bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a new Rapid Antimicrobial Susceptibility system for Gram-negative and Gram-positive bloodstream infections: Speed and accuracy of Alfred 60 AST
Authors: Anton-Vazquez Vanesa , Samuel Adjepong , Cristina Suarez , Timothy Planche
Published: November 2019

Background: Blood stream infections (BSIs) are a major cause of morbidity and mortality. The time from taking blood cultures to obtain results of antibiotic sensitivity can be up to five days which impacts patient care. The Alfred 60 AST™ can reduce laboratory time from positive culture bottle to susceptibility results from 16-25 hours to 5-6 hours, transforming patient care.

Objective: To evaluate the diagnostic accuracy of a rapid antimicrobial susceptibility system, the Alfred 60 AST™, in clinical isolates from patients with BSIs and confirm time to results.

Methods: 301 Gram-negative and 86 Gram-positive isolates were analysed directly from positive blood culture bottles following Gram staining. Antimicrobial susceptibility results and time-to-results obtained by rapid Alfred 60 AST system and BD Phoenix were compared .

Results : A total of 2,196 antimicrobial susceptibility test results (AST) were performed: 1,863 Gram-negative and 333 Gram-positive. AST categorical agreement (CA) for Alfred 60 AST™ was 95% (1772/1863) for Gram-negative and 89% (295/333) for Gram-positive isolates. Gram-negative CA: ampicillin 96% (290/301); ciprofloxacin 95% (283/297); ceftriaxone 96% (75/78); meropenem 97% (288/297); piperacillin-tazobactam 95% (280/295); gentamicin 94% (279/297) and amikacin 93% (277/298). The median time to susceptibility resultsfrom blood culture flagging positive was 6.3 h vs 20 h ( p<0.01 ) for Alfred system vs BD Phoenix™.

Conclusion: Alfred 60 AST system greatly reduced time to antimicrobial susceptibility results in Gram-negative and Gram-positive BSIs with good performance and cost, particularly for Gram-negative bacteraemia.

Keywords: Rapid diagnostics. Bloodstream infection. Bacteraemia. Antimicrobial susceptibility testing. Gram-negative bacteria. Gram-positive bacteria
High index of suspicion for brucellosis in a highly cosmopolitan city in southern China
Authors: Ye Hai-Yan , Xing Fan-Fan , Yang Jin , Lo Simon Kam-Fai , Lau Ricky Wing-Tong , Chen Jonathan Hon-Kwan , Chiu Kelvin Hei-Yeung , Yuen Kwok-Yung
Published: November 2019

Background: Brucellosis is one of the most widespread zoonosis in the world. In China, 90% of human brucellosis occurs in six northern agricultural provinces. However, there is a recent increase in the trend of human brucellosis in southern provinces with limited cases reported in the literature. Our study aims to describe the clinical features and epidemiology of brucellosis in a tertiary hospital in southern China.
Methods: A retrospective case series of brucellosis was conducted between January 1, 2014 and October 31. 2018. Cases were identified based on positive Brucella serology by tube agglutination test, or positive culture from clinical specimen identified by Vitek 2 and MALDL-TOF MS. Clinical details of brucellosis including patients’ occupation, risk factors, and complications were analyzed. Clinical characteristics between patients from Guangdong and other provinces were also compared.
Results: A total of 13 cases of laboratory-confirmed brucellosis were identified. 7 (53.8%) of the patients were male, 6 (46.2%) were female, with age ranging from 29 to 73 years old (median age: 51 years). Five patients (38.5%) were from Guangdong province, while the remaining patients (61.5%) were from other provinces. The commonest risk factors of acquisition were consumption of undercooked meat and goat placenta. Patients from Guangdong province were found to be more likely to have prior placenta consumption and handling of animal meat. The commonest clinical presentations were fever, osteoarticular pain, urinary symptoms, splenomegaly, and lymphadenopathy. Spondylodiscitis/ peripheral joint arthritis (5 patients, 38.5%) was the most prevalent complication, while extra-osteoarticular complications including abdominal aortitis, hepatosplenic abscess, chest wall abscess, and epididymo-orchitis were observed in 4 other patients. Furthermore, it was demonstrated that MALDI-TOF MS is reliable in Brucella identification after additional of reference spectra with standard Brucella strain.
Conclusions: Brucellosis, previously thought to be only found in northern China, is now increasingly seen in highly cosmopolitan part of southern China. MALDI-TOF MS in hospitals in China should include reference spectra with standard Brucella strain to aid bacterial identification in routine clinical practice. In addition to tuberculosis, typhoid fever and typhus, brucellosis should be considered in patients with fever of unknown origin in this locality.
Comprehensive gene expression analysis for exploring the association between glucose metabolism and differentiation of thyroid cancer
Authors: Suh Hoon Young , Choi Hongyoon , Paeng Jin Chul , Cheon Gi Jeong , Chung June-Key , Kang Keon Wook
Published: November 2019

Background: The principle of loss of iodine uptake and increased glucose metabolism according to dedifferentiation of thyroid cancer is clinically assessed by imaging. Though these biological properties are widely applied to appropriate iodine therapy, the understanding of the genomic background of this principle is still lacking. We investigated the association between glucose metabolism and differentiation in advanced thyroid cancer as well as papillary thyroid cancer (PTC). Methods: We used RNA sequencing of 505 patients with PTC obtained from the Cancer Genome Archives and microarray data of poorly-differentiated and anaplastic thyroid cancer (PDTC/ATC). The signatures of GLUT and glycolysis were estimated to assess glucose metabolic profiles. The glucose metabolic profiles were associated with tumor differentiation score (TDS) and BRAFV600E mutation status. In addition, survival analysis of glucose metabolic profiles was performed for predicting recurrence-free survival. Results: In PTC, the glycolysis signature was positively correlated with TDS, while the GLUT signature was inversely correlated with TDS. These correlations were significantly stronger in the BRAFV600E negative group than the positive group. Meanwhile, both GLUT and glycolysis signatures were negatively correlated with TDS in advanced thyroid cancer. The high glycolysis signature was significantly associated with poor prognosis in PTC in spite of high TDS. The glucose metabolic profiles are intricately associated with tumor differentiation in PTC and PDTC/ATC. Conclusions: As glycolysis was an independent prognostic marker, we suggest that the glucose metabolism features of thyroid cancer could be another biological progression marker different from differentiation and provide clinical implications for risk stratification.
Mental distress, perceived need and barriers to receive professional mental health care among university students
Authors: Negash Assegid , Ahmed Matloob , Medhin Girmay , Wondimagegn Dawit , Araya Mesfin
Published: November 2019

Context: There is limited evidence on the extent of the perceived need for professional mental health care and barriers to the delivery of mental distress services among university students in low and middle-income countries. Objective: The current study was designed to assess the prevalence of mental distress, perceived need for professional mental health care and barriers to the delivery of the service for regular undergraduate university students. Methods: A multi-stage sampling technique was used to recruit 1135 regular undergraduate university students. Symptoms of mental distress were evaluated using the Self-Reported Questionnaire (SRQ-20) and a score of eight and above was used to identify positive cases. The perceived need for professional mental health care was assessed using one question with binary responses, whereas barriers to mental health care were assessed using Barriers to Access to Care Evaluation (BACE-30) tool. The association of demographic variables with total mean scores of BACE-III sub-scales was modeled using multiple linear regression. Results: The prevalence of mental distress symptoms was 34.6% and the perceived need for professional mental health care was 70.5%. The top five barriers to receiving professional mental health service were (a) thinking the problem would get better by itself, (b) being unsure where to go to get professional care, (c) wanting to solve the problem by own, (d) denying mental health problem, and (e) preferring to get alternative forms of mental care. Conclusions: The high prevalence of mental distress, mental health care gap, and the report of barriers to professional mental health care among Ethiopian regular undergraduate students is a call for action. Keywords: Mental distress, Perceived need, Barrier, and Professional mental health care.
The long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy combined with radical cystectomy versus radical cystectomy alone for bladder cancer: a propensity-score matching study
Authors: Wahafu Wasilijiang , Liu Sai , Xu Wenbin , Wang Mengtong , He Qingbao , Song Liming , Wang Mingshuai , Yang Feiya , Hua Lin , Niu Yinong , Xing Nianzeng
Published: November 2019

Background:
Bladder cancer is a complex disease associated with high morbidity and mortality. Management of bladder cancer before radical cystectomy continues to be controversial. We compared the long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy (IAC)versus no IAC (NIAC) before radical cystectomy (RC) for bladder cancer.

Methods:
We performed a retrospective review of patients who underwent either one-shot IAC or NIAC before RC between October 2006 and November 2015. A propensity-score matching (1:3) was performed based on key characters. The Kaplan-Meier method was utilized to estimate survival probabilities, and the log-rank test was used to compare survival outcomes between different groups. A multivariable Cox proportional hazard model was used to estimate survival outcomes.

Results:
Twenty-six patients were treated using IAC before RC, and 123 NIAC patients also underwent RC. After matching, there was no significant difference between groups in baseline characteristics, perioperative variables, complication outcomes or tumor characteristics. Compared with clinical tumor stages, pathological tumor stages demonstrated a significant decrease (P=0.002) in the IAC group. There was no significant difference in overall survival (OS, p=0.354) or cancer-specific survival (CSS, p=0.439) between the groups. Among all patients, BMI significantly affected OS (p=0.004), and positive lymph nodes (PLN) significantly affected both OS (p＜0.001) and CSS(p=0.010).

Conclusions:
One-shot neoadjuvant IAC before RC shows safety and tolerability and provides a significant advantage in pathological downstaging but not in OS or CSS. Further study of neoadjuvant combination therapeutic strategies with RC is needed.
Association between anemia and frailty in 13,175 community-dwelling adults aged 50 years and older in China
Authors: Ruan Ye , Guo Yanfei , Kowal Paul , Lu Ye , Liu Chazhen , Sun Shuangyuan , Huang Zhezhou , Zheng Yang , Wang Wenjing , Li Gan , Shi Yan , Wu Fan
Published: November 2019

Background: Anemia and frailty contribute to poor health outcomes in older adults; however, most current research in lower income countries has concentrated on anemia or frailty alone rather than in combination. The aim of the present study was to investigate the association between anemia and frailty in community-dwelling adults aged 50 years and older in China. Methods: The study population was sourced from the 2007/10 SAGE China Wave 1. Anemia was defined as hemoglobin less than 13g/dL for men and less than 12g/dL for women. A Frailty Index (FI) was compiled to assess frailty. The association between anemia and frailty was evaluated using a 2-level hierarchical logistic model. Results: The prevalence of anemia was 31.0% (95%CI: 28.4%, 33.8%) and frailty 14.7% (95%CI: 13.5%, 16.0%). In the univariate regression model, presence of anemia was significantly associated with frailty (OR=1.62, 95% CI: 1.39, 1.90) and the effect remained consistent after adjusting for various potential confounding factors including age, gender, residence, education, household wealth, fruit and vegetable intake, tobacco use, alcohol comsumption and physical activity (adjusted OR =1.31, 95% CI:1.09, 1.57). Each 1 g/dL increase in hemoglobin concentration was associated with 4% decrease in the odds of frailty after adjusting for several confounding variables (adjusted OR =0.96, 95% CI: 0.93, 0.99). Conclusion: Anemia and low hemoglobin concentrations were significantly associated with frailty. Therefore, health care professionals caring for older adults should increase screening, assessment of causes and treatment of anemia as one method of avoiding, delaying or even reversing frailty.
Diagnostic and prognostic value of interleukin-6, pentraxin 3, and procalcitonin levels among sepsis and septic shock patients: a prospective controlled study according to the Sepsis-3 definitions
Authors: Song Juhyun , Park Dae Won , Moon Sungwoo , Cho Han-Jin , Park Jong Hak , Seok Hyeri , Choi Won Seok
Published: November 2019

Background: This study investigated the clinical value of interleukin-6 (IL-6), pentraxin 3 (PTX3), and procalcitonin (PCT) in patients with sepsis and septic shock diagnosed according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).
Methods: Serum levels of IL-6, PTX3, and PCT were measured in 142 enrolled subjects (51 with sepsis, 46 with septic shock, and 45 as controls). Follow-up IL-6 and PTX3 levels were measured in patients with initial septic shock within 24 hours of hospital discharge. Optimal cut-off values were determined for sepsis and septic shock, and prognostic values were evaluated.
Results: Serum IL-6 levels could discriminate sepsis (area under the curve [AUC], 0.83–0.94, P < 0.001; cut-off value, 52.60 pg/mL, 80.4% sensitivity, 88.9% specificity) from controls and could distinguish septic shock (AUC, 0.71-0.89; cut-off value, 348.92 pg/mL, 76.1% sensitivity, 78.4% specificity) from sepsis. Twenty-eight-day mortality was significantly higher in the group with high IL-6 (≥ 348.92 pg/mL) than in the group with low IL-6 (< 348.92 pg/mL) (P = 0.008). IL-6 was an independent risk factor for 28-day mortality among overall patients (hazard ratio, 1.0004; 95% confidence interval, 1.0003–1.0005; p = 0.024). In septic shock patients, both the initial and follow-up PTX3 levels were consistently significantly higher in patients who died than in those who recovered (initial p = 0.004; follow-up P < 0.001).
Conclusions: The diagnostic and prognostic value of IL-6 was superior to those of PTX3 and PCT for sepsis and septic shock.
L-3-n-butylphthalide attenuates inflammation and brain edema in rat intracerebral hemorrhage model
Authors: Zeng Zhou , Gong Xiyu , Hu Zhiping
Published: November 2019

Background：Previous studies have shown that L-3-n-butylphthalide(NBP), which is a compound found in Apium graveolens Linn seed extracts, could have therapeutic effects on acute ischemic stroke through anti-inflammation and by reducing brain edema. The pathological inflammatory pathways and consequent brain edema in intracerebral hemorrhage (ICH) share some characteristics with ischemic stroke. Methods：We hypothesized that NBP has anti-inflammatory and therapeutic effects on rats with ICH. ICH was induced by an infusion of bacterial collagenase type IV into the unilateral striatum of anesthetized rats. The therapeutic effect of NBP was measured by assessing neurological function, brain water content, blood-brain barrier permeability, and expression of tumor necrosis factor-alpha (TNF-α) and matrix metalloproteinase-9 (MMP-9) around the hematoma 48 hours after surgery. Magnetic resonance imaging (MRI) was performed 4 and 48 hours after ICH induction, and ICH-induced injured area volumes were measured using T2-weighted images. Results： The NBP treatment group performed better in the neurological function test than the vehicle group. Moreover, in comparison with the vehicle group, NBP group showed a lower expanded hematoma volume, brain water content, blood-brain barrier permeability, and TNF-α/ MMP-9 expression level. Conclusions：Our results suggested that NBP attenuates inflammation and brain edema in rat ICH model. Therefore, our findings also show the potential for clinical application of NBP in the treatment of ICH. Keywords: L-3-n-butylphthalide; intracerebral haemorrhage; blood-brain barrier; brain edema; anti-inflammation
Double-Chamber Syringe Versus Classical Syringes For Peripheral Intravenous Drug Administration And Catheter Flushing: A Study Protocol For A Randomised Controlled Trial
Authors: Parreira Pedro Miguel , Sousa Liliana B. , Marques Inês A. , Costa Paulo Santos , Braga Luciene M. , Cruz Arménio G. , Salgueiro-Oliveira Anabela
Published: November 2019

Background: The prevention of catheter-related complications is nowadays an important topic of research. Flushing the catheters is considered an important clinical procedure in preventing malfunction and several complications such as phlebitis or infection. Considering the latest guidelines of the Infusion Nurses Society, the flushing involves a pre and post-drug administration, requiring different syringes (with associated overall increased times of preparation/administration of intravenous medication by nurses, also increasing the need for manipulation of the venous catheter).
Methods: A multi-centre, two-arm randomised controlled trial with partially blinded outcome assessment, of 146 adult patients. After eligibility analysis and informed consent, participants will receive usual intravenous administration of drugs with subsequent flushing procedures, with the double-chamber syringe (arm A) or with the classical syringes (arm B). The outcomes assessment will be performed on a daily basis by the unblinded ward team, with the same procedures in both groups. Some main outcomes, such as phlebitis and infiltration, will also be evaluated by nurses from a blinded research team and registered once a day.
Discussion: The study outlined in this protocol will provide valuable insight regarding the effectiveness and safety of this new medical device. The development of a new medical device (dual-chamber syringe, for drug and flush solution) seems to be an important step to facilitate the nurses’ adoption of good clinical practices in intravenous procedures, reducing the catheter manipulations.
Near-infrared auto-fluorescence spectroscopy combining with Fisher’s linear discriminant analysis improves intraoperative real-time identification of normal parathyroid in thyroidectomy
Authors: Liu Junsong , Wang Xiaoxia , Wang Rui , Xu Chongwen , Zhao Ruimin , Li Honghui , Zhang Shaoqiang , Yao Xiaobao
Published: November 2019

Background To evaluate the efficacy of a sensitive, real-time tool for identification and protection of parathyroid glands during thyroidectomy. Methods Near-infrared (NIR) auto-fluorescence was measured intraoperatively from 20 patients undergoing thyroidectomy. To determine the accuracy of NIR identification furtherly, intraoperative fast frozen pathological examination and postoperative immunohistochemical staining were performed on the suspicious parathyroid glands and other neck tissues. Data were extracted for Fisher’s linear discriminant analysis. Results The auto-fluorescence intensity of parathyroid was significantly higher than that of thyroid, fat and lymph node. The peak intensity of auto-fluorescence from parathyroid was 5.55 times as much as that from thyroid at the corresponding wave number. Of the 20 patients, the parathyroid was accurately detected and identified in 19 patients by NIR system, compared with their histopathological results. One suspicious parathyroid tissue did not exhibit characteristic spectra, and finally was proved to be fat tissue by histopathological examination. The NIR auto-fluorescence method had a 100% (19/19) sensitivity of parathyroid glands identification and a high accuracy of 95% (19/20). The positive predictive value was 95%. The parathyroid gland has specific auto-fluorescence spectrum and can be separated from the other three types of tissues through the Fisher’s linear discriminant analysis with the average accuracy rate around 90%.Conclusions NIR auto-fluorescence spectoscopy can accurately identify normal parathyroid glands during thyroidectomy. The Fisher’s linear discriminant analysis demonstrated the specificity of the NIR auto-fluorescence of parathyroid tissue and its efficacy in parathyroid discrimination.
Occupational hazards in medium and large scale industrial sectors in Sri Lanka – Experience of a developing country
Authors: Arnold S.M. , Wickrematilake MSK , Fernando RMSD , Sampath HMRC , Karunapema RPP , Mahesh PKB , Munasinghe PM , Denawaka CJ
Published: November 2019

Objective Occupational hazards is an area where many countries have begun to pay more emphasis as it affects the health of many particularly in developing countries. However, documented literature is scarce in this regard although occupational hazards are common in workplaces. The study was carried out with the objective of describing the physical hazards and control measures adopted in the formal medium and large-scale industrial sector in Sri Lanka. Results Physical hazards detected in the workplaces were; excessive noise (78.3%), poor light (58%), increased temperature (65.2%), and poor ventilation (68.1%). Over 50% of large machinery and 33% of medium-scale machinery were not adequately guarded. Nearly 41% of the machinery were difficult to operate, of them 36.2% had controls in positions which were hard to reach. Of safety measures adopted, only 34.8% had proper demarcation of areas with 28.9% displaying safety signs. Housekeeping was poor in 59.4% and less than 40% had safe storage of raw materials and end products.
Glycogen synthase kinase 3 (GSK-3) controls T-cell motility and interactions with antigen presenting cells
Authors: Taylor Alison , Rudd Christopher E.
Published: November 2019

Objective: The threonine/serine kinase glycogen synthase kinase 3 (GSK-3) targets multiple substrates in T-cells, regulating the expression of Tbet and PD-1 on T-cells. However, it has been unclear whether GSK-3 can affect the motility of T-cells and their interactions with antigen presenting cells.
Results: Here, we show that GSK-3 can regulate T-cell motility. Inhibition of GSK-3, by small molecule SB415286, reduced T-cell motility in terms of distance and displacement. Although SB415286 reduced the number of contacts, the dwell times of established contacts did not differ between T-cells treated with SB415286. These data indicate show that the inhibition of GSK-3 can influence the motility of T-cells and interactions with other cells without affecting the dwell times of cells that make productive contacts.
Successful management of severe diabetic ketoacidosis in a patient with type 2 diabetes with insulin allergy: a case report
Authors: Nguyen Anh Dat , Luong Chinh Quoc , Chi Hieu Chu , Nguyen Van Khoa Dieu , Nguyen Chi Van , Nguyen Anh Tuan , Nguyen Quan Huu , Mai Ton Duy , Nguyen Dinh Van , Nguyen Bay Quang , Tran Thong Huu , Dao Phuong Viet , Nguyen Dat Tuan , Nguyen Nguyet Nhu , Do Son Ngoc
Published: November 2019

BackgroundDiabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that requires immediate treatment. Allergic reaction to insulin is rare, especially when using recombinant human insulin. The clinical presentation of insulin allergy can range from minor local symptoms to a severe generalized allergic reaction such as anaphylaxis. A limited number of cases have been reported on the treatment of severe DKA in patients with type 2 diabetes with insulin allergy. Here, we describe a patient with type 2 diabetes with insulin allergy in which severe DKA resolved after the initiation of continuous intravenous (IV) recombinant human insulin infusion.Case presentationA 58-year-old man with type 2 diabetes initiated subcutaneous insulin administration (SIA) after failure of oral antidiabetic treatment. Symptoms of an allergic reaction developed, including pruritic wheals appearing within 10 minutes of injection and lasting over 24 hours. Both skin prick and intradermal tests were positive with different types of insulin. Two days before admission, he stopped SIA because of allergic symptoms and then experienced weakness and upper abdominal pain. On admission, he was in severe metabolic acidosis with a pH of 6.984 and bicarbonate of 2.5 mmol/litre. The blood glucose level was 20.79 mmol/litre, BUN 4.01 mmol/litre, creatinine 128 µmol/litre, and urinary ketone 11.44 mmol/litre. Over 24 hours, metabolic acidosis was refractory to IV fluids, bicarbonate and potassium replacement, as well as haemodialysis. Ultimately, he received continuous IV recombinant human insulin infusion at a rate of 0.1 units/kg/hour, in combination with haemodiafiltration, and no further allergic reactions were observed. On day 5, ketonaemia and metabolic acidosis completely resolved. He had transitioned from IV insulin infusion to SIA on day 14. He was discharged on day 21 with SIA treatment. Three months later, he had good glycaemic control but still had allergic symptoms at the insulin injection sites.ConclusionsIn this patient, SIA caused an allergic reaction, in contrast to continuous IV insulin infusion for which allergic symptoms did not appear. Continuous IV recombinant human insulin infusion in combination with haemodiafiltration could be an option for the treatment of severe DKA in patients with diabetes with insulin allergy.
Distribution and antimicrobial resistance profiles of bacterial species in stray cats, hospital-visiting cats, and veterinary staff in South Korea
Authors: Jung Woo Kyung , Shin Sook , Park Young Kyung , Lim Suk-Kyung , Moon Dong-Chan , Park Kun Taek , Park Yong Ho
Published: November 2019

Background

Antimicrobial resistance is becoming increasingly important in both human and veterinary medicine. According to the One Health concept, an important step is to monitor the resistance patterns of pathogenic bacteria. In this study, the antimicrobial susceptibility patterns and trends of bacteria isolated from stray cats, hospital-visiting cats, and veterinary staff in South Korea between 2017 and 2018 were investigated.

Results

The minimum inhibitory concentrations of different antibiotics for Staphylococcus spp., Enterobacteriaceae , and Enterococcus spp. were determined to establish representatives of different antibiotic classes relevant for treatment or surveillance. For Coagulase-positive and Coagulase-negative Staphylococci, resistance to fluoroquinolones was below 13%, but resistance to ampicillin and penicillin was high (20–88%). A total of 9.5%, 12.1%, and 40.3% of staphylococcal isolates from stray cats, hospital-visiting cats, and veterinary staff, respectively, were confirmed to be mecA positive. For Enterobacteriaceae , resistance to carbapenems, fluoroquinolones, and 3rd generation cephalosporins was low (0–11.1%). The Enterococcus spp. isolates showed no resistance to vancomycin. The antimicrobial resistance rates of the Staphylococcus spp. and Enterobacteriaceae isolates from stray cats were usually lower than those of isolates from hospital-visiting cats and veterinary staff, but the Enterococcus spp. isolates revealed the opposite. Thus, the antimicrobial resistance varied across bacterial species according to the source from which they were isolated.

Conclusions

Resistance to critically important compounds were low. These results emphasize the fact that more attention should be paid to the use of antimicrobials and the occurrence of antimicrobial resistance in cats.
Effects of sample age on data quality from targeted sequencing of museum specimens: what are we capturing in time?
Authors: McGaughran Angela
Published: November 2019

The authors have withdrawn this preprint from Research Square
Durvalumab in frail and elder patients with stage four NSCLC: Study protocol of the randomized phase II DURATION trial
Authors: Kuon Jonas , Hommertgen Adriane , Krisam Johannes , Lasitschka Felix , Stenzinger Albrecht , Bozorgmehr Farastuk , Maenz Martin , Kieser Meinhard , Schneider Marc , Thomas Michael
Published: November 2019

Background

Elderly patients represent a major fraction of non-small cell lung cancer (NSCLC) patients in routine clinical practice, yet are underrepresented in clinical trials. In particular, data regarding efficacy and safety in frail or elderly patients with respect to immunotherapy is lacking. Importantly, immunosenescence in elderly patients might interfere with activities of immune-modulating drugs such as PD-1/PD-L1 inhibitors. Thus, there is an urgent need to assess safety and efficacy of such inhibitors in this group.

Methods/design

In this prospective, open label, treatment stratified, and randomized phase II study, 200 patients with stage IV NSCLC amenable at least to single-agent chemotherapy. Eligible patients must be 70 years or older and/or “frail” (Charlson Comorbidity Index >1), or have a restricted performance score (ECOG >1). Patients are stratified according to modified Cancer and Age Research Group (CARG) Score: ”fit” patients are allocated to combination chemotherapy (carboplatin/ nab -paclitaxel), “less fit” patients receive single-agent chemotherapy (gemcitabine or vinorelbine). After allocation to strata, patients are randomized 1:1 to receive either 4 cycles of chemotherapy or 2 cycles of chemotherapy followed by 2 cycles of durvalumab and subsequent maintenance treatment with durvalumab every 4 weeks. The primary endpoint is the rate of treatment related grade III/IV adverse events (CTCAE V4.03). As secondary endpoints, progression-free survival according to RECIST 1.1, response rate, overall survival, descriptive subgroup analyses according to PD-L1 expression, and quality of life are addressed. Geriatric screening assessments and functional tests will be performed to complete the phenotyping of a potential “frail” and “elderly” patient cohort (G8-questionnaire, Timed up & go test, 6MWT). The trial is accompanied by a biomaterial repository (FFPE-tissue, Blood samples) to explore potential biomarkers.

Discussion

The DURATION trial will prospectively investigate the safety and tolerability of anti-PD-L1 treatment with durvalumab after chemotherapy in elderly and frail patients and thereby provide new insights into the effect of PD-L1 blockade and the impact of immunosenescence in this cohort of patients.
The effects of washing without water versus the traditional bed bath with water and soap on comfort and physical demands: protocol of a cross-over randomized trial
Authors: Groven Fabian , Zwakhalen Sandra , Odekerken-Schröder Gaby , Tan Frans , Hamers Jan
Published: November 2019

Background The traditional bed bath with water and soap often leads to emotional and physical discomfort among bedridden patients. In addition, the traditional bed bath is physically demanding for nurses. The washing without water concept is increasingly used in healthcare to bathe bedridden patients and is likely to affect emotional and physical comfort dimensions. This protocol describes a study that will assess how washing without water performs compared to the traditional bed bath regarding emotional and physical comfort experienced by the bathed bedridden person and regarding physical demands for the provider of the bed bath.Methods This study uses a randomized cross-over design in which nursing students will simulate the bed baths of patients in a laboratory setting. Students will be randomly allocated to a patient or a nurse group and consequently will respectively receive or provide two bed baths: the traditional bed bath and a washing without water bed bath. The order of the bed baths will be randomly determined. Students will receive instructions about the steps of the bathing methods and case descriptions about their role as a patient or nurse. Questionnaires will be used before and after each bed bath to collect data for the primary outcomes of experienced emotional and physical comfort (among students receiving the bed bath) and physical demands (among students providing the bed bath); and, for secondary outcomes related to bed bathing preferences, grades given to the bathing methods and perceived importance of the bed bath. Differences between the two bathing methods will be analyzed, taking the order of the bed baths into account.Discussion This study will add to the scientific knowledge of the washing without water bed bath, for which evidence on comfort is currently lacking. If differences in comfort between washing without water and the traditional bed bath are detected among nursing students, it is likely these differences will also be present among actual patients and nurses, as generally, patients are more vulnerable and nurses spend more time bathing patients compared to students.
Early gastrografin administration after ileus tube insertion does not improve the clinical outcomes in patients with adhesive small bowel obstruction
Authors: Tamura Yu , Esaki Mitsuru , Ichijima Ryoji , Suzuki Sho , Iwamoto Maho , Moriyama Mitsuhiko , Gotoda Takuji
Published: November 2019

Background

Gastrointestinal decompression through ileus tube is useful for the treatment of adhesive small bowel obstruction (ASBO). Gastrografin administration through the ileus tube is performed if decompression therapy fails to relieve obstruction. However, the appropriate timing of gastrografin administration is unclear. The present study aimed to evaluate the efficacy of gastrografin administration within 48 h after admission.Methods

This retrospective study used the data of patients with ASBO admitted to our hospital between January 2014 and August 2018. The study included those who underwent ileus tube intubation but did not achieve obstruction relief for over 24 h after admission. The patients were classified into the following two groups: those treated with gastrografin administration within 48 h after admission (EGA group) and those treated without gastrografin administration within 48 h after admission (non-EGA [NEGA] group). Propensity-score matching was performed to compensate for confounding differences between the groups. The short-term outcomes of therapeutic effectiveness such as the rate of surgery avoidance, the period until the first stool, period of ileus tube intubation, and total period of hospital admission were evaluated and compared between the two groups.Results

This study included 152 patients: 67 in the EGA group and 85 in the NEGA group. Fifty-five pairs were matched with similar background characteristics. After matching, the rates of surgery avoidance were 89.1% (49/55) and 94.5% (52/55) in the matched EGA and NEGA groups, respectively (P = 0.49). Although the median insertion days of ileus tube in the NEGI group were significantly lesser than those in the EGA group (7 [5–9] vs. 5 [4.5–7], P = 0.017), other therapeutic outcomes were not significantly different between the two groups. In the non-EGA group, 5.5% (3/55) achieved obstruction relief without gastrografin administration.Conclusions

Early gastrografin administration might not be superior to non-early gastrografin administration in clinical outcomes of patients with ASBO. Follow-up by decompression with ileus tube for at least 48 h after admission is required in patients with ASBO, which may avoid unnecessary gastrografin administration and consequently reduce the total cost of treatment.
An Evaluation of the Zambia Sentinel Surveillance System, 2011-2017
Authors: simusika paul , Tempia Stefano , Chentulo Edward , Polansky Lauren , Mazaba Mazyanga , Ndumba Idah , Mbewe Quinn K , Monze Mwaka Anna
Published: November 2019

Background Over the past decade, influenza surveillance has been established in several African countries including Zambia. However, information on the on data quality and reliability of established influenza surveillance systems in Africa are limited. Such information would enable countries to assess the performance of their surveillance systems, identify shortfalls for improvement and provide evidence of data reliability for policy making and public health interventions. Methods We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza surveillance system (ISS) in Zambia during 2011-2017 using 9 attributes: (i) data quality and completeness, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability, (viii) utility, and (ix) sustainability. Each attribute was evaluated using pre-defined indicators. For each indicator we obtained the proportion (expressed as percentage) of the outcome of interest over the total. A scale from 1 to 3 was used to provide a score for each attribute as follows: <60% (as obtained in the calculation above) scored 1 (weak performance); 60-79% scored 2 (moderate performance); ≥80% scored 3 (good performance). An overall score for each attribute and the ISS was obtained by averaging the scores of all evaluated attributes. Results The overall mean score for the ISS in Zambia was 2.6. Key strengths of the system were the quality of data generated (score: 2.9), its flexibility (score: 3.0) especially to monitor viral pathogens other than influenza viruses, its simplicity (score: 2.8), acceptability (score: 3.0) and stability (score: 2.6) over the review period and its relatively low cost ($310,000 per annum). Identified weaknesses related mainly to geographic representativeness (score: 2.0), timeliness (score: 2.5), especially in shipment of samples from remote sites, and sustainability (score: 1.0) in the absence of external funds. Conclusions The system performed moderately well in our evaluation. Key improvements would include improvements in the timeliness of samples shipments and geographical coverage. However, these improvements would result in increased cost and logistical complexity. The ISSS in Zambia is largely reliant on external funds and the acceptability of maintaining the surveillance system through national funds would require evaluation.
Working with patients suffering from chronic diseases – a balancing act for health care professionals. A meta-synthesis of qualitative studies
Authors: Holmen Heidi , Larsen Marie Hamilton , Sallinen Merja Helena , Thoresen Lisbeth , Ahlsen Birgitte , Andersen Marit Helen , Borge Christine Råheim , Eik Hedda , Wahl Astrid Klopstad , Mengshoel Anne Marit
Published: November 2019

Background: The number of patients with long-term chronic diseases is increasing. These patients place a strain on health care systems and health care professionals (HCPs). Presently, we aimed to systematically review the literature on HCPs’ experiences working with patients with long-term chronic diseases such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD). Method: A systematic search of papers published between 2002 and July 2019 was conducted in the Embase, AMED, PsycINFO, MEDLINE, CINAHL, and COCHRANE databases to identify studies reporting qualitative interviews addressing HCPs’ experiences working with adults with COPD, CKD or type 2 diabetes. An interdisciplinary research group were involved in all phases of the study. With the help of NVivo, extracts of each paper were coded, and codes were compared across papers and refined using translational analysis. Further codes were clustered in categories that in turn formed overarching themes. Results : Our comprehensive search identified 4170 citations. Of these, 20 papers met our inclusion criteria. Regarding HCPs’ experiences working with patients with COPD, CKD, or type 2 diabetes, we developed 10 sub-categories that formed three overarching main themes of work experiences: 1) individualizing one’s professional approach within the clinical encounter; 2) managing one’s emotions over time; 3) working to maintain professionalism. Overall these three themes suggest that HCPs’ work is a complex balancing act depending on the interaction between patient and professional, reality and professional ideals, and contextual support and managing one’s own emotions. Conclusion: Few qualitative studies highlighted HCPs’ general working experiences, as they mainly focused on the patients’ experiences or HCPs’ experiences of using particular clinical procedures. This study brings new insights about the complexity embedded in HCPs’ work in terms of weighing different, often contrasting aspects, in order to deliver appropriate practice. Acknowledging, discussing and supporting this complexity can empower HCPs to avoid burning out. Leaders, health organizations, and educational institutions have a particular responsibility to provide HCPs with thorough professional knowledge and systematic support.
The Residential Aged Care Nurse-Led After-Hours Initiative, Enhancing nurse assessment and decision making.
Authors: Moloney Clint , Hunnik Madeleine Van , Hope Carol , Terry Victoria , Issac Hancy
Published: November 2019

Background Current staffing levels and current care standards have been linked to negative clinical outcomes for Residents in living in Residential aged care. Low levels of confidence have impounded a Registered Nurses ability to meet many acute challenges found in this environment. The utilisation of Emergency Department transfers for acute ill residents is an increasing epidemic. This research project aimed to contemporise, adapt, implement and evaluate a set of Clinical Practice Guidelines (CPGs) and a Nurse Practitioner Role in Residential Aged Care adapted with permission from Waitemata District Health Board New Zealand [1, 2]. The purpose of the CPGs was to empower clinical staff in Residential Aged Care Facilities (RACFs), to recognise early clinical deterioration, provide safe evidence based care to residents, and prevent unnecessary transfers of residents to an acute hospital emergency departments.Methods Action research was chosen for this research because it was not only cyclic/participative in nature, but it provided a progressive evaluation of the CPGs implementation and the current context as it related to past, progressive, and post implementation nurse decision making practices. A total of 4 Focus groups with an average of eight respondents were recruited to this study (Total participants, 16 RNs and 16 PCWs).Results Focus group data showed unequivocal evidence of increased confidence among staff in implementing the care guidelines, communicating with fellow professionals, and assessing incidents. The CPGs and NP intervention was successful in engaging staff and developing their confidence with assessment of acute resident issues. Additional longitudinal research is required to better understand the influences of these interventions on ED presentations.Conclusions Research needs to better explore the direct correlation between PCW knowledge, skills, and training, and a failure to rescue residents experiencing an adverse event. This should also encompass more research scrutiny on the impact of poor communication practices between PCWs and the RN. The role NPs play in reducing ED utilisation needs greater long term evaluation to better ascertain clinical care and economic benefits.
Effect of body mass and physical activity on future long-term care use
Authors: Nizalova Olena , Gousia Katerina , Forder Julien
Published: November 2019

Background Obesity and physical activity rates are known predictors of disability and functional limitations, and, in turn, use of health care. In this study, we aim to explore whether obesity and physical inactivity also are significant risk factors for future long-term care needs (both informal and formal care). Methods We use multinomial logistic regression analysis on data from the English Longitudinal Study of Ageing (ELSA) respondents aged 65 and older between 2002 and 2011. Selection issues are tackled using the rich set of control variables, exploiting the data’s longitudinal structure and accounting for loss to follow-up (including death). Control factors include functional limitations (related to ADLs, iADLs and mobility)) and specific existing health conditions, notably diabetes, high blood pressure and cardio-vascular diseases. Results We find that obese older people are 25% more likely to receive informal or privately paid care in two years’ time, but this does not hold for formal care. People who are physically active are 38% less likely to be using any care in two years’ time, with the strongest effect for formal care use. Sensitivity analysis suggests that the results are not driven by either prediabetes or any link between obesity and subjective health, depression, or unobserved heterogeneity.Conclusions This study indicates obesity’s importance in future care costs and provides rationale for promoting a healthier weight for economic benefits, in relation not only to health care, but also long-term care.
Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?
Authors: Lawrenson Ross , Lao Chunhuan , Brown Leonie , Moosa Lucia , Chepulis Lynne , Keenan Rawiri , Kidd Jacquie , Middleton Karen , Conaglen Paul , de Groot Charles , Aitken Denise , Wong Janice
Published: November 2019

Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have NSCLC, had poorer lung function and were more likely to have an ECOG status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). SABR has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.