A randomized controlled trial of GG on antimicrobial-resistant organism colonization.

Objective: Alteration of the colonic microbiota following antimicrobial exposure allows colonization by antimicrobial-resistant organisms (AROs). Ingestion of a probiotic, such as Lactobacillus rhamnosus GG (LGG), could prevent colonization or infection with AROs by promoting healthy colonic microbiota. The purpose of this trial was to determine the effect of LGG administration on ARO colonization in hospitalized patients receiving antibiotics.

An Epidemiologic Perspective on Scaphoid Fracture Treatment and Frequency of Nonunion Surgery in the USA.

Background: Scaphoid fractures treated non-operatively and operatively may be complicated by nonunion.

Questions/purposes: We sought to test the primary hypothesis that the incidence density of scaphoid fracture treatment is higher than previously estimated, to determine the frequency and risk factors for nonunion treatment, and to determine whether the frequency of surgical treatment increased over time.

Methods: The MarketScan database was queried for all records of treatment (casting and surgery) for closed scaphoid fractures over a 6-year period.

An Evaluation of the Prevalence of Vancomycin-Resistant Enterococci (VRE) and Methicillin-Resistant Staphylococcus aureus (MRSA) in Hospital Food.

This prospective cohort study evaluated the presence of MRSA and VRE in the food of hospitalized patients. 149 patients were enrolled and 910 food specimens cultured; 3.2% were positive for MRSA and 2.

Risk for Infection After Allogeneic Hematopoietic Cell Transplant Remains Elevated in the Postengraftment Period.

Background: infection (CDI) is a frequent cause of diarrhea among allogeneic hematopoietic cell transplant (HCT) recipients. It is unknown whether risk factors for CDI vary by time posttransplant.

Methods: We performed a 3-year prospective cohort study of CDI in allogeneic HCT recipients.

Cubital Tunnel Syndrome: Incidence and Demographics in a National Administrative Database.

Background: Compressive neuropathy of the ulnar nerve at the elbow, or cubital tunnel syndrome (CuTS), is the second most common entrapment neuropathy of the upper extremity after carpal tunnel syndrome. While several studies have reported risk factors and outcomes for select populations (mostly surgical), it is difficult to interpret these data without an accurate measure of CuTS disease burden in the general population.

Objective: To estimate the incidence of CuTS among US health plan enrollees, using a large administrative health care claims database comprised of individuals from all 50 states.

All-Payer Analysis of Heart Failure Hospitalization 30-Day Readmission: Comorbidities Matter.

Background: Thirty-day readmission following heart failure hospitalization impacts hospital performance measures and reimbursement. We investigated readmission characteristics and the magnitude of 30-day hospital readmissions after hospital discharge for heart failure using the Healthcare Cost and Utilization Project State Inpatient Databases (SID).

Methods: Adults aged ≥ 40 years hospitalized with a primary discharge diagnosis of heart failure from 2007-2011 were identified in the California, New York, and Florida SIDs.

An Evaluation of Food as a Potential Source for Clostridium difficile Acquisition in Hospitalized Patients.

OBJECTIVE To determine whether Clostridium difficile is present in the food of hospitalized patients and to estimate the risk of subsequent colonization associated with C. difficile in food. METHODS This was a prospective cohort study of inpatients at a university-affiliated tertiary care center, May 9, 2011-July 12, 2012.

Population-based approaches to treatment and readmission after spinal cord injury.

Background: Recent studies in surgical and non-surgical specialties have suggested that patients admitted on the weekend may have worse outcomes. In particular, patients with stroke and acute cardiovascular events have shown worse outcomes with weekend treatment. It is unclear whether this extends to patients with spinal cord injury (SCI).

The Effect of Clinical Chorioamnionitis on Cesarean Delivery in the United States.

Objective: To examine the association of clinical chorioamnionitis on cesarean delivery in a national sample of hospital discharges.

Data Source: Hospital discharge data from the 1998-2010 Nationwide Inpatient Sample.

Study Design: We performed a cross-sectional study and general linear modeling was used to determine the association of clinical chorioamnionitis on risk of cesarean delivery.

Prevalence of qacA/B Genes and Mupirocin Resistance Among Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates in the Setting of Chlorhexidine Bathing Without Mupirocin.

Objective: We aimed to determine the frequency of qacA/B chlorhexidine tolerance genes and high-level mupirocin resistance among MRSA isolates before and after the introduction of a chlorhexidine (CHG) daily bathing intervention in a surgical intensive care unit (SICU).

Design: Retrospective cohort study (2005-2012) SETTING: A large tertiary-care center

Patients: Patients admitted to SICU who had MRSA surveillance cultures of the anterior nares

Methods: A random sample of banked MRSA anterior nares isolates recovered during (2005) and after (2006-2012) implementation of a daily CHG bathing protocol was examined for qacA/B genes and high-level mupirocin resistance. Staphylococcal cassette chromosome mec (SCCmec) typing was also performed.

Randomized Controlled Trial to Determine the Impact of Probiotic Administration on Colonization With Multidrug-Resistant Organisms in Critically Ill Patients.

This was a randomized controlled pilot study of Lactobacillus rhamnosus GG versus standard of care to prevent gastrointestinal multidrug-resistant organism colonization in intensive care unit patients. Among 70 subjects, there were no significant differences in acquisition or loss of any multidrug-resistant organisms (P>.05) and no probiotic-associated adverse events.

Economic impact of bleeding complications after mastectomy.

Background: We sought to determine the incidence of postmastectomy bleeding, identify bleeding predictors, and evaluate the economic impact.

Methods: Using the 2011 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, hospital discharges for a primary diagnosis of breast cancer were extracted using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes 85.34-85.

Association of discharge home with home health care and 30-day readmission after pancreatectomy.

Background: We sought to determine if discharge home with home health care (HHC) is an independent predictor of increased readmission after pancreatectomy.

Study Design: We examined 30-day readmissions in patients undergoing pancreatectomy using the Healthcare Cost and Utilization Project State Inpatient Database for California from 2009 to 2011. Readmissions were categorized as severe or nonsevere using the Modified Accordion Severity Grading System.

Maternal age and risk of labor and delivery complications.

We utilized an updated nationally representative database to examine associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. We used hospital inpatient billing data from the 2009 United States Nationwide Inpatient Sample, part of the Healthcare Cost and Utilization Project. To determine whether the likelihood that maternal morbidity during complications of labor and delivery differed among age groups, separate logistic regression models were run for each complication.

A retrospective comparison of ceftriaxone versus oxacillin for osteoarticular infections due to methicillin-susceptible Staphylococcus aureus.

Background: Antistaphylococcal penicillins are the treatment of choice for methicillin-susceptible Staphylococcus aureus (MSSA) infection. Ceftriaxone can be dosed once daily and is less expensive for outpatient therapy than oxacillin. We compared patient outcomes of MSSA osteoarticular infections treated with ceftriaxone versus oxacillin.

Risk managers, physicians, and disclosure of harmful medical errors.

Background: Physicians are encouraged to disclose medical errors to patients, which often requires close collaboration between physicians and risk managers.

Methods: An anonymous national survey of 2,988 healthcare facility-based risk managers was conducted between November 2004 and March 2005, and results were compared with those of a previous survey (conducted between July 2003 and March 2004) of 1,311 medical physicians in Washington and Missouri. Both surveys included an error-disclosure scenario for an obvious and a less obvious error with scripted response options.

Using focus groups to understand physicians' and nurses' perspectives on error reporting in hospitals.

Background: To increase error reporting, a better understanding of physicians' and nurses' perspectives regarding medical error reporting in hospitals, barriers to reporting, and possible ways to increase reporting is necessary.

Methods: Nine focus groups--four with 49 staff nurses, two with 10 nurse managers, and three with 30 physicians--from 20 academic and community hospitals were conducted in May-June 2002 in the St. Louis metropolitan area.

Body mass index change between pregnancies and small for gestational age births.

Objective: To estimate whether maternal weight changes between pregnancies influence the risk for small for gestational age (SGA) births.

Methods: SGA cases (n = 8,062) below the tenth percentile birth weight for gestational age were selected from liveborn singletons born of Missouri residents during 1989-1997. Normal weight controls (n = 8,062) were selected according to birth year.