Nanosilver/DCOIT-containing surface coating effectively and constantly reduces microbial load in emergency room surfaces

BACKGROUND

Colonization of near-patient surfaces in hospitals plays an important role as a source of healthcare-associated infections. Routine disinfection methods only result in short-term elimination of pathogens.

AIM

To investigate the efficiency of a newly developed antimicrobial coating containing nanosilver in long-term reduction of bacterial burden in hospital surfaces to close the gap between routine disinfection cycles.

METHODS

In this prospective, double-blinded trial, frequently touched surfaces of a routinely used treatment room in an emergency unit of a level-I hospital were treated with a surface coating (nanosilver/DCOIT-coated surface, NCS) containing nanosilver particles and another organic biocidal agent (4,5-dichloro-2-octyl-4-isothiazolin-3-one, DCOIT), whereas surfaces of another room were treated with a coating missing both the nanosilver- and DCOIT-containing ingredient and served as control. Bacterial contamination of the surfaces was examined using contact plates and liquid-based swabs daily for a total trial duration of 90 days. After incubation, total microbial counts and species were assessed.

FINDINGS

In a total of 2880 antimicrobial samples, a significant reduction of the overall bacterial load was observed in the NCS room (median: 0.31 cfu/cm²; interquartile range: 0.00-1.13) compared with the control coated surfaces (0.69 cfu/cm²; 0.06-2.00; P < 0.001). The nanosilver- and DCOIT-containing surface coating reduced the relative risk of a critical bacterial load (defined as >5 cfu/cm²) by 60% (odds ratio 0.38, P < 0.001). No significant difference in species distribution was detected between NCS and control group.

CONCLUSION

Nanosilver-/DCOIT-containing surface coating has shown efficiency for sustainable reduction of bacterial load of frequently touched surfaces in a clinical setting.

Decreased device related thrombus and enhanced neo-endocardial tissue maturation with a new generation left atrial appendage closure (LAAC) device. An anticoagulation and antiplatelet free canin study

Introduction

Device related thrombus (DRT) has been reported in up to 7% of patients post LAAC even while on anticoagulation. Clinical predictors of DRT are poorly understood and may be related to patient, procedural and device factors. A next generation WATCHMAN LAAC device (NG) is identical in shape and geometry to the current WATCHMAN FLX device (CW) but has a device coating designed to make it hemocompatible and less thrombogenic.

Objective

To evaluate the incidence and burden of WM surface thrombus formation as detected longitudinally by TEE and at necropsy in a canine model implanted with the NG device.

Methods

The study included 12 canine (6 implanted with CW and 6 implanted with NG) that underwent serial TEE follow up at 14, 28 and 45 days to evaluate surface thrombus on WM face. This was a challenged canine model designed to induce thrombus with no anticoagulation or antiplatelet use throughout the study. D-dimer levels were measured at 7 days and 45 days and compared to baseline measurements.

Results

All devices were successfully implanted. TEE follow up at 14 days showed noticeably reduced thrombus burden on the NG device compared to CW (fig.1) with even further diminution by 28 days in the NG (6/6) as compared to only in 1/6 in the CW group (fig.2). After 45 days in-life, the post-fixation trim en-face images show a smooth, glistening neoendocardial covering (absence of acute thrombus material) in all (6/6) NG compared to only 2/6 in the CW (fig.3). The CW had 3/6 devices with exuberant, bulging calcified thrombus mass one of which was considered to be a mobile DRT. D Dimer levels at 7 and 45 days were significantly lower relative to baseline in the NG compared to CW.

Conclusion

The NG device compared to the CW device was associated with markedly less thrombus formation at 14 days and no thrombus formation at 28 days post implant on no anticoagulant and no antiplatelet therapy along with a more mature uniform tissue coverage at 45 days. The WATCHMAN FLX Pro device coating is a promising step to reduce DRT even without the use of anticoagulation and antiplatelets and merits further investigation in human studies.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Boston Scientific

[Patient consent for the TraumaRegistry DGU based on the GDPR-A challenge for the hospitals: status quo and solution strategies]

Gemäß der Datenschutz-Grundverordnung (EU-DSGVO, Mai 2018) werden anonymisierte Datensätze mit ausreichend hoher Datendichte als nachverfolgbar eingestuft und benötigen eine Einwilligungserklärung, wenn diese zu Forschungs- oder Qualitätskontrollzwecken zentral ausgewertet werden. Qualitätssicherung und weitere Steigerung der Versorgungsqualität sind im Rahmen der flächendeckenden Schwerstverletztenerhebung im Sinne der Versorgungsforschung allerdings nur mit einer annähernden Vollerhebung möglich. Die über 600 deutschen Kliniken, die am TraumaRegister DGU® teilnehmen, versuchen, von diesem speziellen Patientengut die Einverständniserklärungen zu erhalten. In der Studienklinik wurden über einen 12-Monats-Zeitraum hinweg die Rate an Einwilligungen und die Gründe für eine Ablehnung bzw. Nichteinholung evaluiert.

Bei Anwendung eines ressourcenintensiven Workflows speziell für die Patientenaufklärung und Einholung der TR-Einwilligungen wurden eine Zustimmungsquote der Patienten von 64,5 % und damit gleichzeitig eine Fehlquote von 35,5 % erfasst. Es konnten 98 von 276 potenziellen TraumaRegister-DGU®-Datensätzen nicht eingegeben werden und standen dementsprechend weder für die Qualitätskontrolle noch für die Polytraumaforschung zur Verfügung.

Um die Qualitätskontrolle und die weitere Verbesserung der Versorgungsqualität zu gewährleisten, ist eine annähernde Gesamterfassung des Patientenguts notwendig. Diese lässt sich durch die Notwendigkeit der Einwilligungserklärung jedoch nicht erreichen, wie unsere Studie zeigt. Somit plädieren wir dafür, dass die Möglichkeit geschaffen wird, den TraumaRegister-Datensatz ohne Einwilligung zu erheben, da dieser letztlich einen Regeldatensatz darstellt, vergleichbar mit dem §21-KHEntgG-Datensatz, jedoch im Gegensatz zu diesem pseudonymisiert.

Characterization and effectiveness of pay-for-performance in ophthalmology: a systematic review

Background

To identify, characterize and compare existing pay-for-performance approaches and their impact on the quality of care and efficiency in ophthalmology.

Methods

A systematic evidence-based review was conducted. English, French and German written literature published between 2000 and 2015 were searched in the following databases: Medline (via PubMed), NCBI web site, Scopus, Web of Knowledge, Econlit and the Cochrane Library. Empirical as well as descriptive articles were included. Controlled clinical trials, meta-analyses, randomized controlled studies as well as observational studies were included as empirical articles. Systematic characterization of identified pay-for-performance approaches (P4P approaches) was conducted according to the “Model for Implementing and Monitoring Incentives for Quality” (MIMIQ). Methodological quality of empirical articles was assessed according to the Critical Appraisal Skills Programme (CASP) checklists.

Results

Overall, 13 relevant articles were included. Eleven articles were descriptive and two articles included empirical analyses. Based on these articles, four different pay-for-performance approaches implemented in the United States were identified. With regard to quality and incentive elements, systematic comparison showed numerous differences between P4P approaches. Empirical studies showed isolated cost or quality effects, while a simultaneous examination of these effects was missing.

Conclusion

Research results show that experiences with pay-for-performance approaches in ophthalmology are limited. Identified approaches differ with regard to quality and incentive elements restricting comparability. Two empirical studies are insufficient to draw strong conclusions about the effectiveness and efficiency of these approaches.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2333-x) contains supplementary material, which is available to authorized users.

Screening for low aquatic bioaccumulation (2): physico-chemical constraints

Physico-chemical properties related to the bioavailability of xenobiotics in aquatic environments have been tested for their ability to identify chemicals with low bioconcentration potential. Cut-offs in lipophilicity (log K(OW) < 3 or > 10), solubility and volatility (log Henry constant <-11 [atm (mol L(-1))(-1)]), degradability (ready biodegradability, hydrolysis) and ionisation (>5% ionisation at pH 7) have been adopted and combined into a decision tree based on 382 industrial chemicals. The five-parameter classification scheme was externally validated with 49 pesticides and successfully confirmed with 83 bioaccumulative compounds. The applicability domain of the model has been described in terms of chemical classes (excluding polybrominated compounds (>4 Br), organometallics, compounds with perfluorinated fragments, substances with an acyclic alkyl moiety (chain length > C7) and thiols) and ranges of physico-chemical properties. The present tool allows to securely de-prioritize more than 50% chemicals of low concern with regard to the B criterion (BCF < 2000). Bioassays with compounds with these physico-chemical constraints may be waived because testing may be technically not possible and does not appear scientifically necessary in persistent, bioaccumulative, toxic (PBT) substances and risk assessments.

A central venous catheter coated with benzalkonium chloride for the prevention of catheter-related microbial colonization

In an attempt to overcome infections associated with central venous catheters, a new antiseptic central venous catheter coated with benzalkonium chloride on the internal and external surfaces has been developed and evaluated in a clinical trial. Patients (235) randomly received either a triple-lumen central venous catheter coated with benzalkonium chloride (117) or a polyurethane non-antiseptic catheter (118). The incidence of microbial colonization of both catheters and retained antiseptic activity of the benzalkonium chloride device following removal were determined. The benzalkonium chloride resulted in a significant reduction of the incidence of microbial colonization on both the internal and external catheter surfaces. The reduction in colonization was detected at both the intradermal (21 benzalkonium chloride catheters vs. 38 controls, P = 0.0016) and distal segments of the antiseptic-coated catheters. Following catheter removal retained activity was demonstrated in benzalkonium chloride catheters which had been in place for up to 12 days. No patients developed adverse reactions to the benzalkonium chloride catheters. The findings demonstrate that the benzalkonium chloride catheter significantly reduced the incidence of catheter-associated colonization.

Upper airway findings in patients with nocturnal breathing disorders

This prospective open study was performed to examine the relation between pathologic findings of the upper respiratory tract and the types of noncentral sleep disorders (rhonchopathy, obstructive sleep apnea). 312 men and 274 women aged between 35-75 years attended our outpatient department for relief of their nocturnal breathing disorder. About 1/3 of the patients suffered only of habitual rhonchopathy and 2/3 were obstructive. No findings of the head and neck examination could predict the degree of oxygen desaturation, although pathologies of the nose (73.68%), the soft palate (94.1%) and narrowing of the oro- and hypopharynx (74.19%) were very common in patients with sleep disorder. At least one pathology could be found in every patients. The more pathologies were found the higher was the risk of obstructive sleep apnoea with desaturation below 70%. Unrelated tonsillectomy (51.36%) did not prevent nocturnal breathing disorders.

Evaluation of distal anastomotic intimal hyperplasia: an experimental comparison by arteriography, duplex sonography, angioscopy, and intravascular ultrasound

Routine follow-up investigation methods after peripheral arterial bypass surgery, such as arteriography and colour duplex sonography, do not always allow correct analysis of moderate alterations in the vessel wall, e.g. initial stages of distal anastomotic intimal hyperplasia (DAIH). The aim of this study was to evaluate the efficiency of angioscopy and intravascular ultrasound compared to the named routine methods regarding detection of early DAIH. Eight months after bilateral femoropopliteal bypass surgery with venous grafts in 18 sheep, we investigated the distal anastomotic sites using the named methods. The findings were then correlated to histologic specimens. Intravascular ultrasound presented the highest sensitivity followed by angioscopy, with results markedly different from the findings arrived at by conventional methods.

The haemopoietic effects of thrombopoietin administered post-myelosuppressive carboplatin therapy compared to either pre- and post- or pre-chemotherapy

Balb/c mice (n = 10) were treated with 50 microg/kg recombinant human thrombopoietin (rhTPO) or placebo control by subcutaneous injection daily for 5 d before (pre), or 8d after (post), or 5 d before and 8d after (pre/post) carboplatin (125 mg/kg). RhTPO given post significantly abrogated the platelet (PLT) nadir (413.0 +/- 52.0 v 42.0 +/- 6.0 (x10(9)/l), P<0.01), reduced days to mean PLT recovery (2 v 8d), and increased progenitor (CFU-Meg) colony formation (74.7 +/- 6.7 v 40.7 +/- 3.3 (colonies/10(5) cells), P<0.001) compared to controls. Further, rhTPO given pre/post also significantly abrogated the PLT nadir (132 +/- 29 v 42.0 +/- 6.0 (x10(9)/l), P<0.05), increased megakaryocytes per high-powered field (MHPF) (5.67 +/- 0.9 v 0.33 +/- 0.3, P<0.001) and CFU-Meg (137.7 +/- 13.9 v 40.7 +/- 3.3, P<0.001) compared with controls. However, when comparing the three treatment groups, animals receiving rhTPO post exhibited significantly higher PLT nadirs (413.0 +/- 52.0 v 190 +/- 29 and 132 +/- 29 (x 10(9)/l), P<0.01) and increased CFU-GM (93.7 +/- 10.7 v 20.33 +/- 0.9 and 14.7 +/- 1.45, P< 0.001). All rhTPO groups experienced an abrogation of the haematocrit (HCT) nadir (P< 0.01), although, only the post cohort had a reduction in the days to mean HCT recovery (2 v 12d, P<0.01). These results suggested that post therapeutic rhTPO (post) appears to be more effective in abrogating the platelet nadir and enhancing platelet and HCT recovery following myelosuppressive chemotherapy, than either prophylactic or pre- and post-rhTPO therapy.

Potential for secondary poisoning and biomagnification in marine organisms

For selected priority pollutants, like organochlorine pesticides, PAHs and PCBs, and mercury and cadmium, the transfer along marine food chains was assessed based on monitoring data. Comparison of the acquired body burden for marine fish and the toxicity thresholds for predating marine birds and mammals provides evidence for the relevance of contaminant uptake with the food and the liability for secondary poisoning. As a consequence, contaminant residues in prey organisms (critical body burden) should be used for marine hazard and risk assessments. Evaluations solely from aquatic exposure concentrations are not adequate to account for potential secondary effects in marine ecosystems.

Sequential treatment with rmIL-3 or simultaneous treatment with rmIL-3 or rhIL-11 with thrombopoietin (TPO) fails to enhance in vivo neonatal rat thrombocytopoiesis

Multipotent-lineage nondominant growth factors, acting alone or in combination with lineage-dominant cytokines, are known to influence both myelopoiesis and thrombocytopoiesis. Interleukin (IL)-3 and IL-11 stimulate and expand multilineage progenitor cells and induce thrombocytopoiesis. These cytokines also act synergistically with various other lineage dominant and lineage-nondominant cytokines in vitro to expand primitive and committed hematopoietic stem cells. In this study we investigated the in vivo effects of IL-3 and IL-11 in combination with the c-mpl ligand, thrombopoietin (rhTPO), on neonatal rat hematopoiesis. Newborn Sprague-Dawley rats (24 36 hours old, weighing 6-8 g) were intraperitoneally injected with rhTPO (10 microg/kg) for 14 days, rmIL-3 (10 microg/kg) for 5 days followed by rhTPO (10 microg/kg) for 9 days, rmIL-3 (10 microg/kg) + rhTPO (10 microg/kg) for 14 days, rhIL-11 (250 microg/kg) + rhTPO (10 microg/kg) for 14 days, or PBS/human serum albumin (HSA) for 14 days. When compared with PBS/HSA, rhTPO at a dosage of 10 microg/kg significantly increased platelet count (10(-9) L) (day 6, 569 +/- 37.1 vs. 1446 +/- 43.8, p < 0.001; day 10, 796 +/- 68.3 vs. 1774 +/- 238.4, p < 0.01; day 14, 850 +/- 64.4 vs. 3441 +/- 98.1 /10(-9) l, p < 0.001) and absolute neutrophil count (ANC) (day 6, 335.2 +/- 59.6 vs. 752 +/- 335.2, p < 0.01; day 12, 664 +/- 54.1 vs. 1520 +/- 158.2, p < 0.01). However, rhTPO has no effect on the circulating hematocrit or red blood cell count. RhTPO-treated animals also displayed higher platelet counts (/10(-9) L) vs. rhIL-11 or rhIL-6 beginning on day 6 (day 6, 1597.6 +/- 134.7 vs. 930.7 +/- 67.3 vs. 863 +/- 19.6, p < 0.01; day 8, 1686 +/- 208.4 vs. 990 +/- 29.4, vs. 977 +/- 34.33, p < 0.05; day 10, 1774 +/- 238.4 vs. 1096 +/- 49.6, vs. 937 +/- 65, p < 0.01; day 14, 2187 +/- 127.5 vs. 1280 +/- 35.8 vs. 951 +/- 50.7 /10(-9) L, p < 0.01). Sequential administration of rmIL-3 followed by rhTPO resulted in no significant increase in platelet counts compared with PBS-HSA/rhTPO. RhTPO + rmIL-3 given simultaneously also had no additive effect on the circulating platelet count compared with rhTPO alone. Similarly, no additive effect on circulating platelet counts was observed with rhIL-11 + rhTPO vs. rhTPO alone. Bone marrow studies showed a significant increase in the number of megakaryocytes per high-power field in all the groups treated with rhTPO vs. control (p < 0.05), but no additive effect was seen in neonatal rats additionally receiving either rmIL-3 or rhIL-11. Colony forming unit (CFU)-Meg colony formation was also significantly increased in all the groups treated with rhTPO vs. control (p < 0.05), with no additive effect observed after the addition of either rmIL-3 or rhIL-11. These data suggest that rhTPO is more effective than rmIL-3 or rhIL-11 in inducing neonatal in vivo thrombocytopoiesis in rats, and that no additive effect is to be expected when rhTPO is combined sequentially with rhIL-3 or simultaneously with either rmIL-3 or rhIL-11. We hope that these preclinical data will provide insight into the design and future application of these thrombopoietic cytokines, alone or in combination, to prevent or treat thrombocytopenia.

A longitudinal assessment of hormonal and physical alterations during normal puberty in boys. II. Estrogen levels as determined by an ultrasensitive bioassay

A limited number of reports of estrogen levels in prepubertal and early pubertal boys have been published because previous estrogen assays have lacked adequate sensitivity to quantitate circulating estrogen concentrations. Development of a new ultrasensitive assay has permitted measurement of estrogen levels in 23 normally growing boys progressing through puberty. Concentrations were measured at approximately 4-month intervals over a 5- to 8-yr period. The levels increased with maturation in all and correlated directly with chronological age, bone age, weight, height, pubertal stage, and testosterone and insulin-like growth factor-I levels. Of these factors, the level of testosterone had the greatest influence on the estrogen concentration. The time from peak growth velocity also significantly correlated with estrogen level. The estrogen level correlated positively with growth velocity before the time of peak growth velocity and negatively after peak growth velocity. The estrogen levels first increased significantly an average of 3 yr after pubertal onset and reached a peak by 5 yr after pubertal onset. Peak growth velocity was attained an average of 3 yr after pubertal onset. The greatest increase in the rate of rise of the estrogen level was an 11-fold rise during the year in which puberty began. The next most significant increase was a 4.8-fold rise 3 yr after pubertal onset. With respect to pubertal stage, the greatest absolute change occurred from stage 4 to stage 5 and the greatest fold change occurred from stage 1 to stage 2. The estrogen level did not significantly correlate with the 24-h GH level. In conclusion, circulating estrogen levels are very low in all boys prepubertally and rise steadily during adolescent development. The estrogen level is closely related to testosterone concentration and to the time of peak growth velocity. These findings are consistent with the hypothesis that estrogen at low levels augments skeletal growth and maturation in boys (as well as girls). They are also consistent with the hypothesis that continued exposure to estrogen leads to epiphyseal fusion. Further studies are required to define the separate and combined roles of estrogen, GH, and testosterone, as well as other factors, on growth and sexual development at puberty.

Spatial Organization and Time Dependence of Jupiter's Tropospheric Temperatures, 1980-1993

The spatial organization and time dependence of Jupiter's temperatures near 250-millibar pressure were measured through a jovian year by imaging thermal emission at 18 micrometers. The temperature field is influenced by seasonal radiative forcing, and its banded organization is closely correlated with the visible cloud field. Evidence was found for a quasi-periodic oscillation of temperatures in the Equatorial Zone, a correlation between tropospheric and stratospheric waves in the North Equatorial Belt, and slowly moving thermal features in the North and South Equatorial Belts. There appears to be no common relation between temporal changes of temperature and changes in the visual albedo of the various axisymmetric bands.

Time course for effects of hypoglycemia on insulin gene transcription in vivo

The purpose of these studies was to determine the time course for onset of effects of hypoglycemia on insulin gene transcription in vivo. Using insulin infusions, we found that insulin-induced hypoglycemia decreased levels of precursors for insulin mRNA, reflecting changes in new mRNA synthesis, to new steady-state values within 100 min. These changes were followed by declines in processed insulin mRNA. An alternate infusion technique was developed to lower plasma glucose levels from a constant level of 120-130 to 50-60 mg/dl in < 10 min without changing insulin levels from those maintained during a preceding 1-h control period. Using this protocol, we found that levels of precursors for insulin mRNA remained constant for the first 20 min of hypoglycemia, then decreased rapidly at 40 and 60 min. The initial delay followed by rapid decline suggests that the decrease of insulin gene transcription in response to hypoglycemia is an active process requiring one or more inductive events before implementation.