Casandra Martizano B.S.N.

-III
Secular trends in the medical discharge summary in an acute medical hospital
Author Affiliations 1. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR, China
1.

Correspondence to: Dr K M Chow Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; Chow_Kai_Ming@alumni.cuhk.net

Abstract
Background: Although recent research has reported an evolution in the level of medical care, little is known about secular trends in the medical discharge summary. Methods: The audit evaluated the evolution of discharge summary abstract over a decade in an acute medicine hospital among three successive periods of 1994, 2000, and 2005. Results: Of the 140 random samples of discharge summaries, significant between-cohort difference existed in the logarithm transformed length of discharge summary; the median length of discharge summary increased from 11 lines in 1994 to 26 lines in 2005 (p<0.001 corrected for multiple comparison). The closest univariate associations of discharge summary length were positively with the year of hospitalisation, length of stay, length of wordings about discharge plan and duplication of previous discharge summary, and negatively with clinical or planned admission (all p<0.01). In a multiple linear regression analysis, the year of patient admission correlated significantly with the length of discharge summary (p<0.001). Conclusions: Over the 10 year study period, significant secular trends were seen in the discharge summary length and discharge plan documentation. The causes and implications for these trends deserve further investigation.

http://pmj.bmj.com/content/82/971/615.abstract

Diagnosis of nosocomial pneumonia in medical ward: repeatability of the protected specimen brush + Author Affiliations
1.
1 2

Centre Mdical de Forcilles, F-77170, Frolles-Attilly, and Centre Hospitalier Intercommunal de Crteil, F-94000, Crteil, France

1. B. Herer, Centre Mdical de Forcilles, F-77170, FrollesAttilly, France. Fax: 33 164055591

Abstract
The aims of this study were to assess the repeatability of two pairs of protected specimen brushes (PSB) done successively in the same lung area and either processed at the bedside or in the laboratory, and to provide a description of the bacteriological findings in 39 cases of suspected nosocomial pneumonia occurring in nonventilated patients. Four PSB were divided into two pairs. One pair of brushes (Pb) was prepared at bedside and then sent to the laboratory; the other pair (Pl) was immediately sent to the laboratory for complete processing. According to a 103colony forming units (cfu)mL1 threshold, 49% out of 156 PSB were positive. Using the 103 cfumL threshold, the Pl brushes were 89.7% concordant while the Pb brushes were 76.9% concordant. The repeatability as expressed by -value of the cultures of PSB was higher for Pl brushes than for Pb brushes (-values of 0.795 and 0.537 respectively, p=0.12). Bacterial species were isolated in 58.3% of 156 PSB (176 isolates). In 14 cases, cultures of PSB disclosed more than one micro-organism in a concentration >103cfumL1. The most frequently isolated organisms were Pseudomonas spp. (23.9%), Enterobacteriaceae (23.3%), Streptococcus spp. (21.6%) and Staphylococcus spp. (13.1%). Polymicrobial cultures were more frequent if the patient had a tracheostomy (seven out of the nine patients with a

tracheostomy versus seven out of the 30 patients without a tracheostomy, p<0.01). Bacteriological discrepancies leading to a potential troublesome choice in antibiotherapy were observed in 31.8% of the patients for Pl brushes and 56.5% of the patients for Pb brushes. There is a low degree of repeatability of protected specimen brushes outside intensive care units which seem dependent on sampling processing. The distribution of pathogens found in case of suspicion of nosocomial pneumonia in nonventilated patients appears to be similar to that obtained in ventilator-associated pneumonia. http://erj.ersjournals.com/content/18/1/157.abstract

Medicine Ward Patients in a Large Teaching Hospital: A High-Risk Population for Catheter-Associated Bloodstream
yes platform+medline author author

Infections?

Abstract
BACKGROUND: Infection control surveillance for catheterassociated bloodstream infections (CA-BSIs) is often focused in intensive care units (ICUs), where national benchmark data is available. Limited data on CA-BSI rates are available for non-ICU areas. Increasing acuity among non-ICU patients with central venous catheters (CVCs) raised the need to evaluate these areas. OBJECTIVE: To determine the CA-BSI rate in selected non-ICU medical wards over a 13-month period. METHODS: An infection control specialist performed active surveillance for CA-BSIs on four medical wards (A, B, C, D) from April 2002 to April 2003. CA-BSI was defined using NNIS definitions. CVC days were obtained from an electronic report based on nurses' CVC charting. Type of CVC and CA-BSI microbiology was documented. RESULTS: The general medicine wards each average 510 admissions/day. Each ward has separate nursing staff. A medical

director, nurse manager, and interns/residents are shared between wards A & B and between wards C & D. The mean monthly CVC days for the 13-month period was 141 (range 77215) per ward. Device utilization ratios for the four wards were 0.21, 0.25, 0.19, 0.24, respectively. Forty-two episodes of CA-BSI were identified. The mean CA-BSI rate in Ward A was 5.3/1000 CVC days (n=9); Ward B: 8.0/1000 CVC days (n=16); Ward C: 4.3/1000 CVC days (n=7); and Ward D: 4.9/1000 CVC days (n=10). CA-BSI organisms were: polymicrobial, 12% (n=5); Enterococcus spp., 24% (n=10); Coagulase-negative staphylococci, 24% (n=10); Staphylococcus aureus, 7% (n=3); other gram-positive, 2% (n=1); Pseudomonas aeruginosa, 2% (n=1); Escherichia coli, 2% (n=1); Proteus mirabilis, 2% (n=1); other gram-negative, 10% (n=4); Candida albicans, 12% (n=5), and other Candida, 2% (n=1). Patients with CA-BSI had the following catheters: tunneled, 5% (n=2); non-tunneled, 83% (n=35); and implanted port, 7% (n=3). Two patients had more than one type of CVC. CONCLUSION: Non-ICU medical wards in our study had device utilization ratios that were considerably lower than medical ICUs, but CA-BSI rates were comparable to medical ICUs nationally. Studies of catheter utilization rates and knowledge of CVC care and insertion on medical wards should be performed. Interventions usually focused on ICU personnel may be indicated to prevent CA-BSI on medical wards. http://www.ajicjournal.org/article/S0196-6553%2804%29001555/abstract

I can't help feeling We could have had it all Rolling in the deep There's a fire starting in my heart You had my heart inside your hand Reaching a fever pitch and it's bring me And you played it to the beat out the dark Could have had it all Finally I can see you crystal clear Rolling in the deep Go ahead and sell me out and I'll lay your You had my heart inside your hand ship bare But you played it with a beating See how I'll leave, with every piece of you Don't underestimate the things that I will do your soul through every open door Throw There's a fire starting in my heart Count your blessings to find what you look Reaching a fever pitch and it's bring me out the dark Turn my sorrow into treasured gold The scars of your love remind me of us You pay me back in kind and reap just what They keep me thinking that we almost had itsow you all The scars of your love, they leave me (Now I'm gonna wish you never had met breathless I can't help feeling We could have had it all We could have had it all (Tears are gonna fall, rolling in the deep) Rolling in the deep We could have had it all You had my heart inside your hand And you played it to the beat (Now I'm gonna wish you never had met Baby, I have no story to be told But I've heard one of you and I'm gonnaIt all, it all, it all, it all make your head burn (Tears are gonna fall, rolling in the deep) Think of me in the depths of your despair Making a home down there as mine sure(Now I'm gonna wish you never had met won't be shared The scars of your love remind you of us We could have had it all They keep me thinking that we almost had it are gonna fall, rolling in the deep) (Tears all Rolling in the deep The scars of your love, they leave me breathless (Now I'm gonna wish you never had met

Rolling In The Deep lyrics

me) (Tears are gonna fall, rolling in the deep) You had my heart and soul Rolling in the deep (Tears are gonna fall, rolling in the deep) And you played it to the beat (Now I'm gonna wish you never had met (Now I'm gonna wish you never had metYou had my heart and soul in your hand me) (Tears are gonna fall, rolling in the deep) Could have had it all But you played it, you played it, yo u played it to the beat
"Someone Like You"
I heard that you're settled down That you found a girl and you're married now. I heard that your dreams came true. Guess she gave you things I didn't give to you. Old friend, why are you so shy? Ain't like you to hold back or hide from the light. I hate to turn up out of the blue uninvited But I couldn't stay away, I couldn't fight it. I had hoped you'd see my face and that you'd be reminded That for me it isn't over. Never mind, I'll find someone like you I wish nothing but the best for you too Don't forget me, I beg I remember you said, "Sometimes it lasts in love but sometimes it hurts instead, Sometimes it lasts in love but sometimes it hurts instead, " Yeah You know how the time flies Only yesterday was the time of our lives We were born and raised In a summer haze Bound by the surprise of our glory days I hate to turn up out of the blue uninvited But I couldn't stay away, I couldn't fight it. I'd hoped you'd see my face and that you'd be reminded That for me it isn't over. Never mind, I'll find someone like you I wish nothing but the best for you too Don't forget me, I beg I remember you said, "Sometimes it lasts in love but sometimes it hurts instead." Yeah

Nothing compares No worries or cares Regrets and mistakes They are memories made. Who would have known how bittersweet this would taste? Never mind, I'll find someone like you I wish nothing but the best for you Don't forget me, I beg I remember you said, "Sometimes it lasts in love but sometimes it hurts instead." Never mind, I'll find someone like you I wish nothing but the best for you too Don't forget me, I beg I remember you said, "Sometimes it lasts in love but sometimes it hurts instead, Sometimes it lasts in love but sometimes it hurts instead." Yeah

SUPERBASS
This one is for the boys with the boomin' system Top down, AC with the coolin' system When he come up in the club, he be blazin' up Got stacks on deck like he savin' up And he ill, he real, he might got a deal He pop bottles and he got the right kind of build He cold, he dope, he might sell coke He always in the air, but he never fly coach He a muthafuckin trip, trip, sailor of the ship, ship When he make it drip, drip kiss him on the lip, lip That's the kind of dude I was lookin' for And yes you'll get slapped if you're lookin' ho I said, excuse me you're a hell of a guy I mean my, my, my, my you're like pelican fly I mean, you're so shy and I'm loving your tie You're like slicker than the guy with the thing on his eye, oh Yes I did, yes I did Somebody please tell him who the eff I is I am Nicki Minaj, I mack them dudes up Back coupes up, and chuck the deuce up Boy you got my heartbeat runnin' away

Beating like a drum and it's coming your way Can't you hear that boom, badoom, boom Boom, badoom, boom bass? He got that super bass Boom, badoom, boom Boom, badoom, boom bass Yeah that's that super bass Boom, Boom, Boom, Boom, bass badoom, badoom, badoom, badoom, boom boom, he got that super bass boom boom, yeah that's that super

This one is for the boys in the Polos Entrepreneur niggas in the moguls He could ball with the crew, he could solo But I think I like him better when he dolo And I think I like him better with the fitted cap on He ain't even gotta try to put the mac on He just gotta give me that look, when he give me that look Then the panties comin' off, off, unh Excuse me, you're a hell of a guy You know I really got a thing for American guys I mean, sigh, sickenin' eyes I can tell that you're in touch with your feminine side, oh

Yes I did, yes I did Somebody please tell him who the eff I is I am Nicki Minaj, I mack them dudes up Back coupes up, and chuck the deuce up Boy you got my heartbeat runnin' away Beating like a drum and it's coming your way Can't you hear that boom, badoom, boom Boom, badoom, boom bass? He got that super bass Boom, badoom, boom Boom, badoom, boom bass Yeah that's that super bass Boom, Boom, Boom, Boom, bass badoom, badoom, badoom, badoom, boom boom, he got that super bass boom boom, yeah that's that super

Boy you got my heartbeat runnin' away Don't you hear that heartbeat comin' your way? Oh it be like, boom, badoom, boom Boom, badoom, boom bass Can't you hear that boom, badoom, boom Boom, badoom, boom bass? Boy you got my heartbeat runnin' away Beating like a drum and it's coming your way Can't you hear that boom, badoom, boom Boom, badoom, boom bass? He got that super bass Boom, badoom, boom Boom, badoom, boom bass Yeah that's that super bass Boom, Boom, Boom, Boom, bass badoom, badoom, badoom, badoom, boom boom, he got that super bass boom boom, yeah that's that super

See I need you in my life for me to stay No, no, no, no, no I know you'll stay No, no, no, no, no don't go away