An audit of compliance with the sepsis resuscitation care bundle in patients admitted to A&E with severe sepsis or septic shock.

Severe sepsis and septic shock are syndromes resulting in a systemic inflammatory response and the dysfunction of one or more organs following infection. The Surviving Sepsis Campaign is an international effort to reduce mortality in severe sepsis and septic shock by 25% by 2009 using a care bundle approach. It comprises evidenced-based interventions to be carried out within 6h of onset of sepsis.

Trends in perinatal and infant health disparities between rural American Indians and Alaska natives and rural Whites.

Objectives: We examined disparities in perinatal care, birth outcomes, and infant health between rural American Indian and Alaska Native (AIAN) persons and rural Whites over time.

Methods: We compared perinatal and infant health measures for 217 064 rural AIAN births and 5 032 533 rural non-Hispanic White births.

Results: Among American Indians and Alaska Natives, unadjusted rates of inadequate prenatal care (1985-1987, 36.

Access to specialty health care for rural American Indians in two states.

Context: The Indian Health Service (IHS), whose per capita expenditure for American Indian and Alaska Native (AI/AN) health services is about half that of the US civilian population, is the only source of health care funding for many rural AI/ANs. Specialty services, largely funded through contracts with outside practitioners, may be limited by low IHS funding levels.

Purpose: To examine specialty service access among rural Indian populations in two states.

Trends in colorectal cancer testing among Medicare subpopulations.

Background: In 1998, Medicare initiated universal coverage for colorectal cancer (CRC) screening via fecal occult blood testing (FOBT) and sigmoidoscopy. In mid-2001, universal coverage was advanced to screening colonoscopy. This study sought to determine whether trends in CRC testing differed among racial/ethnic, age, or gender subgroups of the Medicare population.

Ways of knowing: integrating research into CAM education and holism into conventional health professional education.

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs.

Sci-Fri AM: YIS-01: Comprehensive MR distortion correction: Phantom validation and in-vivo application.

MR images provide excellent diagnostic information; however, their treatment planning utility is limited due to geometric uncertainties from both system and patient related sources. Despite this concern, interest in developing MR-based treatment planning protocols is on the rise because of the ease with which clinically relevant structures can be identified in MR. Here we present our systematic approach to quantifying both machine (gradient non-linearity and B inhomogeneity) and patient (susceptibility and chemical shift) distortions.

Panton-Valentine Leukocidin associated with community acquired methicillin resistant Staphylococcus aureus: a case report and review of interim guidelines.

We report a case of community acquired methicillin resistant Staphylococcus aureus pneumonia. The causative organism was positive for the toxin Panton-Valentine Leukocidin. This resulted in a severe pneumonia requiring a prolonged stay on our intensive care unit.

Does surgeon case volume influence nonfatal adverse outcomes after rectal cancer resection?

Background: The aim of this study was to assess the relationship between surgeon and hospital volume and major postoperative complications after rectal cancer surgery, and to define other surgeon and hospital characteristics that may explain observed volume-complication relationships.

Study Design: This was a retrospective cohort design using data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry program for individuals with stage I to III rectal cancer diagnosed between 1992 and 1999 and treated with resection. The patients' Surveillance, Epidemiology, and End Results data were linked with Medicare claims data from 1991 to 2000.

Residual treatment disparities after oncology referral for rectal cancer.

Background: Black patients with rectal cancer are considerably less likely than white patients to receive adjuvant therapy. We examined the hypothesis that the lower treatment rate for blacks is due to underreferral to medical and radiation oncologists.

Methods: We used 1992-1999 Surveillance, Epidemiology, and End Results-Medicare data to identify elderly (> or = 66 years of age) patients who had been hospitalized for resection of stage II or III rectal cancer (n = 2716).

Influence of obstetric practice on workload and practice patterns of family physicians and obstetrician-gynecologists.

Purpose: Obstetric practice among family physicians has declined in recent years. This study compared the practice patterns of family physicians and obstetrician-gynecologists with and without obstetric practices to provide objective information on one potential reason for this decline--the impact of obstetrics on physician lifestyle.

Methods: In 2004, we surveyed all obstetrician-gynecologists, all rural family physicians, and a random sample of urban family physicians identified from professional association lists (N =2,564) about demographics, practice characteristics, and obstetric practices.

The in vivo cytokine release profile following implantation.

There has been no comprehensive study that maps the production of the range of inflammatory cytokines following implantation of a material. There is an urgent requirement for specific data on the real time production of biological markers in order to study their effects in vitro and more accurately predict the in vivo response. This study determined the production of IL-1beta, IL-2, IL-4, IL-6, IL-10, IFNgamma and TNF-alpha in response to a synthetic material implanted in a rat soft tissue model for up to 90 days.

Survival benefits and trends in use of adjuvant therapy among elderly stage II and III rectal cancer patients in the general population.

Background: This study examined elderly stage II and III rectal cancer patients' adjuvant chemoradiation therapy adherence, trends in adherence over time, and the relation of levels of adherence to mortality.

Methods: The authors studied 2886 stage II and III rectal cancer patients who had surgical resection and who appeared in 1992-1999 linked SEER-Medicare claims data. The authors compared measures of adjuvant radiation and chemotherapy receipt and completion between stage II and III patients.

Continuity of care and cancer screening among health plan enrollees.

Context: Although having a usual source of care has been associated with cancer screening, whether there is additional benefit from continuity with a specific physician is uncertain. In addition, little is known about the relationship between continuity of care and receipt of colorectal and prostate cancer screening.

Methods: Subjects were enrolled in a Washington State health plan that operates an integrated delivery system that emphasizes access to primary care.

The use of mobile devices for information sharing in a technology-supported model of care in A&E.

Using a case study as an example, this paper illustrates the current model of care in Accident and Emergency (A & E); in particular, the 'cells' in which data/information is stored and how explicit and accessible it is (or is not) to healthcare professionals. It is a model of care which may be summed up as static information/dynamic clinicians. This paper then describes how mobile devices may be used to track patients through an A&E department.

A refined comorbidity measurement algorithm for claims-based studies of breast, prostate, colorectal, and lung cancer patients.

Purpose: We evaluated (i) how combining comorbid conditions identified from Medicare inpatient or physician claims into a single comorbidity index compared with three other comorbidity indices and (ii) the need for comorbid condition weights that are specific to different cancer sites.

Methods: This observational study used the SEER-Medicare linked database, from which four cohorts of cancer patients were derived: breast (n = 26,377), prostate (n = 53,503), colorectal (n = 26,460), and lung (n = 33,975). We calculated two established (Charlson; NCI) and two new (NCI Combined; Uniform Weights) comorbidity indices, and used Cox proportional hazards models to assess their predictive ability.

Differences among the elderly in the treatment costs of colorectal cancer: how important is race?

Background: Medical expenditures adjusted for price differences are a barometer of total resources devoted to patient care and thus may reflect treatment differentials.

Objective: We sought to estimate costs of the surgical and adjuvant treatment phases of colorectal cancer (CRC) care and cost differences by race (African American-white) and other patient characteristics.

Methods: We used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database for stage II-III rectal and stage III colon cancer cases diagnosed in 1992-1996 to track Medicare approved payments for fee-for-service beneficiaries 66 and older in surgical (within 3 months of diagnosis) and postsurgical phases (13 months after the surgical phase).

Predictors of comprehensive surgical treatment in patients with ovarian cancer.

Background: Providing appropriate surgical treatment for women with ovarian cancer is one of the most effective ways to improve ovarian cancer outcomes. In this study, the authors identified factors that were associated with a measure of comprehensive surgery, so that interventions may be targeted appropriately to improve surgical care.

Methods: Using Healthcare Cost and Utilization Project hospital discharge data from 1999 to 2002 for 9 states, the authors identified 10,432 admissions of women who had an International Classification of Disease, 9th Revision (ICD-9) primary diagnosis of ovarian cancer and who had undergone oophorectomy.

Delivery of cancer screening: how important is the preventive health examination?

Background: Patients and physicians strongly endorse the importance of preventive or periodic health examinations (PHEs). However, the extent to which PHEs contribute to the delivery of cancer screening is uncertain.

Methods: In a retrospective cohort study, we determined the association between receipt of a PHE and cancer testing in a population-based sample of enrollees in a Washington State health plan who were aged 52 to 78 years and eligible for colorectal, breast, or prostate cancer screening in 2002-2003 (N = 64 288).

Characterization, prediction, and correction of geometric distortion in 3 T MR images.

The work presented herein describes our methods and results for predicting, measuring and correcting geometric distortions in a 3 T clinical magnetic resonance (MR) scanner for the purpose of image guidance in radiation treatment planning. Geometric inaccuracies due to both inhomogeneities in the background field and nonlinearities in the applied gradients were easily visualized on the MR images of a regularly structured three-dimensional (3D) grid phantom. From a computed tomography scan, the locations of just under 10 000 control points within the phantom were accurately determined in three dimensions using a MATLAB-based computer program.

Reversible watermarking for authentication of DICOM images.

We propose a watermarking scheme that can recover the original image from the watermarked one. The purpose is to verify the integrity and authenticity of DICOM images. We used 800x600x8 bits ultrasound (US) images in our experiment.

Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship.

Hypothesis: Although numerous studies have demonstrated an association between surgical volume and improved outcome in cancer surgery, the specific structures and mechanisms of care that are associated with volume and lead to improved outcomes remain poorly defined. We hypothesize that there are modifiable surgeon and hospital characteristics that explain observed volume-outcome relationships.

Design: Retrospective cohort study.

Reoperation as a quality indicator in colorectal surgery: a population-based analysis.

Objective: To describe unplanned procedures following colorectal cancer surgery that might be used as intermediate outcome measures, and to determine their association with mortality and length of stay.

Summary Background: Variation in the quality of surgical care, especially for common illnesses like colorectal cancer, has received increasing attention. Nonfatal complications resulting in procedural interventions are likely to play a role in poor outcomes but have not been well explored.

American Indians and Alaska Natives: how do they find their path to medical school?

Background: American Indians and Alaska Natives (AI/ANs) remain underrepresented in the medical profession. This study sought to understand the supports and barriers that AI/AN students encountered on their path to successful medical school entry.

Method: The research team analyzed qualitative semistructured, one-on-one, confidential interviews with 10 AI/AN medical students to identify salient support and barrier themes.