Web-based Report Research Articles

Association Between Hospital and Surgeon Radical Prostatectomy Volume and Patient Outcomes: A Systematic Review

We examined the association between hospital and surgeon volume, and patient outcomes after radical prostatectomy. Databases were searched from 1980 to November 2007 to identify controlled studies published in English. Information on study design, hospital and surgeon annual radical prostatectomy volume, hospital status and patient outcome rates were abstracted using a standardized protocol. Data were pooled with random effects models. A total of 17 original investigations reported patient outcomes in categories of hospital and/or surgeon annual number of radical prostatectomies, and met inclusion criteria. Hospitals with volumes above the mean (43 radical prostatectomies per year) had lower surgery related mortality (rate of difference 0.62, 95% CI 0.47-0.81) and morbidity (rate difference -9.7%, 95% CI -15.8, -3.6). Teaching hospitals had an 18% (95% CI -26, -9) lower rate of surgery related complications. Surgeon volume was not significantly associated with surgery related mortality or positive surgical margins. However, the rate of late urinary complications was 2.4% lower (95% CI -5, -0.1) and the rate of long-term incontinence was 1.2% lower (95% CI -2.5, -0.1) for each 10 additional radical prostatectomies performed by the surgeon annually. Length of stay was lower, corresponding to surgeon volume. Higher provider volumes are associated with better outcomes after radical prostatectomy. Greater understanding of factors leading to this volume-outcome relationship, and the potential benefits and harms of increased regionalization is needed.

Silent Cerebral Infarct Transfusion (SIT) trial imaging core: application of novel imaging information technology for rapid and central review of MRI of the brain.

The Silent Cerebral Infarct Multicenter Transfusion (SIT) Trial is a multi-institutional intervention trial in which children with silent cerebral infarcts are randomized to receive either blood transfusion therapy or observation (standard care) for 36 months. The SIT Trial is scheduled to enroll approximately 1,880 children with sickle cell disease from 29 clinical sites in the United States, Canada, UK, and France. Each child undergoes a screening magnetic resonance imaging (MRI) of the brain to detect the presence of silent cerebral infarct-like lesions, a pre-randomization (baseline) MRI and exit MRI to determine if there are new or enlarged cerebral infarcts, using a designated, prospective imaging protocol. The objective of this manuscript is to describe the innovative method used to process and adjudicate imaging studies for an international trial with a primary endpoint that includes neuroimaging. Institution investigators at each site were provided with computer hardware and software for transmission of MRI images that allow them to strip the scans of all personal information and add unique study identifiers. Three neuroradiologists at separate academic centers review MRI studies and determine the presence or absence of silent cerebral infarct-like lesions. Their findings are subsequently placed on web-based case report forms and sent to the Statistical Coordinating Center. The average time from imaging center receipt of the MRI study to the radiology committee report back to the local site is less than two working days. This novel strategy was designed to maximize efficiency and minimize cost of a complex large multicenter trial that depends heavily on neuroimaging for entry criteria and assessment for the primary outcome measures. The technology, process, and expertise used in the SIT Trial can be adapted to virtually any clinical research trial with digital imaging requirements.

Real World Implementation Lessons and Outcomes from the Worker Interactive Networking (WIN) Project: Workplace-Based Online Caregiver Support and Remote Monitoring of Elders at Home

The objective of this research was to determine the feasibility of and receptivity to the first computerized workplace-based direct caregiver intervention and to assess the effects on businesses, working family caregivers, and their elderly relatives. Working family caregivers, with at least one health and/or safety concern related to an elder residing alone at home during the workday, were recruited from five companies (n = 27). Caregivers received free computer access to the Worker Interactive Networking (WIN) Internet online caregiver support group and a remote elder monitoring system at home for 6 months. The remote monitoring system provided Web-based status reports and e-mail/pager alerts when individualized parameters were exceeded. Motion sensor signals were transmitted to a transponder that uploaded via wireless cellular communications to the project server, thereby not interfering with elders' telephone use. Formative qualitative analyses clarified acceptance and implementation issues. Summative quantitative evaluation determined pilot intervention effects and was conducted by external evaluators. Despite interoperability and cellular reception issues, the system was successfully deployed across four states to a variety of businesses and housing types. Positive results occurred on worker morale, productivity, and reduction of caregiver stress. Participants found it easy to learn and use. Elders did not find the technology "intrusive" or "isolating." Contrary to their expectations, managers reported no abuse of Internet access. Workers expressed a willingness to pay for a similar system in the future ranging from $10 to $130, depending on the features. They would pay the most for the option involving a geriatric nurse coach. The WIN system innovatively tailored to users' wants, and provided users customized control and personalized support. Use of the system was associated with positive outcomes. Enrollment response suggests a specific niche market for remote home monitoring, making it a manageable employee benefit.

A Program to Enhance Completion of Screening Colonoscopy Among Urban Minorities

Although colonoscopy is becoming the preferred screening test for colorectal cancer, screening rates, particularly among minorities, are low. Little is known about the uptake of screening colonoscopy or the factors that predict colonoscopy completion among minorities. This study investigated the use of patient navigation within an open-access referral system and its effects on colonoscopy completion rates among urban minorities. This was a cohort study that took place at a teaching hospital in New York. Participants were mostly African Americans and Hispanics directly referred for screening colonoscopy by primary care clinics from November 2003 to May 2006. Once referred, a bilingual Hispanic female patient navigator facilitated the colonoscopy completion. Completion rates, demographic factors associated with completing colonoscopy, endoscopic findings, and patient satisfaction were analyzed. Of 1169 referrals, 688 patients qualified for and 532 underwent navigation. Two thirds (66%) of navigated patients completed screening colonoscopies, 16% had adenomas, and only 5% had inadequate bowel preps. Women were 1.31 times more likely to complete the colonoscopy than men (P = .014). Hispanics were 1.67 times more likely to complete the colonoscopy than African Americans (P = .013). Hispanic women were 1.50 times more likely to complete the colonoscopy than Hispanic men (P = .009). Patient satisfaction was 98% overall, with 66% reporting that they definitely or probably would not have completed their colonoscopy without navigation. By using a patient navigator, the majority of urban minorities successfully completed their colonoscopies, clinically significant pathology was detected, and patient satisfaction was enhanced. This approach may help increase adherence with screening colonoscopy efforts in other clinical settings.

The difficulties of early detection for infectious disease outbreak in China: A qualitative investigation

Objective To make intensified analysis upon the existing difficulties in early detection for the infectious diseases outbreak in China and put forward some effective measures to improve it. Methods Field investigation and in-depth interview were applied in 23 interviewees from different-level CDC. Results The study findings suggest that although the timeliness of outbreak detection has been improved since SARS epidemic in China, some problems still exist, such as: ▪ lacking syndrome surveillance; ▪ report quality of infectious disease should be improved; ▪ difficulties of identifying the cases at lower social economic status; ▪ adefinitefinancial compensation mechanism for the operation of web-based report system is absent; ▪ insufficient information exchange among different branches. Conclusion Some effective measures must be taken including developing syndrome surveillance system; affording more education and training for related staff; increasing payout on surveillance and establishing an information exchange platform for early detection of disease outbreak.

Leadership Practices that Guided the Implementation of an Electronic Web-based Report Card

Leadership Practices that Guided the Implementation of an Electronic Web-based Report Card

Interpreting Market Share Changes as Evidence for Effectiveness of Quality Report Cards

report cards have become an integral part of the American health care system. Quality From the early, now abandoned, efforts by the then Health Care Financing Administration (HCFA), which began publishing reports with risk-adjusted mortality rates for all hospitals in the country in the mid 1980s, we have moved into an era in which report cards abound. The federal government, through the Centers for Medicare & Medicaid Services (CMS), formerly HCFA, is now publishing Web-based report cards on hospitals, nursing homes, home care agencies, and managed care organizations (see http://www.medicare.gov). Many state governments, health plans, employers, and employer coalitions publish report cards as well. These reports typically focus on the quality of the clinical services of medical providers, although some may include information about other aspects of care, such as office staff courtesy, helpfulness, and respect.1 Although the market seems to have forged enthusiastically ahead with report cards, the scientific evidence about their effectiveness, and in particular, their impact on patient referrals, is mixed. Four review articles have examined studies of various report cards and concluded that, for the most part, there is only minimal evidence that report cards influence referral choices made by patients and their physicians. Mukamel and Mushlin2 reviewed 8 studies, including the HCFA Hospital Mortality reports, the New York State (NYS) and the Pennsylvania Coronary Artery Bypass Graft (CABG) reports, and the Health Plan Employer Data Information Set (HEDIS) managed care report (studies that were published between 1988 and 2000) and concluded that there is only a minimal effect on choice of provider. Marshall et al3 reviewed 9 studies including the HCFA Hospital Mortality reports, the NYS and the Pennsylvania CABG reports, and physician fee data (studies published between 1988 and 1998). They also found that, if an effect on provider choice and market shares is detected, it tends to be small. Schauffler and Mordavsky4 reviewed 16 studies of report cards on hospitals, cardiac surgeons, and managed care organizations (published between 1996 and 2000) that examined choice of providers made by patients, managed care organization, and employers. They also found that the impact of report cards is small and concluded that they do not make a difference in decisionmaking. A more recent review by Werner and Asch5 reached similar conclusions. This body of evidence, which has led some scholars to conclude that report cards do not influence choice of providers, flies in the face of the market's belief in the importance of report cards, as evidenced by the proliferation of these reports in recent years. This apparent paradox warrants examination of the question of whether the conclusions drawn from the empirical evidence indeed imply that the reports have no impact and have failed to play an important role in the health care system. In the remainder of this essay we examine the rationale and theoretical expectations for report cards and then discuss several reasons for the empirical findings of minimal effect on referrals, including the credibility and usefulness of the information in different report cards, their news content, and the impact of providers' capacity limitations. We then argue that a

Use of a Report Card to Implement a Network-Based Palliative Care Program

To report on implementation of a Veterans Affairs (VA) network-wide, standardized, high-quality palliative care (PC) program using a Web-based PC Report Card for performance monitoring and improvement. The PC director and coordinator and facility directors established interdisciplinary teams at five acute care and three nursing home sites. Teams were trained together and subsequently met quarterly for ongoing training. Additionally, the PC director and coordinator developed and implemented a Web-based PC Report Card on the network Intranet for PC coordinator to report performance data monthly to the PC teams. The number of patients in the network who received PC consults more than doubled in the first 4 years of the PC program. The percentage of deaths with PC consultation prior to death increased from 23% in fiscal year (FY) 2002 to 57% in FY06. Over the same period, the average days between the initial PC consultation and patients' death across all sites increased from 23 days to 106 days. All the sites established PC teams and the number of consultations showed a sustained increase over baseline in 2002. All sites improved on the key process measures captured by the Report Card.

A Prototype Web-based Reporting System for Onsite-Offsite Clinician Communication

The communication of imaging findings to a referring physician is an important role of the radiologist. However, communication between onsite and offsite physicians is a time-consuming process that can obstruct work flow and frequently involves no exchange of visual information, which is especially problematic given the importance of radiologic images for diagnosis and treatment. A prototype World Wide Web-based image documentation and reporting system was developed for use in supporting a "communication loop" that is based on the concept of a classic "wet-read" system. The proposed system represents an attempt to address many of the problems seen in current communication work flows by implementing a well-documented and easily accessible communication loop that is adaptable to different types of imaging study evaluation. Images are displayed in a native (DICOM) Digital Imaging and Communications in Medicine format with a Java applet, which allows accurate presentation along with use of various image manipulation tools. The Web-based infrastructure consists of a server that stores imaging studies and reports, with Web browsers that download and install necessary client software on demand. Application logic consists of a set of PHP (hypertext preprocessor) modules that are accessible with an application programming interface. The system may be adapted to any clinician-specialist communication loop, and, because it integrates radiologic standards with Web-based technologies, can more effectively communicate and document imaging data.

Developing and Implementing Automated Risk Assessments in Parole

This article describes the efforts undertaken during the past five years for the Georgia Board of Pardons and Paroles to develop a method for assessing parolee risk to inform the supervision level assignments of Georgia's 23,000 active parolees. The project resulted in an actuarial risk assessment method based on the analysis of over 6,000 parolees. Historically, officers conducted pencil-and-paper assessments on all new parolees entering supervision and reassessments every six months thereafter. The new instruments are automated—offender risk is derived through the execution of computerized programs that access both prison and parole data systems. Parolee risk scores are updated daily, incorporating the dynamics of daily correctional supervision progress or failure, and are provided to parole officers through web-based reports and e-mail.

Maximizing the Adequacy of Medication Treatment in Controlled Trials and Clinical Practice: STAR*D Measurement-Based Care

The success of well-developed protocols has been limited in real-world practice, where even effective strategies have not been sufficient to meet patient needs in routine clinical care owing to Axis I and III comorbidities. The Sequenced Treatment Alternatives to Relieve Depression (STAR(*)D) trial required that antidepressant medication treatment be optimal regarding dose and duration, yet accommodate flexibility to ensure safety given the wide range of comorbid general medical and psychiatric disorders allowed in the trial. The objective of this study was to develop a measurement-based care (MBC) approach and an automated feedback system to ensure adequate and safe antidepressant treatment delivery suitable for both clinical research and routine practice. Ratings of depressive symptom severity and side-effect frequency, intensity, and burden were obtained at each treatment visit using the MBC system that (1) guided medication dose adjustments and treatment duration, (2) documented clinician adherence to treatment recommendations, and (3) provided prompt feedback to clinicians to enhance appropriate treatment decisions. Physician adherence to protocol-specific treatment was monitored based on measured symptoms and side-effect burden, and dose and duration of antidepressant at each critical decision point during the acute phase treatment of major depression. Feedback was provided at the point of care by the clinical coordinators, assisted by Web-based reports following each treatment visit. On the basis of the first treatment step with citalopram, over 85% of treatment encounters had appropriate fidelity to recommendations. Most deviations from treatment recommendations occurred late in treatment and were often justifiable. MBC proved to be feasible and effective in busy primary and psychiatric settings. This approach signals a paradigm shift toward the use of measurement-based clinical decisions, both at the point of care and following each visit, to deliver optimal pharmacotherapy for depression.

Standard Operating Procedures for the Clinical Management of Patients Enrolled in a Prospective Study of Inflammation and the Host Response to Thermal Injury

As part of the National Institutes of General Medical Sciences (NIGMS)-funded Inflammation and the Host Response to Injury study, participating investigators created a database, a clinical data collection protocol, and web-based case report form. To obtain high-quality clinical endpoints for correlation with genomic data, a uniform approach to patient management between centers was required. Standard operating procedures (SOPs) were generated to minimize variability and promote a uniform standard of patient care. The SOPs are necessary to enable validation of the clinical endpoints to be used for comparison with genomic and proteomic information derived from samples of blood and tissue obtained from thermally injured patients. Participating investigators identified areas of potential practice variation and developed a set of SOPs based on available data and sound clinical principles. In the absence of sufficient clinical data to identify a single management strategy, SOPs were designed to apply the best approach to management without interfering with local standards of care. The data- collection instrument, or case report form, was constructed concurrently with the SOPs. Wherever possible, the case report form was modified to collect data that might resolve controversial management issues. Modifications in management strategies that were necessary for children are delineated as needed. Data queries and site visits were conducted to audit compliance. SOPs for 10 areas of clinical care were developed. The institution of the SOPs required minor changes in clinical practice patterns and personnel training but did not require participating centers to procure new technology or alter the utilization of clinical resources significantly. The SOPs represent current management strategies applied to the study population to reduce variation in patient management. The SOPs are easily adaptable to other burn-related clinical protocols as well as to the routine daily management burn patients.

The evolution of technology for electronic materials over the last 50 years

The assignment for this review was modest: “The scope of this area would include synthesis and processing, structure, properties, and performance of electronic, photonic, magnetic, and superconducting materials as well as the materials used in packaging and interconnecting such materials in device structures.” Furthermore, I should provide a perspective on “What materials are being used? What are the drivers behind their use? How much material is being used?” As I began to research this article, I realized that most of the advances in these materials have occurred during the past 50 years. Consider that the microscopic theory of superconductivity was fi rst developed in 1957 and the integrated circuit (IC) was invented in 1959. I was thus faced with either writing an essentially complete history of four different materials areas or providing just a very high-level overview. I have opted for the latter. Even fi nding data on the amounts of these materials used is diffi cult, since the information and communications industries don’t consider tonnage to be an interesting metric. In general, they report the dollar value of their products and perhaps the number of chips or the kilometers of fi ber shipped. Even then, reliable data is often only available from extremely expensive reports compiled by market analysts for commercial purposes. Thus, the uncited estimates used in this discussion come from web-based trade association reports and should not be viewed as highly reliable. They are presented only to get an idea of relative magnitudes of markets.

CORPORATE CYBERSPACE COMMUNICATION VS. PAPER-BASED COMMUNICATION: THE IMPACT OF MEDIA CHOICE ON COST AND BENEFIT

This study investigated how corporate media choices such as cyberspace and paper-based communication impacted cost and benefit. Data were collected from the Fortune 500 companies. The findings indicated that, while all the companies provided the Web version of annual reports on their investor relations page, 53% of the companies still printed and distributed paper-based annual reports in 2005. The average cost of designing, printing, and distributing paper-based annual report was more than $1.7 million per company in one year, which also consumed approximately 647,059 pounds of paper. In contrast, the costs of CD- and Web-based annual reports were only 21% and 3% of the cost of the paper version, respectively. In addition, the cost of distributing e-coupons by email was just 2% of the cost of mailing paper coupons via postal service.

Evaluation of Resident Laparoscopic Performance Using Global Operative Assessment of Laparoscopic Skills

The Global Operative Assessment of Laparoscopic Skills (GOALS), developed by Vassiliou and colleagues, has construct validity in the assessment of surgical residents' laparoscopic skills in dissection of the gallbladder from the liver bed. We hypothesized that GOALS would have construct validity for the entire laparoscopic cholecystectomy procedure and also for laparoscopic appendectomy. Using GOALS, attending surgeons evaluated PGY1 through PGY5 surgical resident performance during laparoscopic cholecystectomy (LC, n = 51) and laparoscopic appendectomy (LA, n = 43). Scores for five domains (depth perception, bimanual dexterity, efficiency, tissue handling, and autonomy) were recorded on a Web-based operative report generator at the conclusion of all cases. Domain scores were recorded using a 5-point Likert scale. Difficulty of the case was similarly rated on a 5-point scale. For analysis, residents were divided into two groups: novice (PGY1 to 3) and experienced (PGY4 to 5). Biostatistical analysis was performed using a two-sample t-test. Paired t-test was used to compare mean scores of residents who performed both LA and LC. For both LC and LA, the experienced group scored higher than novices did in all five domains. The differences were significant in all domains. Using the mean of the scores from all 5 domains for both LC and LA, the experienced residents scored significantly better than novices did (LC 3.93 versus 2.76, p < 0.001) (LA 4.22 versus 2.75, p < 0.001). No significant differences were noted in difficulty of the cases (p = 0.060 for LC and p = 0.19 for LA). This study provides additional evidence in support of GOALS as an assessment tool for objectively measuring technical skills in laparoscopic surgery.

Toward learning from patient safety reporting systems

Purpose To evaluate the frequency and type of factors involved in incidents reported to a patient safety reporting system and answer specific questions to enhance the value of PSRS data to improve patient safety. Materials and Methods Prospective cohort study of incidents reported from adult and pediatric intensive care units (ICUs) in the United States to the web-based, voluntary, and anonymous Intensive Care Unit Safety Reporting System. Results from July 1, 2002, to June 30, 2004. Main outcome variables were incidents that could or did lead to patient harm. Results Analysis includes 2075 incidents from 23 ICUs. Median number of reports/ICU/month was 3; 5 hospitals submitted 58% of reports. Harm was reported in 42% of incidents with 18 deaths. Common event types: medication/therapeutics (42%) and incorrect/incomplete care delivery (20%); 48% of line/tube/drain incidents led to physical harm. Deficiencies in training/education contributed to 49% of incidents and teamwork issues 32%; 42% of incidents had 2 or more contributing factors. As the number of contributing factors per incident increased, so did risk of harm. Conclusions The Intensive Care Unit Safety Reporting System provides a mechanism for multiple ICUs to identify hazards. Data trends show a correlation between multiple contributing factors and higher rates of harm. Further research is needed to help determine how to use PSRS data to improve patient safety.

Creating the Web-based Intensive Care Unit Safety Reporting System

In an effort to improve patient safety, researchers at the Johns Hopkins University designed and implemented a comprehensive Web-based Intensive Care Unit Safety Reporting System (ICUSRS). The ICUSRS collects data about adverse events and near misses from all staff in the ICU. This report reflects data on 854 reports from 18 diverse ICUs across the United States. Reporting is voluntary, and data collected is confidential, with patient, provider, and reporter information deidentified. Preliminary data include system factors reported, degree of patient harm, reporting times, and evaluations of the system. Qualitative and quantitative data are reported back to the ICU site study teams and frontline staff through monthly reports, case discussions, and a quarterly newsletter.

Using Web-based Reporting Systems to Evaluate Health Promotion

While Web-based reporting systems are becoming more common in public health for disease surveillance and for tracking interventions such as immunizations, their use for program evaluation is relatively new. This article describes two Web-based reporting systems developed to enable local agencies that conduct health promotion activities to enter process and outcome data for their own use, as well as for analysis by researchers and funders. The systems support the three major uses of evaluation: accountability, program improvement, and generating knowledge for the field. Annually, these programs obtain evaluation information on thousands of clients and individual and group sessions. Developing and introducing the Web-based systems was time-consuming and required significant State Health Department and local agency resources. Involvement of end users in the development process was critical to creating responsive systems that were accepted by staff in local agencies. Staff members from grantee agencies responded well to systems, as evidenced by high rates of user compliance (over 90%) and positive reactions (over 80%) on anonymous surveys. Concerns about resistance from contractors to use of the system, based on fears about breaches in client confidentiality or concerns about the difficulty in using the technology, were not borne out.

Corporate social and environmental responsibility in web-based reports: Currency in the banking sector?

Abstract The argument that accounting is an interested endeavour, premised on social practices, suggests that an examination of the quantity of corporate social reporting (CSR) in shareholder reports is too simplistic an avenue of exploration. An analysis of web-based financial and CSR reports, using a discourse/textual analytic approach, has raised questions regarding how these issues are given (and denied) prominence in this context by virtue of their physical positioning and persuasive language. In the study, web-based forms of reports of five banking groups are examined, Lloyds/TSB, the Royal Bank of Scotland, HSBC, Barclays and the Co-operative Bank. It is argued that, rather than the production of stand-alone reports signalling the growing importance of CSR considerations, in this context they function to peripheralise the information. Although it is evident that organizations are beginning to articulate a stance with regard to CSR, as increasingly more attention is being paid to social and environmental issues, simple articulation is no longer sufficient.

Update on Resistance among Nosocomial Gram-Negative Pathogens to Extended-Spectrum Cephalosporins and Fluoroquinolones: Results of the Antimicrobial Resistance Management (ARM) Program

Objective To evaluate trends in antibiotic resistance among Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa isolates submitted to the Antimicrobial Resistance Management (ARM) program between 1990 and 2002. Design The ongoing Antimicrobial Resistance Management (ARM) program is a queriable Web-based surveillance system that tracks resistance patterns among U.S. inpatient and outpatient isolates. This report represents data from 285 institutions and over 17 million isolates. Using a Web-based analysis tool, antibiogram and sensitivity reports of E. coli, K. pneumoniae, P. mirabilis, and P. aeruginosa isolates were reviewed for resistance to extended-spectrum cephalosporins and fluoroquinolones. Setting 285 teaching and non-teaching U.S Hospitals nationwide. Results For E. coli, resistance was 3.2% to ciprofloxacin (n = 444,947), 5.4% to levofloxacin (n = 201,532), and 0.8% to cefotaxime (n = 107,394), ceftriaxone (n = 464,931), and cefepime (n = 81,980), respectively. K. pneumoniae isolate resistance was 4.6% to ciprofloxacin (n = 144,698), 4.5% to levofloxacin (n = 57,462), 1.9% to cefotaxime (n = 33,189), 2.0% to ceftriaxone (n = 145,328) and 1.9% to cefepime (n = 25,503). For P. mirabilis, resistance was 12.5% to ciprofloxacin (n = 83,186), 12.2% to levofloxacin (n = 35,277), 1.0% to cefotaxime (n = 18,802), 0.7% to ceftriaxone (83,652), and 2.3% to cefepime (n = 13,968). P. aeruginosa resistance was also higher for fluoroquinolones (only 65.2% of isolates were susceptible to ciprofloxacin) compared to extended-spectrum cephalosporins, with ceftazidime exhibiting the greatest antipseudomonal activity. Clinically significant regional variations in the activity of fluoroquinolones and cephalosporins were apparent. Conclusion Resistance to the fluoroquinolones is increasing dramatically, whereas the third generation cephalosporins remain inherently more active. P. aeruginosa exhibits the most formidable resistance pattern with neither the antipseudomonal cephalosporins nor fluoroquinolones representing acceptable monotherapy options. Given the association between fluoroquinolone resistance and extended-spectrum β-lactamase production, continued surveillance is vital to preserve the activity of existing therapies.