(See the commentary by Moro, on pages 978–980.) Infection surveillance definitions for long-term care facilities (ie, the McGeer Criteria) have not been updated since 1991. An expert consensus panel modified these definitions on the basis of a structured review of the literature. Significant changes were made to the criteria defining urinary tract and respiratory tract infections. New definitions were added for norovirus gastroenteritis and Clostridum difficile infections.

This study suggests that among older adults, the probability of completing ADs is related to personal requests by health care providers, educational level, and exposure to advance care planning media campaigns.

BACKGROUND: Penicillin skin testing (PST) is a simple and reliable way of diagnosing penicillin allergy. After being off the market for 4 years, penicilloyl-polylysine was reintroduced in 2009 as PRE-PEN. We describe the negative predictive value (NPV) of PST and the impact on antibiotic selection in a sample of hospitalized patients with a reported history of penicillin allergy.

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Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods:We randomised 2970 patients from 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were ≥45 years of age were eligible. Patients were randomly assigned to accelerated surgery (goal of surgery within 6 hours of diagnosis; 1487 patients) or standard care (1483 patients). The co-primary outcomes were 1.) mortality, and 2.) a composite of major complications (i.e., mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Outcome adjudicators were masked to treatment allocation, and patients were analysed according to the intention-to-treat principle; ClinicalTrials.gov, NCT02027896. Findings:The median time from hip fracture diagnosis to surgery was 6 hours (interquartile range [IQR] 4-9) in the accelerated-surgery group and 24 hours (IQR 10-42) in the standard-care group, p<0.0001. Death occurred in 140 patients (9%) assigned to accelerated surgery and 154 patients (10%) assigned to standard care; hazard ratio (HR) 0.91, 95% CI 0.72-1.14; absolute risk reduction (ARR) 1%, 95% CI -1-3%; p=0.40. The primary composite outcome occurred in 321 patients (22%) randomised to accelerated surgery and 331 patients (22%) randomised to standard care; HR 0.97, 95% CI 0.83-1.13; ARR 1%, 95% CI -2-3%; p=0.71.Interpretation: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared to standard care.

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In this paper, spatial and temporal variability of drought in Balochistan has been investigated using 36 years of monthly precipitation data recorded at 23 rain gauge stations in the study area. In order to detect and understand precipitation trend on drought severity, Mann-Kendall test is used. Standardized precipitation index is used to compute the severity of drought. Inverse distance weighted method has been used to illustrate the spatial and temporal aspects of drought with varying intensities. In addition, perception and understanding of the 215 farm households about drought are assessed following an in-depth field survey. The results reveal that farmers' perception regarding climatic variability and drought are in line with the results obtained using the secondary climatic data and information. Mann-Kendall test results indicate that negative trends in precipitation are evident for both annual and seasonal scale for more than 70 % of the stations in Balochistan ranging from 137.2 to 283.4 mm over 36 years, which may affect the drought mitigation, local water resources management and agriculture decision making. Furthermore, frequency of severe and extreme droughts is higher in north-west, from central parts towards south, south-east and some coastal areas when analysed quarterly at 3-month winter season and annually for 12-month dry-wet periods. Central-eastern, southwestern, southern and some isolated coastal areas in the south are more susceptible to severe droughts particularly during winter and dry-wet periods because of high variability in precipitation in these areas.M. Ashraf Regional and Rural Development Planning, School of Environment Resources and Development,