Successful identification of pathogens by polymerase chain reaction (PCR)-based electron spray ionization time-of-flight mass spectrometry (ESI-TOF-MS) in culture-negative periprosthetic joint infection.

BACKGROUND: The diagnosis of periprosthetic joint infection poses many challenges, one of which is the difficulty of isolating the infecting organism. Recently, a sophisticated modality (the Ibis Biosciences T5000 biosensor system) has been introduced that uses pan-domain primers in a series of polymerase chain reactions (PCRs) to identify and speciate essentially all bacteria and fungi as well as to identify key antibiotic resistance genes. We investigated the role of the Ibis in identifying infecting organisms in cases of known and suspected periprosthetic joint infection. METHODS: Synovial fluid specimens were collected prospectively from eighty-two patients undergoing eighty-seven arthroplasty procedures (sixty-five knee revisions, fifteen hip revisions, and seven primary knee arthroplasties) and were sent for both conventional culture and Ibis analysis. The surgeon\u27s clinical determination of the cause for revision arthroplasty was failure due to infection in twenty-three cases and noninfectious failure in fifty-seven cases. RESULTS: In the twenty-three cases that were considered on clinical grounds to involve a periprosthetic joint infection, the Ibis detected the same pathogen isolated by conventional culture in seventeen of eighteen cases and also detected one or more organisms in four of the five culture-negative cases. In addition, the Ibis detected organisms in fifty (88%) of the fifty-seven cases in which revision arthroplasty was performed for a presumed noninfectious failure. CONCLUSIONS: The Ibis technology was not only effective at detecting organisms in cases of suspected periprosthetic joint infection in which cultures were negative, but it also suggested that many of the revision arthroplasty cases that have previously been considered to be purely aseptic may have a component of unrecognized, subclinical infection

Using a Resident-Led Process Improvement Committee to Change Pain Medication Prescribing Habits: Early Results

The aims of this project were to: Streamline the ordering of IV and PO pain meds Encourage the appropriate ordering of Ofirmev

Suicide In American Cities

Purpose of Review Suicide rates have risen over the past two decades in the United States of America (USA). Rates are higher in rural settings, but more total suicides occur in urban areas. Understanding risk and protective factors prevalent in urban areas is essential in reducing the individual and public health impact of suicide. Recent Findings Lower rates of suicide in urban settings derive less from underlying differences in mental distress than from variation in access to care and to highly lethal means of suicide. Culturally appropriate interventions incorporating intersectional perspectives are needed to prevent and reduce suicide among people of color, particularly Native American and Black youth, and among lesbian, gay, bisexual, and transgender (LGBT) populations. Summary The Zero Suicide Initiative aims to coordinate multi-level suicide prevention interventions across sites of healthcare, and may be particularly well-suited to urban areas, where sources of care are more densely available and healthcare contacts may be more frequent

Risk Factors for Early Mortality Following Modern Total Hip Arthroplasty.

The aim of this study was to evaluate the incidence of early mortality and identify risk factors for early death following modern uncemented THA. Between 2000 and 2006, we identified patients who died within 90days of THA. Demographics, comorbidities, laboratory studies, and complications were analyzed as risk factors for mortality. 38 of 8261 patients undergoing THA (0.46%) died within 90days postoperatively. Of these, 26% were due to myocardial infarction. Multivariate analysis revealed Charlson index \u3e3, peripheral vascular disease, elevated postoperative glucose, and abnormal postoperative cardiac studies as independent predictors of early mortality following THA. Caution should be taken in patients with increased comorbidities, PVD, perioperative hyperglycemia, and impaired renal function in order to reduce mortality following THA