A pilot study describing knowledge and practices in the health care of men who have sex with men by U.S. Air Force primary care providers.

BACKGROUND: The Centers for Disease Control and Prevention (CDC) recommends annual sexually transmitted infection (STI) screening in men who have sex with men (MSM) that is unique to this patient population. The goal of this study is to establish whether U.S. Air Force (USAF) providers are familiar with these guidelines and determine if USAF providers offer these tests appropriately. METHODS: A survey designed to determine primary care provider knowledge and practices in MSM health care was disseminated via e-mail to 124 primary care providers at 3 separate USAF medical facilities in Northern California from September 15 to 30, 2011. FINDINGS: There was a 46% response rate. 15% of respondents correctly identified all CDC-recommended STI screens. 42% stated that they did not know the CDC screening guidelines. 51% did not screen male patients for MSM activity in the past year. 81% of respondents had not offered the full complement of MSM STI screening in the past year. CONCLUSION: The majority of USAF primary care providers surveyed were not familiar with CDC-recommended annual screening tests for STIs in MSM, and they did not screen for MSM activity or offer MSM STI screening tests regularly. Further studies across the Department of Defense are needed to corroborate the findings of this study.

Economics of Home Monitoring for Apnea in Late Preterm Infants.

BACKGROUND: Apnea of prematurity affects a small proportion but large absolute number of late preterm infants, with out-patient management variably utilized despite relative clinical equipoise and potential for improved cost-effectiveness. METHODS: Over a 5-y period, from 2009 to 2013, infants born at ≥34 weeks gestational age at a level IIIB academic center in Boston, Massachusetts, with discharge-delaying apnea, bradycardia, and desaturation (ABD) events were identified. In-patient costs for discharge-delaying ABD events were compared with hypothetical out-patient management. Out-patient costs took into account 4-10 d of in-patient observation for ABD events before caffeine initiation, 3-5 d of additional in-patient observation before discharge, daily caffeine until 43 weeks corrected gestational age, home pulse oximetry monitoring until 44 weeks corrected gestational age, and consideration of variable readmission rates ranging from 0 to 10%. RESULTS: A total of 425 late preterm and term infants were included in our analysis. Utilization of hypothetical out-patient management resulted in cost savings per eligible patient ranging from $2,422 to $62, dependent upon variable periods of in-patient observation. Sensitivity analysis demonstrated few instances of decreased relative cost-effectiveness. CONCLUSIONS: Out-patient management of discharge-delaying ABD events in a late preterm and term population was a cost-effective alternative to prolonged in-patient observation.

Diagnostic Evaluation and Home Monitor Use in Late Preterm to Term Infants With Apnea, Bradycardia, and Desaturations.

Apnea, bradycardia, and oxygen desaturation events are a common in neonatal intensive care units, with relevant literature to date largely focusing on very low birth weight and extremely low birth weight infants. We conducted a retrospective review of infants born at ≥34 weeks gestational age at 2 tertiary neonatal intensive care units in Boston, MA, between January 2009 and December 2013. Our objectives included (1) describing the diagnostic evaluations performed in late preterm to term infants with discharge-delaying apnea, bradycardia, or oxygen desaturation events and (2) identifying variables associated with home monitor use. Of the 741 eligible infants identified, diagnostic evaluations were variable and infrequent with blood culture, blood glucose, and head ultrasound performed most commonly. The likelihood of home monitor use was greater in infants with either a prolonged inpatient stay or greater gestational age at birth.

Infant botulism mimicking Hirschprung's disease.

We report a case of infant botulism presenting as primary colonic ileus--mimicking Hirschprung's megacolon. Infant botulism should be considered in any infant with constipation and neurologic abnormalities.