Thursday, March 21, 2013

"For All Mankind - The Life & Career of Mick Foley" DVD/Blu-ray contents

DVD Disc 1 ? Main program

A Happy Story

Idyllic Childhood

Huge Fan

Training School

Working the Road

WCW

Sting

Vader

ECW & Japan

Mankind

Dude Love

Hell in a Cell

Mr. Socko

The Rock

Author

Triple H

Commissioner

Going Away

Randy Orton

Making a Difference

Edge

Retirement

Stand Up Comic

A Complete One-Off

DVD Disc 2- Matches

SuperstarsSeptember 1986

Jack Foley & Les Thornton vs. The British Bulldogs

Alternate Commentary: Mick Foley & Joey Styles

?

AWA All Star WrestlingOctober 1988

Cactus Jack & Gary Young vs. Scott Steiner & Billy Travis

?

Wild West WrestlingApril 1989

Cactus Jack Manson vs. Brickhouse Brown

?

Power HourMarch 1990

Cactus Jack vs. Keith Hart

?

Power HourNovember 1991

Submit or Surrender Match

Cactus Jack vs. Sting

?

Clash of the Champions XVIIIJanuary 21, 1992

Falls Count Anywhere Match

Cactus Jack vs. Van Hammer

?

Ft. Lauderdale, FLMay 1995

Barbed Wire Match

Cactus Jack vs. Sandman

?

CyberSlamFebruary 1996

Cactus Jack vs. Shane Douglas

Alternate Commentary: Mick Foley & Joey Styles

?

In Your House: Cold Day in HellMay 11, 1997

Mankind vs. Rocky Maivia

?

In Your House: Canadian StampedeJuly 6, 1997

Mankind vs. Hunter Hearst-Helmsley

?

DVD Disc 3 - Matches

RawNovember 17, 1997

Dude Love vs. Rocky Maivia

?

King of the RingJune 28, 1998

Hell in a Cell

Mankind vs. Undertaker

Alternate Commentary: Mick Foley & Joey Styles

?

RawJuly 13, 1998

WWE Tag Team Championship Match

Mankind & Kane vs. New Age Outlaws

?

In Your House: Rock BottomDecember 13, 1998

WWE Championship Match

Mankind vs. The Rock

?

SmackDownSeptember 2, 1999

WWE Tag Team Championship

Mankind & The Rock vs. Triple H & Shane McMahon

?

SmackDownDecember 16, 1999

Mankind vs. Al Snow

?

No Way OutFebruary 27, 2000

Hell In A Cell ? Retirement Match

Cactus Jack vs. Triple H

?

Blu-ray Disc 1 ? Main program

A Happy Story

Idyllic Childhood

Huge Fan

Training School

Working the Road

WCW

Sting

Vader

ECW & Japan

Mankind

Dude Love

Hell in a Cell

Mr. Socko

The Rock

Author

Triple H

Commissioner

Going Away

Randy Orton

Making a Difference

Edge

Retirement

Stand Up Comic

A Complete One-Off

Blu-ray Disc 1- Matches

SuperstarsSeptember 1986

Jack Foley & Les Thornton vs. The British Bulldogs

Alternate Commentary: Mick Foley & Joey Styles

?

AWA All Star WrestlingOctober 1988

Cactus Jack & Gary Young vs. Scott Steiner & Billy Travis

?

Wild West WrestlingApril 1989

Cactus Jack Manson vs. Brickhouse Brown

?

Power HourMarch 1990

Cactus Jack vs. Keith Hart

?

Power HourNovember 1991

Submit or Surrender Match

Cactus Jack vs. Sting

?

Clash of the Champions XVIIIJanuary 21, 1992

Falls Count Anywhere Match

Cactus Jack vs. Van Hammer

?

Ft. Lauderdale, FLMay 1995

Barbed Wire Match

Cactus Jack vs. Sandman

?

CyberSlamFebruary 1996

Cactus Jack vs. Shane Douglas

Alternate Commentary: Mick Foley & Joey Styles

?

In Your House: Cold Day in HellMay 11, 1997

Mankind vs. Rocky Maivia

?

In Your House: Canadian StampedeJuly 6, 1997

Mankind vs. Hunter Hearst-Helmsley

?

Blu-ray Disc 2 - Matches

RawNovember 17, 1997

Dude Love vs. Rocky Maivia

?

King of the RingJune 28, 1998

Hell in a Cell

Mankind vs. Undertaker

Alternate Commentary: Mick Foley & Joey Styles

?

RawJuly 13, 1998

WWE Tag Team Championship Match

Mankind & Kane vs. New Age Outlaws

?

In Your House: Rock BottomDecember 13, 1998

WWE Championship Match

Mankind vs. The Rock

?

SmackDownSeptember 2, 1999

WWE Tag Team Championship

Mankind & The Rock vs. Triple H & Shane McMahon

?

SmackDownDecember 16, 1999

Mankind vs. Al Snow

?

No Way OutFebruary 27, 2000

Hell In A Cell ? Retirement Match

Cactus Jack vs. Triple H

?

Blu-ray Disc 2 - Blu Ray Exclusives

Promos

?

WCW World Championship WrestlingOctober 5, 1991

Sting?s Birthday Cake

?

WCW Saturday NightSeptember 10, 1994

No Ear Surgery

?

RawApril 5, 2004

Barbie

?

SmackDownAugust 1, 2008

Cutting Edge

?

RawSeptember 24, 2012

Relevancy with CM Punk

?

Stories

Frank Foley

Snowed In

DeNucci Training School

Arrested in Italy?

Cactus Jack ? The Name

Africa

Birth of Bang Bang

Losing Teeth

On the Spot

Wanted T-Shirt

Smoking Flight?

Anti-Hardcore ECW

Farewell in ECW

Vicious Suplex

Kevin Sullivan ? Mentor

Rock ?n Sock Jacket

Disneyland

Loogie Heard ?Round the World

Commentator

Mr. Socko vs. The Cobra

Comedy Show

Favorite Mick Foley Persona

Sheamus Meets Mick

Christmas Cheer

Wardrobe

Thrifty Mick

Great Dad

View Comments

Source: http://www.wwe.com/wweshop/dvd/for-all-mankind-the-life-career-of-mick-foley-dvdblu-ray-contents

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Google eBooks expanding to Australia | flaflom

Google eBooks expanding to Australia



Google e-Books is the new front in the electronic age for Google and with the right strategy, will be a lucrative business for the internet giant which seems to have it?s fingers in everything.

Google e-Books was launched last year to much fan fair in the US before rolling out to the UK and Canada in the past few weeks and Australia this week.

To break into the Australian market, Google has partnered with Australian book giants, Dymocks and Booktopia, with the two offering Google?s eBooks for sale through their websites. The two retailers will become wholesalers for Google?s eBooks.

In terms of numbers, the Google store has hundreds of thousands of titles available for purchase and millions of books that are available for free. The books will be in ePub and PDF formats and can be read on most eBook readers.

Booktopia has fast become one of the biggest online book retailers in Australia. A Booktopia promo code is often available which also attracts consumers.

? Lenovo Thinkpad Tablet 2

Permanent Link

Source: http://flaflom.org/google-ebooks-expanding-to-australia/

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FastHosts Internet Launches Two SSD Dedicated DS1210 Servers

Fasthosts Internet has launched two new dedicated servers which feature the latest SSD technology and quadruple the SSD space on the flagship DS1210.Fasthosts Internet has launched two new dedicated servers which feature the latest SSD technology and quadruple the SSD space on the flagship DS1210.

Web hosting provider Fasthosts Internet announced on Wednesday it has launched two new dedicated servers which feature the latest SSD technology and quadruple the SSD space on the flagship DS1210.

These new server configurations provide customers with many benefits, including fast application launch times, backup solutions. which Fasthosts Internet launched in February 2011, as well as an overall increase in performance.

The web hosting provider is offering an initial promotion of half price for the first 3 months, with prices for the professional range starting from ?84.50 per month.

Fasthosts advanced series offers great value for small businesses while the professional series are designed for high speed, processing power and stability for small to medium-sized businesses.

The new range?s most significant changes are based on the hard disk drive, providing servers that are more robust, resilient and allow for quicker read/write times.

The new servers offer four times the SSD space as they did previously, as well as backup solutions for safer data storage options.

Starting from ?124.50 per month for the first 3 months, and ?249.00 per month thereafter, the 24-core DS1120 offers 32GB RAM, 2 x 250GB SSD and 2 X 1TB SATA HDD.

Available from ?174.50 per month for the first 3 months and ?349.00 per month thereafter, the 32-core DS1210 offers a massive 64GB RAM, 2 x 500GB SSD and 2 x 2TB SATA HDD. Customers will see further savings when they sign up if they opt for annual payments.

Backed by a guaranteed 99.99 percent network uptime, both the DS1120 and DS1210 are ideal for business critical applications or to host large websites, mail or media.

The DS1120 uses 2 x 2.1GHz AMD OpteronTM 12-core processors to deliver energy-efficient performance, while the DS1210 features 2 x 2.1GHz AMD OpteronTM 16-core processors for even more power.

Customers will be provided with unlimited bandwidth, be able to retain complete hands-on remote control of their server at all times, a free SSL certificate for the first year, Parallels Plesk Panel 11, for simple and easy management, a 100Mbps connection, and 24-hour technical support from the UK via the phone or online.

All Fasthosts Windows dedicated servers include 50GB of free online backup space.?Fasthosts also offers a free consultancy service to help customers find the right solution.

?As a part of our ongoing campaign and promise to further inspire and support business, we have introduced these top end servers,? said Claire Lewis, marketing director at Fasthosts Internet. ?Our latest range reflects our mission of working alongside businesses to provide the latest technology and support business growth. Our new 24 and 32 core servers are an excellent opportunity to access huge processing power on an affordable basis. We are confident that even the most demanding professional users will be impressed with the performance and responsiveness.?

Last July,?Fasthosts Internet launched a range of business hosting packages designed to meet the needs of a wide range of businesses.

Talk back: Are you currently offering SSD dedicated servers to your customers? Do you think these new dedicated servers will bring in new business for Fasthosts Internet? Let us know in a comment.

Justin Lee

About Justin Lee

Justin Lee has been a staff analyst with theWHIR since 2004. He writes about a range of web hosting and IT-related issues facing the industry on the WHIR website, as well the print version of the WHIR magazine. Follow him on Twitter @Justin_theWHIR.

Source: http://www.thewhir.com/web-hosting-news/fasthosts-internet-launches-two-ssd-dedicated-ds1210-servers

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Wednesday, March 20, 2013

How Much House Can You Get for $225,000? | Zillow Blog

Each week we take a look at how much house you can expect to get at a specific price point. This week, we?re looking at homes priced around $225,000.

Houston, TX

15322 Greenleaf Ln, Houston, TX?
For sale: $229,900

Houston, TX
This sophisticated colonial-style home in Houston has 4 bedrooms and 2.5 baths. Built in 1987, the property has been well-maintained with beautiful hardwoods and exterior landscaping.

Colorado Springs, CO

814 E. Monument St, Colorado Springs, CO?
For sale: $225,000

Colorado Springs, CO
It?s not every day that you see a turn-of-the-century Victorian hit the market. This 1898 Colorado Springs?home has several notable features including 10-foot ceilings, a claw-foot bathtub and walk-in closets in all 4 bedrooms.

West Hartford, CT

24 Knollwood Rd, West Hartford, CT?
For sale: $229,900

West Hartford, CT

Is there anything more quaint than this 1942 Cape Cod-style home in West Hartford, CT? The 1,275-square-foot cottage is tasteful inside and out?? from a screened-in porch in the backyard to a sunny interior with wooden built-ins and custom-framed windows.

Bend, OR

62697 Larkview Rd, Bend, OR
For sale: $225,000

Bend, OR
This 3-bedroom craftsman is located on reportedly one of the best streets in northeast Bend. The current owner has made several updates to the 2003 construction including a fresh coat of exterior paint, central air conditioning, hardwood floors on the first floor, master bath tile and new carpet.

Albuquerque, NM

6554 Basket Weaver Ave NW, Albuquerque, NM
For sale: $229,500

Albuquerque, NM
Constructed in 2011, this custom home promotes eco-friendly living with gold-level green-building certification. Designed specifically for Albuquerque residents, major attention has been given to the? walls and roof insulation, as well as other engineering details, to make the home both economical and environmentally conscious.

Related:

Source: http://www.zillowblog.com/2013-03-20/how-much-house-can-you-get-for-225000/

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Monday, March 18, 2013

Piikki Organizes and Uploads Your Receipts From Your Phone

Piikki Organizes and Uploads Receipts From Your Phone iOS: Receipts are ridiculously easy to lose, so I always try to snap a picture of important ones with my phone. From now on, I'll be taking those pictures with Piikki.

There are plenty of apps and methods to store receipts on your smartphone, but I have yet to encounter a faster option than Piikki. When you want to store a receipt, Piikki's built-in camera can automatically detect its edges and crop out the background, keeping the file size to a minimum. Once you've taken your photo, the app will automatically store a geotag with your receipt so you can remember where it came from, and you can also key in the amount to keep track of expenses.

My favorite feature of Piikki, though, is one-click uploading to Evernote, Google Drive, or Dropbox. The receipt will still be stored within the app with all its accompanying metadata, but you'll know it's also safely backed up to your cloud services of choice. Piikki is a universal app available for $1.99 in the App Store.

Piikki: Receipt Scanner & Expense Reports ($1.99) | App Store

Source: http://feeds.gawker.com/~r/lifehacker/full/~3/9Ir4eygL0BY/piikki-organizes-and-uploads-your-receipts

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Egypt vigilantes hang 2 thieves by feet in public

EDS NOTE GRAPHIC CONTENT -- Egyptian men surround the bodies of two men who were beaten and hung by vigilantes after being accused of theft in Samanod, about 55 miles (90 kilometers) north of Cairo, Egypt, Sunday March 17, 2013. Egyptian vigilantes beat two men accused of stealing a motorized rickshaw, then stripped them half-naked and hung them still alive in a bus station in a small Nile Delta town on Sunday, according to security officials who said both men died. The killings came a week after the attorney general's office encouraged civilians to arrest lawbreakers and hand them over to police. (AP Photo)

EDS NOTE GRAPHIC CONTENT -- Egyptian men surround the bodies of two men who were beaten and hung by vigilantes after being accused of theft in Samanod, about 55 miles (90 kilometers) north of Cairo, Egypt, Sunday March 17, 2013. Egyptian vigilantes beat two men accused of stealing a motorized rickshaw, then stripped them half-naked and hung them still alive in a bus station in a small Nile Delta town on Sunday, according to security officials who said both men died. The killings came a week after the attorney general's office encouraged civilians to arrest lawbreakers and hand them over to police. (AP Photo)

EDS NOTE GRAPHIC CONTENT -- Egyptians surround the bodies of two men hung by their feet in a bus station after being accused of theft in Samanod, about 55 miles (90 kilometers) north of Cairo, Egypt, Sunday March 17, 2013. Egyptian vigilantes beat two men accused of stealing a motorized rickshaw, stripped them half-naked and hung them by their feet in a crowded bus station in the Nile Delta on Sunday, according to security officials. Both men died.The killings came a week after the attorney general?s office encouraged civilians to arrest lawbreakers and hand them over to police. (AP Photo)

EDS NOTE GRAPHIC CONTENT -- Egyptians surround the bodies of two men hung by their feet in a bus station after being accused of theft in Samanod, about 55 miles (90 kilometers) north of Cairo, Egypt, Sunday March 17, 2013. Egyptian vigilantes beat two men accused of stealing a motorized rickshaw, stripped them half-naked and hung them by their feet in a crowded bus station in the Nile Delta on Sunday, according to security officials. Both men died. The killings came a week after the attorney general's office encouraged civilians to arrest lawbreakers and hand them over to police. (AP Photo)

EDS NOTE GRAPHIC CONTENT -- Egyptians surround the bodies of two men hung by their feet in a bus station after being accused of theft in Samanod, about 55 miles (90 kilometers) north of Cairo, Egypt, Sunday March 17, 2013. Egyptian vigilantes beat two men accused of stealing a motorized rickshaw, stripped them half-naked and hung them by their feet in a crowded bus station in the Nile Delta on Sunday, according to security officials. Both men died. The killings came a week after the attorney general's office encouraged civilians to arrest lawbreakers and hand them over to police. (AP Photo)

EDS NOTE GRAPHIC CONTENT -- Egyptians surround the bodies of two men hung by their feet in a bus station after being accused of theft in Samanod, about 55 miles (90 kilometers) north of Cairo, Egypt, Sunday March 17, 2013. Egyptian vigilantes beat two men accused of stealing a motorized rickshaw, stripped them half-naked and hung them by their feet in a crowded bus station in the Nile Delta on Sunday, according to security officials. Both men died. The killings came a week after the attorney general's office encouraged civilians to arrest lawbreakers and hand them over to police. (AP Photo)

(AP) ? Egyptian vigilantes beat two men accused of stealing a motorized rickshaw on Sunday and then hung them by their feet while some in a watching crowd chanted "kill them!" Both men died, security officials said.

The killings come a week after the attorney general's office encouraged civilians to arrest lawbreakers and hand them over to police. They are emblematic of the chaos sweeping Egypt and a security breakdown of frightening proportions.

It was one of the most extreme cases of vigilantism in two years of sharply deteriorating security following the 2011 uprising. Gruesome photos circulated quickly on Facebook and other social media outlets, showing images taken by people in the crowd of thousands who watched and recorded the lynchings on cell phone cameras.

The killings were in the town of Samanod, about 55 miles (90 kilometers) north of Cairo in the Nile Delta province of Gharbiya.

Mamdouh al-Muneer, spokesman for the Muslim Brotherhood group in the Gharbiya governorate, told The Associated Press that the lynchings followed a spate of rapes in the area. He said there have been a number of incidents in the past several months of girls being abducted while leaving school.

"Unfortunately, the police are completely out of the picture in Gharbiya. They are not comfortable with their position, with the president or with their role after the uprising," he said.

The Brotherhood is the country's dominant political group.

Egypt is currently mired in another wave of protests, clashes and unrest that have plagued the country since the ouster of authoritarian leader Hosni Mubarak in the pro-democracy uprising two years ago.

This wave of unrest has also engulfed the nation's police force. Thousands of officers and low-ranking policemen have broken ranks, staging protests and waging strikes against what they say is the politicization of the force by President Mohammed Morsi, who came from the Muslim Brotherhood, and his interior minister.

The state-run newspaper Ahram reported on its website that the events in Samanod began when the two men were dragged in the street after being caught "red-handed" trying to steal a motorized rickshaw. Witnesses said they were also accused of kidnapping a girl inside the rickshaw, but that she escaped unharmed.

A witness said they were beaten but still alive before they were strung up from the rafters of an open-air bus station. Both were stripped down to their underwear.

Photographs from the scene show one of the bodies hanging with deep, bloody lacerations covering his back. From the front, one of the men's face is completely covered in blood. Other shots showed both hanging by their feet, bruised, cut and bleeding.

A photographer who witnessed the scene told the AP that some in the crowd threatened to kill him if he took pictures of the lynchings with his professional camera.

He said that women and children were in the crowd of about 3,000 watching the lynchings, some from their balconies overlooking the scene, and some chanted in support "kill them!"

Afterward, residents took their bodies and dumped them on the doorstep of a nearby police station, according to witnesses.

Other photographs show the men lying on the ground dead in their underwear, with ropes around their feet.

Their bodies are covered in dirt, bruises, blood and lacerations as a group of men gathered around them. One man in the angry crowd grasped a knife in one fist and another held up a bloodied wooden stick.

Security officials said some in the crowd tried to help free the two men but were pushed back by others.

The bodies were later taken to the morgue for identification, according to security officials who spoke on condition of anonymity because they were not authorized to speak to the media.

Residents also threatened to lynch another two men accused of involvement in attacks on girls.

Witnesses said they were bracing for possible blood feuds between residents of Samanod, where the attack took place, and the nearby village of Mahallahit Ziyad, where the two men killed were from.

Ahram reported that police could not reach the site of the hangings because angry microbus drivers had cut off all the major roads of the nearby city of Mahalla to protest a shortage of diesel fuel, one of Egypt's many crises. Earlier in the day, residents there also burned tires and set up roadblock along a main train track to protest the fuel shortages.

"The lack of security has created a sense of terror here," one witness said, speaking on condition of anonymity for fear of reprisal. "The entire area is shut down because of protests against the fuel shortages."

Citizens have grown bolder in taking matters into their own hands following the 2011 uprising. The country's once powerful and feared police force was left weakened after the revolt.

Thousands of policemen are now on strike to demand better working conditions and they also refuse to confront widespread protests against President Morsi's leadership.

Some of the striking police officers allege that Morsi's Muslim Brotherhood is attempting to control them. The Brotherhood denies that.

Al-Muneer, the Brotherhood spokesman in Gharbiya, accused some policemen of hoping for a collapse of security to pave the way for the old regime to return to power. That same accusation has been leveled at the police repeatedly, both in the midst of the uprising and the aftermath.

He said the Brotherhood fully rejects the killings and said citizens should have arrested the two but then handed them over to police.

The attorney general's call for citizen arrests a week ago was prompted by the police strike and deteriorating security. Opponents of his call fear that this is a prelude to the substitution of police by militias, including those belonging to other Islamist groups allied with Morsi and the Islamic fundamentalist Brotherhood.

Interior Minister Mohammed Ibrahim, who oversees the country's police, met with officers and low-ranking policemen to hear their demands on Sunday.

Two days earlier, Morsi attended traditional Islamic prayers at a Cairo-based camp for riot police. He praised the force despite public criticism over their violent response to anti-government demonstrations.

Morsi is facing an onslaught of challenges, from the police strikes to an increasing number of violent sexual attacks on women to mounting diesel shortages that have crippled daily life for millions in Egypt.

And although vigilante killings are not frequent in Egypt, there have been similar attacks in the past two years.

In 2012 in northern Sharqiya province, police said relatives of a man who was killed when muggers tried to steal his car lynched one of the thieves. They then burned his body while it hung from a light pole.

Another case that year was in the Nile Delta province of Mansoura, where relatives of a victim took justice into their own hands and lynched two suspected killers.

Anger at Morsi was on display again Sunday, when protesters took their demands to the Brotherhood's doorstep. Hundreds clashed with police who fired tear gas at the crowd outside of the Islamist group's Cairo headquarters.

The crowd was responding to an assault on journalists, who claimed they were attacked by Brotherhood members Saturday evening during coverage of a meeting.

The journalists said that after a group of activists sprayed anti-Brotherhood graffiti on the ground outside the group's Cairo headquarters, the Brotherhood guards attacked with sticks and chains.

Brotherhood spokesman Mahmoud Ghozlan said in a statement that guards outside the building were provoked and insulted by the activists and journalists.

Many of the group's offices were attacked across the country in December during violent protests over the drafting of the constitution.

Dozens of journalists rallied outside their syndicate in the capital Cairo against the incident.

Diaa Rashwan, the newly elected head of the syndicate who replaced a figure considered by most journalists as pro-Brotherhood, said he would file a lawsuit against the Brotherhood spokesman for suggesting that journalists had incited the violence.

The opposition party Al-Dustor, led by Nobel laureate Mohamed ElBaradei, blamed the Brotherhood's leadership for allegedly encouraging "militias" loyal to the group to join the fight.

There were clashes on Saturday during protests against Morsi and the Brotherhood during the president's trip to the impoverished governorate of Sohag. The presidency on Sunday denied that opposition protesters had tried to storm the hall where Morsi had been speaking, despite video that showed the attempt.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/cae69a7523db45408eeb2b3a98c0c9c5/Article_2013-03-17-Egypt/id-299e2ffa3e21409ba0472f8e6713ca17

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Wednesday, March 13, 2013

Nearly a third of antibiotic prescriptions for dialysis patients inappropriate

Nearly a third of antibiotic prescriptions for dialysis patients inappropriate [ Back to EurekAlert! ] Public release date: 12-Mar-2013
[ | E-mail | Share Share ]

Contact: Kate Enos
kenos@gymr.com
202-745-5071
Society for Healthcare Epidemiology of America

Dialysis patients face increased risk of antibiotic-resistant infections

Patients who receive hemodialysis are at a significant risk of developing infections, a leading cause of hospitalization and death in this patient population. A new study highlights the need to improve antibiotic use in outpatient dialysis facilities as data shows nearly a third of antibiotic prescriptions are deemed inappropriate. The study is published in the April issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

The United States Renal Data System reported that from 1993 to 2010, the number of hospitalizations due to infection rose by more than 45 percent in chronic hemodialysis (CHD) patients. They noted that patients receiving dialysis were admitted to the hospital two times per year for an average of 12 days, and 36 percent were readmitted within 30 days. During hospitalizations, CHD patients appeared to have contributed to the spread and acquisition of multi-drug resistant organisms (MDROs) among other hospitalized patients.

"The high prevalence of MDROs harbored by CHD patients compared to that in lower-risk populations, compounded by the rising rate of infections, emphasizes the need to reduce the emergence and spread of MDROs in this population," said Graham Snyder, lead researcher in the study. "Despite the high prevalence, there are limited data pertaining to antibiotic use in outpatient hemodialysis units."

Researchers from Boston, in collaboration with the Centers for Disease Control and Prevention, calculated the total antibiotic use over a retrospective 35-month period, and additionally followed 278 patients during a 12-month period and analyzed the antibiotics these patients received at two outpatient dialysis units.

Inappropriate administration of antibiotics was defined as giving antibiotics when criteria for infection based on national guidelines published by major infectious diseases and nephrology societies were not met; failing to use a more narrow-spectrum antimicrobial agent based on culture results; and using antimicrobial prophylaxis when indications for surgical prophylaxis were not met.

A total of 1,003 antimicrobial doses were administered during the 12-month study period. Nearly one in three patients received at least one antimicrobial dose.

Of the 1,003 doses of antibiotics, nearly one-third of antibiotic doses were classified as inappropriate. The most common reason for inappropriate administration was that conditions for infection were not met. Blood-stream infections were the most common misdiagnosed infection based on unmet criteria.

The second most common reason for inappropriate antibiotic administration was using a potent antibiotic when an equally efficacious and available antibiotic less likely to promote resistant bacteria could have been used. The antibiotics most likely to be inappropriately prescribed included vancomycin, which is commonly used for skin-related infections and infections associated with the vascular access used for dialysis, and third or fourth generation cephalosporins, which are used for a broad array of infections.

"Since antimicrobial exposure is the main risk factor for the emergence and spread of MDROs, minimizing inappropriate antimicrobial use is imperative. The findings of this study provide important information toward minimizing inappropriate antimicrobial use in outpatient dialysis units. By identifying key areas, including best practices in documentation and classification of infections, and a focus on antibiotic de-escalation, this study should lead to future antimicrobial stewardship interventions tailored to outpatient dialysis units," said Snyder.

###

Graham M. Snyder, Priti R. Patel, Alexander J. Kallen, James A. Strom, J. Kevin Tucker, and Erika M. C. D'Agata. "Antimicrobial Use in Outpatient Hemodialysis Units." Infection Control and Hospital Epidemiology 34:4 (April 2013).

Published through a partnership between the Society for Healthcare Epidemiology of America and The University of Chicago Press, Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 15 out of 140 journals in its discipline in the latest Journal Citation Reports from Thomson Reuters.

SHEA is a professional society representing more than 2,000 physicians and other healthcare professionals around the world with expertise in healthcare epidemiology and infection prevention and control. SHEA's mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. The society leads this field by promoting science and research and providing high-quality education and training in epidemiologic methods and prevention strategies. SHEA upholds the value and critical contributions of healthcare epidemiology to improving patient care and healthcare worker safety in all healthcare settings. Visit SHEA online at http://www.shea-online.org, on Twitter @SHEA_Epi and Facebook at http://www.facebook.com/SHEApreventingHAIs.



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Nearly a third of antibiotic prescriptions for dialysis patients inappropriate [ Back to EurekAlert! ] Public release date: 12-Mar-2013
[ | E-mail | Share Share ]

Contact: Kate Enos
kenos@gymr.com
202-745-5071
Society for Healthcare Epidemiology of America

Dialysis patients face increased risk of antibiotic-resistant infections

Patients who receive hemodialysis are at a significant risk of developing infections, a leading cause of hospitalization and death in this patient population. A new study highlights the need to improve antibiotic use in outpatient dialysis facilities as data shows nearly a third of antibiotic prescriptions are deemed inappropriate. The study is published in the April issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

The United States Renal Data System reported that from 1993 to 2010, the number of hospitalizations due to infection rose by more than 45 percent in chronic hemodialysis (CHD) patients. They noted that patients receiving dialysis were admitted to the hospital two times per year for an average of 12 days, and 36 percent were readmitted within 30 days. During hospitalizations, CHD patients appeared to have contributed to the spread and acquisition of multi-drug resistant organisms (MDROs) among other hospitalized patients.

"The high prevalence of MDROs harbored by CHD patients compared to that in lower-risk populations, compounded by the rising rate of infections, emphasizes the need to reduce the emergence and spread of MDROs in this population," said Graham Snyder, lead researcher in the study. "Despite the high prevalence, there are limited data pertaining to antibiotic use in outpatient hemodialysis units."

Researchers from Boston, in collaboration with the Centers for Disease Control and Prevention, calculated the total antibiotic use over a retrospective 35-month period, and additionally followed 278 patients during a 12-month period and analyzed the antibiotics these patients received at two outpatient dialysis units.

Inappropriate administration of antibiotics was defined as giving antibiotics when criteria for infection based on national guidelines published by major infectious diseases and nephrology societies were not met; failing to use a more narrow-spectrum antimicrobial agent based on culture results; and using antimicrobial prophylaxis when indications for surgical prophylaxis were not met.

A total of 1,003 antimicrobial doses were administered during the 12-month study period. Nearly one in three patients received at least one antimicrobial dose.

Of the 1,003 doses of antibiotics, nearly one-third of antibiotic doses were classified as inappropriate. The most common reason for inappropriate administration was that conditions for infection were not met. Blood-stream infections were the most common misdiagnosed infection based on unmet criteria.

The second most common reason for inappropriate antibiotic administration was using a potent antibiotic when an equally efficacious and available antibiotic less likely to promote resistant bacteria could have been used. The antibiotics most likely to be inappropriately prescribed included vancomycin, which is commonly used for skin-related infections and infections associated with the vascular access used for dialysis, and third or fourth generation cephalosporins, which are used for a broad array of infections.

"Since antimicrobial exposure is the main risk factor for the emergence and spread of MDROs, minimizing inappropriate antimicrobial use is imperative. The findings of this study provide important information toward minimizing inappropriate antimicrobial use in outpatient dialysis units. By identifying key areas, including best practices in documentation and classification of infections, and a focus on antibiotic de-escalation, this study should lead to future antimicrobial stewardship interventions tailored to outpatient dialysis units," said Snyder.

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Graham M. Snyder, Priti R. Patel, Alexander J. Kallen, James A. Strom, J. Kevin Tucker, and Erika M. C. D'Agata. "Antimicrobial Use in Outpatient Hemodialysis Units." Infection Control and Hospital Epidemiology 34:4 (April 2013).

Published through a partnership between the Society for Healthcare Epidemiology of America and The University of Chicago Press, Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 15 out of 140 journals in its discipline in the latest Journal Citation Reports from Thomson Reuters.

SHEA is a professional society representing more than 2,000 physicians and other healthcare professionals around the world with expertise in healthcare epidemiology and infection prevention and control. SHEA's mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. The society leads this field by promoting science and research and providing high-quality education and training in epidemiologic methods and prevention strategies. SHEA upholds the value and critical contributions of healthcare epidemiology to improving patient care and healthcare worker safety in all healthcare settings. Visit SHEA online at http://www.shea-online.org, on Twitter @SHEA_Epi and Facebook at http://www.facebook.com/SHEApreventingHAIs.



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Source: http://www.eurekalert.org/pub_releases/2013-03/sfhe-nat031213.php

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