Empowering surgical nurses improves compliance rates for antibiotic prophylaxis after caesarean birth

Title.  Empowering surgical nurses improves compliance rates for antibiotic prophylaxis after caesarean birth.
Aim.  This paper is a report of a study of the effect of empowering surgical nurses to ensure that patients receive antibiotic prophylaxis after caesarean birth.
Background.  Despite the consensus that single dose antibiotic prophylaxis is beneficial for women have either elective or non-elective caesarean delivery, hospitals need methods to increase compliance rates.
Method.  In a study in Israel in 2007 surgical nurses were empowered to ensure that a single dose of cefazolin was given to the mother after cord clamping. A computerized system was used to identify women having caesarean births, cultures sent and culture results. Compliance was determined by chart review. Rates of compliance, suspected wound infections, and confirmed wound infections in 2007 were compared to rates in 2006 before the policy change. Relative risks were calculated dividing 2007 rates by those in 2006, and 95% confidence intervals were calculated using Taylor's series that does not assume a normal distribution. Statistical significance was assessed using the chi-square test.
Findings.  The compliance rate was increased from 25% in 2006 to 100% in 2007 (chi-square test, P  < 0·001). Suspected wound infection rates decreased from 16·8% (186/1104) to 12·6% (137/1089) after the intervention (relative risk 0·75, 95% confidence interval, 0·61–0·92).
Conclusion.  Surgical nurses can ensure universal compliance for antibiotic prophylaxis in women after caesarean birth, leading to a reduction in wound infections.     

Comparison of follitropin-beta administered by a pen device with conventional syringe in an ART programme - a retrospective study

Objectives:  This study compares the efficacy and patient tolerance of follitropin-β (recagon) administered using a pen device with conventional syringe in infertile couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment.
Methods:  Data for 481 patients were retrieved retrospectively for the analysis. Conventional syringe group constituted 204 patients with 217 cycles and 265 patients with 294 cycles in the pen-device group. Down-regulation was achieved with GnRH agonist.
Results:  Comparison of follitropin-β administered with pen and syringe showed the following data, respectively. A total dose of 1909·38/2100·65 IU ( P  < 0·001), duration of stimulation, 9·70/10·47 days ( P  < 0·05), oestradiol levels on the day of human chorionic gonadotropin, 1488·34/1067·63 pg/ml, number of follicles reaching >16-mm size, 9·75/7·34 ( P  < 0·05), number of oocytes retrieved, 13·84/9·55 ( P  < 0·001) and number of embryos available for freezing, 4·56/1·30 ( P  < 0·05), the above data were observed in pen/conventional syringe groups, respectively. The live birth rates per cycle were 28·85% and 30·95% in the conventional syringe/pen-device groups, respectively. Patient tolerance with respect to pain at injection site was better with the pen device ( P  < 0·025).
Conclusion:  The data show that follitropin-β administered with pen device is well tolerated and more efficacious with respect to ovarian stimulation outcome compared with the conventional syringe.     

Supportive counselling programme for nursing students experiencing academic failure: randomized controlled trial

Title.  Supportive counselling programme for nursing students experiencing academic failure: randomized controlled trial.
Aim.  This paper is a report of a study examining the effects of a supportive counselling programme on the academic performance of Iranian nursing students experiencing academic failure.
Background.  In order to using limited educational resources effectively, nursing students experiencing academic failure should be immediately identified in order that appropriate intervention can take place.
Method.  Data were collected over a 12-month period in 2006–2007, with 42 Bachelor of Science nursing students who displayed poor academic performance. They were randomly allocated to receive either supportive or ordinary counselling. The mean grades in basic theoretical courses, special courses, and also the combination of both basic and special courses was compared between the two groups.
Findings.  Over the study period, there were improvements in the mean grades of special courses and also in both basic and special courses of male students in the experimental group, compared with those of male students in the control group (0·27 against −1·43, P  = 0·014; and 1·87 against −0·40, P  = 0·009; respectively).
Conclusion.  A supportive counselling programme can improve the academic performance of male nursing students. Replication of the current study with larger samples and longer duration is recommended.     

Manuka honey vs. hydrogel--a prospective, open label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers

Objective. Comparison of desloughing efficacy after four weeks and healing outcomes after 12 weeks in sloughy venous leg ulcers treated with Manuka honey (Woundcare 18+) vs. standard hydrogel therapy (IntraSite Gel). Background. Expert opinion suggests that Manuka honey is effective as a desloughing agent but clinical evidence in the form of a randomised controlled trial is not available. There is a paucity of research which uses Manuka honey in venous ulcers. Design. Prospective, multicentre, open label randomised controlled trial. Method. Randomisation was via remote telephone. One hundred and eight patients with venous leg ulcers having ≥50% wound area covered in slough, not taking antibiotics or immunosuppressant therapy were recruited from vascular centres, acute and community care hospitals and leg ulcer clinics. The efficacy of WoundCare 18+ to deslough the wounds after four weeks and its impact on healing after 12 weeks when compared with IntraSite Gel control was determined. Treatment was applied weekly for four weeks and follow‐up was made at week 12. Results. At week 4, mean % reduction in slough was 67% WoundCare 18+ vs. 52·9% IntraSite Gel (p = 0·054). Mean wound area covered in slough reduced to 29% and 43%, respectively (p = 0·065). Median reduction in wound size was 34% vs. 13% (p = 0·001). At 12 weeks, 44% vs. 33% healed (p = 0·037). Wounds having >50% reduction in slough had greater probability of healing at week 12 (95% confidence interval 1·12, 9·7; risk ratio 3·3; p = 0·029). Infection developed in 6 of the WoundCare 18+ group vs. 12 in the IntraSite Gel group. Conclusion. The WoundCare 18+ group had increased incidence of healing, effective desloughing and a lower incidence of infection than the control. Manuka honey has therapeutic value and further research is required to examine its use in other wound aetiologies. Relevance to clinical practice. This study confirms that Manuka honey may be considered by clinicians for use in sloughy venous ulcers. Additionally, effective desloughing significantly improves healing outcomes.     

Home orthostatic training in chronic fatigue syndrome – a randomized, placebo-controlled feasibility study

Background  Orthostatic (Tilt)-training is an effective treatment for neurally mediated hypotension (NMH). NMH is a frequent finding in chronic fatigue syndrome (CFS). We evaluated home orthostatic training (HOT) in CFS in a randomized placebo-controlled feasibility study.
Methods  Thirty-eight patients with CFS (Fukuda Criteria) were randomly allocated to daily tilt training ( n  = 19) or sham training ( n  = 19) for 6 months. Haemodynamic responses to standing were performed in all subjects using continuous technology (Taskforce) at enrolment, week 1, 4 and 24. Symptom response and compliance were assessed using diaries.
Results  Two patients (one from each arm) withdrew from the study. Fourteen patients in each group complied completely or partially, and patients found the training manageable and achievable. Compared to the sham group, blood pressure while standing dropped to 8·0 mmHg less in the HOT group at 4 weeks (95% CI: 1·0 to 15·0, P  = 0·03). At 4 weeks, the HOT group had higher total peripheral resistance compared to the sham group; mean difference 70·2, 95% CI: −371·4 to 511·8. Changes were maintained at 6 months. There was no significant difference in fatigue between groups at 4 weeks (mean difference 1·4, 95% CI: −13·5 to 16·2), but there was a trend towards improvement in fatigue at 6 months. Compliers had lower fatigue compared to non-compliers.
Conclusions  A placebo-controlled study of HOT in CFS is feasible. HOT is well tolerated and generally complied with. A likely physiological rationale for HOT in CFS is related to reductions in orthostatic intolerance. An adequately powered study including strategies to enhance compliance is warranted.     

Study comparing the double kissing (DK) crush with classical crush for the treatment of coronary bifurcation lesions: the DKCRUSH-1 Bifurcation Study with drug-eluting stents

Background  Classical crush has a lower rate of final kissing balloon inflation (FKBI) immediately after percutaneous coronary intervention (PCI). The double kissing (DK) crush technique has the potential to increase the FKBI rate, and no prospective studies on the comparison of classical with DK crush techniques have been reported.
Materials and methods  Three hundred and eleven patients with true bifurcation lesions were randomly divided into classical ( n  = 156) and DK crush ( n  = 155) groups. Clinical and angiographic details at follow-up at 8 months were indexed. The primary end point was major adverse cardiac events (MACE) including myocardial infarction, cardiac death and target lesion revascularization (TLR) at 8 months.
Results  FKBI was 76% in the classical crush group and 100% in the DK group ( P <  0·001). The incidence of stent thrombosis was 3·2% in the classical crush group (5·1% in without- and 1·7% in with-FKBI) and 1·3% in the DK crush group. Cumulative 8 month MACE was 24·4% in the classical crush group and 11·4% in the DK crush group ( P  = 0·02). The TLR-free survival rate was 75·4% in the classical crush group and 89·5% in the DK crush group ( P  = 0·002).
Conclusions  DK crush technique has the potential of increasing FKBI rate and reducing stent thrombosis, with a further reduction of TLR and cumulative MACE rate at 8 months.     

Bioavailability of oral vitamin E formulations in adult volunteers and children with chronic cholestasis or cystic fibrosis

Purpose:  To test bioequivalence of oral vitamin E formulations, water-soluble tocofersolan (test) and water-miscible (reference), in healthy adult volunteers, and their bioavailability in children with chronic cholestasis or cystic fibrosis.
Methods:  In a two-way open randomized single dose cross-over design, 1200 IU were administered in 12 healthy volunteers and 100 IU/kg in 12 children with chronic cholestasis or cystic fibrosis.
Results:  In healthy volunteers, formulations were not bioequivalent with a higher exposure to tocofersolan. In cholestatic children tocofersolan bioavailability was significantly higher than reference formulation (maximum plasma concentration: P  = 0·008 and AUC: P  = 0·0026). Bioavailability was not statistically different in cystic fibrosis.
Conclusions:  Oral tocofersolan was more bioavailable than the reference formulation in children with chronic cholestasis and similarly bioavailable in cystic fibrosis. Tocofersolan may represent an alternative to painful intramuscular vitamin E injections in chronic cholestasis, or to other oral formulations in cystic fibrosis.     

HONEY DRESSING IN WOUND TREATMENT: A SYSTEMATIC REVIEW

ObjectiveThe use of honey for wound treatment and care purposes is based on thousands of years of history. The development of science and in vitro/in vivo studies have demonstrated that honey contributes to wound healing by showing therapeutic effects by means of the bioactive compounds it contains. The aim of this systematic review was to evaluate the place of honey in wound treatment by investigating the randomized controlled studies.Method30 publications which were obtained as a result of the scans in the databases and which comply with the evaluation criteria were included in the review.ResultsIn the results of the study, it was reported that honey in acute and chronic wounds provided rapid epithelization and wound contraction in wound healing, had anti-inflammatory and debridement effect, decreased the pain, ensured infection control, shortened the time of wound healing and was cost-effective.     

Anti-oxidized low-density lipoprotein antibody levels are associated with the development of type 2 diabetes mellitus

Background  Anti-oxidized low-density lipoprotein (LDL) antibodies are associated with the oxidative capacity of plasma, but whether they protect or promote diabetes is unknown. We undertook a prospective study to determine the predictive capacity of anti-oxidized LDL antibodies for the onset of type 2 diabetes mellitus (T2DM).
Materials and methods  We selected 391 non-diabetic women aged 18–65 years. The subjects were classified as being normal (oral glucose test tolerance normal, OGTT-N), or having impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or T2DM according to their baseline glucose levels and after an OGTT. The same subjects were studied six years later. The levels of anti-oxidized LDL antibodies were classified as above or below the 50th percentile.
Results  Of the women who were OGTT-N at the start of the study and who had anti-oxidized LDL antibody levels below the 50th percentile, only 65·1% were still OGTT-N after 6 years versus 79·5% of those who had anti-oxidized LDL antibody levels above the 50th percentile ( P  = 0·015). Women who had IGT or IFG at the start of the study whose anti-oxidized LDL antibody levels were below the 50th percentile had a relative risk of 9·79 (95% confidence interval, 1·40–68·45) of developing diabetes ( P  < 0·001). Logistic regression analysis showed that the variables predicting the development of a carbohydrate metabolism disorder in the women after 6 years were body mass index ( P  < 0·001) and the levels of anti-oxidized LDL antibodies ( P  = 0·042).
Conclusions  Levels of anti-oxidized LDL antibodies are independent predictors for the development of T2DM in women.     

重组人粒细胞巨噬细胞集落刺激因子治疗烧伤后残余创面

目的:探讨局部应用重组人粒细胞巨噬细胞集落刺激因子(rhGM-CSF)凝胶治疗烧伤后残余创面的安全性和有效性。方法:采用随机、双盲、安慰剂同体对照的研究方法,将120处烧伤后残余创面,随机分为试验组(n=60)和对照组(n=60)。试验组采用rhGM-CSF凝胶治疗,对照组采用空白基质安慰剂治疗,试验周期为21d。观察用药后不良反应和创面愈合时间,以及不同时相点的创面愈合率、总有效率。结果:用药后不良反应轻微。试验组创面平均愈合时间为12.6d(95%可信区间11.9～13.3d),较对照组(16.8d,95%可信区间16.1～17.5d)明显缩短(P<0.01)。用药6、12d后,试验组创面愈合率分别为(53±13)%、(91±12)%,均显著高于对照组[(36±11)%、(73±14)%,P<0.01];试验组总有效率(13.00%、91.67%)均显著高于对照组(1.67%、53.33%,P<0.05);试验组疗效明显优于对照组(P<0.01)。结论:局部应用rhGM-CSF凝胶能促进烧伤后残余创面愈合,并且具有较好的安全性。     

Outcome after device implantation in chronic heart failure is dependent on concomitant medical treatment

Background  Device implantation in chronic heart failure (CHF) for cardiac resynchronization therapy (CRT) with or without implantable cardioverter/defibrillator (ICD) is an established treatment option for symptomatic patients under medical baseline therapy. Although recommended, the need for optimization of medical therapy was never proven. As in 'the real world', medical therapy is not always up-titrated to the desirable dosages; this provides the opportunity to evaluate the impact of optimizing medical therapy in patients who had received a device therapy with proven effectiveness.
Materials and methods  This observational cohort study retrospectively assessed the 'real life'-effect of CRT compared with that of CRT/ICD therapy and the impact of concomitant pharmacotherapy on outcome. Outcome of patients with guideline recommended renin–angiotensin system inhibitor and ß-blocker dosages was compared with that of patients who failed to reach the desired dosages. Mean follow-up for the 205 CHF (95 CRT and 110 CRT/ICD) patients was 16·8 ± 12·4 months.
Results  In the total study cohort, 83 (41%) reached the combined primary endpoint of all-cause death or cardiac hospitalization [CRT group: 25 (26%), CRT/ICD group: 58 (52·7%), P  < 0·001]. Multiple cox regression analysis revealed non-optimized medical therapy at follow-up [HR = 2·080 (1·166–3·710), P  = 0·013] and CRT/ICD vs. CRT [HR = 2·504 (1·550–4·045), P  < 0·001] as significant predictors of the primary endpoint.
Conclusion  Our data stress the importance of professional monitoring and titration of pharmacotherapy not only in medically treated CHF patients but also in patients under device therapy by a heart failure unit or a specialized cardiologist.     

Platelet-rich plasma for the treatment of burn wounds: A meta-analysis of randomized controlled trials

BackgroundTo evaluate the efficacy and safety of platelet-rich plasma in the treatment of burn wounds through a meta-analysis of randomized controlled trials.MethodsWe conducted a comprehensive study from electronic medical journal databases. The primary outcome was healing rate, and the secondary outcomes were healing time, adverse events, pain score and scar score. The data was analyzed using Review Manager 5.3 and Stata 12. The odds ratio (OR) among different groups was calculated by using 95 % confidence interval (CI).ResultsWe included 8 randomized controlled trials with a total of 539 patients. The results showed that platelet-rich plasma could improve the healing rate of burn wound (OR 4.43, 95 % CI 2.13–9.22). The wound healing time of the platelet-rich plasma treatment group was significantly shorter than that of the conventional treatment group (OR –4.23, 95 % CI ?5.48 to ?2.98), both the superficial burn (OR –3.80, 95 % CI ?4.53 to ?3.07) and the deep burn group (OR –4.65, 95 % CI ?6.90 to ?2.40) had shorter healing time. Otherwise, the incidences of adverse events (OR 0.30, 95 % CI 0.11?0.78), pain score (OR –0.80, 95 % CI ?1.40 to ?0.21) and scar score (OR –0.38, 95 % CI ?0.69 to ?0.07) were all better in the platelet rich plasma treatment group.ConclusionTopical platelet-rich plasma treatment on burn wounds can improve wound healing and reduce the incidence of adverse events. Further research is needed to standardize the preparation and use of platelet-rich plasma and to evaluate the long-term clinical outcome of platelet-rich plasma in the treatment of burn wounds.     

Anti-oxidized LDL antibody levels are reduced in women with hypertension

Background  Previous studies have suggested that hypertension may be associated with increased oxidized low-density lipoprotein (LDL). Increased in vitro oxidizability of LDL or elevated titers of anti-oxidized LDL antibodies have been shown in subjects with essential hypertension. However, the relationship between oxidized LDL and hypertension is equivocal. We examined the association between hypertension and levels of IgG anti-oxidized LDL antibodies in a group of women from the general population.
Materials and methods  The study included 619 women classified according to their blood pressure values. IgG anti-oxidized LDL antibodies were measured by enzyme-linked immunosorbent assay and the women were classified as being above or below the 50th percentile.
Results  Hypertension was present in 54·3% of the women. These women had significantly lower levels of IgG anti-oxidized LDL antibodies than the normotensive women (0·280 ± 0·117 vs. 0·336 ± 0·125, P  <   0·001). Both systolic and the diastolic blood pressures showed a significant negative correlation with the levels of IgG anti-oxidized LDL antibodies ( r  = −0·204, P  <   0·001; r  = −0·225, P  <   0·001, respectively). Women with IgG anti-oxidized LDL antibody levels above the 50th percentile had a lower prevalence of hypertension than those with IgG anti-oxidized LDL antibody levels below the 50th percentile (40·2% vs. 59·8%) ( P  <   0·001).
Conclusions  Women with hypertension had lower levels of IgG anti-oxidized LDL antibodies than normotensive women.     

Echo Doppler parameters predict response to cardiac resynchronization therapy

Background  Cardiac resynchronization therapy (CRT) has been shown to reduce heart failure related morbidity and mortality. However, approximately 30% of patients do not respond to CRT. We investigated the usefulness of Echo Doppler parameters to predict reverse remodelling, functional improvement and mortality following CRT.
Materials and methods  Our population consists of 200 consecutive heart failure patients evaluated for ventricular dyssynchrony by echocardiography between February 1999 and May 2007 who subsequently received CRT. Patients were reassessed for signs of reverse remodelling after a mean follow-up of 10 months. Information on vital status was obtained from local registration authorities.
Results  Three parameters significantly predicted reverse remodelling in the logistic regression analysis: the Q-to-E-wave-delay (QED) at a cutoff of 550 ms (odds ratio 4·5, P -value 0·001), the interventricular mechanical delay (IVMD) at a cutoff of 60 ms (odds ratio 2·4, P -value 0·02), and the aortic electromechanical delay (A-EMD) at a cutoff of 140 ms (odds ratio 2·9, P -value 0·004). Furthermore, the QED and the IVMD also predicted all-cause mortality (hazard ratio 0·36, P -value 0·02 and 0·21, P -value 0·004, respectively). Adjustment for confounders did not alter the results.
Conclusions  The QED and IVMD predict reverse remodelling and survival following CRT. These parameters are easy to obtain, provide valuable prognostic information, and should thus be measured in CRT candidates evaluated by echocardiography.     

Improvement of fractional flow reserve and collateral flow by treatment with external counterpulsation (Art.Net.-2 Trial)

Background  Arteriogenesis (collateral artery growth) is nature's most efficient rescue mechanism to overcome the fatal consequences of arterial occlusion or stenosis. The goal of this trial was to investigate the effect of external counterpulsation (ECP) on coronary collateral artery growth.
Materials and methods  A total of 23 patients (age 61 ± 2·5 years) with stable coronary artery disease and at least one haemodynamic significant stenosis eligible for percutaneous coronary intervention were prospectively recruited into the two study groups in a 2 : 1 manner (ECP : control). One group (ECP group, n  = 16) underwent 35 1-h sessions of ECP in 7 weeks. In the control group ( n  = 7), the natural course of collateral circulation over 7 weeks was evaluated. All patients underwent a cardiac catheterization at baseline and after 7 weeks, with invasive measurements of the pressure-derived collateral flow index (CFIp, primary endpoint) and fractional flow reserve (FFR).
Results  In the ECP group, the CFIp (from 0·08 ± 0·01 to 0·15 ± 0·02; P  < 0·001) and FFR (from 0·68 ± 0·03 to 0·79 ± 0·03; P  = 0·001) improved significantly, while in the control group no change was observed. Only the ECP group showed a reduction of the Canadian Cardiovascular Society (CCS, P  = 0·008) and New York Heart Association (NYHA, P  < 0·001) classification.
Conclusion  In this study, we provide direct functional evidence for the stimulation of coronary arteriogenesis via ECP in patients with stable coronary artery disease. These data might open a novel noninvasive and preventive treatment avenue for patients with non-acute vascular stenotic disease.     

Adolescents with asthma: predictors of quality of life

Title.  Adolescents with asthma: predictors of quality of life.
Aim.  This paper is a report of a study to determine the demographic, personal, interpersonal and illness factors associated with asthma quality of life (QOL), as self-reported by adolescents from the United States of America (USA) and Iceland.
Background.  Asthma affects 12% of children in the USA and an estimated 9% in Iceland. Limited research has addressed asthma QOL for adolescents.
Methods.  This cross-sectional exploratory study included adolescents with asthma ( n  =   15 from the USA; n  =   15 from Iceland), aged 13–17 years, primarily recruited from paediatric practices in central Kentucky, USA and Reykjavik, Iceland. Data were collected in 2006. Adolescents in the USA (47% male) had a mean age of 14·1 years ( sd   = 1·5); Icelandic adolescents (73% male) had a mean age of 15·1 years ( sd   = 1·4). Participants completed questionnaires measuring sociodemographic and asthma characteristics, degree of limitations due to asthma, self-rated health, depressive symptoms and asthma QOL. Multiple regression was used to determine predictors of asthma QOL.
Results.  Gender was statistically significantly associated with QOL. The difference in QOL between adolescents in the USA and Iceland was not statistically significant. Statistically significant predictors of higher asthma QOL were a better rating of overall health ( P  < 0·01), not having had a severe asthma attack in the last 6 months ( P  < 0·01), and lower depressive symptoms ( P  < 0·05).
Conclusion.  Interventions designed to decrease depression and prevent asthma exacerbations may improve QOL for adolescents with asthma.     

Medical Honey for Wound Care—Still the ‘Latest Resort’?

While the ancient Egyptians and Greeks used honey for wound care, and a broad spectrum of wounds are treated all over the world with natural unprocessed honeys from different sources, Medihoney has been one of the first medically certified honeys licensed as a medical product for professional wound care in Europe and Australia. Our experience with medical honey in wound care refers only to this product. In this review, we put our clinical experience into a broader perspective to comment on the use of medical honey in wound care. More prospective randomized studies on a wider range of types of wounds are needed to confirm the safety and efficacy of medical honey in wound care. Nonetheless, the current evidence confirming the antibacterial properties and additional beneficial effects of medical honey on wound healing should encourage other wound care professionals to use CE-certified honey dressings with standardized antibacterial activity, such as Medihoney products, as an alternative treatment approach in wounds of different natures.