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Objective.Comparison of studies evaluating patient-to-patient transmission of organisms is difficult, given the lack of standardized criteria. We used fluoroquinolone-resistantEscherichia coli(FQREC) as a model to characterize variability in definitions of relatedness across studies and to evaluate the resultant impact on study conclusions.Design.Narrative review and cohort study.Methods.The narrative review compared relatedness criteria across studies of FQREC. Additionally, an existing database was used to compare relatedness of isolates on the basis of molecular criteria alone versus molecular plus clinical criteria with different temporal cutoffs (hospitalization overlap of ≥1 day or allowance for nonoverlap of hospitalization dates of ≤7 days or ≤30 days).Results.Forty-six articles met narrative review inclusion criteria. Sixteen studies exclusively utilized molecular criteria to define relatedness. Thirty studies included molecular and clinical criteria. Of these, 6 included temporal data (ie, time period of isolate identification), 10 included patient location, and 14 included proximity and temporal criteria. For the database analysis, 353 patients were colonized with FQREC. There were 2 main clusters containing 48 and 17 related isolates within 49 pulsed-field gel electrophoresis types. Among the clusters, 18.4% of isolates were related by molecular criteria. Incorporating clinical criteria, fewer isolates were considered related: 5.7% of isolates using 30-day criteria, 3.1% using 7-day criteria, and 1.4% using 1-day overlap.Conclusions.There is considerable variability in definitions of relatedness of FQREC. Utilizing molecular criteria alone to define relatedness overestimates transmission compared with definitions including clinical criteria. Standard definitions of relatedness in studies of antimicrobial-resistant organisms are needed.

The triage tag is used in Mass Casualty Incident (MCI) to check the priority of patients treatments and conditions. However, it is difficult to grasp a change in the patient's information since it is a paper tag. In this paper, we propose a system using the electronic triage tag (eTriage) that facilitates emergency medical technicians to grasp patients locations and conditions through visualization. This system provides the following three views of the patients information: (1) Inter-site view which shows on a map an overview of the latest status in multiple first-aid stations including the number of technicians and patients of each triage category; (2) Intra-site view which shows detailed status of each first-aid station including the location, triage category, and vital signs of each patient on a 3D map created based on the environment mapping technique; and (3) Individual view which shows vital information of patients on a tablet PC according to its orientation using the augmented reality technique. In this paper, we describe the design and implementation of the proposed system with some preliminary evaluation results., PerNEM 2012 : Pervasive Networks for Emergency Management , Mar 23, 2012 , Lugano, Switzerland

Within the context of the automatic detection of a medical emergency and the aim of providing medical care as fast as possible, it is of utmost importance to detect the current position of the patient. The more precisely the patient location can be determined and the more effectively the paramedics are guided towards the patients current location, the less time is wasted prior to the initial medical care provided to the patient after the emergency has occurred. This paper describes a first, prototypical realization of a combined indoor and outdoor user localization component developed within the Smart Senior project. Apart from a detailed description of the technical background of the realized component, an important aspect discussed in this paper is the distinction between the two different concepts of “locating a user” and “finding a user”.

This paper details the development of a simple webcam joystick, a wireless, or rather cableless, and contactless pointing device by using a webcam and a simple flexible non-electronic joystick. Such a system requires no power source on the joystick, allows for light, robust and very mobile joysticks, and can be extended into a large array of applications. This paper proposes the use of small webcam joysticks as sensors for recording movement, the way wireless sensors are used. Specifically, it could be used as a simple navigation and monitoring system for patient movement in medical wards, where knowledge of patient location and movement could provide instant assistance, pre-emptive action and also hinder untoward patient mix-ups. Experiments and discussions in this paper highlight how a successful implementation is possible, and emphasize the flexibility of such an implementation in a low cost medical environment.

Background: Tigecycline (TIG) is a novel glycylcycline that was approved in 2005 in the US for treatment of complicated skin and skin structure infections and complicated intra-abdominal infections. S. aureus (SA), including methicillin-resistant S. aureus (MRSA), is a leading cause of skin and skin structure infections. This study examines the in vitro activity of TIG against SA, including MRSA, over the last five years. Additionally, data were stratified according to patient location (PL) and specimen source (SS) to determine if any variation in TIG activity against SA was apparent among these subpopulations. Methods: SA isolates were collected from multiple locations across all nine US Bureau of Census regions during ’03—’04 (N = 1,796), ’05 (N = 1,802), and ’06—’07 (N = 1,800) and centrally tested using broth microdilution according to current CLSI standards. TIG activity was analyzed by patient locations (PL; outpatient [OP], intensive-care unit [ICU], and inpatient non-ICU [IP]) and by specimen source (SS; blood [BL], respiratory [RP], and skin and skin structure [SST]). FDA breakpoints were used to interpret all TIG MIC results. Results: Against SA overall, TIG had an MIC50/90 of 0.12/0.12mg/L in ’03—’04 and an MIC50/90 of 0.12/0.25mg/L in both ’05 and ’06—’07. Throughout the study periods, percent susceptibility (%S) of TIG remained ≥99.5%. TIG activity by MIC90 was largely unaffected by methicillin susceptibility status of the isolate (MIC90: 0.12mg/L for MSSA and 0.25mg/L for MRSA in ’03—’04, 0.25mg/L for MSSA and MRSA in ’05, and ’06—’07). In each study period, the activity of TIG by MIC90 was identical among all PL (OP, ICU, and IP) and SS (BL, RP, SST) evaluated relative to TIG activity against SA overall. In the most recent study period (’06—’07), SA isolates were ≥99% S to TIG regardless of PL or SS. Conclusion: By MIC90, TIG in vitro activity was stable against SA over the past five years spanning both its development and introduction to use and the %S of SA isolates to TIG remained unaltered and high (>99.5%). TIG activity by MIC90 was not notably affected by the methicillin susceptibility status of the isolate and was consistent across all PL and SS evaluated.

The patient location information in managing for patient workflow will be worked efficiently within the hospital. We designed the Patient Management and Tracking System (PMTS) based on RFID with RSSI(Received Signal Strength Indication) method. This system is able to track the movement of patient in hospital, and manage the waiting-list of patients at a medical office. Therefore, we are sure that the PMTS will be useful for decreasing a duty of medical staff and increase a convenience of patients.

As development of wireless communication technology has promoted mobility, location based service (LBS) became embossed. The LBS is a service to recognize and utilize a location of a person or a thing through a device that ensures mobility based on wireless communication network. This paper thus researches on healthcare method to respond to emergency rapidly by recognizing a patient's location with the LBS. The LBS also provides location information of a user as well as remote management of organism data such as ECG data or pulse, which is transferred to a hospital or an emergency room.

Routine bacterial sputum culture results from September 1987 through August 1988 were reviewed to determine the relationship of patient location and physician on specimen adequacy. Specimens from patients in intensive care units (ICUs) were more likely to be good than those from other hospital wards. In addition, when physicians were rotating in ICUs, the quality of sputa from their patients was significantly better than when the same physicians were rotating in non-ICUs. As a single factor, patient location (ie, ICU vs non-ICU) is more important than physician in determining the quality of sputum for culture. However, there is no doubt that physician ordering practices and demands for proper specimen collection are also very important factors.

Coronary magnetic resonance imaging (MRI) is not the same as conventional X-ray angiography (XRA). The two techniques differ in many and profound ways. They differ in how they acquire and produce images, how their systems are operated, and, eventually, how the methods are used clinically. XRA is a high-resolution projection method that is capable of delineating very fine structures of the beating heart. Magnetic resonance angiography (MRA) of the coronaries is a mediumresolution method that can produce thin section views along any arbitrary projection. It typically requires synchronization of multiple heartbeats to elicit an image reliably. XRA of the coronary tree is a widely used and accepted means for assessing the caliber of the cardiac vessels. Generations of radiologists and cardiologists have studied coronary images. MR is still in a state of relative infancy. Given the current success of conventional angiography, why is there any interest in MRI of the coronaries? First, conventional X-ray angiography is not without its disadvantages. It is an invasive technique with some patient risk. It is also a projection method lacking threedimensional information. Furthermore, it is restricted to specific view angles by instrumentation and patient location. It is expensive. It lacks the facility to acquire additional cardiac physiologic data in the same setting (e.g., wall motion, perfusion, or characterization of infarcted regions and/or ischemic risk). It requires a team of well-trained experts to perform, and it exposes them and the patient to ionizing radiation. MRA does not offer an advantage compared to XRA in each of these issues. Rather, MRA has some unique capabilities that may define a complementary role for the technique in the clinical setting. MRA has gained clinical acceptance in other areas of the body and may offer a noninvasive means for assessing the health of coronary vessels. This chapter is intended to be a brief technical introduction into the process of MRI and MRA. Subsequent chapters will detail the methods and describe clinical experience to date.

When procedures and processes to assure patient location based on human performance do not work as expected, patients are brought incrementally closer to a possible “wrong patient—wrong procedure” error. We developed a system for automated patient location monitoring and management. Realtime data from an active infrared/radio frequency identification tracking system provides patient location data that are robust and can be compared with an “expected process” model to automatically flag wrong-location events as soon as they occur. The system also generates messages that are automatically sent to process managers via the hospital paging system, thus creating an active alerting function to annunciate errors. We deployed the system to detect and annunciate “patientin-wrong-OR” events. The system detected all “ wrongoperating room (OR)” events, and all “wrong-OR” locations were correctly assigned within 0.50 ± 0.28 minutes (mean ± SD). This corresponded to the measured latency of the tracking system. All wrong-OR events were correctly annunciated via the paging function. This experiment demonstrates that current technology can automatically collect sufficient data to remotely monitor patient flow through a hospital, provide decision support based on predefined rules, and automatically notify stakeholders of errors.

Background: The organized stroke alert is critical in quickly evaluating and treating patients with acute stroke. The purpose of this paper was to further understand how this process functions in a moderate sized general hospital by exploring the effects of patient location and time of day on the pace of evaluation and the eventual outcome of evaluation. Methods: Retrospective chart review. Results: The rate of stroke alerts depended on the time of day and patient location. There was a low probability (41%) that the eventual diagnosis was stroke after a stroke alert, but there was no effect of diagnosis on the pace of evaluation. The time between stroke alert and a computed tomography (CT) scan being read was shortest for patients in the emergency room (ER) and longer for patients in the intensive care unit (ICU) or medical/surgical floors. Patients evaluated on medical/surgical floors were less likely to receive tissue plasminogen activator (tPA) than those evaluated in the ER, even though the comorbidities were similar. This may be due to the greater severity of the comorbidities in patients who were already admitted to the hospital. Conclusion: The rate of tPA administration was lower for stroke alerts called from medical/surgical floors than from the ER. Stroke alerts were most frequent in late afternoon.

The Clinical Laboratory Improvement Amendments require that laboratories have a procedure for reporting “imminent life-threatening results” to caregivers. Although this system has improved timely intervention, inability to reach care providers undermines its impact (1). Prior analysis of critical result reporting practices has identified qualitative factors that lead to delays in critical result reporting, such as patient location, missing provider information, patient heterogeneity, and nonideal “panic” values (2). However, we have not found reports quantifying sources of communication failures in critical result reporting. Here we report sources of communication failures in reporting critical results in our healthcare system, which has 950 beds equally divided between a university and county hospital. In our system, more than 99% of the time, critical results are called to a care provider by a medical technologist. If this method is unsuccessful, the technologist elicits assistance from the laboratory medicine resident on call to ensure that the value is communicated and appropriate action taken. In 2004 our Clinical Pathology residency program began maintaining an online database of all calls to the on-call laboratory …

Introduction: No study has examined the differences in time to antimicrobials between patient locations at the time of severe sepsis and septic shock onset and its impact on outcomes. This study aimed to compare the time from onset of severe sepsis or septic shock to antimicrobial administration bet

Admission and discharge criteria are important decision-making components. Nursing care and management must be considered an imperative part of this criteria. The Nursing Evaluation of Nursing Intensity could identify those patients that may be passed over under standard admission criteria to Intensive Care Units. This tool augments the transfer process as well as helps to determine patient location.

The computer system of the Bacteriology Laboratory at the Hôpital Cardiologique in Lyon is one of the elements in the computer management of patient data. It dovetails in with the various units for admission, patient location, ward surveillance, outpatient appointments. The main objectives are as follows: to improve quality of sample information, to reduce clerical work and accelerate information circulation, to widen the scope of epidemiological research. Computers can register samples, edit laboratory work sheets, entry lists, record results, generate reports, give a visual listing of all analyses performed before a patient leaves hospital, list pending analytical results, make available in the total system all laboratory-validated information, produce automatic billing of analyses and statistical editing. The Bacteriology Laboratory has three visual display units and two printers at its disposal. Computer laboratory management has been operational since May 1977. First results are satisfactory and suggest extension of the system to other laboratories and handling of quality control.

An on-line archive of laboratory results designed specifically for ambulatory care areas is described. It is a direct result of paper-flow problems in clinics, which were manifested by numerous phone calls to the laboratory for test results performed up to 10 months ago, and requiring as much as 30 minutes each for retrieval. The archive is incorporated into the result inquiry program of our laboratory computer and is transparent to the user. Utilization of this system by our personnel saves up to 12 hours of work each day. By capturing in a separate file the patient location of each call for outpatient results we are able to identify the clinics that use the telephone for retrieval of test results.

We describe a surveillance method that identifies excessive rates of positive cultures based on patient location, culture site, and organism identification. During a 6-month period, this surveillance method, coupled with epidemiological investigations, identified 19 small clusters of cross-infections and three small outbreaks of intravenous catheter-related bacteremias. These infections were associated with apparent breakdowns in proper technique. Concurrent, standard surveillance activities identified only three of these problems. These results demonstrate that computer analysis of positive culture rates is a sensitive and time-efficient method for detecting potentially preventable nosocomial infections.

Background Testing for 25-hydroxyvitamin D [25(OH)D] has increased dramatically in recent years. The present report compares overall utilization and results for 25(OH)D orders at two academic medical centers - one in New York and one in Iowa – in order to characterize the vitamin D status of our inpatient and outpatient populations. Results are also compared to those from a national reference laboratory to determine whether patterns at these two institutions reflect those observed nationally. Methods Retrospective data queries of 25(OH)D orders and results were conducted using the laboratory information systems at Weill Cornell Medical College / New York Presbyterian Hospital (WCMC), University of Iowa Hospitals and Clinics (UIHC), and ARUP Laboratories (ARUP). Chart review was conducted for cases with very high or low serum 25(OH)D levels in the WCMC and UIHC datasets. Results The majority of tests were ordered on females and outpatients. Average serum 25(OH)D levels were higher in female versus male patients across most ages in the WCMC, UIHC, and ARUP datasets. As expected, average serum 25(OH)D levels were higher in outpatients than inpatients. Serum 25(OH)D levels showed seasonal periodicity, with average levels higher in summer than winter and correlating to regional UV index. Area plots demonstrated a peak of increased 25(OH)D insufficiency / deficiency in adolescent females, although overall worse 25(OH)D status was found in male versus female patients in the WCMC, UIHC, and ARUP datasets. Surprisingly, improved 25(OH)D status was observed in patients starting near age 50. Finally, chart review of WCMC and UIHC datasets revealed over-supplementation (especially of ≥ 50,000 IU weekly doses) in the rare cases of very high 25(OH)D levels. General nutritional deficiency and/or severe illness was found in most cases of severe 25(OH)D deficiency. Conclusions 25(OH)D status of patients seen by healthcare providers varies according to age, gender, season, and patient location. Improved 25(OH)D status was observed later in life, a finding that may reflect the previously described increased use of vitamin D-containing supplements in such populations. Severe vitamin D deficiency is much more common than vitamin D toxicity.