Spectra MRSA,a New Chromogenic Agar Medium To Screen for Methicillin-Resistant Staphylococcus aureus

A novel chromogenic medium, Spectra MRSA (Remel, Lenexa, KS), was designed to detect methicillin-resistant Staphylococcus aureus (MRSA) rapidly and more efficiently than traditional media (i.e., tryptic soy agar with 5% sheep blood [SBA] and mannitol salt agar [MSA]). A multicenter study (including four clinical trial sites and the Medical College of Wisconsin [MCW] Milwaukee, WI) compared the performance characteristics of Spectra MRSA to those of the traditional media for the detection of MRSA. For this study, 767 nasal swab specimens from the multicenter study (traditional medium used, SBA) and 667 nasal swab specimens from MCW (traditional medium used, MSA) were plated on each test medium and examined after 24 and 48 h of incubation. At 24 h, the sensitivity and the specificity of each medium were as follows: in the multicenter study, 95.4% and 99.7%, respectively, for Spectra MRSA and 93.6% and 100%, respectively, for SBA; at MCW, 95.2% and 99.5%, respectively, for Spectra MRSA and 88.7% and 94.0%, respectively, for MSA. The positive predictive values of each medium at 24 h were as follows: in the multicenter study, 98.1% for Spectra MRSA and 100% for SBA; at MCW, 95.2% for Spectra MRSA and 60.4% for MSA. In our evaluation, we found that Spectra MRSA was able to rapidly identify and differentiate methicillin-resistant S. aureus from methicillin-susceptible S. aureus on the basis of the utilization of chromogens that result in denim blue colonies, thus eliminating the need for biochemical analysis and antimicrobial susceptibility testing. Extending the incubation beyond 24 h did not significantly improve the recovery of MRSA and resulted in decreased specificity.A significant effort has been put forth to determine effective infection control practices that may be used to limit the spread of methicillin-resistant Staphylococcus aureus (MRSA) and minimize its impact on patient care and hospital budgets in response to the increasing rates of occurrence of MRSA in health care settings. Although most hospitals adhere to a policy of contact isolation and attempt to limit inappropriate antimicrobial usage, there is strong evidence that active surveillance cultures (ASCs) for patients at risk for MRSA colonization can increase the chance of identifying occult MRSA reservoirs and further limit the nosocomial spread of the organism (16). Recent reports by Salgado and Farr (17) and Lucet et al. (13) have shown that the organisms in positive cultures of clinical specimens routinely submitted from patients represent only a small fraction of the reservoir of antibiotic-resistant pathogens, and the largest source for nosocomial spread was attributed to asymptomatic, colonized patients who went unrecognized and unisolated in the absence of ASCs. Additionally, consensus suggests that a restricted formulary alone is unlikely to prevent the emergence and persistence of MRSA and that the use of contact precautions is important to prevent the spread of MRSA from colonized patients (5).While the anterior nares are the most common site of S. aureus colonization and the most frequently screened and recommended site for specimen collection due to the satisfactory sensitivities of tests with that type of specimen and the ease with the specimen may be obtained (15, 18, 20), other recent studies have shown that sampling of other body sites (the oropharynx, perianal region, and groin) may enhance the sensitivity of screening for MRSA and predict the likelihood of S. aureus infection (3, 7, 11, 14, 22). Most importantly, it is agreed that the culture of specimens from more body sites would yield higher rates of recovery, but the increased resources required for the screening of specimens from multiple sites outweigh the incremental increase in yield that would be attained (5). In order to reduce the economic burden related to longer patient stays and higher costs associated with therapy and infection control, rapid and accurate tests for screening for MRSA are needed to guide intervention and decrease delays in the implementation of contact precautions. A lengthy turnaround time would further augment the risk for nosocomial transmission; thus, any effective screening protocol should be deemed to have a turnaround time within 24 h.The methods currently available for screening for MRSA include standard culture, methods that use chromogenic media, and molecular-based testing. Although PCR methods have been highly acclaimed in the recent literature for their sensitivity and speed, the cost per test and the up-front laboratory cost of implementation are very high and may generate significant pressure to demonstrate cost savings in an unrealistic time frame (5). Culture methods that employ a selective chromogenic medium have been described to be less costly, more reliable, and faster for screening for MRSA than traditional culture (5, 8). The purpose of the multicenter study described here was to compare the performance of a novel chromogenic medium, Spectra MRSA, with that of traditional culture and validate the use of this product for screening for MRSA from nasal swab specimens.     

Health care leadership academy: a statewide collaboration to enhance nursing leadership competencies

Competency in leadership skills is necessary to manage in the current chaotic health care environment and proactively participate in the creation of a better environment. Although interest in pursuing a career in health care is growing, lack of leadership competence contributes to employee frustration and dissatisfaction, which directly and indirectly impacts the supply of health care workers. To addressthe lack of leadership competence and its disturbing consequences, the Arizona nursing community designed a model for nursing leadership and created a partnership to provide a high-quality, affordable leadership education program focused on enhancing the leadership competencies of frontline nursing supervisors.     

Morphometric MRI findings in the thalamus and brainstem in children after moderate to severe traumatic brain injury

Generalized whole brain volume loss is well documented in moderate to severe traumatic brain injury. Whether this atrophy occurs in the thalamus and brainstem has not been systematically studied in children. Magnetic resonance imaging (MRI) quantitative analysis was used to investigate brain volume loss in the thalamus and brainstem in 16 traumatic brain injury subjects (age range 9-16 years) compared with 16 age and demo-graphically matched controls. Based on multiple analysis of covariance, controlling for age and head size, reduced volume in the thalamus and the midbrain region of the brainstem were found. General linear model analyses revealed a relation between processing speed on a working memory task and midbrain and brain stem volumes. Reduced volume in thalamic and brainstem structures were associated with traumatic brain injury. Reduction in midbrain and thalamic volume is probably a reflection of the secondary effects of diffuse axonal injury and reduction in cortical volume from brain injury.     

Executive functions after traumatic brain injury in children

There is growing recognition that executive function, the superordinate, managerial capacity for directing more modular abilities, is frequently impaired by traumatic brain injury in children and mediates the neurobehavioral sequelae exhibited by these patients. This review encompasses the definition of specific executive functions, age-related changes in executive functions in typically developing children, and the effects of traumatic brain injury on executive functions. The neural substrate for executive functions is described, including relevant functional brain imaging studies that have implicated mediation by prefrontal and parietal cortex and their circuitry. The vulnerability of the neural substrate for executive function to the pathophysiology of traumatic brain injury is discussed, including focal lesions and diffuse axonal injury. Domains of executive functions covered in this review include the basic processes of working memory and inhibition and more complex processes such as decision making. Other domains of executive function, including motivation, self-regulation, and social cognition are discussed in terms of research methodology, clinical assessment, and findings in children with traumatic brain injury. Proposed approaches to the rehabilitation of executive functions are presented.     

Psychosocial needs of families with a child with cancer

PURPOSE: The aims of this study were to map the problems and needs of children with cancer and their families with regard to possible psychosocial interventions, and to do an acceptability study of different ways to provide support. METHODS: The authors performed a cross-sectional structured telephone interview with 56 parents of children with cancer and 13 adolescents from these families. On 0 to 10 analog scales, parents and adolescents rated the importance of different needs, how these needs had been met, the acceptability of different ways of providing supportive interventions, how often these ways had been used, and comfort using them. RESULTS: Parents' mean rating of importance of information needs was 9.42, peer social support 7.84, and self-management therapy 9.21. The ratings of how well these needs had been met were 8.05, 5.30, and 7.13, respectively. Both parents and adolescents ranked getting information written on paper highest, preferred to communicate in a face-to-face support group for peer social support, and preferred a therapist for self-management therapy. The comfort ratings for using different ways to provide the interventions were all high, as was access; 89% of families had computers in their homes, 76% had Internet access. CONCLUSIONS: The needs for information, peer social support, and self-management therapy are all high. There is still room to meet these needs better. Using paper-based, telephone, computer CD, or an interactive Web-based intervention package all seem to be acceptable and accessible ways to meet the needs and might reduce the risk of families developing psychosocial problems.     

The antidepressant efficacy of reboxetine in patients with severe depression

We examined the effectiveness of reboxetine, a norepinephrine reuptake inhibitor (NRI), compared with placebo for the treatment of patients with severe major depression (defined as a score on the 17-item Hamilton Rating Scale for Depression [HAM-D] >/=25). Data were obtained from four prospective, double-blind, randomized, placebo-controlled clinical trials of the efficacy of reboxetine (8 to 10 mg/d) over 4 to 8 weeks in patients with major depression. In three of the trials, reboxetine produced a significantly greater reduction than placebo in mean HAM-D scores from baseline to the last clinical assessment (p < 0.001). There were significantly more responders to treatment (defined as a reduction in HAM-D score >50% between baseline and the last follow-up observation) treated with reboxetine than placebo in three trials. The overall mean responder rate with reboxetine was 63% (range: 56-74%) compared with 36% (range: 20-52%) with placebo. These results demonstrate that reboxetine is significantly more effective than placebo in a subgroup of patients with severe depression.     

Investigating the nursing contribution to commissioning in primary health-care

AIM: This study set out to investigate nurses', doctors' and managers' perceptions of the nursing contribution to commissioning in primary health-care. BACKGROUND: The study was undertaken in the light of the proposal in the government's White Paper The new NHS, Modern, Dependable that community nurses should play a lead role in commissioning health services as members of the new primary care groups. METHOD: Semistructured taped interviews were conducted, with seven community nurses, two community midwives, seven managers and four general practitioners, covering three geographical locations in the UK. The data were transcribed and analysed using a template approach, where text is analysed through the use of an analysis guide, or codebook, consisting of categories, or themes, relevant to the research questions. FINDINGS: The main themes to emerge were that nurses had an important contribution to make to commissioning on the basis of their clinical knowledge, their awareness of health need and their knowledge of health promotion. Additionally, the ability of nurses to negotiate at different levels across professional groups and with the public was perceived as an important skill in a commissioning role. However, findings also indicated that nurses need additional knowledge and skills if they are to perform their role effectively. Being sidelined from the commissioning arena, poor interprofessional collaboration and the potential for resistance from some general practitioners and managers were identified as constraints on the nursing contribution to commissioning. Combining clinical caseloads with commissioning responsibilities and a lack of support systems for nurses in commissioning were also identified as constraints. CONCLUSION: Nurses' commissioning-related knowledge and skills will have to be developed and constraints on the commissioning role of nurses challenged if the perspectives and values of nursing are to help to reshape our healthcare system.     

Tackling tough management issues: advice from the top

Wondering how your peers across the country are managing the myriad challenges that confront HIM professionals? We assembled a panel of experts to address common problems and concerns.