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Biomedical subjects

S M Kralovic

Publications and source records attributed to S M Kralovic.

8 recordsLinked to original sources
PubMed2003

Legionella in the veterans healthcare system: report of an eight-year survey.

The Veterans Health Administration (VHA) of the Department of Veterans Affairs tracks legionella disease in the system of 172 medical centres and additional outpatient clinics using an annual census for reporting. In fiscal year 1999, 3.62 million persons were served by the VHA. From fiscal year 1989-1999, multiple intense interventions were carried out to decrease the number of cases and case rates for legionella disease. From fiscal year 1992-1999, the number of community-acquired and healthcare-associated cases decreased in the VHA by 77 and 95.5% respectively (P = 0.005 and 0.01). Case rates also decreased significantly for community and healthcare-associated cases (P = 0.02 and 0.001, respectively), with the VHA healthcare-associated case rates decreasing at a greater rate than VHA community-acquired case rates (P = 0.02). Over the time of the review, the VHA case rates demonstrated a greater decrease compared to the case rates for the United States as a whole (P = 0.02). Continued surveillance, centrally defined strategies, and local implementation can have a positive outcome for prevention of disease in a large, decentralized healthcare system.

Female↗
PubMed2000

Tuberculosis in the veterans healthcare system: a six-year review and evaluation of programme effectiveness.

The Department of Veterans Affairs operates a large, centrally administered health care system consisting of 173 hospitals and 4 free standing outpatient clinics nationwide with approximately 945,115 hospital discharges, 24.2 million outpatient visits, and 2.86 million persons served annually over the time frame of the review. The purpose of the study was to define whether such a system could effect timely change in the incidence of tuberculosis (TB) using centralized programme planning and flexible field implementation. A retrospective review of the number of newly diagnosed cases of active TB treated at veterans health care facilities between 1 October 1990 and 30 September 1997 was determined by using a standardized annual case census. Intervention included implementation of the most current guidelines for the prevention of transmission of TB in the community and hospital setting, including administrative and engineering controls and a change in personal protective equipment. Centrally directed programme guidance, education, and funding were provided for field use in health care facilities of widely varying size and complexity. The numbers of total reported cases of TB decreased significantly (P < 0.001) throughout the veterans health care system (nationally and regionally), with the case rate decreasing at a rate significantly greater than that seen in the USA as a whole (P < 0.0001). TB associated with multi-drug resistance (isoniazid and rifampin) and HIV coinfection also significantly decreased over the study period. Therefore, a large, centrally administered health care system can effectively combat a re-emerging infectious disease and may also demonstrate a successful outcome greater than seen in other, perhaps less organized health care settings.

Delivery of Health Care↗
PubMed1999

A six-year epidemiologic review of pneumonia in Department of Veterans Affairs facilities.

OBJECTIVE: Pneumonia and acute lower respiratory infections are a major problem in the United States and worldwide. As one of the largest health care organizations in the United States, the Department of Veterans Affairs is an ideal location for an epidemiologic review of pneumonia over an extended period of time. METHODS: Data for this study were retrieved from the Department of Veterans Affairs Austin Automation Center, the central repository for patient data in the Veterans Health Administration (VHA). In addition, specific data regarding penicillin-resistant Streptococcus pneumoniae in VHA facilities were obtained from an annual electronic nationwide census. RESULTS: The case rate of pneumonias as a discharge diagnosis increased during the 6-year period. For the diagnosis group of bronchopneumonia and pneumonia with organism unspecified, the largest subset examined, total numbers and rates for this specific diagnosis increased during the study period. When fiscal year (FY)91 and FY96 were compared, rates increased for three diagnoses: overall pneumonia, pneumonia in infectious diseases classified elsewhere, and pneumococcal pneumonia. Decreases in rates occurred between FY91 and FY96 for pneumonia caused by other specified organisms and other bacterial pneumonia. The total number of discharges from VHA facilities decreased during the 6-year period. CONCLUSIONS: The numbers of episodes of bronchopneumonia and pneumonia with organism unspecified, the largest pneumonia subset, increased during the 6-year period to greater than 27,000 cases. As the number of total discharges from the VHA decreased, the combination of increasing actual numbers and decreasing discharges yielded increased rates for overall pneumonia and certain subsets. These data should be useful in developing aggressive preventive strategies.

Aged↗
PubMed1998

Utility of routine testing of bronchoalveolar lavage fluid for cryptococcal antigen.

All cryptococcal antigen (CrAg) testing performed at our institution between 1989 and 1994 was reviewed for utility of routinely testing of bronchoalveolar lavage fluid (BAL) for this antigen. Forty-two of 1,506 BAL specimens were positive. Seventeen of these were felt to represent false positives (sensitivity, 71%; positive predictive value, 0.59). The data on CrAg in cerebrospinal fluid and serum and the fungal culture and histological results of BAL specimens did not support continued, routine testing of BALs for CrAg to diagnose cryptococcosis.

Antigens, Fungal↗
PubMed1995

Phaeohyphomycosis caused by Dactylaria (human dactylariosis): report of a case with review of the literature.

Phaeohyphomycosis due to Dactylaria (Ochroconis) spp. is a rare infection of man. It was first reported in 1986. All patients have had significant immunosuppression. To our knowledge, this is the second case of phaeohyphomycosis caused by Dactylaria constricta var. gallopava in a liver transplant patient and it developed even though he had been receiving fungal prophylaxis with fluconazole. Moreover, this case may represent nosocomial acquisition. In addition, we have reviewed the English language literature of previously reported patients with phaeohyphomycosis caused by Dactylaria spp.

Amphotericin B↗