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

Discovery of a small molecule agonist of phosphatidylinositol 3-kinase p110α that reactivates latent HIV-1

Combination antiretroviral therapy (cART) can effectively suppress HIV-1 replication, but the latent viral reservoir in resting memory CD4+ T cells is impervious to cART and represents a major barrier to curing HIV-1 infection. Reactivation of latent HIV-1 represents a possible strategy for elimination of this reservoir. In this study we describe the discovery of 1,2,9,10-tetramethoxy-7H-dibenzo[de,g]quinolin-7-one (57704) which reactivates latent HIV-1 in several cell-line models of latency (J89GFP, U1 and ACH-2). 57704 also increased HIV-1 expression in 3 of 4 CD8+-depleted blood mononuclear cell preparations isolated from HIV-1-infected individuals on suppressive cART. In contrast, vorinostat increased HIV-1 expression in only 1 of the 4 donors tested. Importantly, 57704 does not induce global T cell activation. Mechanistic studies revealed that 57704 reactivates latent HIV-1 via the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway. 57704 was found to be an agonist of PI3K with specificity to the p110a isoform, but not the p110β, δ or γ isoforms. Taken together, our work suggests that 57704 could serve as a scaffold for the development of more potent activators of latent HIV-1. Furthermore, it highlights the involvement of the PI3K/Akt pathway in the maintenance of HIV-1 latency. © 2014 Doyon et al

Secondary Endoleak Management Following TEVAR and EVAR.

Endovascular abdominal and thoracic aortic aneurysm repair and are widely used to treat increasingly complex aneurysms. Secondary endoleaks, defined as those detected more than 30 days after the procedure and after previous negative imaging, remain a challenge for aortic specialists, conferring a need for long-term surveillance and reintervention. Endoleaks are classified on the basis of their anatomic site and aetiology. Type 1 and type 2 endoleaks (EL1 and EL2) are the most common endoleaks necessitating intervention. The management of these requires an understanding of their mechanics, and the risk of sac enlargement and rupture due to increased sac pressure. Endovascular techniques are the main treatment approach to manage secondary endoleaks. However, surgery should be considered where endovascular treatments fail to arrest aneurysm growth. This chapter reviews the aetiology, significance, management strategy and techniques for different endoleak types

An Assessment of the Risk Associated with the Movement of Nonpasteurized Liquid Egg (NPLE) and Its Products Into, Within, and Outside of a Control Area During a Highly Pathogenic Avian Influenza Outbreak

Suggested bibliographic citation for this report: Timothy Goldsmith, Janel Funk, David Halvorson, Morgan Hennesey, Brendan Lee, Sasidhar Malladi, Kristina McElroy, Katherine Waters, Todd Weaver, Timothy Clouse. An Assessment of the Risk Associated with the Movement of Nonpasteurized Liquid Egg (NPLE) and Its Products Into, Within, and Outside of a Control Area During a Highly Pathogenic Avian Influenza Outbreak. Collaborative agreement between USDA:APHIS:VS:CEAH and University of Minnesota Center for Animal Health and Food Safety, Fort Collins, CO. January 2009. 123 pgs. Retrieved from the University of Minnesota Digital Conservancy: https://hdl.handle.net/11299/176192This document is a proactive Risk Assessment (RA) that seeks to evaluate the risk that movement of Nonpasteurized Liquid Egg (NPLE) during a highly pathogenic avian influenza (HPAI) outbreak in the poultry industry in the United States will result in the spread of HPAI virus to other premises with poultry. This assessment evaluates risks of HPAI spread associated with the movement of Nonpasteurized Liquid Egg (NPLE) originating from a Monitored Premises within, into, and outside a Control Area.This document was developed through the Continuity of Business / Secure Food Supply Plans / Secure Poultry Supply project initiative. Related documents can be found at: https://www.aphis.usda.gov - search for "Continuity of Business

An Integrative Review of the Barriers and Facilitators to Nurse Engagement in Quality Improvement in the Clinical Practice Setting

Background: Nurse engagement in quality improvement (QI) improves health care quality and outcomes but is typically low in clinical settings. Purpose: An integrative review was conducted to identify facilitators and barriers of nurse engagement in QI. Methods: This integrative review was conducted using an electronic search of databases with search terms specific to nursing engagement in QI. The Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide was used to rate quality and level of evidence. Results: Nine articles met the criteria for review. Top barriers were leadership, education and training, resource constraints, data, culture, and time. Top facilitators were leadership, education and training, culture, mentors, and champions. Conclusion: High-quality literature exploring barriers and facilitators of nurse engagement in QI is lacking. Research is needed to examine the degree to which these barriers and facilitators impact engagement and how they can be addressed to increase it