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Biomedical subjects

C H Alexander

Publications and source records attributed to C H Alexander.

4 recordsLinked to original sources
PubMed1995

Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later.

OBJECTIVE: To investigate the cause of increasing rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection at a university hospital. DESIGN: Review of data collected by prospective hospital wide surveillance regarding rates of nosocomial MRSA colonization and infection. SETTING: A 700-bed university hospital providing primary and tertiary care. PATIENTS: Patients admitted to the hospital between 1986 and 1993 who were found to be infected or colonized with MRSA. MAIN OUTCOME MEASUREMENT: Rates of MRSA infection and colonization. RESULTS: MRSA infection or colonization was identified in 399 patients (0.18%) admitted during the 8-year study. There was no correlation between the annual rates of MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infections (P = .66). The frequency of both nosocomial and non-nosocomial cases increased significantly over the last 4 years of the study (P < .001 for trend). The ratio of patients who had acquired MRSA nosocomially to those admitted who already were infected or colonized decreased significantly during the study period (P = .002 for trend). There was a significant increase in the frequency of patients with MRSA being transferred from nursing homes and other chronic care facilities (P = .011). A cost-benefit analysis suggested that surveillance cultures of patients transferred from other healthcare facilities would save between $20,062 and $462,067 and prevent from 8 to 41 nosocomial infections. CONCLUSIONS: An increase in the incidence of nosocomial MRSA infection was associated with an increased frequency of transfer of colonized patients from nursing homes and other hospitals. The lack of correlation between rates of MRSA and MSSA infections suggested that MRSA infections significantly increased the overall rate of staphylococcal infection. Screening cultures of transfer patients from facilities with a high prevalence of MRSA may offer significant benefit by preventing nosocomial infections and reducing patient days spent in isolation.

Cost-Benefit Analysis↗
PubMed1982

Fetal monitoring in a community hospital: analysis of health maintenance organization, fee-for-service, and clinic populations.

This paper was a review of 2,210 deliveries in a community hospital in which electronic fetal monitoring was used. Patients were evaluated from three different types of group practices-health maintenance organization, fee-for-service, and clinic populations. Electronic fetal monitoring was used in 48%, 41%, and 70% of these groups, respectively. The respective cesarean section rates were 13%, 20%, and 10%. Monitored and nonmonitored, high- and low-risk groups were identified. A higher cesarean section rate for cephalopelvic disproportion was found in the monitored groups. However, this difference was most marked in the fee-for-service group. Perinatal morbidity and mortality results did not differ significantly among the three groups despite differences in electronic fetal monitoring use and cesarean section rates. The use of electronic fetal monitoring did not correlate with the cesarean section rate. Reasonable perinatal morbidity and mortality are compatible with relatively high electronic fetal monitoring rates (70%) and low cesarean section rates (10%). Within certain groups, use of electronic fetal monitoring may increase the cesarean section rate because of an increased diagnosis of cephalopelvic disproportion.

Attitude of Health Personnel↗