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Biomedical subjects

M D Nettleman

Publications and source records attributed to M D Nettleman.

At least 19 recordsLinked to original sources
PubMed1991

Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures.

Data from around the world verify the escalating incidence of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Since MRSA are spread primarily on the hands of health care workers, rates of infection are a function of infection control activities within institutions. Moreover, infections with MRSA are serious and often life-threatening. Thus, there are compelling medical and ethical reasons to invest in control measures. Currently available data suggest the efficacy of three measures: (a) identification of the entire patient reservoir (cases and carriers) for purposes of isolation; (b) strict handwashing between patients to prevent transmission; and (c) treatment of the carrier state in health care workers and patients during periods of high infection rates with safe and effective topical agents such as mupirocin.

Carrier State↗
PubMed1991

Assigning responsibility: using feedback to achieve sustained control of methicillin-resistant Staphylococcus aureus.

Sustained control of endemic methicillin-resistant Staphylococcus aureus (MRSA) originating from multiple sources has not been reported. We describe a simple, inexpensive program based on feedback to physicians that resulted in significant reduction of nosocomial MRSA. When nosocomial cases were identified, the epidemiologist contacted the team resident to encourage increased emphasis on hand washing. Handouts, periodic hand cultures of house staff, and monthly presentations at morning report were also employed. In the first 15 months, nosocomial MRSA decreased from 1.025 to 0.508 cases per 1,000 patient days (p less than 0.01). Monthly rates were significantly decreased for 9 months of 1989 and the first 2 months of 1990. Feedback and assignment of responsibility resulted in a 50% reduction in nosocomial MRSA that has been sustained for 15 months.

Cross Infection↗
PubMed1991

Cost and benefit of secondary prophylaxis for Pneumocystis carinii pneumonia.

OBJECTIVE: To determine the relative cost and benefit of aerosolized pentamidine and the combination product of sulfamethoxazole and trimethoprim sulfate as secondary prophylaxis for Pneumocystis carinii pneumonia. DESIGN: A Markov-based cost-benefit analysis was performed. Drug efficacies, toxicities, and mortality rates were drawn from the current literature. SETTING: Hypothetical. PATIENT POPULATION: Patients infected with the human immunodeficiency virus who had had at least one episode of P carinii pneumonia. INTERVENTIONS: Regimen 1 required the use of aerosolized pentamidine as the sole first-line prophylactic agent in all patients. Regimen 2 required the use of sulfamethoxazole-trimethoprim in all patients who had no history of a toxic reaction to the drug; only patients with a history of toxic effects and those who developed toxic effects while receiving the drug would receive aerosolized pentamidine. Regimen 3 required that no secondary prophylaxis be given. MAIN OUTCOME MEASURES: Net cost, median patient survival, and 5-year survival for each regimen and for regimens 1 and 2 compared with regimen 3. MAIN RESULTS: Regimen 2 was dominant, with a net cost of $6332 per patient and a median survival of 2.050 years. Compared with no prophylaxis, regimen 2 resulted in a savings of $16,503 per patient and a 0.696-year increase in median survival. Compared with regimen 1, regimen 2 resulted in a savings of $2904 and a 0.067-year increase in median survival. CONCLUSIONS: Secondary prophylaxis for P carinii saves money and extends survival. Current data suggest that sulfamethoxazole-trimethoprim should be given whenever it can be tolerated. Use of aerosolized pentamidine as a first-line agent would result in a modest increase in cost and a decrease in life expectancy.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Cost-effectiveness of prenatal testing for Chlamydia trachomatis.

We investigated the cost-effectiveness of strategies for screening pregnant women for Chlamydia trachomatis. Screening was not cost-effective unless certain conditions were met. Direct antigen testing of all pregnant women would be cost-effective if the test cost less than $6.30 or the prevalence of infection exceeded 6%. However, the positive predictive value of the test was only 51%. Culturing was not cost-effective until the prevalence of infection exceeded 14.8%. If a direct antigen test cost less than $3.90 or prevalence exceeded 8.7%, direct antigen testing of all women and using culture to confirm positive direct antigen tests would be cost-effective. If a direct antigen test cost $8.00 and culture cost $25.00, the excess cost of performing a direct antigen test in all women and confirming positive results with culture would be $2.09 per pregnant woman. Screening all pregnant women for chlamydia is not cost-effective, but the excess cost is modest when direct antigen tests are used.

Chlamydia Infections↗
PubMed1991

Amebiasis.

Explore the source record for details and available documents.

Amebicides↗
PubMed1991

Epidemiology of isolation precautions.

OBJECTIVE: To investigate compliance with isolation precautions. DESIGN: A prospective observational study carried out during ten weeks of 1989. Participants were unaware of the study. SETTING: The isolation bay of a 24-bed surgical intensive care unit in a 900-bed university tertiary care facility. PARTICIPANTS: Study participants included any healthcare worker or visitor entering the patient room during designated 15-minute intervals. RESULTS: We observed 467 subjects entering patient rooms. Compliance with strict isolation (65%) was better than with wound/skin (40%) or excretion/secretion (36%) isolation (p less than .01). Visitors were more compliant than healthcare workers (88% versus 41%; p less than .01). Spending more time in the room was associated with improved compliance (p less than .01). Compliance was higher for subjects entering with a group compared with those entering alone (51% versus 41%; p less than .05). The compliance rate for nurses improved as the nurse/patient ratio improved (p = .14). Compliance was independent of severity of illness. Multivariate analysis revealed that the amount of time spent in the room, being a visitor, and use of strict isolation were independent predictors of compliance. CONCLUSIONS: Noncompliance was widespread. When increased demands are placed on the time of physicians and nurses in the name of cost containment, unperceived consequences, such as those resulting from decreased compliance, must be considered.

Cooperative Behavior↗
PubMed1991

Biological warfare and infection control.

Though many agents have been proposed as potential biological weapons, the feasibility of biological warfare is largely a matter of conjecture. The unpredictable and indiscriminate devastation caused by natural epidemics during wartime should warn us of the dangers of employing microbes as weapons.

Anthrax↗
PubMed1991

Cholera, travel, and infection control.

The spread of cholera is a testimony to our inability to provide a consistently decent standard of living to the peoples of the world. Simply separating human sewage from potable water sources would curtail, if not eliminate, the disease. Even persons who acquire cholera would not die if they were given access to rehydration. American travelers should follow sensible food and water precautions, but need not curtail their travels to countries that have cholera.

Cholera↗
PubMed1990

Emporiatrics: diarrhea in travelers.

The degree of discomfort and inconvenience caused by travelers' diarrhea highlights the need to prepare the international traveler thoroughly. In addition to observing food and water precautions, most travelers should carry antibiotics and antimotility agents to be started if diarrhea occurs. Used judiciously, these precautions may prevent an unplanned tour of bathrooms and outhouses in foreign countries.

Bismuth↗
PubMed1990

Emporiatrics: the study of diseases in travelers.

Travel to developing countries is exhilarating and, for the most part, safe. However, the unwary traveler may encounter unexpected tropical diseases, many of which are preventable. Additionally, infected travelers may return with exotic diseases that pose special problems for ICPs.

Developing Countries↗
PubMed1990

Using decision analysis to assess the quality of quality assurance.

Quality assurance is rapidly encroaching on the fields of epidemiology and infection control. If we are to lead this most recent revolution in medical care, we must ensure that our approach is structured, that we reassess our goals and methods regularly and that we achieve the maximal benefit from the resources we consume. According to Colloton, "Unless refined or replaced, the unsophisticated methodologies now emerging on several fronts will be used, with or without our endorsement, to assess the quality of care rendered within all of medical practice."

Cost-Benefit Analysis↗
PubMed1990

Emporiatrics: protecting travelers from malaria.

Travelers to malarious areas of the world should take precautions against mosquito bites and take medications to prevent the disease. Chloroquine is the prophylactic agent of choice in areas where malaria remains sensitive. If no contraindications exist, mefloquine is recommended in areas where chloroquine resistance occurs. Alternative regimens would include doxycycline taken as the sole prophylactic agent, or weekly chloroquine with a treatment dose of Fansidar to be taken if symptoms compatible with malaria occur.

Adult↗
PubMed1990

Nosocomial infections: validation of surveillance and computer modeling to identify patients at risk.

To estimate the accuracy of routine hospital-wide surveillance for nosocomial infection, the authors performed a validation study at the University of Iowa Hospitals and Clinics, a 900-bed tertiary care institution, by daily concurrent surveys of all patients' charts. The study extended over a 10-month period from January to October 1987. The sensitivity and specificity of the reported data were 80.7% (95% confidence interval (CI) 72.2-89.2) and 97.5% (95% CI 96.4-98.5), respectively. The predictive values of positive or negative reports of an infection were 75.3% (95% CI 66.3-84.2) and 98.1% (95% CI 97.3-99.1), respectively. In a separate analysis, the data entry system was reviewed for eight descriptive variables among all patients with infections (n = 443) identified over a 2-month period. The data entry was found to be 94-99% accurate. To improve the efficiency of current surveillance, the authors used data gathered during the study to develop a computer model for the identification of patients with a high probability of having a nosocomial infection. The use of stepwise logistic regression identified five variables which independently predicted infection: age of the patient (years), days of antibiotics, days of hospitalization, and the number of days on which urine and/or wound cultures were obtained. Optimal sensitivity and specificity (81.6% and 72.5%, respectively) were found when the model examined patients with an 8% or higher a priori probability of infection; this figure corresponded to a review of 33% of the patients' charts. Increasing the a priori probability would progressively increase specificity and reduce both sensitivity and the number of charts needed for review. If it is prospectively validated, the model may provide a more efficient mechanism by which to conduct hospital-wide surveillance.

Age Factors↗