lenses in the absence of posterior capsular support. Fifty-nine percent of the 260 respondents stated they perform the procedure almost exclusively during penetrating keratoplasty. Scleral fixation was marginally favored over iris fixation by these surgeons. Most intraoperative problems reported were related to the relative technical difficulty of the procedure, although transient hemorrhage from the ciliary body was also mentioned. Postoperative complications cited included mechanical problems involving the lens and iris, cystoid macular edema, glaucoma, and endophthalmitis.

Demography↗
PubMed1989

Effects of the alpha-mannosidase inhibitors, 1,4-dideoxy-1,4-imino-D-mannitol and swainsonine, on glycoprotein catabolism in cultured macrophages.

Thioglycollate-stimulated murine peritoneal macrophages were cultured for eight days in the presence of swainsonine, or 1,4-dideoxy-1,4-imino-D-mannitol (DIM), or both of these competitive alpha-mannosidase inhibitors together. Analysis of accumulated high-mannose oligosaccharides by reversed phase HPLC after perbenzoylation revealed that DIM- and DIM-plus swainsonine-treated macrophages contained larger amounts of Man7GlcNAc, Man8GlcNAc and Man9GlcNAc, while swainsonine-treated macrophages contained relatively more Man3GlcNAc and Man5GlcNAc. These results are consistent with the known inhibitory effects of DIM and swainsonine on Golgi mannosidases I and II, respectively, and on lysosomal alpha-mannosidase. Depletion of stored oligosaccharides to control values was complete within seven days of terminating swainsonine treatment.

1-Deoxynojirimycin↗
PubMed1989

Antimicrobial therapy in special situations, including extended care facilities and the outpatient setting.

After implementation of the diagnosis-related group (DRG) payment system by the federal government there has been a shift of medical care, including intravenous antibiotic therapy, from the acute care hospital to the extended care facility and to the patient's home. Antibiotic selection in the extended care facility involves consideration of a number of factors such as the health status of the patient and the common infections that occur in patients in these facilities, which generally are similar to hospital-acquired infections. Home intravenous therapy is appropriate for treatment of some infectious diseases and is generally safe, although a number of infections and other complications may occur and may require consideration by the physician and the home therapy nurse. Common infectious complications and choices of antibiotic therapy in these two settings are reviewed.

Anti-Bacterial Agents↗
PubMed1989

Infection control in the long-term healthcare facility.

Residents of long-term care facilities average at least one serious infection per year. This discussion will address why nosocomial infections develop and highlight the most common types of infection in long-term care settings. Prevention and treatment of infections in this highly susceptible population will also be covered, with a focus on infection-control programs for long-term care facilities.

Aged↗
PubMed1989

Nosocomial infections in the elderly.

Aging is associated with an increased frequency and severity of many infectious diseases, including nosocomial infections in the hospital and nursing home. An age-related decline in host defense functions is the primary explanation for this phenomenon. The epidemiology, morbidity, mortality, and preventive aspects of nosocomial infections in the elderly are reviewed in this article.

Age Factors↗
PubMed1989

Lamellar keratectomy and repeat epikeratoplasty following failed epikeratoplasty. A clinicopathologic report.

Although epikeratoplasty (epikeratophakia) for aphakia in children has achieved a high degree of success, there remains a significant incidence of complications, some of which may result in removal of the lenticule. We report a 2-year-old child in whom epikeratoplasty was followed by an acute suppurative keratitis, necessitating removal of the epikeratoplasty lenticule. The recipient bed remained scarred following removal of the lenticule with anterior stomal fibrosis, which precluded good vision. We were able to avoid a penetrating keratoplasty by performing a superficial lamellar keratoplasty with a repeat epikeratoplasty that has remained clear.

Child, Preschool↗