by Jin Ling, Hong Wang, Gaomin Li, Zhen Feng, Yufei Song, Peng Wang, Hong Shao, Hu Zhou, Gang ChenBackground
Escherichia coli is currently unable to be reliably differentiated from Shigella species by routine matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) analysis. In the present study, a reliable and rapid identification method was established for Escherichia coli and Shigella species based on a short-term high-lactose culture using MALDI-TOF MS and artificial neural networks (ANN).Materials and methods
The Escherichia coli and Shigella species colonies, treated with (Condition 1)/without (Condition 2) a short-term culture with an in-house developed high-lactose fluid medium, were prepared for MALDI-TOF MS assays. The MS spectra were acquired in linear positive mode, with a mass range from 2000 to 12000 Da and were then compared to discover new biomarkers for identification. Finally, MS spectra data sets 1 and 2, extracted from the two conditions, were used for ANN training to investigate the benefit on bacterial classification produced by the new biomarkers.Results
Twenty-seven characteristic MS peaks from the Escherichia coli and Shigella species were summarized. Seven unreported MS peaks, with m/z 2330.745, m/z 2341.299, m/z 2371.581, m/z 2401.038, m/z 3794.851, m/z 3824.839 and m/z 3852.548, were discovered in only the spectra from the E. coli strains after a short-term high-lactose culture and were identified as belonging to acid shock protein. The prediction accuracies of the ANN models, based on data set 1 and 2, were 97.71±0.16% and 74.39±0.34% (n = 5), with an extremely remarkable difference (p Conclusions
In summary, adding a short-term high-lactose culture approach before the analysis enabled a reliable and easy differentiation of Escherichia coli from the Shigella species using MALDI-TOF MS and ANN.
by Silvia Pierandrei, Giovanna Blaconà, Benedetta Fabrizzi, Giuseppe Cimino, Natalia Cirilli, Nicole Caporelli, Antonio Angeloni, Marco Cipolli, Marco LucarelliTwo novel and related pathogenic variants of the Cystic Fibrosis Transmembrane conductance Regulator (CFTR) gene were structurally and functionally characterized. These alterations have not been previously described in literature. Two patients with diagnosis of Cystic Fibrosis (CF) based on the presence of one mutated allele, p.Phe508del, pathological sweat test and clinical symptoms were studied. To complete the genotypes of both patients, an extensive genetic and functional analysis of the CFTR gene was performed. Extensive genetic characterization confirmed the presence of p.Phe508del pathogenic variant and revealed, in both patients, the presence of an insertion of part of intron 10 in intron 9 of the CFTR gene, within the (TG)m repeat, with a variable poly-T stretch. The molecular lesions resulted to be very similar in both patients, with only a difference in the number of T in the poly-T stretch. The functional characterization at RNA level revealed a complete anomalous splicing, without exon 10, from the allele with the insertion of both patients. Consequently, the alleles with the insertions are expected not to contribute to the formation of a functional CFTR protein. Molecular and functional features of these alterations are compatible with the definition of novel CF-causing variants of the CFTR gene. This also allowed the completion of the genetic characterization of both patients.
by Sonja Spitzer, Daniela WeberThis paper explores which demographic characteristics substantially bias self-reported physical and cognitive health status of older Europeans. The analysis utilises micro-data for 19 European countries from the Survey of Health, Ageing and Retirement in Europe to compare performance-tested outcomes of mobility and memory with their self-reported equivalents. Relative importance analysis based on multinomial logistic regressions shows that the bias in self-reported health is mostly due to reporting heterogeneities between countries and age groups, whereas gender contributes little to the discrepancy. Concordance of mobility and cognition measures is highly related; however, differences in reporting behaviour due to education and cultural background have a larger impact on self-assessed memory than on self-assessed mobility. Southern as well as Central and Eastern Europeans are much more likely to misreport their physical and cognitive abilities than Northern and Western Europeans. Overall, our results suggest that comparisons of self-reported health between countries and age groups are prone to significant biases, whereas comparisons between genders are credible for most European countries. These findings are crucial given that self-assessed data are often the only information available to researchers and policymakers when asking health-related questions.
by Hirofumi Kato, Mutsuyo Takayama-Ito, Itoe Iizuka-Shiota, Shuetsu Fukushi, Guillermo Posadas-Herrera, Madoka Horiya, Masaaki Satoh, Tomoki Yoshikawa, Souichi Yamada, Shizuko Harada, Hikaru Fujii, Miho Shibamura, Takuya Inagaki, Kinjiro Morimoto, Masayuki Saijo, Chang-Kweng LimMiddle East respiratory syndrome-coronavirus (MERS-CoV) is an emerging virus that causes severe disease with fatal outcomes; however, there are currently no approved vaccines or specific treatments against MERS-CoV. Here, we developed a novel bivalent vaccine against MERS-CoV and rabies virus (RV) using the replication-incompetent P-gene-deficient RV (RVΔP), which has been previously established as a promising and safe viral vector. MERS-CoV spike glycoprotein comprises S1 and S2 subunits, with the S1 subunit being a primary target of neutralizing antibodies. Recombinant RVΔP, which expresses S1 fused with transmembrane and cytoplasmic domains together with 14 amino acids from the ectodomains of the RV-glycoprotein (RV-G), was developed using a reverse genetics method and named RVΔP-MERS/S1. Following generation of RVΔP-MERS/S1 and RVΔP, our analysis revealed that they shared similar growth properties, with the expression of S1 in RVΔP-MERS/S1-infected cells confirmed by immunofluorescence and western blot, and the immunogenicity and pathogenicity evaluated using mouse infection experiments. We observed no rabies-associated signs or symptoms in mice inoculated with RVΔP-MERS/S1. Moreover, virus-specific neutralizing antibodies against both MERS-CoV and RV were induced in mice inoculated intraperitoneally with RVΔP-MERS/S1. These findings indicate that RVΔP-MERS/S1 is a promising and safe bivalent-vaccine candidate against both MERS-CoV and RV.
by Robert Hammond, Rodoniki Athanasiadou, Silvia Curado, Yindalon Aphinyanaphongs, Courtney Abrams, Mary Jo Messito, Rachel Gross, Michelle Katzow, Melanie Jay, Narges Razavian, Brian Elbel
by Brett P. Hughes, Torbjorn Falkmer, Anna Anund, Melissa H. BlackWhile road safety in the United States (U.S.) has been continually improving since the 1970's, there are indications that these improvements are becoming increasingly difficult to sustain. Strategic Highway Safety Plans (SHSPs) are prepared by States to guide road safety management, however assessing the appropriateness of these plans remains a significant challenge, especially for the future in which they are to be applied. This study developed a new methodology to assess SHSPs from the perspectives of comprehensive system-based safety management and relevant future issues that can be applied before SHSPs are implemented, thereby avoiding long periods after implementation before assessing the appropriateness of the plans. A rating scale was developed and applied to assess 48 U.S. SHSPs against two key criteria: 1. a comprehensive framework for road safety, and 2. the anticipated changing, difficult and unpredictable nature of future transport and its context. The analysis concluded that current SHSPs have good national oversight with several strengths but were weak in some areas of content and did not address future challenges. Improvements are suggested to strengthen the plans’ thoroughness by being consistent with systems theory and practice, as well as ways that these SHSPs can be more resilient to future circumstances. Implementing the recommendations in this paper provides the opportunity to adopt a system-based safety management practice that has been successful in other hazardous industries. Doing so is expected to most efficiently and effectively continue the recent improvements to road safety, which is likely to be increasingly difficult otherwise.
An available strategy to counteract academic failure is the development and implementation of student academic self‐efficacy; however, to date, there are no instruments measuring it. The aim of this study was to develop and psychometrically test an academic nurse self‐efficacy scale.
A longitudinal study design was used in accordance with Consensus‐based Standards for the Selection of health status Measurement Instruments guidelines.
A convenience sample of 1,129 nursing students attending the first year of the course were involved. The data collection began in 2014 and went on for three years. Data were collected at the beginning of the first (T0), at the end of the first (T1), at the end of the second (T2) and at the end of the third (T3) year. The academic nurse self‐efficacy scale was evaluated for content and face validity, for construct validity with explorative, confirmative factor analysis and hypothesis testing and for reliability. The standard error and the smallest detectable difference were also evaluated.
Scree plot analysis suggested a four‐factor solution and confirmative factor analysis model reached a good fit. We verified the first hypothesis, partially the second and not the third. The dimensions show a Cronbach's α 0.72–0.83. The smallest detectable difference was 26%.
The academic nurse self‐efficacy scale had good validity and reliability and should be considered for nursing students.
These findings may have an impact on universities, mainly in nursing degree programmes because nurse educators can identify nursing students with low academic self‐efficacy and help them in their academic duties. Indirectly, academic self‐efficacy monitoring can be used for evaluating the effect of different teaching strategies or mentorship support over time.
To obtain a comprehensive insight of the impact of patient and family engagement on patient safety and identify issues in implementing this approach.
Patient and family engagement is increasingly emerging as a potential approach for improving patient safety.
Mixed method multi‐level synthesis.
PubMed, CINAHL, Embase and Cochrance Library (January 2009 ‐ April 2018).
The review was conducted according to the principles recommended by the Cochrane Handbook for Systematic Review and in accordance with the PRISMA guidelines.
Forty‐two relevant studies were identified. Common intervention groups included “direct care” and “organization” levels with “consultation” and “involvement” approaches, while the “health system” level and “partnership and shared leadership” approaches were rarely implemented. Findings revealed positive effects of the interventions on patient safety. Most study participants expressed their willingness to engage in or support patient and family engagement. However, existing gaps and barriers in implementing patient and family engagement were identified.
Future research should further focus on issuing consensus guidelines for implementing patient and family engagement in patient safety, extending the research scope for all aspects of patient and family engagement and patient safety and identifying priority areas for action that is suitable for each health facility.
Policymakers should issue guidelines for implementing patient and family engagement in health‐care systems which would enable health‐care providers to implement patient and family engagement and improve patient safety appropriately and effectively.
Professionalism in nursing has long been steeped in controversy. For many years some argued nurses were only semi‐professional due to a lack of university education and qualifications and a knowledge base and skillset that were not distinctly unique (Adams & Miller, 2001). Nurses are now an established profession with clear and robust educational frameworks, codes of professional conduct and standards of practice (Sills, 1998), regulated by an independent agency or governing body.
This is a study protocol to investigate nurses’ perspectives on refugee healthcare in two countries. The aims are to: 1) explore self‐reported work environment factors, including work stressors, self‐rated leadership, staffing and resources adequacy and teamwork among Jordanian and Lebanese nurses caring for refugees; 2) investigate the relationship between nurse related outcomes (physical health; emotional exhaustion) and their psychosocial work environment; and 3) assess the association between nurses’ perceived work environment factors and implicit rationing of care and quality of patient care.
Globally, the care of refugees is achieving increased attention. Over 6.3 million people are internally displaced and 4.8 million recorded Syrian expatriates are residing in and receiving healthcare services in host neighboring countries.
This is a cross‐sectional, comparative study using a survey design.
The study setting involves both private and public hospitals and primary healthcare centers that provide care to refugees on regular basis in Lebanon and Jordan. The estimated sample size includes 3,000 Registered Nurses from Lebanon and 2,500 nurses and midwives from Jordan.
Workplace factors affecting quality of nursing care and psychosocial status of nurses caring for refugees will be identified. Potential findings will help leaders design interventions to support nurses who are serving refugees for safer care and better patient outcomes. Findings will assist in more efficient resource allocation and management.
New knowledge on the impact of providing healthcare for refugees will be generated based on the structure of nursing care (e.g. work environment), on the nursing process (e.g. implicit rationing of care) and nurse outcomes (health) in two hosting communities. Moreover, factors enabling resilience in patients, providers and systems will be identified and be of potential use in addressing the growing global problem of caring for displaced persons.
To understand how health‐related street outreach is perceived by homeless people with experience of sleeping rough. Specialist nursing and primary care services are expected to provide street outreach but there is no specific guidance on how to deliver it.
A Qualitative Description study.
Purposive opportunistic sampling was used to recruit participants from three drop‐in centres in London. 10 semi‐structured interviews were conducted between 4th and 28th of June 2018 and Braun and Clarke's thematic analysis was used.
Health‐related street outreach was perceived as being able to offer a human connection that reduced the sense of isolation and exclusion commonly experienced on the street. People with experience of sleeping rough felt it could overcome access barriers and provide a bridge to healthcare services. Crucially the right approach was deemed to be essential and was defined by participants in terms of location, timing, the outreach team and the verbal and non‐verbal styles used by outreach workers.
Health‐related street outreach is a valuable health promotion tool for people experiencing homelessness that should be financially supported by healthcare commissioners and employers. Providers of health‐related street outreach must adopt the right approach and the development of guidelines could assist services to achieve this.
The findings of this study can inform planning and review of health‐related street outreach, to ensure that the approach taken by healthcare workers is acceptable to and based on the views of, the people these services are provided for.
Objetivo: La meta de este estudio fue identificar la percepción de los enfermeros y médicos con respecto a los centros de atención de largo plazo, al mismo tiempo, explicar la intervención de los enfermeros en la prescripción médica. Metodología: estudio multinacional transversal en el que participaron enfermeros y médicos en centros de cuidado geriátrico durante las fechas de abril y octubre de 2017. Se utilizaron tres cuestionarios en línea en idiomas francés e inglés. Resultados: un 78.7% de médicos discutieron la relevancia que existe entre las prescripciones y enfermeros competentes. El mapeo demuestra la relación entre el nivel de evidencia que existe en el rol de enfermería y las prescripciones médicas, y enfermeros autorizados en los 51 países participantes. Conclusiones: La relacion interpersonal entre médicos y enfermeros es esencial para facilitar el rol de enfermería en el manejo de tratamientos eficientes.
To synthesize the findings of qualitative research exploring the experiences of being involved in intergenerational interventions in older people's care settings.
A meta‐synthesis of the qualitative literature, employing Sandelowski and Barroso's method, was conducted.
Eight databases were searched in March 2017.
The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso's method.
Four qualitative studies were included in the meta‐synthesis. Thematic analysis revealed four themes: ‘Recreating the family’; ‘Building intergenerational empathy and respect’; ‘Uplifting and energizing’; and ‘Engagement risks and challenges’.
The meta‐synthesis strengthens the evidence that intergenerational interventions can be positive. However, it also shows that there may also be some negative aspects if not planned or managed carefully.
This review contributes to the body of evidence by synthesizing the experiences of older people and children involved in intergenerational interventions. Although qualitative literature supports the quantitative evidence that intergenerational interventions can have a positive effect, intergenerational interventions could also have negative effects on some participants. Older people may feel tired, or experience feelings of infantilization. Practitioners need to be more aware of the potential negative effects of intergenerational interventions and include risk assessment, possibly by requiring ethical scrutiny.
Objetivo principal: evidenciar la problemática de consumo de alcohol en estudiantes de Enfermería de una universidad privada de Bogotá, desde la perspectiva de una joven que estuvo involucrada en el abuso del consumo de alcohol. Metodología: relato biográfico. Resultados principales: se identificaron tres categorías: contexto familiar (ausencia del padre, antecedentes de consumo de alcohol, conflictos familiares, embarazo no deseado), detonantes y condiciones de consumo de alcohol (estrés académico, lugares de consumo, productos que se consumen, comportamientos autodestructivos de las mujeres por el consumo de alcohol) e Interés en evitar que otros jóvenes se conviertan en consumidores de alcohol. Conclusión principal: la presente investigación da cuenta de los riesgos a que está abocada la población universitaria, especialmente las mujeres. Lo cual constituye una voz de alerta para las universidades y para los padres de fa-milia, a fin de que fortalezcan estrategias de prevención de consumo de alcohol y demás sustancias psicoactivas.
To identify clusters based on graduating nursing students’ self‐reported professional competence and their achievement on a national examination. Furthermore, to describe and compare the identified clusters regarding sample characteristics, students’ perceptions of overall quality of the nursing programme and students’ general self‐efficacy.
A cross‐sectional study combining survey data and results from a national examination.
Data were collected at two universities and one university college in Sweden in January 2017, including 179 students in the final term of the nursing programme. The study was based on the Nurse Professional Competence Scale, the General Self‐Efficacy scale and results from the National Clinical Final Examination. A Two‐Step Cluster Analysis was used to identify competence profiles, followed by comparative analyses between clusters.
Three clusters were identified illustrating students’ different competence profiles. Students in Cluster 1 and 2 passed the examination, but differed in their self‐assessments of competence, rating themselves under and above the overall median value respectively. Students in Cluster 3 failed the examination but rated themselves at the overall median level or higher.
The study illustrates how nursing students’ self‐assessed competence might differ from competency assessed by examination, which is challenging for nursing education. Self‐evaluation is a key learning outcome and is, in the long run, essential to patient safety.
The study has identified clusters of students where some overestimate and others underestimate their competence. Students who assessed their competence low but passed the exam assessed their general self‐efficacy lower than other students. The findings illuminate the need for student‐centered strategies in nursing education, including elements of self‐assessment in relation to examination to make the students more aware of their clinical competence.
This study aims to explore the illness experience and needs of patients with pneumoconiosis and the caregiving experience of their respective family caregivers.
This is an exploratory qualitative study.
Participants will be recruited during the annual patient interview with purposive sampling. Those with a confirmed diagnosis of pneumoconiosis for at least 1 year will be eligible. Patients with different levels of physical dependency will be recruited. The respective family caregivers of these patients, who are ≥21 years of age, assuming the role as primary caregivers of a pneumoconiosis patient will also be invited to join. In‐depth interviews will be conducted in patients’ home separately for patients and their caregivers and a home environment assessment will also be undertaken. The interview data will be transcribed verbatim, managed with the software NVivo 11 and analysed with content analysis. The ethical approval has obtained, and this study is supported by a research grant from the Pneumoconiosis Compensation Fund Board of Hong Kong on 14 August 2018.
This study will advance the knowledge on how pneumoconiosis patients and their family caregivers manage the disease in the family context. The findings of this study can inform the development of a family‐oriented care model to support the pneumoconiosis patients and their family caregivers to manage this condition better.
Pneumoconiosis is the most common type of occupational lung disease in the Chinese population. These patients require long‐term comprehensive services and support to assist their disease self‐management. However, little is known about how these patients and their family caregivers manage the disease in the family context. The current study addresses this gap by exploring patients’ illness experience and their family members’ caregiving experience, which is timely to inform the design of family‐oriented model of care to support this clinical cohort.
This study has been registered at ClinicalTrials.gov (NCT04022902).
To understand the perspectives of both healthcare professionals in maternity care and pregnant women with higher‐risk pregnancies about remote monitoring in maternity care.
Qualitative descriptive design.
Individual and focus group interviews were conducted in public maternity care and in a level III hospital in Finland during April–May 2018. The sample consisted of healthcare professionals working in the primary care and at the hospital and hospitalised pregnant women. Altogether, 17 healthcare professionals and four pregnant women participated in the study. The data were analysed using inductive thematic network analysis.
Many possibilities—and an equal number of concerns—were identified regarding remote monitoring in pregnancy, depending on the respondent's viewpoint from holistic to symptom‐centred care. Healthcare staff had reservations about technology due to previous negative experiences and difficulties trusting technology. The pregnant women thought that monitoring would ease the staff's workload if the latter had enough technological skills. Remote monitoring could increase security in pregnancy care but create a feeling of false security if the women ignored their subjective symptoms. Face‐to‐face visits and the uniqueness of human contact were strongly favoured. Pregnant women wished to use monitoring as a confirmation of their subjective feelings.
Remote monitoring could be used as a supplementary system in pregnancy care, though it could replace only some healthcare visits. Pregnant women identified more possibilities for remote monitoring compared with the staff members both in primary care and the hospital.
A comprehensive understanding of pregnant women's and healthcare professionals’ perceptions of remote monitoring in pregnancy was built to be able to develop new technologies in maternity care. In certain cases, remote monitoring would supplement traditional pregnancy follow‐ups. Staff in primary and specialised care, as well as healthcare managers, should support teamwork to be able to understand different approaches to pregnancy care.
Objetivo principal: comparar los pacientes intervenidos de CCR (Cáncer colorrectal) en el contexto de un programa de cribado poblacional versus aquellos diagnosticados por presentar síntomas. Metodología: estudio longitudinal retrospectivo. Se estudiaron dos cohortes de pacientes intervenidos de CCR en el Hospital Clínico de Barcelona (2010-2012) procedentes del Programa de detección pre-coz de CCR de Barcelona (n=59), y de Urgencias o de Consultas Externas por presentar sintomatología (n=118). Resultados principales: Los del grupo cribado presentaron con mayor frecuencia tumores en estadio precoz (estadios I-II) que el grupo síntomas (57,6% vs 23,7%; p<0,001). La necesidad de uso de ostomía, y la estancia hospitalaria fue superior en el grupo síntomas (36,4% vs 10,2%; p=0,001; 10,1 días vs 7,1 días; p<0,001. Conclusión principal: los pacientes con CCR diagnosticados en el contexto de programas de cribado presentan un estadio más precoz, menor estancia hospitalaria y menor necesidad de ostomías. El programa de cribado poblacional presenta beneficios para los pacientes y el sistema sanitario.
Objetivo principal: Conocer la experiencia, el impacto percibido y el manejo de la experiencia de la reconstrucción de la vida cotidiana de los postcuidadores familiares después del proceso de duelo. Metodología: Se realizaron entrevistas en profundidad a 14 informantes que cuidaron a sus familiares durante más de 2 años y que dejaron de atenderlos más de 2 años antes. Los datos fueron recolectados durante un período de 13 meses en 2014-2015. El estudio se enmarca en la teoría fundamentada. Resultados principales: Se obtuvieron tres categorías a partir del análisis de los relatos: el vacío en el postcuidar, el fin del tiempo como cuidador y la transición hacia una nueva vida. Todos los informantes mencionan un vacío, marcado por el aumento del tiempo libre y la pérdida de sentido de su vida. Conclusión principal: Los postcuidadores experimentan una transición en la reconstrucción de su vida cotidiana, en la que el apoyo de los profesionales es esencial. Los postcuidadores pueden ser una fuente de apoyo para otros cuidadores.
The objective was to evaluate Staphylococcus aureus and Pseudomonas aeruginosa colonisation of wounds treated with recombinant epidermal growth factor (EGF) and platelet‐rich plasma (PRP); to analyse the susceptibility profiles of S. aureus and P. aeruginosa isolates from wounds treated with EGF and PRP; and to describe the presence of infection in EGF‐treated and PRP‐treated wounds. Experimental study was performed using clinical specimens collected with swabs. Patients were treated with PRP and EGF in the outpatient clinic of a university hospital. Forty‐three isolates were obtained from 31 patients, 41.9% (13/31) of whom had been treated with EGF and 58.0% (18/31) with PRP. Ten of the 43 isolates were identified as S. aureus, 60.0% (6/10) of which were isolated from PRP‐treated wounds. Among the 33 P. aeruginosa isolates, 66.6% (22/33) were isolated from PRP‐treated wounds. Regarding antimicrobial susceptibility, only one strain isolated from an EGF‐treated wound was identified as methicillin‐resistant S. aureus (MRSA). Among the P. aeruginosa isolates, one obtained from a patient treated with EGF was multidrug‐resistant. Patients treated with EGF had no infections during the follow‐up period, and there was a significant difference between the 1st and 12th week in wound infection improvement in patients treated with PRP (P = .0078).