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Laustrup H, Voss A, Green A, Junker P. SLE disease patterns in a Danish population-based lupus cohort: an 8-year prospective study. Lupus 2009; 19:239-46. [DOI: 10.1177/0961203309351033] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 1995 all systemic lupus erythematosus (SLE) patients in the county of Funen were retrieved from four separate and independent sources as part of an 8-year prospective study to determine the pattern of disease activity and damage accumulation in a community based lupus cohort of predominantly Scandinavian ancestry. Incident cases were subsequently identified by surveillance of these sources. Established and new cases underwent annual, structured interviews, clinical examination and blood sampling. The Systemic Lupus Erythematosus Diseases Activity Index SLEDAI and Systemic Lupus International Collaborating Clinics SLICC scores were calculated. Flares were defined as modified — SLEDAI ≥ 4. The annual flare rate in definite SLE (D-SLE) was 0.21 (95%CI 0.18—0.24) versus 0.03 (95%CI 0.01—0.07) in incomplete SLE (I-SLE). Forty-three per cent of the entire study population had no disease exacerbations. Infections requiring hospital admission and thrombocytopenia were significantly more frequent among patients with relapsing disease (p < 0.04—0.01). Patients with flares had slightly shorter disease duration and were younger at disease onset than patients with a quiescent course. The most recently diagnosed patients had the lowest annual rate of damage accrual. According to flare rate, two major subsets of almost equal size were identified — one having a long quiescent course, the other exhibiting relapses alternating with remissions. An increased risk of flares was associated with short disease duration and younger age at disease onset, infections requiring hospital admission and thrombocytopenia. Temporal damage increment was the lowest in the most recently diagnosed patients. Lupus (2010) 19, 239—246.
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Voss A, Wessel N, Hasart A, Hähnel H, Prasse G, Schirdewan A, Osterziel KJ. Analyse von Kurzzeit-Blutdruck- und Herzfrequenzvariabilität. BIOMED ENG-BIOMED TE 2009. [DOI: 10.1515/bmte.1998.43.s1.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Voss A, Kurths J, Kleiner H, Witt A, Dietz R, Saparin P, Fiehring H, Wessel N. Einsatz von Verfahren der nichtlinearen Dynamik zur Erkennung von Risikopatienten für den plötzlichen Herztod. BIOMED ENG-BIOMED TE 2009. [DOI: 10.1515/bmte.1994.39.s1.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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156
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Laustrup H, Voss A, Green A, Junker P. Occurrence of systemic lupus erythematosus in a Danish community: an 8‐year prospective study. Scand J Rheumatol 2009; 38:128-32. [DOI: 10.1080/03009740802419073] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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157
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Magiorakos AP, Suetens C, Boyd L, Costa C, Cunney R, Drouvot V, Farrugia C, Fernandez-Maillo MM, Iversen BG, Leens E, Michael S, Moro ML, Reinhardt C, Serban R, Vatcheva-Dobrevska R, Wilson K, Heisbourg E, Maltezou HC, Strauss R, Böröcz K, Dolinšek M, Dumpis U, Erne S, Gudlaugsson O, Heczko P, Hedlova D, Holt J, Jõe L, Lyytikäinen O, Riesenfeld-Örn I, Stefkovikova M, Valinteliene R, Voss A, Monnet DL. National Hand Hygiene Campaigns in Europe, 2000-2009. Euro Surveill 2009. [DOI: 10.2807/ese.14.17.19190-en] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hand hygiene represents the single most effective way to prevent healthcare-associated infections. The World Health Organization, as part of its First Global Patient Safety Challenge, recommends implementation of multi-faceted strategies to increase compliance with hand hygiene. A questionnaire was sent by the European Centre for Disease Prevention and Control to 30 European countries, regarding the availability and organisation of their national hand hygiene campaigns. All countries responded. Thirteen countries had organised at least one national campaign during the period 2000-2009 and three countries were in the process of organising a national campaign. Although the remaining countries did not have a national campaign, several reported regional and local hand hygiene activities or educational resources on national websites.
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Magiorakos AP, Suetens C, Boyd L, Costa C, Cunney R, Drouvot V, Farrugia C, Fernandez-Maillo MM, Iversen BG, Leens E, Michael S, Moro ML, Reinhardt C, Serban R, Vatcheva-Dobrevska R, Wilson K, Heisbourg E, Maltezou HC, Strauss R, Borocz K, Dolinsek M, Dumpis U, Erne S, Gudlaugsson O, Heczko P, Hedlova D, Holt J, Joe L, Lyytikainen O, Riesenfeld-Orn I, Stefkovikova M, Valinteliene R, Voss A, Monnet DL. National hand hygiene campaigns in Europe, 2000-2009. Euro Surveill 2009; 14:19190. [PMID: 19422767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Hand hygiene represents the single most effective way to prevent healthcare-associated infections. The World Health Organization, as part of its First Global Patient Safety Challenge, recommends implementation of multi-faceted strategies to increase compliance with hand hygiene. A questionnaire was sent by the European Centre for Disease Prevention and Control to 30 European countries, regarding the availability and organisation of their national hand hygiene campaigns. All countries responded. Thirteen countries had organised at least one national campaign during the period 2000-2009 and three countries were in the process of organising a national campaign. Although the remaining countries did not have a national campaign, several reported regional and local hand hygiene activities or educational resources on national websites.
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Voss A, Schulz S, Koschke M, Bär KJ. Linear and nonlinear analysis of autonomic regulation in depressed patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:2653-6. [PMID: 19163250 DOI: 10.1109/iembs.2008.4649747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To investigate the effect of depression and medication on the autonomic nervous system (ANS) we compared 25 patients suffering from depression with 72 matched control subjects (CON). From every patient three times ECG and non-invasive blood pressure were recorded in: acute non-mediated state (T1), medicated state (T2) and clinical recovered state (T3). Cardiac autonomic regulation was evaluated by linear and nonlinear analysis methods. The results show that non-medicated depressed patients differ significantly from CON (p0.05). In the medicated state considerably high significant differences between depressed patient and CON were found (p0.0001). After an 18 months follow-up a normalization of autonomic parameters was achieved in depressed patients. These results show that depression influences autonomic parameters significantly and that medical treated clinical recovered patients approximate to healthy controls in autonomic regulation.
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de Smet AMGA, Kluytmans JAJW, Cooper BS, Mascini EM, Benus RFJ, van der Werf TS, van der Hoeven JG, Pickkers P, Bogaers-Hofman D, van der Meer NJM, Bernards AT, Kuijper EJ, Joore JCA, Leverstein-van Hall MA, Bindels AJGH, Jansz AR, Wesselink RMJ, de Jongh BM, Dennesen PJW, van Asselt GJ, te Velde LF, Frenay IHME, Kaasjager K, Bosch FH, van Iterson M, Thijsen SFT, Kluge GH, Pauw W, de Vries JW, Kaan JA, Arends JP, Aarts LPHJ, Sturm PDJ, Harinck HIJ, Voss A, Uijtendaal EV, Blok HEM, Thieme Groen ES, Pouw ME, Kalkman CJ, Bonten MJM. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009; 360:20-31. [PMID: 19118302 DOI: 10.1056/nejmoa0800394] [Citation(s) in RCA: 497] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome are conflicting. METHODS We evaluated the effectiveness of SDD and SOD in a crossover study using cluster randomization in 13 intensive care units (ICUs), all in The Netherlands. Patients with an expected duration of intubation of more than 48 hours or an expected ICU stay of more than 72 hours were eligible. In each ICU, three regimens (SDD, SOD, and standard care) were applied in random order over the course of 6 months. Mortality at day 28 was the primary end point. SDD consisted of 4 days of intravenous cefotaxime and topical application of tobramycin, colistin, and amphotericin B in the oropharynx and stomach. SOD consisted of oropharyngeal application only of the same antibiotics. Monthly point-prevalence studies were performed to analyze antibiotic resistance. RESULTS A total of 5939 patients were enrolled in the study, with 1990 assigned to standard care, 1904 to SOD, and 2045 to SDD; crude mortality in the groups at day 28 was 27.5%, 26.6%, and 26.9%, respectively. In a random-effects logistic-regression model with age, sex, Acute Physiology and Chronic Health Evaluation (APACHE II) score, intubation status, and medical specialty used as covariates, odds ratios for death at day 28 in the SOD and SDD groups, as compared with the standard-care group, were 0.86 (95% confidence interval [CI], 0.74 to 0.99) and 0.83 (95% CI, 0.72 to 0.97), respectively. CONCLUSIONS In an ICU population in which the mortality rate associated with standard care was 27.5% at day 28, the rate was reduced by an estimated 3.5 percentage points with SDD and by 2.9 percentage points with SOD. (Controlled Clinical Trials number, ISRCTN35176830.)
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Wertheim HFL, Ammerlaan HSM, Bonten MJM, van den Broek PJ, Troelstra A, Vandenbroucke-Grauls CMJE, Vos MC, Voss A, Nouwen JL, Kluytmans JAJW. [Optimisation of the antibiotic policy in the Netherlands. XII. The SWAB guideline for antimicrobial eradication of MRSA in carriers]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2008; 152:2667-2671. [PMID: 19137966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The 'Stichting Werkgroep Antibioticabeleid' (SWAB; Dutch Working Party on Antibiotics Policy) has developed evidence-based guidelines for the antimicrobial treatment of methicillin-resistant Staphylococcus aureus (MRSA) carriers for the eradication of MRSA. A distinction was made between uncomplicated and complicated carriage depending on the presence or absence of an active MRSA infection, skin lesions, foreign body material, mupirocin resistance and/or extranasal carriage. The indication for treatment is determined by the consequences of carriage for the carrier and his/her environment, the adverse events of treatment, and the likelihood of a successful treatment. The first choice of treatment in uncomplicated carriers is a combination of mupirocin nasal ointment and disinfectant soap for 5 days, along with hygiene advice. If treatment fails, sources in the vicinity of the patient must be sought. Complicated carriers receive a combination of 2 oral antibiotics, in addition to mupirocin nasal ointment and disinfectant soap, for at least 7 days.
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Voss A. Editorial. J Hosp Infect 2008; 70 Suppl 1:1. [DOI: 10.1016/s0195-6701(08)60002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leistner K, Schaaf P, Voss A, Fähler S, Schultz L, Schlörb H. Interfacial Fe(III)-hydroxide formation during Fe–Pt alloy deposition. Electrochim Acta 2008. [DOI: 10.1016/j.electacta.2008.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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164
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Wulf M, Tiemersma E, Kluytmans J, Bogaers D, Leenders A, Jansen M, Berkhout J, Ruijters E, Haverkate D, Isken M, Voss A. MRSA carriage in healthcare personnel in contact with farm animals. J Hosp Infect 2008; 70:186-90. [DOI: 10.1016/j.jhin.2008.06.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Accepted: 06/09/2008] [Indexed: 11/30/2022]
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165
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Ehrenberg H, Mikhailova D, Narayanan N, Fuess H, Ritter C, Trots D, Senyshyn A, Oswald S, Gruner W, Voss A. The effect of structural and compositional details on physical properties of new double perovskites. Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308098243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Rizzo R, Hviid TVF, Govoni M, Padovan M, Rubini M, Melchiorri L, Stignani M, Carturan S, Grappa MT, Fotinidi M, Ferretti S, Voss A, Laustrup H, Junker P, Trotta F, Baricordi OR. HLA-G genotype and HLA-G expression in systemic lupus erythematosus: HLA-G as a putative susceptibility gene in systemic lupus erythematosus. ACTA ACUST UNITED AC 2008; 71:520-9. [PMID: 18380776 DOI: 10.1111/j.1399-0039.2008.01037.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease mainly mediated by the deposit of immune complexes and defects in T lymphocytes and antigen-presenting cells along with a high production of T-helper 2 cytokines. A tolerance-inducible function of nonclassical class Ib human leukocyte antigen (HLA)-G molecule in innate and adaptive cellular responses has been reported, suggesting a role in inflammatory diseases. A 14 bp sequence insertion/deletion polymorphism (rs16375) in the 3'-untranslated region of the HLA-G gene has been associated to the stability of HLA-G messenger RNA. The insertion of the 14 bp sequence seems to be associated with lower levels of soluble HLA-G (sHLA-G). The aim of this study was to evaluate the possible association of the presence of the 14 bp sequence (+14 bp) with SLE. We have HLA-G genotyped 200 SLE patients and 451 healthy control subjects (HS; Italian) and analyzed the plasma levels of sHLA-G and interleukin-10 (IL-10) in a subset of SLE patients and healthy subjects (Italian and Danish). A significant increase of the +14 bp HLA-G allele was detected in the Italian SLE patients compared with HS [P = 0.003, OR 1.44 (95% CI 1.13-1.82)]. A significant increased frequency of HLA-G +14/+14 bp and a decreased frequency of HLA-G -14/-14 bp were observed in SLE patients. There median concentration of sHLA-G was significantly lower in the plasma of SLE patients compared with that in the plasma of healthy controls (P < 0.0001). Furthermore, the results confirmed higher concentrations of IL-10-positive plasma in SLE patients. These results support a potential role for HLA-G in the susceptibility of SLE.
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Wulf MW, Markestein A, van der Linden FT, Voss A, Klaassen C, Verduin CM. First outbreak of methicillin-resistant Staphylococcus aureus ST398 in a Dutch hospital, June 2007. Euro Surveill 2008; 13:8051. [PMID: 18445406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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169
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Wulf MWH, Markestein A, van der Linden FT, Voss A, Klaassen C, Verduin CM. First outbreak of methicillin-resistant Staphylococcus aureus ST398 in a Dutch hospital, June 2007. Euro Surveill 2008. [DOI: 10.2807/ese.13.09.08051-en] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe the first outbreak of non-typable methicillin-resistant Staphylococcus aureus on a surgical ward in the Netherlands in June 2007. Nine cases of infection and/or colonisation were found among patients and healthcare workers.
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170
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Declercq P, Petré D, Gordts B, Voss A. Complicated Community-Acquired Soft Tissue Infection by MRSA from Porcine Origin. Infection 2007. [DOI: 10.1007/s15010-007-9029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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van Damme PA, Meis JFGM, Voss A. [Antibiotic prophylaxis indicated in dental procedures in patients with a joint prosthesis]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2007; 151:2541. [PMID: 18062601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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172
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Wulf MWH, Sørum M, van Nes A, Skov R, Melchers WJG, Klaassen CHW, Voss A. Prevalence of methicillin-resistant Staphylococcus aureus among veterinarians: an international study. Clin Microbiol Infect 2007; 14:29-34. [PMID: 17986212 DOI: 10.1111/j.1469-0691.2007.01873.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pig farmers and veterinarians in contact with livestock in The Netherlands have a higher risk of methicillin-resistant Staphylococcus aureus (MRSA) carriage than the general population. The objective of this study was to investigate whether this is also true for other professionals in contact with pigs in an international setting. A convenience sample of 272 participants at an international conference on pig health in Denmark was screened for MRSA carriage using combined nose/throat swabs and were asked to complete a questionnaire concerning animal contacts, exposure to known MRSA risk-factors, and the protective measures taken when entering pig farms. In total, 34 (12.5%) participants from nine countries carried MRSA. Thirty-one of these isolates were non-typeable by pulsed-field gel electrophoresis following SmaI digestion of chromosomal DNA. All of the non-typeable isolates belonged to spa types (t011, t034, t108, t571, t567 and t899) that correspond to multilocus sequence type 398. All of the above-mentioned spa types, with the exception of t899, have been isolated previously from either Dutch pigs, pig farmers and/or veterinarians. Protective measures, e.g., masks, gowns and gloves, did not protect against MRSA acquisition. Transmission of MRSA from pigs to staff tending to these animals appears to be an international problem, creating a new reservoir for community-acquired MRSA (CA-MRSA) in humans in Europe, and possibly worldwide. The rise of a new zoonotic source of MRSA could have a severe impact on the epidemiology of CA-MRSA, and may have consequences for the control of MRSA, especially in those countries that maintain a low prevalence by means of search-and-destroy policies.
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Declercq P, Petré D, Gordts B, Voss A. Complicated Community-Acquired Soft Tissue Infection by MRSA from Porcine Origin. Infection 2007; 36:590-2. [DOI: 10.1007/s15010-007-7029-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 06/14/2007] [Indexed: 01/04/2023]
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Voss A, Schroeder R, Truebner S, Goernig M, Schirdewan A, Figulla HR. Spontaneous heart rate turbulence in patients with dilated cardiomyopathy. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2006:6426-9. [PMID: 17946766 DOI: 10.1109/iembs.2006.260072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Parameters of heart rate turbulence (HRT) and blood pressure turbulence (BPT) reflect the baroreflex mediated transient acceleration-deceleration response of the sinus node triggered by a premature ventricular complex (PVC) and are known to be useful risk markers in different cardiac diseases. However, the analyses of HRT and BPT are based on the prevalence of PVC. In this study the spontaneous HRT and BPT after most premature normal beats (MPNB) was investigated in comparison to HRT and BPT after PVC. ECG and blood pressure were recorded from 91 patients with dilated cardiomyopathy (DCM) and 45 healthy subjects (REF). In 69% of DCM and 33% of REF data sets PVCs were present. HRT and BPT were determined for all patients with PVC as well as in all patients triggered by MPNB. Univariate statistical analysis of the comparison between DCM and REF revealed similar results for HRT/BPT after PVC and MPNB. In conclusion, HRT and BPT triggered by PVC might be substituted by spontaneous HRT and BPT after MPNB. In contrast to the HRT and BPT after PVC, an increased number of data sets can be included in the analysis and may lead to an enhancement in risk stratification in different cardiac diseases.
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Valencia JF, Vallverdu M, Cygankiewicz I, Voss A, Vazquez R, de Luna AB, Caminal P. Multiscale regularity analysis of the Heart Rate Variability: stratification of cardiac death risk. ACTA ACUST UNITED AC 2007; 2007:5947-50. [DOI: 10.1109/iembs.2007.4353702] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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176
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Boettger M, Grotelüschen M, Voss A, Bär K. Reduced baroreflex sensitivity in acute alcohol withdrawal syndrome. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2006.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bär K, Böttger M, Berger S, Sauer H, Voss A. Evidence for inhibition of baroreflex vagal bradycardia in acute schizophrenia. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2006.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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178
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Mouton J, Bohne M, Klaassen C, Horrevorts A, de Valk H, Voss A. P1640 Evaluation of cefoxitin disks to detect methicillin-resistant coagulase negative staphylococci. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71479-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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179
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Voss A, Wulf M, Sørum M, Skov R, Madsen K. P910 Rule-out Staphylococcus aureus, including MRSA, directly from primary swab cultures using S. aureus PNA FISH. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70751-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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180
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Wulf M, Sorum M, van Nes A, Skov R, Melchers W, Klaassen C, Voss A. P1590 Prevalence of methicillin-resistant Staphylococcus aureus in veterinarians: an international view. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71429-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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181
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Malberg H, Bauernschmitt R, Voss A, Walther T, Faber R, Stepan H, Wessel N. Analysis of cardiovascular oscillations: a new approach to the early prediction of pre-eclampsia. CHAOS (WOODBURY, N.Y.) 2007; 17:015113. [PMID: 17411270 DOI: 10.1063/1.2711660] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Pre-eclampsia (PE) is a serious disorder with high morbidity and mortality occurring during pregnancy; 3%-5% of all pregnant women are affected. Early prediction is still insufficient in clinical practice. Although most pre-eclamptic patients show pathological uterine perfusion in the second trimester, this parameter has a positive predictive accuracy of only 30%, which makes it unsuitable for early, reliable prediction. The study is based on the hypothesis that alterations in cardiovascular regulatory behavior can be used to predict PE. Ninety-six pregnant women in whom Doppler investigation detected perfusion disorders of the uterine arteries were included in the study. Twenty-four of these pregnant women developed PE after the 30th week of gestation. During pregnancy, additional several noninvasive continuous blood pressure recordings were made over 30 min under resting conditions by means of a finger cuff. The time series extracted of systolic as well as diastolic beat-to-beat pressures and the heart rate were studied by variability and coupling analysis to find predictive factors preceding genesis of the disease. In the period between the 18th and 26th weeks of pregnancy, three special variability and baroreflex parameters were able to predict PE several weeks before clinical manifestation. Discriminant function analysis of these parameters was able to predict PE with a sensitivity and specificity of 87.5% and a positive predictive value of 70%. The combined clinical assessment of uterine perfusion and cardiovascular variability demonstrates the best current prediction several weeks before clinical manifestation of PE.
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van Wijk P, Pelk-Jongen M, Wijkmans C, Voss A, Schneeberger P. P1567 Improving handling of blood exposure incidents: a 3-year prospective study. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71406-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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183
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Mouton J, Voss A, Arends J, Bernards S. O435 Prevalence of ESBL in the Netherlands: the ONE study. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70289-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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184
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Caminal P, Giraldo B, Zabaleta H, Vallverdu M, Benito S, Ballesteros D, Lopez-Rodriguez L, Esteban A, Baumert M, Voss A. Joint symbolic dynamic analysis of cardiorespiratory interactions in patients on weaning trials. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2005:4576-9. [PMID: 17281258 DOI: 10.1109/iembs.2005.1615488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Assessing autonomic control provides information about patho-physiological imbalances. Measures of variability of the cardiac interbeat duration RR(n) and the variability of the breath duration T<inf>Tot</inf>(n) are sensitive to those changes. The interactions between RR(n) and T<inf>Tot</inf>(n) are complex and strongly non-linear. A study of joint symbolic dynamics is presented as a new short-term non-linear analysis method to investigate these interactions in patients on weaning trials. 78 patients from mechanical ventilation are studied: Group A (patients that failed to maintain spontaneous breathing and were reconnected) and Group B (patients with successful trials). Using the concept of joint symbolic dynamics, cardiac and respiratory changes were transformed into a word series, and the probability of occurrence of each word type was calculated and compared between both groups. Significant differences were found in 13 words, and the most significant p<inf>n</inf>(W<inf>c010, r010</inf>): 0.0041 ± 0.0036 (group A) against 0.0012 ± 0.0024 (group B), p-value = 0.00001. The number of seldom occurring word types (forbidden words) also presents significant differences fw<inf>cr</inf>: 6.9 ± 6.6 against 13.5 ± 5.3, p-value = 0.00004. Joint symbolic dynamics provides an efficient non-linear representation of cardiorespiratory interactions that offers simple physiological interpretations.
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van den Broek PJ, Kluytmans JAJW, Ummels LC, Voss A, Vandenbroucke-Grauls CMJE. How many infection control staff do we need in hospitals? J Hosp Infect 2007; 65:108-11. [PMID: 17174007 DOI: 10.1016/j.jhin.2006.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 10/06/2006] [Indexed: 11/19/2022]
Abstract
During a one-day workshop experienced infection control practitioners (ICPs) and medical microbiologists debated how much time was needed for the delivery of infection control activities in a model hospital. They agreed a standard of one full-time equivalent (FTE) ICP per 178 hospital beds and one FTE medical microbiologist per 806 hospital beds. This is 40% and 24% more than the usual standard, respectively. Now that official numbers of hospital beds have become an inadequate parameter for work delivered by hospitals, a new standard is proposed, with the number of admissions as the denominator. This is one FTE ICP per 5000 admissions and one medical microbiologist or epidemiologist per 25000 admissions.
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Mazzariol A, Roelofsen E, Koncan R, Voss A, Cornaglia G. Detection of a new SHV-type extended-spectrum beta-lactamase, SHV-31, in a Klebsiella pneumoniae strain causing a large nosocomial outbreak in The Netherlands. Antimicrob Agents Chemother 2006; 51:1082-4. [PMID: 17178800 PMCID: PMC1803151 DOI: 10.1128/aac.00909-06] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A Klebsiella pneumoniae strain resistant to third-generation cephalosporins was isolated in the eastern Netherlands. The strain was found to carry a novel extended-spectrum beta-lactamase, namely, SHV-31. The combination of the two mutations by which SHV-31 differs from SHV-1, namely, L35Q and E240K, had previously only been described in association with one or more additional mutations.
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Voss A, Baier V, Schulz S, Bar KJ. Linear and nonlinear methods for analyses of cardiovascular variability in bipolar disorders. Bipolar Disord 2006; 8:441-52. [PMID: 17042882 DOI: 10.1111/j.1399-5618.2006.00364.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Heart rate variability (HRV), blood pressure variability (BPV), and the assessment of baroreflex sensitivity are widely accepted methods for analyzing and characterizing cardiovascular regulation and for an enhanced risk evaluation in different diseases. As a result of the complexity of the investigated regulatory systems, univariate analyses do not often provide a convenient description of pathological changes in the cardiovascular regulation. Therefore, the application of a multivariate approach is preferable. METHODS We present principal methods of time-domain, frequency-domain, and nonlinear analyses of HRV, BPV as well as methods for coupling and interaction analyses. RESULTS Changes in autonomic nervous system (ANS) tone are known to accompany various mental disorders. Depressive patients frequently complain of symptoms of ANS dysfunction, such as dry mouth, diarrhea, and insomnia. These clinical observations propose the assumption of altered autonomic dysfunction in these patients. In contrast to these clinical assumptions, inconsistent results have been found in studies of HRV in depressive patients. This work therefore covers a brief review of the literature in respect to bipolar disorder and the rationale to study autonomic changes in such a psychiatric disease. CONCLUSIONS Prospective studies of cardiovascular changes in mania and depression are needed to evaluate a psychopathological state in connection with cardiovascular changes and cardiac morbidity and mortality. These studies should consider BPV, coupling and interaction analyses, the application of nonlinear methods, and a multivariate approach in addition to the traditional analysis of HRV.
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188
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Struelens MJ, Wagner D, Bruce J, MacKenzie FM, Cookson BD, Voss A, van den Broek PJ, Gould IM. Status of infection control policies and organisation in European hospitals, 2001: the ARPAC study. Clin Microbiol Infect 2006; 12:729-37. [PMID: 16842567 DOI: 10.1111/j.1469-0691.2006.01462.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patient safety in hospital care depends on effective infection control (IC) programmes. The Antimicrobial Resistance Prevention and Control (ARPAC) study assessed the organisation, components and human resources of IC programmes in European hospitals. A questionnaire survey of policies and procedures implemented in 2001 for the surveillance and control of nosocomial infection and antibiotic resistance was completed by 169 acute-care hospitals from 32 European countries, categorised by five geographical regions. A formal IC programme existed in 72% of hospitals, and a multidisciplinary IC committee was operational in 90%. Trained IC nurses (ICNs) were present in 80% of hospitals (ranging from 54% in south-east and central-eastern Europe, to 100% in northern Europe), whereas 74% had one or more trained IC doctors (ICDs) (ranging from 46% in south-east Europe to 84% in western Europe). Median staffing levels were 2.33 ICNs/1,000 beds and 0.94 ICDs/1,000 beds. The intensity of IC programmes scored higher in centres from northern and western Europe than from other European regions. Written guidelines promoted hand hygiene for healthcare workers in 89% of hospitals, education in 85%, and audit in 46%. Guidelines recommended use of alcohol-based solutions (70%) and/or medicated/antiseptic soap (43%) for decontamination of non-soiled hands. Use of alcohol-based solutions varied according to region, from 41% in southern Europe to 100% in northern Europe, compared with use of medicated soap from 77% in southern Europe to 11% in northern Europe (p < 0.01). These findings showed that IC programmes in European hospitals suffer from major deficiencies in human resources and policies. Staffing levels for ICNs were below recommended standards in the majority of hospitals. Education programmes were incomplete and often not supported by audit of performance. Hand hygiene procedures were sub-standard in one-third of centres. Strengthening of IC policies in European hospitals should be a public health priority.
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Verduyn Lunel F, Koeleman JGM, Spanjaard L, Vandenbroucke-Grauls C, Schultz C, Verbrugh HA, Vos G, Troelstra A, Mascini E, Verweij PE, Voss A. Trends in fungaemia and antifungal susceptibility in the Netherlands. Neth J Med 2006; 64:236-42. [PMID: 16929085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We retrospectively evaluated fungaemia over the period 1996 to 2001 in five university hospitals. Over 350,000 blood cultures were collected during more than 7 million days of hospitalisation. The average rate of fungaemia over the six-year period was 0.82 per 10,000 patient days (range 0.65 to 1.21 per 10,000 patient days). The proportion of bloodstream infections caused by Candida albicans remained stable throughout the study period with a mean of 53% (range 48 to 62%). This is a change from trends described in previous studies, including a survey performed in the Netherlands. This study shows a new, stable rate of fungaemia and no further signs of increasing rate of infections due to non-albicans Candida species. Susceptibility to all tested antifungal agents remained stable throughout the study period.
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Hoffmann B, Karbe H, Krusch C, Müller B, Pause M, Prosiegel M, Puschendorf W, Schleep J, Spranger M, Steube D, Voss A. Patientencharakteristika in der neurologisch/neurochirurgischen Frührehabilitation (Phase B): Eine multizentrische Erfassung im Jahr 2002 in Deutschland. AKTUELLE NEUROLOGIE 2006. [DOI: 10.1055/s-2005-915348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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191
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van Wijk PTL, Pelk-Jongen M, Wijkmans C, Voss A, Schneeberger PM. Quality control for handling of accidental blood exposures. J Hosp Infect 2006; 63:268-74. [PMID: 16697487 DOI: 10.1016/j.jhin.2006.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Accepted: 02/03/2006] [Indexed: 10/24/2022]
Abstract
A regional counselling service was established to handle all accidental blood exposures using a standardized protocol. Levels of risk were assessed using an algorithm. Accidents that posed a risk for the transmission of hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV) were classified as 'high risk', whereas accidents that posed a risk for HBV alone were classified as 'low risk'. Medical interventions were implemented according to the level of risk. During a one-year period, all accidents were registered and analysed for adherence to the standard protocol. In 2003, the centre handled 454 incidents. Of these, 36 (7.9%) incidents were assessed as no risk, 329 (72.5%) were assessed as low risk, and 67 (14.8%) were assessed as high risk. Due to incomplete registration, 22 (4.8%) incidents could not be analysed further. In total, 36% of the incidents with risk for HBV transmission and 40% of the incidents with risk for HCV and HIV transmission were not handled according to the proposed protocol. Breaches consisted of over-reaction (25/396) as well as insufficient response (123/396). Potentially inadequate treatment occurred for HIV postexposure prophylaxis in 12 of 63 incidents. Incomplete follow-up for HCV occurred in 11 of 63 incidents, and lack of HBV immunoglobulin administration occurred in five of 396 incidents, including three high-risk incidents. In 21 of 396 low-risk exposures, the breaches in protocol resulted from late reporting. It remains difficult to achieve an acceptable level of standardized care when using standard operational procedures. Documentation and evaluation of flaws are essential to improve the system.
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Koene RPM, Tjioe M, Hoondert K, van de Vrie W, Olde Rikkert MGM, Wulfen M, Voss A. [Scabies outbreak in a hospital and in 8 health-care institutions caused by an elderly patient with scabies crustosa]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2006; 150:918-23. [PMID: 16686094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
An outbreak of scabies in a teaching hospital, two nursing homes and six health-care institutions for the elderly, occurred in the Nijmegen area in the Netherlands, between September 2004 and April 2005. In November 2004 the diagnosis of scabies crustosa (scabies norvegica) was made in the index patient - a 78-year-old woman. An atypical presentation, without much itching, as is not infrequently seen in elderly patients, resulted in there being a considerable delay before the diagnosis was made. This resulted in a total of 51 people, both in and outside the hospital, becoming infected. Based on article 7 of the Dutch Infectious Diseases Act, the Municipal Health Service (GGD) advised institutions on the policy and carried out both source and contact tracing. According to this Act notification and cooperation between hospital, care institutions and the GGD are of importance for the effective handling of epidemics. Systemic treatment with ivermectin is the main alternative to local treatment in outbreaks in institutions.
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Bär KJ, Böttger M, Berger S, Sauer H, Voss A. Evidence for inhibition of baroreflex vagal bradycardia in acute schizophrenia. KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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194
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Boettger M, Grotelüschen M, Voss A, Bär KJ. Reduced baroreflex sensitivity in acute alcohol withdrawal syndrome. KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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195
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van Wijk PTL, Pelk-Jongen M, de Boer E, Voss A, Wijkmans C, Schneeberger PM. Differences between Hospital- and Community-Acquired Blood Exposure Incidents Revealed by a Regional Expert Counseling Center. Infection 2006; 34:17-21. [PMID: 16501897 DOI: 10.1007/s15010-006-4125-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Accepted: 06/06/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE One year (2003) regional analysis of all blood exposure incidents from hospitals as well as from the community. DESIGN Establishment of an easily accessible regional expert counseling center, operating 24 h a day, for all accidental blood exposures. Tasks of the center were to register incoming calls, to inform and counsel the victim, to assess the risk of the incident, and to provide a plan of further actions, including prophylactic measures. SETTING A Dutch region (Northeast Brabant) with 500,000 inhabitants and two major hospitals (1,786 beds). RESULTS A total of 454 incidents (1.2 per day) were recorded. Only half of the incidents occurred in the hospital setting (n = 234), whereas the others (n = 220) took place in the community setting. Nearly all (95%, n = 432) incidents occurred during work, and most of them (84%, n = 385) were related to health care activities. In the hospital setting injuries occurred with physicians (13%), nursing staff (45%), operating room (OR) staff (13%), ancillary (18%), others (10%). In the community setting, incidents took place among healthcare workers (48%), detention and police officers (10%), civilians (10%), general practitioners/dentists and their staff (8%), cleaning staff (4%) and work-related incidents not falling into any of the above categories (7%). More low risk incidents took place outside the hospital (87% vs. 68% in hospital), while high-risk incidents predominantly occurred within the hospital setting (23% vs. 6%). The hepatitis-B immunization rate was significantly lower in victims from the community than in those working in hospitals (38% vs. 96%). Reports from incidents in the community setting were delayed. CONCLUSIONS Incidents that expose individuals to blood-borne pathogens occur equally frequent in the hospital and non-hospital (community) setting. Therefore, a regional expert counseling center, accessible around-the-clock, for all types of blood-exposure incidents is needed. Blood-exposure prevention programs should aim at a reduction of high-risk incidents within hospitals, and at increasing the awareness for vaccination and early reporting within the community setting.
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Muilwijk J, Walenkamp GHIM, Voss A, Wille JC, van den Hof S. Random effect modelling of patient-related risk factors in orthopaedic procedures: results from the Dutch nosocomial infection surveillance network 'PREZIES'. J Hosp Infect 2006; 62:319-26. [PMID: 16406851 DOI: 10.1016/j.jhin.2005.08.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Accepted: 08/03/2005] [Indexed: 11/17/2022]
Abstract
In the Dutch surveillance for surgical site infections (SSIs), data from 70277 orthopaedic procedures with 1895 SSIs were collected between 1996 and 2003. The aims of this study were: (1) to analyse the trends in SSIs associated with Gram-positive and Gram-negative bacteria; (2) to estimate patient-related risk factors for deep and superficial SSIs after all orthopaedic procedures, with special attention to primary total hip arthroplasty (THA); and (3) to analyse inherent differences in infection risk between hospitals. A random effect model was used to estimate the odds ratios of patient-related risk factors for developing an SSI, and to describe the distribution of the most widespread bacterial species responsible for SSIs among hospitals. Gram-positive organisms, mainly staphylococci, were the main cause of both deep (84.0%) and superficial SSIs (69.1%) after orthopaedic procedures. The percentage of SSIs after THA caused by coagulase-negative staphylococci decreased over the surveillance period, while the contribution of Staphylococcus aureus increased. Temporary elevations in the incidence of the most widespread pathogen species were observed within hospitals. Patient-related factors such as the National Nosocomial Infections Surveillance System risk index or age had little effect on the predictive power of the random effect models. This study underlines the usefulness of a random effect model, which adjusts risk estimates for random variation between hospitals, in a multicentre study on risk factors for SSIs.
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Wulf M, Van Nes A, Eikelenboom-Boskamp A, De Vries J, Melchers W, Klaassen C, Voss A. P4.14 Prevalence of Methicillin Resistant Staphylococcus aureus in Dutch Veterinarians and Veterinary Students. J Hosp Infect 2006. [DOI: 10.1016/s0195-6701(06)60076-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baier V, Baumert M, Caminal P, Vallverdú M, Faber R, Voss A. Hidden Markov Models Based on Symbolic Dynamics for Statistical Modeling of Cardiovascular Control in Hypertensive Pregnancy Disorders. IEEE Trans Biomed Eng 2006; 53:140-3. [PMID: 16402614 DOI: 10.1109/tbme.2005.859812] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Discrete hidden Markov models (HMMs) were applied to classify pregnancy disorders. The observation sequence was generated by transforming RR and systolic blood pressure time series using symbolic dynamics. Time series were recorded from 15 women with pregnancy-induced hypertension, 34 with preeclampsia and 41 controls beyond 30th gestational week. HMMs with five to ten hidden states were found to be sufficient to characterize different blood pressure variability, whereas significant classification in RR-based HMMs was found using fifteen hidden states. Pregnancy disorders preeclampsia and pregnancy induced hypertension revealed different patho-physiological autonomous regulation supposing different etiology of both disorders.
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Caminal P, Vallverdú M, Giraldo B, Benito S, Vázquez G, Voss A. Optimized Symbolic Dynamics Approach for the Analysis of the Respiratory Pattern. IEEE Trans Biomed Eng 2005; 52:1832-9. [PMID: 16285386 DOI: 10.1109/tbme.2005.856293] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Traditional time domain techniques of data analysis are often not sufficient to characterize the complex dynamics of respiration. In this paper, the respiratory pattern variability is analyzed using symbolic dynamics. A group of 20 patients on weaning trials from mechanical ventilation are studied at two different pressure support ventilation levels, in order to obtain respiratory volume signals with different variability. Time series of inspiratory time, expiratory time, breathing duration, fractional inspiratory time, tidal volume and mean inspiratory flow are analyzed. Two different symbol alphabets, with three and four symbols, are considered to characterize the respiratory pattern variability. Assessment of the method is made using the 40 respiratory volume signals classified using clinical criteria into two classes: low variability (LV) or high variability (HV). A discriminant analysis using single indexes from symbolic dynamics has been able to classify the respiratory volume signals with an out-of-sample accuracy of 100%.
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Kluytmans-Vandenbergh MFQ, Kluytmans JAJW, Voss A. Dutch Guideline for Preventing Nosocomial Transmission of Highly Resistant Microorganisms (HRMO). Infection 2005; 33:309-13. [PMID: 16258859 DOI: 10.1007/s15010-005-5079-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Accepted: 06/20/2005] [Indexed: 10/25/2022]
Abstract
Hospitals are faced with the increasingly rapid emergence and dissemination of antimicrobial-resistant microorganisms. US and European guidelines on the prevention of antimicrobial resistance in hospitals were, until recently, mainly directed at methicillin-resistant Staphylococcus aureus (MRSA). In 2004, the Dutch Working Party on Infection Prevention issued a guideline on the prevention of nosocomial transmission of highly resistant microorganisms (HRMO), in order to fulfill the growing need for additional guidance on the control of other pathogens with acquired resistance and the potential to spread within hospitals (such as glycopeptide-resistant Enterococcus faecium, penicillin-resistant Streptococcus pneumoniae, extendedspectrum beta-lactamase producing Enterobacteriaceae, and other (multi)drug-resistant gram-negatives). In addition to providing criteria for defining HRMO, the Dutch guideline provides recommendations on isolation of patients, active surveillance, and contact tracing. The guideline will enable the comparison of HRMO rates between hospitals, and may be used to evaluate the efficacy of programs to control antibiotic use and/or nosocomial transmission of resistant pathogens. The eventual success of nationwide implementation of this guideline remains to be established in the coming years.
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