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surgical laparoscopic experience during the first year on a teaching service.recently, general surgeons have become actively involved in laparoscopic operations. the best method for teaching these techniques to surgical residents is unclear. since june 1990, at st. luke's-roosevelt hospital center in new york city, we have instituted a formal course of instruction for surgical residents. this includes a reference syllabus, didactic instruction, use of an inanimate training device and a hands-on practice in swine. clinically, the residents progress from observer to camera ...19921448732
laboratory surveillance method for nosocomial clostridium difficile diarrhea.clostridium difficile is the most common infectious cause of endemic nosocomial diarrhea, but traditional surveillance methods for this infection can be time-consuming. the purpose of this article is to (1) describe a laboratory surveillance method for nosocomial diarrhea and nosocomial clostridium difficile diarrhea (cdd) that does not require chart review and (2) describe some of the epidemiology of these infections at a university-affiliated, public hospital by using this surveillance method.19989503108
results of chapter project on statistical analysis. 19989503120
evaluation of an interdisciplinary re-isolation policy for patients with previous clostridium difficile diarrhea.diarrhea caused by clostridium difficile is increasingly recognized as a nosocomial problem. the effectiveness and cost of a new program to decrease nosocomial spread by identifying patients scheduled for readmission who were previously positive for toxin was evaluated.19989836843
hiv and diarrhea in the era of haart: 1998 new york state hospitalizations.this study reflects an attempt to identify the causes of diarrheal illness in hospitalized hiv patients in light of therapeutic advancements in hiv management.200010840348
impact of nosocomial infection on length of stay and functional improvement among patients admitted to an acute rehabilitation unit.to identify factors predictive of length of stay (los) and the level of functional improvement achieved among patients admitted to an acute rehabilitation unit for the first time, with special reference to the role of nosocomial infection.200111232883
risk factors for acquisition of clostridium difficile-associated diarrhea among outpatients at a cancer hospital.clostridium difficile-associated diarrhea (cdad) is an important infection in hospital settings. its impact on outpatient care has not been well defined.200516156323
detection of zoonotic pathogens and characterization of novel viruses carried by commensal rattus norvegicus in new york city.norway rats (rattus norvegicus) are globally distributed and concentrate in urban environments, where they live and feed in closer proximity to human populations than most other mammals. despite the potential role of rats as reservoirs of zoonotic diseases, the microbial diversity present in urban rat populations remains unexplored. in this study, we used targeted molecular assays to detect known bacterial, viral, and protozoan human pathogens and unbiased high-throughput sequencing to identify ...201425316698
clostridium difficile at a community hospital in the bronx, new york: incidence prevalence and risk factors from 2006 to 2008.the rate of clostridium difficile has increased over the last decade. this study was undertaken to determine the incidence, prevalence, and risk factors for infection at a 460-bed community hospital in the bronx, new york.201121458681
rapid molecular characterization of clostridium difficile and assessment of populations of c. difficile in stool specimens.our laboratory has developed testing methods that use real-time pcr and pyrosequencing analysis to enable the rapid identification of potential hypervirulent clostridium difficile strains. we describe a real-time pcr assay that detects four c. difficile genes encoding toxins a (tcda) and b (tcdb) and the binary toxin genes (cdta and cdtb), as well as a pyrosequencing assay that detects common deletions in the tcdc gene in less than 4 h. a subset of historical and recent c. difficile isolates (n ...200919403775
accounting for regression-to-the-mean in tests for recent changes in institutional performance: analysis and power.recent changes in individual units are often of interest when monitoring and assessing the performance of healthcare providers. we consider three high profile examples: (a) annual teenage pregnancy rates in english local authorities, (b) quarterly rates of the hospital-acquired infection clostridium difficile in national health service (nhs) trusts and (c) annual mortality rates following heart surgery in new york state hospitals. increasingly, government targets call for continual improvements, ...200919358144
vancomycin-resistant enterococci in stool specimens submitted for clostridium difficile cytotoxin assay.the prevalence of, and clinical risk factors associated with, vancomycin-resistant enterococcal colonization were investigated in patients suspected of having clostridium difficile infection. stools submitted for c difficile cytotoxin testing were screened for vancomycin-resistant enterococci (vre). isolates were speciated and characterized further by antibiotic susceptibility testing, dna fingerprinting, and dna:dna hybridization for detection of specific vancomycin resistance genes. of the 79 ...19979154478
epidemiology, clinical manifestations, and outcome of clostridium difficile-associated diarrhea.clostridium difficile gastrointestinal disease is an important nosocomial infection and is associated with recent antibiotic use. this study evaluated c. difficile-associated diarrhea (cdad) over a 2-yr period.19948147353
community-associated clostridium difficile infections, monroe county, new york, usa.we conducted active sentinel surveillance in monroe county, new york, usa, to compare incidence of community-associated clostridium difficile infections (ca-cdis) with that of health care-associated infections (ha-cdis) and identify exposure and strain type differences between ca and ha cases. patients positive for c. difficile toxin and with no documented health care exposure in the previous 12 weeks were defined as possible ca case-patients. patients with onset in a health care setting or rece ...201222377231
burden of clostridium difficile infection in long-term care facilities in monroe county, new york.long-term care facility (ltcf) residents are at increased risk of clostridium difficile infection (cdi). however, little is known about the incidence, recurrence, and severity of cdi in ltcfs or the extent to which acute care exposure contributes to cdi in ltcfs. we describe the epidemiology of cdi in a cohort of ltcf residents in monroe county, new york, where recent estimates suggest a cdi incidence in hospitals of 9.2 cases per 10,000 patient-days.201223041808
prevention of hospital-onset clostridium difficile infection in the new york metropolitan region using a collaborative intervention model.the incidence, severity, and associated costs of clostridium difficile (c. difficile) infection (cdi) have dramatically increased in hospitals over the past decade, indicating an urgent need for strategies to prevent transmission of c. difficile. this article describes a multifaceted collaborative approach to reduce hospital-onset cdi rates in 35 acute care hospitals in the new york metropolitan region. hospitals participated in a comprehensive cdi reduction intervention and formed interdiscipli ...201423294050
clinical characteristics of patients who test positive for clostridium difficile by repeat pcr.the high sensitivity of pcr assays for diagnosing clostridium difficile infection (cdi) has greatly reduced the need for repeat testing after a negative result. nevertheless, a small subset of patients do test positive within 7 days of a negative test. the aim of this study was to evaluate the clinical characteristics of these patients to determine when repeat testing may be appropriate. the results of all xpert c. difficile pcr (cepheid, sunnyvale ca) tests performed in the clinical microbiolog ...201425122866
notice to readers: the effect of falsified clostridium difficile infections surveillance data on results reported in mmwr.in 2012, mmwr published the report, "vital signs: preventing clostridium difficile infections," which examined clostridium difficile infection (cdi) surveillance data. this report contained several errors pertaining to emerging infections program (eip) data. these errors occurred as a result of scientific misconduct by a former employee of the oregon health authority. the public health service office of research integrity has determined that the former employee falsified or fabricated data for 5 ...201526355659
asymptomatic rectal colonization with carbapenem-resistant enterobacteriaceae and clostridium difficile among residents of a long-term care facility in new york city.residents of long-term care facilities (ltcfs) are at increased risk for colonization and development of infections with multidrug-resistant organisms. this study was undertaken to determine prevalence of asymptomatic rectal colonization with clostridium difficile (and proportion of 027/nap1/bi ribotype) or carbapenem-resistant enterobacteriaceae (cre) in an ltcf population.201626796684
Liver Graft Failure and Hyperbilirubinemia in Liver Transplantation Recipients After Clostridium difficile Infection.Liver transplant recipients are at high risk for Clostridium difficile infection. We have recently encountered multiple cases of CDI in our liver transplant recipients and for some of them it led to severe hyperbilirubinemia, liver failure, and even death. Our goals are to report our experience and analyze the factors that contributed to unfavorable outcomes.201122172853
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