Studies on transition metal octacyano-complexes and related species

Imperial Users onl

Waiting for test results before isolating patients with Clostridium difficile disease may be associated with increased transmission

Clostridium difficile is an infection that is associated with environmental contamination. Rapid isolation is recommended to prevent transmission. UK Guidelines state that patients with suspected infection should be isolated within two hours of the onset of symptoms [1], however they also state that the diarrhoea should not be clearly attributable to another cause. This can cause confusion and in busy clinical settings diarrhoea can be attributed to the administration of laxatives and other causes, meaning that patients may not be isolated until after a positive test result is received

Occasional essay: upper motor neuron syndrome in amyotrophic lateral sclerosis

The diagnosis of amyotrophic lateral sclerosis (ALS) requires recognition of both lower (LMN) and upper motor neuron (UMN) dysfunction.1 However, classical UMN signs are frequently difficult to identify in ALS.2 LMN involvement is sensitively detected by electromyography (EMG)3 but, as yet, there are no generally accepted markers for monitoring UMN abnormalities,4 the neurobiology of ALS itself, and disease spread through the brain and spinal cord,.5 Full clinical assessment is therefore necessary to exclude other diagnoses and to monitor disease progression. In part, this difficulty regarding detection of UMN involvement in ALS derives from the definition of ‘the UMN syndrome’. Abnormalities of motor control in ALS require reformulation within an expanded concept of the UMN, together with the neuropathological, neuro-imaging and neurophysiological abnormalities in ALS. We review these issues here

Surveillance of surgical site infection: more accurate definitions and more intensive recordings needed

Surgical site infection (SSI) continues to be a burden on systems that deliver healthcare and on patients who suffer morbidity, and mortality, associated with this complication of medical intervention. Surveillance of SSI is often an integral part of organizational infection prevention and control activities, but unless post-discharge surveillance is carried out in a robust manner the data may be inaccurate and misleading. Coupled with a lack of robust application of definitions, variations in methods of case-finding and incomplete follow-up, the results may lead to a false sense of security or conversely cause unnecessary anxieties. Data from national surveillance schemes that purport to be suitable for benchmarking are often at odds with published rates from well-designed studies and the reasons for this should be examined. If benchmarking is truly desirable and if clinicians are to have confidence in the outputs, surveillance schemes should ensure that participating organizations adopt a consistent approach to definitions, case-finding methodologies following discharge, and to robust follow-up, to ensure that every opportunity is taken to maximize the return rate and enhance data validity

Feasibility of implementing pulse oximetry screening for congenital heart disease in a community hospital.

Objective: Pulse oximetry has been recognized as a promising screening tool for critical congenital heart disease (CCHD). The aim of this research was to study the feasibility of implementation in a community hospital setting. Study Design: Meetings were conducted to determine an implementation plan. Pulse oximetry was performed on the right hand and foot after 24h of age. Newborns with a saturation 95% or a 3% difference were considered to have a positive screen. Screening barriers, screening time and ability to effectively screen all eligible newborns were noted. Result: From January 2009 through May 2010, of 6841 eligible newborns, 6745 newborns (98.6%) were screened. Of the nine infants with positive pulse oximetry screens, one had CCHD, four had CHD and four others were determined to have false positive screens. Average screening time was 3.5min (0 to 35min). Conclusion: Pulse oximetry can be implemented successfully in community hospitals without an excessive number of false positives or additional nursing staff

Strategies to Reduce Non-Ventilator-Associated Hospital-Acquired Pneumonia: A Systematic Review

Background Point prevalence studies identify that pneumonia is the most common healthcare associated infection. However, non-ventilator associated healthcare associated pneumonia (NV-HAP) is both underreported and understudied. Most research conducted to date, focuses on ventilator associated pneumonia. We conducted a systematic review, to provide the latest evidence for strategies to reduce NV-HAP and describe the methodological approaches used. Methods We performed a systematic search to identify research exploring and evaluating NV-HAP preventive measures in hospitals and aged-care facilities. The electronic database Medline was searched, for peer-reviewed articles published between 1st January 1998 and 31st August 2018. An assessment of the study quality and risk of bias of included articles was conducted using the Newcastle–Ottawa Scale. Results The literature search yielded 1551 articles, with 15 articles meeting the inclusion criteria. The majority of strategies for NV-HAP prevention focussed on oral care (n = 9). Three studies evaluated a form of physical activity, such as passive movements, two studies used dysphagia screening and management; and another study evaluated prophylactic antibiotics. Most studies (n = 12) were conducted in a hospital setting. Six of the fifteen studies were randomised controlled trials. Conclusion There was considerable heterogeneity in the included studies, including the type of intervention, study design, methods and definitions used to diagnose the NV-HAP. To date, interventions to reduce NV-HAP appear to be based broadly on the themes of improving oral care, increased mobility or movement and dysphagia management