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Despite increasing use, limited data has been published comparing safety of different outpatient parenteral antimicrobial therapy (OPAT) models. Potential risks of self-administration at home include venous access device infection and other line complications. This study aims to investigate rates and predictors of intravenous access device complications in a large OPAT cohort. This is a retrospective cohort study of all uses of midlines, peripherally inserted central catheters (PICCs) and tunnelled central venous catheters (TCVCs) with univariate and multivariate (logistic regression) analysis of factors associated with line infections (LIs) and with other line events (OLEs). On univariate analysis, line infections were associated with length of line use, female sex and TCVC lines (compared to midlines). Patients self-administering OPAT in the home had a non-significantly lower rate of LIs. On multivariate analysis only duration of line use was a significant predictor of LIs-OR 1.012 (95%CI 1.001-1.023). For OLEs, multivariate analysis suggested that only line type and use of flucloxacillin were significant explanatory variables. In this cohort, there is no evidence that self-administration of OPAT is associated with higher rates of venous access device complications after controlling for confounding variables. [ABSTRACT FROM AUTHOR]

Abstract: Use of outpatient parenteral antimicrobial therapy (OPAT) is increasing in settings with advanced healthcare systems internationally. This study describes a large OPAT service cohort developed in the west of Scotland and includes trends over a 10-year period of this service. Data were retrieved from a prospectively maintained electronic case database. Patient and logistic variables were collated for all OPAT episodes (n =2638, resulting in 39035 days of patient care over 10 years). Skin and soft-tissue infections and bone and joint infections accounted for 77% of OPAT cases, but a wide range of other conditions have been treated in this cohort. Outcome variables were evaluated for all first OPAT attendances (n =2233), amongst which a successful outcome (cure or improvement) was found for 2063 (92.4%). Unplanned admission was observed in 9.1% of patients (6.3 events per 1000 OPAT patient days). Healthcare-associated infection rates were low: amongst first OPAT attendances, 14 intravenous line infections were observed (0.4 per 1000 OPAT patient days). Statistically significant trends over time included: a decrease in OPAT treatment time; increased referrals from non-local and secondary care sources; increased rate of co-morbidity of OPAT referrals; and increased self/carer administration of antimicrobials. Outcome proportions (success and adverse events) did not vary over time. This cohort study adds to the increasing observational data suggesting that OPAT is safe, effective and acceptable for treating a wide variety of infections. Observed trends over a 10-year period suggest that this model of infection management is adaptable and sustainable. [Copyright &y& Elsevier]

This case study reflects on the care of a diabetic patient with an extensive pressure ulcer on the heel. It addresses the issue of the limitations of scope of practice and expertise of the tissue viability nurse with regard to effective treatment of the diabetic foot. Methods of autolytic, sharp and surgical debridement are all attempted with varying degrees of success, together with one application of larval therapy. The importance of collaboration with members of the multidisciplinary team is addressed. Unfortunately, the final patient outcome is not yet known but this has provided a valuable reflective learning experience for myself as a tissue viability nurse. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about risk of sexual disorders in women, published in February 2001 issue of the journal "Sexually Transmitted Infections."

Discusses several options for the beneficial reuse of biosolids in Victoria. Key issues of interest; Analysis of pertinent topics and relevant issues; Implications on sludge management for the 21st century.

The fictive temperature of vitreous silica containing approximately 900 wt ppm of hydroxyl groups was monitored with small angle x-ray scattering. The measurements were carried out during annealing and while scanning the temperature, with annealing temperatures ranging between 930 and 1330 K. Fitting the data to the Adam-Gibbs-Fulcher equation by using the Tool-Narayanaswamy method yields a particularly simple thermorheological behavior for type-III vitreous silica. Unlike the general case for glass kinetics, including vitreous silica with low hydroxyl content, the relaxation time constant is nearly decoupled from the fictive temperature. This high degree of decoupling of the state of the glass and the relaxation rate agrees with the results of viscosity measurements. By improving the data analysis procedure, we have significantly increased the precision of the results, and it was possible to resolve changes of the activation energy of the relaxation processes to within 0.5%. This has made sample aging effects that had previously been undetectable visible. [ABSTRACT FROM AUTHOR]