Newer glycopeptide antibiotics for treatment of complicated skin and soft tissue infections: systematic review, network meta-analysis and cost analysis.

OBJECTIVES: Skin and soft tissue infections (SSTIs) carry significant economic burden, as well as morbidity and mortality, especially when caused by methicillin-resistant Staphylococcus aureus (MRSA). Several new MRSA-active antibiotics have been developed, including semisynthetic glycopeptides (telavancin, dalbavancin and oritavancin). Of these, dalbavancin and oritavancin offer extended dosing intervals. METHODS: We performed a systematic review, network meta-analysis and cost analysis to compare the newer glycopeptides to standard care and to each other for the treatment of complicated SSTIs (cSSTI). A search for randomized controlled trials (RCTs) was conducted in Medline, Embase and the Cochrane Central Register of Controlled Trials. We also developed a model to evaluate the costs associated with dalbavancin and oritavancin from the third-party payer perspective. RESULTS: Seven RCTs met the inclusion criteria. Network meta-analyses suggested that the clinical response to telavancin, dalbavancin and oritavancin was similar to standard care (odds ratio (OR) 1.09, 95% confidence interval (CI) 0.90-1.33; OR 0.78, 95% CI 0.52-1.18; and OR 1.06, 95% CI 0.85-1.33, respectively). Head-to-head comparisons showed no difference in clinical response between oritavancin and dalbavancin (OR 1.36; 95% CI 0.85-2.18), oritavancin and telavancin (OR 0.98; 95% CI 0.72-1.31) or dalbavancin and telavancin (OR 0.72; 95% CI 0.45-1.13). Telavancin had a higher incidence of overall adverse events compared to standard care (OR 1.33; 95% CI 1.10-1.61). Compared to telavancin, there were fewer overall adverse events with dalbavancin (OR 0.58; 95% CI 0.45-0.76) and oritavancin (OR 0.71; 95% CI 0.55-0.92). Studies were of high quality overall. Our cost analyses demonstrated that dalbavancin and oritavancin were less costly compared to standard care under baseline assumptions and many scenarios evaluated. The use of dalbavancin could save third-party payers $1442 to $4803 per cSSTI, while the use of oritavancin could save $3571 to $6932 per cSSTI. CONCLUSIONS: Dalbavancin and oritavancin demonstrate efficacy and safety comparable to standard care in well-designed RCTs and result in cost savings when standard care is treatment that covers MRSA.

Reduction in Clostridium difficile infection associated with the introduction of hydrogen peroxide vapour automated room disinfection.

The clinical impact of implementing hydrogen peroxide vapour (HPV) disinfection of rooms vacated by patients with Clostridium difficile infection (CDI) was evaluated. Breakpoint time series analysis indicated a significant reduction (P<0.001) in the CDI rate at the time when HPV disinfection was implemented, resulting in a reduction in the CDI rate from 1.0 to 0.4 cases per 1000 patient-days in the 24 months before HPV usage compared with the first 24 months of HPV usage. HPV should be considered to augment the terminal disinfection of rooms vacated by patients with CDI.

A case for unique allied health student enrollment control within a selective university setting.

Expanding allied health preprofessional enrollment encouraged analyzing graduation outcomes to identify criteria that would help control future enrollment. High School Class PERCENTILE Rank, First year Students' predicted QUARTILE ranks and ACT scores were independent variables in the study. QUARTILE reflected predicted First year Students' GPA. Relationships between graduating, PERCENTILE, ACT and QUARTILE were assessed by discriminant analysis, t tests and ANOVA. Students' last-known-LOCATION (University of Missouri-Columbia(UMC) School of Health Related Profession (SHRP), left UMC, another UMC division) was also investigated concerning GRADUATION status and QUARTILE by Chi Square analysis. Results suggested PERCENTILE discriminated between graduates of UMC SHRP and other UMC divisions. SHRP graduates had a higher PERCENTILE mean than graduates of other UMC divisions. Students in the lowest quartile had little chance of graduating from an SHRP program. Excluding the lowest quarter of First year Students from SHRP would effectively control enrollment.

Comparison of the frictional coefficients for selected archwire-bracket slot combinations in the dry and wet states.

Coefficients of friction were evaluated in the dry and wet (saliva) states for stainless steel, cobalt-chromium, nickel titanium, and beta-titanium wires against either stainless steel or polycrystalline alumina brackets. For both operators' experiments, an 0.010" stainless steel ligature wire pressed each archwire into the 0.018" or 0.022" bracket slot at 34 degrees C. In the dry state and regardless of slot size, the mean kinetic coefficients of friction were smallest for the all-stainless steel combinations (0.14) and largest for the beta-titanium wire combinations (0.46). The coefficients of the polycrystalline alumina combinations were generally greater than the corresponding combinations that included stainless steel brackets. In the wet state, the kinetic coefficients of the all-stainless steel combinations increased up to 0.05 over the dry state. In contrast, all beta-titanium wire combinations in the wet state decreased to 50% of the values in the dry state. The mixed reports that saliva may promote adhesive and lubricious behaviors may have some substance.

Relationship of the diameter and tensile strength of nylon sutures to the USP specification and the effect of preconditioning.

Nylon monofilament sutures were tested in a straight pull as well as a conventional knot pull tensile test. In each test, sutures were evaluated following storage under prevailing atmospheric conditions or saturation in whole human blood. Blood saturation decreased the ultimate tensile strength by as much as 20%. The present investigation of sutures that were stored under prevailing atmospheric conditions substantiated the proposal previously made for polypropylene monofilaments--that 60% of the ultimate tensile strength could be established as a fundamental USP criterion for Class I monofilament sutures.

Role expectations of the respiratory therapy practitioner as reported by the role incumbent and other health care professionals.

The field of respiratory care has expanded quickly because of the technological advances of the past decade. This expansion has led the respiratory therapy practitioner (RTP) to view himself as functioning in a capacity that goes beyond technical competence to include patient evaluation and management. Other health care professionals, however, seem reluctant to accept this broadened role. This study sought to determine whether differences in RTP role expectations could be identified among RTPs, registered nurses, and physicians. In general, each group reported a similar pattern of expectations. However, major differences were identified between the physicians and RTPs in viewing tasks requiring independent clinical decisions and the modification of prescribed therapy. The nurse and RTP groups differed from the physician group in expectations related to recommending and obtaining additional patient data. No significant difference was found in expectations related to the removal of bronchopulmonary secretions. It is clear that the role of the RTP is not completely identified, accepted, or understood. Because of the inconsistencies in role expectations, the potential for role conflict may be increased and the effectiveness of the health care team reduced.