bluuebunny/crossref_metadata_2025 huggingface dataset:
Nursing theories and their relevance to contemporary infection control practice
Authors: Mawdsley S.
Published: September 2007

s nursing strives to be recognised as a profession the theories that underpin our practice are increasingly put under the microscope. Nursing theory and its relevance to clinical practice has long been a subject of controversy. Indeed, a lack of agreement in the professional literature serves to confuse nurses and has caused many to dismiss nursing theory as being long-winded and irrelevant to everyday practice. Such nonchalance can have far-reaching effects on the quality of patient care provided within hospital settings, particularly in matters pertinent to the control of healthcare-associated infection. This article examines these theories and identifies just how relevant they are to modern day infection control practice.
Infection Control Nurses Association Research and Development Group: research strategy for 2005 to 2010
Authors: Loveday H.P. , Prieto J. , Case M. , Curran E. , Hodgson G. , Hughes J. , Hughes F. , Portsmouth J. , Madeo M. , Odum J. , Williams D.
Published: September 2007

he Research and Development Group was reestablished in October 2004 to advance the Infection Control Nurses Association's research aspirations. This strategy is the result of the work of the group since its first meeting in January 2005. The draft strategy was discussed and approved by branch representatives and the National Executive Committee in June 2005. It sets out the background and objectives for the research and development strategic plan for the period 2005 to 2010. The strategy will be launched at the ICNA's annual conference in Torquay in September 2005.
The history of infection control: Poliomyelitis part 2: 1950-2005 — a disease controlled (almost)
Authors: Newsom S.W.B.
Published: September 2007

his article is the seventeenth in a series of articles outlining the key developments in the history of infection control.
Review of the treatment of hepatitis C: where are we now?
Authors: Mitchell B.
Published: September 2007

epatitis C is a viral illness increasing in prevalence and causing considerable burden for the health services across the world. Treatment for this disease has progressed remarkably over the past decade. The purpose of this review is to examine past treatments for hepatitis C and explore the drugs used today to combat this virus.
Re-emerging infections: Part six — exotic infections
Authors: Mayon-White R.
Published: September 2007

This, the sixth and last article in the series, focuses on exotic infections. Exotic infections are those that have not been endemic in the UK in the last two centuries, and they occur (or would occur) by being imported. The exotic infections fall into two main classes: those that are truly exotic, because the environmental conditions in the UK do not allow the vectors or other modes of transmission of infection to exist, and those that could be transmitted in the UK, but are unlikely to do so under present conditions. Dengue fever and malaria — both mosquito-borne infections, are examples of the first, while typhoid fever, smallpox and plague are examples of the latter, as these have been transmitted in the UK in the last 100 years.
In vitro test of different urine-meters in an experimental bladder-drainage model: prevention of ascending contamination depends on construction of the urine-meter
Authors: Frimodt-Møller N. , Corneliussen L.
Published: September 2007

Modern urine-meters are provided with the urine collection bag directly attached to the measuring device, thus providing a closed collection system. The systems vary, however, in respect to how the measuring devices are emptied into the urine collection bag. Using an in vitro ascending contamination model we compared three systems: the Unometer (Unomedical), the Bard Urinemeter and the Curity Urinemeter (Kendall), which all differ in the methods of emptying. The urine collection bags were inoculated with Pseudomonas aeruginosa , and subsequently sampled daily at six different sites for up to seven days in order to determine the degree and timing of ascending contamination of the systems. Unometer was significantly less contaminated at the urine-meter level at day seven than both Bard (0/8 vs. 4/4, P=0.002) and Curity (0/8 vs. 8/8, P=0.0002), respectively, as well as significantly less contaminated in the infusion-catheter above the urine-meter at day seven than Bard (0/8 vs. 4/4, P= 0.002), but not so as compared to Curity (0/8 vs. 1/8, P =1,0). The Bard and Curity systems empty the devices by tilting thereby probably contaminating the devices, while the Unometer is emptied via a non-return valve in the bottom of the device.
The infection control nurse in England — past, present and future
Authors: Perry C.
Published: September 2007

Originating in England, infection control nurse posts have become well established throughout the world over the last 45 years. As health care during this time has changed, so has the role of the infection control nurse. However, some of the role components and the challenges faced are the same in 2005 as they were in 1959. While infection control nurses are responsible for implementing a large element of an establishment's infection control programme, other staff groups also now play important roles in supporting infection prevention activities. This article describes the development of the infection control nurse in English hospitals and identifies role developments that will enable them to function in an ever-changing healthcare environment.
Hospital volunteers' perceptions and understanding of infection control: an exploratory study
Authors: Waheed H. , Hughes J. , Hall I. , Owen T.
Published: September 2007

Hospital volunteers are fast establishing themselves as an integral part of hospital life, yet a review of the literature shows that at present they are the least researched group in the health sector. This paper reports an ethnographic study that explored hospital volunteers' perceptions and understanding of infection control. The main themes identified provided an insight into how volunteers perceived risks to patients and themselves. The research was conducted while Waheed was a final year student at Liverpool Hope University, where she was supervised by Hall as part of the Interchange programme of students conducting research with community groups (Hall and Hall, 1996). Hughes and Owen were the partners in the research, representing the Volunteer Scheme at Aintree Hospitals NHS Trust.
Double-blind peer reviewed paper Problem-based learning — a case for infection control
Authors: Cole M.
Published: September 2007

odern health care requires a workforce that is capable of exploring complex issues, articulate,M and has the capacity to develop problem-solving strategies based on reflective decision-making. The importance of education in the prevention of health care-associated infection is well documented, however measuring the effectiveness of infection control educational programmes has been problematic with insufficient programmes and unsatisfactory levels of compliance being reported. Nursing has traditionally favoured didactic approaches to teaching that suffer from theory overload and treat learners as empty vessels waiting to be filled with knowledge.

Infection control nurses should consider innovative student-centred approaches such as problem-based learning (PBL) that recognises learners as cognitive beings, with a frame of reference constructed from a lifetime of experience. In PBL a problem or trigger is encountered in the learning process and serves as a focus for the application of problem-solving or reasoning skills. Clinically relevant material can translate problem solving into the learner's experiential language, enhance intrinsic motivation and assist them to become more adaptable and self-directed.

As content experts, ICNs are well positioned to produce material grounded in reality, which will stimulate the students and guide them towards their learning outcomes. An example of a problem-based case study is included.
Pathway to success — the introduction of an integrated care pathway for delivery of care to methicillin-resistant Staphylococcus aureus-positive patients
Authors: Wolstenholme S.
Published: September 2007

ethicillin-resistant Staphylococcus aureus (MRSA) continues to attract widespread media attention.M This article describes the identification of poor compliance with trust policy for the management of MRSA positive patients, and subsequent development, implementation and evaluation of an integrated care pathway (ICP) for the delivery of care to these patients. The effectiveness of the ICP and its impact on care delivery is discussed.
Extended-spectrum beta lactamases: an overview
Authors: Damoa-Siakwan S.
Published: September 2007

ver recent months organisms producing extended-spectrum beta lactamases (ESBLs) have become an increasing problem in hospitals and the community. The situation was mentioned in this year's chief medical officer's report and subsequently received attention from national and local media. The aim of this article is to give an overview of the microbiology of ESBLs, to examine the epidemiology and to look at possible methods of treatment and control.
Double-blind peer reviewed paper The role of healthcare workers in influenza prevention: Part one
Authors: Chalmers C.
Published: September 2007

espite being considered by many as a minor disease, influenza remains a leading cause of respiratory infection, attributing to many deaths in the UK each year. This article offers an overview of influenza and its prevention, focusing on the use of influenza vaccination in healthcare workers as a public health measure. It highlights potential benefits beyond the protection of individuals against influenza, and considers the impact of health behaviour on improving vaccination uptake in healthcare workers.
Is there an opportunity to reduce urinary catheter-related infections? Exploring variation in catheterisation rates in care homes
Authors: McNulty C.A.M. , Bowen J. , Foy C. , Gunn K. , Freeman E. , Tompkins D. , Brady A. , Ejidokun T. , Donald I. , Smith G.E.
Published: September 2007

rinary catheterisation in care homes is associated with increased morbidity, hospitalisation and mortality. The authors aimed to determine whether staffing, resident underlying illness or nursing band, or use of other toileting methods were responsible for the wide variation in urinary catheterisation rates found in English care homes. The authors approached randomly-selected registered care homes in three former health districts in England. A questionnaire survey was used to determine the number of residents in each nursing care band and with different medical conditions that were catheterised, and the home's management of residents' continence. The number of residents or staffing did not influence catheterisation rate. Higher catheterisation rate homes had a lower proportion of high band nursing residents and residents with incontinence, severe physical disability and dementia than the other homes. Only urinary retention (3 per cent of residents) was significantly more common in the higher catheterisation rate homes. There was no difference in continence care before inserting a catheter. The authors suggest that care culture and staff attitudes to catheterisation should be explored in greater depth using structured interviews or focus groups. This may allow the identification of key factors that can be targeted in order to reduce catheterisation rates and the associated morbidity.
Understanding healthcare worker uptake of influenza vaccination: a survey
Authors: Chalmers C.
Published: September 2007

he growing threat of pandemic influenza highlights the importance of influenza vaccination as a public health measure. Yet despite the many benefits associated with influenza vaccination, national uptake by healthcare workers has remained low since being introduced for such staff in 2000. Improving uptake of influenza vaccination in healthcare workers has potential health benefits for individuals in terms of protection against the disease. Other possible benefits include a reduction in risk of nosocomial transmission to patient populations, improved public health for the population as a whole along with more efficient use of healthcare resources within the NHS. This research explored factors influencing influenza vaccination uptake in healthcare workers, by investigating knowledge, attitudes and behaviour of qualified nursing staff directly involved in patient care in NHS Lanarkshire. Differences in knowledge, attitudes and behaviours towards influenza vaccination were found across the targeted population. Such findings have the potential to inform and enhance the design and implementation of upcoming vaccination campaigns.
Exploring patients' views on colonisation with meticillin-resistant Staphylococcus aureus
Authors: Criddle P. , Potter J.
Published: September 2007

his qualitative study follows previous research on how meticillin-resistant Staphylococcus aureus (MRSA) affects patients as reported by healthcare workers. The aim of this study was to research the phenomenon of being colonised with MRSA from the patient's perspective. A total of 14 patients were interviewed following discharge from hospital, transcripts were then analysed using an interpretive phenomenological approach. The key findings are reported under the four themes of information provision, patient understanding, lived experience and information needs. Poor information provision was a key theme, experienced by many patients. This resulted in some patients feeling confused and often anxious, and for some affected their lives both in and out of hospital. Providing good quality and reassuring information appropriate to the patient and their current condition is key to improving understanding, deflecting the impact of the media and reducing significance of this symptom-free state. Recommendations for practice include enhanced training for healthcare workers on how to address sensitively the patient's information needs and reduce unnecessary confusion and distress.
Evidence-based infection control — a national resource
Authors: Wiseman S. , Kostkova P. , D'Souza S. , Mani-Saada J. , Madle G.
Published: September 2007

With constant information overflow, it is getting increasingly difficult for healthcare professionals to be aware of the latest guidelines, policies and research and to implement these at local level. The National Resource for Infection Control (NRIC) project (see: www.nric.org.uk) provides a `single one-stop shop' not only for infection control teams who may require national policy, guidance and available evidence to help write or update local infection prevention and control guidance, but also to assist all staff who work in any healthcare setting to be able to access information that will enable them to practise safely. Funded by the Department of Health, NRIC is endorsed by the National electronic Library of Infection (NeLI) (see: www.neli.org.uk).
Investigation and management of an outbreak of ocular adenovirus infections: a New Zealand experience
Authors: Taylor M.A. , Schousboe M.
Published: September 2007

Nosocomial ocular infections are uncommon (Durand et al, 2004), though they do occur both as sporadic cases and as outbreaks. A common viral cause of these cases and outbreaks is adenovirus, which has also caused epidemics of keratoconjunctivitis. Adenovirus has been shown to remain viable on environmental surfaces for extended periods and thus can be transmitted by hospital equipment. Many patients presenting to ophthalmology clinics require contact with the specialised equipment used for examinations within the department. As with all hospital equipment and surfaces, thorough cleaning and disinfection is essential between patients. Following an unexpected increase in the number of adenovirus type 19 isolates from eye swabs taken from patients being seen on the second or subsequent appointment in the eye outpatient's department of the Canterbury District Health Board in New Zealand, the infection control service undertook a review of the area and practices, including the cleaning and disinfecting processes, within the department. As this was the first such outbreak within the organisation, the investigation included a literature review of ocular adenovirus infections and outbreaks worldwide. Recommendations made included an enhanced cleaning protocol for tonometer tips, better cleaning of the environment and improvements in the implementation of standard precautions by staff. Following the introduction of these changes, rates of adenoviral eye infections returned to pre-outbreak levels.
Infection control and the education of students
Authors: Clark S.
Published: September 2007

The importance of infection control in clinical care has long been recognised by healthcare practitioners (Meers et al, 1981), but in the last decade the public have become much more aware of healthcare-associated infections through the media and in particular its attention to MRSA and the increase in rates in the UK (BBC, 2005a). Clostridium difficile has added to the concerns regarding the care provided in hospitals and has reinforced the need for urgent action in the control of infection if patients are to receive high quality care. Since the appointment of the first infection control nurse over 40 years ago, education has been at the centre of infection control and prevention (Jenner and Wilson, 2000) As most healthcare students now undertake their theoretical work in universities it is essential that they have infection control input to prepare them, not only for their placements, but also for being future practitioners. There must be a robust approach to the teaching and learning of infection control issues and its preventative and control strategies, both in the academic and practice environment. There is a lack of evidence regarding explicit infection control in the curricula of most healthcare pathways, which needs to be addressed if infection rates are to be reduced.
From ideas to action: writing for publication
Authors: Cooper T. , Proctor S.
Published: September 2007

This article provides key guidance on how to approach writing for publication in journals such as the British Journal of Infection Control.
Conference review: Fourth Congress of the European Operating Room Nurses Association
Authors: Weaving P.
Published: September 2007

his is a report of the fourth triennial Congress of the European Operating Room Nurses Association, which took place in Dublin, Ireland in May 2006.
An investigation of the microbiological contamination of ultrasound equipment
Authors: Sykes A. , Appleby M. , Perry J. , Gould K.
Published: September 2007

ltrasound equipment comes into direct contact with patients and practitioners during scanning procedures, enabling it to be a potential vehicle for the spread of nosocomial infections. A study was undertaken to determine the extent of contamination on this equipment and therefore the efficacy of the present decontamination guidelines.

Five ultrasound machines were sampled over a period of three months. Three used for non-invasive procedures and two for invasive procedures. The equipment was sampled from the probe, probe holder, keyboard and gel.

The results revealed that 64.5% of the total samples were contaminated with environmental organisms, 7.7% with potential pathogens and 27.8% were no growth. The most significant contamination was found on the non-invasive equipment, probably due to the lower level of decontamination practices designated for this equipment.

Following the study, comprehensive decontamination guidelines for all ultrasound equipment were devised and distributed to all ultrasound departments, and staff were educated on the need for improved decontamination regimes.
Peer-reviewed paper Surveillance of meticillin-resistant Staphylococcus aureus in community hospitals in North Cumbria in 2005
Authors: Weaving P. , Blaylock P. , Galdins A. , Knowles M. , Long T. , Smith P. , Wagstaff R.
Published: September 2007

his paper describes a three-month surveillance project performed to determine the incidence of meticillin-resistant Staphylococcus aureus carriage on admission to community hospitals in North Cumbria. The survey also attempted to identify the rate of acquisition of MRSA in the community hospitals during the study period. Study design and limitations are described. Results reveal that almost 9% of admissions had previously undetected MRSA carriage. Discharge screening demonstrated that 2.8% of patients admitted during the study period probably acquired MRSA during their admission. The utility of this information is discussed, and possibilities for future work explored.
Hospital-acquired rotavirus infection in paediatric inpatients
Authors: Allan C. , Todd P.J. , Cunniffe J.G. , Maxwell M.J.
Published: September 2007

otavirus is one of the major agents of paediatric hospital-acquired infections. The authors performed an audit of hospital-acquired rotavirus infection in a large UK district hospital with two paediatric wards. The rate of such acquired rotavirus infection was 1.9% of the total number of rotavirus infections recorded over a 4.5-year period, which is a lower figure than that seen in other similar reports and could indicate the effectiveness of the infection control precautions adopted.
Infection control link professionals' knowledge of Clostridium difficile
Authors: Vaughan N. , Randle J. , Adams G.
Published: September 2007

lostridium difficile is a common cause of diarrhoea in hospitalised patients. It can result in longer hospital stays and due to the need for strict isolation procedures can add significantly to nursing workload. Additionally, it can be very distressing for the patient and if patients are vulnerable to infection it can have serious health consequences. Cross-transmission can be limited by good infection prevention and control practices, however this relies on a sound knowledge base and support from the infection control team. This small-scale study reports on infection control link professionals' knowledge and assesses how they would utilise this knowledge in practice situations. Findings imply that the knowledge base concerning the microorganism was poor, but knowledge relating to general infection procedures was good.
Review of guidance for pandemic influenza
Authors: Millership S. , Edoo M.
Published: September 2007

ntense international interest following serious human infections with avian influenza and the possibility of the virus becoming a pandemic strain has resulted in a huge range of literature on the subject. There is a confusing mixture of evidence-based information and expert, sometimes conflicting, opinion. The following is an attempt to distill essential points and highlight where advice differs. Guidance is frequently revised; as the Health Protection Agency points out this is `an ongoing activity' (HPA, 2006b). There is a clear need to simply the numerous publications into a few readable documents to assist busy professionals who do not have time to search the multitude of publications currently available.
Infection control policies and procedures for meticillin-resistant Staphylococcus aureus in care homes for older people in Northern Ireland: a questionnaire study
Authors: Tunney MM , Hughes CM , Magee J.
Published: September 2007

ackground: Limited information is available regarding the role of infection control in the prevention of infection in nursing and residential care homes.

Objectives: To determine what infection control policies and procedures are in place in care homes for older people in Northern Ireland.

Methods: Anonymous postal questionnaire survey of all 410 nursing and residential homes in Northern Ireland that provide care to residents over the age of 65.

Results: A total of 318 (78%) questionnaires were returned. Visits from infection control nurses from health boards or community trusts were infrequent, with only 23% of homes receiving such a visit. Nearly all homes (99.7%) had a policy on infection control, with 72.4% and 84.3% of homes having a policy on the admission and care of residents with meticillin-resistant Staphylococcus aureus (MRSA) respectively. Of those respondents that had a policy on admission of persons with MRSA, only a small percentage (9.2%) would not admit residents with MRSA. Only 11% of respondents believed that MRSA was a problem in their particular home, but at least 30% agreed that there was a problem with MRSA in care homes. A desire was expressed for more information and support, with 75% of respondents agreeing that more information should be provided to homes on MRSA.

Conclusions: There is a clear need for additional infection control advice to be available to care homes and for the development of uniform policies and an infection control audit tool. The audit tool could then be used to ensure that the appropriate policies and standards are in place within care homes and that these standards are met on an ongoing basis.
Infection control and the law: legal and ethical obligations
Authors: Portsmouth J.
Published: September 2007

While there is no case law relating specifically to non-compliance with infection control practices, this article will examine to what extent, if any, current case law could be used to establish whether or not a healthcare professional who had failed to implement to an acceptable standard infection control practices had acted negligently, and as a result caused a patient to develop a healthcare-associated infection.
Comparison of detergent-based cleaning, disinfectant-based cleaning, and detergent-based cleaning after enhanced domestic staff training within a source isolation facility
Authors: Patel S.S. , Pevalin D.J. , Prosser R. , Couchman A.
Published: September 2007

Source isolation facilities should be adequately cleaned to minimise the risk of cross-infection via the environment and fomites. The aim of this study was to compare the effectiveness of cleaning with detergent, cleaning with detergent followed by sodium hypochlorite and cleaning with detergent after enhanced training for domestic staff within isolation facilities in a district general hospital in southern England. Frequent `hand touch' sites in two isolation rooms were sampled, using contact plates. A total of 567 plates were collected.

Bacterial total viable counts (TVCs) and environmental meticillin-resistant Staphylococcus aureus (MRSA) were used as surrogate markers to compare the efficacy of the cleaning methods.

The results indicate that cleaning with water and detergent followed by sodium hypochlorite achieved significantly lower TVCs for most sampling sites, but only significantly lower environmental MRSA detections from a minority of sample sites. No one method of cleaning consistently eliminated MRSA from the environment. These results provide some preliminary evidence for the use of detergent and hypochlorite cleaning within source isolation facilities.
Probiotics in health maintenance: do they really work?
Authors: Balcázar J.L.
Published: September 2007

Probiotics are live micro-organisms that confer a health benefit to the host by providing both a nutritional benefit and protection against pathogens. This is a review of the present state of knowledge concerning probiotics, with emphasis on the criteria used for selection and clinical evidence of their beneficial effects.
Evaluation of a patient-held record for Meticillin Resistant Staphylococcus Aureus (MRSA)
Authors: Ritchie L.
Published: September 2007

his paper describes a small-scale evaluation of a patient-held record for MRSA, carried out in NHS T Dumfries and Galloway. The patient-held record was developed in response to the Health Act (2006) Code of Practice requirement to ensure effective communication about infection, both with the patient and with other healthcare providers. The suitability and acceptability of the patient-held record to patients and senior healthcare professionals in primary and community care is described, along with possible benefits of implementing this model of communication. Limitations and further work are considered, including the need to perform a larger study with the patient-held record in use in order to confirm whether it does make a difference over time.
Applying Behavioral Science to Behavior Change Communication: The Pathways to Change Tools
Authors: Petraglia Joseph , Galavotti Christine , Harford Nicola , Pappas-DeLuca Katina A. , Mooki Maungo
Published: September 2007

Entertainment-education (EE) is a popular vehicle for behavior change communication (BCC) in many areas of public health, especially in the developing world where soap operas and other serial drama formats play a central role in encouraging people to avoid risky behavior. Yet BCC/EE developers have been largely unable to integrate behavioral theory and research systematically into storylines and scripts, depending instead on external, technical oversight of what should be an essentially local, creative process. This article describes how the Modeling and Reinforcement to Combat HIV/AIDS project at the Centers for Disease Control and Prevention has developed a set of tools through which creative writers can exercise greater control over the behavioral content of their stories. The Pathways to Change tools both guide scriptwriters as they write BCC/EE storylines and help project managers monitor BCC/EE products for theoretical fidelity and sensitivity to research.
Review: Systemic consequences of COPD
Authors: Tkáč Ján , Man S. F. Paul , Sin Don D.
Published: September 2007

Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic lung condition, affecting ∼10% of adults over the age of 40 years in the western world. Research over the past 10 years has shown that COPD is more than just a lung disorder; it affects other end-organs including the cardiovascular and the musculoskeletal systems, making it a multi-component, multi-system disease. COPD increases the risk for ischemic heart disease, stroke, osteoporosis, cachexia, and muscle weakness by two to threefold, independent of other factors such as smoking and age. The mechanisms by which COPD affects these end-organs, however, are unclear. In this paper, we review some of the common and serious extra-pulmonary manifestations of COPD and the potential mechanisms by which they can be linked with COPD.
Three-dimensional computed tomography imaging in an animal model of emphysema
Authors: Froese A. R. , Ask K. , Labiris R. , Farncombe T. , Warburton D. , Inman M. D. , Gauldie J. , Kolb M.
Published: September 2007

Emphysema is a major health problem and novel drugs are needed. Animal disease models are pivotal in their development, but the validity and sensitivity of current tools for the evaluation of drug efficacy is limited. The usefulness of micro computed tomography (CT) as an innovative tool to assess emphysema in a mouse model was investigated.

Serial CT scans were performed in bi-weekly intervals in Smad3 knockout (KO) mice, which spontaneously develop airspace enlargement. Lung density was quantified in two- and three-dimensional images and correlated to mean linear intercept and lung compliance.

CT scans of Smad3 KO lungs revealed a significant decrease in lung density at age 8 weeks and a further progression at age 14 weeks with respect to age-matched wild-type (WT) animals. Emphysema could be reliably assessed with both the two- and three-dimensional approach, but the three-dimensional approach was superior, due to normalisation to lung volumes and less variability. Lung compliance by week 14 was 0.053±0.005 and 0.034±0.002% of maximum volume·cmH2O−1for KO and WT mice, respectively, reflecting significant physiologically relevant emphysema.

Small animal computed tomography imaging and density quantification in a reconstructed three-dimensional image is a useful tool for quantifying emphysematous changes in an animal disease model. It adds significant information to conventional assessment.
Demographic characteristics of patients with extrapulmonary tuberculosis in Germany
Authors: Forssbohm M. , Zwahlen M. , Loddenkemper R. , Rieder H. L.
Published: September 2007

The aim of the present study was to determine the demographics of patients with extrapulmonary tuberculosis in Germany.

Data on 26,302 tuberculosis cases from a national survey carried out during the period 1996–2000 were analysed.

The crude proportion of tuberculosis patients with extrapulmonary manifestations was 21.6%. Extrapulmonary tuberculosis was most likely among females, children aged <15 yrs and persons originating from Africa and Asia. Females tended to be more likely to have any form of extrapulmonary tuberculosis than males, except pleural tuberculosis. The strength of this association was strongest in the age range 25–64 yrs and less pronounced amongst the oldest patients. Children were particularly prone to the development of lymphatic and meningeal tuberculosis, whereas the likelihood of genitourinary tuberculosis increased with increasing age. Asian and African patients were generally more likely than persons from other areas to have lymphatic, osteoarticular, meningeal and miliary tuberculosis.

The analysis shows important differences, by age, sex and origin, in the likelihood of a tuberculosis patient presenting with extrapulmonary tuberculosis. Since the relative contribution of the foreign-born to tuberculosis in low-prevalence countries is rising, extrapulmonary tuberculosis must be taken into account more often in the differential diagnostic work-up of these patients, particularly among those originating from Asia and Africa.
A USA-based registry for pulmonary arterial hypertension: 1982–2006
Authors: Thenappan T. , Shah S. J. , Rich S. , Gomberg-Maitland M.
Published: September 2007

The aim of this study was to define the epidemiology of World Health Organization (WHO) Group I pulmonary arterial hypertension (PAH) in a large referral centre in the USA.

The Pulmonary Hypertension Connection registry, initiated in 2004, evaluated all patients in a single USA practice from 1982–2006. For comparison, the authors divided the group by incidentversusprevalent cohorts, aetiology and by treatment era.

In total, 578 patients (77% female) aged 48±14 yrs were entered. Of these, 80% had class III or IV symptoms. Over time, connective tissue disease-associated PAH increased, while referrals for HIV remained low. One-third of patients were referred on calcium channel blocker therapy even though only 4.6% had an acute response to vasodilator challenge. When compared by treatment era, there were no differences in the severity of PAH. However, survival had improved over time, with a 1-yr survival of 85% in the incident cohort.

In the USA, pulmonary arterial hypertension patients are still referred to tertiary centres too late. Referral of connective tissue disease is increasing, while referral of HIV remains low. Inappropriate calcium channel blocker treatment is common. Survival rates have increased but remain low suggesting that prognosis is improving but PAH is still a progressive, fatal disease.
Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?
Authors: Otero R. , Trujillo-Santos J. , Cayuela A. , Rodríguez C. , Barron M. , Martín J. J. , Monreal M.
Published: September 2007

Patients with acute pulmonary embolism (PE) presenting with haemodynamic instability have the worst prognosis. However, what is understood by haemodynamic instability has not been clearly defined.

The Registro Informatizado de la Enfermedad Tromboembólica (RIETE) is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute deep vein thrombosis or PE. The present authors compared the predictive value of a systolic blood pressure (SBP) value of <100 mmHg and <90 mmHg and the shock index (cardiac frequency divided by SBP) on 30-day mortality in consecutive patients with PE.

As of May 2006, 6,599 patients with PE were enrolled in the study. Of these, 417 (6.3%) died within 30 days: 153 of the initial PE, 29 of recurrent PE and 235 due to other causes. Of the 417 individuals who died, 127 (30%) had a positive shock index, 60 (14%) had SBP <100 mmHg and 33 (7.9%) had SBP <90 mmHg. On multivariate analysis any of the three parameters were independently associated with an increased mortality. The shock index had a higher sensitivity (30.5versus14.4 and 7.9% for SBP <100 mmHg and <90 mmHg, respectively) but lower specificity (86.3versus93.0 and 96.6).

All three measures of haemodynamic instability are independent predictors of 30-day mortality. However, while the shock index had the highest sensitivity, a systolic blood pressure value <90 mmHg had the highest specificity.
Expression and role of EGFR ligands induced in airway cells by PM2.5and its components
Authors: Rumelhard M. , Ramgolam K. , Hamel R. , Marano F. , Baeza-Squiban A.
Published: September 2007

The aim of the current study was to establish the epidermal growth factor receptor (EGFR) ligand expression profile in human airway epithelial cells exposed to either particulate matter (PM) with an aerodynamic diameter <2.5 μm (PM2.5) or its components and the involvement of EGFR ligands in PM2.5-provoked airway inflammation.

EGFR ligand mRNA and protein expression were studied in a human bronchial epithelial cell line and normal nasal cells exposed to noncytotoxic concentrations of PM2.5or its components. The autocrine role of EGFR ligands in airway epithelial cell pro-inflammation was determined by adding conditioned media from PM2.5-treated cells to fresh cells and measuring the secretion of granulocyte-macrophage colony-stimulating factor (GM-CSF), a pro-inflammatory biomarker.

PM2.5increased amphiregulin, transforming growth factor-α and heparin-binding EGF-like growth factor mRNA expression and protein secretion, with a slight contribution of aqueous metallic compounds and a strong participation of organic components putatively attributed to PM polyaromatic hydrocarbon content. PM2.5-induced EGFR ligands were involved in cellular GM-CSF release.

The current study revealed upregulation of several epidermal growth factor receptor ligands by airway epithelial cells exposed to particulate matter with an aerodynamic diameter <2.5 μm and their contribution to bronchial epithelial cell granulocyte-macrophage colony-stimulating factor secretion by an autocrine action, suggesting that these ligands could elicit and sustain the particulate matter-induced airway pro-inflammatory response and contribute to bronchial remodelling.
Value of cancer antigen 125 for diagnosis of pleural endometriosis in females with recurrent pneumothorax
Authors: Bagan P. , Berna P. , Assouad J. , Hupertan V. , Le Pimpec Barthes F. , Riquet M.
Published: September 2007

The thorax is the most frequent extrapelvic location of endometriosis. Thoracic endometriosis is probably responsible for the high rate of recurrent pneumothoraces in females. The goal of the present prospective study was to assess the value of cancer antigen (CA)125 measurement in the detection of endometriosis in order to further enable early and adequate treatment of catamenial pneumothorax.

Between January 2004 and March 2006, 31 females (mean age 32 yrs) underwent pneumothorax surgery. The control group comprised 17 males (mean age 27 yrs), who underwent videothoracoscopic pleural abrasion. Serum CA125 was measured around a menstrual period in females and before surgery in males.

Videothoracoscopically diagnosed endometriosis occurred in 29% of females. The CA125 concentration was significantly higher in females with endometriosis compared to disease-free females (76.1versus16 U·mL−1). The mean value in males was similar to that observed in disease-free females.

The frequency of thoracic endometriosis-related pneumothorax corresponds to, on average, a third of females presenting with recurrent pneumothorax. Early detection can be achieved with serum cancer antigen 125 measurement and may be helpful in indicating videothoracoscopic surgery.
Chronic bronchitis sub-phenotype within COPD: inflammation in sputum and biopsies
Authors: Snoeck-Stroband J. B. , Lapperre T. S. , Gosman M. M. E. , Boezen H. M. , Timens W. , ten Hacken N. H. T. , Sont J. K. , Sterk P. J. , Hiemstra P. S.
Published: September 2007

The presence of chronic bronchitis predicts a more rapid decline of forced expiratory volume in one second (FEV1) in patients with chronic obstructive pulmonary disease (COPD). The hallmark of COPD is airway inflammation. It was hypothesised that COPD patients with chronic bronchitis are characterised by a distinct inflammatory cell profile, as measured in bronchial biopsies and sputum.

From 114 COPD patients (male/female ratio 99/15, mean±sdage 62±8 yrs, current smoking 63%, post-bronchodilator FEV163±9% predicted, no steroids), with and without chronic bronchitis, inflammatory cell counts in bronchial biopsies and induced sputum were measured. Analysis was carried out by logistic regression.

COPD patients with chronic bronchitis had lower eosinophil counts in biopsies and higher percentages of sputum eosinophils than patients without those symptoms, which remained after adjustment for smoking and sex. Patients with chronic bronchitis also showed higher percentages of macrophages and lower percentages of neutrophils in sputum, which could be explained by differences in smoking and sex.

It was concluded that chronic bronchitis reflects an inflammatory sub-phenotype among patients with chronic obstructive pulmonary disease. The present results indicate a preferential distribution of eosinophils towards the airway lumen in patients with chronic bronchitis. This may have implications for anti-inflammatory treatment of chronic obstructive pulmonary disease patients with chronic bronchitis.
Inflammation-related genes up-regulated in schizophrenia brains
Authors: Saetre Peter , Emilsson Lina , Axelsson Elin , Kreuger Johan , Lindholm Eva , Jazin Elena
Published: September 2007

Background

Multiple studies have shown that brain gene expression is disturbed in subjects suffering from schizophrenia. However, disentangling disease effects from alterations caused by medication is a challenging task. The main goal of this study is to find transcriptional alterations in schizophrenia that are independent of neuroleptic treatment.

Methods

We compared the transcriptional profiles in brain autopsy samples from 55 control individuals with that from 55 schizophrenic subjects, subdivided according to the type of antipsychotic medication received.

Results

Using global and high-resolution mRNA quantification techniques, we show that genes involved in immune response (GO:0006955) are up regulated in all groups of patients, including those not treated at the time of death. In particular, IFITM2, IFITM3, SERPINA3, and GBP1 showed increased mRNA levels in schizophrenia (p-values from qPCR ≤ 0.01). These four genes were co-expressed in both schizophrenic subjects and controls. In-vitro experiments suggest that these genes are expressed in both oligodendrocyte and endothelial cells, where transcription is inducible by the inflammatory cytokines TNF-α, IFN-α and IFN-γ.

Conclusion

Although the modified genes are not classical indicators of chronic or acute inflammation, our results indicate alterations of inflammation-related pathways in schizophrenia. In addition, the observation in oligodendrocyte cells suggests that alterations in inflammatory-related genes may have consequences for myelination. Our findings encourage future research to explore whether anti-inflammatory agents can be used in combination with traditional antipsychotics for a more efficient treatment of schizophrenia.
Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence
Authors: Stevenson Catherine R , Forouhi Nita G , Roglic Gojka , Williams Brian G , Lauer Jeremy A , Dye Chirstopher , Unwin Nigel
Published: September 2007

Background

Tuberculosis (TB) remains a major cause of mortality in developing countries, and in these countries diabetes prevalence is increasing rapidly. Diabetes increases the risk of TB. Our aim was to assess the potential impact of diabetes as a risk factor for incident pulmonary tuberculosis, using India as an example.

Methods

We constructed an epidemiological model using data on tuberculosis incidence, diabetes prevalence, population structure, and relative risk of tuberculosis associated with diabetes. We evaluated the contribution made by diabetes to both tuberculosis incidence, and to the difference between tuberculosis incidence in urban and rural areas.

Results

In India in 2000 there were an estimated 20.7 million adults with diabetes, and 900,000 incident adult cases of pulmonary tuberculosis. Our calculations suggest that diabetes accounts for 14.8% (uncertainty range 7.1% to 23.8%) of pulmonary tuberculosis and 20.2% (8.3% to 41.9%) of smear-positive (i.e. infectious) tuberculosis.

We estimate that the increased diabetes prevalence in urban areas is associated with a 15.2% greater smear-positive tuberculosis incidence in urban than rural areas – over a fifth of the estimated total difference.

Conclusion

Diabetes makes a substantial contribution to the burden of incident tuberculosis in India, and the association is particularly strong for the infectious form of tuberculosis. The current diabetes epidemic may lead to a resurgence of tuberculosis in endemic regions, especially in urban areas. This potentially carries a risk of global spread with serious implications for tuberculosis control and the achievement of the United Nations Millennium Development Goals.
World Antimalarial Resistance Network (WARN) III: Molecular markers for drug resistant malaria
Authors: Plowe Christopher V , Roper Cally , Barnwell John W , Happi Christian T , Joshi Hema H , Mbacham Wilfred , Meshnick Steven R , Mugittu Kefas , Naidoo Inbarani , Price Ric N , Shafer Robert W , Sibley Carol H , Sutherland Colin J , Zimmerman Peter A , Rosenthal Philip J
Published: September 2007

Molecular markers for drug resistant malaria represent public health tools of great but mostly unrealized potential value. A key reason for the failure of molecular resistance markers to live up to their potential is that data on the their prevalence is scattered in disparate databases with no linkage to the clinical, in vitro and pharmacokinetic data that are needed to relate the genetic data to relevant phenotypes. The ongoing replacement of older monotherapies for malaria by new, more effective combination therapies presents an opportunity to create an open access database that brings together standardized data on molecular markers of drug resistant malaria from around the world. This paper presents a rationale for creating a global database of molecular markers for drug resistant malaria and for linking it to similar databases containing results from clinical trials of drug efficacy, in vitro studies of drug susceptibility, and pharmacokinetic studies of antimalarial drugs, in a World Antimalarial Resistance Network (WARN). This database will be a global resource, guiding the selection of first line drugs for treating uncomplicated malaria, for preventing malaria in travelers and for intermittent preventive treatment of malaria in pregnant women, infants and other vulnerable groups. Perhaps most important, a global database for molecular markers of drug resistant malaria will accelerate the identification and validation of markers for resistance to artemisinin-based combination therapies and, thereby, potentially prolong the useful therapeutic lives of these important new drugs.