Reviewing the WHO guidelines for antibiotic use for sepsis in neonates and children

Background Guidelines from 2005 for treating suspected sepsis in low- and middle-income countries (LMIC) recommended hospitalisation and prophylactic intramuscular (IM) or intravenous (IV) ampicillin and gentamicin. In 2015, recommendations when referral to hospital is not possible suggest the administration of IM gentamicin and oral amoxicillin. In an era of increasing antimicrobial resistance, an updated review of the appropriate empirical therapy for treating sepsis (taking into account susceptibility patterns, cost and risk of adverse events) in neonates and children is necessary. Methods Systematic literature review and international guidelines were used to identify published evidence regarding the treatment of (suspected) sepsis. Results Five adequately designed and powered studies comparing antibiotic treatments in a low-risk community in neonates and young infants in LMIC were identified. These addressed potential simplifications of the current WHO treatment of reference, for infants for whom admission to inpatient care was not possible. Research is lacking regarding the treatment of suspected sepsis in neonates and children with hospital-acquired sepsis, despite rising antimicrobial resistance rates worldwide. Conclusions Current WHO guidelines supporting the use of gentamicin and penicillin for hospital-based patients or gentamicin (IM) and amoxicillin (oral) when referral to a hospital is not possible are in accordance with currently available evidence and other international guidelines, and there is no strong evidence to change this. The benefit of a cephalosporin alone or in combination as a second-line therapy in regions with known high rates of non-susceptibility is not well established. Further research into hospital-acquired sepsis in neonates and children is required

Massive open online courses for nurses' and healthcare professionals' continuous education: a scoping review

AIM: To map the main characteristics of massive open online courses, and their effectiveness, facilitators and barriers in continuing education among nurses and other healthcare professionals.BACKGROUND: Online continuous education attracted new attention among educators and managers with regard to how to best design, implement it and evaluate its effectiveness.INTRODUCTION: No studies to date have mapped the state of research on massive open online courses and the facilitators promoting their effectiveness in continuing education.METHODS: A scoping review performed in 2020 by following the Preferred Reporting Items for Systematic reviews and Meta-analysis extension-Scoping Reviews. Electronic databases were searched for primary and secondary studies, written in English. Identified barriers/facilitators were categorized using a content analysis.RESULTS: Of the 1149 studies, 31 were included, and the majority had an explorative research design. Massive open online courses documented to date are characterized by their (a) developers' countries and providers, mainly the United Stated and universities, respectively; (b) variety of teaching methods and contents, including infectious diseases; (c) using both qualitative and quantitative assessment methods; and (d) multidisciplinary target audience ranging from 40 to 83000 participants, including nurses. Facilitators of and barriers to effectiveness depend on their pedagogical background, appropriate course design, delivery and implementation as well as on the learners' profile.DISCUSSION: Studies available to date are mainly based on experiential projects. A variety of strategies promoting massive online courses' effectiveness have emerged.CONCLUSION: Some public health issues may benefit from massive education, as a unique system promoting a quick and effective continuous education.IMPLICATIONS FOR NURSING/HEALTH/SOCIAL POLICY: Clinical nurses, nurse managers and educators should consider available evidence on massive online courses' when making decisions on which strategy to use to maintain competencies. Moreover, as a public health tool, massive online courses should be derived from a strong cooperation between political, scientific and professional bodies

Effect of flavonoids on upper respiratory tract infections and immune function: A systematic review and meta-analysis

Previous research on animals indicates flavonoid compounds have immunomodulatory properties; however, human research remains inconclusive. The aim of this systematic review was to assess the efficacy of dietary flavonoids on upper respiratory tract infections (URTIs) and immune function in healthy adults. A created search strategy was run against Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and EMBASE classic, CINAHL, and AMED. The returned studies were initially screened, and 2 reviewers independently assessed the remaining studies for eligibility against prespecified criteria. Fourteen studies, of 387 initially identified, were included in this review, and the primary outcome measure was the effect of flavonoids on URTI incidence, duration, and severity. Of the included studies, flavonoid supplementation ranged from 0.2 to 1.2 g/d. Overall, flavonoid supplementation decreased URTI incidence by 33% (95% CI: 31%, 36%) compared with control, with no apparent adverse effects. Sick-day count was decreased by 40% with flavonoid supplementation, although unclear. Differences in bio-immune markers (e.g., interleukin-6, tumor necrosis factor-α, interferon-γ, neutrophils) were trivial between the intervention and control groups during the intervention and after exercise when a postintervention exercise bout was included. These findings suggest that flavonoids are a viable supplement to decrease URTI incidence in an otherwise healthy population