Evaluation of a microbiological screening and acceptance procedure for cryopreserved skin allografts based on 14 day cultures

Viable donor skin is still considered the gold standard for the temporary covering of burns. Since 1985, the Brussels military skin bank supplies cryopreserved viable cadaveric skin for therapeutic use. Unfortunately, viable skin can not be sterilised, which increases the risk of disease transmission. On the other hand, every effort should be made to ensure that the largest possible part of the donated skin is processed into high-performance grafts. Cryopreserved skin allografts that fail bacterial or fungal screening are reworked into ‘sterile’ non-viable glycerolised skin allografts. The transposition of the European Human Cell and Tissue Directives into Belgian Law has prompted us to install a pragmatic microbiological screening and acceptance procedure, which is based on 14 day enrichment broth cultures of finished product samples and treats the complex issues of ‘acceptable bioburden’ and ‘absence of objectionable organisms’. In this paper we evaluate this procedure applied on 148 skin donations. An incubation time of 14 days allowed for the detection of an additional 16.9% (25/148) of contaminated skin compared to our classic 3 day incubation protocol and consequently increased the share of non-viable glycerolised skin with 8.4%. Importantly, 24% of these slow-growing microorganisms were considered to be potentially pathogenic. In addition, we raise the issue of ‘representative sampling’ of heterogeneously contaminated skin. In summary, we feel that our present microbiological testing and acceptance procedure assures adequate patient safety and skin availability. The question remains, however, whether the supposed increased safety of our skin grafts outweighs the reduced overall clinical performance and the increase in work load and costs

The lived experience of adults with myasthenia gravis: a phenomenological study

Myasthenia gravis (MG) is a disorder of the neuromuscular junction (NMJ) that causes fatigue and fluctuating muscle weakness. The physiology of this disease is well understood and there are numerous medically focused articles that outline historical data, randomized controlled trials of treatment options and unusual case studies. There is limited nursing literature about MG; most nurse-led research focuses on fatigue. No published research examines the life experiences of people with MG. The aim of this study was to examine and understand the lived experiences of adults with MG. An interpretive phenomenological approach has been used that applies the research methodology of van Manen (1990). Seven people living with MG were interviewed and their experiences of the disease recorded. Questions were broadly worded about various topics related to MG, that included diagnosis, symptoms, treatments and coping strategies, and were guided by individual experiences. Thematic analysis revealed that MG affects every aspect of a person’s ‘lifeworld’: their sense of time, body, space and their relationships with others. The findings of this study highlight three main themes embedded in the data that a person with MG experiences: living with uncertainty, living with weakness and living with change. These experiences have been interpreted and discussed to gain a deep understanding of the meaning of the disease. This study raises awareness of MG for nurses and other health professionals. It provides a unique view of the disease and explores the meaning of MG, from a perspective where a paucity of such literature exists

Invertebrate Scavenging Communities

Invertebrate scavengers of terrestrial and aquatic carrion include a broad and enormously diverse grouping of various arthropods, nematodes, and molluscs. By far the most functionally important in terrestrial ecosystems are insects, especially the flies, with crustaceans performing this role in marine ecosystems, although a multi-trophic foodweb of numerous invertebrate taxa can be found at most carcasses in most environments. The occurrence of different taxa, and the dynamics of their colonization and various competitive interactions varies across terrestrial and aquatic realms, and is greatly influenced by geographic region, climate, habitat, season, and other biotic factors. This sub-chapter focuses on the invertebrate use of carrion in both terrestrial and aquatic ecosystems, and highlights the role of different groups of invertebrates, and the biotic and abiotic factors that influence their occurrence and succession at decaying carcasses