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Central line-associated bloodstream infection (CLABSI) causes significant harm in neonatal intensive care unit (NICU) patients. However, data regarding risk factors and prevention strategies for CLABSI in NICU patients is limited.
Objective:
To examine risk factors for CLABSI in a NICU population, with particular interest in central line type and site placement.
Design:
Retrospective case–control study.
Setting:
NICU (Level IV, 67 bed) at a pediatric hospital in South Texas.
Participants:
All central line insertions and subsequent CLABSI cases were extracted from the EHR for NICU admissions occurring from January 1, 2018, to November 3, 2022 (N = 1,356), along with potential CLABSI risk factors.
Methods:
Central line insertions resulting in CLABSI (N = 35) were compared to instances without CLABSI (N = 1,321) using bivariate and multivariate analysis, with propensity score matching.
Results:
Multivariate risk factors include implantable device (odds ratio [OR] = 14.5, P < .001), neck site placement (OR = 7.2, P < .001), and device dwell time (OR = 5.6, P = .001), as well as years 2021 (OR = 5.1, P = .017) and 2022 (OR = 5.9, P = .011). This indicates the odds of contracting CLABSI are 14.5 times higher when an implantable central line is used compared to the reference category (PICC devices). When cases are paired with matched controls, likelihood of CLABSI is 7.1% higher in patients with an implantable device than in similar patients with other central lines (p = 0.034).
Conclusions:
Implantable central lines are an independent risk factor for CLABSI in NICU patients at this facility.
In this review we identified cohort and cross-sectional studies that assessed pain in community-dwelling older people (>65 years) reliably characterized as frail. Secondly, we considered biologically plausible mechanisms that may alter pain perception, or contribute to, or exacerbate pain in an older person with frailty. Thirdly, we considered specific implications of pain management for this group of people. From the limited data from the seven included studies, it would appear that the presence of pain is higher in older people with frailty compared with people characterized as pre-frail or not frail. Thus older people reporting pain are more likely to be frail. However, a lack of prospective data precludes inferences about the direction of the relationship: that is whether pain or frailty is the antecedent. Further research is needed to understand the direction of the relationship, and to identify appropriate pain management strategies for older people with frailty.
Our recent data have confirmed that maximum oxygen delivery in racing Thoroughbreds is positively correlated to left ventricular mass measured by echocardiography. A similar, but weaker relationship also exists between left ventricular mass and Timeform performance rating in commercial racehorses. The relationship of the Thoroughbred heart to racing success and the special problems that selective breeding for aerobic capacity have had in this species are reviewed in this article. Experimental Physiology (2003) 88.5, 659-663.
There is a growing interest in ‘evidence-based policy making’ in the UK. However, there remains some confusion about what evidence-based policy making actually means. This paper outlines some of the models used to understand how evidence is thought to shape or inform policy in order to explore the assumptions underlying ‘evidence-based policy making.’ By way of example, it considers the process of evidence seeking and in particular the systematic review as a presumed ‘gold standard’ of the EBP movement. It highlights some of the opportunities and challenges represented in this approach for policy research. The final part of the paper outlines some questions of capacity that need to be addressed if the social sciences are to make a more effective contribution to policy debate in Britain.
This Current Awareness column, and previous Current Awareness columns, are now fully searchable in the new caLIM database (Current Awareness for Legal Information Managers). The caLIM database is available on the Institute of Advanced Legal Studies website at: http://ials.sas.ac.uk/library/caware/caware.htm
This study examined the effects of a student-mediated conflict
resolution program on
primary school (junior kindergarten to grade 5) playground aggression.
Mediation teams of
grade 5 students (approximately age 10) participated in 15 hours of training
according to the
model developed by Cunningham, Cunningham, and Martorelli (1997). Following
baseline
observations, mediation was introduced onto the playgrounds of three schools
according to
a multiple baseline design. Mediators successfully resolved approximately
90% of the
playground conflicts in which they intervened. Direct observations suggest
that the student
mediation program reduced physically aggressive playground behavior by
51% to 65%.
These effects were sustained at 1-year follow-up observations. Teacher
and mediator
satisfaction questionnaires provided strong support for impact, feasibility,
and acceptability
of this program.
Aspirates were obtained from 142 masses in 120 patients who presented with palpable swellings in the head and neck region. 120 specimens (84.51 per cent) were adequate for diagnostic purposes and the remaining 22 (15.49 per cent) were unsatisfactory. Final diagnosis was based on resection histology in 87 cases and close clinical follow-up in 55 patients. The overall sensitivity and specificity including unsatisfactory aspirates was 81.37 per cent and 93 per cent respectively (if the technically inadequate specimens were deleted 98.81 per cent and 94.44 per cent). In comparison with the final diagnosis typing of malignant tumours was possible in 58.33 per cent. The correct diagnosis was made in 63.89 per cent of benign lesions.
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