Development and implementation of a customised rapid syndromic diagnostic test for severe pneumonia

\ua9 2022 Navapurkar V et al. Background: The diagnosis of pneumonia has been hampered by a reliance on bacterial cultures which take several days to return a result, and are frequently negative. In critically ill patients this leads to the use of empiric, broad-spectrum antimicrobials and compromises good antimicrobial stewardship. The objective of this study was to establish the performance of a syndromic molecular diagnostic approach, using a custom TaqMan array card (TAC) covering 52 respiratory pathogens, and assess its impact on antimicrobial prescribing. Methods: The TAC was validated against a retrospective multi-centre cohort of broncho-alveolar lavage samples. The TAC was assessed prospectively in patients undergoing investigation for suspected pneumonia, with a comparator cohort formed of patients investigated when the TAC laboratory team were unavailable. Co-primary outcomes were sensitivity compared to conventional microbiology and, for the prospective study, time to result. Metagenomic sequencing was performed to validate findings in prospective samples. Antibiotic free days (AFD) were compared between the study cohort and comparator group. Results: 128 stored samples were tested, with sensitivity of 97% (95% confidence interval (CI) 88-100%). Prospectively, 95 patients were tested by TAC, with 71 forming the comparator group. TAC returned results 51 hours (interquartile range 41-69 hours) faster than culture and with sensitivity of 92% (95% CI 83-98%) compared to conventional microbiology. 94% of organisms identified by sequencing were detected by TAC. There was a significant difference in the distribution of AFDs with more AFDs in the TAC group (p=0.02). TAC group were more likely to experience antimicrobial de-escalation (odds ratio 2.9 (95%1.5-5.5)). Conclusions: Implementation of a syndromic molecular diagnostic approach to pneumonia led to faster results, with high sensitivity and impact on antibiotic prescribing

Patterns and predictors of place of cancer death for the oldest old

BACKGROUND: Cancer patients increasingly are among older age groups, but to date little work has examined the trends in cancer among older people, particularly in relation to end of life care and death. This study describes the older population who die of cancer and the factors which may affect their place of death. METHODS: A Cross-sectional analysis of national data was performed. The study included all people aged 75 and over dying of cancer in England and Wales between 1995 and 1999. The population was divided into exclusive 5 year age cohorts, up to 100 years and over. Descriptive analysis explored demographic characteristics, cancer type and place of death. RESULTS: Between 1995 and 1999, 315,462 people aged 75 and over were registered as dying from cancer. The number who died increased each year slightly over the 5 year period (1.2%). In the 75–79 age group, 55 % were men, in those aged 100 and over this fell to 16%. On reaching their hundreds, the most common cause of death for men was malignancies of the genital organs; and for women it was breast cancer. The most frequent place of death for women in their hundreds was the care home; for men it was hospitals. Those dying from lymphatic and haematopoietic malignancies were most likely to die in hospitals, those with head and neck malignancies in hospices and breast cancer patients in a care home. CONCLUSION: The finding of rising proportions of cancer deaths in institutions with increasing age suggests a need to ensure that appropriate high quality care is available to this growing section of the population

The subject of functional foods: Accounts of using foods containing phytosterols

This paper explores the notion of the late modern or reflexive subject, for whom consumption, rationality, autonomy and a reflexive attitude to risk are said to be constitutive. Drawing on an example of 'ordinary' health consumption (Gronow and Warde, 2001), the paper addresses what kinds of consumer identities emerge in people's talk about buying or eating foods containing phytosterols. These are 'functional foods' which are marketed on the basis that they actively lower cholesterol. Based on interviews with people who say that they buy or eat these foods, the analysis focuses on participants' reported trajectories relating to how this came about. Participants' accounts contain a number of explicit and implicit reasons for buying or eating the foods, which I characterise as agential, contextual, or non-agential, depending on the degree to which they draw on the agency of the actual purchaser or eater. These different types of explanations can be ordered in terms of their appeals to rationality, risk consciousness and autonomy. In agential explanations, people talk, for example, of doing something good for themselves, or experimenting with the foods. These explanations explicitly position consumers as health conscious, autonomous and rational to varying degrees. Contextual explanations drew on, for example, the role of doctors or family history in alerting people to a potential problem. These suggest both a different sense of risk consciousness, which may be prompted or contextual, and a less autonomous kind of consumer who is connected to others through a set of family and other relationships. Non-agential explanations, for example, where people attributed their consumption to others or to habit, appeal neither to the rationality, the health consciousness nor the autonomy of the actual consumer. The analysis helps to reinforce the potentially contextual or fluctuating nature of risk consciousness, and the relational and non-instrumental aspects of daily practices