Surgical wound infections documented after hospital discharge

Shorter lengths of hospitalization may result in more surgical wound infections being documented after hospital discharge. The current investigation analyzed 1644 surgical procedures performed over a 3-month period, and documented surgical wound infections both before and for 1 month after hospital discharge. Physician and patient questionnaires were used. One hundred eight infections were noted, of which 50 (46%) were seen after hospital discharge by either the patient or the surgeon. Rates of infection were 5.2%, 7.5%, and 7.5% for clean, clean-contaminated, and contaminated-dirty categories, respectively. Had postdischarge surveillance not been used, rates would have appeared to be 2.5%, 6.5%, and 6.8% for the same surgical classes. Infections following clean and clean-contaminated procedures were more likely to be noticed after hospital discharge. Excluding those that were patient-documented, wound infection rates would have been 4.2% (clean), 6.3% (clean-contaminated) and 6.8% (contaminated-dirty). Postdischarge surveillance is imperative to meaningfully document true rates of surgical wound infection, inasmuch as increasing numbers are likely to occur only after patients leave the hospital.     

Comparison of resource utilization for Medicaid dementia patients using nursing homes versus home and community based waivers for long-term care

BACKGROUND: Medicaid waiver home and community-based long-term care services (HCBS) may provide a partial solution to the escalating costs of long-term care. Persons with dementia can have complex caregiving needs; it is unknown whether their expenditures and resource utilization differ between community-based versus institutional settings. OBJECTIVE: To compare expenditures and resource utilization for Medicaid recipients with dementia who received long-term care through a nursing home versus HCBS waivers. DESIGN: Twelve-month cohort study. SETTING: Indiana Medicaid administrative data from 2001 through 2004. PARTICIPANTS: Medicaid recipients with dementia who lived in the community 6 months before receiving long-term care through nursing homes (N = 1534) or HCBS waivers (N = 174). MEASUREMENTS: Monthly inpatient and emergency department rates and total expenditures adjusted for prior use, demographics, insurance status, and comorbidities. RESULTS: Adjusted rates of inpatient use were stable for nursing home patients (0.06) but significantly increased over 12 months for HCBS recipients (0.07-0.12; P = 0.048). Adjusted total expenditures increased over 12 months from $1419 to $2002 for HCBS recipients (P < 0.001), but remained stable for those in nursing homes ($3413-$3336). Long-term care expenditures were on average $1688 per month higher for those in nursing homes. CONCLUSIONS: The escalation in inpatient use for HCBS waiver recipients suggests that future development of HCBS programs should consider the unique needs of persons with dementia so as to optimize their health outcomes. Despite increasing inpatient use among HCBS recipients, their overall expenditures remained significantly lower than those of nursing home patients.     

Ethnographic research: a qualitative research approach to study of the interdisciplinary team

Ethnography, one of many kinds of qualitative research, employs cultural theory, which emphasizes part-whole relationships, context, and multiple perspectives. Theory and method are intrinsically related. In ethnographic research, the primary instrument is human. Multiple observations, researchers, and sources of data contribute to the soundness of the study. This paper describes ethnographic research utilizing the study of interdisciplinary team-work as an exemplar.     

G-protein expression in melanotropes changes coincident with innervation of the developing rat pituitary intermediate lobe

The two isoforms of the dopamine D₂ receptor, the D_2short and the D_2long differ in a 29 amino acid insert in the third cytoplasmic loop with which G proteins interact. We have previously reported that in rat melanotropes, expression of D_2short increases markedly at the end of the first postnatal week which is concurrent with innervation of the intermediate lobe. Using immunohistochemistry, this study examined expression of Gα_i1/2, Gα_i3, Gα_o and Gα_s proteins before and after dopaminergic innervation. Gα_i3 increased through gestational day 20, and then remained level to postnatal day 6. At this time, coinciding with the induction of D_2short expression, Gα_i3 immunoreactive intensity increased markedly, possibly indicating co-regulation of these receptors. On postnatal day 6, Gα_s immunoreactive intensity increased in some, but not all, melanotropes. The resulting heterogeneity in G_s expression persisted in the adult. Gα_i1/2 immunoreactivity did not change and Gα_o was detected only subsequent to the event of innervation. Thus, dopamine released from axons and acting through D₂ receptor stimulation could increase Gα_i3 immunoreactivity and decrease Gα_s immunoreactive intensity in some melanotropes.     

Renal cell carcinoma with solitary metachronous contralateral adrenal metastasis. Experience with 2 cases and review of the literature.

We report on 2 cases of renal cell carcinoma with solitary metachronous contralateral adrenal metastasis occurring up to four years after radical nephrectomy. Both patients were treated with adrenalectomy and steroid replacement. One patient died with distant metastases twenty-eight months after adrenalectomy and the other is alive with no evidence of disease four years postoperatively. Such a presentation of hypernephroma is rare, with only 1 such case having been found in the literature.     

Alagille syndrome and deletion of 20p.

We add five cases of 20p deletion to the 10 cases already published. Four had craniofacial, vertebral, ocular, and cardiovascular features of Alagille syndrome, which adds weight to the assignment of this disorder to the short arm of chromosome 20. Included in our series is the first report of familial transmission of a 20p deletion.