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Article-at-a-Glance Background A Nurse Practitioner (NP) Concurrent Intervention Model shown effective for controlling telemetry usage was extended to patients with community-acquired pneumonia (CAP) and patients with chronic obstructive pulmonary disease (COPD). Methods In spring 2000, investigators at Hackensack University Medical Center and the University of Medicine and Dentistry of New Jersey–New Jersey Medical School began an intervention to increase compliance with the Centers for Medicare & Medicaid Services (CMS) performance measures for CAP. Cost-reduction efforts were introduced by using previously described criteria for switching from intravenous to oral medication and for hospital discharge. Results Use of the NP intervention model for patients admitted with CAP and for COPD patients resulted in significant reductions in length of stay and cost savings. Discussion Concurrent intervention by a nurse practitioner can help achieve excellent compliance with performance measures for CAP and be applied to other chronic respiratory diseases such as COPD.

A previously healthy 70-year-old man presented with a rapidly progressive and fulminant infection due to Vibrio damsela after suffering a knife cut while filleting bluefish at the New Jersey Shore. Despite appropriate antibiotic therapy and localized wound exploration, the patient died. To our knowledge, this is the first reported case of V damsela sepsis with simultaneous isolation of the organism from both blood and wound. We are reporting this case to heighten physicians' awareness of this infection and the importance of early management with antibiotics and surgical consultation. (Arch Intern Med. 1993;153:1838-1840)

This report describes the first successful treatment of an adult on continuous ambulatory peritoneal dialysis with Aspergillus peritonitis. The published literature is also reviewed. Early removal of the peritoneal catheter combined with antifungal chemotherapy appear to be necessary for cure in patients with this disease.

Head injury in patients is frequently accompanied by respiratory disturbances, notably arterial hypoxemia and pulmonary edema (1). These findings are attributed to the increased intracranial pressure which often accompanies head injury. In animals, experimentally induced head injury or high intracranial pressure (ICP) causes a variety of circulatory and respiratory effects, such as systemic and pulmonary hemodynamic changes (2), arterial hypoxemia (3), increased CO diffusing capacity (4) and lung tissue changes (5).

This article reviewed the past experience and updated the present data on vancomycin. In recent years, with the release of more purified preparations of vancomycin and new clinical problems facing the clinician (that is, increasing prevalence of serious methicillin-resistant staphylococcal infections; use of hemodialysis and CAPD; widespread use of prosthetic devices; aggressive chemotherapy), the indication for vancomycin use has increased dramatically. More information is needed on the distribution of vancomycin in body tissues and the incidence and mechanisms of toxicity. Close surveillance of in vitro susceptibility patterns will be necessary as widespread use of vancomycin continues to increase.

• All patients receiving cefoxitin and cefamandole were prospectively reviewed for appropriate and inappropriate utilization. There were two eight-week survey periods. In period 1, 81 (70%) of 115 patients received cefoxitin appropriately and six (40%) of 15 patients received cefamandole appropriately. In patients receiving antibiotics inappropriately, 12 (35%) of the 34 receiving cefoxitin and eight (89%) of the nine receiving cefamandole had infections that could have been treated with less expensive, equally efficacious antibiotics. Changes in antibiotic therapy were made in 79% of patients based on our recommendations. The estimated annual cost saving for these antibiotics was $40,290. During period 2, 73 (91%) of 80 patients were given cefoxitin appropriately and 14 (61%) of 23 patients received cefamandole appropriately. Forty-three percent of those receiving cefoxitin and 33% of those receiving cefamandole inappropriately could have been treated with a less expensive, equally efficacious antibiotic. In 88% of patients, the attending physicians followed our recommendations. ( Arch Intern Med 1985;145:1978-1981)