1. 1

2. Hip hemiarthroplasty after displaced femoral neck fracture: a survivorship analysis Femoral neck fracture – broken knee joint Total Hip Arthroplasty – Yes….better results for patients than internal fixation and hemiarthroplasty. Some Results for age group 60 + differ from this: “0-35 % dislocation cases” – quite high  REASON ? Major one is comorbidities! 2

3. Biomarkers as a Tool for Management of Immunosuppression in Transplant Patients Immuno-suppressive drugs Without immunosuppression therapy, transplatation surgery could be fatal. Therapeutic drug monitoring – DOES NOT reflect adverse effects to immune cells. Pharmacodynamic monitoring (biomarkers) 3

4. Problem of infection in the ICU Infections possible - ventilator-associated pneumonia, catheter-associated urinary tract infection, catheter-related bloodstream infection Need to be attentive to horizontal infection and use proper antibiotics for multi- resistant bacteria like MRSA. 4

5.  Managing infection in the critical care unit: how can infection control make the ICU safe?  Infection Control in the ICU  Device Related Nosocomial Infection In ICU 5

6. 6 Ventilator Associated Pneumonia Antibiotic Resistance Pathogens Catheter-related Infections

7.  Modifiable ◦ Frequency of ventilator circuit changes ◦ Antibiotic usage  Nonmodifiable ◦ Patient age and gender ◦ Severity of illness ◦ Coma 7  Bronchoscopic techniques  Nonbronchoscopic techniques  Balance between initial antibiotic and overuse Risk FactorsPrevention

8. Decrease Infection in Neonatal Intensive Care Unit 8 Source: Improvement Report: Reducing the Incidence of Nosocomial Infection of Very Low Birth Weight Infants http://www.ihi.org/IHI/Topics/PatientS afety/SafetyGeneral/ImprovementStori es/ReduceIncidenceofNosocomialInfect ionofVLBWInfants.htm Image: www.mauryregional.com/NICU.htm www.mauryregional.com/NICU.htm

9. Long-Term Acute Care Hospital 9 Source: Reducing Hospital-Acquired Infections in a Long-Term Acute Care Hospital http://www.ihi.org/IHI/Topics/Healthc areAssociatedInfections/InfectionsGen eral/ImprovementStories/ReducingHAIi nLongTermAcuteCareHospital.htm Hand Hygiene Active Surveillance Culture

10. VAP rate per 1,000 device days CR-BSI rate per 1,000 device days Year 1997200420022004 Medical ICU 29188.23.4 Surgical ICU Similar declines 10.54.5 Burn Center Similar declines 9.51.85 10 Source: Pursuing Perfection: Report from HealthPartners’ Regions Hospital on Reducing Hospital-Acquired Infection: Ventilator-Associated Pneumonia and Catheter-Related Bloodstream Infection http://www.ihi.org/IHI/Topics/Critical Care/IntensiveCare/ImprovementStorie s/PursuingPerfectionReportfromHealth PartnersonReducingVAPCRBSI.htm Bundle Methodology VAP: Ventilator-Associated Pneumonia CR-BSIs: Catheter-Related Bloodstream Infections Pursuing perfection in fighting with VAP and CR-BSIs in ICU

11. 11