26 results
Evaluation of a complex intervention for prisoners with common mental health problems, near to and after release: the Engager randomised controlled trial
- Richard Byng, Tim Kirkpatrick, Charlotte Lennox, Fiona C. Warren, Rob Anderson, Sarah Louise Brand, Lynne Callaghan, Lauren Carroll, Graham Durcan, Laura Gill, Sara Goodier, Jonathan Graham, Rebecca Greer, Mark Haddad, Tirril Harris, William Henley, Rachael Hunter, Sarah Leonard, Mike Maguire, Susan Michie, Christabel Owens, Mark Pearson, Cath Quinn, Sarah Rybczynska-Bunt, Caroline Stevenson, Amy Stewart, Alex Stirzaker, Roxanne Todd, Florian Walter, Lauren Weston, Nat Wright, Rod S. Taylor, Jenny Shaw
-
- Journal:
- The British Journal of Psychiatry / Volume 222 / Issue 1 / January 2023
- Published online by Cambridge University Press:
- 18 August 2022, pp. 18-26
- Print publication:
- January 2023
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background
Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse.
AimsThis study aims to evaluate whether the Engager intervention improves mental health outcomes following release.
MethodThe design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3–5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT).
ResultsIn total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI –1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact.
ConclusionsEngager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.
Risk Factors for In-Hospital Mortality from COVID-19 Among Nursing Home Patients—An Urban Center Experience
- Amit Vahia, Mamta Sharma, Leonard Johnson, Ashish Bhargava, Louis Saravolatz, Susan Szpunar
-
- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, p. s48
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Background: As the COVID-19 pandemic continues, special attention is focused on high-risk patients. In this study, we assessed the risk factors for COVID-19 mortality in nursing home patients. Methods: In this retrospective cohort study, we reviewed the electronic medical records of SARS-COV-2 PCR–positive nursing-home patients between March 8 and June 14, 2020. The primary outcome was in-hospital mortality. Risk factors were compared between those who were discharged or died using the Student t test, the Mann-Whitney U test, χ2 analysis, and logistic regression. Results: Among 169 hospitalized nursing-home patients, the case fatality rate was 43.2%. The mean age was 72.3 ± 13.8 years; 92 patients (54.4%) were male; and 112 patients (66.3%) were black. Within the first day of hospitalization, 83 (49%) patients developed fever. On admission, 24 (14.2%) patients were hypotensive. Leukopenia, lymphopenia, and thrombocytopenia were present in 20 (12%), 91 (53%), and 40 (23.7%) patients, respectively. Among the inflammatory markers, elevations in CRP and ferritin levels occurred in 79% and 24%, respectively. Intensive care admission was needed for 40 patients (23.7%). Septic shock occurred in 25 patients (14.8%). Patients over the age of 70 were more likely to die than younger patients (OR, 2.2; 95% CI, 1.2– 4.1; P = .20). Patients with a fever on admission were more likely to die than those who were afebrile (OR, 2.03; 95% CI, 1.08–3.8; P = .03). Also, 66.7% hypotensive patients died compared to 39.3% normotensive patients (OR, 3.1; 95% CI, 1.2–7.7 P = .01). Intubated patients died more often than those not intubated, 78.4% versus 33.3%, respectively (OR=7.3, p < 0.001, CI 3.1, 17.2) Factors significantly associated with death included higher mean qSofa (p < 0.001), higher median Charlson scores (0.02), thrombocytopenia (p = 0.04) and lymphocytopenia (0.04). From multivariable logistic regression, independent factors associated with death were Charlson score (OR=1.2, p=0.05), qSofa (OR=2.0, p=0.004), thrombocytopenia (OR = 3.0, p = 0.01) and BMI less than 25 (OR = 3.5, p=0.002). Conclusions: Our multivariable analysis revealed that patients with a greater burden of comorbidities, lower BMI, higher qSOFA sepsis score, and thrombocytopenia had a higher risk of death, perhaps because of severe infection despite a robust immune response.
Funding: No
Disclosures: None
Farewells, thanks and welcomes
- Alex Brown, Helena da Silva, Susan Leonard, Mary Louise Nagata
-
- Journal:
- Continuity and Change / Volume 35 / Issue 3 / December 2020
- Published online by Cambridge University Press:
- 21 December 2020, p. 253
- Print publication:
- December 2020
-
- Article
- Export citation
Lean management in a liaison psychiatry department: implementation, benefits and pitfalls
- Lauren Alexander, Susan Moore, Nigel Salter, Leonard Douglas
-
- Journal:
- BJPsych Bulletin / Volume 44 / Issue 1 / February 2020
- Published online by Cambridge University Press:
- 02 October 2019, pp. 18-25
- Print publication:
- February 2020
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Aims and method
To apply process mapping, a component of lean management, to a liaison psychiatry service of an emergency department. Lean management is a strategy that has been adapted to healthcare from business and production industries and aims to improve efficiency of a process. The process consisted of four stages: individual interviews with stakeholders, generation of process maps, allocation of goals and assessment of outcomes.
ResultsThere was a significant reduction in length of stay of psychiatric patients in the emergency department (median difference: 1 h; P = 0.015). Five of the six goals were met successfully.
Clinical implicationsThis article demonstrates a management intervention that successfully reduced length of stay in an emergency department. Further to the improvements in tangible (quantitative) outcomes, process mapping improved interpersonal relations between different disciplines. This paper may be used to guide similar quality improvement exercises in other areas of healthcare.
Immigration, Occupation, and Inequality in Emergent Nineteenth-Century New England Cities
- Susan Hautaniemi Leonard, Christopher Robinson, Douglas L. Anderton
-
- Journal:
- Social Science History / Volume 41 / Issue 4 / Winter 2017
- Published online by Cambridge University Press:
- 13 October 2017, pp. 645-671
- Print publication:
- Winter 2017
-
- Article
- Export citation
-
This article explores the social interactions of immigration, occupation, and wealth in two urban industrial cities of nineteenth-century New England that were largely built upon, and shaped by, immigration: the very rapidly growing factory town of Holyoke, Massachusetts, and a more mixed-market and steadily growing nearby community of Northampton, Massachusetts. Both communities were emergent, rapidly industrializing, inland cities, providing a quite distinct immigration context than large established cities of the East Coast. Both were destinations for the same general ethnic immigration waves over the late nineteenth century, but with very different, and differently impacted, social spaces into which immigrants arrived. Contrasting and considering both these emergent cities allows us to ascertain the extent to which the occupational distribution and accumulation of wealth by immigrant groups supports the broad pattern of nineteenth-century assimilation, and reveals ways in which other migration processes may have been at odds, or intertwined, with the long-term historical assimilation of immigrants in such communities. Our findings support a traditional assimilationist perspective in emergent urban-industrial centers. However, they also reveal the role of universal immiseration in an industrial city dual-labor market in facilitating or forcing assimilation, the temporal advantages for ethnic groups of arriving early in growing settlements, and the more individualistic nature of economic enclaves in gaining advantages over time that did not manifest across broad immigrant or occupational groups.
Migration in the 1930s: Beyond the Dust Bowl
- Myron P. Gutmann, Daniel Brown, Angela R. Cunningham, James Dykes, Susan Hautaniemi Leonard, Jani Little, Jeremy Mikecz, Paul W. Rhode, Seth Spielman, Kenneth M. Sylvester
-
- Journal:
- Social Science History / Volume 40 / Issue 4 / Winter 2016
- Published online by Cambridge University Press:
- 03 November 2016, pp. 707-740
- Print publication:
- Winter 2016
-
- Article
- Export citation
-
This paper analyzes in detail the role of environmental and economic shocks in the migration of the 1930s. The 1940 US Census of Population asked every inhabitant where they lived five years earlier, a unique source for understanding migration flows and networks. Earlier research documented migrant origins and destinations, but we will show how short-term and annual weather conditions at sending locations in the 1930s explain those flows, and how they operated through agricultural success. Beyond demographic data, we use data about temperature and precipitation, plus data about agricultural production from the agricultural census. The widely known migration literature for the 1930s describes an era of relatively low migration, with much of the migration that did occur radiating outward from the Dust Bowl region and the cotton South. Our work about the complete United States will provide a fuller examination of migration in this socially and economically important era.
Thirty years of Continuity and Change
- CHRIS BRIGGS, SUSAN LEONARD, JULIE MARFANY, MARY LOUISE NAGATA
-
- Journal:
- Continuity and Change / Volume 30 / Issue 1 / May 2015
- Published online by Cambridge University Press:
- 05 May 2015, p. 1
- Print publication:
- May 2015
-
- Article
-
- You have access Access
- HTML
- Export citation
The PANDAS Subgroup: Recognition and Treatment
- Susan E. Swedo, Marjorie Garvey, Lisa Snider, Charlotte Hamilton, Henrietta L. Leonard
-
- Journal:
- CNS Spectrums / Volume 6 / Issue 5 / May 2001
- Published online by Cambridge University Press:
- 07 November 2014, pp. 419-426
-
- Article
- Export citation
-
A subgroup of patients with childhood-onset obsessive-compulsive disorder (OCD) has been identified who share a common clinical course characterized by dramatic symptom exacerbations following Group A beta-hemolytic streptococcal (GABHS) infections. The term PANDAS has been applied to the subgroup, to indicate the postulated etiology of their symptoms: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. Five clinical characteristics define the PANDAS subgroup: presence of OCD and/or tic disorder, prepubertal symptom onset, sudden onset or abrupt exacerbations (sawtooth course), association with neurological abnormalities (presence of adventitious movements or motoric hyperactivity during exacerbations), and temporal association between symptom exacerbations and GABHS infections. Post-streptococcal symptom exacerbations are typically quite dramatic, with patients reporting that their symptoms “…came on overnight” or “…appeared all of a sudden a few days after I had a sore throat.” The post-streptococcal inflammatory nature of the neuropsychiatric symptoms provides novel opportunities for treatment and prevention, including immunomodulatory therapies such as therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG). A recently completed placebo-controlled trial revealed that both IVIG and TPE were effective in reducing neuropsychiatric symptom severity (40% to 55% reductions, respectively) for a group of severely ill children with OCD and/or tic disorders. Further research is required to determine why the treatments are helpful, as well as to ascertain whether or not antibiotic prophylaxis can help prevent post-streptococcal symptom exacerbations.
Contributors
-
- By R. Steven Ackley, Kirrie J. Ballard, Roelien Bastiaanse, Gregory J. Benner, Glenis Benson, Diane M. Bless, Tobias Bormann, Tim Bressmann, Karen Bryan, Catherine Christo, Nadine P. Connor, Karen Croot, Louise Cummings, Susan Ellis Weismer, Perrine Ferré, Sabina Flagmeier, Megan Hodge, Jinyi Hung, Yves Joanette, Laurence B. Leonard, Anja Lowit, Patricia McCabe, Brigid McNeill, Julie Morris, Bruce E. Murdoch, J. Ron Nelson, Courtenay Frazier Norbury, Ronald S. Prins, Linda Rammage, Jamie Reilly, John E. Riski, Donald A. Robin, Susan Rvachew, Kathleen Scaler Scott, Katherine Short-Meyerson, Vesna Stojanovik, Leanne Togher, Janet Webster, Anne Whitworth, Maximiliano A. Wilson, J. Scott Yaruss
- Edited by Louise Cummings, Nottingham Trent University
-
- Book:
- The Cambridge Handbook of Communication Disorders
- Published online:
- 05 March 2015
- Print publication:
- 24 October 2013, pp -
-
- Chapter
- Export citation
Contributors
-
- By Ashok Agarwal, Linda D. Applegarth, Nelson E. Bennett, Nancy L. Brackett, Melissa B. Brisman, Mark F. H. Brougham, Cara B. Cimmino, Owen K. Davis, Rian J. Dickstein, Michael L. Eisenberg, Mikkel Fode, Gretchen A. Gignac, Bruce R. Gilbert, Ellen R. Goldmark, Marc Goldstein, Wayne J. G. Hellstrom, Wayland Hsiao, Jack Huang, Kathleen Hwang, Ann A. Jakubowski, Keith Jarvi, Loren Jones, Hey-Joo Kang, Joanne Frankel Kelvin, Mohit Khera, Thomas F. Kolon, Kate H. Kraft, Andrew C. Kramer, Dolores J. Lamb, Andrew B. Lassman, Helen R. Levey, Larry I. Lipshultz, Charles M. Lynne, Akanksha Mehta, Marvin L. Meistrich, Gregory C. Mitchell, Mark A. Moyad, John P. Mulhall, Lauren Murray, Craig Niederberger, Ariella Noy, Robert D. Oates, Dana A. Ohl, Kutluk Oktay, Ndidiamaka Onwubalili, Fabio Firmbach Pasqualatto, Elena Pentsova, Susanne A. Quallich, Gwendolyn P. Quinn, Alex Ridgeway, Matthew T. Roberts, Kenny A. Rodriguez-Wallberg, Allison B. Rosen, Lisa Rosenzweig, Edmund S. Sabanegh, Hossein Sadeghi-Nejad, Mary K. Samplaski, Jay I. Sandlow, Peter N. Schlegel, Gunapala Shetty, Mark Sigman, Jens Sønksen, Peter J. Stahl, Eytan Stein, Doron S. Stember, Raanan Tal, Susan T. Vadaparampil, W. Hamish, B. Wallace, Leonard H. Wexler, Daniel H. Williams
- Edited by John P. Mulhall, Memorial Sloan-Kettering Cancer Center, New York
- Edited in association with Linda D. Applegarth, Robert D. Oates, Peter N. Schlegel
-
- Book:
- Fertility Preservation in Male Cancer Patients
- Published online:
- 05 March 2013
- Print publication:
- 21 February 2013, pp vii-x
-
- Chapter
- Export citation
Notes on Contributors
-
- By Susan F. Beegel, Milton A. Cohen, Nancy R. Comley, Kirk Curnutt, Albert J. DeFazio, Suzanne del Gizzo, David M. Earle, Carl P. Eby, Robert E. Fleming, Stacey Guill, Peter L. Hays, Ryan Hediger, Gary Edward Holcomb, Jill Jividen, Hilary K. Justice, Verna Kale, Jeremy Kaye, J. Gerald Kennedy, Kelli A. Larson, Leonard J. Leff, Nghana tamu Lewis, Kevin Maier, Miriam B. Mandel, James H. Meredith, Peter Messent, Debra A. Moddelmog, Lisa Narbeshuber, Matthew Nickel, Charles M. Oliver, Mark P. Ott, James Plath, Russ Pottle, Ann Putnam, John Raeburn, Gail Sinclair, Sandra Spanier, Amy Strong, Thomas Strychacz, Frederic Svoboda, Robert W. Trogdon, Lisa Tyler, Alex Vernon, Emily O. Wittman, Susan Wrynn
- Edited by Debra A. Moddelmog, Ohio State University, Suzanne del Gizzo
-
- Book:
- Ernest Hemingway in Context
- Published online:
- 18 December 2013
- Print publication:
- 17 December 2012, pp xi-xxii
-
- Chapter
- Export citation
Immigration, wealth and the ‘mortality plateau’ in emergent industrial cities of nineteenth-century Massachusetts
- SUSAN HAUTANIEMI LEONARD, JEFFREY K. BEEMER, DOUGLAS L. ANDERTON
-
- Journal:
- Continuity and Change / Volume 27 / Issue 3 / December 2012
- Published online by Cambridge University Press:
- 05 December 2012, pp. 433-459
- Print publication:
- December 2012
-
- Article
- Export citation
-
The mortality transition in Western Europe and the United States encompassed a much more complex set of conditions and experiences than earlier thought. Our research addresses the complex set of relationships among growing urban communities, family wealth, immigration and mortality in New England by examining individual-level, sociodemographic mortality correlates during the nineteenth-century mortality plateau and its early twentieth-century decline. In contrast to earlier theories that proposed a more uniform mortality transition, we offer an alternative hypothesis that focuses on the impact of family wealth and immigration on individual-level mortality during the early stages of the mortality transition in Northampton and Holyoke, Massachusetts.
Contributors
-
- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
-
- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
-
- Chapter
- Export citation
Contributors
-
- By Shanley Allen, Edith L. Bavin, Judith Becker Bryant, Heike Behrens, Ruth A. Berman, Eve V. Clark, Stephen Crain, Suzanne Curtin, Katherine Demuth, Rory A. DePaolis, Cristina D. Dye, Claire Foley, Angela D. Friederici, Susan Goldin-Meadow, Barbara Höhle, Dan Hufnagle, Tamar Keren-Portnoy, Laurence B. Leonard, Diane Lillo-Martin, Catherine Lord, Barbara C. Lust, Rhiannon J. Luyster, Barbara Zurer Pearson, Fiona M. Richardson, Jesse Snedeker, Sabine Stoll, Erik Thiessen, Michael S. C. Thomas, Michael Tomasello, J. Bruce Tomblin, Kamil Ud Deen, Virginia Valian, Marilyn M. Vihman
- Edited by Edith L. Bavin, La Trobe University, Victoria
-
- Book:
- The Cambridge Handbook of Child Language
- Published online:
- 05 June 2012
- Print publication:
- 23 March 2009, pp ix-x
-
- Chapter
- Export citation
Integrated Capacitors with Nb2O5 Dielectric for Decoupling Applications
- Susan Jacob, Leonard W. Schaper, Mourad Benamara
-
- Journal:
- MRS Online Proceedings Library Archive / Volume 1158 / 2009
- Published online by Cambridge University Press:
- 31 January 2011, 1158-F03-08
- Print publication:
- 2009
-
- Article
- Export citation
-
As electronic systems are scaling down further and further, there is the constant need to utilize all the board area with maximum efficiency. Since passive components occupy most of the space on boards, it is very important to scale them down. New techniques allow for “integrated” passives as opposed to their discrete counterparts. Integrated capacitors can be embedded within the substrate, leaving room for other components on the board surface. In order to improve the area efficiency of these integrated capacitors, researchers have formed multilayered capacitors in the past. This increases the capacitance density, but is time consuming and expensive due to too many process steps. With increased circuit density, a currently demonstrated dielectric, Ta2O5, could be replaced with a potential high-k dielectric that can store more charge in a smaller area than a capacitor with Ta2O5. Niobium pentoxide (Nb2O5) with k∼41 is an emerging dielectric for high-k capacitor applications. This paper investigates niobium pentoxide as a next generation high-k planar capacitor dielectric. Niobium pentoxide dielectric was formed by reactive sputtering and anodization. Dielectric characterization was done using X-ray photoelectron spectroscopy (XPS), Transmission Electron Microscopy (TEM), and Atomic Force Microscopy (AFM). Thin film planar capacitor structures were fabricated using Nb2O5 dielectric and electrically characterized. The results presented include dielectric material characterization, design, capacitance, and breakdown voltage measurements.
Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals
- Erik R. Dubberke, Dale N. Gerding, David Classen, Kathleen M. Arias, Kelly Podgorny, Deverick J. Anderson, Helen Burstin, David P. Calfee, Susan E. Coffin, Victoria Fraser, Frances A. Griffin, Peter Gross, Keith S. Kaye, Michael Klompas, Evelyn Lo, Jonas Marschall, Leonard A. Mermel, Lindsay Nicolle, David A. Pegues, Trish M. Perl, Sanjay Saint, Cassandra D. Salgado, Robert A. Weinstein, Robert Wise, Deborah S. Yokoe
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 29 / Issue S1 / October 2008
- Published online by Cambridge University Press:
- 02 January 2015, pp. S81-S92
- Print publication:
- October 2008
-
- Article
- Export citation
-
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile infection (CDI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.
1. Increasing rates of CDI
C. difficile now rivals methicillin-resistant Staphylococcus aureus (MRSA) as the most common organism to cause healthcare-associated infections in the United States.
a. In the United States, the proportion of hospital discharges in which the patient received the International Classification of Diseases, Ninth Revision discharge diagnosis code for CDI more than doubled between 2000 and 2003, and CDI rates continued to increase in 2004 and 2005 (L. C. McDonald, MD, personal communication, July 2007). These increases have been seen in pediatric and adult populations, but elderly individuals have been disproportionately affected. CDI incidence has also increased in Canada and Europe.
b. There have been numerous reports of an increase in CDI severity.
c. Most reports of increases in the incidence and severity of CDI have been associated with the BI/NAP1/027 strain of C. difficile. This strain produces more toxins A and B in vitro than do many other strains of C. difficile, produces a third toxin (binary toxin), and is highly resistant to fluoroquinolones.
Strategies to Prevent Transmission of Methicillin-Resistant Staphylococcus aureus in Acute Care Hospitals
- David P. Calfee, Cassandra D. Salgado, David Classen, Kathleen M. Arias, Kelly Podgorny, Deverick J. Anderson, Helen Burstin, Susan E. Coffin, Erik R. Dubberke, Victoria Fraser, Dale N. Gerding, Frances A. Griffin, Peter Gross, Keith S. Kaye, Michael Klompas, Evelyn Lo, Jonas Marschall, Leonard A. Mermel, Lindsay Nicolle, David A. Pegues, Trish M. Perl, Sanjay Saint, Robert A. Weinstein, Robert Wise, Deborah S. Yokoe
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 29 / Issue S1 / October 2008
- Published online by Cambridge University Press:
- 02 January 2015, pp. S62-S80
- Print publication:
- October 2008
-
- Article
- Export citation
-
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). Our intent in this document is to highlight practical recommendations in a concise format to assist acute care hospitals in their efforts to prevent transmission of methicillin-resistant Staphylococcus aureus (MRSA). Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary, Introduction, and accompanying editorial for additional discussion.
1. Burden of HAIs caused by MRSA in acute care facilities
a. In the United States, the proportion of hospital-associated S. aureus infections that are caused by strains resistant to methicillin has steadily increased. In 2004, MRSA accounted for 63% of S. aureus infections in hospitals.
b. Although the proportion of S. aureus–associated HAIs among intensive care unit (ICU) patients that are due to methicillin-resistant strains has increased (a relative measure of the MRSA problem), recent data suggest that the incidence of central line–associated bloodstream infection caused by MRSA (an absolute measure of the problem) has decreased in several types of ICUs since 2001. Although these findings suggest that there has been some success in preventing nosocomial MRSA transmission and infection, many patient groups continue to be at risk for such transmission.
c. MRSA has also been documented in other areas of the hospital and in other types of healthcare facilities, including those that provide long-term care.
Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals
- Susan E. Coffin, Michael Klompas, David Classen, Kathleen M. Arias, Kelly Podgorny, Deverick J. Anderson, Helen Burstin, David P. Calfee, Erik R. Dubberke, Victoria Fraser, Dale N. Gerding, Frances A. Griffin, Peter Gross, Keith S. Kaye, Evelyn Lo, Jonas Marschall, Leonard A. Mermel, Lindsay Nicolle, David A. Pegues, Trish M. Perl, Sanjay Saint, Cassandra D. Salgado, Robert A. Weinstein, Robert Wise, Deborah S. Yokoe
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 29 / Issue S1 / October 2008
- Published online by Cambridge University Press:
- 02 January 2015, pp. S31-S40
- Print publication:
- October 2008
-
- Article
- Export citation
-
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their ventilator-associated pneumonia (VAP) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.
1. Occurrence of VAP in acute care facilities.
a. VAP is one of the most common infections acquired by adults and children in intensive care units (ICUs).
i. In early studies, it was reported that 10%-20% of patients undergoing ventilation developed VAP. More-recent publications report rates of VAP that range from 1 to 4 cases per 1,000 ventilator-days, but rates may exceed 10 cases per 1,000 ventilator-days in some neonatal and surgical patient populations. The results of recent quality improvement initiatives, however, suggest that many cases of VAP might be prevented by careful attention to the process of care.
2. Outcomes associated with VAP
a. VAP is a cause of significant patient morbidity and mortality, increased utilization of healthcare resources, and excess cost.
i. The mortality attributable to VAP may exceed 10%.
ii. Patients with VAP require prolonged periods of mechanical ventilation, extended hospitalizations, excess use of antimicrobial medications, and increased direct medical costs.
Strategies to Prevent Surgical Site Infections in Acute Care Hospitals
- Deverick J. Anderson, Keith S. Kaye, David Classen, Kathleen M. Arias, Kelly Podgorny, Helen Burstin, David P. Calfee, Susan E. Coffin, Erik R. Dubberke, Victoria Fraser, Dale N. Gerding, Frances A. Griffin, Peter Gross, Michael Klompas, Evelyn Lo, Jonas Marschall, Leonard A. Mermel, Lindsay Nicolle, David A. Pegues, Trish M. Perl, Sanjay Saint, Cassandra D. Salgado, Robert A. Weinstein, Robert Wise, Deborah S. Yokoe
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 29 / Issue S1 / October 2008
- Published online by Cambridge University Press:
- 02 January 2015, pp. S51-S61
- Print publication:
- October 2008
-
- Article
- Export citation
-
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals to implement and prioritize their surgical site infection (SSI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.
1. Burden of SSIs as complications in acute care facilities.
a. SSIs occur in 2%-5% of patients undergoing inpatient surgery in the United States.
b. Approximately 500,000 SSIs occur each year.
2. Outcomes associated with SSI
a. Each SSI is associated with approximately 7-10 additional postoperative hospital days.
b. Patients with an SSI have a 2-11 times higher risk of death, compared with operative patients without an SSI.
i. Seventy-seven percent of deaths among patients with SSI are direcdy attributable to SSI.
c. Attributable costs of SSI vary, depending on the type of operative procedure and the type of infecting pathogen; published estimates range from $3,000 to $29,000.
i. SSIs are believed to account for up to $10 billion annually in healthcare expenditures.
1. Definitions
a. The Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System and the National Healthcare Safety Network definitions for SSI are widely used.
b. SSIs are classified as follows (Figure):
i. Superficial incisional (involving only skin or subcutaneous tissue of the incision)
ii. Deep incisional (involving fascia and/or muscular layers)
iii. Organ/space
Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals
- Jonas Marschall, Leonard A. Mermel, David Classen, Kathleen M. Arias, Kelly Podgorny, Deverick J. Anderson, Helen Burstin, David P. Calfee, Susan E. Coffin, Erik R. Dubberke, Victoria Fraser, Dale N. Gerding, Frances A. Griffin, Peter Gross, Keith S. Kaye, Michael Klompas, Evelyn Lo, Lindsay Nicolle, David A. Pegues, Trish M. Perl, Sanjay Saint, Cassandra D. Salgado, Robert A. Weinstein, Robert Wise, Deborah S. Yokoe
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 29 / Issue S1 / October 2008
- Published online by Cambridge University Press:
- 02 January 2015, pp. S22-S30
- Print publication:
- October 2008
-
- Article
- Export citation
-
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line–associated bloodstream infection (CLABSI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.
1. Patients at risk for CLABSIs in acute care facilities
a. Intensive care unit (ICU) population: The risk of CLABSI in ICU patients is high. Reasons for this include the frequent insertion of multiple catheters, the use of specific types of catheters that are almost exclusively inserted in ICU patients and associated with substantial risk (eg, arterial catheters), and the fact that catheters are frequently placed in emergency circumstances, repeatedly accessed each day, and often needed for extended periods.
b. Non-ICU population: Although the primary focus of attention over the past 2 decades has been the ICU setting, recent data suggest that the greatest numbers of patients with central lines are in hospital units outside the ICU, where there is a substantial risk of CLABSI.
2. Outcomes associated with hospital-acquired CLABSI
a. Increased length of hospital stay
b. Increased cost; the non-inflation-adjusted attributable cost of CLABSIs has been found to vary from $3,700 to $29,000 per episode