“Fever means antibiotic”, the Omani public’s attitudes to the use of antibiotics for treating the common cold

Background: Antimicrobial resistance is a worldwide concern to reserve the effectiveness of antibiotics in therapy. The irrational use of antibiotics is one of the factors contributing to antimicrobial resistance. In depth exploration of the public’s attitudes towards the use of antibiotics for treating the common cold will improve understanding of the factors that cause the indiscriminate use of antibiotics; and could have an impact on antimicrobial resistance. Method: Semi-structured interviews were conducted with individuals recruited from public places, within governorate of Muscat, Oman. The interviews explored public perceptions about self care of minor ailments. The data was analysed by applying the principles of constructivist grounded theory. Results: Twenty-one participants were interviewed. Emerging themes included attitude to medicines in general, comprising specifically the use of antibiotics. Some participants indicated that it was necessary to take antibiotics for conditions associated with fever or severe sore throats. They believed that fever and inflammation is always a sign of bacterial infection that requires antibiotics. Participants did not understand the concept of bacterial resistance but thought that overuse of antibiotics affected their immunity to colds and sore throats. Access to antibiotics for treating the common cold is highly influenced by physicians’ prescribing behaviours, and there was a clear variance percieved between the private and public primary health sectors with regards to antibiotic prescribing practice. Conclusion: Due to misunderstanding, people believe that antibiotics are needed to treat colds and sore throats. These findings suggest there is a need for educational intervention and better enforcement of regulations in Oman

Localized cytokine responses to total knee arthroplasty and total knee revision complications

Background The study of localized immune-related factors has proven beneficial for a variety of conditions, and one area of interest in the field of orthopaedics is the impact of implants and localized infections on immune response. Several cytokines have shown increased systemic concentrations (in serum/plasma) in response to implants and infection, but tissue-level cytokines have not been investigated as thoroughly. Methods This exploratory study investigated tissue-level cytokines in a cohort of patients (N = 17) in response to total knee arthroplasty and total knee revision to better understand the immune response to implants and localized infection (e.g., prosthetic joint infection). The overall goal of this study was to provide insight into the localized cytokine response of tissues and identify tissue-level markers specific to inflammation caused by implants vs. inflammation caused by infection. Tissues were collected across several anatomical locations and assayed with a panel of 20 human inflammatory cytokines to understand spatial differences in cytokine levels. Results In this study, six cytokines were elevated in implanted joints, as compared to native joints: IL-10, IL-12p70, IL-13, IL-17A, IL-4, and TNF-α (p \u3c 0.05). Seven cytokines showed infection-dependent increases in localized tissues: IL-1α, IL-1β, IL-6, IL-8, MCP-1, MIP-1α, and MIP-1β (p \u3c 0.05). Conclusions This study demonstrated that differences exist in tissue-level cytokines in response to presence of implant, and some cytokines were specifically elevated for infection; these responses may be informative of overall tissue health. These results highlight the utility of investigating localized cytokine concentrations to offer novel insights for total knee arthroplasty and total knee revision procedures, as well as their complications. Ultimately, this information could provide additional, quantitative measurements of tissue to aid clinical decision making and patient treatment options

A systematic review of postgraduate training programmes directed at pharmacists entering primary care

This systematic review explores the international postgraduate education and training programmes designed to provide or develop knowledge or skills focused on enabling pharmacists to work in a general practice setting. Four thousand, eight hundred and seventy-one (4,871) articles were identified from database searches of SCOPUS, EMBASE, Medline, CINAHL, IPA, Web of Science and ERIC. After removal of duplicates and article screening, seven articles were included. Educational content, setting, contact time and methods of assessment varied across all studies. There is paucity of published literature relating to the development and evaluation of education programmes directed at pharmacists entering into general practice. A combination of work and classroom-based education provided by general practitioners and pharmacists already working in primary care is deemed most beneficial coupled with systematic debriefing sessions at the completion of training courses. The findings suggest future training should focus on specific disease states

Revision workshops in elementary mathematics enhance student performance in routine laboratory calculations

The ability to understand and implement calculations required for molarity and dilution computations that are routinely undertaken in the laboratory are essential skills that should be possessed by all students entering an undergraduate Life Sciences degree. However, it is increasingly recognized that the majority of these students are ill equipped to reliably carry out such calculations. There are several factors that conspire against students' understanding of this topic, with the alien concept of the mole in relation to the mass of compounds and the engineering notation required when expressing the relatively small quantities typically involved being two key examples. In this report, we highlight teaching methods delivered via revision workshops to undergraduate Life Sciences students at the University of Nottingham. Workshops were designed to 1) expose student deficiencies in basic numeracy skills and remedy these deficiencies, 2) introduce molarity and dilution calculations and illustrate their workings in a step-by-step manner, and 3) allow students to appreciate the magnitude of numbers. Preworkshop to postworkshop comparisons demonstrated a considerable improvement in students' performance, which attenuated with time. The findings of our study suggest that an ability to carry out laboratory calculations cannot be assumed in students entering Life Sciences degrees in the United Kingdom but that explicit instruction in the form of workshops improves proficiency to a level of competence that allows students to prosper in the laboratory environment

Reliability and efficiency evaluation of a community pharmacy dispensing process using a coloured Petri-net approach

© 2018 It has been estimated that European customers visit community pharmacies to access essential primary healthcare around 46 million times every day. Studies of dispensing error rates in community pharmacies have reported error rates of between 0.08% and 3.3% per item dispensed. While severe cases of dispensing inaccuracies often garner a high level of media coverage, less significant errors are also causing inefficiencies in primary healthcare delivery. If a variety of dispensing protocols and their consequences could be analysed using a modelling tool, the results would form the evidence for decisions on best practice guidelines in order to improve patient safety and pharmacy efficiency. This paper presents a Coloured Petri Net (CPN) modelling technique for analysing the reliability and efficiency of a community pharmacy dispensing process. The proposed approach is a novel method for considering reliability and efficiency in a single simulation based model. The CPN model represents how a team of practitioners work together to complete a set of tasks carried out in community pharmacies. It describes a close-to-reality dispensing process, which evaluates pharmacy performance over a number of key performance indicators of process reliability and efficiency, and records how staff distribute their time between tasks. Where possible, results are validated against published studies of community pharmacies

Evidence for Divisome Localization Mechanisms Independent of the Min System and SlmA in Escherichia coli

Cell division in Escherichia coli starts with assembly of FtsZ protofilaments into a ring-like structure, the Z-ring. Positioning of the Z-ring at midcell is thought to be coordinated by two regulatory systems, nucleoid occlusion and the Min system. In E. coli, nucleoid occlusion is mediated by the SlmA proteins. Here, we address the question of whether there are additional positioning systems that are capable of localizing the E. coli divisome with respect to the cell center. Using quantitative fluorescence imaging we show that slow growing cells lacking functional Min and SlmA nucleoid occlusion systems continue to divide preferentially at midcell. We find that the initial Z-ring assembly occurs over the center of the nucleoid instead of nucleoid-free regions under these conditions. We determine that Z-ring formation begins shortly after the arrival of the Ter macrodomain at the nucleoid center. Removal of either the MatP, ZapB, or ZapA proteins significantly affects the accuracy and precision of Z-ring positioning relative to the nucleoid center in these cells in accordance with the idea that these proteins link the Ter macrodomain and the Z-ring. Interestingly, even in the absence of Min, SlmA, and the putative Ter macrodomain – Z-ring link, there remains a weak midcell positioning bias for the Z-ring. Our work demonstrates that additional Z-ring localization systems are present in E. colithan are known currently. In particular, we identify that the Ter macrodomain acts as a landmark for the Z-ring in the presence of MatP, ZapB and ZapA proteins

The electronic frailty index as an indicator of community healthcare service utilisation in the older population

Background: older people with frailty are particularly high users of healthcare services, however a lack of standardised recording of frailty in different healthcare electronic datasets has limited investigations into healthcare service usage and demand of the older frail population. Objectives: to investigate the community service demand of frail patients using the electronic frailty index (eFI) as a measure of frailty. Study design and setting a retrospective cohort study using anonymised linked healthcare patient data from primary care, community services and acute hospitals in Norfolk. Participants: patients aged 65 and over who had an eFI assessment score established in their primary care electronic patient record in Norwich based General Practices. Results: we include data from 22,859 patients with an eFI score. Frailty severity increased with age and was associated with increased acute hospital admission within a 6-month window. Patients with a frail eFI score were also more likely to have a community service referral within a 6-month window of frailty assessment, with a RR of 1.84 (1.76–1.93) for mild frailty, 1.96 (1.83–2.09) for moderate frailty and 2.95 (2.76–3.14) for severe frailty scores. We also found that frail patients had more community referrals per patient then those classified as fit and required more care plans per community referral. Conclusions: eFI score was an indicator of community service use, with increasing severity of frailty being associated with higher community healthcare requirements. The eFI may help planning of community services for the frail population