Nosocomial infections in U.S. hospitals, 1975-1976: estimated frequency by selected characteristics of patients.

To obtain estimates of the frequency of nosocomial infections nationwide, those occurring at the four major sites--urinary tract, surgical wound, lower respiratory tract and bloodstream--were diagnosed in a stratified random sample of 169,526 adult, general medical and surgical patients selected from 338 hospitals representative of the "mainstream" of U.S. hospitals. We estimate that in the mid-1970s one or more infections developed in 5.23 percent (+/- 0.16) of the patients and that 6.62 (+/- 0.24) infections occurred among every 100 admissions. Risks were significantly related to age, sex, service, duration of total and of preoperative hospitalization, presence of previous nosocomial or community-acquired infection, types of underlying illnesses and operations, duration of surgery, and treatment with urinary catheters, continuous ventilatory support or immunosuppressive medications. Seventy-one percent of the nosocomial infections occurred in the 42 percent of patients undergoing surgery and 56 percent in the 38 percent financed by Medicare, Medicaid or other public health care plans.

A review of multicenter controlled studies of fluoxetine vs. imipramine and placebo in outpatients with major depressive disorder.

The efficacy of fluoxetine was evaluated in depressed patients in double-blind imipramine- and placebo-controlled clinical trials. Fluoxetine produced greater improvement than placebo on all major efficacy parameters and was comparable to imipramine with respect to the primary indicators of depression. Fluoxetine had significantly less associated anticholinergic effects, dizziness, drowsiness, somatosensory disturbance, and excessive sweating than imipramine. Although nausea occurred more frequently in fluoxetine patients, it was generally mild and well tolerated. A significantly smaller percentage of fluoxetine than imipramine patients terminated therapy because of adverse experiences.

Readiness, action, and resolve for change: do health care leaders have what it takes?

Careful assessment and planning are not enough to lead organizational change. Success depends on deliberate action by leaders and the resolve to stay the course.

Continuous improvement in health care: transforming the hospital department.

Each department in a hospital is given the responsibility of managing its own day-to-day work. For the hospital as a whole to change, the individual departments must undergo a similar change. As each department aligns itself with the purposes of the whole organization, synergy is created and the hospital gradually, incrementally, becomes a new kind of place to give and receive care.

Using information technology to improve the quality and efficiency of clinical trial research in academic medical centers.

In the area of clinical trial research, academic medical centers (AMCs) need to create additional capacity and improve performance on vital indicators to attract more studies, as they are currently losing their share to stand-alone research sites. Through the utilization of information technology, AMCs will be in a better position to fend off the competitive threats to their clinical research dollars. Most AMCs are in an enviable position to leverage the value of information technology because of the existing people, processes, and technologies that probably already exist throughout the AMC. The challenge, then, is to deploy these resources in a different manner to support clinical trial research.

Application of a versatile instrument for production of cutaneous anesthesia without needle penetration of the skin.

A self-contained jet injector, the Syrjet Mk II, can be used for needleless injection of anesthetic agents into the skin and subcutaneous tissues. Although designed for dental use, its compact size, simplicity, and versatility make it suited for many medical applications where a relatively small anesthetic field is desired, especially in children. It provides an anesthetic area for the introduction of standard hypodermic needles for more extensive tissue infiltration, or for definitive anesthesia for procedures such as marrow aspiration, biopsies, small lesion excision, and in certain field blocks such as digital or facial sensory. It is significantly free of side effects and complications.

The SENIC sampling process: design for choosing hospitals and patients and results of sample selection.

To achieve its primary objectives, the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) focused its attention on a target population of patients referred to as SENIC-eligible admissions in a target population of hospitals referred to as the "SENIC Universe." SENIC thus required a design for sampling hospitals and patients within these hospitals and a valid procedure for projecting sample results to the target population. This paper presents the details of the sampling design used, describes the actual process of selecting hospitals and patients for the surveys, explains the procedure used to project sample results to the target population, and examines the possibility of bias in the design and hospital selection process. As with most large-scale sample surveys, the design and sample selection processes for the surveys in Phases II and III of SENIC were complicated by incomplete frame, nonresponse and measurement problems. Nevertheless, adjustments to reduce the effects of some of these problems have been made through the development of a valid procedure for projecting sample results to the target population, and it appears unlikely that practically important nonsampling biases will result from the estimation procedures applied to this sample of hospitals.