Use of Feedback Data to Reduce Surgical Site Infections and Optimize Antibiotic Use in Surgery: A Systematic Scoping Review.

OBJECTIVE: Surgical site infection (SSI) prevention remains significant, particularly in the era of antimicrobial resistance. Feedback on practices and outcomes is known to be key to reduce SSI rates and optimize antibiotic usage. However, the optimal method, format and frequency of feedback for surgical teams remains unclear. The objective of the study is to understand how data from surveillance and audit are fed back in routine surgical practice. METHODS: A systematic scoping review was conducted, using well-established implementation science frameworks to code the data. Two electronic health-oriented databases (MEDLINE, EMBASE) were searched to September 2019. We included studies that assessed the use of feedback as a strategy either in the prevention and management of SSI and/or in the use of antibiotics perioperatively. RESULTS: We identified 21 studies: 17 focused on SSI rates and outcomes and 10 studies described antimicrobial stewardship for SSI (with some overlap in focus). Several interventions were reported, mostly multimodal with feedback as a component. Feedback was often provided in written format (62%), either individualized (38%) or in group (48%). Only 25% of the studies reported that feedback cascaded down to the frontline perioperative staff. In 65% of the studies, 1 to 5 implementation strategies were used while only 5% of the studies reported to have utilized more than 15 implementation strategies. Among studies reporting antibiotic usage in surgery, most (71%) discussed compliance with surgical antibiotic prophylaxis. CONCLUSIONS: Our findings highlight the need to provide feedback to all levels of perioperative care providers involved in patient care. Future research in this area should report implementation parameters in more detail

Inhibition of HER2 enriches for Jagged1-dependent breast cancer stem cells: role for membrane Jagged1

Purpose: Human Epidermal Growth Factor Receptor 2 (HER2) positive breast cancer is driven by cells possessing stem-like properties of self-renewal and differentiation, referred to as Cancer Stem Cells (CSCs). CSCs are implicated in radiotherapy, chemotherapy resistance, and tumor recurrence. Notch promotes breast CSCs survival and self-renewal, and overexpression of Notch1 and the Notch ligand Jagged1 predict poor outcome. Resistance to anti-HER2 therapy in HER2+ breast cancer requires Notch1, and that combination of trastuzumab and a Gamma Secretase Inhibitor (GSI) prevents tumor relapse in xenograft models. Experimental Design: The current study investigates mechanisms by which HER2 tyrosine kinase activity regulates Notch-dependent CSC survival and tumor initiation. Results: Lapatinib-mediated HER2 inhibition shifts the population of HER2+ breast cancer cells from low membrane Jagged1 expressing to higher levels, independent of sensitivity to anti-HER2 treatment within the bulk cell population. This increase in membrane Jagged1 is associated with higher Notch receptor expression, activation, and enrichment of CSCs in vitro and in vivo. Importantly, lapatinib treatment results in growth arrest and cell death of Jagged1 low-expressing cells while the Jagged1 high-expressing cells continue to cycle. High membrane Jagged1 protein expression predicts poor overall cumulative survival in women with HER2+ breast cancer. Conclusions: These results indicate that higher membrane Jagged1 expression may be used to either predict response to anti-HER2 therapy or for detection of Notch sensitive CSCs post therapy. Sequential blockade of HER2 followed by Jagged1 or Notch could be more effective than simultaneous blockade to prevent drug resistance and tumor progression

Salivary Glucose Oxidase from Caterpillars Mediates the Induction of Rapid and Delayed-Induced Defenses in the Tomato Plant

Caterpillars produce oral secretions that may serve as cues to elicit plant defenses, but in other cases these secretions have been shown to suppress plant defenses. Ongoing work in our laboratory has focused on the salivary secretions of the tomato fruitworm, Helicoverpa zea. In previous studies we have shown that saliva and its principal component glucose oxidase acts as an effector by suppressing defenses in tobacco. In this current study, we report that saliva elicits a burst of jasmonic acid (JA) and the induction of late responding defense genes such as proteinase inhibitor 2 (Pin2). Transcripts encoding early response genes associated with the JA pathway were not affected by saliva. We also observed a delayed response to saliva with increased densities of Type VI glandular trichomes in newly emerged leaves. Proteomic analysis of saliva revealed glucose oxidase (GOX) was the most abundant protein identified and we confirmed that it plays a primary role in the induction of defenses in tomato. These results suggest that the recognition of GOX in tomato may represent a case for effector-triggered immunity. Examination of saliva from other caterpillar species indicates that saliva from the noctuids Spodoptera exigua and Heliothis virescens also induced Pin2 transcripts

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Évaluation de la couverture vaccinale contre la diphtérie, le tétanos, la poliomyélite, l'hépatite B et la coqueluche de la population adulte en Savoie

Objectifs : Évaluer la couverture vaccinale contre la diphtérie, le tétanos, la poliomyélite, l'hépatite B et la coqueluche de la population adulte en Savoie, déterminer l'existence ou non d'un document de référence et les modalités de suivi par un échantillon de médecins généralistes. Matériel et méthodes : Enquête épidémiologique descriptive menée sur neuf sites du département, l'espace de santé publique du centre hospitalier de Chambéry, quatre cabinets de médecine de ville et quatre cabinets de médecine rurale. Résultats : Trois cent quatre vingt dix neuf (399) patients âgés de 46,10 ans en moyenne, ont été inclus dans l'étude. Quatre-vingts pour cent (80%), ont été considérés comme à jour contre le tétanos, 69% contre la diphtérie et la poliomyélite; données sensiblement identiques à celles obtenues sur le département de l'Isère en 2002. Quarante-quatre pour cent (44%) des patients ont été considérés comme à jour contre l'hépatite B, couverture vaccinale largement insuffisante et sans franche progression depuis 7 ans comparativement aux études de 2002. La couverture vaccinale contre la coqueluche apparaît médiocre avec seulement 10% des patients à jour pour cette étude, et ce, malgré un recul de 5 ans sur la mise en place de la stratégie du cocooning .Enfin, 37% de la population étudiée ne possédaient aucun document récapitulatif des vaccinations. Conclusion : Les résultats sont en faveur d'une faible protection vaccinale globale en particulier contre l'hépatite B et la coqueluche pour les tranches d'âge concernées, qui tend à s'aggraver avec l'âge. La mise en place d'un support récapitulatif des vaccinations, universel, fiable et facilement accessible constitue une priorité de santé publique au regard de la faible documentation vaccinale.Objective : Evaluation of the immunisation cover for diphteria, tetanus, poliomyelitis, hepatitis B and pertussis of the adult population of the Savoie region, of the existence of a vaccination record document, and the method of patient follow upby general practitionners. Methods : Descriptive epidemiological survey of nine health centres in the region, the public health clinic at Chambery hospital, four urban general practice surgeries and four rural general practice surgeries. Results : Three hundred and ninety nine (399) patients with an average age of 46,10 years were included in the study . Eighty percent (80%), were considereted up to date concerning tetanus, 69% for diphteria and poliomyelitis . These results are comparable to those found in the neighbouring Isere region in 2002 . Forty four percent (44%) of patients were up to date for hepatitis B, which is largery insufficient, and no improvement on the results found in 2002 . The vaccination cover for pertussis was mediocre with only 10% of patients up to date in this study, and this despite the introduction of a booster dose strategy for adults five years ago .Of the population studied, 37% possessed no document regarding vaccination status. Conclusion : Overall low rates of vaccination cover were found, particularly for hepatitis B and pertussis in the age groups studied, this worsens with increasing age. The introduction of a document to accurately record vaccinations, to be used universally, and easily accessible for all, is a public health priority in view of the poor immunisation records found.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Insights into the Saliva of the Brown Marmorated Stink Bug <i>Halyomorpha halys</i> (Hemiptera: Pentatomidae)

<div><p>We examined the salivary gland structure of the brown marmorated stink bug (Pentatomidae: <i>Halyomorpha halys</i>) and developed methods for independent collection of watery saliva and sheath saliva. This stink bug has become a serious invasive pest of agriculture in the United States and its saliva is largely responsible for the damage it causes. We determined by protein gel analysis and shotgun proteomics that the suite of proteins comprising the sheath and watery saliva are very distinct. Our results indicate that a substantial amount of sheath proteins are derived from tomato when stink bugs feed on tomato fruit. Consequently, the sheath saliva is comprised of both insect and plant-derived proteins. Both sheath and watery saliva possessed amylase activities, but polyphenol oxidase and glucose oxidase activities were not detected in either saliva. Peroxidase activity was only detected in salivary sheaths, but only when stink bugs fed on tomato. Proteomic analysis indicated that the peroxidase was likely of plant origin. We also determined that sheath saliva, but not watery saliva elicited the jasmonate inducible defense gene <i>proteinase inhibitor 2</i> (<i>Pin2</i>), but this induction was only observed when sheaths had been collected from tomato. This indicates that the eliciting factor of the saliva is likely of plant origin. Lastly, neither watery or sheath saliva affected the expression of the salicylate inducible gene pathogenesis related gene (<i>Pr1a-P4</i>).</p></div

Effect of saliva from brown marmorated stink bug on expression of the pathogenesis related <i>Pr1a(P4)</i> defense gene in tomato.

<p>Relative expression of <i>Pr1a(P4)</i> in tomato leaves 24 h after wounding and application of PBS, watery saliva or salivary sheath extract from tomato-fed BMSB (a) or BMSB held in plastic cups without food (b). For each treatment n = 5 and the median untreated plant was used as the calibrator. (Fisher’s P < 0.05, following ANOVA). Error bars represent +SE.</p

Salivary protein distribution of watery and sheath saliva from the brown marmorated stink bug.

<p>Relative abundance of peptides identified by LC- MS/MS from BMSB watery saliva (a) or BMSB salivary sheaths (b).</p

Salivary glands of brown marmorated stink bug.

<p>Structure of BMSB salivary glands. (a) anterior lobe of principal gland; (b) posterior lobe of principal gland; (c) salivary duct; (d) accessory gland. Illustration by Nick Sloff.</p