Incidence, Predictors, and Outcomes of Pseudomonas aeruginosa Associated Acute Appendicitis in Children.

BACKGROUND: Pseudomonas aeruginosa (PSA) is an infectious pathogen associated with acute appendicitis; however, it is not consistently addressed by empirical antibiotic therapy, despite potential complications. OBJECTIVES: To investigate the incidence, predictors, and outcomes of PSA-associated acute appendicitis in children. METHODS: We conducted a retrospective analysis involving pediatric patients who underwent acute appendicitis surgery and had positive peritoneal cultures. Clinical, microbiological, and intraoperative data were extracted from medical records. RESULTS: Among 2523 children with acute appendicitis, 798 (31.6%) underwent peritoneal cultures, revealing 338 positive cases (42.3%), with PSA detected in 77 cases (22.8%). Children with PSA were three times more likely to exhibit high intraoperative grading ≥ 3 (93.4% vs. 76.8%, 95% confidence interval [95%CI] 1.2-8.3, P = 0.023) and nearly four times more likely to have polymicrobial cultures (88.3% vs. 62.1%, 95%CI 1.8-8.0, P < 0.001) than those without PSA in peritoneal cultures. Duration of symptoms did not predict PSA isolation (P = 0.827). Patients with PSA had longer median hospital stays (8 days, interquartile range [IQR] 7-10) than those with other pathogens (7 days, IQR 5-9) (P = 0.004). Antibiotic treatment duration, intensive care unit admission rates, readmission, and mortality were similar between the two groups (P = 0.893, 0.197, 0.760, and 0.761, respectively). CONCLUSIONS: PSA is a common pathogen in children diagnosed with acute appendicitis and positive peritoneal cultures. The likelihood of isolating PSA increases with high-grade intraoperative assessment and in the presence of multiple pathogens in peritoneal cultures, suggests antipseudomonal treatment.

Noise levels associated with New York City's mass transit systems.

OBJECTIVES: We measured noise levels associated with various forms of mass transit and compared them to exposure guidelines designed to protect against noise-induced hearing loss. METHODS: We used noise dosimetry to measure time-integrated noise levels in a representative sample of New York City mass transit systems (subways, buses, ferries, tramway, and commuter railways) aboard transit vehicles and at vehicle boarding platforms or terminals during June and July 2007. RESULTS: Of the transit types evaluated, subway cars and platforms had the highest associated equivalent continuous average (L(eq)) and maximum noise levels. All transit types had L(eq) levels appreciably above 70 A-weighted decibels, the threshold at which noise-induced hearing loss is considered possible. CONCLUSIONS: Mass transit noise exposure has the potential to exceed limits recommended by the World Health Organization and the US Environmental Protection Agency and thus cause noise-induced hearing loss among riders of all forms of mass transit given sufficient exposure durations. Environmental noise-control efforts in mass transit and, in cases in which controls are infeasible, the use of personal hearing protection would benefit the ridership's hearing health.

Approaching the Evidence Basis for Aviation-Derived Teamwork Training in Medicine.

The Institute of Medicine has suggested that training in team behavior, leadership, communication, and other human factors could reduce medical errors and improve patient safety. Training on such topics has been adapted from teamwork training programs used in military and commercial aviation, called crew resource management (CRM). The principles behind CRM programs have been deployed in a number of clinical settings over the past 2 decades, and there are now several CRM vendors. Little is known about this nascent industry, and the emerging research supporting CRM programs lacks standardization and conclusive evidence. The objectives of this study were to report on the body of empirical data about CRM training in clinical settings and to provide a conceptual framework for evaluating its effectiveness in medicine. Using the proposed conceptual framework, the authors further examine currently published methods of measuring effectiveness and identify future directions for the use of teamwork training in medicine.

Organizational climate and nurse health outcomes in the United States: a systematic review.

Increasing interest has been focused on understanding the role working conditions play in terms of the serious issues facing hospitals today, including quality of patient care, nurse shortages, and financial challenges. One particular working condition that has been the subject of recent research, is the impact of organizational climate on nurses' well-being, including occupational health outcomes. To examine evidence-based research on the association between organizational climate and occupational health outcomes among acute-care registered nurses, a systematic review of published studies was conducted. Studies assessing the association between organizational climate variables and three common health outcomes in nurses (blood/body fluid exposures, musculoskeletal disorders, and burnout) were reviewed. Fourteen studies met the inclusion criteria. Although most were cross-sectional in design and variability was noted across studies with respect to operational definitions and assessment measures, all noted significant associations between specific negative aspects of hospital organizational climate and adverse health impacts in registered nurses. While evidence for an association between organizational climate constructs and nurses' health was found, data were limited and some of the relationships were weak. Additional studies are warranted to clarify the nature of these complex relationships.

Utility of routine blood tests after elective laparoscopic cholecystectomy for symptomatic gallstones.

AIM: To evaluate the value of blood testing after elective laparoscopic cholecystectomy and its association with procedure related complications. METHODS: Charts of all patients undergoing elective laparoscopic cholecystectomy from January 2013 through December 2014 were reviewed retrospectively for demographics, indication for surgery, operative course and outcome. In our institution the decision to perform postoperative blood analysis is left for the discretion of the surgeon, therefore we had the possibility to compare the results of those who had blood analyses results to those who did not. Analysis was performed to identify variables associated with the decision to perform postoperative blood tests. Subsequently a univariate and multivariate analyses was performed comparing the two cohorts. Secondary subgroup analysis was performed to identify factors associated with procedure related complications. RESULTS: Five hundred and thirty-two elective laparoscopic cholecystectomies for symptomatic gallstones were performed during the study period. Sixty-four percent of the patients (n = 340) had blood tests taken post operatively. Patients that had laboratory tests taken were older (P = 0.006, OR = 1.01), had longer surgery (P < 0.001, OR = 3.22) had more drains placed (P < 0.001, OR = 3.2) and stayed longer in the hospital (P < 0.001, OR = 1.2). A subgroup analysis of the patients who experienced complications revealed longer stay in the hospital (P < 0.001), higher body mass index (BMI) (P = 0.04, OR = 1.08), increased rates of drain placement (P = 0.006, OR = 3.1) and higher conversion rates (P = 0.01, OR = 14.6). Postoperative blood tests withdrawals were not associated with complications (P = 0.44). On Multivariate analysis BMI and drain placement were independently associated with complications. CONCLUSION: The current study indicate that routine postoperative blood tests after elective laparoscopic cholecystectomy for symptomatic gallstones does not predict complications and may have an added benefit in diagnosis and management of cases were the surgeon encountered true technical difficulty during surgery.

Approaching the evidence basis for aviation-derived teamwork training in medicine.

The Institute of Medicine has suggested that training in team behavior, leadership, communication, and other human factors could reduce medical errors and improve patient safety. Training on such topics has been adapted from teamwork training programs used in military and commercial aviation, called crew resource management (CRM). The principles behind CRM programs have been deployed in a number of clinical settings over the past 2 decades, and there are now several CRM vendors. Little is known about this nascent industry, and the emerging research supporting CRM programs lacks standardization and conclusive evidence. The objectives of this study were to report on the body of empirical data about CRM training in clinical settings and to provide a conceptual framework for evaluating its effectiveness in medicine. Using the proposed conceptual framework, the authors further examine currently published methods of measuring effectiveness and identify future directions for the use of teamwork training in medicine.

Influenza vaccination: financial burden or public health solution?

Influenza drives up both direct and indirect costs for employers. Vaccinating employees can help with prevention, but the answer to keeping costs down may be herd immunity.