Inhibition of Bacterial Adherence on the Surface of Stents and Bacterial Growth in Bile by Bismuth Dimercaprol

Bacterial infection and biofilm formation on the surface of biliary stents is believed to be one of the main factors in stent occlusion. This study explored the role of the new reagent, bismuth dimercaprol, in preventing bacterial adherence and bacterial biofilm formation on the surface of biliary stents. Sterile porcine bile preparations, infected separately with Escherichia coli, Klebsiella pneumoniae, Enterobacter, and Enterococcus, were used as the perfusion media in an in vitro perfusion system. The bacterial growth in the media and the bacterial adherence on the surface of stents were tested when different concentrations of bismuth dimercaprol were used in the perfusion media. BisBAL (5 μ M) did not inhibit the growth of any of the tested bacterial species. It did, however, significantly decrease the amount of bacteria adhering to the surface of stents for all bacterial strains except Escherichia coli. Bismuth dimercaprol (20 μ M) significantly inhibited the growth of Escherichia coli, Klebsiella pneumoniae, and Enterobacter and, thereby, significantly decreased the amount of these bacteria adhering to the surface of stents. The unique bactericidal and anitbiofilm activities of bismuth thiols might contribute to delaying the process of biliary stent occlusion if the effective concentrations of bismuth thiols could be delivered to the target sites. The feasibility of this application of bismuth thiols deserves further investigation.     

Education of garment workers: prevention of work related musculoskeletal disorders.

This educational intervention was designed as part of a garment worker occupational health and safety initiative, with the goal to reduce musculoskeletal symptoms in this monolingual Cantonese speaking population. Using risk communication and the Chinese concepts of yin and yang, the class curriculum was designed to be participatory. It focused on linking symptoms to high risk work activities; explaining the nature of musculoskeletal injury; and encouraging compliance with self care measures of ice, stretching, and early symptom reporting. A total of 21 women completed the Healthy Work Classes, with an increase in perceived levels of energy measured after each class. Additionally, contingency contracting for both individual and workplace change was piloted. This curriculum was revised to become a "train the trainer" program, with training of garment worker leaders and the goal to disseminate this prevention based curriculum to garment workers in the Oakland, California community.     

The development of an accredited bowel-management course

Bowel management--particularly digital rectal examination (DRE) and the manual removal of faeces--has been a contentious issue for some time. In the past few years this has been brought to the fore by a number of cases of professional misconduct by nurses.     

Clinical skills: evidence-based nursing care of people with rheumatoid arthritis

Rheumatoid arthritis is a complex inflammatory disease with an unknown cause, uncertain prognosis and no known cure. The physical symptoms of this chronic disease can impact on the patient's psychological state and also affect the family unit and social/economic viability. Nursing patients with such a multifaceted illness is a skilled and complex task and it is imperative that the care provided is optimal, timely and underpinned by patient education. Evidence-based nursing care founded on an in-depth knowledge of the disease and its treatments will help to achieve optimal patient outcome.     

Discharge planning: a collaboration between provider and payer case managers using Medicare's Conditions of Participation

Discharge planning is a legally mandated function for hospitals and is one of the "basic" hospital roles as outlined in Medicare's Conditions of Participation. This article will define discharge planning; describe the steps in the discharge planning process; list rules and regulations that influence discharge planning in hospitals; and compare hospital-based actions with payer-based actions when planning discharges. Case managers who work for payers interact with hospital-based case managers to facilitate the discharge planning process for patients. Those who form this patient-provider-payer triangle will benefit by reviewing the dynamics of the discharge planning process.     

Labor analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women

BACKGROUND: The authors performed an individual patient meta-analysis of 2,703 nulliparous women who were randomized to either epidural analgesia or intravenous opioids for pain relief during labor from five trials conducted at their hospital. The primary purpose in this meta-analysis was to evaluate the effects of epidural analgesia during labor on the rate of cesarean delivery. METHODS: Between November 1, 1993, and November 3, 2000, 2,703 nulliparous women (2,188 healthy parturients and 515 women with pregnancy-induced hypertension) in spontaneous labor at term were randomized to receive either epidural analgesia or intravenous opioid analgesia in the five studies. Epidural analgesia was initiated with either epidural bupivacaine or intrathecal sufentanil and was maintained with a low-dose (0.0625% or 0.125%) mixture of bupivacaine with fentanyl. Intravenous opioid analgesia was initiated with 50 mg meperidine and 25 mg promethazine hydrochloride and was maintained with intravenous boluses of meperidine as needed. RESULTS: A total of 1,339 nulliparous women were randomized to receive epidural analgesia, and 1,364 women were randomized to receive intravenous meperidine analgesia. There was no difference in the rate of cesarean deliveries between the two analgesia groups (epidural analgesia, 10.5% [140 of 1,339] vs. intravenous meperidine analgesia, 10.3% [141 of 1,364]; adjusted odds ratio, 1.04; 95% confidence interval, 0.81-1.34; P = 0.920). Significantly more women randomized to epidural analgesia had forceps deliveries compared to meperidine analgesia (13% [172 of 1,339] vs. 7% [101 of 1,364]; adjusted odds ratio, 1.86; 95% confidence interval, 1.43-2.40; P < 0.001). Epidural women had longer first and second stages of labor. Women who received epidural analgesia reported lower pain scores during labor and delivery compared to women who received intravenous meperidine analgesia. CONCLUSION: Epidural analgesia compared to intravenous meperidine analgesia during labor does not increase the number of cesarean deliveries.     

Coding for effective denial management

Nearly everyone will agree that accurate and consistent coding of diagnoses and procedures is the cornerstone for operating a compliant practice. The CPT or HCPCS procedure code tells the payor what service was performed and also (in most cases) determines the amount of payment. The ICD-9-CM diagnosis code, on the other hand, tells the payor why the service was performed. If the diagnosis code does not meet the payor's criteria for medical necessity, all payment for the service will be denied. Implementation of an effective denial management program can help "stop the bleeding." Denial management is a comprehensive process that works in two ways. First, it evaluates the cause of denials and takes steps to prevent them. Second, denial management creates specific procedures for refiling or appealing claims that are initially denied. Accurate, consistent and compliant coding is key to both of these functions. The process of proactively managing claim denials also reveals a practice's administrative strengths and weaknesses, enabling radiology business managers to streamline processes, eliminate duplicated efforts and shift a larger proportion of the staff's focus from paperwork to servicing patients--all of which are sure to enhance operations and improve practice management and office morale. Accurate coding requires a program of ongoing training and education in both CPT and ICD-9-CM coding. Radiology business managers must make education a top priority for their coding staff. Front office staff, technologists and radiologists should also be familiar with the types of information needed for accurate coding. A good staff training program will also cover the proper use of Advance Beneficiary Notices (ABNs). Registration and coding staff should understand how to determine whether the patient's clinical history meets criteria for Medicare coverage, and how to administer an ABN if the exam is likely to be denied. Staff should also understand the restrictions on use of ABNs and the compliance risks associated with improper use. Finally, training programs should include routine audits to monitor coders for competence and precision. Constantly changing codes and guidelines mean that a coder's skills can quickly become obsolete if not reinforced by ongoing training and monitoring. Comprehensive reporting and routine analysis of claim denials is without a doubt one of the greatest assets to a practice that is suffering from excessive claim denials and should be considered an investment capable of providing both short and long term ROIs. Some radiologists may lack the funding or human resources needed to implement truly effective coding programs for their staff members. In these circumstances, radiology business managers should consider outsourcing their coding.     

Information technology in health professional education: why IT matters

This paper analyses the potential of information technology (IT) to transform the process of learning in higher education, particularly health professional education. It is argued that IT, although very much part of the infrastructure of the modern university has yet to make its full impact on teaching and learning processes. The expectations of students and demands for improved flexibility and access make it inevitable that IT will become an integral part of teaching and learning despite inherent resistance to change. The potential benefits of IT are identified as: transmission of high quality content, support of life-long learning, flexibility of access and enhanced opportunities for communication. These concepts are explored in the context of health professional education. It is argued that universities cannot survive without harnessing the power of IT to improve the educational experience of students but lecturers should ensure that this is underpinned by sound educational theory.     

Assessment and treatment of chest pain

Chest pain is one of the main reasons for emergency admission to hospital in the UK. Jackie Tough examines the causes and treatment of chest pain and offers a structured system for taking the patient's history.