Patients In Health Care Settings Research Articles

Knowledge, Attitude and Practice Health Care Ethics among Speech Language Pathologists

BACKGROUND: Speech Language Pathology is guided by ethical principle as it is the tool for professional discipline. It is generally agreed that morality is all about right and wrong conduct based on socially approved norms. Healthcare ethics deals with moral code of conduct to patients in healthcare setting, taking in consideration of individuality, safety, welfare and self respect of them. Increase in unethical behavior from healthcare professional is an problematic issue of immediate concern. OBJECTIVE: To assess the knowledge, attitudes and practice of health care ethics among speech language pathologists. Methodology: The Cross Sectional study was done among Speech Language Pathologists at Riphah College of Rehabilitation Sciences, Lahore, within the duration of six months from 1st jan 2017 to 30th june 2017 by using Convenient Sampling Technique. 104 Speech and language Pathologist (SLP) were included in the study. To conduct the research, standardized questionnaire was used which was previously used for assessing the (KAP) knowledge, attitudes and practice healthcare ethics among physiotherapists and medical students. The data was analyzed by Statistical package for Social sciences ( SPSS ) software 20.Percentage of responses were calculated. Chi-square test was applied to check the level of significance among different categories of available variables. RESULTS: A total of 104 respondent speech language pathologists, were included in the study. The distribution of gender comprised of 37.5% (n=39) males and 62.5% (n=65) females with 72.1% age range from the 23-28 years age group.62% (n=65) speech language pathologists were unaware about the main contents of ethical knowledge.42%(n=44) speech language pathologists responded that knowledge of ethics is very important to their work and majority 35.58%(n=37) got knowledge through lectures and seminars.83.6% respondents were aware about the existence of no ethical committee at their institutions. As far as gender distribution was concerned 12% male and 27% female responded that knowledge of ethics is very important in work setting. Knowledge and attitude of healthcare ethics have a general manifestation on practical application of healthcare ethics. CONCLUSION: Overall results of the study showed gaps in knowledge but significant relationship towards attitude and practice of healthcare ethics in speech language pathologists and institutions. Effort should be made to increase the knowledge about the ethics in medical profession.

Feasibility of a communication program: improving communication between nurses and persons with aphasia in a peripheral hospital

ABSTRACTBackground: Difficulty in communicating (due to aphasia) can have serious consequences for patients in health care settings. Communication Partner Training is effective for improving communication between people with aphasia and health care professionals.Aim and Objective: This study aims to evaluate the feasibility of developing and introducing a Communication Program which focuses on improving communication between nurses and persons with aphasia in a peripheral hospital setting.Methods & Procedures: A mixed-methods feasibility study was conducted with a pre-test post-test design in the quantitative part and two focus group discussions in the qualitative part. Nurses received training for communicating with persons with aphasia. In the pre-test and post-test, nurses filled in a questionnaire for barriers and facilitators and a feasibility questionnaire. Nurses’ attitudes towards the Communication Program were further explored in two focus group discussions.Outcomes & Results: Forty six nurses took part in the training sessions. Most nurses were satisfied about the Communication Program (24/30) and intended to continue using it (25/30). Almost all nurses saw positive effects for patients with aphasia (27/30), such as an increase in the ability to communicate. However, nurses reported that using the program was time consuming and that they still often experienced frustration when communicating with persons with aphasia.Conclusions: Improving communication with persons with aphasia via the Communication Program seems feasible and valuable according to nurses. Nurses probably need more support during implementation of the Communication Program, mainly due to time barriers and the complexity of communicating with persons with aphasia. Further research should focus on revising the program, training health care professionals with different educational backgrounds, and assessing the implementation of this communication partner training in health care settings.

518. Modeling the Potential Impact of Administering Vaccines Against Clostridium difficile Infection to Individuals in Healthcare Facilities

BackgroundVaccines against Clostridium difficile infection (CDI) are in development, with potential to directly protect those vaccinated and to mitigate transmission by reducing environmental contamination caused by prevented symptoms. For a vaccine that may or may not alter susceptibility to acquiring colonization, its projected transmission-reduction effect may depend on the contribution of symptomatic CDI to overall transmission, which remains uncertain. Mathematical models can help project population effects of vaccine administration under assumptions consistent with existing data.MethodsWe designed a simulation model of CDI among patients in a network of 10 short- and long-term acute care hospitals and nursing homes. Model calibration relied on published infection and carriage data and whole genome sequencing studies that estimated the fraction of CDI attributable to transmission from other CDI patients in healthcare settings. The modeled vaccine effectiveness for reducing the rate of progression to CDI among carriers was set at 75%, achieved after completing a vaccine course. We then simulated initiation of this vaccine course to a random subset of patients at transfer or live discharge and tallied direct and indirect CDI-reduction effects per vaccinated patient over 5 years.ResultsModel calibration found that data are consistent with higher infectivity of CDI patients over other carriers by a factor of 30–85, depending on assumed rates of initial carriage importation. Vaccine simulations produced an average reduction of 36 CDI cases per 1,000 vaccinated patients, with 25 of those cases prevented among those vaccinated and 11 prevented among unvaccinated patients. These results were robust across transmission and carriage rates supported by data.ConclusionOur findings demonstrate potential for a vaccine against CDI to reduce transmissions in healthcare facilities, even if it does not decrease acquisition of carriage per exposure among those receiving it. The finding is robust to the remaining uncertainty around the relative prevalence and infectivity of CDI patients among all carriers. The vaccine will have maximal impact if received by individuals likely to experience future infections in settings where environmental contamination poses risk to others.Disclosures D. Toth, Pfizer, Inc.: Research Contractor, Research support. M. Samore, Pfizer, Inc.: Research Contractor, Research support. H. Yu, Pfizer, Inc: Employee and Shareholder, Salary. A. Quintana, Pfizer, Inc.: Employee and Shareholder, Salary. D. L. Swerdlow, Pfizer Inc.: Employee and Shareholder, Salary.

Candida auris: The recent emergence of a multidrug-resistant fungal pathogen.

Candida auris is an emerging multidrug-resistant yeast that causes serious invasive infections with high mortality. It was first discovered in 2009, and since then, individual cases or outbreaks have been reported from over 20 countries on five continents. Controlling C. auris is challenging for several reasons: (1) it is resistant to multiple classes of antifungals, (2) it can be misidentified as other yeasts by commonly available identification methods, and (3) because of its ability to colonize patients perhaps indefinitely and persist in the healthcare environment, it can spread between patients in healthcare settings. The transmissibility and high levels of antifungal resistance that are characteristic of C. auris set it apart from most other Candida species. A robust response that involves the laboratory, clinicians, and public health agencies is needed to identify and treat infections and prevent transmission. We review the global emergence, biology, challenges with laboratory identification, drug resistance, clinical manifestations, treatment, risk factors for infection, transmission, and control of C. auris.

Beyond the List of Traits: Addressing and Assessing Cultural Needs of Patients in Health Care Settings

Historically, cultural competence included providing a list of traits or characteristics germane to ethnic and racial groups. Although it is important to understand cultural groups broadly rather t...

Ethical challenges faced by healthcare professionals who care for suicidal patients: a scoping review.

For each one of the approximately 800,000 people who die from suicide every year, an additional twenty people attempt suicide. Many of these attempts result in hospitalization or in contact with other healthcare services. However, many personal, educational, and institutional barriers make it difficult for healthcare professionals to care for suicidal individuals. We reviewedliterature that discusses suicidal patients in healthcare settings in order to highlight common ethical issues and to identify knowledge gaps.A sample was generated via PubMed using keywords "[(ethics OR *ethic*) AND suicid*] AND [English (Language) OR French (Language)]" (final N = 52), ethics content wasextracted according to scoping review methodology, and categorized thematically. We identified three main areas posing ethical challenges for health professionals caring for suicidal individuals and their families. These were: (1) making clinical decisions for patients in acute care or when presented with specific circumstances; (2) issues arising from therapeutic relationships in chronic care, and (3) organizational factors. There is considerable uncertainty about how to resolve ethical issues when caring for someone who is suicidal. The stigma associated with suicide and mental illness, problems associated with risk-benefit assessments, and the fear of being held liable for malpractice should a patient die by suicide were overarching themes present across these three categories. Caring for suicidal patients is clinically and ethically challenging. The current literature highlights the complexity and range of decisions that need to be made. More attention should be paid to the difficulties faced by healthcare professionals and the development of solutions.

Prostate Cancer Information Available in Health-Care Provider Offices: An Analysis of Content, Readability, and Cultural Sensitivity.

Prostate cancer (PrCA) is the most common cancer affecting men in the United States, and African American men have the highest incidence among men in the United States. Little is known about the PrCA-related educational materials being provided to patients in health-care settings. Content, readability, and cultural sensitivity of materials available in providers’ practices in South Carolina were examined. A total of 44 educational materials about PrCA and associated sexual dysfunction was collected from 16 general and specialty practices. The content of the materials was coded, and cultural sensitivity was assessed using the Cultural Sensitivity Assessment Tool. Flesch Reading Ease, Flesch-Kincaid Grade Level, and the Simple Measure of Gobbledygook were used to assess readability. Communication with health-care providers (52.3%), side effects of PrCA treatment (40.9%), sexual dysfunction and its treatment (38.6%), and treatment options (34.1%) were frequently presented. All materials had acceptable cultural sensitivity scores; however, 2.3% and 15.9% of materials demonstrated unacceptable cultural sensitivity regarding format and visual messages, respectively. Readability of the materials varied. More than half of the materials were written above a high-school reading level. PrCA-related materials available in health-care practices may not meet patients’ needs regarding content, cultural sensitivity, and readability. A wide range of educational materials that address various aspects of PrCA, including treatment options and side effects, should be presented in plain language and be culturally sensitive.

Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from the European Centre for Disease Prevention and Control

BackgroundInfections with carbapenem-resistant Enterobacteriaceae (CRE) are increasingly being reported from patients in healthcare settings. They are associated with high patient morbidity, attributable mortality and hospital costs. Patients who are “at-risk” may be carriers of these multidrug-resistant Enterobacteriaceae (MDR-E).The purpose of this guidance is to raise awareness and identify the “at-risk” patient when admitted to a healthcare setting and to outline effective infection prevention and control measures to halt the entry and spread of CRE.MethodsThe guidance was created by a group of experts who were functioning independently of their organisations, during two meetings hosted by the European Centre for Disease Prevention and Control. A list of epidemiological risk factors placing patients “at-risk” for carriage with CRE was created by the experts. The conclusions of a systematic review on the prevention of spread of CRE, with the addition of expert opinion, were used to construct lists of core and supplemental infection prevention and control measures to be implemented for “at-risk” patients upon admission to healthcare settings.ResultsIndividuals with the following profile are “at-risk” for carriage of CRE: a) a history of an overnight stay in a healthcare setting in the last 12 months, b) dialysis-dependent or cancer chemotherapy in the last 12 months, c) known previous carriage of CRE in the last 12 months and d) epidemiological linkage to a known carrier of a CRE.Core infection prevention and control measures that should be considered for all patients in healthcare settings were compiled. Preliminary supplemental measures to be implemented for “at-risk” patients on admission are: pre-emptive isolation, active screening for CRE, and contact precautions. Patients who are confirmed positive for CRE will need additional supplemental measures.ConclusionsStrengthening the microbiological capacity, surveillance and reporting of new cases of CRE in healthcare settings and countries is necessary to monitor the epidemiological situation so that, if necessary, the implemented CRE prevention strategies can be refined in a timely manner. Creating a large communication network to exchange this information would be helpful to understand the extent of the CRE reservoir and to prevent infections in healthcare settings, by applying the principles outlined here.This guidance document offers suggestions for best practices, but is in no way prescriptive for all healthcare settings and all countries. Successful implementation will result if there is local commitment and accountability. The options for intervention can be adopted or adapted to local needs, depending on the availability of financial and structural resources.

Design of the HPTN 065 (TLC-Plus) study: A study to evaluate the feasibility of an enhanced test, link-to-care, plus treat approach for HIV prevention in the United States.

Background/AimsHIV continues to be a major public health threat in the United States, and mathematical modeling has demonstrated that the universal effective use of antiretroviral therapy among all HIV-positive individuals (i.e. the “test and treat” approach) has the potential to control HIV. However, to accomplish this, all the steps that define the HIV care continuum must be achieved at high levels, including HIV testing and diagnosis, linkage to and retention in clinical care, antiretroviral medication initiation, and adherence to achieve and maintain viral suppression. The HPTN 065 (Test, Link-to-Care Plus Treat [TLC-Plus]) study was designed to determine the feasibility of the “test and treat” approach in the United States.MethodsHPTN 065 was conducted in two intervention communities, Bronx, NY, and Washington, DC, along with four non-intervention communities, Chicago, IL; Houston, TX; Miami, FL; and Philadelphia, PA. The study consisted of five components: (1) exploring the feasibility of expanded HIV testing via social mobilization and the universal offer of testing in hospital settings, (2) evaluating the effectiveness of financial incentives to increase linkage to care, (3) evaluating the effectiveness of financial incentives to increase viral suppression, (4) evaluating the effectiveness of a computer-delivered intervention to decrease risk behavior in HIV-positive patients in healthcare settings, and (5) administering provider and patient surveys to assess knowledge and attitudes regarding the use of antiretroviral therapy for prevention and the use of financial incentives to improve health outcomes. The study used observational cohorts, cluster and individual randomization, and made novel use of the existing national HIV surveillance data infrastructure. All components were developed with input from a community advisory board, and pragmatic methods were used to implement and assess the outcomes for each study component.ResultsA total of 76 sites in Washington, DC, and the Bronx, NY, participated in the study: 37 HIV test sites, including 16 hospitals, and 39 HIV care sites. Between September 2010 and December 2014, all study components were successfully implemented at these sites and resulted in valid outcomes. Our pragmatic approach to the study design, implementation, and the assessment of study outcomes allowed the study to be conducted within established programmatic structures and processes. In addition, it was successfully layered on the ongoing standard of care and existing data infrastructure without disrupting health services.ConclusionThe HPTN 065 study demonstrated the feasibility of implementing and evaluating a multi-component “test and treat” trial that included a large number of community sites and involved pragmatic approaches to study implementation and evaluation.

Managing Difficult Patients: Roles of Psychologists in the Age of Interdisciplinary Care.

Various problems can occur during encounters between health providers and patients. In some instances, clinicians attribute these problems to patients being "difficult." However, clinicians' perception of difficulties in the clinical encounter are also influenced by: clinicians' own attitudes, thoughts, and behavior; the specific setting in which patient and clinician interact; and properties of the healthcare organization in which they are embedded. This article explores how psychologists in medical settings can serve as a resource that: improves patient care for difficult patients; supports provider wellness; provides relevant education to clinical providers; and reduces the stress that difficult patients place on the healthcare system. The definition, scope, and impact of difficult patients in healthcare settings are reviewed, including an examination of patient, clinician, and systems factors that contribute to the etiology of difficult clinical encounters. Strategies are discussed that may prevent or limit the adverse impact of difficult patients in healthcare, with special emphasis on the roles of psychologists in interprofessional healthcare teams.

Bariatric Surgery Patients' Perceptions of Weight-Related Stigma in Healthcare Settings Impair Post-surgery Dietary Adherence

Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients' experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery.Objectives: (1) Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2) understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3) explore provider and patient perspectives on adherence and stigma in healthcare settings.Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis.Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance.Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias internalization could enhance dietary adherence, regardless of time since patient's weight-loss surgery.

Are health care personnel trained in correct use of personal protective equipment?

Effective use of personal protective equipment (PPE) is essential to protect personnel and patients in health care settings. However, in a survey of 222 health care personnel, PPE training was often suboptimal with no requirement for demonstration of proficiency. Fourteen percent of physicians reported no previous training in use of PPE.

Including Language Access into Medicaid ACO Design

Quality health care relies upon communication in a patient's preferred language. Language access in health care occurs when individuals are: (1) Welcomed by providers regardless of language ability; and (2) Offered quality language services as part of their care. Federal law generally requires access to health care and quality language services for deaf and Limited English Proficient (LEP) patients in health care settings, but these patients still find it hard to access health care and quality language services.Meanwhile, several states are implementing Medicaid Accountable Care Organization (ACO) initiatives to reduce health care costs and improve health care quality. Alternative payment methods used in these initiatives can give Accountable Care Organizations more flexibility to design linguistically accessible care, but they can also put ACOs at increased financial risk for the cost of care. If these new payment methods do not account for differences in patient language needs, ACO initiatives could have the unintended consequence of rewarding ACOs who do not reach out to deaf and LEP communities or offer quality language services.We reviewed public documents related to Medicaid ACO initiatives in six states. Some of these documents address language access. More could be done, however, to pay for language access efforts. This article describes Medicaid ACO initiatives and explores how different payment tools could be leveraged to reward ACOs for increased access to care and quality language services. We find that a combination of payment tools might be helpful to encourage both access and quality.

Knowledge, attitude, and practices and influencing factors related to seasonal influenza vaccination among health-care workers in Qingdao, China, 2013–14: a prospective cohort study

BackgroundSeasonal influenza vaccination among health-care workers can prevent influenza infection among patients in health-care settings. The aim of this study was to investigate the awareness and knowledge of seasonal influenza and the influenza vaccine among health-care workers and to analyse factors affecting vaccination among health personnel to formulate targeted strategies to increase vaccination. MethodsWe used cluster sampling to select eight health institutions in Qingdao, China. A prospective cohort study was conducted in November, 2013 (before flu season), and the random follow-up survey was in June, 2014 (after flu season). Eligible participants were health-care workers (aged 18–65 years), full-time employees providing direct patient care. All individuals signed the agreement of the informed ethics letter before the survey. We applied χ2-test and logistic regression to analyse factors influencing vaccination. FindingsBetween November, 2013, and May, 2014, we recruited 1852 eligible health-care workers, of whom 1301 (70%) completed the cohort study. At the post-influenza-season follow-up survey, 63 (5%) health-care workers reported receiving influenza vaccination during the prior influenza season. The main reason for not being vaccinated, given by 412 (43%) unvaccinated respondents, was concerns about side-effects. Among all health-care workers who completed the pre-season survey, 258 (21%) health-care workers responded correctly to a question about how long the influenza virus remains alive in the air, 557 (43%) believed the influenza vaccine was safe, 113 (9%) believed they could become infected with influenza due to vaccination, and 216 (17%) thought they would likely get vaccinated in the upcoming season. Pre-season vaccination intention was higher in the vaccinated group than the non-vaccinated group. In multivariate analysis, factors increasing vaccination included working in a primary-care level hospital, prior vaccination history, a more positive attitude towards vaccination, and a greater vaccination intention in the pre-season. InterpretationThe influenza vaccination rate among health-care workers in Qingdao is low. Among all health-care workers, vaccination intention in the pre-influenza season was weak, and knowledge about influenza transmission and the safety and side-effects of influenza vaccination was poor. Health-care education focusing on safety and importance of seasonal influenza vaccine might increase vaccination coverage in this group. FundingCooperative Agreement Number U2G/GH000961, funded by the Centers for Disease Control and Prevention, USA. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Microbiological and molecular epidemiological analyses of community-associated methicillin-resistant Staphylococcus aureus at a tertiary care hospital in Japan.

Molecular characterization of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is generally conducted referred to staphylococcal cassette chromosome mec (SCCmec) type IV or V. CA-MRSA is now a cause of concern since such strains have been isolated not only from individuals in a community but also from patients in healthcare settings. The aim of this study was to analyze microbiological and molecular epidemiological features of CA-MRSA strains at a Japanese tertiary care hospital using PCR based-open reading frame typing (POT). This technique allows for molecular classification into CA-MRSA (POT-CA) and hospital-associated (HA-) MRSA (POT-HA) with clonal discrimination. Clinical MRSA isolates obtained from consecutive patients between October 1, 2012 and September 30, 2013 at the hospital were analyzed in combination with the clinical definition for CA-MRSA by the Centers for Disease Control and Prevention and POT. Of 219 isolates (76 clonal groups), 64 (29.3%) were clinical-HA/POT-CA isolates (22 clonal groups). Some clones of them accumulated in this hospital and might be involved in nosocomial transmission. Virulent factors of the isolates were analyzed, and only one (1.6%) Panton-Valentine leukocidin gene positive isolate but no arginine catabolic mobile element genes positive isolate were found in clinical-HA/POT-CA. Additionally, clinical-HA/POT-CA isolates showed higher antimicrobial susceptibility than clinical-HA/POT-HA, especially to minocycline, doxycycline, and amikacin. The most frequent genotype of molecular CA-MRSA was multi-locus sequence type 5-SCCmecIV, previously not detected in Japan. Although CA-MRSA at this hospital showed low virulence and higher antimicrobial susceptibility, the risk of nosocomial infection from them should be recognized, requiring stricter infection control measures.

The implementation of Ebola personal protective equipment training in a large Canadian acute care hospital

Effective use of personal protective equipment (PPE) is essential to protect personnel and patients in health care settings. However, in a survey of 222 health care personnel, PPE training was often suboptimal with no requirement for demonstration of proficiency. Fourteen percent of physicians reported no previous training in use of PPE.

Prevalence of health care associated infections in a tertiary care hospital in Dakshina Kannada, Karnataka: A hospital based cross sectional study

Background: Health Care-Associated Infections (HCAI) affect millions of people each year and raise a great risk for patients in health care settings, leading to high rates of morbidity and mortality. Objective: To estimate the prevalence of HCAI and to explore the association between certain socio-demographic factors, invasive procedures and mean duration of hospital stay with HCAI in a tertiary-care hospital. Materials and Methods: Data was obtained from the patients who were admitted for more than 48 hours in the general wards and their records in tertiary-care hospital for duration of 3 months (February 2014 to April 2014). Results: Among 290 patients, the prevalence of HCAI was estimated to be 11.7%. The prevalence of HCAI was proportionately less among men (10.2%) than in women (14.2%), was more (15.6%) among patients who underwent invasive procedures after admission and with mean duration of hospital stay of 12.47 days. Conclusion: Health Care- Associated Infections (HCAIs) were found to be significantly associated with increased duration of hospital stay and invasive procedures done after admission. Prevalence was higher in patients aged more than 40 years.

Antibiogram Typing and Biochemical Characterization of Klebsiella pneumoniae after Biofield Treatment

Klebsiella pneumoniae (K. pneumoniae) is a common nosocomial pathogen causing respiratory tract (pneumoniae) and blood stream infections. Multidrug-resistant (MDR) isolates of K. pneumoniae infections are difficult to treat in patients in health care settings. Aim of the present study was to determine the impact of Mr. Trivedi’s biofield treatment on four MDR clinical lab isolates (LS) of K. pneumoniae (LS 2, LS 6, LS 7, and LS 14). Samples were divided into two groups i.e. control and biofield treated. Control and treated groups were analyzed for antimicrobial susceptibility pattern, minimum inhibitory concentration (MIC), biochemical study and biotype number using MicroScan Walk-Away® system. The analysis was done on day 10 after biofield treatment as compared with control group. Antimicrobial sensitivity assay showed that there was 46.42% alteration in sensitivity of tested antimicrobials in treated group of MDR K. pneumonia isolates. MIC results showed an alteration in 30% of tested antimicrobials out of thirty after biofield treatment in clinical isolates of K. pneumoniae. An increase in antimicrobial sensitivity and decrease in MIC value was reported (in LS 6) in case of piperacillin/tazobactam and piperacillin. Biochemical study showed a 15.15% change in biochemical reactions as compared to control. A significant change in biotype numbers were reported in all four clinical isolates of MDR K. pneumoniae after biofield treatment as compared to control group. On the basis of changed biotype number after biofield treatment, new organism was identified as Enterobacter aerogenes in LS 2 and LS 14. These results suggest that biofield treatment has a significant effect on altering the antimicrobial sensitivity, MIC values, biochemical reactions and biotype number of multidrug-resistant isolates of K. pneumoniae.

Effects of librarian-provided services in healthcare settings: a systematic review.

To assess the effects of librarian-provided services in healthcare settings on patient, healthcare provider, and researcher outcomes. Medline, CINAHL, ERIC, LISA (Library and Information Science Abstracts), and the Cochrane Central Register of Controlled Trials were searched from inception to June 2013. Studies involving librarian-provided services for patients encountering the healthcare system, healthcare providers, or researchers were eligible for inclusion. All librarian-provided services in healthcare settings were considered as an intervention, including hospitals, primary care settings, or public health clinics. Twenty-five articles fulfilled our eligibility criteria, including 22 primary publications and three companion reports. The majority of studies (15/22 primary publications) examined librarians providing instruction in literature searching to healthcare trainees, and measured literature searching proficiency. Other studies analyzed librarian-provided literature searching services and instruction in question formulation as well as the impact of librarian-provided services on patient length of stay in hospital. No studies were found that investigated librarians providing direct services to researchers or patients in healthcare settings. Librarian-provided services directed to participants in training programs (eg, students, residents) improve skills in searching the literature to facilitate the integration of research evidence into clinical decision-making. Services provided to clinicians were shown to be effective in saving time for health professionals and providing relevant information for decision-making. Two studies indicated patient length of stay was reduced when clinicians requested literature searches related to a patient's case.

Point-of-Care Genetic Tests for Infectious Disease: Legal Considerations

Personalized medicine will play an important role in the treatment of infectious diseases. Molecular microbiology diagnostics have the potential to identify pathogens with great accuracy and rapidity. The speed of identification is particularly crucial to effective clinical management of many infections. An important complement to precision diagnostic techniques is moving towards point-of-care application, to avoid the costly diagnostic delays associated with transport and laboratory analysis. Point-of-care molecular diagnostics are expected to have a significant impact in combating hospital acquired infections (‘HAIs’). HAIs are a major cause of increased morbidity and death among patients in health care settings globally. These infections are often antibiotic resistant, and affect already weakened patients. It is hoped that molecular diagnostics will eventually allow for the rapid identification of a particular strain of pathogen(s), even for unculturable and polymicrobial infections. This article considers how the existing legal and normative framework governing hospitals’ responses to HAIs may affect the introduction of rapid, point-of-care molecular diagnostics. To this end, we carried out a review of international, national, and institutional guidelines addressing hospital duties to prevent, control, and rapidly diagnose HAIs. We also reviewed relevant legislation and case law in Canada and the United States. In particular, we consider if the complex normative framework governing hospitals helps or hinders the adoption and implementation of precision diagnostic tools. We conclude that health-care institutions are likely to come under increasing pressure – both ethical and legal – to adopt rapid molecular diagnostics as part of their response to HAIs.