Routine Hospital Use Research Articles

Perceptual and objective physical quality of chest images: a comparison between digital radiographic chest images processed for cancer screening and pneumoconiosis screening in Japan.

This study (1) evaluated the perceptual and objective physical quality of digital radiographic chest images processed for different purposes (routine hospital use, lung cancer screening, and pneumoconiosis screening), and (2) quantified objectively the quality of chest images visually graded by the Japan National Federation of Industrial Health Organization (ZENEIREN). Four observers rated the images using a visual grading score (VGS) according to ZENEIREN's quality criteria. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured. Between groups, differences were assessed using ANOVA (followed by Bonferroni multiple comparisons) or unpaired t-test. The Pearson's correlation coefficients were calculated for the correlation between perceptual quality and objective physical image quality. The image quality perceived by the observers and the SNR measurements were highest for the images generated using parameters recommended for lung cancer screening. The images processed for pneumoconiosis screening were rated poorest by the observers and showed the lowest objective physical quality measurements. The chest images rated high quality by ZENEIREN generally showed a higher objective physical image quality. The SNR correlated well with VGS, but CNR did not. Highly significant differences between the processing parameters indicate that image processing strongly influences the perceptual quality of digital radiographic chest images.

P139 Candida : An important partner in polymicrobial colonization on indwelling medical devices

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMIndwelling medical devices are of routine use in hospitals for patient care but they lead to the colonization of microbes on their surface making the patient vulnerable to device-related infections (DRI). Biofilms formed due to the growth of microbes are the most common cause of device-related infections.ObjectivesTo isolate, identify and study the microbial colonization of indwelling medical devices (urinary catheters and central venous catheters).To quantify the biofilm formed by the isolates.MethodIn the present study, microflora was isolated from urinary catheters (n = 28) and central venous catheters (n = 25) that were catheterized in ICU patients. Quantification of biofilm was done by Crystal violet assay.ResultsAmong 28 urinary catheters, 14 catheters had polymicrobial colonisation (n = 10 mixed bacterial and fungal colonization, n = 3 polybacterial, and n = 1 polyfungal), 10 catheters were observed to have mono-species colonization (n = 6 fungal, n = 4 bacterial), while 4 catheters did not show any colonization. Whereas among 25 central venous catheters, only 3 catheters showed mono-bacterial colonization and 2 catheters showed mono-fungal growth and 20 catheters did not show any colonization. A total of 46 isolates were obtained from all urinary and central venous catheters, out of which Candida spp. was found to be highest in number with n = 13 and 30% of total isolates obtained (the Fig. 1 shows the distribution of microflora obtained). The interesting observation in the study is that Candida spp. is found to have multi-species colonization with bacterial isolates (Pseudomonas aeuroginosa, Klebsiella pneumoniae, Staphylococcus haemolyticus, Enterococcus faecium, and Stenotrophomonas maltophilia) as well as fungal isolates (Trichosporon asahii). Quantification of biofilm formed by these isolates was carried out by crystal violet assay and it was observed that 35.6% isolates formed strong biofilm of which Candida spp. was a major contributor. It was also observed that Candida spp. was always the stronger biofilm forming partner in mixed species biofilms.ConclusionIt was concluded that majority of colonization on indwelling medical devices are polymicrobial and Candida spp. appears as an important partner in polymicrobial colonization. Among all obtained isolates maximum were strong biofilm forming of which Candida spp. were the major contributors.

Comparison of culture, confocal microscopy and PCR in routine hospital use for microbial keratitis diagnosis

AimsTo evaluate the sensitivity and specificity of polymerase chain reaction (PCR), in vivo confocal microscopy (IVCM) and culture for microbial keratitis (MK) diagnosis.MethodsRetrospective review of PCR, IVCM and culture results for MK diagnosis at Moorfields Eye Hospital between August 2013 and December 2014.ResultsPCR results were available for 259 MK patients with concurrent culture for 203/259 and IVCM for 149/259. Sensitivities and specificities with 95% confidence intervals [95% CI] were calculated for Acanthamoeba keratitis (AK) and fungal keratitis (FK), by comparison with culture, for both IVCM and PCR. For AK, FK and bacterial keratitis (BK) sensitivities were calculated, for each diagnostic method, by comparison with a composite reference standard (a positive result for one or more of culture, PCR or IVCM having a specificity of 100% by definition). For the latter, sensitivities with [95% CI] were: for AK, IVCM 77.1% [62.7–88.0%], PCR 63.3% [48.3–76.6%], culture 35.6 [21.9–51.2]; for FK, IVCM 81.8% [48.2–97.7%], PCR 30.8% [9.09–61.4%], culture 41.7% [15.2–72.3%]; for BK, PCR 25.0% [14.7–37.9%], culture 95.6% [87.6–99.1%].ConclusionIVCM was the most sensitive technique for AK and FK diagnosis but culture remains our gold standard for BK. These findings reflect results to be expected from service providers to UK ophthalmology units and demonstrates the need at our centre for ongoing diagnostic result audit leading to the potential to improve PCR diagnosis. Both FK and AK are now common in the UK; ophthalmology units need to have all these techniques available to optimise their MK management.

Validation of the Geriatric Check in acohort of hospitalized neurological patients

The Geriatrie-Check was developed as ascreening tool for the identification of older patients with geriatric treatment requirements in hospitals. It was recommended by the Baden-Wuerttemberg Hospitals Association for routine use in hospitals in 2014 although no published validation studies are available. The test takes 3-5 min. Validation of the Geriatrie-Check in aprospective cohort of hospitalized neurological patients with and without geriatric characteristics. In this prospective cross-sectional observational study at the University Hospital Tübingen, Germany the Geriatrie-Check was compared with acomprehensive geriatric assessment in 107 neurological inpatients aged 70years and older (41% women, mean age 76.7years). The Geriatrie-Check classified 61patients (57%) as geriatric patients. These patients with apositive result in the Geriatrie-Check had ahigher percentage of frailty (according to Fried etal.), higher values in the Gérontopôle frailty screening tool, higher values in the geriatric screening according to Lachs et el., slower gait speed, lower grip force, needed longer for the timed up-and-go test, had agreater fear of falling in the Falls Efficacy Scale - International, lower scores in the Mini Mental State Examination, needed more time to perform the Trail Making TestA and B, had higher values in the Beck's Depressions InventarII and lower values in the visual analogue scale of the EQ-5D. Ahigher percentage of patients took more than five different drugs. The Geriatrie-Check has been shown to be auseful and valid tool for the identification of geriatric inpatients in neurological wards due to the good agreement with the results of the geriatric assessment.

Breath analysis using external cavity diode lasers: a review.

Most techniques that are used for diagnosis and therapy of diseases are invasive. Reliable noninvasive methods are always needed for the comfort of patients. Owing to its noninvasiveness, ease of use, and easy repeatability, exhaled breath analysis is a very good candidate for this purpose. Breath analysis can be performed using different techniques, such as gas chromatography mass spectrometry (MS), proton transfer reaction-MS, and selected ion flow tube-MS. However, these devices are bulky and require complicated procedures for sample collection and preconcentration. Therefore, these are not practical for routine applications in hospitals. Laser-based techniques with small size, robustness, low cost, low response time, accuracy, precision, high sensitivity, selectivity, low detection limit, real-time, and point-of-care detection have a great potential for routine use in hospitals. In this review paper, the recent advances in the fields of external cavity lasers and breath analysis for detection of diseases are presented.

DETECTION OF CANCER BIOMARKERS WITH NANOTECHNOLOGY

Early detection of cancer biomarkers with high prec ision is critically important for cancer therapy. A variety of sensors based on different nanostructured materi als have attracted intensive research interest due to their potential for highly sensitive and selective detect ion of cancer biomarkers. This review covers the us e of a variety of nanostructured materials, including carb on nanotubes, silicon nanowires, gold nanoparticles and quantum dots, in the fabrication of sensors. Emphas es are placed on how the detection systems work and what detection limits can be achieved. Some assays described in this review outperform established methods for cancer biomarker detection. It is highl y promising that these sensors would soon move into commercial-scale production and find routine use in hospitals.

Evaluation of microbiocidal activity of superoxidized water on hospital isolates

Prevention of nosocomial infections, pre-operative and post-operative complications is directly linked with effective disinfection and decontamination. Microbial decontamination is the most serious challenge to the today's health care practice despite the abundance of disinfectants and chemicals as there are increasing reports of emergence of resistance to the action of commonly used disinfectants. There is a need to evaluate the efficacy of newer methods of asepsis for better patient management. This study was designed to evaluate the microbiocidal activity of superoxidized water (SOW) on common clinical isolates, ATCC strains, vegetative cells and spores of Bacillus subtilis. Bacterial suspensions were treated with SOW and deionized water (control). All the tubes were incubated at 37°C for 0.5, 2.5 and 5.0 min. The number of viable cells was counted. All the clinical isolates and ATCC strains were killed within 0.5 min of exposure to the SOW. Vegetative cells and spores of B. subtilis were killed after 5.0 min. We conclude that SOW is an effective microbiocidal agent for routine hospital use.

Can We Use Incident Reports to Detect Hospital Adverse Events?

Background: The gold standard method to assess hospital adverse events (AEs) is retrospective chart review. A cheaper alternative is incident reports (IRs) routinely used by hospitals to note adverse outcomes or accidents experienced by patients. Yet little is known about the value of IRs to detect AEs. Objectives: To assess the proportion of AEs measured through chart reviews that are detected by IRs and to describe the types of AEs documented by IRs. Methods: A random sample of 2213 charts of adult patients hospitalized in 19 short-stay hospitals in the province of Quebec, Canada, were assessed. An AE was defined as an unintended injury or complication caused by clinical care. Research nurses assessed selected charts for screening criteria known to be associated with an AE. Physicians reviewed the positively screened charts to identify AEs. Results: Incident reports were present in only 15.5% of charts with AEs, and in 4.4% of charts without AEs. The presence of an IR in a chart varied, depending on the type of procedures or events associated with the AE and the consequence of the AE. Discussion: In their current form, IRs are not that useful to detect hospital AEs as defined in this study. For better quality assurance, the information collected using IRs should be expanded to cover a wider range of AEs. Given their routine use in hospitals and their relatively low cost, efforts should be made to make better use of IRs to improve patient care.

Routine Hospital Use of a New Commercial Whole Blood Interferon-γ Assay for the Diagnosis of Tuberculosis Infection

Routine Hospital Use of a New Commercial Whole Blood Interferon-γ Assay for the Diagnosis of Tuberculosis Infection

Routine Hospital Use of a New Commercial Whole Blood Interferon-γ Assay for the Diagnosis of Tuberculosis Infection

Interferon (IFN)-gamma blood tests may improve the current level of diagnostic accuracy for tuberculosis infection. The QuantiFERON-TB Gold (QFT-Gold) has been used in selected populations and shows higher specificity than the tuberculin skin test (TST). To evaluate the QFT-Gold test in unselected patients and assess the level of agreement with the TST. The test has been routinely performed on whole blood samples in our microbiology laboratory for 8 months. Demographic, clinical, and microbiological data have been collected and correlated to the QFT-Gold results. Of 318 patients tested, 68 (21.4%) gave an indeterminate (low positive mitogen control) QFT-Gold result. Indeterminate results were significantly overrepresented in patients with a negative TST (28.9% vs. 6.6% in TST-positive patients; p < 0.0001, chi2 test) and were more frequent in patients receiving immunosuppressive therapies than in those who were not receiving such treatments (odds ratio, 3.35; 95% confidence interval, 1.84-6.08; p < 0.0001). After excluding indeterminate results, the concordance between QFT-Gold and TST was significantly lower in Bacille Calmette-Guérin-vaccinated individuals (41.5%) than in nonvaccinated individuals (80.3%) (p < 0.0001). In 11 patients with active tuberculosis (5 culture-confirmed), QFT-Gold provided more positive results than the TST (66.7% vs. 33.3%; p = 0.165). The QFT-Gold test is feasible in routine hospital use for the diagnosis of tuberculosis infection. As with the TST, immunosuppression may negatively affect the test's performance, with a significant rate of indeterminate results in the most vulnerable population.

Accuracy of an Infrared Tympanic Thermometer

The use of infrared thermometry to measure temperatures in hospitalized patients is increasing. Although infrared thermometers have been proven to be accurate when they are used by well-trained personnel, no previous studies have examined their accuracy during routine hospital use. To determine the accuracy and observer variability of temperatures measured with an infrared tympanic thermometer (TT). Prospective, observational study. ICUs of a 300-bed teaching community hospital. Fifty-one critically ill patients. The mean of three tympanic temperatures measured with the infrared TT (tempTTs) was compared to temperatures simultaneously measured with the thermistor of right heart catheters and rectal mercury thermometers for the following three groups of observers who had been certified in the use of the infrared TT: a single critical care nurse (CCN)/educator (Ed); CCNs, and floor nurses (FNs)/clinical care practitioners (CCPs). Two rounds of measurements were given to 51 patients by 153 observers. Temperatures of the pulmonary artery (PA) measured with the thermistor of right heart catheters (tempPAs) ranged from 96.5 to 102.6 degrees F, with a mean (-/+ SD) of 99.3+/-1.1 degrees F. The intraobserver variabilities (correlation coefficients) of the tempTTs ranged from 0.90 for those measured by FNs/CCPs, to 0.92 for those measured by CCNs, to 0.98 for those measured by the CCN/Ed. Accuracy, arbitrarily defined as within a deviation of -/+0.5 degrees F of the tempPA, was 100% for the rectal mercury thermometer and 98.0% for the infrared TT when used by the CCN/Ed. The accuracy of the infrared TT was 80% when measured by CCNs and 61% when measured by FNs/CCPs. Differences between tempPAs and tempTTs measured by the CCN/Ed ranged from 0 to 0.7 degrees F, with a mean of 0.2 degrees F. Similarly, differences between tempPAs and tempTTs measured by CCNs ranged from 0 to 2.4 degrees F, with a mean difference of 0.3 degrees F. However, differences between tempPAs and tempTTs measured by FNs/CCPs ranged from 0 to 3.0 degrees F, with a mean of 0.6 degrees F (greater differences than those obtained by the CCNs; p < 0.01). The accuracy of rectal mercury thermometry was 100%. If a temperature > or = 101.0 degrees F had been considered as the threshold at which a fever is present, and if the mean of three measurements had been used to designate temperature, workups that were either inappropriately performed or omitted would have resulted from 2% of tempTTs measured by the CCN/Ed, 1% of those measured by CCNs, and 4% of those measured by FNs/CCPs. When used properly, both tympanic and rectal thermometry are very accurate. However, the infrared TT produced measurements that were both less accurate and less reproducible when used by nurses who routinely used it in clinical practice.

Preliminary validation of a clinical scale for measuring the duration of post‐traumatic amnesia

An operational definition of post-traumatic amnesia is presented and a standardized procedure for the measurement of post-traumatic amnesia, which has been clinically tested in over 100 patients with severe, closed head injury is described. Twenty patients with severe head injuries who were still experiencing post-traumatic amnesia (as defined in this study), were assessed on an independent test of learning ability, as were 20 other patients with severe head injury who were no longer suffering post-traumatic amnesia. The performance of the two groups differed significantly; those in a state of post-traumatic amnesia performed more poorly. Both these groups showed significant impairment when compared with a control group of 20 patients who were in hospital because of orthopaedic injuries that were suffered during a motor vehicle accident. These preliminary results are sufficiently encouraging to recommend this simple procedure for routine use in hospitals, to enhance the accuracy of measuring the severity of head injury. The medicolegal use of this measure is also discussed.

Objective measurement of basement membrane abnormalities in human neoplasms of colorectum and of breast.

The basement membrane (lamina densa) was evaluated as normal, absent, multilayered, or otherwise abnormal at intercepts of an array of parallcl lines superimposed nearly perpendicularly on basement membrane regions. Six to eight consecutive photographs of the basement membrane region of three to four areas of three non‐neoplastic lesions and eight neoplastic lesions of colorectum, and two non‐neoplastic and six neoplastic lesions of the female breast were thus examined. Statistical analyses showed that there was no significant difference between three regions of three non‐neoplastic lesions, nor between the three nonneoplastic lesions of colorectum. The analyses were by χ2 tests performed comparing counts of absent basement membrane with those of all other types of basement membrane lumped together. Significant differences were observed between the sum of the non‐neoplastic lesions and the individual neoplasms. Differences between regions of the same lesion were observed only in malignant neoplasms. In breast lesions similarly, where the observations were pooled into three groups, i.e. counts of normal, absent, or other type of basement membrane, no difference between regions of the same lesion were observed in a duct hyperplasia and a fibroadenoma, but such differences were seen amongst adenocarcinomas and other lesions. Comparing the sum of observations of the above two lesions with the other lesions individually, there was generally an increasingly high χ2 value with increasing malignancy. Thus this approach to evaluation of neoplasms may provide an objective measure which correlates with prognosis. It is adaptable to routine use in hospitals with electron microscopy facilities.

Instantaneous fetal heart rate monitoring by electromagnetic methods

Fetal magnetocardiography (FMCG) is a new complementary external method for accurate antepartal FHR recording. Because of the low magnetic noise level required it is not yet suitable for routine hospital use. Fifty-six simultaneous FMCG and external FECG measurements were made in order to compare these methods for instantaneous FHR recording. The error of the FHR value obtained with the instrumentation described is less than 1 per cent. Our results show that FMCG can be used for FHR processing from week 30 of gestation until term. Thirty-five of the measurements were done during this period. From these, a readable FHR curve was obtained in 21 cases with FMCG and in 12 cases with external FECG. The maternal complexes were always present in the FECG, but in only 15 of the recorded FMCG's.

An autopsy study of bronchial mucous gland hypertrophy in Glasgow.

Hypertrophy of the bronchial mucous glands was measured by the Reid index method in 359 specimens of right main bronchus obtained from consecutive autopsies performed in a general hospital in Glasgow. in 119 of these cases, the mucous glands were also measured by the point-counting technique. There was a close correlation between these 2 methods of estimating bronchial mucous gland size, and the Reid index retains a useful place both as a quick method of measurement for routine hospital use and in epidemiologic studies. the total incidence of mucous gland hypertrophy in the range observed in bronchitis, which was defined as a Reid index of greater than 0.50 or a point count of greater than 16.7 per cent, was 31 per cent by the Reid Index and 33 per cent by point counting. This incidence was approximately 2.5 times greater than that obtained in a large clinical survey. Mucous gland hypertrophy in the bronchitis range was more common in men than women but did not increase in incidence with increasing age in...

Activity of penicillinase in Staphylococcus aureus as studied by the iodometric method.

Among naturally occurring strains of Staphylococcus aureus, resistance to penicillin G is observed only in those that produce penicillinase [1]. Strains lacking this enzyme are invariably highly sensitive to the action of penicillin. Elaboration of penicillinase thus appears to be the only clinically important mechanism of resistance to penicillin in these organisms [2]. A test for the activity of penicillinase that is rapid and simple enough to be employed in the clinical bacteriology laboratory would be useful as a guide to antibiotic therapy, since it would detect the substance actually responsible for resistance to penicillin. Several tests for detection of penicillinase have been devised [3-14], but most of them are too cumbersome or too time-consuming for routine hospital use. A simple plate test based on the iodometric assay originally described by Ferret [10] circumvents most of the disadvantages inherent in other methods. This test has been used by Anderson and Lewis in the investigation of resistance to ampicillin in Salmonella typhimurium [15], and by Novick and Richmond in genetic studies on S. aureus [16], but to our knowledge has not been employed for routine work in hospital bacteriology. This study was undertaken to investigate the usefulness of this test in the evaluation of strains of

Long-term evaluation of decontamination of inhalation-therapy equipment and the occurrence of necrotizing pneumonia.

Abstract Inhalation-therapy equipment incorporating reservoir nebulization was sampled for bacterial contamination during a four-year period after the introduction of routine daily decontamination with 0.25 per cent acetic acid. The incidence of contamination was found to be less than 10 per cent during the last three study years, as compared to 84 per cent before the use of the acetic acid regimen. Residual contamination was related to personnel error or corrosion of nebulizer jets. During the preacetic acid era the prevalence of necrotizing pneumonia due to gram-negative bacilli at autopsy was 7.9 per cent, whereas in the last two years studied, the incidence was 2.2 and 2.1 per cent. This prevalence is similar to that found before the use of reservoir nebulizers. These data indicate that daily decontamination of reservoir nebulizer equipment with 0.25 per cent acetic acid is effective and practical in routine hospital use.

ESTIMATION OF ALKALI RESERVE: A METHOD FOR ROUTINE HOSPITAL USE WITH SMALL AMOUNTS OF PLASMA

ESTIMATION OF ALKALI RESERVE: A METHOD FOR ROUTINE HOSPITAL USE WITH SMALL AMOUNTS OF PLASMA