Evidence-driven Diagnosis and Treatment of Acute Urinary Tract Infections in Long-term Care

Misdiagnosis of asymptomatic bacteriuria as a urinary tract infection continues to occur, leading to the overuse of antibiotics. Due to the growing elderly population in long-term care facilities (LTCFs), LTCFs can play a critical role in antimicrobial stewardship. Urinary tract infections are a starting point for moving toward antimicrobial stewardship, since urinary tract infections are common in LTCFs. A retrospective chart review of 156 cases with suspected urinary tract infections (UTIs) was completed in a LTCF. The purpose of the scholarly project was to assess diagnostic and treatment practices for UTIs and compare them to a diagnostic and treatment algorithm. The overarching finding of the scholarly project was that this particular LTCF’s management of UTIs did not correspond with the selected algorithm’s recommendations. Because the elderly frequently have complex and confounding health factors related to UTIs, the selected algorithm did not adequately capture the nuances for UTI diagnosis in the elderly population. As currently published, the algorithm is not generalizable to elderly women in LTCFs. The symptoms component of the diagnostic portion of the algorithm may benefit from further revision for use in the elderly population. Small-scale change at LTCFs could include encouragement of watchful waiting and improved use of guidelines for antibiotic treatment

The Leadership Role in Online Support Programs for Beginning Teachers

As distance learning opportunities foster a wide array for online mentoring, program administrators are in need of research supporting the successful development and management of such efforts. This qualitative research examined the leadership perspectives, skills, and strategies involved in developing and administering an online support program (also referred to as electronic mentoring) designed to help beginning teachers transition into the profession and improve their retention (National Commission on Teaching and America\u27s Future, 2003). The population was comprised of all known programs established to date in the United States. Interviews were conducted of 28 program administrators representing 20 online programs for new teachers. Data were collected via interviews and triangulated with multiple artifacts. Consistent with practices by Strauss and Corbin (2007), data were analyzed using open, axial, and selective coding to identify, organize, and relate categories and themes. Through this analysis process, the core category, The Leadership Role in Online Support Programs for Beginning Teachers, emerged and was based upon the interrelationships among five subcategories: (a) needs and benefits of participants, (b) program development, (c) professional development, (d) technology considerations, and (e) leadership strategies. The grounded theory resulting from these findings concluded that, successful administrators need to develop a detailed plan for online programs, weighing necessary program components including (a) an educationally diverse program team; (b) early establishment of program goals; (c) reliable methods of assessment of outcomes using constant formative evaluation; (d) a secure, reliable, non-evaluative environment; (e) training in effective online communications and relationship building; and (f) a value-added experience for participants. The leadership role of online support programs for beginning teachers requires administrators to have an in-depth understanding of the developmental needs of new teachers in concert with principles of adult learning theory and means of maximizing professional development. Of greater import than technology skills were the ability to effectively communicate online and manage in a collaborative, facilitative, ever-changing environment. Future studies should examine requirements for participants\u27 online engagement, comparative technology for online support systems, roles adopted by facilitators, and methods of assessment of program effectiveness

TB/HIV integration at primary care level: A quantitative assessment at 3 clinics in Johannesburg, South Africa

Background. In 2004 the World Health Organization (WHO) released the Interim Policy on Collaborative TB/HIV activities. According to the policy, for people living with HIV (PLWH), activities include intensified case finding, isoniazid preventive therapy (IPT) and infection control. For TB patients, activities included HIV counselling and testing (HCT), prevention messages, and cotrimoxazole preventive therapy (CPT), care and support, and antiretroviral therapy (ART) for those with HIV-associated TB. While important progress has been made in implementation, targets of the WHO Global Plan to Stop TB have not been reached. Objective. To quantify TB/HIV integration at 3 primary healthcare clinics in Johannesburg, South Africa. Methods. Routinely collected TB and HIV data from the HCT register, TB ‘suspect’ register, TB treatment register, clinic files and HIV electronic database, collected over a 3-month period, were reviewed. Results. Of 1 104 people receiving HCT: 306 (28%) were HIV-positive; a CD4 count was documented for 57%; and few received TB screening or IPT. In clinic encounters among PLWH, 921 (15%) had documented TB symptoms; only 10% were assessed by smear microscopy, and few asymptomatic PLWH were offered IPT. Infection control was poorly documented and implemented. HIV status was documented for 155 (75%) of the 208 TB patients; 90% were HIV-positive and 88% had a documented CD4 count. Provision of CPT and ART was poorly documented. Conclusion. The coverage of most TB/HIV collaborative activities was below Global Plan targets. The lack of standardised recording tools and incomplete documentation impeded assessment at facility level and limited the accuracy of compiled data

The patient impact of point-of-care vs. laboratory placement of Xpert<SUP>®</SUP> MTB/RIF

The Xpert® MTB/RIF assay can diagnose tuberculosis (TB) rapidly and with great accuracy. The effect of Xpert placement at point of care (POC) vs. at an off-site laboratory on patient management remains unknown

Osiris: A Modern, High-Performance, Coupled, Multi-Physics Code For Nuclear Reactor Core Analysis

To meet the simulation needs of the GNEP program, LLNL is leveraging a suite of high-performance codes to be used in the development of a multi-physics tool for modeling nuclear reactor cores. The Osiris code project, which began last summer, is employing modern computational science techniques in the development of the individual physics modules and the coupling framework. Initial development is focused on coupling thermal-hydraulics and neutral-particle transport, while later phases of the project will add thermal-structural mechanics and isotope depletion. Osiris will be applicable to the design of existing and future reactor systems through the use of first-principles, coupled physics models with fine-scale spatial resolution in three dimensions and fine-scale particle-energy resolution. Our intent is to replace an existing set of legacy, serial codes which require significant approximations and assumptions, with an integrated, coupled code that permits the design of a reactor core using a first-principles physics approach on a wide range of computing platforms, including the world's most powerful parallel computers. A key research activity of this effort deals with the efficient and scalable coupling of physics modules which utilize rather disparate mesh topologies. Our approach allows each code module to use a mesh topology and resolution that is optimal for the physics being solved, and employs a mesh-mapping and data-transfer module to effect the coupling. Additional research is planned in the area of scalable, parallel thermal-hydraulics, high-spatial-accuracy depletion and coupled-physics simulation using Monte Carlo transport

Point-of-care Xpert® MTB/RIF for smear-negative tuberculosis suspects at a primary care clinic in South Africa

To assess the clinical utility and cost of point-of-care Xpert® MTB/RIF for the diagnosis of smear-negative tuberculosis (TB)

Use of a Javid™ shunt in the management of axillary artery injury as a complication of fracture of the surgical neck of the humerus: a case report

<p>Abstract</p> <p>Introduction</p> <p>Axillary artery injury is a rare but severe complication of fractures of the surgical neck of the humerus.</p> <p>Case presentation</p> <p>We present a case of axillary artery pseudoaneurysm secondary to such a fracture, in a 82-year-old white woman, presenting 10 weeks after the initial injury, successfully treated with subclavian to brachial reversed vein bypass together with simultaneous open reduction and internal fixation of the fracture. We discuss the use of a Javid™ shunt during combined upper limb revascularisation and open reduction and internal fixation of the fractured humerus.</p> <p>Conclusion</p> <p>This case highlights the usefulness of a Javid™ shunt, over other forms of vascular shunts, in prompt restoration of blood flow to effect limb salvage. It can be considered as a temporary measure whilst awaiting definitive revascularisation which can be performed following fracture fixation.</p