Safety and efficacy of ceftriaxone for amyotrophic lateral sclerosis: a multi-stage, randomised, double-blind, placebo-controlled trial.

Background: Glutamate excitotoxicity might contribute to the pathophysiology of amyotrophic lateral sclerosis. In animal models, decreased excitatory aminoacid transporter 2 (EAAT2) overexpression delays disease onset and prolongs survival, and ceftriaxone increases EAAT2 activity. We aimed to assess the safety and efficacy of ceftriaxone for amyotrophic lateral sclerosis in a combined phase 1, 2, and 3 clinical trial.

Design and initial results of a multi-phase randomized trial of ceftriaxone in amyotrophic lateral sclerosis.

Objectives: Ceftriaxone increases expression of the astrocytic glutamate transporter, EAAT2, which might protect from glutamate-mediated excitotoxicity. A trial using a novel three stage nonstop design, incorporating Phases I-III, tested ceftriaxone in ALS. Stage 1 determined the cerebrospinal fluid pharmacokinetics of ceftriaxone in subjects with ALS.

Diagnostic accuracy of laxative-free computed tomographic colonography for detection of adenomatous polyps in asymptomatic adults: a prospective evaluation.

Background: Colon screening by optical colonoscopy (OC) or computed tomographic colonography (CTC) requires a laxative bowel preparation, which inhibits screening participation.

Objective: To assess the performance of detecting adenomas 6 mm or larger and patient experience of laxative-free, computer-aided CTC.

Design: Prospective test comparison of laxative-free CTC and OC.

Functional alignment, not structural integration, of medical schools and teaching hospitals is associated with high performance in academic health centers.

Background: Debates continue regarding optimal structures for governance and administration between medical schools and their teaching hospitals.

Methods: Structural integration (SI) for 85 academic health centers was characterized as high (single leader or fiduciary) or low (multiple leaders or fiduciaries). Functional alignment (FA) was estimated from questionnaire responses by teaching hospitals' chief executive officers, and an index was calculated quantifying organizational collaboration across several functional areas.

Harmful medication errors involving unfractionated and low-molecular-weight heparin in three patient safety reporting programs.

Background: External reporting of medical errors a adverse events enables learning from the errors of others in the pursuit of systems-level improvements that can prevent future errors. It is logical to presume that medication errors involving the use of anticoagulants, among the most frequently cited product classes involved in harmful medication errors, would be captured in a variety of patient safety reporting programs.

Methods: Data on reported errors involving the anticoagulant heparin were reviewed, compared, and aggregated from the databases of three large patient safety reporting programs-MEDMARX, the Pennsylvania Patient Safety Authority's Patient Safety Reporting System, and the University Health System Consortium, together representing more than 1,000 reporting organizations for 2005

Results: Approximately 300,000 medication errors and near misses were reported to the programs, and 10,359-a mean of 3.

Is there a relationship between high-quality performance in major teaching hospitals and residents' knowledge of quality and patient safety?

Purpose: The relationship of the quality of teaching hospitals' clinical performance to resident education in quality and patient safety is unclear. The authors studied residents' knowledge of these areas in major teaching hospitals with higher- and lower-quality performance rankings. They assessed the presence of formal and informal quality curricula to determine whether programmatic differences exist.

Ambulatory quality improvement in academic medical centers: a changing landscape.

Efforts to improve the quality of ambulatory care have received tremendous attention as bold new initiatives aimed at influencing the environment of care through financial incentives, public transparency, and information technology rapidly spread. Academic medical centers, which represent a long tradition of excellence and innovation in medical care, might be expected to lead the charge in these new arenas, but motivation for change may be mitigated by the unique complexity and multiple goals of these institutions. A survey conducted in the fall of 2006 examined the early impact of these major new influences on faculty practice plans.

Organizational factors associated with high performance in quality and safety in academic medical centers.

Purpose: Leaders of academic medical centers (AMCs) are challenged to ensure consistent high performance in quality and safety across all clinical services. The authors sought to identify organizational factors associated with AMCs that stood out from their peers in a composite scoring system for quality and safety derived from patient-level data.

Method: A scoring method using measures of safety, mortality, clinical effectiveness, and equity of care was applied to discharge abstract data from 79 AMCs for 2003-2004.

The relationship between evidence-based practices and survival in patients requiring prolonged mechanical ventilation in academic medical centers.

Studies suggest variable adoption of evidence-based practice guidelines. The authors hypothesized that compliance with guidelines for patients requiring mechanical ventilation would vary among academic medical centers and that this variation might be associated with survival. A total of 1463 intensive care unit cases receiving continuous mechanical ventilation for >96 hours were reviewed.

Video capsule endoscopy.

Purpose Of Review: The small bowel has been a difficult organ for gastroenterologists to evaluate. Small bowel radiographs and CT scanning have not had a high diagnostic rate, especially in patients presenting with small bowel bleeding. The video capsule "endoscope" has allowed for the direct visualization of the small bowel mucosa.

Outpatient quality improvement in academic faculty practice plans: does it exist?

The purpose of this study was to (a) investigate the extent to which academic faculty practice plans (FPPs) are currently involved in ambulatory care quality improvement (QI), (b) describe the structure of QI initiatives at outpatient FPPs, and (c) delineate facilitators and barriers to development of FPP outpatient QI initiatives. Members of the Steering Committee of the Group Practice Council of the University HealthSystem Consortium (UHC), representing the leadership of 88 FPPs, were asked to respond to a 38-item Web-based questionnaire during February and March 2003. The survey elicited information on the organizational characteristics of FPPs, their current degree of engagement in outpatient QI activities, and factors driving interest and barriers impeding efforts to conduct outpatient QI initiatives.

Cost analysis and clinical impact of weekly ventilator circuit changes in patients in intensive care unit.

Background: The introduction of heated circuits and sealed, single-use humidifiers has prompted some investigators to question the traditional recommendations for changing ventilator circuits. We studied the clinical and cost impact of extending the circuit change interval from 72 hours to 7 days in our two intensive care units with 17 beds.

Methods: With standard surveillance definitions from the Centers for Disease Control and Prevention and the National Nosocomial Infections Surveillance System, baseline pneumonia rates were established for a 3-month period.

Effect of time and temperature on inactivation of aminoglycosides by ampicillin at neonatal dosages.

The administration of gentamicin at least 1 hour before administration of ampicillin in neonates has been advocated because of in vitro inactivation of aminoglycosides by beta-lactam antibiotics. This method would cause a delay in ampicillin dosing in the treatment of serious bacterial infections and unnecessarily complicate nursing procedures. We studied the effect of varying concentrations of ampicillin (50, 100, 200, and 400 micrograms/ml) on aminoglycosidic antibiotics in vitro with the use of stock solutions diluted in pooled sera obtained from cord blood and incubated samples at 25 degrees C, 37 degrees C, and 40 degrees C.

A cluster of atypical skin lesions in well-baby nurseries and a neonatal intensive care unit.

We describe an epidemiologic investigation that elucidated the cause of vesicular and bullous skin lesions of the hands and feet that occurred in three otherwise well neonates during a 24-hour period. The investigation encompassed two well-baby nurseries of 28 and 17 beds and one level III neonatal intensive care unit (NICU) of 31 beds located in a 440-bed university-affiliated community hospital. Work-up for infectious causes of the skin lesions in the initial three cases had negative results.

A phase II multicenter, double-blind, randomized, placebo-controlled study of three dosages of an immunomodulator (PGG-glucan) in high-risk surgical patients.

Objective: To examine the safety and efficacy of multiple doses of PGG-glucan (poly-[1-6]-B-D-glucopyranosyl-[1-3]-B-D-glucopyranose) in high-risk patients undergoing major thoracic or abdominal surgery.

Design: An interventional, multicenter, double-blind, randomized, placebo-controlled study.

Setting: Four university-affiliated medical centers.

Pneumococcal crepitant cellulitis caused by a bronchocutaneous fistula.

An elderly woman who had received radiation treatment for carcinoma of the lung presented with erythema, crepitus and pain over the scapular area. Streptococcus pneumoniae was isolated in pure culture from the subcutaneous tissues, and a bronchocutaneous fistula was demonstrated.