Carbapenem-Resistant Enterobacteriaceae Detection Practices in California: What Are We Missing?

Background: The Clinical and Laboratory Standards Institute (CLSI) revised the carbapenem breakpoints for Enterobacteriaceae in 2010. The number of hospitals that adopted revised breakpoints and the clinical impact of delayed adoption has not been explored. Methods: We performed a cross-sectional, voluntary survey of microbiology laboratories from California acute care hospitals and long-term acute care hospitals (LTAC) to determine use of revised CLSI breakpoints. Carbapenem-resistant Enterobacteriaceae (CRE) clinical isolates from a single tertiary-care hospital from 2013 to 2017 were examined. All isolates with an elevated minimum inhibitory concentration (MIC; ≥2 µg/mL) to imipenem or meropenem were tested for the presence of carbapenemase genes by polymerase chain reaction (PCR). Results: We received responses from 128 laboratories that serve 264/393 (67%) of hospitals and LTACs. Current CLSI carbapenem breakpoints for Enterobacteriaceae were used by 92/128 (72%) laboratories. Among laboratories that used current breakpoints, time to implementation varied from 0 to 68 months (mean, 41 months; median, 55 months). Application of historical breakpoints to isolates with a carbapenemase gene detected by PCR resulted in susceptibility rates of 8.9%, 18.6%, and 18.6% to ertapenem, imipenem, and meropenem, respectively. By current breakpoints, <1% of these isolates were susceptible to ertapenem or imipenem and 2.6% to meropenem. Conclusion: Clinicians and epidemiologists should be aware that use of outdated MIC breakpoints for Enterobacteriaceae remains common and can result in reports of false susceptibility to carbapenems and missed identification of carbapenemase producers. This misclassification could have consequences for patient care and infection control efforts to address carbapenemase-producing Enterobacteriaceae.

Geriatric intervention: Strategy to enhance the social roles of the elderly / Intervención situacional gerontológica: estrategia para potenciar los roles sociales de los mayores

At the global level, population aging is an issue that is becoming increasingly important due to the great impact it will have on the 21st century society. It is essential to develop policies, strategies and actions aimed at addressing the issues that will arise from the rapid increase in this segment of population. The aim of this paper is to propose the geriatric intervention as a strategy for the development of the older people in their community. We expose the epistemological frame, the theoretical and methodological support and the need to find a language to incorporate the older adult actively to society, in a condition of total equality. The moments of the situation analysis for strategic planning (explanatory, normative, strategic, tactical and operational) are explained. The model has been implemented in Chile and inspired the community development centers (CDC). It has been implemented as well in community interventions of social work. Working from this perspective implies to overcome the approaches that visualize older adults only as sick or disabled people, to assume the dynamics of life that these people experience in their communitarian spaces, as well as the possibility to continue with their development, to exercise citizenship, to demand respect for their rights and enhance their social roles.

A nivel global, el envejecimiento de la población es un tema que adquiere cada día mayor relevancia por el gran impacto que habrá de tener en la sociedad del siglo XXI. Es fundamental la elaboración de políticas, estrategias y acciones encaminadas a la atención de los problemas que derivarán del aumento vertiginoso de este segmento de la población. Este trabajo tiene como objetivo proponer la intervención situacional gerontológica como una estrategia para el desarrollo de las personas mayores en su comunidad. Se presenta el sustento epistemológico, teórico y metodológico y se precisa la necesidad de buscar un lenguaje que permita incorporar a la persona envejecida activamente a la sociedad, en condición de total igualdad. Se explican los momentos de la planificación situacional (explicativo, normativo, estratégico y táctico-operacional). El modelo ha sido aplicado en Chile y dio origen a los centros de desarrollo comunitario (CDC). Se ha implementado en intervenciones comunitarias de trabajo social. Intervenir desde esta perspectiva implica superar los enfoques que visualizan a las personas envejecidas solo como enfermos o discapacitados y asumir la dinámica de vida que presentan las personas mayores en sus espacios comunitarios y la posibilidad de continuar con su desarrollo, ejercer la ciudadanía, exigir respeto a sus derechos y potenciar sus roles sociales.

Gerontología: un mirada bibliométrica de las citaciones clásicas en Web Of Science (1975-2018) / Gerontology: a bibliometric look at classical citations in Web Of Science (1975-2018)

Resumen La gerontología es comprendida como un enfoque interdisciplinario que aborda el proceso de envejecimiento y vejez. El presente artículo caracteriza la evolución de la investigación en el campo gerontológico durante los últimos 44 años a través de un análisis bibliométrico de los trabajos de mayor impacto en el área. Se revisaron 94 publicaciones de la colección principal de la Web of Science (WoS) de Thomson Reuters en el periodo 1975-2018. Se analizan las publicaciones y su evolución longitudinal, el acoplamiento de documentos clásicos, áreas de investigación, autores y co-autorías, revistas y países. Se concluye que Estados Unidos es el país que reúne la mayor cantidad de publicaciones, citas y revistas de difusión de textos clásicos.

Abstract Gerontology is understood as an interdisciplinary approach that addresses the process of aging and old age. The present article characterizes the evolution of research in the gerontological field during the last 44 years through a bibliometric analysis of the works of greatest impact in the area. Ninety-four publications were reviewed from the main collection of the Web of Science (WoS) by Thomson Reuters in the period 1975-2018. The publications and their longitudinal evolution, the coupling of classic documents, research areas, authors and co-authors, journals and countries are analyzed. It is concluded that the United States is the country with the largest number of publications, citations and journals disseminating classical texts.

Duodenal tumor presenting as acquired hemophilia in an 88-year-old woman: a clinical case and review of the literature.

Acquired hemophilia is a rare disease, presenting with severe hemorrhage, we present a case caused by a duodenal tumor, the clinical management, ethical implications, treatment recommendations, and a review of the literature.