Impact of tetanus-diphtheria-acellular pertussis immunization during pregnancy on subsequent infant immunization seroresponses : follow-up from a large randomized placebo-controlled trial

Background: Pertussis immunization during pregnancy results in high pertussis antibody concentrations in young infants but may interfere with infant immune responses to post-natal immunization. Methods: This phase IV, multi-country, open-label study assessed the immunogenicity and safety of infant primary vaccination with DTaP-HepB-IPV/Hib and 13-valent pneumococcal conjugate vaccine (PCV13). Enrolled infants (6\u201314 weeks old) were born to mothers who were randomized to receive reduced-antigen-content diphtheria-tetanus-three-component acellular pertussis vaccine (Tdap group) or placebo (control group) during pregnancy (270/7\u2013366/7 weeks\u2019 gestation) with crossover immunization postpartum. All infants received 2 or 3 DTaP-HepB-IPV/Hib and PCV13 doses according to national schedules. Immunogenicity was assessed in infants pre- and 1 month post-primary vaccination. The primary objective was to assess seroprotection/vaccine response rates for DTaP-HepB-IPV/Hib antigens 1 month post-primary vaccination. Results: 601 infants (Tdap group: 296; control group: 305) were vaccinated. One month post-priming, seroprotection rates were 100% (diphtheria; tetanus), 6598.5% (hepatitis B), 6595.9% (polio) and 6594.5% (Hib) in both groups. Vaccine response rates for pertussis antigens were significantly lower in infants whose mothers received pregnancy Tdap (37.5\u201377.1%) versus placebo (90.0\u201399.2%). Solicited and unsolicited adverse event rates were similar between groups. Serious adverse events occurred in 2.4% (Tdap group) and 5.6% (control group) of infants, none were vaccination-related. Conclusions: Pertussis antibodies transferred during pregnancy may decrease the risk of pertussis infection in the first months of life but interfere with the infant's ability to produce pertussis antibodies, the clinical significance of which remains unknown. Safety and reactogenicity results were consistent with previous experience

Relation between hyponatraemia and falls by acute hospitalised patients: A case-control study

Aims and objectives To investigate the possible association between hyponatremia and falls, in a sample of hospitalised adult patients. Background In-hospital falls are a problem of major importance, provoking a significant decline in the quality of life of many patients. Recent studies have identified a relationship between such falls and the presence of hyponatremia. Design Analytical retrospective observational case-control study. Methods The study population consisted of hospitalised patients who had suffered an in-hospital fall during the period 2014–2016. For each case, two controls who had not suffered any such fall were recruited. These cases and controls were matched according to gender, age, hospitalisation unit and date of admission. Study data were obtained from the hospital’s record of falls, regarding the patients’ socio-demographic factors, physical and psychological conditions and blood levels of sodium, potassium, urea and creatinine. The study is reported in accordance with STrengthening the Reporting of OBservational studies in Epidemiology guidelines. Results The study sample consisted of 555 patients (185 cases and 370 controls). Hyponatraemia was detected in 57 cases (30.8%). A statistically significant relationship was found between the presence of hyponatraemia and the occurrence of falls: OR = 2.04. Other risk factors for falls were hypercreatinaemia OR 2.49, hyperuraemia OR 1.82, disorientation, need for ambulatory assistance and longer hospital stay. Conclusions From the study findings, we conclude that hyponatraemia is a predictor of falls by acute hospitalised patients. Further research is needed on the relationship between hypercreatinaemia, hyperuraemia and falls. (...)Funding for open access charge: Universidad de Málaga / CBUA. This research received no specific grant from any funding agency in the public, commercial, or not-for- profit sectors

Lean emergency medical operations

The fundamental responsibilities of Emergency Medical Service (EMS) systems are to provide urgent medical care, such as pre-hospital care, and to transport the patient to the hospital if needed. The agility and efficiency of EMS systems are major public concerns. Since the EMS process involved is fundamentally a transportation process, the Lean Transportation approach is a viable option for improving Emergency Medical Service (EMS) operations performance. The identification of waste during the ambulance cycle time is the basis for designing an operations improvement strategy. The scheme utilized uses modified versions of the Transportation Value Stream Map (TVSM) and The Operational Vehicle Effectiveness (TOVE) Index. Thus, availability, performance and quality wastes are identified to define the improvement strategy. Results of the application for the Monterrey metropolitan operations of the Mexican Red Cross are provided.N/

Reduce turnaround time through waste elimination.

According to the NHS Confederation (2012), “It’s not good to be a patient stuck on an ambulance trolley in a corridor, but the patients at risk are the road traffic accidents or heart attacks still waiting for the ambulance service to respond”. Ambulance Turnaround time is a measure of particular interest in the performance of Emergency Medical Systems (EMS). It determines the degree of coordination and communication with the health institutions where each patient will receive his final treatment. Its value is key in the determination of the ambulance capacity of the operations system of an EMS institution. Long turnaround times decreases the availability of ambulances for future services and furthermore, it increases ambulance response times and patient´s health risk. This work is about applying an improvement approach based on Lean Thinking for reducing ambulance turnaround time in the EMS operations of the Red Cross located in metropolitan Monterrey, Mexico. Results of the application are provided.N/

An App Performance Optimization Advisor for Mobile Device App Marketplaces

On mobile phones, users and developers use apps official marketplaces serving as repositories of apps. The Google Play Store and Apple Store are the official marketplaces of Android and Apple products which offer more than a million apps. Although both repositories offer description of apps, information concerning performance is not available. Due to the constrained hardware of mobile devices, users and developers have to meticulously manage the resources available and they should be given access to performance information about apps. Even if this information was available, the selection of apps would still depend on user preferences and it would require a huge cognitive effort to make optimal decisions. Considering this fact we propose APOA, a recommendation system which can be implemented in any marketplace for helping users and developers to compare apps in terms of performance. APOA uses as input metric values of apps and a set of metrics to optimize. It solves an optimization problem and it generates optimal sets of apps for different user's context. We show how APOA works over an Android case study. Out of 140 apps, we define typical usage scenarios and we collect measurements of power, CPU, memory, and network usages to demonstrate the benefit of using APOA.Comment: 18 pages, 8 figure

Transport operations optimisation through lean implementation – a case study

Lean has benefited industries, however, the research regarding its implementation in the transportation sector is limited. Therefore, there is huge potential for the implementation of Lean in the transportation sector. With the growing population and production, traffic congestion is no surprise, placing constraints on transport operations. This research utilises two extensions of the Lean tools of Transportation Value Stream Mapping (TVSM) and Transportation Overall Vehicle Effectiveness (TOVE). This research presents a case study of company XYZ based in Thailand, to optimise their transport operations through utilisation of Lean and its extensions mentioned earlier. As a result, the TOVE index is projected to improve from 17% to 31% and TVSM from 51% – 70%. The empirical study presented in this research paves the way for further research and adoption of Lean in transportation operations.N/

Necesidades espirituales y calidad de vida en el cuidado enfermero en los hospitales San Juan de Dios de Andalucía

RESUMEN Introducción: El sufrimiento espiritual es un síntoma prevalente en enfermos terminales y que puede afectar a su calidad de vida. La Sociedad Española de Cuidados Paliativos señala como elemento fundamental del tratamiento, una atención integral que tenga en cuenta los aspectos espirituales. Los profesionales sanitarios, y más especialmente los profesionales de Enfermería debieran ocuparse de atender, de una forma efectiva, las necesidades espirituales de los enfermos al final de la vida en el marco de un plan de cuidados personalizado. Objetivo: Describir y analizar las necesidades espirituales de los enfermos en situación terminal sujetos a cuidados paliativos en el ámbito hospitalario de la Orden Hospitalaria de San Juan de Dios de Andalucía, y su relación con la calidad de vida. Metodología: El diseño de investigación es de enfoque mixto (cuantitativo y cualitativo). Se realizaron un total de veintiocho entrevistas a enfermos en situación terminal en los Hospitales de San Juan de Dios de Andalucía occidental. En este estudio se han utilizado variables que en un principio corresponderían al ámbito cuantitativo, indicadores de la clasificación de resultados de enfermería (NOC) y se han transformado en categorías cualitativas (preguntas de entrevista). De la misma forma, se ha actuado con las variables, actividades de la clasificación de intervenciones de enfermería (NIC) y con diagnósticos enfermeros (NANDA). La secuencia empleada para el análisis de datos cualitativos se realizó con el programa ATLAS.ti 7.1.5. Tras la entrevista se les pasó a los pacientes la Escala de Cuidados Paliativos basada en la de Serra-Prat. Por otra parte, el Cuestionario de actitudes de la enfermera hacia los cuidados espirituales y religiosos se aplicó a un total de 305 profesionales de enfermería de los hospitales anteriormente mencionados. El análisis de datos cualitativo se realizó con el programa SPSS versión 23. Resultados: En los resultados obtenidos de las entrevistas con los pacientes se ha podido comprobar que éstos expresan un significativo bienestar espiritual que relacionan con los cuidados espirituales enfermeros recibidos. Los datos obtenidos en la Escala de calidad de vida, aplicadas a los pacientes hospitalizados, indican una vivencia positiva de su calidad de vida. Por otra parte, resultó favorable la actitud de los profesionales de Enfermería hacia las intervenciones en los cuidados espirituales y religiosos que son esenciales para integrar la correcta atención espiritual y religiosa, sistemáticamente, en los planes de cuidados generales de los pacientes. Conclusiones: La satisfacción de las necesidades espirituales y religiosas se sitúa en el ámbito de intimidad más profunda de las personas y posee una estrecha relación con la percepción de los pacientes sobre la propia calidad de vida. El cuidado espiritual y religioso ha de ser proporcionado en equipo multiprofesional, en el que los profesionales de Enfermería deben tener un papel especialmente activo. Los hallazgos obtenidos a través de los métodos utilizados en este estudio concuerdan en que el cuidado espiritual enfermero mejora la calidad de vida del paciente paliativo en situación de enfermedad terminal

Top 100 cited classical articles in sentinel lymph nodes biopsy for breast cancer

BackgroundThe sentinel lymph node biopsy (SLNB) takes on a critical significance in breast cancer surgery since it is the gold standard for assessing axillary lymph node (ALN) metastasis and determining whether to perform axillary lymph node dissection (ALND). A bibliometric analysis is beneficial to visualize characteristics and hotspots in the field of sentinel lymph nodes (SLNs), and it is conducive to summarizing the important themes in the field to provide more insights into SLNs and facilitate the management of SLNs.Materials and methodsSearch terms relating to SLNs were aggregated and searched in the Web of Science core collection database to identify the top 100 most cited articles. Bibliometric tools were employed to identify and analyze publications for annual article volume, authors, countries, institutions, keywords, as well as hotspot topics.ResultsThe period was from 1998 to 2018. The total number of citations ranged from 160 to 1925. LANCET ONCOLOGY and JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION were the top two journals in which the above articles were published. Giuliano, AE was the author with the highest number of articles in this field with 15. EUROPEAN INST ONCOL is the institution with the highest number of publications, with 35 articles. Hotspots include the following 4 topics, false-negative SLNs after neoadjuvant chemotherapy; prediction of metastatic SLNs; quality of life and postoperative complications; and lymphography of SLNs.ConclusionThis study applies bibliometric tools to analyze the most influential literature, the top 100 cited articles in the field of SLNB, to provide researchers and physicians with research priorities and hotspots

The Tiger Vol. 103 Issue 16 2009-09-18

https://tigerprints.clemson.edu/tiger_newspaper/2391/thumbnail.jp