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At least 145 records · Page 8Linked to original sources
PubMed1995

Inability of human sperm to change their orientation in response to external chemical stimuli.

OBJECTIVE: To investigate whether human sperm can respond to external chemical stimuli by orienting themselves toward chemoattractants or withdrawing from hostile environments. DESIGN: Controlled laboratory assays. SETTING: Normal human sperm and two other flagellated micro-organisms were exposed to various potential chemoattractant or chemorepellent substances. INTERVENTION: Human sperm, Euglena viridis, and Escherichia coli were exposed to various substances from the female reproductive system or to various toxic agents by placing them within tiny wells in a sealed minichamber. They were followed by microscopic observation and by intermittent photography. MAIN OUTCOME MEASURE: Images of photographed micro-organisms were analyzed for signs of attraction to or withdrawal from the test substances. RESULTS: Human sperm neither changed their orientation toward nor accumulated next to the well that contained cervical mucus, uterine cavity and follicular fluid, cumulus cells, or intact nonfertilized human eggs. Contrary to other micro-organisms that turned away from sources of hydrochloric acid, sodium hydroxide, ethanol, or glutaraldehyde, human sperm did not withdraw from these solutions. They swam along the ascending chemical gradient, facing ahead while becoming immobilized by these agents. CONCLUSION: It may be implied from the observation that they did not turn away from a hostile environment when expected to do so or turn toward chemoattractants that human sperm do not respond to external chemical stimuli and, most probably, chemotaxis between human sperm and ova in nature does not exist.

Animals↗
PubMed2002

Pathogenic agents of chronic suppurative otitis media in Ilorin, Nigeria.

OBJECTIVE: To determine the type and pattern of antibiotic susceptibility of the pathogenic micro-organisms causing chronic suppurative otitis media (CSOM) in our environment. DESIGN: A retrospective study of ear discharges from patients presenting consecutively with chronic suppurative otitis media. SETTINGS: University of Ilorin Teaching Hospital, a major referral centre in the Middle Belt region of Nigeria. MAIN OUTCOME MEASURES: Bacterial isolates and their sensitivity patterns. SUBJECTS: Three hundred and seventy five patients aged between eight months and 70 years referred to the ear, nose, and throat clinic of The University of Ilorin Teaching Hospital were enrolled in the study. RESULTS: About 95.5% and 4.5% of the specimens were culture positive and negative respectively. The commonest bacterial aetiologic agents were Pseudomonas aeruginosa (26.0%) and Proteus spp (21.8%). Peak prevalence of 30.5% occurred among the 0-5 years age group. Seventy five per cent of isolates were gram-negative bacteria. Ofloxacin produced 100% sensitivity in both gram positive and gram-negative organisms tested. Colistin, ceftazidime and cefuroxime were highly active (80%) against the gram-negative bacteria while erythromycin and cloxacillin were very effective (80%) against the gram-positive isolates. CONCLUSION: Chronic suppurative otitis media is still highly prevalent in our environment, affecting mainly children. The antibiotic susceptibility pattern of pathogenic isolates is different from those of other regions of Nigeria with increasing resistance recorded for some organisms. Hence, where possible and available, susceptibility tests should guide the management of CSOM in this environment, otherwise, ofloxacin if indicated and cloxacillin/erythromycin may provide relief and delay emergence of resistant strains.

Adolescent↗
PubMed1992

[Origin and distribution of seasonal allergies. A primary care view].

OBJECTIVE: To describe the seasonal allergy distribution and its relation with grass pollen in environment. DESIGN: Ecological and descriptive study. SITE. Primary care centre in townshipe Coslada (Madrid). PATIENTS OR OTHER PARTICIPANT: People who are attended because of seasonal allergy from 20th April to 14th June in 1990 and 1991, of the total people covered by a primary care team. MAIN MEASUREMENTS AND RESULTS: No differences were found in relation to sex. 5-19 age group cumulated 66.1 and 61.2% of the episodes in 1990 and 1991 respectively. 36.2 and 31% (1990-1991) described respiratory difficulties and 21.5 and 18.8% respiratory wheezings. 82.7 and 88.4% of patients asserted that the symptoms repeated annually. Patients who related known allergy, 91.8 and 98.3% attributed their problems to grass pollen. Correlations of r = 0.5207 (p < 0.001) in 1990 and r = 0.4978 (p < 0.01) in 1991 between grass pollen the day before and the notification date were found. CONCLUSIONS: We found the highest care assistance in the infant-juvenile age group, the same as an important number of cases with asthmatic symptomatology. We seen a moderate relationship between the episodes notification date and grass pollen in the environment.

Adolescent↗
PubMed2002

An advanced computer-aided geometric modeling and fabrication method for human middle ear.

This paper presents a practical and systematic method for reconstructing accurate computer and physical models of the entire human middle ear. The proposed method starts with the histological section preparation of human temporal bone. Through tracing outlines of the middle ear components on the sections, a set of discrete points is obtained and employed to construct B-spline curves that represent the exterior contours of the components using a curve-fitting technique. The surface-skinning technique is then employed to quilt the B-spline curves for smooth boundary surfaces of the middle ear components using B-spline surfaces. The solid models of the middle ear components are constructed using these surfaces and then assembled to create the entire middle ear in a computer-aided design environment. This method not only provides an effective way to visualize and measure the three-dimensional structure of the middle ear, but also provides a detailed knowledge of middle ear geometry that is required for finite element analysis or multibody dynamic analysis of the human middle ear. In addition, the geometric model constructed using the proposed method is smooth and can be fabricated in various scales using solid freeform fabrication technology. The physical model of the human middle ear is extremely effective in realizing the middle ear anatomy and enhancing discussion and collaboration among researchers and physicians.

Anatomy, Cross-Sectional↗
PubMed1992

[Sarcoidosis: retrospective analysis of 14 cases].

OBJECTIVE: A clinical evaluation of Sarcoidosis in our environment. DESIGN: A retrospective and descriptive analysis of 14 cases encountered between 1988 and 1990. SITE. In-hospital patients studied within a catchment area of 200,000 people. PATIENTS AND OTHERS PARTICIPANTS: 13 women and 1 man ranging in age from 24 to 63 (X = 37. DS 13). All of them were confirmed histologically. MAIN MEASUREMENTS AND RESULTS: Six patients received V.O. steroid treatment. 28.5% started as Nodose Erythema, 28.5% as Respiratory Syndrome, 21% as general Toxic Syndrome. 35% were without clinical symptoms; 25% Arthralgias, 21% cough. Thoracic X-ray with bilateral hiliar adenopathies 78%; interstitial pattern 28.5%. Analytically, Monocitosis was presented in 43%; Anaemia, Hypergammaglobulinemia, rise in Transaminases in 35%; a normal ACE in 50% and raised ACE in 35%. There was a positive pulmonary Cammagraphy (Galio) in 50%. Diagnostic confirmation was made by means of transbronchial B (28%), Mediastinoscopy (14%), open Pulmonary B. (14%), Hepatic B (14%), osseous B. and Daniels (14%) and peripheric adenopathy B (14%). Pulmonary circulatory capacity (DLCO-KCO) was decreased in 3 cases. Statistic 1, 71%; 11, 14%, 111, 14%. CONCLUSIONS: Sarcoidosis is not so rare in our environment as had been thought. Factors such as a Northerly geographical situation, low temperatures, the long duration of the disease, improvement in diagnostic methods and a high level of awareness have all influenced this high number of cases found in an area of 200,000 inhabitants. The disease's clinical behaviour in our environment does not differ from that described by other spanish and foreign authors.

Adult↗
PubMed2005

Soft drinks, candy, and fast food: what parents and teachers think about the middle school food environment.

OBJECTIVE: To assess the opinions and beliefs of parents and teachers of middle school students regarding the school food environment. DESIGN: Surveys mailed to parents and placed in teachers' school mailboxes included questions about adolescents' eating practices, food choice at school, and school-related food policies and practices. SUBJECTS/SETTINGS: A convenience sample of parents (n=350; response rate: 350/526=66%) and teachers (n=490; response rate: 490/701=70%) of middle school students from 16 schools in the St Paul-Minneapolis metropolitan area who participated in the Teens Eating for Energy and Nutrition at School study. STATISTICAL ANALYSIS: Descriptive statistics examined the prevalence of parents' and teachers' opinions and beliefs about adolescents' eating practices, food choice at school, and school-related food policies and practices. RESULTS: Most parents and teachers agreed that the nutritional health of students should be a school priority. However, only 18% of parents and 31% of teachers believed schools give adequate attention to student nutrition. Among both parents and teachers, 90% agreed that more healthy snacks and beverages should be available in school vending machines and on school a la carte lines. CONCLUSIONS: Findings suggest that parents and teachers are concerned about the nutritional health of students and the "state of health" of the school food environment. Dietetic and other health professionals who work in school settings should actively engage parents and teachers in the process of affecting and monitoring policies and practices that foster a healthy school food environment.

Adolescent↗
PubMed2004

A Comparison of Thermoregulation With Creatine Supplementation Between the Sexes in a Thermoneutral Environment.

OBJECTIVE: To compare the effect of creatine supplementation on thermoregulation in males and females during exercise in a thermoneutral environment. DESIGN AND SETTING: Male and female subjects participated in 30 minutes of cycle ergometry in nonsupplemented (NS) and creatine-supplemented (Cr) conditions at 70% to 75% of predetermined peak oxygen consumption. SUBJECTS: Ten male and ten female subjects were evaluated with and without creatine supplementation. MEASUREMENTS: Analyses were performed during exercise for core temperature and mean skin temperature using two 2 x 2 x 7 mixed-factorial analyses of variance (ANOVAs). We compared mean differences between NS and Cr conditions and sex for heart rate, systolic blood pressure, and diastolic blood pressure using 3 2 x 2 x 4 mixed-factorial ANOVAs. Three 2 x 2 mixed-factorial ANOVAs were computed to examine differences between sex and conditions for the following variables: nude body weight and blood urea nitrogen before and after exercise and urine specific gravity. RESULTS: Significant time effects were found for core temperature, skin temperature, heart rate, and diastolic blood pressure. Time effect and difference between the sexes for systolic blood pressure were both significant. Differences in nude body weight and blood urea nitrogen before and after exercise were greater for males, but there was no difference between conditions. No significant difference between sex and condition for urine specific gravity was noted. CONCLUSIONS: Short-term creatine supplementation did not affect thermoregulation between the sexes when exercising in a thermoneutral environment. Differences in changes in nude body weight before and after exercise may be due to a higher sweating rate in males versus females. Differences in blood urea nitrogen before and after exercise between the sexes may be due to a reduced glomerular filtration rate coupled with greater muscle creatine breakdown in males.

Journal Article↗
PubMed2000

Sheltered versus nonsheltered homeless women differences in health, behavior, victimization, and utilization of care.

OBJECTIVE: To contrast sociodemographic characteristics, physical and mental health status, substance use, sexual behaviors, victimization, and utilization of health services between homeless women residing in sheltered and non-sheltered environments. DESIGN: Cross-sectional survey. A structured scale was used to measure mental health status. Physical health status, substance use, sexual behavior, history of adult victimization, and health services utilization were measured by content-specific items. SETTING: Shelters (N = 47) and outdoor locations in Los Angeles. PARTICIPANTS: One thousand fifty-one homeless women. RESULTS: Homeless women living on the streets were more likely than sheltered women to be white and longer-term homeless. Controlling for sociodemographic characteristics, multiple logistic regression analyses revealed that unsheltered women had over 3 times greater odds of fair or poor physical health, and over 12 times greater odds of poor mental health than sheltered homeless women. They were also more likely than sheltered women to report using alcohol or noninjection drugs, to have multiple sexual partners, and to have a history of physical assault. About half of the overall sample reported utilization of a variety of health services; however, unsheltered homeless women were less likely to utilize all of the health services that were assessed, including drug treatment. CONCLUSIONS: There is a critical need for aggressive outreach programs that provide mental health services and substance abuse treatment for homeless women on the streets. Comprehensive services that also include medical care, family planning, violence prevention, and behavioral risk reduction may be particularly valuable for homeless women, especially those living in unsheltered environments.

Adult↗
PubMed2003

Activity of three disinfectants and acidified nitrite against Clostridium difficile spores.

OBJECTIVE: To identify environmentally safe, rapidly acting agents for killing spores of Clostridium difficile in the hospital environment. DESIGN: Three classic disinfectants (2% glutaraldehyde, 1.6% peracetyl ions, and 70% isopropanol) and acidified nitrite were compared for activity against C. difficile spores. Four strains of C. difficile belonging to different serogroups were tested using a dilution-neutralization method according to preliminary European Standard prEN 14347. For peracetyl ions and acidified nitrite, the subjective cleaning effect and the sporicidal activity was also tested in the presence of organic load. RESULTS: Peracetyl ions were highly sporicidal and yielded a minimum 4 log10 reduction of germinating spores already at short exposure times, independent of organic load conditions. Isopropanol 70% showed low or no inactivation at all exposure times, whereas glutaraldehyde and acidified nitrite each resulted in an increasing inactivation factor (IF) over time, from an IF greater than 1.4 at 5 minutes of exposure time to greater than 4.1 at 30 minutes. Soiling conditions did not influence the effect of acidified nitrite. There was no difference in the IF among the 4 strains tested for any of the investigated agents. Acidified nitrite demonstrated a good subjective cleaning effect and peracetyl ions demonstrated a satisfactory effect. CONCLUSIONS: Cidal activity was shown against C. difficile spores by glutaraldehyde, peracetyl ions, and acidified nitrite. As acidified nitrite and peracetyl ions are considered to be environmentally safe chemicals, these agents seem well suited for the disinfection of C. difficile spores in the hospital environment.

Clostridioides difficile↗
PubMed2006

Impact of wearing an intra-oral lubricating device on oral health in dry mouth patients.

OBJECTIVE: To establish whether an intra-oral lubricating device for dry mouth alters the oral environment. DESIGN: A single-blind randomized cross-over study. METHOD: Twenty-nine dentate subjects from the Sjogren's syndrome clinic attended on five occasions at 4-week intervals. They were randomized, having the device fitted on either the second or the fourth visit for the experimental period, whilst using their preferred method of lubrication throughout the rest of the study. The preferred methods of lubrication were either water (group 1, n = 10) or saliva substitute (group 2, n = 9) or sugar-free chewing gum (group 3, n = 10). At each visit microbiological, unstimulated and stimulated saliva samples were collected. Dry mouth score, speech test and periodontal indices were recorded. RESULTS: The water lubrication group (1) had a resting salivary flow greater than lubrication groups (2 and 3) by post-ANOVA contrasts (P < 0.001). The postdevice data also demonstrated a salivary flow greater than lubrication group (3) by post-ANOVA contrasts (P < 0.05). The epithelial cell count using the Spearman correlation was high, possibly reflecting increased viscosity of the saliva (P = 0.044). The speech test indicated that the experimental subjects had difficulty in speaking (P = 0.001). This was slightly easier postdevice wear. Streptococcus mutans (P = 0.009) and Lactobacillus (P = 0.058) increased in the saliva after wearing the device. Salivary flow rate, Candida albicans, oral dryness, speaking and periodontal indices were unchanged. CONCLUSIONS: The oral environment was altered by wearing a lubricating device with an increase in the numbers of Strep. mutans and Lactobacillus. Clinical dryness and speech test correlated with the mean whole salivary flow suggesting a screening method for xerostomia.

Adult↗
PubMedDate not supplied

Community pharmacists' work environments: evidence from the 2004 National Pharmacist Workforce Study.

OBJECTIVES: To describe characteristics of community pharmacists' current practice environments and pharmacists perceptions' about aspects of their work environments. DESIGN: Cross-sectional study. SETTING: Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies) in the United States. PARTICIPANTS: 1,564 actively practicing pharmacists. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists. MAIN OUTCOME MEASURES: Hours the pharmacy was open; staffing; workload, perceptions of workload, and impact of the current workload on them and their work; equipment and technology available and used; and impact of equipment and technology at the practice site. Responses were compared with those from the 2000 National Pharmacist Workforce Survey. RESULTS: Hours of operation varied across practice settings in 2004 and were similar to those reported in 2000. Pharmacist and technician staffing varied somewhat across settings, but overall pharmacists were working with more technicians in 2004 compared with 2000. The number of prescriptions personally dispensed daily (personal workload) increased for pharmacists in all practice settings from 2000 to 2004. When pharmacists reported the impact of their current workload, motivation to work at the pharmacy and job satisfaction were rated most positive, and opportunity to take adequate breaks were rated most negative. Equipment used for facilitating the dispensing process was more common in pharmacies than equipment related to patient care activities. More than one half of pharmacists reported that equipment and technology increased their level of productivity, quality of care, financial performance, and job satisfaction in the pharmacy. CONCLUSION: Pharmacists' work environments tend to be oriented toward traditional dispensing roles and activities. Staff, equipment, and information technology resources are available to facilitate both dispensing and patient care activities, and these resources have increased productivity, quality of care, and pharmacists' satisfaction.

Community Pharmacy Services↗
PubMed1999

Computer-aided craniofacial surgical planning implemented in CAD software.

Accurate presurgical planning is imperative for successful cranial surgery. This article introduces a simulation program developed in a computer-aided design environment. The neurocranium is introduced as a mathematical surface, since this is the part on which the actual operation will be performed. The viscerocranium, which serves as reference, is visualized using small triangular surfaces. The development of the program commenced with a classification of the different surgical techniques mentioned in the literature into six basic actions. The use of mathematically described surfaces has the advantage that the program can simulate actions which change the shape of a surface and perform an on-line estimation of the fracture risk during bending. Three-point bending tests were carried out to provide the necessary data to perform the mathematical check, as these data are not available in the literature. A database with reference distances was introduced to guide the surgeon to obtain the best possible results. During one clinical trial, the computer was taken into the operating room so that the surgical plan developed with the simulation program could be applied to the actual operation.

Brain↗
PubMed2005

Occupational stress, job satisfaction, and working environment among Icelandic nurses: a cross-sectional questionnaire survey.

BACKGROUND: Nurses' occupational stress decreases job satisfaction, increases turnover rate, and reduces nursing quality. At different workplaces nurses are confronted with different work tasks, working conditions and hence different sources of stress. OBJECTIVES: The purpose of this study was to explore what factors contribute to work-related stress among Icelandic nurses working within and outside the hospital environment. DESIGN: The study used a cross-sectional survey design. SETTINGS AND PARTICIPANTS: The study population was composed of all working nurses registered at the Icelandic Nurses' Association (INA). Approximately 95% (N=2,234) of Icelandic nurses are members of the INA. Questionnaires were posted to 522 (23.4%) randomly selected participants. The response rate was 42% (N=219), representing 9.8% of the population. Data was analyzed from 206 nurses; 35% worked outside the hospital setting and 65% were hospital based. METHODS: Data was gathered on demographic information and indicators of working conditions, occupational stress, workload, and job satisfaction. A stepwise, multiple linear regression model was employed to calculate significant predictors of occupational stress. RESULTS: The findings suggest that the strenuous conditions of Icelandic nurses are felt more severely among hospital nurses than among nurses working outside hospital settings. The study identified which sources of occupational stress are specific to each of the two groups. CONCLUSIONS: The study found several factors that contribute to work-related stress. These findings can be used to guide preventive measures to diminish occupational stress among Icelandic nurses.

Absenteeism↗
PubMed2004

Intussusception in children seen at Muhimbili National Hospital, Dar es Salaam.

OBJECTIVE: To review infants and children with intussusception and assess its magnitude of concern and any seasonal variation in our environment. DESIGN: A retrospective study. SETTING: Muhimbili National Hospital general paediatric and surgical wards from January 2000 to February 2004. METHODOLOGY: The charts of all infants and children up to the age of 10 years diagnosed to have intussusception were reviewed. Demographic factors evaluated included age, incidence in up to one-year olds, sex, month of presentation to assess seasonal variation, clinical features, methods of diagnosis and management, aetiology and any recurrence. RESULTS: Twenty eight children were diagnosed to have intussusception. Sixteen were males and 12 females (M:F=l .3:1). Of these, 21(75%) were infants (up to the age of one year), nine were boys and 12 were girls( M.F=l:1.3). Incidence rate in this age group was approximately 1: 7557. Most cases presented in January-March(39.3%) and July to September(39.3%). No case was seen in the month of April during the 4-year period. Except in 2002, there has been a male preponderance. The aetiology was mainly idiopathic (85.7%), there were three cases suspected to be due to mesenteric adenitis and one case of intraluminal haemangioma. There were two recurrent cases, one was within a week with no known aetiology. All patients presented with vomiting and abdominal pain/distension. Preceding gastro-enteritis was common. The majority of the cases, 17(60.7%) presented with the classic triad of vomiting, rectal bleeding and abdominal pain/distension. Abdominal mass was often difficult to palpate due to gross or tense abdomen and was only palpated in four cases(14.3%). Air or barium reduction is not done at our institution due to apart from lack of facilities, majority of the children present late, >48 hours from the onset of symptoms and diagnosis was mainly based on clinical symptoms and signs of intestinal obstruction and confirmed with presence of multiple fluid levels on a plain erect abdominal X-ray. All children were then managed by surgery, 11(39.3%) underwent bowel resection. Histopathology reports of those available did not show cause of intussusception. Seven patients died postoperatively, hospital mortality of 25%. CONCLUSION: The approximate incidence of intussusception in less than one-year olds is 1:7557 in Dar es Salaam. It is a concern in our environment causing considerable morbidity and mortality due to late presentation and efforts should be made to improve sanitation and hygiene, referring health facilities, socio-economic factors and probably look into ways of preventing the problem occurring. Seasonal variation was seen, most cases(78.6%) presenting in the dry season when there is shortage of water in the city.

Child↗
PubMed1996

Sterility of filgrastim (G-CSF) in syringes.

OBJECTIVE: To determine if the sterility of filgrastim (G-CSF) is maintained for up to 7 days when aseptically transferred from the vial to tuberculin syringes in a laminar air flow environment. DESIGN: The study was conducted in two phases: a validation and an experimental phase. The method was validated by inoculating samples of sterile filgrastim solution with common bacterial and fungal skin contaminants. Samples were aseptically drawn into syringes in a class 100 horizontal laminar air flow hood and refrigerated. The samples were equally divided and transferred to microbiology culture media at times 0, 24 hours, 48 hours, and 7 days; incubated; and the organisms identified and quantitated. In the experimental phase, samples of filgrastim were aseptically drawn into syringes, separated into three groups, and refrigerated. At 24 hours, 48 hours, and 7 days, the samples were transferred to broth, incubated, and observed for the development of turbidity. SETTING: A class 100 laminar air flow hood in a pediatric hospital pharmacy and a home-infusion pharmacy class 100,000 clean room. MAIN OUTCOME MEASURES: The sterility of filgrastim in syringes was determined by comparing experimental broth culture tubes to a control tube and observing for the development of turbidity. RESULTS: Filgrastim demonstrated the ability to support the growth of intentionally inoculated skin contaminants, both qualitatively and quantitatively. However, when aseptically transferred to syringes and refrigerated, all tested filgrastim samples remained sterile for at least 7 days. CONCLUSIONS: Syringes of filgrastim remain sterile for 7 days when prepared in a class 100 laminar air flow hood, using aseptic technique, and stored under refrigeration. This change in practice can result in significant cost savings.

Drug Contamination↗
PubMed1999

Review of hazards associated with children placed in adult beds.

OBJECTIVES: To identify and assess dangers associated with placing children younger than 2 years to sleep in adult beds. This article focuses on overlying, wedging, and strangulation hazards and the relationship of these hazards to children's sleeping environments. DESIGN: A retrospective review and analysis of data collected by the US Consumer Product Safety Commission on deaths of children younger than 2 years in standard adult beds, daybeds, and waterbeds. The review included incident data from January 1990 through December 1997. RESULTS: The 8-year records showed a total of 515 deaths of children younger than 2 years who were placed to sleep on adult beds. Of these deaths, 121 were reported to be due to overlying of the child by a parent, other adult, or sibling sleeping in bed with the child and 394 were due to entrapment in the bed structure. Most of these deaths seem to have resulted from suffocation or strangulation caused by entrapment of the child's head in various structures of the bed. CONCLUSIONS: Placing children younger than 2 years to sleep in adult beds exposes them to potentially fatal hazards that are generally not recognized by the parent or caregiver. These hazards include overlying by a parent, sibling, or other adult sharing the bed; entrapment or wedging of the child between the mattress and another object; head entrapment in bed railings; and suffocation on waterbeds. Parents and caregivers should be alerted to these avoidable hazards.

Adult↗
PubMed1994

A decade of reduced gram-negative infections and mortality associated with improved isolation of burned patients.

OBJECTIVE: To compare the incidence of gram-negative bacteremia (GNB) and mortality in patients with large burns (> or = 20% of total body surface) hospitalized in either an open ward (OW) or a single-bed isolation (IW) environment. DESIGN: Retrospective cohort study. SETTING: The US Army Institute of Surgical Research, Burn Center, Ft Sam Houston, Tex. PATIENTS: Two thousand five hundred nineteen consecutive patients with large burns divided into two 10-year cohorts. Patients in the first cohort period were treated under OW conditions; patients in the second cohort period, under IW conditions. Infection (bacteremia) data were from a laboratory database. A microbial surveillance system was used to monitor patient isolation. Mortality was compared with predicted mortality derived by logistic regression of outcome, burn size, and age of patients without bacteremia in the study. MAIN OUTCOME MEASURES: Presence of GNB and survival. RESULTS: The incidence of GNB was higher in the OW cohort (31.2%) than the IW cohort (12.0%) (P < .001). The postinjury time of first GNB was delayed in the IW vs the OW cohort (28.9 days vs 11.8 days, respectively) (P < .001). For patients who had GNB in the OW cohort, mortality was higher than predicted (observed-predicted mortality ratio, 1.61) (P < .001). Such increased mortality was not present in the IW cohort. Multiple antibiotic-resistant gram-negative pathogens were endemic in the OW cohort. There was no evidence of cross infection or endemic conditions with multiple antibiotic-resistant gram-negative pathogens in the IW cohort. CONCLUSION: Improvements in isolation of burned patients were associated with decreased incidence of GNB, delayed postinjury time of GNB, and improved survival. Improved survival is likely related to decreased susceptibility as a result of longer exposure to the benefits of treatment and wound closure. These results suggest that, in patients with severe burn injuries, gram-negative infections and the related mortality can largely be prevented.

Adult↗