Biofilms are the source of vascular catheter infections and arefound uniformly on central venous catheters after 3 days.Only about half of these biofilms are culture positive.Of those that are culture positive the timing of initial colonization varies by catheter site:subcutaneous segment (average:5.1 days),tip segment (8.6d),and lumen (13.1d).The more organisms that come to reside on a catheter,the greater the likelihood that the catheter will have associated purulence or bloodstream infection.The risk of catheter-related bloodstream infection ranges considerably from≤2/1 000 patient days (peripheral venous catheters,peripherally inserted central catheters (PICC)),cuffed central venous catheters,ports,10/1 000 patient days (arterial and Wwan-Ganz catheters)to 30-50/1 000 patient days (multilumen,hemodialysis).Intrinsic factors that affect the risk of vascular catheter infection include host factors,type of organism,catheter material,and the manufacturing process.Humans are quite susceptible to Saureus,rabbits are not.S.epidermidis requires a polysaccharide adhesin to produce catheter infections.Silicone catheters have a greater risk of infection than polyurethane,polyvinylchloride,or teflon,and this increased risk is related to excess complement activation.Extrinsic factors that can affect the risk of infection include the use of maximal sterile barriers,chlorhexidine skin preparation,insertion by inadequately trained personnel,the number of line breaks,hyperalimentation fluid (favors yeasts),5% dextrose (favors gram-negative organisms),and lipid emulsions (favors Malassezia).

Health services managers are responsible for management and financing of health care in a variety of delivery models. This article provides information about the profession of health services management. It includes a brief historical overview of the profession, describes the various job roles that health service managers can assume, and outlines the educational curriculum to prepare and qualify for a career as health services manager. Educational preparation is available at the baccalaureate, masters, and doctoral levels. Finally, the article discusses future prospects for employment in the profession.

Family physicians can play an important role in providing lifestyle advice that aims to prevent or delay chronic disease. Given the vast amount of evidence that regular physical activity improves health and wellbeing, providing brief tailored advice in a clinic setting has the potential to make a positive impact on population health. Working side by side with physicians, the Health Promotion Board has developed the Physical Activity Advice Tool (PAAT) to enable physicians to quickly and accurately provide evidence-based tailored physical activity advice.

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Aviation* ; Emergencies* ; Medical Assistance*

Objective To describe changes that occur in stent morphology and structure after its implantation in coronary bifurcation.Side branch (SB) compromise after stenting of main vessel in coronary bifurcation is a major intraprocedural problem and for the long term,as a place of restenosis.Methods We created an elastic wall model (parent vessel diameter 3.5mm,daughter branches 3.5mm and 2.75mm)with 30,45 and 60 degree distal angulation between branches.After stent implantation,struts to the side branch were opened with 2.0mm and consequently 3.0mm diameter balloons.Subsequent balloon redilatations and kissing balloon inflations (KBI) were performed.All stages of the procedure were photographed with magnification up to 100 times.Results We found that the leading mechanism for side branch compromise was carina displacement,and discovered theoretical description for expected ostial stenosis severity.Based on our model we found that displacement of bifurcation flow divider cause SB stenosis with almost perfect coincidence with our theoretical predictions.Opening of stent cells through the proximal and distal stent struts always increased interslrut distance,but never achieved good apposition to the wall.Balloon diameter increase didn't give proportional enlargement in stent cell diameters.KBI leads to some small better stent positioning,correcting main vessel strut dislodgment from wall,but never gave full strut-wall contact.Distance between struts and wall was minimal only when the stent cell perfectly faced ostium of SB.This was also our observation that the shape of ostium of SB becomed eUiptically-bean shaped after stent implantation and generally kept that shape during consequent stages of experiment.Measured diameter and area stenosis were perfectly fitted and theoretically predicted from our concept Conclusion We have described stent-wall deformations in stent-balloon technique for treatment of coronary bifurcation demonstrating carina displacement as possibly main mechanism of side branch compromise after main vessel stenting.We have shown that KBI could not give full strut-wall contact if there is no perfect facing of stem cell and SB ostium.(J Geroatr Cardool 2008;5(1):43-49)

One of the main problems of treatment of bifurcation lesions is side branch (SB) stenosis appearing after stent placement in the main vessel.The aim of this study was to create quantitative method for prediction of side branch compromise extent.We accepted that the main mechanism for SB ostial stenosis is flow divider (FD) displacement from stent struts after stent implantation in the main vessel.Using easily measurable parameters from coronary angiography,as SB diameter,angle α (initial angle between axes of parent vessel and SB axis) and angle α' (angle between above mentioned axes after stent placement) we can calculate percentage diameter stenosis at branch ostium (%DS):%DS = sin (α - α')/(tan α).In boundary condition of full FD displacement %DS = cos α.We tested our theoretical predictions with fluoroscopic observation of elastic wall model of bifurcation (45°distal angle between branches)permitting wall deformations with stent.There is full coincidence of values of %DS and percentage area stenosis (%AS).The regular formulas for calculations of %DS and %AS overestimate stenosis severity between 10% and 25%.Our model tests have shown full coincidence between predicted values for %DS and observed values.We demonstrate that part of the SB ostium is not visible in regular angiography and contributes to ostial lumen area.This is a method that permits quantitative prediction of side branch compromise.