Biomedical subjects
E Larson
Publications and source records attributed to E Larson.
Using the CURN Project to teach research utilization in a baccalaureate program.
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Innovations in health care: antisepsis as a case study.
An innovation often occurs in several arenas almost simultaneously, after being preceded by a long preparatory period when information and experience are accrued to the point at which opinion is influenced to change. Nevertheless, the introduction of an innovation is usually accompanied by resistance and hostility. This article traces the development of the concept and practice of antisepsis in health care, with emphasis on the contributions of three individuals who were contemporaries practicing in different health care fields, but who apparently were uninfluenced by each others' work. Semmelweis, a Hungarian obstetrician, recognized the importance of person-to-person transmission of infectious agents and effected dramatic reductions in puerperal mortality by requiring antiseptic handwashing. Lister, a Scottish surgeon, was the first physician to apply the germ theory to clinical practice and developed the techniques of antiseptic surgery and wound care, resulting in dramatic reductions in surgical mortality. Nightingale, a British nurse, initiated sanitary reforms in hospitals, schools, and military camps in England and abroad, incorporating high levels of environmental and personal hygiene. These reforms were also succeeded by dramatic reductions in mortality. In light of historical and current evidence of efficacy and the evidence of continued inadequacies in practice, it seems reasonable to speculate that further reductions in nosocomial infection rates are possible by a more careful application among individual practitioners of the basic principles of antisepsis.
Case 1. Postnatally acquired cytomegalovirus hepatitis.
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Case 7. Clear cell sarcoma of kidney.
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From process to outcome in infection control.
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Maintaining quality in clinical research and evaluation: when corrective action is necessary.
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Comparison of normal versus heparinized saline for flushing infusion devices.
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Handwashing: it's essential--even when you use gloves.
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Validating the certification process for infection control practice.
Approximately 5 years ago a task analysis was conducted by the Certification Board of Infection Control (CBIC) to describe infection control practice. This task analysis served as the basis for development of the certification examination. This article describes the process used to update and revalidate the original task analysis to ensure the continued validity and job relatedness of the certification process. Using a modified Delphi technique, several panels of representative expert infection control practitioners (ICPs), a total of 29 persons, participated in an iterative process to define the practice dimensions of infection control and to link these practice dimensions to the certification examination. In general, there was a high level of congruence between respondents on the original task analysis and the expert panels, although a few differences in practice were identified among ICPs in extended care facilities and a few new tasks were identified. In addition, a revised content outline for the examination was created by placing clusters of knowledge statements together around common themes.
Guideline for use of topical antimicrobial agents.
This Guideline is based on published data available at the time of writing. The ideal means for comparing performance of various antimicrobial agents is through the conduct of carefully designed, large-scale clinical trials. Recommendations contained in this Guideline are subject to modification as additional data become available. It particularly should be noted that the implementation of universal precautions or body substance isolation has resulted in marked increase in the use of gloves for direct patient contact. Whether there is an additional cost-benefit rationale for handwashing with an antimicrobial agent remains to be studied.
Postdoctoral nursing education in infection control: program description.
The need to identify and evaluate those clinical practices that are efficacious in reducing risk of nosocomial infection is clear. A model of large-scale programmatic evaluation is the Study of the Efficacy of Nosocomial Infection Control. Other important clinical studies have demonstrated the effectiveness of practices such as closed urinary drainage and management of intravascular lines and the ineffectiveness of such practices as double bagging and routine gowning in the newborn nursery. Clearly, research is one essential way to direct practice in infection control. It is our goal that the Johnson & Johnson/SURGIKOS Postdoctoral Nursing Fellows in Infection Control will make a significant contribution to the knowledge base in the specialty. The need for collaboration by government, industry, and academia in addressing health care research needs has been recently emphasized. We also believe that this Program can serve as one model for such a collaborative effort.
Description of case-mix adjusters by the Severity of Illness Working Group of the Society of Hospital Epidemiologists of America (SHEA).
Hospitals, insurance companies, and federal and state governments are increasingly concerned about reducing patient cost expenditures while maintaining high quality patient care. One method of reducing expenditures has been to tie hospital reimbursement with a prospective payment system based on diagnosis-related groups (DRGs). However, reimbursement under the DRG system is not acceptable for all patients in all hospitals because it is neither an accurate predictor of costs nor of clinical outcome. This deficiency poses significant problems for hospitals because DRGs are used nationwide as the prospective payment system for inpatients covered by Medicare. Several case-mix adjusters have been proposed to modify DRGs to improve their accuracy in predicting costs and outcome. We reviewed five of the most widely available indices: Acute Physiologic and Chronic Health Evaluation (APACHE II), Coded Disease Staging, Computerized Severity Index (CSI), Medical Illness Severity Group System (MEDISGROUPS), and Patient Management Categories (PMC). Recommendations for the use of a single case-mix adjuster cannot be made at this time because all indices have not been compared in sufficiently diverse settings and because some are better predictors of costs while others are better predictors of clinical outcome. Hospital epidemiologists and other infection control practitioners should be informed about these indices and their potential applications as they expand their role beyond infection control problems to issues concerning cost containment, quality assurance, and reimbursement.
Nosocomial infection rates as an indicator of quality.
An interest in using nosocomial infection rates as an outcome measure to reflect quality of care in hospitals prompted us to consider factors in addition to quality that influence these rates. Approximately one third of nosocomial infections are potentially preventable, and changes in this "preventable" stratum of infections should reflect variations in quality. However, it will be necessary to identify those potentially preventable infections by calculating rates which are adjusted for intrinsic patient risk. Five other factors necessary for nosocomial infection rates to be a valid and reliable indicator of quality include identification of critical indicators (e.g., types of infection) and sampling schemes that most accurately reflect variations in quality; adoption of standardized, objective definitions of site-specific nosocomial infections; adoption of universal denominators across institutions; development of a monitoring system to assess compliance with surveillance and reporting procedures; and the adoption of more standardized training for infection control practitioners.
Excess disability in demented elderly outpatients. The rule of halves.
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Vero toxin producing E coli in haemorrhagic colitis.
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A causal link between handwashing and risk of infection? Examination of the evidence.
To examine evidence of a causal link between handwashing and risk of infection, a review of published literature from 1879 through 1986 was conducted. In the 107 years studied, 423 articles specifically related to handwashing were found. Articles were categorized as studies to evaluate products (50.8%), review articles (29.1%), behavioral studies (10.9%), methodologic studies (2.8%), studies linking handwashing to infection (3.3%), and other (3.1%). There was an increase in the proportion of handwashing articles published in the 1980s with the rate (9.4/10(5) citations/year) being almost double that of any other period studied. Nonexperimental and experimental studies related to handwashing were reviewed and evidence for a causal association evaluated. Except for specificity, all the elements for causality, including temporality, strength, plausibility, consistency of the association, and dose response were present. It was therefore concluded that emphasis on handwashing as a primary infection control measure has not been misplaced and should continue.
The infection control practitioner as investigator of clinical phenomena.
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