Prolonged and large outbreak of invasive group A Streptococcus disease within a nursing home: repeated intrafacility transmission of a single strain.

OBJECTIVES: Multiple invasive group A Streptococcus (GAS) infections were reported to public health by a skilled nursing facility (facility A) in Illinois between May 2014 and August 2016. Cases continued despite interventions including antibiotic prophylaxis for all residents and staff. Two other geographically close facilities reported contemporaneous outbreaks of GAS. We investigated potential reasons for ongoing transmission. METHODS: We obtained epidemiologic data from chart review of cases and review of facility and public health records from previous investigations into the outbreak. Infection control practices at facility A were observed and evaluated. Whole genome sequencing followed by phylogenetic analysis was performed on available isolates from the three facilities. RESULTS: From 2014 to 2016, 19 invasive and 60 noninvasive GAS infections were identified at facility A occurring in three clusters. Infection control evaluations during clusters 2 and 3 identified hand hygiene compliance rates of 14% to 25%, appropriate personal protective equipment use in only 33% of observed instances, and deficient wound-care practices. GAS isolates from residents and staff of all three facilities were subtype emm89.0; on phylogenetic analysis, facility A isolates were monophyletic and distinct. CONCLUSIONS: Inadequate infection control and improper wound-care practices likely led to this 28-month-long outbreak of severe infections in a skilled nursing facility. Whole genome sequencing and phylogenetic analysis suggested that intrafacility transmission of a single highly transmissible GAS strain was responsible for the outbreak in facility A. Integration of genomic epidemiology tools with traditional epidemiology and infection control assessments was helpful in investigation of a facility-wide outbreak.

Interdisciplinary health professional education: a historical review.

A historical review was conducted to examine the advances made, nationally and internationally, in interdisciplinary health professional education since the mid-1960s. One hundred and nineteen articles were reviewed and divided by decade into the following subheadings: models, courses, communication/group process issues, and international perspectives. Twenty-seven articles, categorized as models, defined the conceptual field, described curriculum and program development, or provided a framework for evaluation. Thirty-two articles dealt with interdisciplinary courses, focusing on objectives, content areas, or innovative methods. Nine articles contributed content on interdisciplinary communication and group process issues, from which guidelines were abstracted. Fifty-one articles contributed an international perspective, leading to the recognition that interdisciplinary health professional education, practice, and research is a global movement.

Do new surgeons have higher surgical-site infection rates?

We compared class I surgical-site infection (SSI) rates for new and experienced surgeons. Data showed that new surgeons in two surgical subspecialties associated with higher baseline SSI rates had rates higher than their experienced colleagues. They took longer in the operating room (OR), but did not operate on sicker patients. As the surgeons gained more experience (as measured by cumulative cases), their OR times and SSI rates decreased toward their colleagues'. New surgeons who perform infection-prone surgery may have higher SSI rates than more experienced colleagues until they gain experience. A new surgeon's SSI rate could be one factor considered in assessing competence.

Effects of exposure to information about appearance stereotyping and discrimination on women's body images.

OBJECTIVE: There is widespread public dissemination of research findings and media messages regarding social advantages of physical attractiveness and liabilities of unattractiveness. The purpose of this experimental study was to determine the effects of such information on women's body-image experiences. METHOD: College women (n = 66) listened to one of two audiotapes that detailed research-based information either on the subject of appearance stereotyping and discrimination or on the control topic of television violence and aggression. RESULTS: Although the two conditions did not differentially alter mood, exposure to appearance-related versus control information produced significantly less favorable body-image evaluations. Furthermore, as predicted, women who were schematically invested in their physical appearance were especially susceptible to the deleterious effects of the appearance information. DISCUSSION: The scientific and clinical implications of these findings were discussed, particularly with respect to eating disturbances.

Facilitating factors for, barriers to, and outcomes of interdisciplinary education projects in the health sciences.

Appropriate collaboration and communication among health professionals is viewed as increasingly important in meeting the challenges of today's health care system. Student socialization to interdisciplinary practice is thought to be facilitated through interdisciplinary academic and clinical learning experiences during the educational program. The purpose of this article is to identify factors commonly cited as facilitating and inhibiting interdisciplinary education, to provide insight for the development of successful interdisciplinary education projects.

A review of the use of nursing diagnosis in U.S. nurse practice acts.

PURPOSE: To determine how many state nurse practice acts include the term or concept of "nursing diagnosis" and describe their similarities and differences. METHODS: Investigators independently divided the practice acts of the 50 states and the District of Columbia into those that did or did not include the term "nursing diagnosis" or the word "diagnosis" within a nursing context. To describe other differences, the investigators operationally defined and independently categorized each act as trendsetting, contemporary, or traditional. FINDINGS: Thirty-three of the 51 practice acts used the term "diagnosis" within nursing context. Of these 33, 13 were identified as trendsetters and 20 as contemporary. Seven trendsetting and 5 contemporary practice acts used the NANDA-based language or "response" when describing the "what" of nursing diagnosis. None of the trendsetting practice acts, but 8 of the contemporary acts, used the NANDA-based "individual, family or community" when describing the "who" of nursing diagnosis. CONCLUSIONS: The language of nursing is changing. The majority of practice acts now define the practice of professional nursing as including the diagnostic act, although the manner in which they use the term varies.

Patients' perceptions of uncertainty and stress during weaning from mechanical ventilation.

Weaning from mechanical ventilation is physiologically and psychologically stressful for patients. The critical care nurse is in an optimal position to reduce patients' stress during this process. The findings of this exploratory study suggest practice changes--based on patients' perspectives--that help reduce patients' feelings of uncertainty and stress as they are weaned from mechanical ventilation.

Characteristics of patient visits to nurse practitioners and physician assistants in hospital outpatient departments.

Many authors have described differences between nurse practitioners and physician assistants. Most studies have compared physician with nonphysician providers' practice. Few studies have compared nurse practitioners and physician assistants, and none has used a national data base. This exploratory, atheoretical research examined which of the following characteristics predicted patients being seen by nurse practitioners and physician assistants: patient and hospital demographics, diagnosis, diagnostic/screening services, therapeutic services, and disposition of the visit. The data set used for analysis was the 1992 National Hospital Ambulatory Medical Care Survey. Based on a multistage probability design yielding national estimates for patient visits in hospital outpatient settings, the National Hospital Ambulatory Medical Care Survey showed that there were 2,847 weighted patient visits to either nurse practitioners or physician assistants (4.6 million patient visits using national estimates). Results of multivariate logistic regression suggest that nurse practitioners were the most likely nonphysician provider for outpatients receiving more health promotion and counseling (therapeutic) services and for those needing women's and children's services. Outpatients in rural areas predicted visits to physician assistants. As more nonphysician providers enter the work force, the results of this research may assist with understanding the utilization of nurse practitioners and physician assistants in primary care.

Ontogeny of the electrophysiological activity of dopaminergic cells with special reference to the influence of adrenal medullary grafts on aging.

A variety of neurological impairments during aging involves pathological changes in the basal ganglia, with the consequent deterioration of motor activities. The purpose of this study was to determine whether the extracellular activity of dopaminergic cells of the substantia nigra pars compacta of Wistar rats changes with age, and if so whether ventricular adrenal medullary grafts can influence the electrophysiological activity of the oldest age group. The results indicate that there is a significant decrease in the firing frequency of substantia nigra cells which begins at 18 months of age and is most prominent by 22-24 months of age. The rate of firing was improved with adrenal medulla grafts placed in the lateral ventricle. In addition, it was also observed that with age there is an increase in the number of cells which fire at slower frequencies. Quinpirole administration induced a significant decrease in firing frequency in all age groups, including the grafted animals. These results suggest that in the aged Wistar rats there is an impairment in the response of SNC cells, which can be partially restored by fetal adrenal medullary grafts.