Hospitals strategies

Janssen RS, St Louis ME, Satten GA, et al. (1992) HIV infection among patients in US acute care hospitals. Strategies for the counseling and testing of hospital patients. N Engl J Med 327 445-452... 

At the time of hospital admission, all patients should be evaluated for their risk of VTE, and strategies to prevent VTE... 

The goal of an effective VTE prophylaxis program is to identify all patients at risk, determine each patient s level of risk, and select and implement regimens that provide sufficient protection for the level of risk. OAt the time of hospital admission, all patients should be evaluated for their risk of VTE, and strategies to prevent VTE appropriate for each patient s level of risk should be routinely employed. Prophylaxis should be continued throughout the period of risk. The risk classification criteria and recommended prophylaxis strategies published... 

Rapid sub-typing of bacteria is needed for protection of public health and in civil-, criminal-, or terror-related forensics. Distinction of microbiological sub-types can signal important differences that affect the health risk from microbial infection and treatment strategies for disease. It can also be used to monitor the emergence of mutant strains.1 In cases of nosocomial (hospital-incurred) infections and outbreaks, sub-typing capability could be used as an alternative for identifying the route by which infection spreads. Many studies... 

Hospital Effluent Management Strategies and PhC Removal Efficiencies of Various... 

From a treatment perspective, despite their specific contents, hospital waste-waters (HWWs) are quite often considered to be of comparable pollutant nature to UWWs and, as such, are discharged directly into public sewers and co-treated with UWWs at the nearest WWTP. Unsurprisingly, this management strategy is currently the subject of lively debate in the scientific community [12-14], which has recently begun to evaluate the hospital contribution to UWWs in terms of micropollutant load at a local level. 

First and foremost, proper management of hospital effluent should take into consideration the characteristics of both the hospital structure and its catchment area. In case of a new healthcare structure, the main aspects to consider when devising its wastewater management strategy are ... 

Verlicchi P, Galletti A, Al Aukidy M (2011) Hospital wastewaters quali-quantitative characterization and strategies for their treatment and disposal. In Sharma SK, Sanghi R (eds) Water treatment and pollution prevention advances in research. Springer (in press)... 

Since survival rates for out-of-hospital cardiac arrest are quite low, ranging from 2 to 25% in the United States [32], secondary prevention strategies only address a small minority of ischemic cardiomyopathy patients at risk for SCD. A more substantial reduction in SCD will result from primary prevention of SCD with ICD implantation. Evidence for this strategy comes from several recent trials. The findings of primary prevention trials for SCD in ischemic cardiomyopathy are summarized in Table 3.1. 

PTCA offered a different strategy to obtain vessel patency. Success rates were greater than 90% with low rates of bleeding and mortality [41, 42]. This was seen with both low in-hospital and 6 month mortality and reinfarction rate compared to thrombolysis (5.1% versus 12% p = 0.02 and 8.5% versus 16.8% p = 0.02, respectively) [43]. While there was no immediate benefit on ejection fraction, a similar study comparing PTCA with streptokinase showed a significant improvement in LVEF at the time of discharge with early PTCA (51 11 versus 45 12 = 0.004) [44]. 

One drawback to this method is that physicians in the trial may treat all patients similarly, whether they are in the protocol-driven arm or the usual care arm of the smdy. This contamination can be partially overcome by randomizing physicians to the protocol or usual care arms, and can be overcome more completely by randomizing the sites of care (e.g., different hospitals for different arms of the study). However, these options require large numbers of physicians and/or sites of care and, thus, are costly to implement. Moreover, such a strategy may result in nonrandom assignment of patients to treatment arms. 

While some prospective data collection is required for almost all pharmacoeconomic studies, the amount of data to be collected for the pharmacoeconomic evaluation is still the subject of much debate. There is no definitive means of addressing this issue at present. Phase II studies can be used to develop data that will help determine which resource consumption items are essential for the economic evaluation. Without this opportunity for prior data collection, however, we must rely upon expert opinion to suggest major resource consumption items that should be monitored within the study. Duplicate data collection strategies (prospective evaluation of resource consumption within the study s case report form with retrospective assessment of resource consumption from hospital bills) can be used to ensure that data collection strategies do not miss critical data elements. 

Goldberg RJ, Spencer FA, Okolo J, Lessard D, Yarzebski J, Gore JM. Long-term trends (1986-2003) in the use of coronary reperfusion strategies in patients hospitalized with acute myocardial infarction in Central Massachusetts. Int J Cardiol 2008 [Epub ahead of print]. 

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