Non-toxigenic Corynebacterium diphtheriae in hallux ulceration.

INTRODUCTION: Toxigenic Corynebacterium diphtheriae causes classical diphtheria. Skin infections by toxigenic or non-toxigenic Corynebacterium diphtheriae are prevalent in the tropics but are rarely reported. CASE PRESENTATION: We report the identification of a non-toxigenic Corynebacterium diphtheriae (biovar Gravis) isolate in a 52-year-old Cambodian male. The patient presented purulent and non-healing ulcerations on the right hallux. The wound has healed after 7 days of antibiotic therapy with a favourable outcome. CONCLUSIONS: This case represents, to our knowledge, the first report of Corynebacterium diphtheriae in Cambodia in the last 10 years, and highlights the lack of diagnosis and notifications of diphtheria. It is important to raise awareness among clinicians and to set up diphtheria surveillance in Cambodia.

Managing the complexity of a systemwide electronic medical record design and implementation: lessons for nurse leaders.

Nurse executives are critical to the successful planning, implementation, and adoption of technology to support the workflow and documentation needs of nurses and other end users. Informed by key principles of complexity theory, the enormous task of broad-based implementation of a standardized electronic medical record can be accomplished through the thoughtful development of flexible structures and change management principles that promote intelligent decision making and adoption by key stakeholders.

Measuring the benefits of IT-enabled care transformation.

In February 2005, Banner Health invested in healthcare IT as it implemented evidence-based practices of care at its newest hospital, Banner Estrella Medical Center in Phoenix. Combined with clinician-designed workflows, extensive training, and cultural change, the initiative saved the system $2.6 million through: Improvements in nurse retention. Decreased incidence of adverse drug events. Reduced length of stay. Fewer patients leaving the ED without treatment. Reduced days in A/R. Decreased expenses.