Variation in high-priority drug-drug interaction alerts across institutions and electronic health records.

Objective: The United States Office of the National Coordinator for Health Information Technology sponsored the development of a "high-priority" list of drug-drug interactions (DDIs) to be used for clinical decision support. We assessed current adoption of this list and current alerting practice for these DDIs with regard to alert implementation (presence or absence of an alert) and display (alert appearance as interruptive or passive).

Materials And Methods: We conducted evaluations of electronic health records (EHRs) at a convenience sample of health care organizations across the United States using a standardized testing protocol with simulated orders.

Development and field testing of a self-assessment guide for computer-based provider order entry.

Despite the benefits of computerized provider order entry (CPOE), numerous reports of unexpected CPOE-related safety concerns have surfaced. As part of a larger project to improve the safety of electronic health records (EHRs), we developed and field tested a CPOE "safety self-assessment" guide through literature searches, expert opinion, and site visits. We then conducted a field test of this guide with nine hospital chief medical informatics officers (CMIOs), who were identified through the Association of Medical Directors of Information Systems.

Bone cyst of a fishy origin: from an old catfish spine puncture wound to the foot.

A rare first metatarsal unicameral-type bone cyst with a deceptive radiographic appearance and size and an unusual pathological etiology was identified in a female patient. This eccentric cyst was observed only postoperatively by radiograph. Review of the patient's history documented a foot injury from a catfish spine as the etiology of this chronically inflamed cyst.

Salmonella Urosepsis Complicated by Metastatic osteomyelitis of the Chest Wall.

Although tens of thousands of Salmonella infections occur annually in this country, most involve the gastrointestinal tract with involvement of the urinary tract being quite infrequent.1-3 I would like to report a case of urosepsis due to Salmonella with eventual development of metastatic osteomyelitis of a rib that proved refractory to treatment. A 59-year-old Latin American male who resided in the Texas Rio Grande Valley presented to an emergency room with inability to void, having first noted a decreased urinary stream and dribbling a few months earlier.

Tricuspid valve group B streptococcal endocarditis following elective abortion.

Streptococcus agalactiae, a group B streptococcus, has been a well-known cause of postpartum and postabortion endocarditis since the preantibiotic era. Streptococcus agalactiae is capable of infecting normal valves and usually produces left-sided disease. We describe a 30-year-old woman who developed tricuspid valve endocarditis due to S.

Novel plasmid-mediated beta-lactamase in members of the family Enterobacteriaceae from Ohio.

Epidemiologic studies of plasmid-mediated resistance at the Cleveland Veterans Administration Medical Center revealed that related plasmids had disseminated among members of the family Enterobacteriaceae. We studied the beta-lactamases encoded by these plasmids in Escherichia coli C600 transformants or transconjugants. Substrate and inhibition profiles of the enzymes determined by two of these plasmids suggested an activity resembling TEM-1; however, isoelectric focusing revealed a pI of 7.

Intra-abdominal infections in the elderly: diagnosis and management.

With appendicitis, elderly patients commonly delay 2 or 3 days after symptoms begin before seeking medical attention, the patient often attributing the abdominal discomfort to indigestion, "gas," or constipation. Reduced gastric acidity secondary to gastric surgery, aging, or medications can increase susceptibility to many enteric pathogens, leading to a higher risk of infectious diarrhea.

Wangiella dermatitidis endocarditis in an intravenous drug user.

Wangiella dermatitidis is an infrequently encountered dematiacious fungus that usually causes localized infections of the skin and subcutaneous tissues. This report presents the first well-documented case of natural valve infection caused by this organism as it occurred in intravenous drug abuser. His course has been complicated by relapsing infection of two aortic prostheses and dissemination to the vertebral spine.

Infections due to Lancefield group G streptococci.

The group G streptococcus has surfaced in the past 10 to 15 years as an important opportunistic and nosocomial pathogen. Although more precise organism recognition accounts for a portion of these cases, there can be little doubt that the group G streptococcus has become a more prevalent pathogen. Commercial kits, utilizing staphylococcal coagglutination or latex agglutination, are now available, affording all clinical laboratories the opportunity to identify this organism easily.

Variability in DNA sequence of closely related nosocomial gentamicin-resistant plasmids.

Endemic gentamicin-resistant plasmids derived from 12 species of gram-negative bacilli were analyzed by restriction-endonuclease digestion. These digests showed wide variations in digest patterns, but one or more common fragments were seen in all plasmids studied. Southern blot analysis using one plasmid as a probe revealed that most but not all of these plasmids shared extensive regions of homology.