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I could not agree more with Shannon Brownlee's excellent article 'Doctors Without Borders' (April) on why we should not trust medical journals. Although I once required my students to restrict […]

Elective in-patient surgery is a common occurrence among older persons and primary care physicians are routinely called on to provide preoperative assessment and perioperative risk management of these patients. Older [...]

AbstractObjectives:To characterize risk factors associated with pneumococcal disease and asymptomatic colonization during an outbreak of multidrug-resistant Streptococcus pneumoniae(MDRSP) among AIDS patients in a long-term–care facility (LTCF), evaluate the efficacy of antimicrobial prophylaxis in eliminating MDRSP colonization, and describe the emergence of fluoroquinolone resistance in the MDRSP outbreak strain.Design:Epidemiologic investigation based on chart review and characterization of SP strains by antimicrobial susceptibility testing and PFGE and prospective MDRSP surveillance.Setting:An 80-bed AIDS-care unit in an LTCF.Participants:Staff and residents on the unit.Results:From April 1995 through January 1996, 7 cases of MDRSP occurred. A nasopharyngeal (NP) swab survey of all residents (n = 65) and staff (n = 70) detected asymptomatic colonization among 6 residents (9%), but no staff. Isolates were sensitive only to rifampin, ofloxacin, and vancomycin. A 7-day course of rifampin and ofloxacin was given to eliminate colonization among residents: NP swab surveys at 1, 4, and 10 weeks after prophylaxis identified 1 or more colonized residents at each follow-up with isolates showing resistance to one or both treatment drugs. Between 1996 and 1999, an additional 6 patients were diagnosed with fluoroquinolone-resistant (FQ-R) MDRSP infection, with PFGE results demonstrating that the outbreak strain had persisted 3 years after the initial outbreak was recognized.Conclusions:Chemoprophylaxis likely contributed to the development of a FQ-R outbreak strain that continued to be transmitted in the facility through 1999. Long-term control of future MDRSP outbreaks should rely primarily on vaccination and strict infection control measures.

In industrial practice, one is often confronted with injuries that are serious enough to hamper the workman's efficiency but not quite sufficient to keep him from work the prescribed length of time. An example of such an injury is a fracture of a carpal or metacarpal bone. It has been my custom, after reduction of such fractures, to splint them by yucca board or tongue blade, and after two weeks to begin motion. The patient usually begins work before he should. CONSTRUCTION OF SPLINT Recently, a patient with mechanical ability devised a splint that I have been using since with excellent success. The splint is composed of an old kid glove, cut out at the fingers (except for the finger or fingers involved). On the outside of the glove a thin pocket of leather is sewed, the size of which is dependent on the area to be immobilized. Into these

Presents letters to the editor referencing articles and topics discussed in previous issues. "There Goes the Neighborhood," which focused on the real estate market; "Doctors Without Borders," which focused on why people should not trust medical journals; "Euro Brash," which encourages the British public to vote in favor of the European Union Constitution; "Dire Straights," which discussed state-sanctioned marriage; "Twisted Sisters," which reviewed the book "Pledged: The Secret Life of Sororities," by Alexandra Robbins.