Objectives The last prevalence survey encompassing urban populations was part of the nationwide Health and Nutrition examination survey (NHANES I) in the 1970's. We carried out a prevalence survey for hip osteoarthritis (OA) in the Framingham Study Community cohort. Methods Persons age 50 and older living in Framingham in 2002 – 2005 were recruited by random digit dialing without respect to joint pain or arthritis. Anteroposterior standing long-limb radiographs of the lower extremities including the pelvis were obtained and read for radiographic hip OA (ROA) by two trained physicians with all possible cases of ROA confirmed by an experienced musculoskeletal radiologist. ROA was defined as Kellgren-Lawrence score ≥ 2. Using a homunculus in which the hip joint was depicted, participants were asked whether they had hip pain on most days. Those who said ‘yes’ were defined as having hip pain. Symptomatic hip OA (SxOA) was defined as radiographic OA with ipsilateral hip pain. We defined a person as having hip OA if at least one of their hip joints was affected. Results Of 978 subjects studied (mean age 63.5 years; 56% women), age-standardized prevalence of ROA was 19.6% (95% CI 16.7%-23.0%) and SxOA was 4.2% (95% CI 2.9%-6.1%%). Overall, we found that men had higher prevalence of ROA (p<0.0001) compared to women, but men did not have a higher prevalence of SxOA compared to women (5.2% vs 3%, p=0.08). Conclusion In conclusion, hip osteoarthritis is a common condition in middle aged and older persons in urban and suburban U.S.
BACKGROUND Although optimal utilization of blood cultures has been studied in populations, including emergency room and intensive care patients, less is known about the use of blood cultures in populations consisting exclusively of patients on a medical service. OBJECTIVE To identify the physician‐selected indication and yield of blood cultures ordered after hospitalization to an acute medical service and to identify populations in which blood cultures may not be necessary. DESIGN, SETTING, AND PATIENTS A prospective cohort study was performed at a single Veterans Affairs Medical Center from October 1, 2014 through April 15, 2015. Participants included all hospitalized patients on a medical service for whom a blood culture was ordered. MEASUREMENTS The main outcomes were the rate of true positive blood cultures and the predictors of true positive cultures. RESULTS The true positive rate was 3.6% per order. The most common physician‐selected indications were fever and leukocytosis, neither of which alone was highly predictive of true positive blood cultures. The only indication significantly associated with a true positive blood culture was “follow‐up previous positive” (likelihood ratio [LR]+ 3.4, 95% confidence interval [CI]: 1.8‐6.5). The only clinical predictors were a working diagnosis of bacteremia/endocarditis (LR+ 3.7, 95% CI: 2.5‐5.7) and absence of antibiotic exposure within 72 hours of the culture (LR+ 2.4, 95% CI: 1.2‐4.9). CONCLUSIONS The rate of true positive blood cultures among patients on a medical service was lower than previously studied. Using objective and easily obtainable clinical characteristics, including antibiotic exposure and working diagnosis, may improve the likelihood of true positive blood cultures. Journal of Hospital Medicine 2016;11:336–340. © 2016 Society of Hospital Medicine
IMPORTANCE Aerosol-borne SARS-CoV-2 has not been linked specifically to nosocomial outbreaks. OBJECTIVE To explore the genomic concordance of SARS-CoV-2 from aerosol particles of various sizes and infected nurses and patients during a nosocomial outbreak of COVID-19. DESIGN, SETTING, AND PARTICIPANTS This cohort study included patients and nursing staff in a US Department of Veterans Affairs inpatient hospital unit and long-term-care facility during a
The emergence of multidrug-resistant (MDR) uropathogens is making the treatment of urinary tract infections (UTIs) more challenging. We sought to evaluate the accuracy of empiric therapy for MDR UTIs and the utility of prior culture data in improving the accuracy of the therapy chosen. The electronic health records from three U.S. Department of Veterans Affairs facilities were retrospectively reviewed for the treatments used for MDR UTIs over 4 years. An MDR UTI was defined as an infection caused by a uropathogen resistant to three or more classes of drugs and identified by a clinician to require therapy. Previous data on culture results, antimicrobial use, and outcomes were captured from records from inpatient and outpatient settings. Among 126 patient episodes of MDR UTIs, the choices of empiric therapy against the index pathogen were accurate in 66 (52%) episodes. For the 95 patient episodes for which prior microbiologic data were available, when empiric therapy was concordant with the prior microbiologic data, the rate of accuracy of the treatment against the uropathogen improved from 32% to 76% (odds ratio, 6.9; 95% confidence interval, 2.7 to 17.1; P < 0.001). Genitourinary tract (GU)-directed agents (nitrofurantoin or sulfa agents) were equally as likely as broad-spectrum agents to be accurate (P ؍ 0.3). Choosing an agent concordant with previous microbiologic data significantly increased the chance of accuracy of therapy for MDR UTIs, even if the previous uropathogen was a different species. Also, GU-directed or broad-spectrum therapy choices were equally likely to be accurate. The accuracy of empiric therapy could be improved by the use of these simple rules.T he incidence of infections caused by multidrug-resistant (MDR) Gram-negative bacterial uropathogens is increasing among both hospitalized patients and patients in the community (1, 2). The emergence of these pathogens creates challenges for physicians when choosing empiric treatment, as therapeutic options are often limited. Current guidelines for the treatment of urinary tract infections (UTIs) from the Infectious Diseases Society of America (IDSA) recommend that antimicrobial resistance rates be considered and that patient risk factors be taken into account (3). However, with rates of extended-spectrum beta-lactamase (ESBL) production among uropathogens approaching 10% (4, 5), additional strategies for selecting an accurate antimicrobial agent are needed.Studies suggest that empiric treatment for patients with bacteremia caused by ESBL-producing strains accurately covers the pathogen in only half of all cases (6, 7). Inaccurate therapy has been associated with both increased morbidity and increased mortality (6-8). In addition, use of inaccurate therapy for MDR UTIs can increase both the cost of care and the length of stay for hospitalized patients (9). As urinary sources are one of the most common sources of bacteremia caused by Gram-negative bacteria and treatment for UTIs is usually initiated prior to the availability of microbiologic data,...
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