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    <recommendedItem id="20100101_19_3274"
                     title="New Guidelines Out for Pneumococcal Vaccine (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/InfectiousDisease/Vaccines/tb/22034?impressionId=1284020681833"
                     
      &lt;p&gt;Adults with asthma and those who smoke should receive the 23-valent polysaccharide vaccine to prevent pneumococcal disease, according to new recommendations from the CDC.&lt;/p&gt;
&lt;p&gt;But the agency&apos;s Advisory Committee on Immunization Practices (ACIP) is no longer recommending routine use of the vaccine for all Alaska Natives and American Indians younger than 65 unless they have medical or behavioral reasons  --  such as alcohol and tobacco use  --  that put them at increased risk, or if they live in areas where the rates of invasive disease are high.&lt;/p&gt;
&lt;p&gt;The new recommendations were published in the Sept. 3 issue of &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Herd effects have reduced the overall incidence of pneumococcal infections since the introduction of the 7-valent vaccine in 2000, but invasive disease  --  bacteremia, meningitis, or infection at other normally sterile sites  --  remains a threat, with 43,500 cases and 5,000 deaths occurring in 2009, according to the CDC.&lt;/p&gt;
&lt;p&gt;Between 1998 and 2007, the incidence of invasive disease among adults younger than 65 with high-risk conditions increased from 52% to 59%, and from 69% to 81% in those 65 and older.&lt;/p&gt;
&lt;p&gt;&quot;This trend suggests that adults with high-risk conditions might not have benefited as much from the indirect protective effects of childhood [7-valent pneumococcal conjugate vaccine] immunization as persons who are relatively healthy,&quot; the CDC report stated.&lt;/p&gt;
&lt;p&gt;As support for the asthma recommendation, CDC cited a case-control study in Tennessee that found an adjusted odds ratio of 2.4 (95% CI 1.8 to 3.3) for invasive pneumococcal disease in patients with asthma compared with those without the disease.&lt;/p&gt;
&lt;p&gt;And for smoking, CDC data from 2001 to 2003 suggested that more than half of patients ages 18 to 64 with invasive disease were current cigarette smokers.&lt;/p&gt;
&lt;p&gt;In addition, a case-control study identified a fourfold increased risk for smokers (adjusted OR 4.1, 95% CI 2.4 to 7.3), with risk correlating with number of cigarettes smoked and pack-years of smoking.&lt;/p&gt;
&lt;p&gt;Along with the vaccine, smokers should be given smoking cessation guidance, because the risk for invasive disease decreases by almost 15% each year after quitting.&lt;/p&gt;
&lt;p&gt;Estimated efficacy of the 23-valent vaccine, according to observational studies, ranges from 50% to 80% among immuncompetent adults, but efficacy is less clear, ranging from 10% to 74%, among the immunocompromised and the elderly.&lt;/p&gt;
&lt;p&gt;The report also states that everyone should receive the pneumococcal vaccine at age 65.&lt;/p&gt;
&lt;p&gt;Anyone who received a dose of the vaccine before 65 can be given a second dose if five years have passed since the first dose, and immunocompromised or asplenic patients ages 19 to 64 should be given a second dose five years after the first.&lt;/p&gt;
&lt;p&gt;Multiple revaccinations are not recommended because of uncertainty about benefits and risks.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors are employees of the CDC.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3230"
                     title="Hospital-Acquired Infections Trend Downward"
                     score="0.011"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/tb/21985?impressionId=1284020681833"
                     
      &lt;p&gt;Although healthcare-associated infections (HAIs) remain a large and at least partly avoidable problem in hospitals, it appears to be less of one than it was a few years ago, according to the Agency for Healthcare Research and Quality.&lt;/p&gt;
&lt;p&gt;After peaking in 2004 and 2005 at 2.30 per 1,000 hospital stays, HAI rates among adults declined to 2.03 per 1,000 stays in 2007, according to the most recent data from the Healthcare Cost and Utilization Project, summarized in an AHRQ statistical brief.&lt;/p&gt;
&lt;p&gt;The 2007 figure was identical to the rate seen in 2000 when the project first began collecting data, according to AHRQ researchers led by Claudia Steiner, MD, MPH.&lt;/p&gt;
&lt;p&gt;HAIs were recorded in just 0.2% of hospital stays in 2007.&lt;/p&gt;
&lt;p&gt;All patient subgroups, stratified by age, geographic region, and type of payer, shared in the decline, the researchers also found.&lt;/p&gt;
&lt;p&gt;The findings were seemingly at odds with &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/19568&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/19568&quot; target=&quot;_blank&quot;&gt;another AHRQ report&lt;/a&gt; issued earlier in the year. The agency&apos;s 2009 National Healthcare Quality Report, released in April, struck a pessimistic note by highlighting increases in the 2007 data for certain types of infections  --  postoperative sepsis and urinary tract infections  --  from 2006.&lt;/p&gt;
&lt;p&gt;But the new report indicates that, overall, 2007 was better than the previous year for HAIs, with the rate per 1,000 hospital stays down from 2.19 in 2006.&lt;/p&gt;
&lt;p&gt;No explanation for the downward trend was offered by Steiner and colleagues, but other investigators who have identified declining hospital infection rates have suggested that improved adherence to treatment guidelines and better management of risk factors for HAIs are responsible.&lt;/p&gt;
&lt;p&gt;The new report identified several hospital characteristics that were significantly (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) associated with increased rates of HAIs: &lt;ul&gt; &lt;li&gt;Hospital size of 500 beds or more&lt;/li&gt; &lt;li&gt;Location in metropolitan area&lt;/li&gt; &lt;li&gt;Teaching hospital&lt;/li&gt; &lt;li&gt;Private for-profit status&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The report also indicated that stays marked by HAIs were distributed almost equally between male and female patients, in contrast with the nearly 2:1 ratio of women to men among hospital patients overall.&lt;/p&gt;
&lt;p&gt;The Healthcare Cost and Utilization Project collects data on all inpatients treated at a rotating nationwide sample of about 1,000 short-term, non-federal hospitals.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3233"
                     title="Tie Healthcare Jobs to Flu Vaccination, Groups Say (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/tb/21987?impressionId=1284020681833"
                     
      Healthcare workers should receive annual influenza vaccinations as a condition of employment and professional privileges, according to an updated position paper endorsed by two major infectious disease organizations.&lt;br&gt;
&lt;br&gt;Healthcare personnel have a professional and ethical responsibility to help prevent the spread of infectious pathogens among patients and themselves, a writing group for the Society of Healthcare Epidemiology of America (SHEA) concluded in a position paper published online in &lt;em&gt;Infection Control and Hospital Epidemiology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;SHEA views influenza vaccination of healthcare personnel as a core patient and healthcare personnel safety practice with which noncompliance should not be tolerated,&quot; Thomas R. Talbot, MD, of Vanderbilt University in Nashville, Tenn., and co-authors wrote.&lt;br&gt;
&lt;br&gt;The recommendation has the endorsement of the Infectious Diseases Society of America (IDSA).&lt;p&gt;&lt;/p&gt;
&lt;p&gt;The update affirms and strengthens SHEA&apos;s support for vaccination against influence among healthcare personnel, originally set forth in a 2005 position paper, also endorsed by IDSA (&lt;em&gt;Infect Control Hosp Epidemiol&lt;/em&gt; 2005; 26: 882-890).&lt;/p&gt;
&lt;p&gt;&quot;Healthcare providers are ethically obligated to take measures proven to keep patients from acquiring influenza in healthcare settings,&quot; SHEA president Neil Fishman, MD, of the University of Pennsylvania in Philadelphia, said in a statement.&lt;/p&gt;
&lt;p&gt;&quot;Mandatory vaccination is the cornerstone to a comprehensive program designed to prevent the spread of influenza which also included identification and isolation of infected patients, adherence to hand hygiene and cough etiquette, the appropriate use of protective equipment, and restriction of ill healthcare personnel and visitors in the facility.&lt;/p&gt;
&lt;p&gt;Aside from making vaccination a condition of employment and privileges, the position paper incorporates new evidence that has come to light since publication of the 2005 document that strengthens SHEA&apos;s position on the issue, Talbot and coauthors noted.&lt;/p&gt;
&lt;p&gt;The 2005 document addressed vaccine allocation during shortages at the time, and SHEA&apos;s position on the topic has not changed, the authors wrote in an executive summary.&lt;/p&gt;
&lt;p&gt;SHEA&apos;s support for mandatory vaccination of healthcare personnel reflects &quot;continued frustration surrounding low and unimproved ... vaccination rates.&quot; A 2009 study by the Rand Corp. showed that almost 40% of healthcare workers had no plans to get vaccinated against influenza despite growing concern about the health threat posed by H1N1 virus.&lt;/p&gt;
&lt;p&gt;Studies based on statistical models have shown that a 100% vaccination rate among healthcare personnel in acute-care facilities would reduce the risk of influenza among hospitalized patients by 43%.&lt;/p&gt;
&lt;p&gt;Moreover, vaccination of all personnel in nursing homes would reduce influenza incidence among patients in those facilities by 60%, Talbot and coauthors noted. Other studies have shown that vaccination of healthcare personnel against influenza also reduces patient mortality, they added.&lt;/p&gt;
&lt;p&gt;Multiple healthcare facilities have already adopted mandatory vaccination policies; the first such policy was implemented in 2004 at Virginia Mason Medical Center in Seattle.&lt;/p&gt;
&lt;p&gt;After BJC Healthcare in St. Louis implemented a mandatory vaccination policy in 2008 to 2009, the vaccination rate among their healthcare personnel increased from 71% to 98.4%. Noting that eight employees were terminated for failure to get vaccinated, authors of the SHEA position paper cited the terminations as an indication of institutional commitment to its vaccination policy.&lt;/p&gt;
&lt;p&gt;In 2009, New York became the first state to require influenza vaccination for healthcare personnel.&lt;/p&gt;
&lt;p&gt;Influenza vaccination as a condition of employment should be a component of comprehensive immunization programs in healthcare settings. Other strategies recommended by SHEA include: &lt;ul&gt; &lt;li&gt;Using vaccination rates as a quality measure&lt;/li&gt; &lt;li&gt;Requiring unvaccinated personnel to wear a mask during influenza season&lt;/li&gt; &lt;li&gt;Requiring signed declination statements for personnel that refuse vaccination&lt;/li&gt; &lt;li&gt;Allowing exemptions from vaccination only in cases of medical contraindications&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Talbot disclosed relationships with Joint Commission Resources, GlaxoSmithKline, and Sanofi Pasteur, and spousal relationships with Wyeth, Vaxxinate, and Sanofi Pasteur.&lt;/p&gt;&lt;p&gt;Several coauthors of the writing committee disclosed relationships with mutiple commercial interests.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3195"
                     title="ESC: Hot Line Actually Only Lukewarm"
                     score="0.008"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21936?impressionId=1284020681833"
                     
      &lt;p&gt;STOCKHOLM  --  Intracoronary bone marrow cell transplantation extended survival in patients with chronic heart failure due to ischemic cardiomyopathy  --  that was the good news. The bad news was that the finding was not &quot;new&quot; at all  --  it had already been published.&lt;/p&gt;
&lt;p&gt;Late today the European Society of Cardiology said it would sanction the researcher who reported the stem cell study by barring him from presenting research at ESC congresses for two years.&lt;/p&gt;
&lt;p&gt;The ESC guidelines for Hot Line trials specifically state that the information submitted should be new, unpublished data. Yet, the STAR trial was accepted for presentation as a Hot Line trial at the ESC annual meeting here.&lt;/p&gt;
&lt;p&gt;When asked by &lt;em&gt;MedPage Today&lt;/em&gt; to point out the &quot;news&quot; in the Hot Line presentation, STAR lead investigator Bodo-Eckehard Strauer, MD, of the Heinrich Heine University of D&amp;#252;sseldorf, Germany, said the news was that bone marrow cell therapy significantly improved survival in patients with chronic cardiomyopathy, which he illustrated with a slide showing a Kaplan-Meier curve  --  the same graph that was published in the July issue of the &lt;em&gt;European Journal of Heart Failure.&lt;/em&gt; Moreover, every data slide in Strauer&apos;s presentation matched the tables in the published paper.&lt;/p&gt;
&lt;p&gt;Late today, the ESC acknowledged the breach of congress rules in a statement saying that it &quot;acknowledges that significant information pertaining to the results of the STAR Heart Study, presented today at ESC Congress 2010 as novel had already been published prior to [the] ESC Congress.&quot;&lt;/p&gt;
&lt;p&gt;The presentation therefore, &quot;clearly breaks ESC rules for Hot Line Sessions, which state that information must be first presented at ESC Congresses in order to qualify for presentation in a Hot Line session.&quot;&lt;/p&gt;
&lt;p&gt;The ESC said it was not informed of the publication before the meeting. As a result of the violation, the ESC said it would &quot;not accept abstracts from this investigator for a period of two years.&quot;&lt;/p&gt;
&lt;p&gt;According to information in the journal, Strauer and colleagues submitted their paper in February, revised it in April, and the journal accepted it in late April.&lt;/p&gt;
&lt;p&gt;It should be noted that the &lt;em&gt;European Journal of Heart Failure &lt;/em&gt;is a journal of the ESC.&lt;/p&gt;
&lt;p&gt;Immediately after the press briefing &lt;em&gt;MedPage Today&lt;/em&gt; asked Fausto Pinto, MD, PhD, the ESC program chair, and ESC President Roberto Ferrari, MD, why they had accepted the STAR paper as a Hot Line presentation. They said &quot;we thought there were new data.&quot;&lt;/p&gt;
&lt;p&gt;Ferrari then added, &quot;We were snookered.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3182"
                     title="Rapid Response System Cuts Cardiac Arrest Rate (CME/CE)"
                     score="0.007"
                     href="http://www.medpagetoday.com/CriticalCare/GeneralCriticalCare/tb/21913?impressionId=1284020681833"
                     
      &lt;p&gt;Implementation of a rapid response system in a large Veterans Affairs hospital resulted in a significant reduction in the number of cardiac arrests, a study found.&lt;/p&gt;
&lt;p&gt;Compared with rates in the nine months before the introduction of the emergency response system, dubbed &quot;the eTeam,&quot; the rate of cardiac arrests fell from a mean of 10.1 per 1,000 discharges to 4.36 per 1,000 (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01), according to Geoffrey K. Lighthall, MD, PhD, of Stanford University in California, and colleagues.&lt;/p&gt;
&lt;p&gt;This represented a decrease of 57%, the researchers reported in the September issue of &lt;em&gt;Anesthesia &amp;amp; Analgesia&lt;/em&gt;&lt;em&gt;&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Because the use of such rapid response systems has been questioned because of their need for extra personnel and resources, Lighthall and colleagues analyzed outcomes in the months before and after the introduction of the system in the VA Palo Alto medical center, which has about 13,000 annual admissions.&lt;/p&gt;
&lt;p&gt;The eTeam team included an intensive care fellow and attending physician, anesthesiologist, pharmacist, respiratory therapist, intensive care nurse, and a medical resident.&lt;/p&gt;
&lt;p&gt;Posters throughout the hospital listed numerous specific criteria that would warrant activation of the emergency team, such as respiratory distress, hypotension, inadequate urine output, delirium, and seizures.&lt;/p&gt;
&lt;p&gt;Between July 2005 and September 2007 the eTeam received 378 calls, one-third of them for respiratory insufficiency, followed by hypotension and deterioration in mental status.&lt;/p&gt;
&lt;p&gt;Patients were transferred to a higher level of care in 58% of cases, and the average time per call was 30 minutes.&lt;/p&gt;
&lt;p&gt;Call volume during the day was about twice of that occurring during the night.&lt;/p&gt;
&lt;p&gt;A total of 68% of patients received an oxygen mask, 67% had arterial blood gas testing done, fluids were administered to 60% of patients, and an electrocardiogram was done in 56%.&lt;/p&gt;
&lt;p&gt;In addition to the decrease in cardiac arrests, the number of respiratory arrests was &quot;strikingly lower&quot; after the intervention, falling from 17 in the previous year to one in the first year after the system was in place and to two in each of the following two years.&lt;/p&gt;
&lt;p&gt;After implementation of the rapid response emergency system, hospital-wide mortality fell by 17.3%, from 2.71 to 2.24 per 100 discharges (&lt;em&gt;P&lt;/em&gt;=0.0431).&lt;/p&gt;
&lt;p&gt;Full-code mortality, which also included patients with do-not-resuscitate orders, was reduced by 43%, from 0.68 to 0.39 per 100 discharges (&lt;em&gt;P&lt;/em&gt;=0.0031).&lt;/p&gt;
&lt;p&gt;But a time series analysis found only a slight decreasing trend in mortality, both pre- and post-intervention.&lt;/p&gt;
&lt;p&gt;Lighthall&apos;s team noted that, despite the decrease in cardiac arrests after the emergency system was in place, there was no change in the percentage of patients who already displayed at least one of the call criteria before an actual arrest occurred.&lt;/p&gt;
&lt;p&gt;This observation, along with the fact that two-thirds of calls resulted in the patient being transferred to the intensive care unit, suggested that the system was being underutilized.&lt;/p&gt;
&lt;p&gt;&quot;The reasons for what we perceive as underutilization are unclear but, from periodic review of cases, the reasons seem to include physician reluctance to accept help, refresher training of nursing and ancillary staff is too infrequent, and poor prior experiences with team members,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The day-night variation in calls to the eTeam also may reflect underutilization as well as inadequate patient oversight at night, particularly since acute cardiac, respiratory, and neurologic events are more frequent during the late night and early morning.&lt;/p&gt;
&lt;p&gt;&quot;Together, these findings indicate a role for improved vigilance, monitoring, and perhaps change of practice during the night hours,&quot; Lighthall and colleagues concluded.&lt;/p&gt;
&lt;p&gt;They noted that because some departments in the hospital had expressed concern that the presence of the emergency team might deprive trainees of important educational experiences, they designed a mentoring component in the system, with experienced clinicians providing bedside instruction on acute care diagnosis.&lt;/p&gt;
&lt;p&gt;A limitation of the study was the inability to include a comparable control group, because the investigators didn&apos;t have access to outcomes data from other VA hospitals, the authors said. The study was also limited to one VA facility.&lt;/p&gt;
&lt;p&gt;&quot;Our results suggest that further reductions in morbidity can be realized&quot; by use of rapid response systems throughout the VA network, Lighthall and colleagues wrote, and they called for larger cooperative studies to be done in the VA system to compare different system designs to see which may be associated with optimal outcomes.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>
