Biomedical subjects

R A Weinstein

Publications and source records attributed to R A Weinstein.

149 records · Page 9Linked to original sources

PubMedDate not supplied

Sequential electron microscopic healing study of grafted palatal mucosal.

Human palatal mucosa may be glycerolized, frozen, thawed, and autogenically transplanted with success after a storage period. Although tissue damage is observed, both on a light and electron microscopic level, this is not clinically significant. This damage is attributed to the glycerolization, freezing, and thawing processes. As evidenced primarily by our ultrastructural study, regeneration of grafted epithelium is effected via the basal cell layer. The formation of intracytoplasmic vesicular structures and alterations in both the basal lamina and intercellular substances may play a significant role in the regenerative process. The electron microscope has served to elucidate changes in regenerating cells that have not been previously observed by light microscopy.

Cell Nucleus↗

PubMedDate not supplied

Nosocomial infection update.

Historically, staphylococci, pseudomonads, and Escherichia coli have been the nosocomial infection troika; nosocomial pneumonia, surgical wound infections, and vascular access-related bacteremia have caused the most illness and death in hospitalized patients; and intensive care units have been the epicenters of antibiotic resistance. Acquired antimicrobial resistance is the major problem, and vancomycin-resistant Staphylococcus aureus is the pathogen of greatest concern. The shift to outpatient care is leaving the most vulnerable patients in hospitals. Aging of our population and increasingly aggressive medical and surgical interventions, including implanted foreign bodies, organ transplantations, and xenotransplantation, create a cohort of particularly susceptible persons. Renovation of aging hospitals increases risk of airborne fungal and other infections. To prevent and control these emerging nosocomial infections, we need to increase national surveillance, "risk adjust" infection rates so that interhospital comparisons are valid, develop more noninvasive infection-resistant devices, and work with health-care workers on better implementation of existing control measures such as hand washing.

Cross Infection↗

PubMedDate not supplied

Controlling antimicrobial resistance in hospitals: infection control and use of antibiotics.

Antimicrobial-drug resistance in hospitals is driven by failures of hospital hygiene, selective pressures created by overuse of antibiotics, and mobile genetic elements that can encode bacterial resistance mechanisms. Attention to hand hygiene is constrained by the time it takes to wash hands and by the adverse effects of repeated handwashing on the skin. Alcohol-based hand rubs can overcome the time problem and actually improve skin condition. Universal glove use could close gaps left by incomplete adherence to hand hygiene. Various interventions have been described to improve antibiotic use. The most effective have been programs restricting use of antibiotics and computer-based order forms for health providers.

Alcohols↗

PubMedDate not supplied

The design of pressure monitoring devices: Infection control considerations.

Reports of infections related to in-use contamination or incomplete sterilization of pressure monitoring devices have appeared infrequently. However, review of our experience with such infections suggests a need for the medical instrumentation industry to stress infection prevention in the design of monitoring devices. Notably, it will be important for the industry to: (a) design pressure monitoring devices that can be sterilized rapidly, efficiently, and easily between use in different patients, even during periods of peak monitoring use; (b) develop reliable and simple means for aseptically calibrating and setting up monitoring devices after sterilization; and (c) design simple monitoring systems that will be resistant to in-use contamination and that will allow patients' monitoring tubing and fluid to be replaced aseptically at regular intervals.

Cross Infection↗

PubMedDate not supplied

Racial differences in care among hospitalized patients with Pneumocystis carinii pneumonia in Chicago, New York, Los Angeles, Miami, and Raleigh-Durham.

BACKGROUND: While strategies for medical care for human immunodeficiency virus-related Pneumocystis carinii pneumonia (PCP) are well established, racial variations in care have not been evaluated. OBJECTIVE: To determine whether sociodemographic characteristics influence patterns of care and patient outcomes, by analyzing the use of diagnostic tests and anti-PCP medications and in-hospital mortality rates for persons who were hospitalized with human immunodeficiency virus-related PCP. METHODS: Retrospective chart review of a cohort of 627 Veterans Administration (VA) patients and 1547 non-VA patients with empirically treated or cytologically confirmed PCP who were hospitalized from 1987 to 1990. Outcomes included representative aspects of the process of care for PCP and short-term mortality rates. RESULTS: Among VA patients, black and Hispanic patients were not significantly different from white patients with regard to in-hospital mortality rates, use and timing of a bronchoscopy, or receipt of timely anti-PCP medications. Among non-VA patients, black and Hispanic patients were more likely to die in the hospital and less likely to undergo a diagnostic bronchoscopy in the first 2 days of hospitalization. These racial and ethnic group differences in the use of a bronchoscopy and in-hospital mortality among non-VA patients were almost fully accounted for by differences in health insurance status and hospital characteristics. CONCLUSIONS: Racial factors do not appear to be an important determinant of the intensity of diagnostic or therapeutic care among patients who are hospitalized with PCP. Variations in care are largely attributable to differences in health insurance and admitting hospital characteristics.

AIDS-Related Opportunistic Infections↗