Universal screening for meticillin-resistant Staphylococcus aureus : interim results from the NHS Scotland pathfinder project

Following recommendations from a Health Technology Assessment (HTA), a prospective cohort study of meticillin-resistant Staphylococcus aureus (MRSA) screening of all admissions (N = 29 690) to six acute hospitals in three regions in Scotland indicated that 7.5% of patientswere colonised on admission to hospital. Factors associated with colonisation included re-admission, specialty of admission (highest in nephrology, care of the elderly, dermatology and vascular surgery), increasing age, and the source of admission (care home or other hospital). Three percent of all those who were identified as colonised developed hospital-associated MRSA infection, compared with only 0.1% of those not colonised. Specialtieswith a high rate of colonisation on admission also had higher rates of MRSA infection. Very few patients refused screening (11 patients, 0.03%) or had treatment deferred (14 patients, 0.05%). Several organisational issues were identified, including difficulties in achieving complete uptake of screening (88%) or decolonisation (41%); the latter was largely due to short duration of stay and turnaround time for test results. Patient movement resulted in a decision to decontaminate all positive patients rather than just those in high risk specialties as proposed by the HTA. Issues also included a lack of isolation facilities to manage patients with MRSA. The study raises significant concerns about the contribution of decolonisation to reducing risks in hospital due to short duration of stay, and reinforces the central role of infection control precautions. Further study is required before the HTA model can be re-run and conclusions redrawn on the cost and clinical effectiveness of universal MRSA screening

Integrating the liberal arts into the body of knowledge for civil engineering systems engineers

The paper outlines the case for a body of knowledge for civil engineering systems engineers to include, alongside its primary focus on engineering and technology, supplementary strands from the liberal arts. A case is made for future thought leaders in civil engineering systems to be exposed to a body of knowledge that goes well beyond current UK engineering undergraduate content, providing the formation for a lifetime career in the design, planning, development and administration of infrastructure and cities systems. This would equip systems engineers with empathy and understanding of the social, economic, governance, cultural, philosophical, historic, and business context behind complex civil engineering systems and enhance skills in analysis, synthesis, collaboration, leadership, and communication skills. A set of exemplar modules is provided to complement the engineering and technology content of post-graduate systems courses

The Experiences of Specialist Nurses Working Within the Uro-oncology Multidisciplinary Team in the United Kingdom.

PURPOSE: United Kingdom prostate cancer nursing care is provided by a variety of urology and uro-oncology nurses. The experience of working in multidisciplinary teams (MDT) was investigated in a national study. DESIGN: The study consisted of a national survey with descriptive statistics and thematic analysis. METHODS: A secondary analysis of a data subset from a UK whole population survey was undertaken (n = 285) of the specialist nursing workforce and the services they provide. Data were collected on the experience of working in the MDT. RESULTS: Forty-five percent of the respondents felt that they worked in a functional MDT, 12% felt that they worked in a dysfunctional MDT, and 3.5% found the MDT meeting intimidating. Furthermore, 34% of the nurses felt that they could constructively challenge all members of the MDT in meetings. Themes emerging from open-ended questions were lack of interest in nonmedical concerns by other team members, ability to constructively challenge decisions or views within the meeting, and little opportunity for patients' wishes to be expressed. CONCLUSIONS: Despite expertise and experience, nurses had a variable, often negative, experience of the MDT. It is necessary to ensure that all participants can contribute and are heard and valued. More emphasis should be given to patients' nonmedical needs

Stress Distribution in Porcelain-Fused-to-Gold Crowns and Preparations Constructed with Photoelastic Plastics

Composite models representing porcelain-fused-to-gold restorations were constructed from photoelastic plastics. Better stress distributions resulted when the porcelain-gold joint was as far as feasible from the loading site, a bulk of gold was present on the lingual shoulder, and the porcelain-gold joint at the shoulder was 30° from the horizontal.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66999/2/10.1177_00220345710500053101.pd

Antibiotic cycling versus mixing: the difficulty of using mathematical models to definitively quantify their relative merits.

Published PDF version deposited in accordance with SHERPA RoMEO guidelines.We ask the question Which antibiotic deployment protocols select best against drug-resistant microbes: mixing or periodic cycling? and demonstrate that the statistical distribution of the performances of both sets of protocols, mixing and periodic cycling, must have overlapping supports. In other words, it is a general, mathematical result that there must be mixing policies that outperform cycling policies and vice versa. As a result, we agree with the tenet of Bonhoefer et al. [1] that one should not apply the results of [2] to conclude that an antibiotic cycling policy that implements cycles of drug restriction and prioritisation on an ad-hoc basis can select against drug-resistant microbial pathogens in a clinical setting any better than random drug use. However, nor should we conclude that a random, per-patient drug-assignment protocol is the de facto optimal method for allocating antibiotics to patients in any general sense

Comparative in vitro activity of Meropenem, Imipenem and Piperacillin/tazobactam against 1071 clinical isolates using 2 different methods: a French multicentre study

<p>Abstract</p> <p>Background</p> <p>Meropenem is a carbapenem that has an excellent activity against many gram-positive and gram-negative aerobic, facultative, and anaerobic bacteria. The major objective of the present study was to assess the <it>in vitro </it>activity of meropenem compared to imipenem and piperacillin/tazobactam, against 1071 non-repetitive isolates collected from patients with bacteremia (55%), pneumonia (29%), peritonitis (12%) and wound infections (3%), in 15 French hospitals in 2006. The secondary aim of the study was to compare the results of routinely testings and those obtained by a referent laboratory.</p> <p>Method</p> <p>Susceptibility testing and Minimum Inhibitory Concentrations (MICs) of meropenem, imipenem and piperacillin/tazobactam were determined locally by Etest method. Susceptibility to meropenem was confirmed at a central laboratory by disc diffusion method and MICs determined by agar dilution method for meropenem, imipenem and piperacillin/tazobactam.</p> <p>Results</p> <p>Cumulative susceptibility rates against <it>Escherichia coli </it>were, meropenem and imipenem: 100% and piperacillin/tazobactam: 90%. Against other <it>Enterobacteriaceae</it>, the rates were meropenem: 99%, imipenem: 98% and piperacillin/tazobactam: 90%. All <it>Staphylococci</it>, <it>Streptococci </it>and anaerobes were susceptible to the three antibiotics. Against non fermeters, meropenem was active on 84-94% of the strains, imipenem on 84-98% of the strains and piperacillin/tazobactam on 90-100% of the strains.</p> <p>Conclusions</p> <p>Compared to imipenem, meropenem displays lower MICs against <it>Enterobacteriaceae</it>, <it>Escherichia coli </it>and <it>Pseudomonas aeruginosa</it>. Except for non fermenters, MICs90 of carbapenems were <4 mg/L. Piperacillin/tazobactam was less active against <it>Enterobacteriaceae </it>and <it>Acinetobacter </it>but not <it>P. aeruginosa</it>. Some discrepancies were noted between MICs determined by Etest accross centres and MICs determined by agar dilution method at the central laboratory. Discrepancies were more common for imipenem testing and more frequently related to a few centres. Overall MICs determined by Etest were in general higher (0.5 log to 1 log fold) than MICs by agar dilution.</p

A realist review of how community-based drug checking services could be designed and implemented to promote engagement of people who use drugs

With rising numbers of drug-related deaths in the UK and globally, exploration of interventions that seek to reduce drug-related harm is essential. Drug checking services (DCS) allow people to submit drug samples for chemical analysis and receive feedback about the sample, as well as harm reduction advice. The use of DCS is often linked to festival and/or nightlife settings and to so-called ‘recreational’ drug use, but research has also shown the potential of community-based DCS as an intervention serving more varied demographics of people who use drugs, including more marginalised individuals and those experiencing drug dependence. Whilst there is a growing evidence base on the effectiveness of drug checking as a harm reduction intervention, there is still limited evidence of the underlying mechanisms and processes within DCS which may aid implementation and subsequent engagement of people who use drugs. This presents a challenge to understanding why engagement differs across types of DCS, and how best to develop and deliver services across different contexts and for different populations. To explore the contexts and mechanisms which impact engagement in community-based DCS, a realist review was undertaken to synthesise the international evidence for the delivery and implementation of DCS. There were 133 sources included in the review. From these sources the underlying contexts, mechanisms, and outcomes relating to DCS implementation and engagement were developed and refined into seven programme theories. The findings of this review are theoretically novel and hold practical relevance for the design of DCS, with implications for optimisation, tailoring, and implementing services to reach individuals in different settings

Synthesis of iron-doped TiO2 nanoparticles by ball-milling process : the influence of process parameters on the structural, optical, magnetic, and photocatalytic properties

Titanium dioxide (TiO2) absorbs only a small fraction of incoming sunlight in the visible region thus limiting its photocatalytic efficiency and concomitant photocatalytic ability. The large-scale application of TiO2 nanoparticles has been limited due to the need of using an ultraviolet excitation source to achieve high photocatalytic activity. The inclusion of foreign chemical elements in the TiO2 lattice can tune its band gap resulting in an absorption edge red-shifted to lower energies enhancing the photocatalytic performance in the visible region of the electromagnetic spectrum. In this research work, TiO2 nanoparticles were doped with iron powder in a planetary ball-milling system using stainless steel balls. The correlation between milling rotation speeds with structural and morphologic characteristics, optical and magnetic properties, and photocatalytic abilities of bare and Fedoped TiO2 powders was studied and discussed.This work was partially financed by FCT-Fundacao para a Ciencia e Tecnologia-under the project PTDC/FIS/120412/2010: "Nanobased concepts for Innovative & Eco-sustainable constructive material's surfaces.