Throat and rectal swabs may have an important role in MRSA screening of critically ill patients.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) is a major problem in intensive care units (ICU). International guidelines recommend screening patients for MRSA on admission, although consensus on sites required for optimum detection has not been reached. Our aim was to determine whether throat and rectal swabs identified a significant number of additional MRSA-colonised patients not captured by swabbing at keratinized skin carriage sites (anterior nares, perineum and axillae). DESIGN: Prospective cohort study. SETTING: 30-Bed medical and surgical ICU in a tertiary teaching hospital. PATIENTS: One thousand four hundred and eighty adult patients consecutively admitted over 15 months. MEASUREMENTS AND RESULTS: Swabs from carriage sites (anterior nares, perineum, axillae, throat and rectum), wounds and clinical samples taken within 48 h of ICU admission were analysed to identify patients admitted with MRSA. A complete set of carriage swabs were received from 1,470 patients. 105 (7%) patients were admitted with MRSA of which 63 (60%) were detected by a pooled keratinized skin swab (anterior nares, perineum, axillae). A further 36 (34%) patients were detected only by throat or rectal swabs. Indeed, throat and rectal swabs combined had a higher sensitivity than pooled keratinised skin swabs (76 vs. 60% P = 0.0247). Swabs from all carriage sites together detected 95% (100) of MRSA positive patients, with five patients being positive at wound sites only. CONCLUSIONS: The throat and rectum are important and potentially hidden sites of MRSA carriage in critically ill patients. These findings prompt the need for larger studies to determine the most cost-effective screening strategy for MRSA detection. DESCRIPTOR: Non-pulmonary nosocomial infections

The act of discovery : an ethnography of the subject-object relation in archaeological practice.

SIGLEAvailable from British Library Document Supply Centre- DSC:D98102 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

English reaction to Catherine II's foreign policy

Thesis (M.A.)--Boston University, 1931. This item was digitized by the Internet Archive

Mr. Walsh on the Measurement of General Exchange Value

n/

Self-care for health in rural Bangladesh

An interest in human coping applicable to endemic disease environments such as Bangladesh now includes disease mitigation and management through self-care. Although a frequently utilised treatment, research into the reasons behind self-care preference, types of self-care practised and the implications this has for individuals and communities in developing countries such as Bangladesh is lacking. This research therefore examines the adoption of self-care in Bangladesh and seeks to understand if it is an effective disease management strategy. A mixed methods approach was employed, targeting a representative sample of different gender, age and socioeconomic status across three locations. 630 questionnaires, 47 semi-structured interviews, 15 focus group discussions, 20 key informant interviews and a series of participatory research tools were applied to explore how and why people use self-care. Data were also used to identify behaviours indicative of appropriate and inappropriate self-care that are beneficial or detrimental to the individual. A detailed and complex picture of self-care emerged. It is widely used to prevent and respond to illness through traditional, herbal and modern pharmaceutical actions. Common illnesses and endemic diseases such as fever and diarrhoeal diseases were most frequently treated through self-care. A declining natural resource base, a hazardous flood environment and communication breakdown between doctors and patients can restrict self-care adoption. However, economic savings on healthcare expenditure, reduced opportunity costs and the means to preserve dignity represented positive aspects of self-care amongst participants. Examination of these factors demonstrated the failings of current health service provision as well as the potential for better self-care integration into existing healthcare approaches. Wider lessons for disease management were therefore derived from self-care including the importance of low cost manifold strategies and the value of local knowledge and ownership. It is concluded that although self-care is not a panacea for the burden of ill health there is evidence to suggest it can play a crucial role in coping with the insurmountable disease risks people face in Bangladesh. In doing so the research contributes to understanding self-care in developing countries as an integrated and integral component of the primary health care system and infectious disease risk reduction more widely