Comparing national point prevalence surveys of healthcare-associated infection and antimicrobial prescribing: a methodological approach to adjust for differences in case-mix.

BACKGROUND: National point prevalence surveys (PPS) of healthcare-associated infection (HAI) and antimicrobial prescribing in hospitals were conducted in 2011 and 2016 in Scotland. When comparing results of PPS, it is important to adjust for any differences in patient case-mix that may confound the comparison. AIM: To describe the methodology used to compare prevalence for the two surveys and illustrate the importance of taking case-mix (patient and hospital stay characteristics) into account. METHODS: Multivariate models (clustered logistic regression) that adjusted for differences in patient case-mix were used to describe the difference in prevalence of six outcomes (HAI, antimicrobial prescribing and four devices: central vascular catheter, peripheral vascular catheter, urinary catheterisation and intubation) between the 2011 and 2016 PPS. Univariate models that did not adjust for these differences were also developed for comparison to show the importance of adjusting for confounders. RESULTS: Without adjustment for case-mix, HAI and intubation prevalence estimates were not significantly different in 2016 compared with 2011 although with adjustment, the prevalence of both was significantly lower (P=0.03 and P=0.02, respectively). These associations were only identified after adjustment for confounding by case-mix. CONCLUSIONS: While prevalence surveys do not provide intelligence on temporal trends as an incidence-based surveillance system would, if limitations and caveats are acknowledged, it is possible to compare two prevalence surveys to describe changing epidemiology. Adjusting for differences in case-mix is essential for robust comparisons. This methodology may be useful for other countries that are conducting large, repeated prevalence surveys.

The Adolescent Intensive Management Team: an intensive outreach mental health service for high-risk adolescents.

OBJECTIVE: The aim of this paper was to describe the Adolescent Intensive Management (AIM) team at the Austin Child and Adolescent Mental Health Service (CAMHS), a unique model of intensive outreach service with high-risk and difficult-to-engage adolescents, and describe the profile of clients referred to it. METHOD: This study used a retrospective review of clients' data, collected through file audit, over a 12-month period. RESULTS: The result of the study showed that a 100% retention rate of adolescents with complex social, emotional and mental health needs is possible in a flexible and multi-system approach to service provision. CONCLUSION: Clients referred to the CAMHS' AIM team displayed a pattern of multiple risk factors and comorbidities. Low caseload of 8-10 clients per clinician allowed flexibility and a level of intensity to make any necessary changes in service provision to better suit the client's needs. The majority of clients showed improvement in functioning following intervention by the team.

Leiomyoma of the female urethra.

The Authors reported a case of leiomyoma of the urethra in a 31-years old woman. Differential diagnosis, surgical treatment and prognosis were discussed.

Pelvic floor reconstructive surgery: which aspects remain controversial?

PURPOSE OF REVIEW: The article focuses on recently published original and review papers on current controversial aspects of pelvic reconstructive surgery. RECENT FINDINGS: A detailed Medline search was performed on records published in the previous 12 months. Controversial areas concerning which important work has been recently published include (a) prophylactic treatment of stress urinary incontinence, (b) the use of prosthetic materials (particularly for anterior segment reconstruction), (c) laparoscopic surgery. The considerations of the recent International Consultation on Incontinence are also reported. Other controversial areas in the field of pelvic reconstructive surgery such as the question of uterine preservation during the surgery for uterovaginal prolapse provided no significant new data in the period of this review. SUMMARY: In this evolving field, there is still poor standardization of what constitutes anatomical and functional cure. The transvaginal approach is the most promising of all techniques, and new techniques are evolved mainly in this area. There continues to be a need for multicenter prospective randomized trials providing level I evidence. Recurrence rates, particularly in the anterior wall, are still unacceptably high. Evidence is urgently needed to decide whether the use of prosthetic materials may provide the answer, if so, which material and which method?

Changing trends in incidence and mortality of thyroid cancer in Scotland.

OBJECTIVE: The incidence of thyroid cancer is increasing in several countries. The aim was to investigate trends in the incidence and mortality of thyroid cancer in Scotland, where thyroid cancer is relatively uncommon, between 1960 and 2002. DESIGN: Descriptive epidemiological study. METHODS: Thyroid cancer registrations between 1960 and 2000 were obtained from the Scottish Cancer Registry. Mortality data (1960-2002) and population estimates were supplied by the Registrar General for Scotland. Incidence and mortality data are expressed as age-specific rates and European age-standardized rates (EASRs). RESULTS: Thyroid cancer was three times more common in females than in males and was more common in older than younger age groups. Between 1960 and 2000, the annual EASR of thyroid cancer increased from 1.76 to 3.54 per 100,000 for females (P < 0.001) and from 0.83 to 1.25 per 100,000 in males (P < 0.001). The overall thyroid cancer increase between 1975 and 2000 was primarily caused by an increase in papillary thyroid cancer, particularly over the most recent decade. The incidence of follicular thyroid cancer also increased while the incidence of anaplastic and medullary thyroid cancer did not change significantly. Mortality from thyroid cancer fell progressively between 1960 and 2002. EASR for females decreased from 1.05 to 0.28 (P < 0.001) and in males from 0.73 to 0.34 (P < 0.001). For both sexes, in general, survival at 1-, 5- and 10-year follow-up intervals from diagnosis improved steadily over the study period. In both females and males, survival from thyroid cancer was better if the diagnosis was made under the age of 50 years. CONCLUSIONS: Thyroid cancer incidence has increased in Scotland over the past 40 years. This is accompanied by a change in the distribution of histological type with a particular increase in papillary carcinoma. The reasons for this may relate partly to changes in clinical practice and histological criteria. Falling mortality in the face of increasing incidence reflects improvements in survival, which should improve further with the introduction and implementation of standardized treatment protocols.