The revolving door between hospital and community: extended-spectrum beta-lactamase-producing Escherichia coli in Dublin.

BACKGROUND: Escherichia coli that produce extended-spectrum beta-lactamases (ESBLs) are an increasing cause of healthcare-associated infection, and community healthcare facilities may be a reservoir for important epidemic clones. AIM: To characterize retrospectively and investigate the epidemiology of ESBL-producing E. coli collected in a Dublin hospital, during 2009 and 2010, and to investigate the dissemination of specific clones within hospital and community healthcare facilities. METHODS: Pulsed-field gel electrophoresis (PFGE) was used to determine the genetic relatedness of 100 ESBL-producing E. coli isolates. Phylogenetic groups were determined and the O25b-ST131 clone identified in the collection. The genetic data were correlated with antimicrobial susceptibility, clinical and demographic data to explore the epidemiology of specific clones. FINDINGS: Phylogenetic groups B2 (62%) and D (18%) were the most common and were associated with non-urinary isolates (P CONCLUSIONS: E. coli O25b-ST131 is largely responsible for ESBL-producing E. coli in LTCFs in Dublin. The distribution of ESBL-producing E. coli in our hospital and community highlights a \u27revolving door\u27 through which these resistant bacteria spread and disseminate

The Association Between Organizational Characteristics and Strategic Information Systems Planning: A Study of U.S. Hospitals

Despite the potential of Strategic Information System Planning (SISP) to reduce cost and improve quality, hospitals have been slow to have strategic plans on Information Systems. Our objective was to explore which organizational characteristics influence SISP in healthcare. Data on Information Systems plans from the HIMSS analytics database was combined with organizational characteristics data from the American Hospital Association. Logistic regression analyses on a sample of 2,495 hospitals revealed that hospitals with system membership and for profit status had a greater likelihood of selecting ‘computerized medical records’ (OR=1.88, OR=6.60 respectively, p<0.05), ‘decreasing medical errors’ (OR=7.02, p<0.05), ‘resolving integration issues’ (OR=1.36, OR=0.15 respectively, p<0.05), ‘migrating towards a paperless environment (OR=1.66, OR=8.28 respectively, p<0.05), and ‘reducing the number of software vendors’ (OR=1.78, OR=0.23 respectively, p<0.05) as their Information System plans. System membership and ownership status are associated with SISP. An understanding of the hospital characteristics that may impact Strategic Information Systems Planning, managers would assist managers in making informed decisions about planning and implementing Information Systems at their hospitals

Exploring the potential of grass feedstock from marginal land in Ireland: Does marginal mean lower yield?

peer-reviewedThe production of biomass feedstock from marginal land has attracted much attention as a means of avoiding conflict between the production of food and fuel. Yield potentials from marginal lands have generally not been quantified although it is generally assumed that lower biomass yields can be expected from marginal lands. A three year study was conducted in Ireland in order to determine if grass yields of perennial rhizomatous grasses (cocksfoot, tall fescue, reed canary grass, festulolium) for anaerobic digestion from three marginal land sites (very wet site, very dry site, site prone to flooding) could match yields from better soils. Randomised complete block designs were established on each site in 2012 with two varieties of each grass species as treatments. Three grass harvests were taken from each site in 2013 and in 2014. There was no significant difference between yields from the control site and those from the very dry site and the site prone to flooding. Biomass yields from the very wet site were 85% of those from the control site. Highest yields were obtained from festulolium which were significantly higher than yields from perennial ryegrass. An energy analysis showed that maximising the production of grass from low lying mineral marginal grassland in Ireland could provide enough energy to meet the energy requirements of both the private car fleet and the heavy goods vehicle fleet while avoiding conflict with food production which could be concentrated on conventional land

Coexistent sarcoidosis and lymphangioleiomyomatosis in a patient with cystic lung disease

A 45-year-old lady presented acutely with pleuritic chest pain, haemoptysis, and dyspnoea. Her background was significant for a 1.4 cm renal angiomyolipoma, and she was an ex-smoker without any relevant family history. A computed tomography (CT) pulmonary angiogram was negative for a pulmonary embolism but demonstrated diffuse cystic change throughout both lungs. A bronchoscopy confirmed a normal endobronchial tree, and pulmonary function tests demonstrated moderate airways obstruction, with reversibility and a normal diffusion capacity for carbon monoxide (DLCO). A video-assisted thoracoscopic surgery (VATS) lung biopsy showed non-caseating granulomas, and serum angiotensin converting enzyme (ACE) was elevated consistent with a diagnosis of pulmonary sarcoidosis. Further sectioning indicated focal areas that stained positive for Human Melanoma Black 45 (HMB-45), confirming lymphangioleiomyomatosis (LAM). A diagnosis of cystic lung disease secondary to coexistent sarcoidosis and LAM was made

Path to Success: Development of the Pharmacist Through the Continuum of Pharmacy School and Beyond

Objective: To explore the processes and opportunities provided in the co-curriculum of the Wegmans School of Pharmacy (WSoP) that contribute to the development of successful pharmacy graduates. Methods: Pharmacy career preparation begins at orientation with workshops on emotional intelligence, leadership, and the APhA Career Pathway Evaluation Program. During the P1 through P4 years, the optional Student Development Workshop Series (SDW) offers seminars for students on a variety of topics including time management, exam taking strategies/anxiety management, learning styles, personal “brand” creation, CV/portfolio development, and interview soft skills. All students may participate in the annual WSoP Career Day, which offers networking and career opportunities, including post-graduate training options. During the P4 year, there is opportunity for a structured Residency/Fellowship Preparation Program (RPP). Additionally, local pharmacy residents/fellows participate in a Residency Teaching/Learning Curriculum Program (TLC) to develop academic teaching and precepting skills. Results: The SDW program has been successful and well attended with greater than 90% of students finding the topics relevant to their post-graduate success. After the RPP, ASHP residency match results in the 2016 class yielded an improvement from previous years, with 76 % of applied students and 94% of ranked students matching programs in Phase 1. Of the TLC participants, 90% documented an improvement in multiple types of teaching skills. Implications: Based on data and student/faculty input, career development is reassessed and improved continuously at WSoP. In the near future, a method for tracking graduates will be designed to further monitor the impact of programs on student success

Australasian Malignant PLeural Effusion (AMPLE)-3 trial: Study protocol for a multi-centre randomised study comparing indwelling pleural catheter (±talc pleurodesis) versus video-assisted thoracoscopic surgery for management of malignant pleural effusion

Introduction: Malignant pleural effusions (MPEs) are common. MPE causes significant breathlessness and impairs quality of life. Indwelling pleural catheters (IPC) allow ambulatory drainage and reduce hospital days and re-intervention rates when compared to standard talc slurry pleurodesis. Daily drainage accelerates pleurodesis, and talc instillation via the IPC has been proven feasible and safe. Surgical pleurodesis via video-assisted thoracoscopic surgery (VATS) is considered a one-off intervention for MPE and is often recommended to patients who are fit for surgery. The AMPLE-3 trial is the first randomised trial to compare IPC (±talc pleurodesis) and VATS pleurodesis in those who are fit for surgery. Methods and analysis: A multi-centre, open-labelled randomised trial of patients with symptomatic MPE, expected survival of ≥ 6 months and good performance status randomised 1:1 to either IPC or VATS pleurodesis. Participant randomisation will be minimised for (i) cancer type (mesothelioma vs non-mesothelioma); (ii) previous pleurodesis (vs not); and (iii) trapped lung, if known (vs not). Primary outcome is the need for further ipsilateral pleural interventions over 12 months or until death, if sooner. Secondary outcomes include days in hospital, quality of life (QoL) measures, physical activity levels, safety profile, health economics, adverse events, and survival. The trial will recruit 158 participants who will be followed up for 12 months. Ethics and dissemination: Sir Charles Gairdner and Osborne Park Health Care Group (HREC) has approved the study (reference: RGS356). Results will be published in peer-reviewed journals and presented at scientific meetings. Discussion: Both IPC and VATS are commonly used procedures for MPE. The AMPLE-3 trial will provide data to help define the merits and shortcomings of these procedures and inform future clinical care algorithms. Trial registration: Australia New Zealand Clinical Trial Registry ACTRN12618001013257. Registered on 18 June 2018. Protocol version: Version 3.00/4.02.1

A Randomized Trial to Increase Colonoscopy Screening in Members of High-Risk Families in the Colorectal Cancer Family Registry and Cancer Genetics Network

Individuals with a strong family history of colorectal cancer (CRC) have significant risk for CRC, though adherence to colonoscopy screening in these groups remains low. This study assessed whether a tailored, telephone counseling intervention can increase adherence to colonoscopy in members of high risk families in a randomized, controlled trial

Cohort comparison study of cardiac disease and atherosclerotic burden in type 2 diabetic adults using whole body cardiovascular magnetic resonance imaging

BACKGROUND: Whole body cardiovascular MR (WB CVMR) combines whole body angiography and cardiac MR assessment. It is accepted that there is a high disease burden in patients with diabetes, however the quantification of the whole body atheroma burden in both arterial and cardiac disease has not been previously reported. In this study we compare the quantified atheroma burden in those individuals with and without diabetes by clinical cardiovascular disease (CVD) status. METHODS: 158 participants underwent WB CVMR, and were categorised into one of four groups: (1) type 2 diabetes mellitus (T2DM) with CVD; (2) T2DM without CVD; (3) CVD without T2DM; (4) healthy controls. The arterial tree was subdivided into 31 segments and each scored according to the degree of stenosis. From this a standardised atheroma score (SAS) was calculated. Cardiac MR and late gadolinium enhancement images of the left ventricle were obtained for assessment of mass, volume and myocardial scar assessment. RESULTS: 148 participants completed the study protocol—61 % male, with mean age of 64 ± 8.2 years. SAS was highest in those with cardiovascular disease without diabetes [10.1 (0–39.5)], followed by those with T2DM and CVD [4 (0–41.1)], then those with T2DM only [3.23 (0–19.4)] with healthy controls having the lowest atheroma score [2.4 (0–19.4)]. Both groups with a prior history of CVD had a higher SAS and left ventricular mass than those without (p < 0.001 for both). However after accounting for known cardiovascular risk factors, only the SAS in the group with CVD without T2DM remained significantly elevated. 6 % of the T2DM group had evidence of silent myocardial infarct, with this subcohort having a higher SAS than the remainder of the T2DM group [7.7 (4–19) vs. 2.8 (0–17), p = 0.024]. CONCLUSIONS: Global atheroma burden was significantly higher in those with known cardiovascular disease and without diabetes but not in those with diabetes and cardiovascular disease suggesting that cardiovascular events may occur at a lower atheroma burden in diabetes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12933-015-0284-2) contains supplementary material, which is available to authorized users

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Proximity to overhead power lines and childhood leukaemia: an international pooled analysis

© 2018, Cancer Research UK. Background: Although studies have consistently found an association between childhood leukaemia risk and magnetic fields, the associations between childhood leukaemia and distance to overhead power lines have been inconsistent. We pooled data from multiple studies to assess the association with distance and evaluate whether it is due to magnetic fields or other factors associated with distance from lines. Methods: We present a pooled analysis combining individual-level data (29,049 cases and 68,231 controls) from 11 record-based studies. Results: There was no material association between childhood leukaemia and distance to nearest overhead power line of any voltage. Among children living < 50 m from 200 + kV power lines, the adjusted odds ratio for childhood leukaemia was 1.33 (95% CI: 0.92–1.93). The odds ratio was higher among children diagnosed before age 5 years. There was no association with calculated magnetic fields. Odds ratios remained unchanged with adjustment for potential confounders. Conclusions: In this first comprehensive pooled analysis of childhood leukaemia and distance to power lines, we found a small and imprecise risk for residences < 50 m of 200 + kV lines that was not explained by high magnetic fields. Reasons for the increased risk, found in this and many other studies, remains to be elucidated