Compliance with hand hygiene and glove use in a university-affiliated hospital.

OBJECTIVE: The hands of healthcare workers often transmit pathogens causing nosocomial infections. This study examined compliance with handwashing and glove use. SETtING: A university-affiliated hospital. DESIGN: Compliance was observed covertly. Healthcare workers' demographics, hand hygiene facilities, indications for hand hygiene, compliance with handwashing and glove use in each procedure, and duration of handwashing were recorded. RESULTS: Nine nurses and 33 assistant physicians were monitored during the study. One researcher recorded 1400 potential opportunities for handwashing during 15-minute observation periods. The mean duration of handwashing was 10 +/- 2 seconds. Most healthcare workers (99.3%) used liquid soap during handwashing, but 79.8% did not dry their hands. For all indications, compliance with handwashing was 31.9% and compliance with glove use was 58.8%. Compliance with handwashing varied inversely with both the number of indications for hand hygiene and the number of patient beds in the hospital room. Compliance with handwashing was better in dirty high-risk situations. CONCLUSION: Compliance with handwashing was low, suggesting the need for new motivational strategies such as supplying feedback regarding compliance rates     

Vitamin D deficiency is associated with low mood and worse cognitive performance in older adults.

BACKGROUND: Vitamin D deficiency is common in older adults and has been implicated in psychiatric and neurologic disorders. This study examined the relationship among vitamin D status, cognitive performance, mood, and physical performance in older adults. METHODS: A cross-sectional group of 80 participants, 40 with mild Alzheimer disease (AD) and 40 nondemented persons, were selected from a longitudinal study of memory and aging. Cognitive function was assessed using the Short Blessed Test (SBT), Mini-Mental State Exam (MMSE), Clinical Dementia Rating (CDR; a higher Sum of Boxes score indicates greater dementia severity), and a factor score from a neuropsychometric battery; mood was assessed using clinician's diagnosis and the depression symptoms inventory. The Physical Performance Test (PPT) was used to measure functional status. Serum 25-hydroxyvitamin D levels were measured for all participants. RESULTS: The mean vitamin D level in the total sample was 18.58 ng/mL (standard deviation: 7.59); 58% of the participants had abnormally low vitamin D levels defined as less than 20 ng/mL. After adjusting for age, race, gender, and season of vitamin D determination, vitamin D deficiency was associated with presence of an active mood disorder (odds ratio: 11.69, 95% confidence interval: 2.04-66.86; Wald chi(2) = 7.66, df = 2, p = 0.022). Using the same covariates in a linear regression model, vitamin D deficiency was associated with worse performance on the SBT (F = 5.22, df = [2, 77], p = 0.044) and higher CDR Sum of Box scores (F = 3.20, df = [2, 77], p = 0.047) in the vitamin D-deficient group. There was no difference in performance on the MMSE, PPT, or factor scores between the vitamin D groups. CONCLUSIONS: In a cross-section of older adults, vitamin D deficiency was associated with low mood and with impairment on two of four measures of cognitive performance.     

Transoesophageal echocardiographic findings in patients with ischemic lacunar and nonlacunar stroke.

The aim of this study was to compare risk factors and concomitant potential cardioembolic sources detected by transthoracic (TTE) and transoesophageal echocardiography (TEE) in patients with lacunar and nonlacunar infarcts. Clinical data of 139 patients with a first episode of ischemic stroke who underwent both TTE and TEE were analysed. Patients were divided into two groups, lacunar (LACI=36), and nonlacunar infarcts (NLACI=103); then the latter group was divided into two subgroups, anterior (ACI=76) and posterior circulation infarct (POCI=27). Presence of hypertension and diabetes mellitus were not significantly different between LACI and NLACI groups. The rate of potential cardioembolic risk factors detected by echocardiography was similar in the NLACI groups. At least one potential cardiac source of embolism was identified in 44% (n=16) of LACI, 52.6% (n=40) of ACI and 55.5% (n=15) of POCI patients. Atrial fibrillation was significantly frequent in the ACI group. No significant differences were found between all groups regarding age, sex, hyperlipidemia, and smoking. Our findings demonstrate that hypertension and diabetes mellitus are equally important in the pathogenesis of both LACI and NLACI groups and there is a need for careful cardiac evaluation in cases even with lacunar infarct.     

Congenital absence of pulmonary valve leaflets with intact ventricular septum in a neonate.

Symptomatic infants with congenital absence of pulmonary valve leaflets suffer primarily from respiratory insufficiency caused by bronchial compression by the dilated pulmonary arteries, and have a high mortality rate. We report the successful treatment of absent pulmonary valve syndrome with intact ventricular septum in a neonate. The treatment consisted of resection of the pulmonary artery aneurysm and enlargement of the pulmonary annulus.     

A phase I trial of α-interferon in combination with pentostatin in hematologic malignancies

Pentostatin, a novel inhibitor of adenosine deaminase, has shown activity in various lymphoid malignancies of both the T and B cell lineage. This agent has unique side effects and in general myelosuppression has been mild. Interferon has both antiviral and antineoplastic properties. This agent has shown activity in hairy cell leukemia, chronic granulocytic leukemia, low grade lymphoma, and myeloma. Side effects from interferon are in general dissimilar to those that have been seen with pentostatin and in particular myelosuppression has not been a major toxicity with low doses of interferon. This current trial explored the combination of pentostatin and interferon in hematologic malignancies. Fifteen patients were enrolled in this phase I trial at a fixed dose of pentostatin of 4 mg/m² biweekly and interferon at doses of 0.5, 1, 2, or 4 million units/m² of interferon. At the first three dose levels of interferon nausea and vomiting were the predominant toxicity and appeared to worsen with time on study. Fatigue also was seen at the lowest level of interferon and was severe enough to cause two individuals to discontinue the study medications. At higher dose levels of interferon, myelosuppression, nausea and vomiting, and fatigue were the predominant toxicities. One patient with hairy cell leukemia had a complete response and a second patient with T cell cutaneous lymphoma had a partial response which lasted for 6 to 7 weeks. The maximum tolerated dose of interferon with pentostatin in this patient population was four million units/m².     

Alterations in the dimensions of aortopulmonary septum in hypertensive subjects.

The neural crest origin of the aortopulmonary septum has led us to investigate the septum for a special function, and we designed the present study to assess the alteration, if any, in the dimensions of the aortopulmonary septum in hypertension. The dimensions of the aortopulmonary septum were measured by echocardiography in 36 hypertensive and 36 age- and sex-matched normotensive subjects. Echocardiographic examination included measurement of the cross-sectional area of the aortopulmonary septum with standard two-dimensional views from the parasternal windows. Standardization of this dimension with appropriate cardiac measurements such as aortic and internal left ventricular diameters was also performed to provide growth-independent estimates of septal size. The average area of the septum in the hypertensive group was 2.183 +/- 0.391 cm2, significantly lower than that in the normotensive group (2.370 +/- 0.415 cm2). There were also significant differences in the area of the aortopulmonary septum between the groups when the values were standardized with internal left ventricular diameters. In conclusion, these data confirm that the aortopulmonary septum is smaller in hypertensive than in normotensive humans. This difference might be the result of a possible function of the aortopulmonary septum in blood pressure regulation.