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Perception may be as important as reality when it comes to preventing needlestick injuries to health care workers. The more workers perceive that their facility has a "culture of safety," the less likely they are to sustain a needlestick, reports Scott Grytdal, MPH, an epidemiologist at the Centers for Disease Control and Prevention.
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The editors do us a fascinating and frightening favor by reprinting this historical firsthand account by a physician-in-training facing the 1918 flu pandemic at the University of Pennsylvania School of Medicine in Philadelphia.
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Two distinctly different infections are sparking common concern about their virulence and alarming increase: A new strain of Clostridium difficile (C. diff) and the increasing threat of community-associated methicillin-resistant Staphylococcus aureus(CA-MRSA).
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According to the rapidly changing map on the web site of the Association for Professionals in Infection Control and Epidemiology (APIC), as this issue went to press, 14 states had adopted laws requiring mandatory reporting of hospital infection rates and many others are in some stage of legislative study or discussion.
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Fueled by anger and frustration often linked to the death or injury of a loved one, a grass-roots consumer movement is arising nationally to demand more openness and accountability about hospital-acquired infections.
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Methicillin-resistant Staphylococcus aureus (MRSA) in the community was the cause of the majority of skin and soft tissue infections, and was predominantly of one strain different from MRSA of hospital origin.
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A prospective randomized trial carried out over a 6-year period of time enrolled 180 patients with ARDS of at least 7 days duration, and randomized them to receive either methylprednisolone or placebo. There was no significant difference noted in mortality at 60 days, though there was some improvement in ventilator-free and shock-free days during the first 28 days in patients treated with steroids. Steroids were also associated with an increased risk of death if started more than 2 weeks after the onset of ARDS.
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In a retrospective analysis, medical ICU patients requiring mechanical ventilation for 2 days or more had lower ICU and hospital mortality (but more ventilator-associated pneumonia) if they were begun on enteral feeding during that time than if they were not.
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Fatigue occurs commonly in patients with cancer, particularly when receiving chemotherapy or radiation. Furthermore, in long term survivors, persistent fatigue occurs in up to one third. Although anemia is one contributing factor, fatigue certainly occurs in its absence as well. Two recent reports are reviewed; one addressing the mechanisms and biochemical markers of persistent fatigue, and the other introducing a novel therapeutic approach directed at chemotherapy-associated fatigue. It is quite apparent that dysregulation of inflammatory mechanisms accounts for some component of fatigue and anti-inflammatory treatments may be of great value.
