Pediatric Epstein-Barr Virus Carriers With or Without Tonsillar Enlargement May Substantially Contribute to Spreading of the Virus

Background. Human-to-human transmission of the persistent infection establishing Epstein-Barr virus (EBV) occurs via saliva. Tonsils act as important portal of entry and exit of EBV. The contagiousness of pediatric EBV carriers and the role played by tonsillar enlargement (TE) are not known. Methods. We compared EBV shedding in mouthwash samples from pediatric EBV carriers with or without TE to that in mouthwash samples from pediatric patients with infectious mononucleosis (IM), the symptomatic form of primary infection if delayed after the age of 5 years. EBV DNA was quantified by polymerase chain reaction, and contagiousness was assessed using the cord lymphocyte transformation assay. Results. EBV carriers with TE shed EBV DNA at an almost similar frequency (although in lower amounts) as pediatric patients with acute IM but more frequently (P ! .001) and in higher amounts (Pp.038) than EBV carriers without TE. EBV DNA levels in mouthwash samples from EBV carriers with TE mirrored levels in tonsils and gradually declined after tonsillectomy. Almost half of the mouthwash samples from pediatric EBV carriers contained infectious EBV. Conclusions. Pediatric EBV carriers-in particular, those with TE-may considerably contribute to the spreading of EBV in industrialized countrie

Wandel, Evolution, Fortschritt – Beschreibung, Bewertung und Steuerung von Prozessen in Natur, Technik, Kultur und Gesellschaft: Editorial

„Alles ist Prozess“ – so könnte man meinen, rückt doch der Prozess als Beschreibungskategorie und damit die Prozessualität der jeweils betrachteten Phänomene in den letzten Jahrzehnten immer stärker in den Fokus wissenschaftlicher und außerwissenschaftlicher Reflexionen. Heute werden Prozesse in allen Bereichen – Natur, Technik, Wirtschaft, Politik, Gesellschaft und Kultur – nicht mehr nur diagnostiziert oder gedeutet, vielmehr werden sie überwacht, zu steuern und zu regulieren versucht, sie werden ‚optimiert‘, ‚gemanaged‘ und nicht zuletzt will Veränderung auch ‚kommuniziert‘ sein

Developing a reflection and analysis tool (We-ReAlyse) for readmissions to the intensive care unit: A quality improvement project

Readmissions to the intensive care unit are associated with poorer patient outcomes and health prognoses, alongside increased lengths of stay and mortality risk. To improve quality of care and patients' safety, it is essential to understand influencing factors relevant to specific patient populations and settings. A standardized tool for systematic retrospective analysis of readmissions would help healthcare professionals understand risks and reasons affecting readmissions; however, no such tool exists.; This study's purpose was to develop a tool (We-ReAlyse) to analyze readmissions to the intensive care unit from general units by reflecting on affected patients' pathways from intensive care discharge to readmission. The results will highlight case-specific causes of readmission and potential areas for departmental- and institutional-level improvements.; A root cause analysis approach guided this quality improvement project. The tool's iterative development process included a literature search, a clinical expert panel, and a testing in January and February 2021.; The We-ReAlyse tool guides healthcare professionals to identify areas for quality improvement by reflecting the patient's pathway from the initial intensive care stay to readmission. Ten readmissions were analyzed by using the We-ReAlyse tool, resulting in key insights about possible root causes like the handover process, patient's care needs, the resources on the general unit and the use of different electronic healthcare record systems.; The We-ReAlyse tool provides a visualization/objectification of issues related to intensive care readmissions, gathering data upon which to base quality improvement interventions. Based on the information on how multi-level risk profiles and knowledge deficits contribute to readmission rates, nurses can target specific quality improvements to reduce those rates.; With the We-ReAlyse tool, we have the opportunity to collect detailed information about ICU readmissions for an in-depth analysis. This will allow health professionals in all involved departments to discuss and either correct or cope with the identified issues. In the long term, this will allow continuous, concerted efforts to reduce and prevent ICU readmissions. To obtain more data for analysis and to further refine and simplify the tool, it may be applied to larger samples of ICU readmissions. Furthermore, to test its generalizability, the tool should be applied to patients from other departments and other hospitals. Adapting it to an electronic version would facilitate the timely and comprehensive collection of necessary information. Finally, the tool's emphasis comprises reflecting on and analyzing ICU readmissions, allowing clinicians to develop interventions targeting the identified problems. Therefore, future research in this area will require the development and evaluation of potential interventions

Expression of TRAIL, IP-10, and CRP in children with suspected COVID-19 and real-life impact of a computational signature on clinical decision-making: a prospective cohort study

Purpose We evaluated the host-response marker score “BV” and its components TRAIL, IP-10, and CRP in SARS-CoV-2 positive children, and estimated the potential impact on clinical decision-making. Methods We prospectively analyzed levels of TRAIL, IP-10, CRP, and the BV score, in children with suspected COVID19. Classifcation of infectious etiology was performed by an expert panel. We used a 5-point-questionnaire to evaluate the intention to treat with antibiotics before and after receiving test results. Results We screened 111 children, of whom 6 (5.4%) were positive for SARS-CoV-2. A total of 53 children were included for the exploratory analysis. Median age was 3.1 years (interquartile range [IQR] 1.3–4.3), and 54.7% (n=29) were girls. A viral and a bacterial biomarker pattern was found in 27/53 (50.9%) and 15/53 (28.3%), respectively. BV scores difered between COVID-19, children with other viral infections, and children with bacterial infections (medians 29.5 vs. 9 vs. 66; p=0.0006). Similarly, median TRAIL levels were diferent (65.5 vs. 110 vs. 78; p=0.037). We found no diferences in IP-10 levels (555 vs. 504 vs. 285; p=0.22). We found a concordance between physicians’ “unlikely intention to treat” children with a viral test result in most cases (n=19/24, 79.2%). When physicians expressed a “likely intention to treat” (n=15), BV test revealed 5 bacterial, viral, and equivocal scores each. Antibiotics were withheld in three cases (20%). Overall, 27/42 (64%) of pediatricians appraised the BV test positively, and considered it helpful in clinical practice. Conclusion Host-response based categorization of infectious diseases might help to overcome diagnostic uncertainty, support clinical decision-making and reduce unnecessary antibiotic treatment

TNF-related apoptosis-inducing ligand, interferon gamma-induced protein 10, and C-reactive protein in predicting the progression of SARS-CoV-2 infection : a prospective cohort study

Background: Early prognostication of COVID-19 severity will potentially improve patient care. Biomarkers, such as TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10), and C-reactive protein (CRP), might represent possible tools for point-of-care testing and severity prediction. Methods: In this prospective cohort study, we analyzed serum levels of TRAIL, IP-10, and CRP in patients with COVID-19, compared them with control subjects, and investigated the association with disease sever ity. Results: A total of 899 measurements were performed in 132 patients (mean age 64 years, 40.2% females). Among patients with COVID-19, TRAIL levels were lower (49.5 vs 87 pg/ml, P = 0.0142), whereas IP-10 and CRP showed higher levels (667.5 vs 127 pg/ml, P <0.001; 75.3 vs 1.6 mg/l, P <0.001) than healthy controls. TRAIL yielded an inverse correlation with length of hospital and intensive care unit (ICU) stay, Simplified Acute Physiology Score II, and National Early Warning Score, and IP-10 showed a positive cor relation with disease severity. Multivariable regression revealed that obesity (adjusted odds ratio [aOR] 5.434, 95% confidence interval [CI] 1.005-29.38), CRP (aOR 1.014, 95% CI 1.002-1.027), and peak IP-10 (aOR 1.001, 95% CI 1.00-1.002) were independent predictors of in-ICU mortality

Wandel, Evolution, Fortschritt – Beschreibung, Bewertung und Steuerung von Prozessen in Natur, Technik, Kultur und Gesellschaft: Editorial

„Alles ist Prozess“ – so könnte man meinen, rückt doch der Prozess als Beschreibungskategorie und damit die Prozessualität der jeweils betrachteten Phänomene in den letzten Jahrzehnten immer stärker in den Fokus wissenschaftlicher und außerwissenschaftlicher Reflexionen. Heute werden Prozesse in allen Bereichen – Natur, Technik, Wirtschaft, Politik, Gesellschaft und Kultur – nicht mehr nur diagnostiziert oder gedeutet, vielmehr werden sie überwacht, zu steuern und zu regulieren versucht, sie werden ‚optimiert‘, ‚gemanaged‘ und nicht zuletzt will Veränderung auch ‚kommuniziert‘ sein

Wandel, Evolution, Fortschritt – Beschreibung, Bewertung und Steuerung von Prozessen in Natur, Technik, Kultur und Gesellschaft: Editorial

„Alles ist Prozess“ – so könnte man meinen, rückt doch der Prozess als Beschreibungskategorie und damit die Prozessualität der jeweils betrachteten Phänomene in den letzten Jahrzehnten immer stärker in den Fokus wissenschaftlicher und außerwissenschaftlicher Reflexionen. Heute werden Prozesse in allen Bereichen – Natur, Technik, Wirtschaft, Politik, Gesellschaft und Kultur – nicht mehr nur diagnostiziert oder gedeutet, vielmehr werden sie überwacht, zu steuern und zu regulieren versucht, sie werden ‚optimiert‘, ‚gemanaged‘ und nicht zuletzt will Veränderung auch ‚kommuniziert‘ sein