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Accuracy of healthcare worker recall and medical record review for identifying infectious exposures to hospitalized patients.

https://arctichealth.org/en/permalink/ahliterature168575
Source
Infect Control Hosp Epidemiol. 2006 Jul;27(7):722-8
Publication Type
Article
Date
Jul-2006
Author
M. Aquino
J M Raboud
A. McGeer
K. Green
R. Chow
P. Dimoulas
M. Loeb
D. Scales
Author Affiliation
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Source
Infect Control Hosp Epidemiol. 2006 Jul;27(7):722-8
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Disease Transmission, Infectious
Environmental Exposure
Hospitalization
Humans
Inpatients
Medical Audit
Mental Recall
Ontario
Personnel, Hospital
Abstract
To determine the validity of using healthcare worker (HCW) recall of patient interactions and medical record review for contact tracing in a critical care setting.
Trained observers recorded the interactions of nurses, respiratory therapists, and service assistants with study patients in a medical-surgical intensive care unit. These observers' records were used as the reference standard to test the criterion validity of using HCW recall data or medical record review data to identify exposure characteristics. We assessed the effects of previous quarantine of the HCW (because of possible exposure) and the availability of patients' medical records for use as memory aids on the accuracy of HCW recall.
A 10-bed medical-surgical intensive care unit at Mount Sinai Hospital in Toronto, Ontario.
Thirty-six HCWs observed caring for 16 patients, for a total of 55 healthcare worker shifts.
Recall accuracy was better among HCWs who were provided with patient medical records as memory aids (P
PubMed ID
16807848 View in PubMed
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Adherence to antibiotic guidelines for pneumonia in chronic-care facilities in Ontario.

https://arctichealth.org/en/permalink/ahliterature192097
Source
Clin Invest Med. 2001 Dec;24(6):304-10
Publication Type
Article
Date
Dec-2001
Author
M. Loeb
A E Simor
L. Landry
A. McGeer
Author Affiliation
Division of Medical Microbiology and Infectious Diseases, McMaster University and the Hamilton Regional Laboratory Program, Ont. loebm@mcmaster.ca
Source
Clin Invest Med. 2001 Dec;24(6):304-10
Date
Dec-2001
Language
English
Publication Type
Article
Keywords
Aged
Anti-Bacterial Agents - therapeutic use
Chronic Disease
Cohort Studies
Female
Humans
Long-Term Care
Male
Ontario - epidemiology
Pneumonia - drug therapy - mortality - radiography
Practice Guidelines as Topic
Prospective Studies
Treatment Outcome
Abstract
To evaluate adherence to antibiotic recommendations for the treatment of pneumonia in patients who receive long-term care and to assess outcomes associated with these recommendations.
A prospective cohort study.
Twenty-two facilities that provide long-term care in southern Ontario.
Older adults treated with antibiotics for a presumptive diagnosis of pneumonia and those with radiologically confirmed pneumonia
Over a 12-month period, older patients who were treated with antibiotics for presumptive pneumonia were prospectively identified. A random sample of these antibiotic courses (646 courses in 638 patients) was reviewed using a standardized data collection form, and demographic and clinical data were collected. Antibiotic courses were classified according to Canadian and American Thoracic Society antibiotic recommendations for pneumonia. In patients with radiologically confirmed pneumonia, the effect of adherence to these recommendations on mortality and persistence of symptoms was assessed.
Only 27.6% (178 of 646) of antibiotic prescriptions evaluated met antibiotic recommendations for nursing-home-acquired pneumonia, and the proportion meeting these varied greatly by facility, ranging from 0% to 53% (median 31%). For patients with radiologically confirmed pneumonia, age (adjusted odds ratio [OR] 1.6, 95% confidence interval [CI] 1.0-2.4, per increase in 10 yr, p = 0.02), sex (adjusted OR 3.0, 95% CI 1.1-8.0, p = 0.03), and adherence to recommended antibiotics (OR 3.0, 95% CI 1.3-7.2, p = 0.01) were associated with death. Adherence to the recommended antibiotics was also associated with adverse reactions, which occurred in 10% of prescriptions meeting the recommendations (OR 2.4, 95% CI 1.3-4.6, p = 0.01).
Adherence to recommended guidelines for antibiotic treatment was low and highly variable among study facilities. Use of recommended antibiotic regimens was associated with increased adverse events and worse outcomes in patients with radiologically confirmed pneumonia.
Notes
Comment In: Clin Invest Med. 2002 Jun;25(3):63-4; author reply 6412137250
PubMed ID
11767234 View in PubMed
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Annualized incidence and spectrum of illness from an outbreak investigation of Bell's palsy.

https://arctichealth.org/en/permalink/ahliterature188646
Source
Neuroepidemiology. 2002 Sep-Oct;21(5):255-61
Publication Type
Article
Author
A M Morris
S L Deeks
M D Hill
G. Midroni
W C Goldstein
T. Mazzulli
R. Davidson
S G Squires
T. Marrie
A. McGeer
D E Low
Author Affiliation
Mount Sinai Hospital, Department of Microbiology, University of Toronto, Toronto, Ont., Canada.
Source
Neuroepidemiology. 2002 Sep-Oct;21(5):255-61
Language
English
Publication Type
Article
Keywords
Bell Palsy - epidemiology - etiology - microbiology
Diagnostic Errors
Health Surveys
Humans
Incidence
Infection - complications
Nova Scotia - epidemiology
Ontario - epidemiology
Risk factors
Abstract
There are limited clinical and epidemiological data on patients diagnosed with Bell's palsy. While investigating an apparent clustering of Bell's palsy, we sought to characterize the spectrum of illness in patients with this diagnosis.
A telephone survey of persons with idiopathic facial (Bell's) palsy in the Greater Toronto Area (GTA, population = 4.99 million) and Nova Scotia (population = 0.93 million) from August 1 to November 15, 1997 collected information on subject demographics, neurological symptoms, constitutional symptoms, medical investigation and management. Information regarding potential risks for exposure to infectious agents, past medical history, and family history of Bell's palsy was also collected. Subjects with other secondary causes of facial palsy were excluded.
In the GTA and Nova Scotia, 222 and 36 patients were diagnosed with idiopathic facial (Bell's) palsy, respectively. The crude annualized incidence of Bell's palsy was 15.2 and 13.1 per 100,000 population in the GTA and Nova Scotia, respectively. There was no temporal or geographical clustering, and symptomatology did not differ significantly between the two samples. The mean age was 45 years, with 55% of subjects being female. The most common symptoms accompanying Bell's palsy were increased tearing (63%), pain in or around the ear (63%), and taste abnormalities (52%). A significant number of patients reported neurological symptoms not attributable to the facial nerve.
No clustering of cases of Bell's palsy was observed to support an infectious etiology for the condition. Misdiagnosis of the etiology of facial weakness is common. Patients diagnosed with Bell's palsy have a variety of neurological symptoms, many of which cannot be attributed to a facial nerve disorder.
PubMed ID
12207155 View in PubMed
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Antibiotic use in Ontario facilities that provide chronic care.

https://arctichealth.org/en/permalink/ahliterature194246
Source
J Gen Intern Med. 2001 Jun;16(6):376-83
Publication Type
Article
Date
Jun-2001
Author
M. Loeb
A E Simor
L. Landry
S. Walter
M. McArthur
J. Duffy
D. Kwan
A. McGeer
Author Affiliation
Division of Microbiology, Department of Pathology, McMaster University, Hamilton, Ontario, Canada. loebm@mcmaster.ca
Source
J Gen Intern Med. 2001 Jun;16(6):376-83
Date
Jun-2001
Language
English
Publication Type
Article
Keywords
Aged
Anti-Bacterial Agents - therapeutic use
Chronic Disease - drug therapy - epidemiology
Cohort Studies
Humans
Infection - drug therapy - epidemiology
Ontario - epidemiology
Prospective Studies
Abstract
To determine the incidence and variability of antibiotic use in facilities which provide chronic care and to determine how often clinical criteria for infection are met when antibiotics are prescribed in these facilities.
A prospective, 12-month, observational cohort study.
Twenty-two facilities which provide chronic care in southwestern Ontario.
Patients who were treated with systemic antibiotics over the study period.
Characteristics of antibiotic prescriptions (name, dose, duration, and indication) and clinical features of randomly selected patients who were treated with antibiotics.
A total of 9,373 courses of antibiotics were prescribed for 2,408 patients (66% of all patients in study facilities). The incidence of antibiotic prescriptions in the facilities ranged from 2.9 to 13.9 antibiotic courses per 1,000 patient-days. Thirty-six percent of antibiotics were prescribed for respiratory tract infections, 33% for urinary infections, and 13% for skin and soft tissue infections. Standardized surveillance definitions of infection were met in 49% of the 1,602 randomly selected patients who were prescribed antibiotics. Diagnostic criteria for respiratory, urinary, and skin infection were met in 58%, 28%, and 65% of prescriptions, respectively. One third of antibiotic prescriptions for a urinary indication were for asymptomatic bacteriuria. Adverse reactions were noted in 6% of prescriptions for respiratory and urinary infections and 4% of prescriptions for skin infection.
Antibiotic use is frequent and highly variable amongst patients who receive chronic care. Reducing antibiotic prescriptions for asymptomatic bacteriuria represents an important way to optimize antibiotic use in this population.
Notes
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PubMed ID
11422634 View in PubMed
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Antibodies to capsular polysaccharides of group B Streptococcus in pregnant Canadian women: relationship to colonization status and infection in the neonate.

https://arctichealth.org/en/permalink/ahliterature194114
Source
J Infect Dis. 2001 Aug 1;184(3):285-91
Publication Type
Article
Date
Aug-1-2001
Author
H D Davies
C. Adair
A. McGeer
D. Ma
S. Robertson
M. Mucenski
L. Kowalsky
G. Tyrell
C J Baker
Author Affiliation
Departments of Microbiology and Infectious Disease, Pediatrics, and Community Health Sciences and Child Health Research Unit, Alberta Children's Hospital, University of Calgary, Calgary,T2T-5C7, Canada. dele.davies@crha-health.ab.ca
Source
J Infect Dis. 2001 Aug 1;184(3):285-91
Date
Aug-1-2001
Language
English
Publication Type
Article
Keywords
Adult
Alberta
Antibodies, Bacterial - blood
Canada
Cohort Studies
Female
Humans
Immunoglobulin G - blood
Infant, Newborn
Infectious Disease Transmission, Vertical
Parity
Polysaccharides, Bacterial - immunology
Population Surveillance
Pregnancy
Pregnancy Complications, Infectious - microbiology
Rectum - microbiology
Serotyping
Streptococcal Infections - blood - immunology - transmission
Streptococcus agalactiae - immunology - isolation & purification
Vagina - microbiology
Abstract
In a cohort study of 1207 pregnant women in Alberta, Canada, the serotype distributions of vaginal-rectal group B Streptococcus (GBS) isolates were compared with all isolates from neonates with invasive GBS disease identified by population-based surveillance. Serum concentrations of Ia, Ib, II, III, and V capsular polysaccharide (CPS)-specific IgG also were determined, according to serotype of the vaginal-rectal colonizing GBS strain. GBS colonization was detected in 19.5% (235 of 1207) of women. Serotype III accounted for 20.6% (48 of 233) of colonizing strains available for typing but for 37% (27 of 73) of invasive isolates from neonates (P
PubMed ID
11443553 View in PubMed
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Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae in Canada during 2000.

https://arctichealth.org/en/permalink/ahliterature190557
Source
Antimicrob Agents Chemother. 2002 May;46(5):1295-301
Publication Type
Article
Date
May-2002
Author
Donald E Low
Joyce de Azavedo
Karl Weiss
Tony Mazzulli
Magdalena Kuhn
Deirdre Church
Kevin Forward
George Zhanel
Andrew Simor
A. McGeer
Author Affiliation
Department of Microbiology, Toronto Medical Laboratories and Mount Sinai Hospital, Toronto, Ontario, Canada. dlow@mtsinai.on.ca
Source
Antimicrob Agents Chemother. 2002 May;46(5):1295-301
Date
May-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Anti-Bacterial Agents - pharmacology
Canada - epidemiology
Child
Child, Preschool
Drug Resistance, Bacterial
Humans
Infant
Infant, Newborn
Microbial Sensitivity Tests
Middle Aged
Pneumococcal infections - epidemiology - microbiology
Population Surveillance
Streptococcus pneumoniae - drug effects - isolation & purification
Abstract
A total of 2,245 clinical isolates of Streptococcus pneumoniae were collected from 63 microbiology laboratories from across Canada during 2000 and characterized at a central laboratory. Of these isolates, 12.4% were not susceptible to penicillin (penicillin MIC, >or=0.12 microg/ml) and 5.8% were resistant (MIC, >or=2 microg/ml). Resistance rates among non-beta-lactam agents were the following: macrolides, 11.1%; clindamycin, 5.7%; chloramphenicol, 2.2%; levofloxacin, 0.9%; gatifloxacin, 0.8%; moxifloxacin, 0.4%; and trimethoprim-sulfamethoxazole, 11.3%. The MICs at which 90% of the isolates were inhibited (MIC90s) of the fluoroquinolones were the following: gemifloxacin, 0.03 microg/ml; BMS-284756, 0.06 microg/ml; moxifloxacin, 0.12 microg/ml; gatifloxacin, 0.25 microg/ml; levofloxacin, 1 microg/ml; and ciprofloxacin, 1 microg/ml. Of 578 isolates from the lower respiratory tract, 21 (3.6%) were inhibited at ciprofloxacin MICs of >or=4 microg/ml. None of the 768 isolates from children were inhibited at ciprofloxacin MICs of >or=4 microg/ml, compared to 3 of 731 (0.6%) from those ages 15 to 64 (all of these >60 years old), and 27 of 707 (3.8%) from those over 65. The MIC90s for ABT-773 and telithromycin were 0.015 microg/ml for macrolide-susceptible isolates and 0.12 and 0.5 microg/ml, respectively, for macrolide-resistant isolates. The MIC of linezolid was
Notes
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PubMed ID
11959559 View in PubMed
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A blinded comparison of three laboratory protocols for the identification of patients colonized with methicillin-resistant Staphylococcus aureus.

https://arctichealth.org/en/permalink/ahliterature194989
Source
Infect Control Hosp Epidemiol. 2001 Mar;22(3):152-6
Publication Type
Article
Date
Mar-2001
Author
M. Gardam
J. Brunton
B. Willey
A. McGeer
D. Low
J. Conly
Author Affiliation
Department of Microbiology, University Health Network, University of Toronto, Ontario, Canada.
Source
Infect Control Hosp Epidemiol. 2001 Mar;22(3):152-6
Date
Mar-2001
Language
English
Publication Type
Article
Keywords
Clinical Laboratory Techniques - standards
Costs and Cost Analysis
Humans
Laboratories - economics
Methicillin Resistance
Microbiology
Ontario
Reproducibility of Results
Staphylococcus aureus - drug effects - isolation & purification
Abstract
To compare three laboratory screening protocols for the detection of methicillin-resistant Staphylococcus aureus (MRSA) from surveillance specimens (mannitol-salt agar containing 2 microg/mL of oxacillin [MSA-2], mannitol-salt agar containing 4 microg/mL of oxacillin [MSA-4], and a broth-containing protocol as recommended by the American Society for Microbiology [M-ASM]).
Blinded comparative laboratory study and cost analysis.
University-affiliated microbiology laboratory.
Outcome measurements included rate of detection of MRSA-positive specimens and patients, turnaround time, and media and technologist costs. All MRSA culture swabs obtained from any patient site from November 1998 to April 1999 were included.
The M-ASM protocol detected between 19.1% and 32.0% more MRSA-positive specimens and between 13.3% and 23.3% more MRSA-positive patients per surveillance event than the MSA-4 and MSA-2 protocols, respectively. There was no difference in positive-culture reporting time between the M-ASM and MSA4 protocols. The broth-containing protocol was 2- to 2.5-fold more expensive than the simpler protocols, taking into account media and laboratory personnel costs.
It remains to be determined whether it is cost beneficial for a hospital to adopt the M-ASM, as the potential cost of MRSA transmission from unidentified MRSA-colonized patients is unknown. A broth-containing protocol should be considered the gold standard in future studies examining newer MRSA screening protocols
PubMed ID
11310693 View in PubMed
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Broth microdilution testing of Haemophilus influenzae with haemophilus test medium versus lysed horse blood broth. Canadian Haemophilus Study Group.

https://arctichealth.org/en/permalink/ahliterature223213
Source
J Clin Microbiol. 1992 Sep;30(9):2284-9
Publication Type
Article
Date
Sep-1992
Author
S R Scriver
D E Low
A E Simor
B. Toye
A. McGeer
R. Jaeger
Author Affiliation
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Source
J Clin Microbiol. 1992 Sep;30(9):2284-9
Date
Sep-1992
Language
English
Publication Type
Article
Keywords
Amoxicillin - chemistry
Bacteriological Techniques
Blood
Canada - epidemiology
Clavulanic Acids - chemistry
Culture Media - metabolism - standards
Drug Stability
Evaluation Studies as Topic
Haemophilus Infections - diagnosis
Haemophilus influenzae - enzymology - growth & development - isolation & purification
Humans
Microbial Sensitivity Tests - methods
Observer Variation
Reproducibility of Results
beta-Lactamases - analysis
Abstract
Broth microdilution testing of 702 community-acquired isolates of Haemophilus influenzae from across Canada was performed with both Mueller-Hinton broth supplemented with 3% lysed horse blood broth (LHB) (BBL Microbiology Systems, Cockeysville, Md.) and haemophilus test medium (HTM). The prevalence of beta-lactamase production was found to be 26% with no regional variation. MICs determined with LHB tended to be higher than those with HTM, but interpretive errors due to these differences were observed only rarely with trimethoprim-sulfamethoxazole (n = 5), cefaclor (n = 8), and cefamandole (n = 3). The interobserver variability in MIC determinations was found to be greater when LHB was used than when HTM was used. There was no difference in intraobserver variability between the two medium formulations. beta-Lactamase-positive isolates developed false resistance to amoxicillin-clavulanate 2 weeks after microdilution panels of both types of medium were stored at -20 degrees C but not when panels were stored at -70 degrees C. In conclusion, this study supports the use of HTM rather than LHB for sensitivity testing of H. influenzae because of its lower rate of interobserver variability and its ability to support the growth of these organisms, which is comparable to that of LHB.
Notes
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PubMed ID
1400992 View in PubMed
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Calicivirus gastroenteritis in a geriatric long-term care facility--Ontario.

https://arctichealth.org/en/permalink/ahliterature227985
Source
Can Dis Wkly Rep. 1990 Nov 24;16(47):239-40, 243
Publication Type
Article
Date
Nov-24-1990

Caring for severe acute respiratory syndrome (SARS) patients in acute care institutions in the greater Toronto area.

https://arctichealth.org/en/permalink/ahliterature151470
Source
Can Commun Dis Rep. 2008 Dec;34(12):1-17
Publication Type
Article
Date
Dec-2008

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