To assess the prevalence of antimicrobial-resistant pathogens among the most common blood-stream isolates, we examined antimicrobial susceptibility data from The Surveillance Network Database—USA, an ...electronic surveillance system that collects data from 118 clinical microbiology laboratories across the United States. Between 1995 and 1997, resistance to both vancomycin and ampicillin was much more prevalent among Enterococcus faecium than Enterococcus faecalis, suggesting the need for laboratories to identify to species. When staphylococcal isolates were examined for reduced susceptibility to vancomycin (minimum inhibitory concentration = 4 μg/mL), the frequency was highest in methicillin-resistant coagulase-negative staphylococci. We also learned that nonsusceptibility to ceftazidime in Klebsiella pneumoniae was more prevalent among isolates from blood (12.7%) than among isolates from urine (7.1%) or respiratory sources (9.3%). Although antimicrobial resistance is low overall for isolates of Escherichia coli from blood, the prevalence of cefoxitin resistance among ceftazidime-resistant strains (61.9%) suggests the action of mechanisms other than extended-spectrum β-lactamase.
Background Lean practices have been widely used by health care organizations to meet efficiency, performance and quality improvement needs. The lean health care literature shows that the effective ...implementation of lean requires a holistic system-wide approach. However, there is still limited evidence on what drives effective system-wide lean implementation in health care. The existing literature suggests that a deeper understanding of how lean interventions interact with the organizational context is necessary to identify the critical variables to successfully sustain system-wide lean strategies. Purpose and methodology: A multiple case study of three Italian hospitals is conducted with the aim to explore the organizational conditions that are relevant for an effective system-wide lean implementation. A conceptual framework, built on socio-technical system schemas, is used to guide data collection and analysis.
The analysis points out the importance to support lean implementation with an integrated and coordinated strategy involving the social, technical, and external components of the overall hospital system.
BACKGROUND: Despite the ongoing trend towards centralized procurement for Medical Devices (MDs) in Italy, the lack of national guidelines translates into heterogeneity of tender specifications and ...lack of comparability and governability of MDs purchasing processes. OBJECTIVES: To develop a methodology for comparative analysis of tenders for MDs procurement, with the ultimate goal of drafting a national standardized tender dossier. METHODS: The work focused on sanitary gloves. We performed a systematic search and collected documents related to all awarded, expired and ongoing Italian regional tenders from 2015 onwards. We developed an ad hoc extraction protocol of relevant information and performed comprehensive analyses at both dossier and lot level. RESULTS: 13 regional tenders were implemented in 12 out of the 21 Italian Regions during the analyzed period. Both structure and contents of the retrieved documents were highly heterogeneous among the contracting authorities. The characteristics used in lot description were more detailed than those included in the Italian National Classification System of MDs (CND). Consequently, the groups of MDs in the CND include heterogeneous devices. This should be considered in comparative analysis of MDs unit price. Finally, awarding criteria of lots differed substantially among tenders, with quality weighting varying between 30 and 60%. CONCLUSIONS: Tender specifications and criteria should be harmonized among contracting authorities. A higher adherence between classification system and characteristics of the purchased goods is recommended. Finally, technical aspects and quality should have a higher importance in awarding public contracts. Our analysis contributed to the implementation of the procurement of MDs in Italy in several ways. First, the Italian Ministry of Health (MoH) has started a revision of the CND. Second, the authors supported the Italian MoH and Regions in drafting national guidelines for procurement of MDs and a standardized tender dossier for sanitary gloves, aimed at overcoming the current fragmentation in public procurement documents.
Abstract
Human polymorphonuclear cells (PMN) and monocytes (MO) from four ovarian cancer patients and seventeen normal donors were in vitro pretreated with different concentrations (25, 50 and 100IU, ...respectively) of rhGM-CSF. Phagocytosis and killing of PMN and MO as well as PMN polarization were evaluated in cancer patients before treatment (T0) and at the end of each chemotherapeutic cycle (T1, T2, T3 and T4, respectively) in comparison with normal donors. RhGM-CSF did not affect phagocytosis and killing of PMN and MO. On the other hand, this cytokine was per se endowed with the capacity to enhance PMN polarization in both cancer patients (at T2 interval) and normal donors.
Indoor air is a complex mixture of chemicals and airborne particles. Volatile Organic Compounds (VOC), a broad class of chemicals including diverse compounds such as Aldehydes, Terpenes, Aromatic and ...Aliphatic Hydrocarbons and Halogenated Volatile Organics, are an important category of indoor air pollutants. The evaluation of exposure to low doses of Chloroform and Benzene through the measurement of Chloroform and Benzene in urine was performed. Results show that biological monitoring may be helpful in indoor environmental studies in non occupational situations.
Feline chronic enteropathy (CE) is a common gastrointestinal disorder in cats and mainly comprises inflammatory bowel disease (IBD) and small cell lymphoma (SCL). Differentiation between IBD and SCL ...can be diagnostically challenging. We characterized the fecal metabolome of 14 healthy cats and 22 cats with naturally occurring CE (11 cats with IBD and 11 cats with SCL). Principal component analysis and heat map analysis showed distinct clustering between cats with CE and healthy controls. Random forest classification revealed good group prediction for healthy cats and cats with CE, with an overall out-of-bag error rate of 16.7%. Univariate analysis indicated that levels of 84 compounds in cats with CE differed from those in healthy cats. Polyunsaturated fatty acids held discriminatory power in differentiating IBD from SCL. Metabolomic profiles of cats with CE resembled those in people with CE with significant alterations of metabolites related to tryptophan, arachidonic acid, and glutathione pathways.
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