215 results on '"Mody L"'
Search Results
202. Use of urinary collection devices in skilled nursing facilities in five states.
- Author
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Rogers MA, Mody L, Kaufman SR, Fries BE, McMahon LF Jr, and Saint S
- Subjects
- Age Factors, Aged, Aged, 80 and over, Alzheimer Disease epidemiology, Aphasia epidemiology, Cohort Studies, Female, Hip Fractures epidemiology, Humans, Likelihood Functions, Long-Term Care statistics & numerical data, Male, Obesity epidemiology, Retrospective Studies, Risk Factors, Sex Factors, United States, Urinary Incontinence epidemiology, Utilization Review, Catheters, Indwelling statistics & numerical data, Diapers, Adult statistics & numerical data, Frail Elderly statistics & numerical data, Skilled Nursing Facilities statistics & numerical data, Urinary Catheterization statistics & numerical data, Urinary Incontinence nursing
- Abstract
Objectives: To assess use of urinary collection devices (external, intermittent, and indwelling catheters; pads or briefs) and examine predictors of indwelling catheters in skilled nursing facilities (SNFs)., Design: Retrospective cohort study., Setting: SNFs in California, Florida, Michigan, New York, and Texas., Participants: All patients admitted to SNFs in 2003 who remained there for 1 year (N=57,302)., Measurements: Characteristics of patients who used different collection strategies (indwelling, intermittent, and external catheterization; pads or briefs) and predictors of indwelling urinary catheterization from the Nursing Home Minimum Data Set using multinomial logistic regression., Results: The prevalence of indwelling catheterization was 12.6% at admission and 4.5% at the annual assessment (P<.001). Intermittent and external catheterization were infrequently used (<1% at admission and annual assessment). Paraplegia, quadriplegia, multiple sclerosis, and comatose state were strongly associated with indwelling catheterization. Male residents were more likely to use an indwelling catheter at every assessment, as were obese patients; individuals with diabetes mellitus, renal failure, skin conditions, deep vein thrombosis, aphasia, or end-stage disease; and those who were taking more medications., Conclusion: Coinciding with federal regulations, urinary catheterization was lower than has been reported previously and declined over time. Further reduction should be targeted at the evaluation of skin problems, appropriateness of multiple medications, and alternative measures in patients with diabetes mellitus, obesity, deep vein thrombosis, and communication problems.
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- 2008
- Full Text
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203. Epidemiology of Staphylococcus aureus colonization in nursing home residents.
- Author
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Mody L, Kauffman CA, Donabedian S, Zervos M, and Bradley SF
- Subjects
- Community-Acquired Infections epidemiology, Community-Acquired Infections microbiology, DNA, Bacterial genetics, Electrophoresis, Gel, Pulsed-Field, Humans, Methicillin Resistance, Michigan epidemiology, Staphylococcus aureus drug effects, Staphylococcus aureus genetics, Nursing Homes, Staphylococcal Infections epidemiology, Staphylococcus aureus isolation & purification
- Abstract
Background: We sought to characterize the clinical and molecular epidemiologic characteristics of Staphylococcus aureus colonization (especially extranasal colonization) and to determine the extent to which community-associated methicillin-resistant S. aureus (MRSA) has emerged in community nursing homes., Methods: The study enrolled a total of 213 residents, with or without an indwelling device, from 14 nursing homes in southeastern Michigan. Samples were obtained from the nares, oropharynx, groin, perianal area, wounds, and enteral feeding tube site. Standard microbiologic methods were used to identify methicillin-susceptible S. aureus and MRSA. Molecular epidemiologic methods included pulsed-field gel electrophoresis, PCR detection of Panton-Valentine leukocidin, and SCCmec and agr typing., Results: One hundred thirty-one residents (62%) were colonized with S. aureus (MRSA colonization in 86). S. aureus colonization occurred in 80 (76%) of 105 residents with indwelling devices and in 51 (47%) of 108 residents without indwelling devices (P<.001). Of the 86 residents who were colonized with MRSA, nares culture results were positive for only 56 (65%). Residents with devices in place were more likely to be colonized at multiple sites. Eleven different strains of MRSA were identified by pulsed-field gel electrophoresis. Seventy-three residents (85%) were colonized with hospital-associated SCCmec II strains, and 8 (9%) were colonized with community-associated SCCmec IV strains, 2 of which carried Panton-Valentine leukocidin., Conclusions: Extranasal colonization with MRSA is common among nursing home residents-particularly among residents with an indwelling device. We documented the emergence of community-associated SCCmec IV MRSA strains in the community nursing home setting in southeastern Michigan.
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- 2008
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204. Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group.
- Author
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Mody L, Maheshwari S, Galecki A, Kauffman CA, and Bradley SF
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- Aged, Bacteria isolation & purification, Bacterial Infections drug therapy, Case-Control Studies, Cross-Sectional Studies, Enteral Nutrition instrumentation, Female, Humans, Logistic Models, Male, Methicillin Resistance, Michigan epidemiology, Risk Factors, Urinary Catheterization instrumentation, Vancomycin Resistance, Bacterial Infections epidemiology, Catheters, Indwelling adverse effects, Drug Resistance, Microbial, Nursing Homes
- Abstract
Objectives: To quantify the relationship between indwelling devices (urinary catheters, feeding tubes, and peripherally inserted central catheters) and carriage of antimicrobial-resistant pathogens in nursing home residents., Design: Cross-sectional., Setting: Community nursing home in Southeast Michigan., Participants: Residents with indwelling devices (n=100) and randomly selected control residents (n=100) in 14 nursing homes., Measurements: Data on age, functional status, and Charlson comorbidity score were collected. Samples were obtained from nares, oropharynx, groin, wounds, perianal area, and enteral feeding tube site. Standard microbiological methods were used to identify methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and ceftazidime-resistant (CTZ-R) gram-negative bacteria (GNB)., Results: Use of indwelling devices was associated with colonization with MRSA at any site (odds ratio (OR)=2.0, P=.04), groin (OR=4.8, P=.006), and perianal area (OR=3.6, P=.01) and CTZ-R GNB at any site (OR=5.6, P=.003). Use of enteral feeding tubes was associated with MRSA colonization in the oropharynx (OR=3.3, P=.02)., Conclusion: Use of indwelling devices is associated with greater colonization with antimicrobial-resistant pathogens. This study serves as an initial step in defining a high-risk group that merits intensive infection control efforts.
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- 2007
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205. Pandemic influenza planning in nursing homes: are we prepared?
- Author
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Mody L and Cinti S
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- Humans, Influenza Vaccines supply & distribution, Influenza, Human prevention & control, Retrospective Studies, United States epidemiology, Disease Outbreaks prevention & control, Health Planning Guidelines, Influenza A Virus, H5N1 Subtype, Influenza, Human epidemiology, Nursing Homes
- Abstract
Avian influenza or Influenza A (H5N1) is caused by a viral strain that occurs naturally in wild birds, but to which humans are immunologically naïve. If an influenza pandemic occurs, it is expected to have dire consequences, including millions of deaths, social disruption, and enormous economic consequences. The Department of Health and Human Resources plan, released in November 2005, clearly affirms the threat of a pandemic. Anticipating a disruption in many factions of society, every segment of the healthcare industry, including nursing homes, will be affected and will need to be self-sufficient. Disruption of vaccine distribution during the seasonal influenza vaccine shortage during the 2004/05 influenza season is but one example of erratic emergency planning. Nursing homes will have to make vital decisions and provide care to older adults who will not be on the initial priority list for vaccine. At the same time, nursing homes will face an anticipated shortage of antiviral medications and be expected to provide surge capacity for overwhelmed hospitals. This article provides an overview of current recommendations for pandemic preparedness and the potential effect of a pandemic on the nursing home industry. It highlights the need for collaborative planning and dialogue between nursing homes and various stakeholders already heavily invested in pandemic preparedness.
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- 2007
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206. Infection control issues in older adults.
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Mody L
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- Age Factors, Aged, Aged, 80 and over, Humans, Infections transmission, Morbidity trends, Risk Factors, United States epidemiology, Disease Transmission, Infectious prevention & control, Infection Control organization & administration, Infections epidemiology
- Abstract
Older adults receive care from various settings, including acute care hospitals, skilled nursing facilities, nursing homes, group homes, outpatient primary care, specialty clinics, and home. In these various settings, older adults are exposed to pathogens, which makes them "vectors" that transport pathogens from one setting to another and makes them vulnerable to care fragmentation. These health care settings face unique challenges that require individualized infection control programs. Infection control programs should address: surveillance for infections and antimicrobial resistance, outbreak investigation and a control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs.
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- 2007
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207. Optimizing antimicrobial use in nursing homes: no longer optional.
- Author
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Mody L
- Subjects
- Aged, Drug Utilization standards, Homes for the Aged, Humans, Nursing Homes, Anti-Bacterial Agents therapeutic use
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- 2007
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208. Assessment of pneumonia in older adults: effect of functional status.
- Author
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Mody L, Sun R, and Bradley SF
- Subjects
- Aged, Aged, 80 and over, Comorbidity, Female, Geriatric Assessment, Hospital Mortality, Humans, Length of Stay, Male, Odds Ratio, Pneumonia diagnostic imaging, Pneumonia mortality, Prospective Studies, Radiography, Pneumonia epidemiology
- Abstract
Objectives: Evaluate the effect of preadmission functional status on severity of pneumonia, length of hospital stay (LOS), and all-cause 30-day and 1-year mortality of adults aged 60 and older and to understand the effect of pneumonia on short-term functional impairment., Design: Prospective cohort study., Setting: University hospital., Participants: One hundred twelve patients with radiograph-proven pneumonia (mean age 74.6) were enrolled., Measurements: Functional status and comorbidities were assessed using the Functional Autonomy Measurement System (SMAF) and Charlson Comorbidity Index. Clinical information was used to calculate the Pneumonia Prognostic Index (PPI)., Results: Eighty-four (75%) patients were functionally independent (FI) before admission, with a SMAF score of 40 or lower. Dementia and aspiration history were higher in the group that was functionally dependent (FD) before admission (P<.001). The FI group had less-severe pneumonia per the PPI and shorter mean LOS+/-standard deviation (5.62+/-0.51 days) than the FD group (11.42+/-2.58, P<.004). The FI group had lower 1-year mortality (19/65, 23%) than the FD group (14/28, 50%), and the difference remained significant after adjusting for Charlson Index and severity of illness (P=.009). All patients lost function after admission, with loss being more pronounced in the FI group (mean change 19.24+/-12.9 vs 4.72+/-6.55, P<.001)., Conclusion: Older adults who were FI before admission were more likely to present with less-severe pneumonia and have a shorter LOS. In addition, further loss of function was common in these patients. Assessment of function before and during hospitalization should be an integral part of clinical evaluation in all older adults with pneumonia.
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- 2006
- Full Text
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209. Impact of the 2004-2005 influenza vaccine shortage on immunization practices in long-term care facilities.
- Author
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Mody L, Langa KM, and Malani PN
- Subjects
- Centers for Disease Control and Prevention, U.S., Cross-Sectional Studies, Guidelines as Topic, Humans, Influenza Vaccines administration & dosage, Long-Term Care organization & administration, Organizational Policy, Surveys and Questionnaires, United States, Vaccination statistics & numerical data, Immunization Programs standards, Influenza Vaccines supply & distribution, Influenza, Human prevention & control, Patient Selection, Residential Facilities organization & administration
- Abstract
Objective: To assess the response of long-term care facilities (LTCFs) to the 2004-2005 influenza vaccine shortage and the impact on resident and healthcare worker (HCW) immunization rates., Methods: A 12-item questionnaire was sent to 824 randomly selected LTCFs in December 2004. The following 2 open-ended questions were also asked: "How did you cope with the vaccine shortage?" and "Who helped you get your supply?" Immunization rates reported by LTCF administrators for 2003-2003 and 2003-2004 were compared with those for 2004-2005. Immunization rates were defined as the proportion of all eligible residents and HCWs who received influenza vaccine., Results: Responses were received from 380 LTCFs (46.3%), which had a total of 38,447 beds. Resident mean influenza immunization rates (+/-SD) decreased from 85%+/-15.3% in 2002-2003 and 85.1%+/-15.3% in 2003-2004 to 81.9%+/-19.4% in the 2004-2005 influenza season (P=.025). The immunization rates among HCWs also decreased from 51% in 2002-2003 and 2003-2004 to 38.4% in 2004-2005 (P<.001). In response to one of the open-ended questions, 96 facilities (25.3%) reported that they obtained vaccine from 2 or more sources. Eight percent commented on specific intensified infection control efforts, and only 2.3% commented on emergency preparedness., Conclusions: The influenza vaccine shortage in 2004-2005 impacted immunization practices of LTCFs across the United States, leading to decreases in both resident and HCW vaccination rates. The significant decrease in vaccination rates in LTCFs is of concern and has broad implications for policy makers working on emergency preparedness for a possible pandemic of influenza.
- Published
- 2006
- Full Text
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210. Molecular epidemiology of Staphylococcus aureus colonization in 2 long-term care facilities.
- Author
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Mody L, Flannery E, Bielaczyc A, and Bradley SF
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- Colony Count, Microbial, Female, Humans, Long-Term Care, Male, Michigan, Nursing Homes, Staphylococcal Infections diagnosis, Staphylococcus aureus pathogenicity, Methicillin Resistance, Molecular Epidemiology, Staphylococcal Infections epidemiology, Staphylococcus aureus growth & development
- Abstract
Persistent colonization with Staphylococcus aureus was assessed in 22 nursing home residents. Eighteen residents (82%) remained colonized with the same strain found at baseline; 6 (33%) of 18 residents transiently acquired a new strain. Four residents (18%) acquired a new persistent strain. Residents colonized with methicillin-resistant S. aureus were more likely to acquire a new strain (67%) than were residents colonized with methicillin-susceptible S. aureus (20%) (P=.04).
- Published
- 2006
- Full Text
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211. In vivo transfer of high-level mupirocin resistance from Staphylococcus epidermidis to methicillin-resistant Staphylococcus aureus associated with failure of mupirocin prophylaxis.
- Author
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Hurdle JG, O'Neill AJ, Mody L, Chopra I, and Bradley SF
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- Aged, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Bacterial Proteins genetics, Carrier State drug therapy, Carrier State microbiology, Conjugation, Genetic, Drug Resistance, Multiple, Bacterial, Humans, Male, Methicillin Resistance, Mupirocin pharmacology, Nuclear Proteins genetics, Nursing Homes, R Factors genetics, R Factors isolation & purification, Staphylococcal Infections microbiology, Staphylococcus aureus genetics, Staphylococcus epidermidis genetics, Antibiotic Prophylaxis, Drug Resistance, Bacterial genetics, Gene Transfer, Horizontal, Mupirocin therapeutic use, Staphylococcal Infections prevention & control, Staphylococcus aureus drug effects, Staphylococcus epidermidis drug effects
- Abstract
Objectives: We examined the molecular basis of the emergence of mupirocin resistance in a methicillin-resistant Staphylococcus aureus (MRSA) strain colonizing a nursing home resident undergoing mupirocin prophylaxis., Patient and Methods: A persistent carrier of mupirocin-susceptible MRSA participated in a trial of mupirocin for nasal decolonization among nursing home residents. During prophylaxis a high-level mupirocin-resistant MRSA emerged in the nasal isolates from this patient. S. aureus and coagulase-negative staphylococci were isolated prior to, during and after 14 days of mupirocin treatment. The staphylococcal isolates and their plasmids were examined by molecular genetic methods., Results: All mupirocin-susceptible and -resistant MRSA isolates possessed the same genotype. The patient was also colonized by a single mupirocin-resistant Staphylococcus epidermidis strain. The mupirocin-resistant MRSA and S. epidermidis strains harboured identical plasmids that carried the mupA determinant and genes for conjugative DNA transfer in staphylococci. These plasmids could be transferred in vitro from both clinical isolates to S. aureus RN2677., Conclusions: The MRSA strain contained a conjugative plasmid expressing mupA that was identical with that found in the S. epidermidis strain which colonized the patient. These findings suggest that transfer of mupA from S. epidermidis to MRSA probably occurred during mupirocin prophylaxis.
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- 2005
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212. Preventing infections in nursing homes: a survey of infection control practices in southeast Michigan.
- Author
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Mody L, Langa KM, Saint S, and Bradley SF
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- Guideline Adherence, Humans, Influenza, Human prevention & control, Michigan, Pneumococcal Infections prevention & control, Surveys and Questionnaires, Vaccination, Cross Infection prevention & control, Infection Control, Nursing Homes
- Abstract
Background: Studies on adherence to infection control policies in nursing homes (NHs) are limited. This pilot study explores the use of various infection control practices and the role of infection control practitioners in southeast Michigan NHs., Methods: A 43-item self-administered questionnaire and explanatory cover letter were mailed to 105 licensed NHs in southeast Michigan. A second mailing was sent to the nonresponders 4 weeks later., Results: Significant variability existed in adoption of various infection control measures with respect to time spent in infection control activities (50% of facilities having a full-time infection control practitioner), definitions used in monitoring infections, and immunization rates (influenza: range, 0%-100%; mean, 73.2%; pneumococcal: range, 0%-100%; mean, 38.5%)., Conclusion: Although strides have been made in infection control research in NHs, significant variations exist in implementation of infection control methods and guidelines. Future research should focus on identifying barriers to infection control in NHs.
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- 2005
- Full Text
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213. Introduction of a waterless alcohol-based hand rub in a long-term-care facility.
- Author
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Mody L, McNeil SA, Sun R, Bradley SE, and Kauffman CA
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- Anti-Infective Agents, Local administration & dosage, Candida isolation & purification, Enterococcus isolation & purification, Ethanol administration & dosage, Gram-Negative Bacteria isolation & purification, Hand microbiology, Humans, Hygiene, Nursing Staff, Staphylococcus aureus isolation & purification, Anti-Infective Agents, Local pharmacology, Ethanol pharmacology, Hand Disinfection methods, Hand Disinfection standards, Nursing Homes
- Abstract
Objective: To examine the impact of introduction of an alcohol-based hand rub on hand hygiene knowledge and compliance and hand colonization of healthcare workers (HCWs) in a long-term-care facility (LTCF)., Methods: Two floors of an LTCF participated. Ward A used the hand rub as an adjunct to soap and water; ward B was the control. HCWs' hands were cultured using the bag-broth technique for Staphylococcus aureus, gram-negative bacilli (GNB), Candida, and vancomycin-resistant enterococci (VRE). HCWs completed a questionnaire at baseline and after an educational intervention and introduction of rub., Results: Hand hygiene practices, knowledge, and opinions did not change after the educational or rub intervention. Ward A HCWs thought that the rub was faster (P = .002) and less drying (P = .04) than soap. Hand hygiene frequency did not differ at baseline between the two floors, but increased on ward A by the end of the study (P = .04). HCWs were colonized frequently with GNB (66%), Candida (41%), S. aureus (20%), and VRE (9%). Although colonization did not change from baseline on either ward, the rub was more effective in clearing GNB P =.03) and S. aureus (P = .003). Nosocomial infection rates did not change., Conclusion: The alcohol-based hand rub was a faster, more convenient, less drying method of hand hygiene for HCWs in an LTCF, and it improved compliance. Although microbial colonization did not change, the rub was more efficacious in removing pathogens already present on the hands of HCWs.
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- 2003
- Full Text
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214. Community-acquired pneumonia in older veterans: does the pneumonia prognosis index help?
- Author
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Mody L, Sun R, and Bradley S
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- Aged, Aged, 80 and over, Community-Acquired Infections complications, Female, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Pneumonia complications, Veterans
- Abstract
Objectives: Mortality rates from pneumonia increase steadily with age. Recently, a disease severity model (the Pneumonia Prognosis Index (PPI)) has been developed to predict mortality from community-acquired pneumonia (CAP). PPI ranks severity of pneumonia from 1 to 5, with 5 being most severe. This retrospective study utilizes the PPI to address the prognosis of CAP in older adults., Design: Retrospective review of medical charts., Setting: Department of Veterans Affairs Medical Center., Participants: All adults aged 60 and older admitted to a Veterans Affairs Medical Center with CAP between January 1 and December 31, 1998., Measurements: PPI was calculated using subjects' demographics, comorbidities, presenting symptoms, and laboratory measurements., Results: Eighty-two patients aged 60 and older were admitted with 101 episodes of CAP. The mean age +/- standard deviation was 72 +/- 9. Seventy-four episodes were admitted from the emergency room, 20 from another hospital, seven from nursing homes, and five from outpatient clinics. Mean length of stay was 7.1 +/- 6 days. Comorbid conditions included coronary artery disease, diabetes mellitus, congestive heart failure, neoplasm, stroke, and renal failure. Most episodes fell into higher PPI classes, with 20% in Class 3, 46% in Class 4, and 32% in Class 5. PPI score was significantly related to length of stay (P < .001), intensity of care (P < .0001), and presence of complications (P <.001). Mortality was 14% at 30 days: 0.5% in Class 3,10.8% in Class 4, and 25% in Class 5., Conclusion: The PPI was effective in identifying older adults with CAP who were at risk of a poor outcome, but the practical utility of this index remains to be determined.Further prospective studies are required to elucidate the importance of comorbidities, severity at presentation, and premorbid functional status on clinical and functional outcomes of CAP in older adults.
- Published
- 2002
- Full Text
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215. Clostridium difficile-associated diarrhea in a VA medical center: clustering of cases, association with antibiotic usage, and impact on HIV-infected patients.
- Author
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Mody LR, Smith SM, and Dever LL
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- Adult, Aged, Case-Control Studies, Cephalosporins pharmacology, Cephalosporins therapeutic use, Clostridioides difficile drug effects, Clostridioides difficile pathogenicity, Diarrhea microbiology, Enterocolitis, Pseudomembranous complications, Enterocolitis, Pseudomembranous drug therapy, Feces microbiology, Female, Hospitals, Veterans, Humans, Male, Middle Aged, Clostridioides difficile isolation & purification, Diarrhea etiology, Enterocolitis, Pseudomembranous epidemiology, HIV Infections complications
- Abstract
A case-control study of patients with stools assayed for Clostridium difficile toxin over a 24-month period at a Veterans Affairs hospital found that the majority of cases (70.6%) occurred in temporal clusters. Clustering was particularly evident on a designated human immunodeficiency virus (HIV) unit. Thirty-four (75.5%) of 45 HIV-infected patients with C difficile-associated diarrhea (CDAD) died during their hospitalization. Third-generation cephalosporins were the antibiotics most strongly associated with CDAD.
- Published
- 2001
- Full Text
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