Eradication of carriage with methicillin-resistant Staphylococcus aureus: determinants of treatment failure

Background: Using data from an observational study in which the effectiveness of a guideline for eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage was evaluated, we identified variables that were associated with treatment failure. Methods: A multivariate logistic regression model was performed with subgroup analyses for uncomplicated and complicated MRSA carriage (the latter including MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and for those treated according to the guideline (i.e. mupirocin nasal ointment and chlorhexidine soap solution for uncomplicated carriage, in combination with two oral antibiotics for complicated carriage). Results: Six hundred and thirteen MRSA carriers were included, of whom 333 (54%) had complicated carriage; 327 of 530 patients (62%) with known complexity of carriage were treated according to the guideline with an absolute increase in treatment success of 20% (95% confidence interval 12%-28%). Among those with uncomplicated carriage, guideline adherence [adjusted odds ratio (OR alpha) 7.4 (1.7-31.7)], chronic pulmonary disease [OR alpha 44 (2.9-668)], throat carriage [OR alpha 2.9 (1.4-6.1)], perineal carriage [OR alpha 2.2 (1.1-4.4)] and carriage among household contacts [OR alpha 5.6 (1.2-26)] were associated with treatment failure. Among those with complicated carriage, guideline adherence was associated with treatment success [OR alpha 0.2 (0.1-0.3)], whereas throat carriage [OR alpha 4.4 (2.3-8.3)] and dependence in activities of daily living [OR alpha 3.6 (1.4-8.9)] were associated with failure. Conclusions: Guideline adherence, especially among those with complicated MRSA carriage, was associated with treatment success. Adding patients with extranasal carriage or dependence in daily self-care activities to the definition of complicated carriage, and treating them likewise, may further increase treatment success.Antimicrobial treatment and prevention of infection

Conceptual Approach for the Design of Radiology Reporting Interfaces: The Talking Template

Within the coming decade, traditional dictation supported by human transcription for radiology reports will be replaced by one or more computerized methods. This paper discusses the cognitive and process efficiency problems arising from currently available technology including speech recognition and menu-driven interfaces. A specific concept for interaction with the reporting interface is proposed. This is called the „talking template” and departs from other designs by providing for all interactions to be mediated through audible prompts and microphone controls. The radiologist can recapture efficiency and cognitive focus by dictating while viewing images without the „look away” problem inherent in other interfaces

Comparative economics: evolution and the modern economy

Human economy, Evolution, Emergence, Intentionality, Market, O1, Q2, Q57,

Identification of seven new prostate cancer susceptibility loci through a genome-wide association study

Prostate cancer (PrCa) is the most frequently diagnosed male cancer in developed countries. To identify common PrCa susceptibility alleles, we have previously conducted a genome-wide association study in which 541, 129 SNPs were genotyped in 1,854 PrCa cases with clinically detected disease and 1,894 controls. We have now evaluated promising associations in a second stage, in which we genotyped 43,671 SNPs in 3,650 PrCa cases and 3,940 controls, and a third stage, involving an additional 16,229 cases and 14,821 controls from 21 studies. In addition to previously identified loci, we identified a further seven new prostate cancer susceptibility loci on chromosomes 2, 4, 8, 11, and 22 (P=1.6×10−8 to P=2.7×10−33)