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Biomedical subjects

R M Massanari

Publications and source records attributed to R M Massanari.

At least 19 recordsLinked to original sources
PubMed2000

Reengineering and infection control programs: commentary and a case study.

Transformation of the health care system has been an ongoing process for generations, but many changes in the past 2 decades have focused on reducing costs in concert with rapidly changing technologies and demands for high quality care. Many cost-containment efforts in the 1990s are characterized by attempts to apply the business model for "reengineering the corporation" to health care systems. This commentary reviews principles of reengineering and how strategies to reduce costs through market forces, competition, and downsizing can result in substantial problems for bureaucratic organizations unaccustomed to rapid change and innovation. A case study drawn from experiences of a large metropolitan academic health care system is presented, with specific focus on lessons that will be helpful to infection control professionals (ICPs) confronted with similar situations.

Academic Medical Centers↗
PubMed1997

Infection control in ambulatory care.

This article provides a structured review of the English literature focusing on areas that theoretically pose the greatest risk for nosocomial infections in ambulatory care. The review describes variations in methods of surveillance and a general paucity of studies that provide reliable estimates of the risk for infections in the ambulatory environment.

Ambulatory Care↗
PubMed1996

Managed care and the infectious diseases specialist.

There is growing demand to contain health care costs and to reassess the value of medical services. The traditional hospital, academic, and research roles of the infectious disease (ID) specialist are threatened, yet there is an increasing need for expertise because of growing antimicrobial resistance and emerging pathogens. Opportunities exist to develop and expand services for the care of patients infected with human immunodeficiency virus and in infection control, epidemiology, outcomes research, outpatient intravenous therapy, and resource management. It is important for ID physicians to appreciate the principles involved in managed care and the areas in which ID services can be valuable. To be effective, physicians need to know about tools such as practice guidelines, physician profiling, outcomes monitoring, computerized information management, risk sharing, networking, and marketing, as well as related legal issues. With a positive attitude toward learning, application, and leadership, ID physicians can redefine their role and expand their services through managed care.

Ambulatory Care↗
PubMed1995

Designing surveillance for noninfectious outcomes of medical care.

We present basic information that a hospital epidemiologist needs when designing a surveillance system for noninfectious adverse outcomes of care. Specific topics reflect key characteristics of such a surveillance system: the purpose, rationale, priorities, definitions, data collection tools, data collection, analysis and reporting, and validation.

Adverse Drug Reaction Reporting Systems↗
PubMed1994

Profiling physician practice: a potential for misuse.

Profiling physician practice is not unfamiliar to hospital epidemiologists. Surgeon-specific postoperative wound infection rates have been used to monitor and improve the quality of surgical outcomes. However, concerns for small sample sizes, validity of methods for risk adjustment, and reliability of data collection methods along with other methodologic concerns have resulted in mixed opinions regarding physician profiling as a tool for improving quality of care. In light of pressures for healthcare reform and skepticism regarding physicians' decision making, it is unlikely that methodologic concerns will dissuade regulators and managers from expanding scrutiny of physician practice.

Data Collection↗
PubMed1991

Late-onset congenital syphilis. A retrospective look at University of Iowa Hospital admissions.

A retrospective review of 766,742 hospital admissions was performed between 1966 and 1986 at the University of Iowa Hospital for the diagnosis of congenital syphilis. Although 88 individuals were identified with this diagnosis, adequate treatment was documented in only 33 (38%). Thirty-nine of the 88 individuals identified were initially seen for visual complaints by the ophthalmology department. We recommend that all physicians increase their index of suspicion for this disease, and institute appropriate therapy and follow-up if late congenital syphilis is diagnosed.

Adolescent↗
PubMed1990

The epidemiology of cytomegalovirus infection among patients with burns.

To determine the epidemiology of cytomegalovirus (CMV) infections among patients with burns, we prospectively studied 120 burn patients admitted to the University of Iowa Burn Center over a two-and-one-half year period. At the time of their admission, 44% of the patients had serologic evidence of prior CMV infection. Among 44 seropositive patients, 23 (52%) had four-fold or greater rises in CMV antibody titers. These patients had more severe burns (mean body surface area burn [BSAB] 26.8%) than those who did not exhibit titer rises (mean BSAB 16.2%, p = .04). Among 43 seronegative patients observed for at least 65 days after discharge from the center, eight (18.6%) seroconverted. Patients who seroconverted had longer hospital stays (p = .03), trends toward more severe burns (p = .08) and a younger age (p = .15) than patients who remained seronegative. Despite frequent serologic evidence of CMV infection, CMV did not contribute, either directly or indirectly, to the morbidity or mortality of burns in these patients.

Adolescent↗
PubMed1990

Cardiovascular surgery prophylaxis. A randomized, controlled comparison of cefazolin and cefuroxime.

A prospective double-blind trial was performed at a tertiary care center to evaluate perioperative cephalosporin prophylaxis in cardiac operations. Patients were randomized to receive either cefazolin (n = 104) or cefuroxime (n = 109), the preoperative dose being given within 1 hour before the initial incision. Drugs were continued for 48 hours (cefazolin, 1 gm intravenously every 8 hours; cefuroxime, 1.5 gm intravenously every 12 hours). Postoperative infections were assessed by trained nurse clinicians, and data were analyzed by the intention-to-treat principle. Sternal wound infections or mediastinitis occurred in one of 104 patients treated with cefazolin and 10 of 109 treated with cefuroxime (p = 0.01). Deep sternal wounds (including mediastinitis and sternal osteomyelitis) occurred in none of the cefazolin-treated patients and five cefuroxime-treated patients (p = 0.06). Although overall nosocomial infection rates were similar (16.3 versus 19.3 per 100), wound infection occurred somewhat more frequently with streptococci (groups B and D) in patients receiving cefazolin (four versus zero, p = 0.110); conversely staphylococcal infections were more frequent in the cefuroxime group (seven versus one, p = 0.066). Mean and median postoperative stay was 1 day shorter in the cefazolin group. In contrast to findings of a previous report, our data indicate that cefazolin prevented more sternal wound infections than cefuroxime, a finding that supports prophylaxis with a first-generation cephalosporin.

Adult↗
PubMed1989

Use of cellular hydrophobicity, slime production, and species identification markers for the clinical significance of coagulase-negative staphylococcal isolates.

Determining the clinical relevance of coagulase-negative staphylococci isolated from cultures of clinical specimens remains a common dilemma. One hundred eighteen strains of coagulase-negative staphylococci isolated from patients with and without indwelling foreign bodies were characterized with regard to cell-surface hydrophobicity, slime production, and species to determine the predictive value of these phenotypic markers in distinguishing clinically significant from insignificant isolates. The single test with the highest positive predictive value was hydrophobicity (79%). Hydrophobicity and speciation had the greatest combined predictive value of any two tests (89%), and this increased to only 90% when determination of slime production was added. These tests provide additional clinical information when coagulase-negative staphylococci are isolated in culture.

Bacterial Adhesion↗
PubMed1989

Nosocomial infections in critical care units: causation and prevention.

Nosocomial infections reflect a dynamic interaction between host, agent, and environment. In the compromised host, the microbes most frequently associated with nosocomial infections in the ICU are bacteria that normally reside in or on body surfaces or in the environment. Infections occur when the host, compromised by the underlying disease, is exposed to a variety of diagnostic and therapeutic interventions that disrupt normal physical and chemical barriers and allow direct access to the internal milieu of the host. Efforts to prevent nosocomial infections in critical care units must take into consideration the interplay of all of these factors to be successful.

Bacterial Infections↗
PubMed1988

Nosocomial aseptic meningitis associated with administration of OKT3.

An outbreak of nosocomial aseptic meningitis involving four renal allograft recipients on the transplant service occurred in July 1986, shortly after the release of the murine monoclonal antibody OKT3 for therapy for acute allograft rejection. No bacteria, fungi, or viruses were isolated from cultures of the cerebrospinal fluid of the four patients. All four had acute allograft rejection treated with OKT3 and developed signs and/or symptoms of meningitis within 72 hours of receiving the drug. To identify potential risk factors, the four patients with aseptic meningitis were compared with 12 patients on the renal transplant service in July 1986 who did not have signs or symptoms of meningitis. The development of aseptic meningitis was strongly associated with administration of OKT3. Because of this association, prospective surveillance of meningitis in patients receiving OKT3 was instituted. From November 1986 to May 1987, three (14%) of 21 patients treated with OKT3 developed aseptic meningitis. The clinical course of aseptic meningitis associated with OKT3 appears to be benign and self-limited. Nonetheless, this observation warrants continued surveillance of OKT3 therapy.

Antibodies, Monoclonal↗
PubMed1988

Organization and operation of the hospital-infection-control program of the University of Iowa Hospitals and Clinics.

The University of Iowa Hospitals and Clinics is located in the center of the United States in Eastern Iowa, has 1,000 hospital beds, and is the largest university owned teaching hospital in the country. Over 35,000 patients are admitted each year. The infection control efforts began in 1969 and were broadened in 1976 with the establishment and implementation of the Program of Epidemiology directed by W.J. Hierholzer, Jr., M.D., hospital epidemiologist. Hospital-wide surveillance is routinely performed by three and a half full-time equivalent LPN practitioners who assess problems and evaluate data essential to realistic identification of nosocomial infection rates, implementation of controls and evaluation of control measures. Nosocomial infection surveillance, utilizing modified CDC criteria, has been performed since July 1976. Ward rounds are made by staff, utilizing nursing care and medication Kardex's, microbiology, hematology and X-ray reports. Importantly, the surveillance system is being validated by concurrent prospective surveys to determine the sensitivity and specificity of reporting data. Outbreaks/epidemics of infections, such as Legionella pneumonia, diarrhea of unknown species, and wounds, as well as burns from manufactured changes in cautery grounds, have been identified and controlled before they have become major epidemics. Surveillance has identified one epidemic per 10,000 patients admitted.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross Infection↗
PubMed1988

Development of the quantitative micro-test for slime production by coagulase-negative staphylococci.

The macro-test for slime production by coagulase-negative staphylococci was adapted to a spectrophotometric micro-test assay to obtain more objective and quantitative information on slime production. A total of 135 isolates of coagulase-negative staphylococci (70 macro-test-positive and 65 macro-test-negative) were tested by both methods. The quantitative micro-test optical density readings were (mean +/- SD) 1.176 +/- 0.294 and 0.130 +/- 0.095 for the macro-test-positive and -negative groups, respectively. The micro-test was reproducible and demonstrated quantitative differences in slime production among the different species of coagulase-negative staphylococci. Aside from Staphylococcus epidermidis, the majority of the coagulase-negative staphylococci had very low optical density readings, indicating little or no slime production under the conditions employed in this assay. This test allows one to study the relative production of slime by different strains and species of coagulase-negative staphylococci, and may be useful in studying the effects of different conditions, such as antibiotic exposure, on slime production.

Bacterial Proteins↗
PubMed1988

Cost of nosocomial infection: relative contributions of laboratory, antibiotic, and per diem costs in serious Staphylococcus aureus infections.

This study reports an analysis of the relative importance of laboratory antibiotic, and per diem costs of caring for 58 patients with serious Staphylococcus aureus nosocomial infections. Laboratory costs accounted for 2%, antibiotics for 21%, and per diem costs for 77% of total infection-related costs. Only 45% of patients were hospitalized for additional days specifically because of infection, but these patients stayed an average of 18 extra days. Nosocomial infections with S. aureus resistant to penicillinase-resistant penicillins (PRP) were more frequently associated with additional infection-related days of hospitalization than were PRP-susceptible infections. The cost of PRP-resistant infections was also significantly greater than PRP-susceptible infections, primarily because of the costs of additional days of hospitalization. Rational strategies to control costs of nosocomial infection should focus on two approaches: (1) prevention and (2) reduction of acute hospital days attributable to infections.

Adult↗