Recommended Time Period Research Articles

Recommendations and current practices for the reconstitution and storage of botulinum toxin type A

Current guidelines from the Centers for Disease Control and Prevention (CDC) regarding the reconstitution and storage of botulinum toxin type A (BT-A) differ from those of the Centers for Medicare and Medicaid Services and current clinical practice. CDC guidelines require single-patient use of BT-A vials. Strict adherence to these guidelines creates waste and a significant financial impediment, and does not confer increased protection from infection, assuming standard safe injection practices are followed. This study examines current clinical practices and provides expert consensus recommendations regarding the reconstitution and storage of BT-A. A review of the literature on the sterility and efficacy of BT-A stored beyond the recommended time period of 4 hours is also presented. An Internet-based survey was used to analyze the current practices of physician members of the American Society for Dermatologic Surgery who administer botulinum type A toxins. After reconstitution, the majority of physicians (68.6%) routinely store BT-A for a period of greater than 1 week and safely use each toxin vial for more than one patient. Not a single case of infection was observed. This was a single survey with a 32.2% response rate. A single vial of BT-A can be safely administered to multiple patients, assuming standard safe injection techniques are followed. After reconstitution, Our data suggest that BT-A can be stored beyond the recommended time period of 4 hours.

Acute Coronary Syndrome: Factors Affecting Time to Arrival in a Diverse Urban Setting

This study seeks to better understand how individuals of different cultural/ethnic backgrounds in an urban setting assess the signs and symptoms of Acute Coronary Syndrome (ACS) and the ensuing decision to take urgent action. Few studies exist which examine these differences and enhance understanding of how to address these differences and, ultimately, reduce morbidity and mortality from ACS. Face-to-face interviews were conducted with a convenience sample of urban patients of different cultural and socioeconomic backgrounds regarding their actions upon recognition of ACS signs and symptoms. Patients (423) with presumed or diagnosed ACS were interviewed within 12 h of arrival at the urban emergency rooms. Among the different cultural groups, Haitians delayed the longest (median) from symptom onset to hospital arrival (8.24 h), followed by Caribbeans (7.83 h), African Americans (6.62 h) and Hispanics (6.00 h). Although these delay intervals were not statistically significant across groups, each racial/ethnic group sought care well beyond the recommended time period of 3 h after initial recognition of ACS signs and symptoms. Among all the cultural groups, the two key factors motivating early arrival were being employed and taking positive actions. ACS symptom perception by different cultural groups appears to play an important role in the decision to seek emergency treatment. This is an area that has not been widely studied among or within different cultural/ethnic groups. As such, further research is needed to delineate these concepts and actions and to provide opportunities for appropriate education.

CARESS: The Canadian Registry of Palivizumab

Palivizumab is indicated for respiratory syncytial virus (RSV) prophylaxis in high-risk children. However, relatively little is known about the current use, compliance, and outcomes associated with this medication. A prospective, observational, registry based on 27 sites, with monthly follow-up of infants at high risk for RSV who received at least 1 dose of palivizumab during the 2005-2009 RSV seasons. A total of 5286 children were enrolled (56.6% male; 71.7% white; average gestational age, 32.1 ± 5.5 weeks). Of them, 3741 patients (70.8%) were prophylaxed for prematurity only, 449 (8.5%) for bronchopulmonary dysplasia/chronic lung disease, 508 (9.6%) for congenital heart disease, and 588 (11.1%) for other reasons. Overall, 19,485 doses were given. On average, infants received 86.0% ± 28.4% of their expected number of injections; 71.2% of infants received their injections in the recommended time periods. Of the 5286 participants enrolled, 308 patients were hospitalized for respiratory tract illness (hospitalization rate, 5.8%). The RSV-hospitalization rate was calculated as 1.38%. Having siblings increased likelihood of hospitalization (66.9% vs. 55.7%, P < 0.005), and was significantly correlated with time to hospitalization in this cohort (P = 0.050). The overall RSV-hospitalization rate in our study was within the range found in previous reports (1.3%-5.3%), although it did not mimic the declining rates of the US Palivizumab Outcomes Registry. This could be due to increased testing for RSV when hospitalized and increasing rates of prophylaxis of infants with underlying medical disorders.

Vaccination coverage and timeliness in three South African areas: a prospective study.

BackgroundTimely vaccination is important to induce adequate protective immunity. We measured vaccination timeliness and vaccination coverage in three geographical areas in South Africa.MethodsThis study used vaccination information from a community-based cluster-randomized trial promoting exclusive breastfeeding in three South African sites (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal) between 2006 and 2008. Five interview visits were carried out between birth and up to 2 years of age (median follow-up time 18 months), and 1137 children were included in the analysis. We used Kaplan-Meier time-to-event analysis to describe vaccination coverage and timeliness in line with the Expanded Program on Immunization for the first eight vaccines. This included Bacillus Calmette-Guérin (BCG), four oral polio vaccines and 3 doses of the pentavalent vaccine which protects against diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B.ResultsThe proportion receiving all these eight recommended vaccines were 94% in Paarl (95% confidence interval [CI] 91-96), 62% in Rietvlei (95%CI 54-68) and 88% in Umlazi (95%CI 84-91). Slightly fewer children received all vaccines within the recommended time periods. The situation was worst for the last pentavalent- and oral polio vaccines. The hazard ratio for incomplete vaccination was 7.2 (95%CI 4.7-11) for Rietvlei compared to Paarl.ConclusionsThere were large differences between the different South African sites in terms of vaccination coverage and timeliness, with the poorer areas of Rietvlei performing worse than the better-off areas in Paarl. The vaccination coverage was lower for the vaccines given at an older age. There is a need for continued efforts to improve vaccination coverage and timeliness, in particular in rural areas.Trial registration numberClinicalTrials.gov: NCT00397150

Effect of Health Care System Distrust on Breast and Cervical Cancer Screening in Philadelphia, Pennsylvania

We investigated whether health care system distrust is a barrier to breast and cervical cancer screening and whether different dimensions of distrust-values and competence-have different impacts on cancer screening. We utilized data on 5268 women aged 18 years and older living in Philadelphia, Pennsylvania, and analyzed their use of screening services via logistic and multinomial logistic regression. High levels of health care system distrust were associated with lower utilization of breast and cervical cancer screening services. The associations differed by dimensions of distrust. Specifically, a high level of competence distrust was associated with a reduced likelihood of having Papanicolaou tests, and women with high levels of values distrust were less likely to have breast examinations within the recommended time period. Independent of other covariates, individual health care resources and health status were associated with utilization of cancer screening. Health care system distrust is a barrier to breast and cervical cancer screening even after control for demographic and socioeconomic determinants. Rebuilding confidence in the health care system may improve personal and public health by increasing the utilization of preventive health services.

Diatom biomonitoring of streams: Reliability of reference sites and the response of metrics to environmental variations across temporal scales

Benthic diatoms are widely used indicators of human impacts on stream ecosystems because they are very responsive to changing environmental conditions. However, little research has explicitly focused on their reliability with regards to temporal variation in assemblage structure and environmental conditions. We examined variability in diatom-environment relationships at bi-weekly, monthly, and yearly time scales from 7 reference, 7 agricultural, and 2 acid mine drainage (AMD)-impacted streams, and how nutrient and pH fluctuations may affect the interpretation of diatom metrics and the Diatom Model Affinity (DMA) index. Reference streams had less bi-weekly variability in NO 3-N concentrations than non-reference streams. The % eutraphentic diatoms and DMA scores were more strongly correlated with seasonal means of NO 3-N and PO 4-P concentrations than with same day concentrations. Most nutrient indicator metrics had strong correlations with watershed land use. All 14 non-AMD streams experienced substantial increases in NO 3-N and decreases in temperature from November to May, which were associated with high species turnover, substantial changes in community structure, reduced diversity and richness, increased relative abundances of high nutrient diatoms, and decreases in low nutrient diatoms and DMA scores. The % acidophilic diatoms and DMA scores were significantly correlated with increased pH associated with greater precipitation at AMD sites from December to April ( r = −0.77, r = 0.62, respectively; P < 0.01). Yearly, DMA scores for all reference streams were consistently in the minimally impaired category, whereas scores for non-reference streams varied among impairment categories. Reference sites serve as reliable benchmarks for diatom ecological integrity during the summer. In this region, June to October is a recommended time period for diatom sampling in monitoring programs because subsequent shifts in hydrologic regimes, nutrients, and diatom assemblages occurred, affecting all sites and masking among stream differences attributable to agricultural land uses.

Need of Improvement in Timing of Prophylactic Antibiotic in Elective Surgery

Infections in surgery are major concern of morbidity, mortality, and costs. Timely antibiotic prophylaxis before incision ensures optimum concentration of AP in blood and tissues to prevent surgical site infections . However, proper timing of AP remains problematic as reported by various studies, though none so far from Nepal. Aim of this prospective observational study was to assess and address the issues for improvements in timing of AP. The pattern of antibiotic prophylaxis were prospectively collected in respect to time of induction, and incision time were recorded on predesigned 'AP form'. The study included all the elective major cases who received AP of intravenous Cefazoline 1 g as per our existing protocol. The emergency surgeries and obstetric cases were excluded from the study. There were 125 cases of which 89% received AP before incision (63% within 5 minutes before incision), while 11% had AP after the incision and 1% within the recommended time period of 2 hour to 30 minutes before incision. Current practice of antibiotic prophylaxis (AP) needs improvement as per standard guidelines of AP within 2 hour to 30 before incision.

Factors affecting time to adjuvant chemotherapy in stage III colon cancer patients.

e14097 Background: A survival benefit has been shown when chemotherapy is administered within a two month period following surgery for colon cancer. Whether chemotherapy administered sooner after definitive surgery for colorectal cancer (CRC) affects survival continues to be controversial. We compared time to chemotherapy and determined if cancer outcomes are affected by time to chemotherapy. In addition, we evaluated clinical factors that may be predictive of time to chemotherapy. Methods: Data was abstracted from 156 consecutive Stage III colon cancer patients treated with surgery followed by adjuvant chemotherapy from 2001-2008. Results: The median time to chemotherapy was 44 days. 105/156 (67.3%) patients received chemotherapy within 56 days. Clinical factors including age, gender, location of cancer and type of surgery (open v. laparoscopic) were not predictive of time to chemotherapy on multivariate analysis. However, time period when the patient was treated (2001–2004 [Time 1] v. 2005–2008 [Time 2]) did significantly affect time to chemotherapy (p = 0.0078). Days to chemotherapy during Time 1 were fewer than during Time 2 (median 38 days v. 43 days, p = 0.0003). Also the percentage of patients who received chemotherapy within 56 days for time period 1 vs 2 was 75 vs. 58.3, respectively, (p = 0.0268). When analyzed by time periods, overall survival was better in patients treated in Time 1 than in patients treated in Time 2 on univariate and confirmed on multivariate analysis, (p = 0.0202). Conclusions: Although most patients received chemotherapy within the recommended time period, patients still benefited from decreasing time to chemotherapy. In this study, we did not identify clinical factors predictive of time to chemotherapy. Based on these results, we recommend that time to chemotherapy in CRC patients be minimized in order to improve patient survival. No significant financial relationships to disclose.

Home parenteral nutrition in Scotland: frequency of monitoring, adequacy of review and consequence for complication rates

Background and aims Home parenteral nutrition (HPN) has been a major advance in the management of patients with gastrointestinal failure. It demands regular monitoring to ensure optimal intake, assess treatment response, and minimize complications. The Scottish Home Parenteral Nutrition Managed Clinical Network (MCN) produced a guideline advising three-monthly monitoring of biochemistry, micronutrients, vitamins, weight, and anthropometry. This study assesses the frequency and adequacy of monitoring of these complex patients and investigates any effect of this on complication rate. Methods All patients receiving HPN funded by the National Health Service in Scotland are known to the MCN via the National Contract for provision of HPN. Data are collected in an MS Access database; 2006 data is extracted. Results There were 141 HPN clinic assessments for 53 patients. Sixteen (30%) were seen every 100 d as recommended by the guideline. Sixty percent of reviews were within 100 d of the previous appointment. Duration of HPN treatment inversely correlated with frequency of review. Bloods were checked at 93% of reviews, weight at 86%, anthropometry at 24%, and vitamins and micronutrients measurement at 62% of clinics. No difference in complication rates was found between those reviewed within the recommended time periods and those reviewed less often. Conclusions Less than one-third of patients met the current recommended review frequency. Routine bloods and weight measurements were good, micronutrients less so; anthropometry is poorly monitored. Complication rates were not increased in HPN patients reviewed less often.

Multipurpose Solutions and Rates of Biocidal Efficacy

To investigate the hypothesis that reasonable levels of disinfection are achievable over relatively short exposure durations of microorganisms to multipurpose solutions, this study examined the stand-alone disinfection efficacy at 10, 20, and 30 min of five different multipurpose solutions products, each against five different pathogens eye care practitioners may encounter in their contact lens practice. ReNu MultiPlus, ReNu Multi-Purpose, AQuify, OptiFree Express, and OptiFree RepleniSH were evaluated for their microbiocidal efficacy using the stand-alone method at 10, 20, and 30 min of exposure to either Fusarium solani, Candida albicans, Staphylococcus aureus, Serratia marcescens, or Pseudomonas aeruginosa. Solutions which showed significantly higher rates of disinfection at 30 min were ReNu MultiPlus against Fusarium solani and Candida albicans, and both ReNu MultiPlus and AQuify against Staphylococcus aureus and Serratia marcescens. There were no statistically significant differences at 30 min amongst solutions against Pseudomonas aeruginosa. The product attribute of rapid rate of disinfection may give a greater level of assurance to practitioners when patients are noncompliant and do not follow the recommended time period for lens disinfection. The results of this study, however, should not be interpreted as a recommendation to use any of the solutions tested for a disinfection period less than the recommended soak time. Patient compliance with recommended lens care regimens is essential in minimizing the risk of contamination of contact lenses and lens care accessories.

Delay in admission for elective coronary-artery bypass grafting is associated with increased in-hospital mortality

BackgroundMany health care systems now use priority wait lists for scheduling elective coronary artery bypass grafting (CABG) surgery, but there have not yet been any direct estimates of reductions in in-hospital mortality rate afforded by ensuring that the operation is performed within recommended time periods.MethodsWe used a population-based registry to identify patients with established coronary artery disease who underwent isolated CABG in British Columbia, Canada. We studied whether postoperative survival during hospital admission for CABG differed significantly among patients who waited for surgery longer than the recommended time, 6 weeks for patients needing semi-urgent surgery and 12 weeks for those needing non-urgent surgery.ResultsAmong 7316 patients who underwent CABG, 97 died during the same hospital admission, for a province-wide death rate at discharge of 1.3%. The observed proportion of patients who died during the same admission was 1.0% (27 deaths among 2675 patients) for patients treated within the recommended time and 1.5% (70 among 4641) for whom CABG was delayed. After adjustment for age, sex, anatomy, comorbidity, calendar period, hospital, and mode of admission, patients with early CABG were only 2/3 as likely as those for whom CABG was delayed to experience in-hospital death (odds ratio 0.61; 95% confidence interval [CI] 0.39 to 0.96). There was a linear trend of 5% increase in the odds of in-hospital death for every additional month of delay before surgery, adjusted OR = 1.05 (95% CI 1.00 to 1.11).ConclusionWe found a significant survival benefit from performing surgical revascularization within the time deemed acceptable to consultant surgeons for patients requiring the treatment on a semi-urgent or non-urgent basis.

Are We Achieving the Current Waiting Time Targets in Lung Cancer Treatment? Result of a Prospective Study from a Large United Kingdom Teaching Hospital

Recent United Kingdom National Cancer Plan guidelines have specified a number of waiting time targets to prevent delays in the treatment of lung cancer. This study was performed to compare our waiting times with national recommendations. All newly diagnosed cases of lung cancer presenting to our institution were entered into a prospective tracking study by a dedicated audit officer. From September 2003 to December 2005, a total of 342 patients were entered into the study. Of these, 193 (56%) were referred by general practitioners; the remaining 114 (46%) were internal referrals. The Cancer Plan waiting time targets are mainly applicable to general practitioners referrals, which formed the study group. All the patients were seen in chest outpatient clinics within the recommended 2-week period. However, there was a delay in starting all forms of treatment. The median waiting time to any form of treatment was 60 days (recommendation, 62 days for all patients). From specialist referrals, the median waiting times for radiotherapy, surgery, and chemotherapy were 43, 25, and 16.5 days compared with recommended maximums of 28, 28, and 7 days, respectively. These data demonstrate that although patients receive outpatient consultation in the recommended time period, the National Cancer Plan treatment target of 62 days for patients referred by general practitioners is not being achieved. A concerted effort by all clinicians is required to meet the prescribed target times.

UK waiting time targets in lung cancer treatment: are they achievable? Results of a prospective tracking study

BackgroundRecent guidelines have specified a number of waiting time targets to prevent delay in the treatment of lung cancer. This study was carried out to assess the quality of lung cancer services and compare with national recommendations.MethodsAll newly diagnosed cases of lung cancer presenting to our institution via general practitioner referral were entered into a prospective tracking study by a dedicated audit officer. From September 2003 to March 2005 a total of 247 patients were entered into the study. Of these 133 (54%) were referred by general practitioners and the remainder 114 (46%) were internal referrals. The Cancer Plan waiting time targets are mainly applicable to GP referrals, which formed the study group.ResultsAll the patients were seen in chest out-patients clinic within the recommended two weeks period. However there was a delay in starting all forms of treatment. The median waiting time to any form of treatment was 60 days (recommendation 62 days for all patients).ConclusionThis data demonstrates that although patients receive out patient consultation in the recommended time period, the National Cancer Plan 62 days GP referral to treatment target is not being achieved. A concerted effort by all clinicians is required to meet the prescribed target times.

Folic acid supplements are more effective than increased dietary folate intake in elevating serum folate levels

In 1992, recommendations were disseminated aimed at reducing the incidence of neural tube defects. Women were advised to increase consumption of folic acid supplements and dietary folates during the periconceptional period and a major integrated national campaign was launched to help achieve this. In this study we found that only one-quarter of the women with an uncomplicated obstetric history and 51% with a complicated obstetric history took supplements for the recommended time period. Dietary modification was extremely unusual. Serum analysis demonstrated that intake of folic acid supplements provides a greater elevation in serum folate levels than dietary food intake, suggesting dietary manipulation is an ineffective strategy and that efforts would be better focused on increasing supplement intake at a clinically important time. More effective education strategies are required, and since approximately one-third of pregnancies are unplanned, fortification of foods with folic acid is warranted.

Accuracy of polyether and addition silicone after long-term immersion disinfection

Statement of problem. Some studies have demonstrated that short-term immersion disinfection does not affect the accuracy of polyether or addition silicone materials. Impressions are often disinfected for longer than recommended time periods. Purpose. This study evaluated these materials after simulating overnight disinfection. Material and methods. Impressions were made of a master model with Extrude Extra material with Extrude Wash addition silicone and Impregum F material in combination with Permadyne Garant polyether material. Nondisinfected impressions served as controls, whereas the disinfected samples were immersed for 18 hours in a full strength 2% acid glutaraldehyde solution. Anteroposterior and cross arch dimensions of the working cast and occlusogingival, mesiodistal, and buccolingual dimensions of working die were assessed. The data were analyzed with one-way analysis of variance at “alpha” = 0.05. Results. No significant differences were observed for anteroposterior and cross arch dimension when compared with the master model. However, significant differences were found for occlusogingival dimension at 18 hours of disinfection for both materials. The addition silicone 18-hour disinfection group was significantly less accurate in the mesiodistal dimension. Conclusion. Accuracy of both impression materials was adversely affected with 18 hours of immersion disinfection. Long-term (18 hours) immersion disinfection will affect the fit of fixed partial prostheses. (J Prosthet Dent 1997;78:245-9.)

Community health-related physical fitness testing and the National Garden Festival Health Fair at Stoke-on-Trent.

A brief review of the literature on the effectiveness of health-related fitness (HRF) tests in the promotion of exercise is presented. The paper then describes one particular community project which used HRF tests as part of exercise promotion. The purpose of such a project was to give people some indication of their present cardio-respiratory fitness, muscular strength, and flexibility with a view to highlighting the components of HRF and areas of concern for future action. Other measures, such as self-reported activity patterns, smoking, alcohol, and diet were also taken. During the six months of the Festival in 1986, over 250,000 people visited the Health Fair (HF), and 15,000 volunteered to take the fitness tests; 13,373 were actually completed. As part of the evaluation of the HRF tests at the HF, a sample of 3,000 (500 per month) was used. A follow-up survey on 350 was mailed 12 months after the end of the Festival and 173 people replied. The follow-up survey showed that just under 50 per cent of males followed their 8-week exercise programme (given to them after their HRF tests) for the recommended time period. However, this figure dropped to 21.4 per cent for females. Of those who started exercise after their HRF tests, 12.5 per cent (females) and 18.4 per cent (males) gave up within two months, otherwise most were still involved (87.5 per cent females, 71.4 per cent males) after 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)