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Results of a survey measuring frequency types, and reasons for missed care at three acute care hospitals in North Carolina are described. Results also are compared to those of a previous, similar study in the midwestern United States., The ability of health care leaders to implement effective strategies to improve patient satisfaction scores, quality of care, and patient outcomes becomes increasingly important as reimbursement becomes more closely tied [...]

OBJECTIVE--Although intensive glycemic control achieved with insulin therapy increases the incidence of both moderate and severe hypoglycemia, clinical reports of cognitive impairment due to severe hypoglycemia have been highly variable. It was hypothesized that recurrent moderate hypoglycemia preconditions the brain and protects against damage caused by severe hypoglycemia. RESEARCH DESIGN AND METHODS--Nine-week-old male Sprague-Dawley rats were subjected to either 3 consecutive days of recurrent moderate (25-40 mg/dl) hypoglycemia (RH) or saline injections. On the fourth day, rats were subjected to a hyperinsulinemic (0.2 units x [kg.sup.-1], [min.sup.-1]) severe hypoglycemic (~11 mg/dl) clamp for 60 or 90 min. Neuronal damage was subsequently assessed by hematoxylin-eosin and Fhioro-Jade B staining. The functional significance of severe hypoglycemia-induced brain damage was evaluated by motor and cognitive testing. RESULTS--Severe hypoglycemia induced brain damage and striking deficits in spatial learning and memory. Rats subjected to recurrent moderate hypoglycemia had 62-74% less brain cell death and were protected from most of these cognitive disturbances. CONCLUSIONS--Antecedent recurrent moderate hypoglycemia preconditioned the brain and markedly limited both the extent of severe hypoglycemia-induced neuronal damage and associated cognitive impairment. In conclusion, changes brought about by recurrent moderate hypoglycemia can be viewed, paradoxically, as providing a beneficial adaptive response in that there is mitigation against severe hypoglycemia-induced brain damage and cognitive dysfunction., Hypoglycemiais the major obstacle in achieving tight glycemic control in people with diabetes (1). Intensive insulin therapy increases the risk of iatrogenic hypoglycemia (2). Episodes of both moderate and severe [...]

Objectives: To describe the population in whom bloodstream infections with vancobycin-resistant enterococci occur and the clinical and microbiologic features of infection. Methods: From June 1, 1991, to January 31, 1994, 73 patients with bloodstream infections with vancomycin-resistant enterococci were identified by retrospective review of hospital charts and microbiology records. Results: Fifty-two (73%) of 71 patients with evaluable data were hospitalized in an intensive care unit, the adult oncology unit, or the acquired immunodeficiency syndrome unit. Before the development of the bloodstream infection with vancomycin-resistant entetococci, patients were hospitalized and received antibiotics for a median of 26 and 25.5 days, respectively. A hematologic malignancy, respiratory failure, or renal failure requiring dialysis was present in 59 patients (83%). Acute Physiology and Chronic Health Evaluation 11 scores of the patients ranged from 6 to 35 (median, 17). Forty-five (63%) of the patients died. Compared with 37 patients who had only a single positive blood culture, the 34 patients with 2 or more blood cultures positive for vancomycin-resistant enterococci more often were neutropenic or had acquired immunodeficiency syndrome (740/0 vs 35%; P=.002). Conclusions: Bloodstream infections with vancomycin-resistant enterococci predominantly affect severely ill patients who have received extensive antibiotic treatment during a prolonged hospitalization. Immunocompromised patients are more likely to have a persistent bloodstream infection with vancomycin-resistant enterococci.

* Objective: To assess the efficacy of control measures in decreasing nosocomial transmission of multidrug-resistant tuberculosis. * Design: Retrospective cohort study. * Setting: A teaching hospital in New York City. * Population: 40 patients hospitalized with multidrug-resistant tuberculosis (case-patients) and health care workers receiving tuberculin skin testing. * Interventions: Centers for Disease Control and Prevention (CDC) 1990 guidelines for preventing transmission of tuberculosis, including 1) prompt isolation and treatment of patients with tuberculosis; 2) rapid diagnostic techniques for processing Mycobacterium tuberculosis specimens; 3) negative-pressure isolation rooms; and 4) molded surgical masks for health care workers. * Measurements: Proportion of case-patients with nosocomially acquired tuberculosis and rate of tuberculin skin test conversion among health care workers before and after implementation of control measures. * Results: The proportion of patients with multidrug-resistant strains of M. tuberculosis decreased after the interventions (10 of 70 [14%] compared with 30 of 95 [32%] patients before the intervention; relative risk [RR], 0.5; 95% Cl, 0.2 to 0.9). Before onset of multidrug-resistant tuberculosis, case-patients in the intervention period were as likely to be hospitalized on high-risk wards containing patients with tuberculosis (4 of 10 compared with 17 of 30 patients; RR, 0.7; P = 0.5) but were less likely to be exposed to another case-patient with tuberculosis (1 of 1 0 compared with 20 of 30 patients; RR, 0.2; P = 0.003). Tuberculin skin test conversion rates for health care workers assigned to wards housing patients with tuberculosis were lower in the intervention period than in the preintervention period (4 of 78 [5%] compared with 15 of 90 [17%] conversions; P = 0.02), decreasing to levels observed for workers assigned to other wards (4 of 78 [5%] compared with 9 of 228 [4%] conversions; P = 0.7). * Conclusions: implementing control measures reduced nosocomial transmission of multidrug-resistant strains to patients and health care workers., Transmission of multidrug-resistant tuberculosis (MDR-TB) to hospital patients and staff may be decreased if hospitals implement and adhere to strict control measures. Control measures include better laboratory methods for diagnosing and reporting MDR-TB, improved isolation and treatment of tuberculosis patients, changes in isolation room ventilation and enhanced respiratory protection worn by health care workers. Researchers analyzed in-hospital transmission patterns at one medical center experiencing an outbreak of MDR-TB before and after implementation of control measures. The proportion of patients with MDR-TB decreased from 32% before control measures to 14% after. Although the percentages of health care workers with a positive tuberculin skin test were similar in both periods, further analysis showed that workers with direct patient contact and those working on wards with tuberculosis patients had lower rates of skin test conversions after control measures were implemented.