Continued early onset group B streptococcal infections in the era of intrapartum prophylaxis.

Objective: The objective of the study was to determine the rate of early onset group B streptococcus (EOGBS) infection in Utah and identify potential areas of failure in EOGBS prevention.

Study Design: We queried the microbiology records of Intermountain Healthcare for infants with culture-confirmed EOGBS between 1 January 2002 and 31 May 2006 and calculated rates of EOGBS per 1000 deliveries. We reviewed the infant and maternal records of each EOGBS case to identify possible failures in EOGBS prevention.

Validity of electronic medical record-based rules for the early detection of meningitis and encephalitis.

Diseases of the central nervous system (CNS) such as meningitis or encephalitis may represent events of public health interest due to emerging infections and/or NIH/CDC Category B priority pathogens. Apart from influencing treatment and management of the index case, some diagnoses such as meningococcal meningitis warrant an immediate public health response. Others such as West Nile Virus may require public education and vector control.

Safety of prescribing PDE-5 inhibitors via e-medicine vs traditional medicine.

Objective: To determine the safety of a US-based, state-regulated Internet system vs a multispecialty primary care system for prescribing phosphodiesterase type 5 (PDE-5) inhibitors for erectile dysfunction.

Patients And Methods: From January 1, 2001, through December 31, 2005, 500 e-medicine clients (mean+/-SD age, 47+/-11 years; hypertension, 60%; type 2 diabetes mellitus, 2%; mean+/-SD number of medications, 0.4+/-0.

Hypoxia-regulated protein expression, patient characteristics, and preoperative imaging as predictors of survival in adults with glioblastoma multiforme.

Background: Regions of hypoxia within glioblastoma multiforme (GBM) are common and may influence a tumor's aggressiveness, response to treatment, and the patient's overall survival. In this study, the authors examined 4 markers of hypoxia (hypoxia-inducible factor 1 [HIF-1alpha], glucose transporter 1 [GLUT-1], vascular endothelial growth factor [VEGF], and carbonic anhydrase 9 [CA IX]), cellular proliferation and microvascular density (MVD) indices, extent of surgical resection, and preoperative imaging characteristics and compared them with the overall survival rates of adults with GBM.

Methods: In this retrospective cohort study, patients who had lower grade astrocytomas were compared with patients who had GBM to verify that the methods used could establish differences between tumor grades.

The acute effect of atrioventricular pacing on sympathetic nerve activity in patients with normal and depressed left ventricular function.

Although modest elevations in pacing rate improve cardiac output and induce reflex sympathoinhibition, the threshold rate above which hemodynamic perturbations induce reflex sympathoexcitation remains unknown. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressures (MAP) and sympathetic nerve activity (SNA) were measured during normal sinus rhythm (NSR) and atrioventricular (AV) sequential pacing in 25 patients. Pacing was performed at 100, 120, and 140 beats/min with an AV interval of 100 ms.

Misoprostol effects on diclofenac-induced cardiorenal changes in salt-sensitive patients with hypertension: the MEDIC Study.

Study Objective: To determine whether coadministration of misoprostol with the nonsteroidal antiinflammatory drug diclofenac lessens the increase in blood pressure and improves the alterations in renal hemodynamics induced by diclofenac.

Design: Prospective, randomized, double-blind, placebo-controlled, crossover study.

Setting: Two university research centers.

A simulation-based evaluation of methods to estimate the impact of an adverse event on hospital length of stay.

Introduction: We used agent-based simulation to examine the problem of time-varying confounding when estimating the effect of an adverse event on hospital length of stay. Conventional analytic methods were compared with inverse probability weighting (IPW).

Methods: A cohort of hospitalized patients, at risk for experiencing an adverse event, was simulated.

Right ventricle-to-pulmonary artery conduit longevity: is it related to allograft size?

Background: Cryopreserved valved allografts are routinely oversized to account for somatic growth in children requiring right ventricle-to-pulmonary artery (RV-PA) continuity. The objective of this study is to determine the effect of oversizing on conduit longevity.

Methods: We reviewed the records of all patients undergoing RV-PA cryopreserved valved allograft placement from 1988 to 2006 for diagnosis, age, allograft type, time to valved conduit explant, and indication for surgery.

The osteoporosis self-assessment screening tool: a useful tool for the orthopaedic surgeon.

Background: Simple and effective methods are needed to identify patients at risk for osteoporosis or osteoporosis-related fracture so that they can be screened with use of dual x-ray absorptiometry and counseled for treatment. Currently, we use a cumbersome survey assessing thirty-two risk factors. A much simpler score based on the Osteoporosis Self-Assessment Screening Tool (OST score) has been established as highly sensitive and specific in women, but similar data are lacking for men.

Trends and predictors for vagotomy when performing oversew of acute bleeding duodenal ulcer in the United States.

Background: In the era of Helicobacter pylori treatment, the role of vagotomy in bleeding duodenal ulcers is debatable. National outcomes were evaluated to determine the current surgical treatment and use of vagotomy for bleeding duodenal ulcers.

Methods: Data from the Nationwide Inpatient Sample (NIS) were used from years 1999 to 2003.

Opioid-related adverse drug events in surgical hospitalizations: impact on costs and length of stay.

Background: Opioid analgesics remain a mainstay in the treatment of pain associated with surgical procedures. Such use is associated with adverse drug events (ADEs).

Objective: To investigate the impact of opioid-related ADEs on total hospital costs and length of stay (LOS) in adult surgical patients.

Mortality of late-preterm (near-term) newborns in Utah.

Objectives: The purpose of this work was to determine the relative risk for mortality and the causes and ages of death for late-preterm newborns (gestational age of 34-36 weeks) compared with those born at term.

Methods: We reviewed data from birth and death certificates of infants born in Utah between 1999 and 2004. We calculated early neonatal (first week), neonatal (first 28 days), and infant (first year) mortality rates for each weekly estimated gestational age cohort from 34 to 42 weeks and, using 40 weeks as the reference, risk ratios for each cohort.

The effects of rate and irregularity on sympathetic nerve activity in human subjects.

Background: We have recently shown that atrial fibrillation is associated with an increase in sympathetic nerve activity (SNA) compared with sinus rhythm. It remains unclear, however, whether these findings are true at various rates and whether the magnitude of sympathoexcitation is related to the degree of irregularity.

Objective: To determine the role of irregularity in mediating the SNA changes at various pacing rates.

Preeclampsia and subsequent risk of cancer in Utah.

Objective: The purpose of this study was to determine if preeclampsia is associated with a reduced risk of cancer later in life.

Study Design: We performed a cohort study where women with preeclampsia over the interval 1947 to 1999 were identified from the Utah Population Database. Preeclamptics (n = 17,432) were matched 1:3 with nonpreeclamptics (n = 52,296) on maternal age and birth year.

Use of a personal digital assistant for managing antibiotic prescribing for outpatient respiratory tract infections in rural communities.

Objective: To assess the acceptability and usage of a standalone personal digital assistant (PDA)-based clinical decision-support system (CDSS) for the diagnosis and management of acute respiratory tract infections (RTIs) in the outpatient setting.

Design: Observational study performed as part of a larger randomized trial in six rural communities in Utah and Idaho from January 2002 to March 2004. Ninety-nine primary care providers received a PDA-based CDSS for use at the point-of-care, and were asked to use the tool with at least 200 patients with suspected RTIs.

Elevated plasma phenylalanine in severe malaria and implications for pathophysiology of neurological complications.

Cerebral malaria is associated with decreased production of nitric oxide and decreased levels of its precursor, l-arginine. Abnormal amino acid metabolism may thus be an important factor in malaria pathogenesis. We sought to determine if other amino acid abnormalities are associated with disease severity in falciparum malaria.

Recurrent catheter-related bloodstream infections: Risk factors and outcome.

Objective: To identify risk factors for recurrent catheter related bloodstream infections (CR-BSIs). The study was undertaken at the University of Utah Hospital and involved patients who had a CR-BSI followed by catheter removal and reinsertion between January 1998 and February 2002.

Design: A retrospective chart review for the cohort study of catheters initially infected, which were then followed to study risk factors for a subsequent infection.

Evaluation of a learning collaborative to improve the delivery of preventive services by pediatric practices.

Objective: Effective delivery of preventive services is an essential component of high-quality pediatric health care. However, both variation in and deviation from accepted guidelines have been reported. Learning collaboratives (LCs) have been shown to result in improvement in several aspects of pediatric care.

The role of pre-emptive re-transplant in graft and recipient outcome.

Background: The effect of the pre-emptive re-transplant, and of inter-transplant waiting time generally, on graft and recipient survival is not well established.

Methods: Analysis of the United States Renal Data System (USRDS) data (1/1/90 through 12/31/00; n = 92,844) was performed. Cox regression was used to analyse time to event, with an additional analysis to stratify by transplant era.

Weaknesses in the classification criteria for antithrombotic-related major bleeding events.

We asked two physicians to review the medical records (electronic and paper) of 100 patients on antithrombotics. The physicians used published classification criteria to identify all of the bleeding events that the patients experienced. The goal of the review was to investigate whether the physicians would identify the same antithrombotic related major bleeding events (ARMBEs) for each patient.

Mechanisms by which antibiotics promote dissemination of resistant pneumococci in human populations.

Mechanisms by which antimicrobials contribute to dissemination of pneumococcal resistance are incompletely characterized. A serial cross-sectional study of nasopharyngeal pneumococcal carriage in healthy, home-living children View Article and Find Full Text PDF

Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial.

Context: The impact of clinical decision support systems (CDSS) on antimicrobial prescribing in ambulatory settings has not previously been evaluated.

Objective: To measure the added value of CDSS when coupled with a community intervention to reduce inappropriate prescribing of antimicrobial drugs for acute respiratory tract infections.

Design, Participants And Setting: Cluster randomized trial that included 407,460 inhabitants and 334 primary care clinicians in 12 rural communities in Utah and Idaho (6 with 1 shared characteristic and 6 with another), and a third group of 6 communities that served as nonstudy controls.

Association of intrapartum antibiotic exposure and late-onset serious bacterial infections in infants.

Objective: Recommendations to prevent vertical transmission of group B Streptococcus (GBS) infections have resulted in many women's receiving antibiotics during labor with an associated reduction in early-onset GBS infections in their newborn infants. However, a potential relationship of intrapartum antibiotics (IPA) to the occurrence of late-onset (7-90 days) serious bacterial infections (SBIs) in term infants has not been reported. The objectives of this study were to determine whether infants with late-onset SBI were more likely than healthy control infants to have been exposed to IPA and whether there was a greater likelihood of antibiotic resistance in bacteria that were isolated from infants who had an SBI and had been exposed to IPA compared with those who had not.

Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci in rural communities, western United States.

The impact and prevalence of antimicrobial drug resistance in rural community healthcare settings is uncertain. Prospective surveillance in 51 rural hospitals in Idaho and Utah examined the epidemiologic features of clinical cases of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Thirty-two cases of VRE were reported; for 6, the patient had no prior healthcare exposure or coexisting condition.