Microbial inhibition on hospital garments treated with Dow Corning 5700 antimicrobial agent.

We evaluated the efficacy of the antimicrobial activity of cotton-polyester fabric treated with 3-(trimethoxysilyl)propyldimethyloctadecyl ammonium chloride (DC 5700), a quaternary ammonium compound bound irreversibly to the material. Significant antimicrobial activity was observed with 58 of 61 gram-positive cocci but with only 1 of 35 gram-negative bacilli and 0 of 5 yeasts. No inhibition of bacilli or yeasts was observed when the DC 5700 concentration ranged from 0.05 to 1.0% or when antimicrobial activity was assayed by the agar overlay bioassay or broth agitation methods.     

Modified Thayer-Martin medium for recovery of Nocardia species from contaminated specimens.

Specimens submitted for isolation of Nocardia species are frequently contaminated with other bacteria. Although decontamination with sodium hydroxide or benzalkonium chloride can remove these bacteria, this treatment is also toxic for Nocardia species. We demonstrate that modified Thayer-Martin medium can be used for selective isolation of Nocardia species.     

Effect of decontamination procedures on recovery of Nocardia spp.

Exposure to 0.5% N-acetyl-L-cysteine (NAC), 2% NaOH-NAC, or benzalkonium chloride in trisodium phosphate (Zephiran-TSP) was toxic for Nocardia isolates. The number of viable Nocardia cells in a standardized suspension was reduced by 10(2) to 10(6) after a 30-min exposure to 2% NaOH-NAC and by 10(4) or more after a 30-min treatment with Zephiran-TSP.     

Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

Background

Whether compensation for professional services drives the use of those services is an important question that has not been answered in a robust manner. Specifically, there is a growing concern that spine care practitioners may preferentially choose more costly or invasive procedures in a fee-for-service system, irrespective of the underlying lumbar disorder being treated.

Questions/purposes

(1) Were proportions of interbody fusions higher in the fee-for-service setting as opposed to the salaried Department of Defense setting? (2) Were the odds of interbody fusion increased in a fee-for-service setting after controlling for indications for surgery?

Methods

Patients surgically treated for lumbar disc herniation, spinal stenosis, and spondylolisthesis (2006–2014) were identified. Patients were divided into two groups based on whether the surgery was performed in the fee-for-service setting (beneficiaries receive care at a civilian facility with expenses covered by TRICARE insurance) or at a Department of Defense facility (direct care). There were 28,344 patients in the entire study, 21,290 treated in fee-for-service and 7054 treated in Department of Defense facilities. Differences in the rates of fusion-based procedures, discectomy, and decompression between both healthcare settings were assessed using multinomial logistic regression to adjust for differences in case-mix and surgical indication.

Results

TRICARE beneficiaries treated for lumbar spinal disorders in the fee-for-service setting had higher odds of receiving interbody fusions (fee-for-service: 7267 of 21,290 [34%], direct care: 1539 of 7054 [22%], odds ratio [OR]: 1.25 [95% confidence interval 1.20–1.30], p < 0.001). Purchased care patients were more likely to receive interbody fusions for a diagnosis of disc herniation (adjusted OR 2.61 [2.36–2.89], p < 0.001) and for spinal stenosis (adjusted OR 1.39 [1.15–1.69], p < 0.001); however, there was no difference for patients with spondylolisthesis (adjusted OR 0.99 [0.84–1.16], p = 0.86).

Conclusions

The preferential use of interbody fusion procedures was higher in the fee-for-service setting irrespective of the underlying diagnosis. These results speak to the existence of provider inducement within the field of spine surgery. This reality portends poor performance for surgical practices and hospitals in Accountable Care Organizations and bundled payment programs in which provider inducement is allowed to persist.

Level of Evidence

Level III, economic and decision analysis.

     

Percutaneous ethanol injection and radio-frequency ablation for the treatment of nonresectable colorectal liver metastases – techniques and results

Background: Percutaneous ethanol injection (PEI) and radio-frequency (RF) ablation are possible palliative treatment modalities for patients with non-resectable liver metastases of colorectal carcinomas. The different techniques are explained and reviewed. Results: PEI did not show promising results for the treatment of liver metastases. RF results were more encouraging; some studies showed improved mean survival times for patients when a complete necrosis of the metastases could be achieved. The maximum diameter of the necrotic area possible in a single session is about 5 cm. Conclusion: PEI and RF are palliative last-line treatment strategies for patients with non-resectable liver metastases and should only be applied if chemotherapy is not sufficient or not possible. The long-term efficacy of RF ablation in this group of patients has to be evaluated. Received: 10 March 1999 Accepted: 29 June 1999     

Incidence and predictors of acute kidney injury in an urban cohort of subjects with HIV and hepatitis C virus coinfection

Coinfection with hepatitis C (HCV) significantly increases the risk of acute and chronic renal disease in HIV-infected individuals. However, the burden of acute kidney injury (AKI) directly attributable to HIV among HCV-infected individuals and associated risk factors are not well understood. Within a prospective cohort, AKI episodes were identified by a rise in creatinine of 0.5 mg/dL. Incidence of first AKI events was calculated for HIV/HCV coinfected versus HCV monoinfected subjects, and multivariable analyses using Cox proportional hazards were performed to identify predictors of AKI. Throughout the study period, 35% HIV/HCV coinfected and 17% HCV monoinfected subjects developed AKI, with incidence of 8.74/100 person-years and 3.53/100 person-years, respectively (hazard ratio (HR) 2.48; [95% confidence interval (CI) 1.50, 3.74]). In multivariable analysis, HIV coinfection (HR 2.19 [1.33, 3.62]), decompensated cirrhosis (HR 6.64 [3.81, 11.6]), and cocaine use (HR 2.06 [1.15, 3.71]) were independently associated with AKI. HCV genotype, HCV viral load, hazardous drinking, and heroin use were not associated with AKI. Study limitations included potential misclassification bias of HCV-infected individuals as serial HIV antibody testing was not routinely performed after study entry, and inability to adjust for tenofovir use in multivariable analysis. In conclusion, among subjects with HCV infection, decompensated cirrhosis, HIV coinfection, and cocaine use are associated with increased risk of AKI. These findings highlight the importance of preventing and treating cirrhosis, controlling HIV coinfection, and reducing cocaine use in HIV/HCV coinfected persons.