Mobility and other predictors of hospitalization for urinary tract infection: a retrospective cohort study

Abstract Background Many hospitalizations for residents of skilled nursing facilities are potentially avoidable. Factors that could prevent hospitalization for urinary tract infection (UTI) were investigated, with focus on patient mobility. Methods A retrospective cohort study was conducted using 2003–2004 data from the Centers for Medicare and Medicaid Services. The study included 408,192 residents of 4267 skilled nursing facilities in California, Florida, Michigan, New York, and Texas. The patients were followed over time, from admission to the skilled nursing facility to discharge or, for those who were not discharged, for 1 year. Cox proportional hazards regression was conducted with hospitalization for UTI as the outcome. Results The ability to walk was associated with a 69% lower rate of hospitalization for UTI. Maintaining or improving walking ability over time reduced the risk of hospitalization for UTI by 39% to 76% for patients with various conditions. For residents with severe mobility problems, such as being in a wheelchair or having a missing limb, maintaining or improving mobility (in bed or when transferring) reduced the risk of hospitalization for UTI by 38% to 80%. Other potentially modifiable predictors included a physician visit at the time of admission to the skilled nursing facility (Hazard Ratio (HR), 0.68), use of an indwelling urinary catheter (HR, 2.78), infection with Clostridium difficile or an antibiotic-resistant microorganism (HR, 1.20), and use of 10 or more medications (HR, 1.31). Patient characteristics associated with hospitalization for UTI were advancing age, being Hispanic or African-American, and having diabetes mellitus, renal failure, Parkinson's disease, dementia, or stroke. Conclusion Maintaining or improving mobility (walking, transferring between positions, or moving in bed) was associated with a lower risk of hospitalization for UTI. A physician visit at the time of admission to the skilled nursing facility also reduced the risk of hospitalization for UTI.http://deepblue.lib.umich.edu/bitstream/2027.42/112369/1/12877_2008_Article_125.pd

Prevention of urinary tract infections in nursing homes: lack of evidence-based prescription?

<p>Abstract</p> <p>Background</p> <p>Urinary tract infections (UTIs, including upper and lower symptomatic) are the most common infections in nursing homes and prevention may reduce patient suffering, antibiotic use and resistance. The spectre of agents used in preventing UTIs in nursing homes is scarcely documented and the aim of this study was to explore which agents are prescribed for this purpose.</p> <p>Methods</p> <p>We conducted a one-day, point-prevalence study in 44 Norwegian nursing homes during April-May 2006. Nursing home residents prescribed any agent for UTI prophylaxis were included. Information recorded was type of agent and dose, patient age and gender, together with nursing home characteristics. Appropriateness of prophylactic prescribing was evaluated with references to evidence in the literature and current national guidelines.</p> <p>Results</p> <p>The study included 1473 residents. 18% (n = 269) of the residents had at least one agent recorded as prophylaxis of UTI, varying between 0-50% among the nursing homes. Methenamine was used by 48% of residents prescribed prophylaxis, vitamin C by 32%, and cranberry products by 10%. Estrogens were used by 30% but only one third was for vaginal administration. Trimethoprim and nitrofurantoin were used as prophylaxis by 5% and 4%, respectively.</p> <p>Conclusions</p> <p>The agents frequently prescribed to prevent UTIs in Norwegian nursing homes lack documented efficacy including methenamine and vitamin C. Recommended agents like trimethoprim, nitrofurantoin and vaginal estrogens are infrequently used. We conclude that prescribing of prophylactic agents for UTIs in nursing homes is not evidence-based.</p

Ants Sow the Seeds of Global Diversification in Flowering Plants

Background: The extraordinary diversification of angiosperm plants in the Cretaceous and Tertiary periods has produced an estimated 250,000–300,000 living angiosperm species and has fundamentally altered terrestrial ecosystems. Interactions with animals as pollinators or seed dispersers have long been suspected as drivers of angiosperm diversification, yet empirical examples remain sparse or inconclusive. Seed dispersal by ants (myrmecochory) may drive diversification as it can reduce extinction by providing selective advantages to plants and can increase speciation by enhancing geographical isolation by extremely limited dispersal distances. Methodology/Principal Findings: Using the most comprehensive sister-group comparison to date, we tested the hypothesis that myrmecochory leads to higher diversification rates in angiosperm plants. As predicted, diversification rates were substantially higher in ant-dispersed plants than in their non-myrmecochorous relatives. Data from 101 angiosperm lineages in 241 genera from all continents except Antarctica revealed that ant-dispersed lineages contained on average more than twice as many species as did their non-myrmecochorous sister groups. Contrasts in species diversity between sister groups demonstrated that diversification rates did not depend on seed dispersal mode in the sister group and were higher in myrmecochorous lineages in most biogeographic regions. Conclusions/Significance: Myrmecochory, which has evolved independently at least 100 times in angiosperms and is estimated to be present in at least 77 families and 11 000 species, is a key evolutionary innovation and a globally important driver of plant diversity. Myrmecochory provides the best example to date for a consistent effect of any mutualism on largescale diversification

ICAR: endoscopic skull‐base surgery

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Strategies for Graphical Model Selection

this paper is to examine the predictive performance of the Markov chain Monte Carlo method and compare the predictive performance of both approaches. This work is of direct relevance to probabilistic knowledge-based systems systems where model uncertainty abounds (Bradshaw et al., 1992)

O desafio da aplicação da metodologia de captura-recaptura na vigilância do diabetes mellitus em idosos: lições de uma experiência no Brasil The challenge of applying capture-recapture methodology to diabetes mellitus surveillance in the elderly: lessons from a Brazilian experience

O presente estudo buscou avaliar a factibilidade da implantação de um sistema de vigilância do diabetes mellitus na população idosa, empregando para tal fontes de dados sobre morbidade (hospitalar e ambulatorial) e mortalidade e a metodologia de captura-recaptura. Modelos loglineares foram ajustados para o conjunto da amostra e nos estratos formados pelo sexo e a faixa etária. Setecentos e quarenta pacientes foram identificados no conjunto das fontes. O modelo selecionado para o conjunto da amostra estimou um total de 22.925 casos (IC90%: 11.354-57.269), que é implausivelmente elevado sugerindo uma forte dependência negativa final entre as fontes. A estratificação segundo sexo e faixa etária levou a valores pontuais mais plausíveis, embora ainda imprecisos. O único estrato que apresentou valores precisos foi o de mulheres com 60 a 69 anos (1.290 casos; IC90%: 779-2.476). Os fatores que possivelmente explicam estes resultados são: (a) o número pequeno dos casos captados na fonte ambulatorial atendidos em unidades especializadas e de maior complexidade; (b) o sub-registro do diabetes.<br>The purpose of this study was to evaluate the feasibility of establishing a surveillance system for diabetes mellitus in the elderly using data sources on morbidity (hospital and outpatient data) and mortality and the capture-recapture methodology. Log-linear models were adjusted for the entire sample and for gender and age strata. Seven hundred and forty patients were identified in the three combined sources. The model selected for the whole sample when the first linkage strategy was deployed estimated a total of 22,925 cases (90%CI: 11,354-57,269), an implausibly high figure that suggested a strong final negative dependency between sources. Age and gender stratification led to more plausible point values, which nevertheless still lacked precision. The only subset that displayed precise values was the 60-to-69-year-old female stratum (1,290 cases; 90%CI: 779-2,476). The factors that possibly explain these results are: (a) the low number of cases originated in the specialized and more complex facilities in the outpatient data source and (b) overall underreporting of diabetes mellitus cases