Incidence and Predictors of Nonventilator Hospital-Acquired Pneumonia in a Community Hospital

BACKGROUND

Nonventilator hospital-acquired pneumonia (NV-HAP) is a common hospital-acquired condition that is amenable to basic nursing care interventions.

PURPOSE

The purpose of this study was to determine the incidence of NV-HAP in a California community hospital and to identify the patient and nursing care factors including missed nursing care associated with its development.

METHODS

A retrospective study identified possible NV-HAP cases with ICD-10 (International Classification of Diseases, Tenth Revision) codes and then validated cases using Centers for Disease Control and Prevention confirmatory criteria.

RESULTS

The incidence of NV-HAP in our hospital was 0.64 cases per 1000 patient-days. Patient factors most strongly associated with NV-HAP were age (each year of increased age was associated with a 4% increased likelihood of developing NV-HAP) (OR = 1.04-1.07) and the presence of underlying disease, which reduced odds of developing NV-HAP by 36% (OR = 0.36; 95% CI, 0.12-0.98). Head-of-bed elevation reduced by 26% the odds of developing NV-HAP (OR = 0.26; 95% CI, 0.07-0.08).

CONCLUSIONS

NV-HAP can be predicted and potentially prevented. Paradoxically, the presence of underlying disease was not positively associated with the development of NV-HAP in this study.

UK retinopathy of prematurity treatment survey

BACKGROUND

Since the CRYO-ROP study showed the benefit of treating babies with ROP, a number of different treatment modalities have become available. Solid-state lasers have been extensively used in the treatment of ROP since their introduction some 10 years ago. Diode, argon and frequency-doubled YAG (FD-YAG) lasers have all been used to perform photocoagulation in ROP. We aimed to assess current treatment practices of ROP treatment in the UK.

METHODS

A questionnaire survey was performed in June 2004 and sent to all consultants known to be involved in the treatment or screening of ROP patients. We asked about the number of patients treated in the last year, the treatment method, and whether there had been any serious complications.

RESULTS

In all, 53 questionnaires were sent out, of which 42 were returned. Also, 30 respondents treated ROP. Of these 19 used transpupillary diode, 11 argon, and three FD-YAG. Cryotherapy and transscleral diode laser were used by two centres in particular cases. In all, 20 patients were treated with FD-YAG, 21 with argon laser, and 188 with diode laser. The number of burns per eye varied from 800 to 2500. Reported complications included hyphaema, retinal haemorrhage, and acute cataract formation; however, there was no significant difference in complications between different types of laser used.

DISCUSSION

This survey of laser use in the treatment of ROP has shown that diode laser is now the most common mode of treatment in the UK. The incidence of complications was similar for centres using argon, diode, or FD-YAG laser.

UK survey of attitudes to local anaesthesia for vitreoretinal surgery

BACKGROUND

The use of local anaesthesia (LA) for vitreoretinal (VR) surgery is growing although surgeons in the UK traditionally use general anaesthesia.

PURPOSE

To assess the use and attitudes towards local anaesthesia for VR surgery among the members of the British and Eire Association of Vitreo-retinal Surgeons (BEAVRS).

METHODS

A questionnaire was sent to members of BEAVRS. Use of LA was assessed for the following procedures: macular hole; diabetic vitrectomy; vitrectomy; cryopexy and gas; buckling and re-buckling procedures. Attitudes of surgeons generally using LA for primary retinal detachment surgery (> 50% of cases) were compared with those generally using general anaesthesia (GA) (> 50% of cases).

RESULTS

33.6% of surgeons preferred LA for macular hole; 26.2% for diabetic vitrectomy; 23.3% for vitrectomy, cryopexy and gas; 21.4% for buckling procedures; and 9.35% for re-buckling procedures. When surgeons routinely using LA were compared with those regularly using GA they considered LA less stressful for patients and surgeon, patients tolerant to longer operations, and buckling or redo surgery no more difficult under LA. However, both groups considered surgery on young patients and teaching relatively more difficult under LA.

CONCLUSION

The use of LA may convey benefits for VR surgery and faster rehabilitation for patients. However, we identified wide variations in the use of and attitudes to LA for VR surgery in British surgeons.

Screening for diabetic retinopathy using digital colour photography and oral fluorescein angiography

PURPOSE

To evaluate digital colour photography and oral fluorescein angiography (OFA) for diabetic retinopathy screening.

METHODS

Thirty-seven patients were selected from either a diabetic retinopathy screening or a medical retina clinic. Three 45 degrees colour digital images and a single macula 45 degrees OFA image were taken from each eye. Standard seven-field stereo photography with ETDRS grading was used as a gold standard for data comparison. The images were assessed by two graders and the results of each method compared using the McNemar test.

RESULTS

Five eyes had no diabetic retinopathy, 50 had background diabetic retinopathy, 3 had pre-proliferative diabetic retinopathy, 11 had proliferative disease and 3 had quiescent posttreatment disease. Clinically significant macular oedema was present in 25 eyes and absent in 48. For grading diabetic retinopathy digital colour photography produced a sensitivity of 0.87 (specificity 0.83); OFA produced a sensitivity of 0.87 (specificity 0.80) (p = 0.1). For the detection of diabetic maculopathy, the sensitivity of digital colour photography was 0.48 (specificity of 0.95) and for OFA was 0.87 (specificity 0.87) (p < 0.01).

CONCLUSION

This pilot study has shown that both digital colour photography and OFA compare well with conventional methods for diabetic retinopathy screening. The results encourage the further evaluation of OFA in the screening for diabetic maculopathy.

Natural history of diabetic macular streak exudates: evidence from a screening programme

BACKGROUND/AIMS

Diabetic retinopathy screening guidelines recommend referral to an ophthalmologist if there is exudate within one disc diameter of the fovea. Many of these patients, however, have resolution of small amounts of exudate without treatment. This study aimed to assess whether patients with minimal streak or dot exudates within one disc diameter of the fovea can be monitored in a screening programme without compromising visual acuity.

METHODS

A retrospective review of records and Polaroid photographs obtained by one screening centre over a 10 year period was performed. Outcomes measured were referral rates, alteration of Snellen visual acuity, and the need for macular photocoagulation treatment.

RESULTS

55 patients (74 eyes) fulfilled entry criteria (37 streak and 37 dot exudates). Mean follow up was 56.1 months (range 12-127 months). Twenty five patients (30 eyes) were referred to an ophthalmologist. 13 eyes (17.6%) required macular photocoagulation treatment. Four eyes (5.4%) lost two or more lines of Snellen acuity over the follow up period (three from macular oedema and one from macular ischaemia). There was no relation between the presence or resolution of minimal exudate and visual loss (p>0.2).

CONCLUSION

It is appropriate to monitor eyes with streak or dot macular exudates at 6-9 monthly intervals in a screening programme.

Retinal blood flow in diabetic retinopathy

OBJECTIVES

(a) To report on the basic parameters of retinal blood flow in a population of diabetic patients with and without retinopathy and non-diabetic controls; (b) to formulate a haemodynamic model for the pathogenesis of diabetic retinopathy from this and other studies.

DESIGN

Laser-Doppler velocimetry and computerised image analysis to determine retinal blood flow in a large cross sectional study.

SETTING

Diabetic retinopathy outpatient clinic.

SUBJECTS

24 non-diabetic controls and 76 diabetic subjects were studied (63 patients with insulin dependent diabetes, 13 with non-insulin dependent diabetes). Of the diabetic subjects, 12 had no diabetic retinopathy, 27 had background retinopathy, 13 had pre-proliferative retinopathy, 12 had proliferative retinopathy, and 12 had had pan-retinal photocoagulation for proliferative retinopathy.

MAIN OUTCOME MEASURES

Retinal blood flow (microliters/min) and conductance (rate of flow per unit of perfusion pressure).

RESULTS

In comparison with non-diabetic controls (9.52 microliters/min) and diabetic patients with no diabetic retinopathy (9.12 microliters/min) retinal blood flow was significantly increased in all grades of untreated diabetic retinopathy (background 12.13 microliters/min, pre-proliferative 15.27 microliters/min, proliferative 13.88 microliters/min). There was a significant decrease in flow after pan-retinal photocoagulation in comparison with all the other groups studied (4.48 microliters/min). Conductance of the retinal circulation was higher in the untreated diabetic retinopathy groups. These results were independent of age, sex, type of diabetes, duration of diabetes, glycated haemoglobin concentration, blood glucose concentration, blood pressure, and intraocular pressure.

CONCLUSIONS

Retinal blood flow is significantly increased in diabetic retinopathy in comparison with non-diabetic controls and diabetic subjects with no retinopathy. This has implications for controlling hypertension and hyperglycaemia as a strategy in reducing morbidity from diabetic retinopathy.

Effect of meal on retinal blood flow in IDDM patients

OBJECTIVE

The effect of postprandial hyperglycemia on retinal blood flow was examined in 11 adults with insulin-dependent diabetes mellitus (IDDM) and 9 nondiabetic subjects.

RESEARCH DESIGN AND METHODS

Retinal blood flow was measured with bidirectional laser Doppler velocimetry before and 60 and 120 min after a 50-g carbohydrate breakfast. Diabetic subjects were studied twice, being randomized to take their usual insulin (isoglycemic study) or to omit their morning short-acting insulin (hyperglycemic study). Nondiabetic subjects were studied once and received no insulin.

RESULTS

Plasma glucose rose significantly (from 11.5 +/- 5.2 to 22.1 +/- 5.5 mM, P less than 0.001) during the hyperglycemic study but not during the isoglycemic or nondiabetic studies. There were no significant changes in blood pressure or retinal blood flow in any of the groups studied.

CONCLUSIONS

Short-term hyperglycemia does not increase retinal blood flow.