Objective We compared differences in the hospital charges, length of hospital stay, and mortality between patients with healthcare- and community-associated bloodstream infections, urinary tract infections, and pneumonia due to antimicrobial-resistant versus -susceptible bacterial strains. Methods A retrospective analysis of an electronic database compiled from laboratory, pharmacy, surgery, financial, and patient location and device utilization sources was undertaken on 5699 inpatients who developed healthcare-or community-associated infections between 2006 and 2008 from 4 hospitals (1 community, 1 pediatric, 2 tertiary/quaternary care) in Manhattan. The main outcome measures were hospital charges, length of stay, and mortality among patients with antimicrobial-resistant and -susceptible infections caused by Staphylococcus aureus, Enterococcus faecium, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Results Controlling for multiple confounders using linear regression and nearest neighbor matching based on propensity score estimates, resistant healthcare- and community-associated infections, when compared with susceptible strains of the same organism, were associated with significantly higher charges ($15 626; confidence interval [CI], $4339–$26 913 and $25 573; CI, $9331–$41 816, respectively) and longer hospital stays for community-associated infections (3.3; CI, 1.5–5.4). Patients with resistant healthcare-associated infections also had a significantly higher death rate (0.04; CI, 0.01–0.08). Conclusions With careful matching of patients infected with the same organism, antimicrobial resistance was associated with higher charges, length of stay, and death rates. The difference in estimates after accounting for censoring for death highlight divergent social and hospital incentives in reducing patient risk for antimicrobial resistant infections.

SUMMARYHealth literacy (HL) is a key determinant of health in a contemporary society characterized by abundant information. Previous studies have suggested that basic or functional HL is positively associated with health, whereas evidences on the association between health and communicative/critical HL are scarce. Furthermore, confounding by socioeconomic status on HL-health association has been poorly tested. Using cross-sectional data from a nationally representative community-based survey in Japan, we investigated whether communicative/critical HL is associated with self-rated health independent of socioeconomic status. A total of 1237 subjects participated in this study; the response rate was 62%. To measure communicative/critical HL, we used three questions assessing the respondents' ability to select, to communicate to others and to evaluate specific healthrelated information. Potential confounders included demographic factors, household income, employment status, and educational attainment. A multivariate model revealed that good self-reported health was significantly associated with younger age [odds ratio (OR), 0.99; 95% confidence interval (CI), 0.97-0.99], employment (OR, 2.89; 95% CI, 1.06-7.88) and higher communicative/critical HL scores (OR 2.75; 95%CI,. Respondents with lower education were likely to have poorer communicative/critical HL. These results imply that to close the health gap, policy interventions should focus on the promotion of HL among deprived sociodemographic groups.

Children in the community with HCoV detected generally had mild illness as demonstrated by few medically attended cases. In hospitalized children, young age and CCCs, but not HCoV type, were associated with increased severity of illness.

Objective Prevention of Clostridium difficile infection (CDI) in acute care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009. Design We searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015. Setting We included studies performed in acute care hospitals. Patients or participants We included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates. Interventions We used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible. Results Of 3236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% on the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand hygiene practices were not effective for reducing CDI rates. Conclusions Daily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates.

To reveal the acoustic characteristics associated with hypernasality and to ascertain their correlation to the severity of hypernasality, 30 speech samples produced by 15 maxillectomy patients were acoustically analysed with and without an obturator prosthesis in place. The isolated, sustained Japanese vowel /i/ was used as the stimulus for acoustic measurement and perceptual judgment to evaluate the severity of hypernasality. Normalized 1/3-octave spectral analysis demonstrated the spectral characteristics of hypernasality as a rise in amplitude between the first and second formants around the 1 kHz region, and a reduction in amplitude of the frequencies higher than the second formant. High correlation was shown between the perceptual ratings and the predicted values derived from stepwise regression analysis.

Background-The use of electronic medical records to identify common healthcare-associated infections (HAIs), including pneumonia, surgical site infections, bloodstream infections and urinary tract infections (UTIs), has been proposed as an efficient tool to perform HAI surveillance and to guide infection prevention efforts. Increased attention on HAIs as a safety and quality issue has led to public health reporting requirements and a focus on quality improvement activities around HAIs. Traditional surveillance to detect HAIs and focus prevention efforts is labor intensive and computer algorithms could be useful to screen electronic data and provide actionable information.

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Tumor necrosis factor (TNF)-alpha, a primary mediator of inflammatory responses, is increased in patients with active Crohn's disease (CD) and considered to play an important role in the regulation of inflammation in CD. Infliximab (IFX) is a chimeric murine-human monoclonal IgG1 antibody that targets TNF-alpha and is used as a therapeutic agent for CD. Although that dosage regimen has been established through clinical trial experience, it has not been analyzed theoretically. We analyzed of sequential changes of the Crohn's disease activity index (CDAI) using a pharmacokinetic-pharmacodynamic model integrating the pharmacokinetics of IFX and turnover rate of TNF-alpha. The time course effects of IFX derived from the present model were matched to reported data regarding CDAI ratios, and we found that the clinical effect of IFX reached a maximum value 2 to 4 weeks after administration and was maintained for the next several weeks. Our results suggested that the standard dosage regimen of IFX is theoretically appropriate. Further, based on the results of various dosage regimens, a second administration of IFX 2 weeks after the first dose was shown to achieve remission in the early stage of active CD, when IFX was given as a repeated treatment.