Veralgemeende of selectieve screening voor dragerschap van methicilline resistente Staphylococcus aureus bij opname op een geriatrische dienst

Doel: De risicofactoren voor dragerschap van methicilline resistente Staphylococcus aureus (MRSA) bevestigen, een vereenvoudigde risicoscore opstellen en nagaan of hiermee een gerichte MRSA screening mogelijk is. Studie-opzet: Een prospectieve studie met MRSA screening van 1125 geriatrische patiënten binnen de 24 u na opname. Methoden: Afname van een lijst met risicofactoren, gebaseerd op recent gepubliceerde risicoscores (Preop Score en Ger Score). Resultaten: De prevalentie van MRSA dragerschap in onze populatie was 8,44%. Multivariaat analyse weerhield leeftijd ≥ 87jaar, aanwezigheid van verblijfscatheter en MRSA in het verleden als onafhankelijke risicofactoren. De nieuw samengestelde score (Novel Score met cut-off ≥1) had een sensitiviteit van 73,7%, specificiteit van 64%, positief predictieve waarde van 15,9%, negatief predictieve waarde van 96,3% en area under the curve van 0,688. De Novel Score laat een reductie van het aantal screeningen toe van 57,2%, maar mist 26% van de positieve gevallen. Zestien % van de MRSA-dragers ontwikkelden een infectie met MRSA waarvoor behandeling met vancomycine. Conclusie: Een belangrijke reductie in werkbelasting en kosten is mogelijk wanneer we een gerichte MRSA screening doorvoeren in vergelijking met een veralgemeende screening. Bij een selectieve screening kunnen echter MRSA dragers gemist worden, zodat de epidemiologische context, het transmissierisico en het MRSA infectierisico in rekening gebracht moeten worden vooraleer over te gaan op een gerichte screening

Paediatric aortic valve replacement:a meta-analysis and microsimulation study

AIMS: To support decision-making in children undergoing aortic valve replacement (AVR), by providing a comprehensive overview of published outcomes after paediatric AVR, and microsimulation-based age-specific estimates of outcome with different valve substitutes. METHODS AND RESULTS: A systematic review of published literature reporting clinical outcome after paediatric AVR (mean age &lt;18 years) published between 1/1/1990 and 11/08/2021 was conducted. Publications reporting outcome after paediatric Ross procedure, mechanical AVR (mAVR), homograft AVR (hAVR), and/or bioprosthetic AVR were considered for inclusion. Early risks (&lt;30d), late event rates (&gt;30d) and time-to-event data were pooled and entered into a microsimulation model. Sixty-eight studies, of which one prospective and 67 retrospective cohort studies, were included, encompassing a total of 5259 patients (37 435 patient-years; median follow-up: 5.9 years; range 1-21 years). Pooled mean age for the Ross procedure, mAVR, and hAVR was 9.2 ± 5.6, 13.0 ± 3.4, and 8.4 ± 5.4 years, respectively. Pooled early mortality for the Ross procedure, mAVR, and hAVR was 3.7% (95% CI, 3.0%-4.7%), 7.0% (5.1%-9.6%), and 10.6% (6.6%-17.0%), respectively, and late mortality rate was 0.5%/year (0.4%-0.7%/year), 1.0%/year (0.6%-1.5%/year), and 1.4%/year (0.8%-2.5%/year), respectively. Microsimulation-based mean life-expectancy in the first 20 years was 18.9 years (18.6-19.1 years) after Ross (relative life-expectancy: 94.8%) and 17.0 years (16.5-17.6 years) after mAVR (relative life-expectancy: 86.3%). Microsimulation-based 20-year risk of aortic valve reintervention was 42.0% (95% CI: 39.6%-44.6%) after Ross and 17.8% (95% CI: 17.0%-19.4%) after mAVR. CONCLUSION: Results of paediatric AVR are currently suboptimal with substantial mortality especially in the very young with considerable reintervention hazards for all valve substitutes, but the Ross procedure provides a survival benefit over mAVR. Pros and cons of substitutes should be carefully weighed during paediatric valve selection.</p

The role of hazard- and risk-based approaches in ensuring food safety

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An observational study of quality of motion in the aging cervical spine: sequence of segmental contributions in dynamic fluoroscopy recordings.

BACKGROUND: The term 'physiological motion of the spine' is commonly used although no proper definition exists. Previous work has revealed a consistent sequence of cervical segmental contributions in 80-90% of young healthy individuals. Age has been shown to be associated with a decreased quantity of motion. Therefore, it is of interest to study whether this sequence persists throughout aging. The aim of this prospective cohort study is to investigate if the consistent sequence of cervical segmental contributions in young asymptomatic individuals remains present in elderly asymptomatic individuals. METHODS: In this prospective cohort study, dynamic flexion to extension cinematographic recordings of the cervical spine were made in asymptomatic individuals aged 55-70 years old. Individuals without neck pain and without severe degenerative changes were included. Two recordings were made in each individual with a 2-to-4-week interval (T1 and T2). Segmental rotation of each individual segment between C4 and C7 was calculated to determine the sequence of segmental contributions. Secondary outcomes were segmental range of motion (sRoM) and sagittal alignment. RESULTS: Ten individuals, with an average age of 61 years, were included. The predefined consistent sequence of segmental contributions was found in 10% of the individuals at T1 and 0% at T2. sRoM and total range of motion (tRoM) were low in all participants. There was no statistically significant correlation between sagittal alignment, degeneration and sRoM in the respective segments, nor between cervical lordosis and tRoM. CONCLUSIONS: This study shows that aging is associated with loss of the consistent motion pattern that was observed in young asymptomatic individuals. The altered contribution of the cervical segments during extension did not appear to be correlated to the degree of degeneration or sagittal alignment. Trial registration clinicaltrials.gov NCT04222777, registered 10.01.2020

EAES and SAGES 2018 consensus conference on acute diverticulitis management:evidence-based recommendations for clinical practice

Background Acute diverticulitis (AD) presents a unique diagnostic and therapeutic challenge for general surgeons. This collaborative project between EAES and SAGES aimed to summarize recent evidence and draw statements of recommendation to guide our members on comprehensive AD management. Methods Systematic reviews of the literature were conducted across six AD topics by an international steering group including experts from both societies. Topics encompassed the epidemiology, diagnosis, management of non-complicated and complicated AD as well as emergency and elective operative AD management. Consensus statements and recommendations were generated, and the quality of the evidence and recommendation strength rated with the GRADE system. Modified Delphi methodology was used to reach consensus among experts prior to surveying the EAES and SAGES membership on the recommendations and likelihood to impact their practice. Results were presented at both EAES and SAGES annual meetings with live re-voting carried out for recommendations with < 70% agreement. Results A total of 51 consensus statements and 41 recommendations across all six topics were agreed upon by the experts and submitted for members’ online voting. Based on 1004 complete surveys and over 300 live votes at the SAGES and EAES Diverticulitis Consensus Conference (DCC), consensus was achieved for 97.6% (40/41) of recommendations with 92% (38/41) agreement on the likelihood that these recommendations would change practice if not already applied. Areas of persistent disagreement included the selective use of imaging to guide AD diagnosis, recommendations against antibiotics in non-complicated AD, and routine colonic evaluation after resolution of non-complicated diverticulitis. Conclusion This joint EAES and SAGES consensus conference updates clinicians on the current evidence and provides a set of recommendations that can guide clinical AD management practice

How to Choose the Right Inhaler Using a Patient-Centric Approach?

There are many different inhaler devices and medications on the market for the treatment of asthma and chronic obstructive pulmonary disease, with over 230 drug-delivery system combinations available. However, despite the abundance of effective treatment options, the achieved disease control in clinical practice often remains unsatisfactory. In this context, a key determining factor is the match or mismatch of an inhalation device with the characteristics or needs of an individual patient. Indeed, to date, no ideal device exists that fits all patients, and a personalized approach needs to be considered. Several useful choice-guiding algorithms have been developed in the recent years to improve inhaler-patient matching, but a comprehensive tool that translates the multifactorial complexity of inhalation therapy into a user-friendly algorithm is still lacking. To address this, a multidisciplinary expert panel has developed an evidence-based practical treatment tool that allows a straightforward way of choosing the right inhaler for each patient

Atmospheric pressure roll-to-roll plasma enhanced CVD of high quality silica-like bilayer encapsulation films

A glow like atmospheric pressure dielectric barrier discharge in a roll-to-roll setup was used to synthesize 90 nm silica-like bilayer encapsulation films composed of a 30 nm dense “barrier layer” and a comparatively less dense 60 nm “buffer layer” onto a polyethylene 2,6 naphthalate substrate by means of plasma enhanced chemical vapor deposition. Tetraethyl orthosilicate was used as the precursor gas, together with a mixture of nitrogen, oxygen, and argon. The microstructure, chemical composition, morphology, and permeation properties of the films were studied as a function of the specific energy delivered per precursor molecule, and oxygen concentration in the gas mixture, during the deposition of the barrier layer. The presence of the buffer layer within the bilayer architecture critically enhanced the encapsulation performance of the bilayer films, and this in conjunction with increasing the specific energy delivered per precursor molecule during the barrier layer deposition to a value of 20 keV, enabled an effective water vapor transmission rate as low as 6.9 × 10−4 g m−2 d−1 (at 40 °C, 90% relative humidity (RH)) to be achieved. Furthermore, the bilayer film structure has given rise to a remarkable 50% reduction in deposition energy consumption per barrier area with respect to single layer silica-like films of equivalent encapsulation performance and thickness.</p