News Briefs
News Briefs
Aortic-valve sclerosis linked to AMI risk
Aortic-valve sclerosis is common in the elderly and was thought until recently to be relatively harmless. But the results of a study suggest that it is actually associated with an increased risk of death due to cardiovascular disease.1 The condition is characterized by a thickening and stiffening of the valve leading from the heart to the aorta.
Investigators at the University of Washington in Seattle, Wake Forest University in Winston-Salem, NC, and the Mayo Clinic in Rochester, MN, assessed the EKGs of 5,600 subjects 65 or older.
At baseline, the aortic valve was normal in 70% of subjects, sclerotic but without outflow obstruction in 29%, and stenotic in 2%. After five years, the researchers found a stepwise increase in deaths from cardiovascular causes as well as deaths from other causes with increasing aortic-valve abnormality. Cardiovascular-related deaths were 6% in the group with normal valves, 10% in the groups with sclerotic valves, and nearly 20% in the groups with stenotic valves. Overall mortality was 15% in the normal valve group, 22% in the sclerotic group, and 41% in the stenotic group.
Their conclusion was that aortic sclerosis "is associated with an increase of approximately 50% in the risk of death from cardiovascular causes and the risk of myocardial infarction."
In an editorial accompanying the study, Blase A. Carabello, MD, of the Houston VA Medical Center commented that assessment of aortic sclerosis requires only a stethoscope, as the condition generally causes a slight murmur, and is an easy way to assess risk. But he cautioned that we cannot draw any conclusions about the link between aortic valve disease and risk of mortality. About a quarter of adults over 65 have aortic sclerosis that does not interfere with blood flow.
Reference
1. Otto CM, Lind BK, Kitzman DW, et al. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 1999; 341:142-147.
ICP cuts task duplication in hand off to CMs
In a cost-saving measure that was at once innovative and seemingly heretical, an infection control professional (ICP) farmed out surveillance duties and eliminated a vacant full-time position in her department.
"Before you order a psych consult on me, let me tell you why," Arlene Potts, MPH, CIC, said recently in Baltimore at the annual conference of the Association for Professionals in Infection Control and Epidemiology. Potts is manager of infection control at Robert Wood Johnson University Hospital in New Brunswick, NJ, where the infection control department was staffed by two full-time ICPs until a co-worker resigned in 1996.
While advertising and interviewing for a replacement, Potts assumed the task of conducting chart review to identify nosocomial infections. In doing so, she noticed that outcomes managers — case managers assigned to every patient admitted to the hospital — were also reviewing and identifying infections and similar adverse events. Observing the duplication of effort, Potts proposed that the infection control position be eliminated and the outcomes managers be formally trained to identify nosocomial infections. "Needless to say, the proposal was well-received," she said.
The program included establishment of common definitions, a computer software program to compile data, and training of the case managers, Potts noted. Now the case managers are accurately reporting infections, and the elimination of the ICP position saves the hospital $60,000 in salary and benefits annually. The change required $40,000 in start-up costs for the initial development and coding of the computer programs, and the new surveillance system cost the hospital about $10,000 annually thereafter. Thus, the new system results in a net annual savings of approximately $50,000 due to the elimination of the ICP position.
Even if Potts finds another position is needed later, the case manager surveillance would likely continue and new IC staff would assume other duties.
"I work for a very supportive institution; and as we are growing, they see that I am already spreading myself a little thin with meetings, reports, [etc.]," she says. "There probably will come a day when we are going to need another [ICP] position. But if that comes next year, I’ve already saved the hospital $150,000."
CDC steps up SEARCH for resistant staph isolates
Alarmed by emerging vancomycin resistance in strains of S. aureus, the Centers for Disease Control and Prevention (CDC) is upgrading surveillance for the pathogen, and urging clinicians to submit isolates for confirmation.
Since the first strains of glycopeptide (vancomycin) intermediate-resistant S. aureus (GISA) were reported in Japan and the United States, concerns have increased that full-blown resistance to the last-line drug could arise in staph strains.
To that end, the CDC has created SEARCH (Surveillance for Emerging Antimicrobial Resistance Connected to Health care). SEARCH is a network of voluntary participants (i.e., hospitals, private industries, professional organizations, and state health departments) joined to report the isolation of S. aureus with reduced susceptibility to vancomycin. All U.S. health care organizations or practitioners are encouraged to report such isolates to the program; and after notifying their state health departments, send the isolates to CDC for confirmatory testing.
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