In vivo selection for transmissible drug resistance in Salmonella typhi during antimicrobial therapy.

We report the recovery of Salmonella typhi that acquired resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and gentamicin subsequent to multiple antibiotic therapy. Escherichia coli and Klebsiella pneumoniae isolates which were recovered from the same stool sample displayed identical resistance patterns. Agarose gel electrophoresis revealed that S. typhi and laboratory-derived transconjugants contained a high-molecular-weight plasmid present in the resistant intestinal bacteria.     

Die morphologischen Veränderungen der Blutkörperchen,speciell der Erythrocyten bei der Toluylendiamin-Vergiftung

Ohne ZusammenfassungHierzu Taf. XII.     

Intraabdominelle Hernie der Bursa omentalis bei geschlossenem Foramen Winslowii

Ohne ZusammenfassungMit 1 Figur im Text.     

Mittheilung über zwei Fälle von congenitaler Nierenverlagerung

Ohne Zusammenfassung     

Kenosha County falls prevention study: a randomized, controlled trial of an intermediate-intensity, community-based multifactorial falls intervention

OBJECTIVES: To decrease the rate of falls in high-risk community-dwelling older adults. DESIGN: Randomized, controlled trial. SETTING: Community-based. PARTICIPANTS: Three hundred forty-nine adults aged 65 and older with two falls in the previous year or one fall in the previous 2 years with injury or balance problems. INTERVENTION: Subjects received two in-home visits from a trained nurse or physical therapist who assessed falls risk factors using an algorithm. The intervention consisted of recommendations to the subject and their primary physician, referrals to physical therapy and other providers, 11 monthly telephone calls, and a balance exercise plan. Control subjects received a home safety assessment. MEASUREMENTS: The primary outcome was rate of falls per year in the community. Secondary outcomes included all-cause hospitalizations and nursing home admissions per year. RESULTS: There was no difference in rate of falls between the intervention and control groups (rate ratio (RR)=0.81, P=.27). Nursing home days were fewer in the intervention group (10.3 vs 20.5 days, P=.04). Intervention subjects with a Mini-Mental State Examination (MMSE) score of 27 or less had a lower rate of falls (RR=0.55; P=.05) and, if they lived with someone, had fewer hospitalizations (RR=0.44, P=.05), nursing home admissions (RR=0.15, P=.003), and nursing home days (7.5 vs 58.2, P=.008). CONCLUSION: This multifactorial intervention did not decrease falls in at-risk community-living adults but did decrease nursing home utilization. There was evidence of efficacy in the subgroup who had an MMSE score of 27 or less and lived with a caregiver, but validation is required.     

Task allocation in cancer medication management - integrating the pharmacist

Objective

This study was conducted to define the task allocation in multiprofessional cancer medication management (MCMM) with a special focus on the role of the pharmacist as well as patient education and counseling. The acceptance of the proposed task allocation and the perceptions on multiprofessional teamwork were explored on a national level.

Methods

We held local focus group meetings (University of Bonn with collaboration partners) to identify MCMM tasks. With the Delphi technique the tasks were allocated to physicians, pharmacists and nurses. Professionals (members of the German Cancer Society) were approached nationwide via an online questionnaire to evaluate the acceptance of the MCMM model and explore their perceptions on multiprofessional teamwork.

Results

The MCMM model comprised 38 tasks including 11 on patient education and counseling. It was rated to be reasonable (79%) and feasible (68%). Barriers and benefits of multiprofessional teamwork stated were patient-, team-, therapy-, structure-, and resources-related.

Conclusions

The MCMM model integrates the pharmacist with responsibilities in patient education and counseling as well as prevention of drug-related problems. The approach was generally appreciated nationwide by the professions.

Practice implications

The proposed model can serve as a tool to trigger changes in cancer medication management.