Comparative study of the PARK and ASTRAL post-accidental decision support software

The French radioecological assessment model ASTRAL and the German model PARK have been developed to evaluate the radiological situation in the case of an accidental release of radionuclides and a widespread contamination of the environment. For decision makers it is of importance that the results on foodstuff contamination and on dose to humans are in fairly good agreement, when areas of the common border are affected. Therefore a comparative study has been done for two scenarios, assuming accidental releases on 1 June and 1 October. The study indicates that the models' structures and the transfer parameters are in good agreement. Only model principles for root vegetables are different in both models. Significant differences in results on the contamination of foodstuff and on dose to humans by ingestion are caused by different assumptions on dates of harvest and feeding methods of animals. A corresponding harmonization is essential with respect to decision making.     

Continuous feedings of fortified human milk lead to nutrient losses of fat, calcium and phosphorous

Substantial losses of nutrients may occur during tube (gavage) feeding of fortified human milk. Our objective was to compare the losses of key macronutrients and minerals based on method of fortification and gavage feeding method. We used clinically available gavage feeding systems and measured pre- and post-feeding (end-point) nutrient content of calcium (Ca), phosphorus (Phos), protein, and fat. Comparisons were made between continuous, gravity bolus, and 30-minute infusion pump feeding systems, as well as human milk fortified with donor human milk-based and bovine milk-based human milk fortifier using an in vitro model. Feeding method was significantly associated with fat and Ca losses, with increased losses in continuous feeds. Fat losses in continuous feeds were substantial, with 40 ± 3 % of initial fat lost during the feeding process. After correction for feeding method, human milk fortified with donor milk-based fortifier was associated with significantly less loss of Ca (8 ± 4% vs. 28 ± 4%, p< 0.001), Phos (3 ± 4% vs. 24 ± 4%, p < 0.001), and fat (17 ± 2% vs. 25 ± 2%, p = 0.001) than human milk fortified with a bovine milk-based fortifier (Mean ± SEM).     

Administration des médicaments par sonde de nutrition entérale : de l’audit de pratiques à l’élaboration d’outils pour aider le personnel soignant

ObjectiveThere are several iatrogenic risks administrating drugs via feeding tubes, so the Anaes made recommendations about it in 2000. This study was organized to investigate on the administration practices and needs of the nurses in order to enlighten their difficulties and to set improvement plans.MethodsDuring 2 months, in the ORL service of Saint-Étienne's university hospital, a pharmacist resident evaluated the actual drug administration practices and had private talks with the nurses.ResultsTwenty-six patients on enteral nutrition were included. It appeared that all the drugs were crushed in a small plate and then melt with water before administration. In 21 % of cases, the drug was not suitable with tube feeding. The hand washing was observed in 50 % of the cases and the use of gloves in only 8 %. The 10 individual discussions with nurses show that they suffer from a lack of information (about galenic and risks) and that they need functional tools. Trainings and specific information were displayed as for example a poster of well practicing, a list of galenic forms suitable or not with drug administration and a book with suitable used drugs was distributed.ConclusionDespite of national advices, drug administration via feeding tube remains a source of problems. Thanks to this study, we now know what is done today, and the needs of the care teams; corrective actions can be established.     

Ethanol calories do not enhance breast cancer in isocalorically fed C3H/Ou mice

Mammary tumorigenesis is augmented when C3H/Ou mice are fed diet ad libitum but delayed when calories are restricted by 40%. Three feeding experiments were done to evaluate the effect of ethanol on mammary tumorigenesis in isocalorically fed C3H/Ou mice: 1) ad libitum feeding of semipurified solid diet, with one group receiving 12% ethanol (15 g/kg/day) in the drinking water while controls received water alone; 2) isocaloric pair feeding of semipurified solid diet, with ethanol (4 g/kg/day) administered by gavage five times per week; and 3) isocaloric pair feeding of Lieber‐DeCarli liquid diet, with one group receiving 29% of calories as ethanol (20 g/kg/day) in the diet. Despite administration of ethanol to isocalorically fed C3H/Ou mice for 65 weeks by three different methods, mammary tumor development was not enhanced. In two of the three ethanol‐consuming groups, weight gain and mean body weight were less in the ethanol‐consuming mice than in the controls, despite equal total calorie consumption. In only one ethanol‐consuming group, where mice received ethanol as a 12% solution in the drinking water, was any difference noted in the tendency to develop mammary tumors. In this case, delay in tumorigenesis was apparent in the ethanol‐consuming animals (p = 0.03). These findings do not support the hypothesis that ethanol calories augment the risk for breast tumorigenesis among breast cancer‐prone mice consuming isocaloric diets. Instead, reductions in weight gain and body weight among ethanol‐consuming mice and an apparent reduction in mammary tumorigenesis in one of three experimental groups suggest that ethanol may decrease metabolic utilization of calories and hence contribute to lowered energy availability. This in turn could decrease tumorigenesis.     

Ascending contamination of a jejunostomy feeding reservoir

In general bacterial contamination of enteral feeding solutions is considered to be exogenous in origin. However, during feeding through catheter jejunostomy another source of contamination seems possible. We describe a patient in whom bacterial contamination of the feeding solution given through a catheter jejunostomy occurred frequently. Microbiological evaluation of several feeding samples showed that with this particular type of catheter enterostomy contamination was dual in origin. A not aseptic manipulation of the feed prior to administration led only to slight contamination. Most of the contamination however was endogenous--ie. ascending from the gut of the patient. In contrast to some previous studies, no clinical or laboratory deterioration could be observed in relation to the contamination. The food value of the feed expressed as the glucose concentration was significantly reduced after contamination with the causative organisms.     

综合医院数据库非常规热备份问题分析

目的:通过对1例数据库热备份出现的问题进行分析,寻求医院数据库非常规热备份解决方案。方法:对数据库服务器扩容升级过程中进行数据库非常规热备份,观察并重现非常规热备份导致的异常现象,详细记录扩容升级步骤及出现的问题,分析原因,总结综合医院数据库服务器备份方案。结果:解决了医院数据库系统热备份过程中出现的问题,成功进行了数据库无损备份。结论:对数据库进行非常规热备份目的是,一旦出现问题可以利用备份数据最大程度进行数据恢复,尽管期间有可能会导致数据不一致等不确定问题,但还是应该按照规范流程进行数据库备份。     

Microbiological evaluation of four enteral feeding systems which have been deliberately subjected to faulty handling procedures.

The present study was designed to investigate the levels of contamination in four currently used 1000 mL, 'ready-to-hang', enteral feeding systems--Osmolite (Ross Ready-To-Hang), Steriflo, Dripac-flex and Easybag, when faulty handling procedures were used during assembly of the systems. The top of the nutrient container and the proximal (container) end of the pump set of each system were touched during assembly by a researcher whose hands had been deliberately contaminated with Klebsiella aerogenes. Once assembled systems were run continuously for 24 h delivering 1000 mL of feed. Feed samples for microbiological analysis were taken from the distal (patient) end of the feeding tube at 0 h and 24 h and from the feed remaining in the nutrient container at the end of administration (24 h). Five systems of each type were run. Five controls were also run for each type of system, where all procedures were carried out wearing sterile gloves. Eighty-seven percent of feed samples collected from the Osmolite systems and 80% of those from the Steriflo systems were found to contain K. aerogenes, with 13% of feed samples from both systems containing > or = 10(4) cfu/mL, a level of contamination, considered by many, as that above which feed is unacceptable for patient consumption. The percentage of feed systems containing the test organism was much lower in the Dripac-flex and Easybag systems, with K. aerogenes being detected in 27% and 13% of samples respectively. No feed samples from either of these systems contained > or = 10(4) cfu/mL. From the results it can be concluded that deviation from the manufacturers instructions when assembling enteral feeding systems can lead to bacterial contamination of these systems. The results also highlight the effect that system design, such as recessed pump set spikes and recessed nutrient container seals (both of which prevent care workers accidentally touching parts of the feeding system which may come into contact with the feed) have on reducing the number of bacteria gaining entry to the feed in the systems.     

Genotoxic risks to nurses from contamination of the work environment with antineoplastic drugs in Japan

The aims of the present study were to clarify the work environment contamination by antineoplastic drugs in a hospital ward and to assess the genotoxic risks to nurses who routinely handle antineoplastic drugs in Japan. The exposed group consisted of 19 female nurses who routinely handled antineoplastic drugs. The control group consisted of 18 female nurses who did not handle antineoplastic drugs in the same hospital as the exposed group. The genotoxicity of the 19 antineoplastic drugs used in the hospital ward and 8 wipe samples of the workbench after handling of antineoplastic drugs were measured using the umu assay. Lymphocyte DNA damage (tail length) was measured with alkaline methods of the single cell gel electrophoresis assay (comet assay). Of the 19 antineoplastic drugs, dacarbazine, bleomycin, daunorubicin, doxorubicin, pirarubicin, carboplatin, cisplatin and etoposide induced genotoxicity. Of the 8 sampling d, the umu activity of the wipe sample was positive on 3 d. Contamination of the workbench was found when the nurses handled more drugs than on other days. The medians of the tail length in the comet assay were 8.5 and 5.1 microm, respectively, for the exposed and control groups, with a significant difference (p=0.004 by Mann-Whitney's U-test). In the present study, the nurses of the exposed group were considered to have been exposed to antineoplastic drugs and lymphocyte DNA damage of the exposed group was suggested to be induced by antineoplastic drugs.     

Comparison of continuous vs intermittent nasogastric enteral feeding in trauma patients: perceptions and practice.

Enteral nutrition support (ENS) may be administered by continuous administration or by intermittent bolus, but few studies have compared the advantages and limitations associated with these methods in the trauma patient population. The purpose of this prospective randomized study was to evaluate the impact of continuous vs intermittent nasogastric enteral feeding on gastrointestinal tolerance, pulmonary aspiration, and nutritional indices. A survey of medical and surgical intensive care unit nursing staff was performed to assess perceptions and attitudes toward these 2 delivery methods. Eighteen trauma patients [Injury Severity Score (ISS) > or = 20] were enrolled in the study; 9 received continuous ENS (CENS) and 9 received intermittent bolus ENS (IENS). Interruption of ENS delivery occurred in more IENS than CENS patients due to elevated residuals and emesis. Diarrhea occurred in more patients (5/9 vs 2/9) and for a longer duration (14/65 vs 6/49 ENS days) in the IENS group compared with the CENS group. Aspiration was detected in 1 IENS patient. Method of nutrient delivery did not seem to influence urine urea nitrogen (UUN) measurements or prealbumin concentrations. Nurses surveyed in the study (n = 25) preferred CENS (84%) compared with IENS (12%). Data from this study suggest that CENS through a nasoenteric feeding tube may facilitate nutrient intake with less gastrointestinal complications in severely injured trauma patients compared with IENS. In addition, the majority of nurses surveyed preferred the continuous method for nutrient delivery.     

Ethanol calories do not enhance breast cancer in isocalorically fed C3H/Ou mice.

Mammary tumorigenesis is augmented when C3H/Ou mice are fed diet ad libitum but delayed when calories are restricted by 40%. Three feeding experiments were done to evaluate the effect of ethanol on mammary tumorigenesis in isocalorically fed C3H/Ou mice: 1) ad libitum feeding of semipurified solid diet, with one group receiving 12% ethanol (15 g/kg/day) in the drinking water while controls received water alone; 2) isocaloric pair feeding of semipurified solid diet, with ethanol (4 g/kg/day) administered by gavage five time per week; and 3) isocaloric pair feeding of Lieber-DeCarli liquid diet, with one group receiving 29% of calories as ethanol (20 g/kg/day) in the diet. Despite administration of ethanol to isocalorically fed C3H/Ou mice for 65 weeks by three different methods, mammary tumor development was not enhanced. In two of the three ethanol-consuming groups, weight gain and mean body weight were less in the ethanol-consuming mice than in the controls, despite equal total calorie consumption. In only one ethanol-consuming group, where mice received ethanol as a 12% solution in the drinking water, was any difference noted in the tendency to develop mammary tumors. In this case, delay in tumorigenesis was apparent in the ethanol-consuming animals (p = 0.03). These findings do not support the hypothesis that ethanol calories augment the risk of breast tumorigenesis among breast cancer-prone mice consuming isocaloric diets. Instead, reductions in weight gain and body weight among ethanol-consuming mice and an apparent reduction in mammary tumorigenesis in one of three experimental groups suggest that ethanol may decrease metabolic utilization of calories and hence contribute to lowered energy availability.(ABSTRACT TRUNCATED AT 250 WORDS)     

急性脑梗死鼻饲患者腹泻风险预测模型的构建

目的 构建急性脑梗死(ACI)鼻饲患者腹泻风险预测模型.方法 回顾性分析2016年1月至2018年6月期间某院重症医学科、神经内科收治的ACI鼻饲患者的临床资料.收集患者入院时的相关情况资料以及腹泻情况等.应用SPSS 25.0和R 3.6.1软件进行统计分析,构建列线图预测模型并评价.结果 收集114例符合纳入标准的...     

Infection control in neonatal intensive care units

Healthcare-associated infection is a major problem in acute hospital settings. Hand decontamination is considered to be the most effective means of preventing healthcare-associated infection, but is poorly performed. Few studies have examined technique, which may be important in neonatal intensive care units (NICUs) where clinical procedures are intricate and could result in contamination of many areas of the hand, resulting in cross-infection. This study examined technique in six NICUs. Eighty-eight nurses were observed. A scoring system was developed so that technique could be quantified and subjected to statistical testing. The mean score was 6.29 out of 11 when hands were washed and 3.87 out of 7 when alcohol hand rub was used, indicating that performance was not optimal. Scores for technique were not significantly different in each NICU. Senior nurses achieved higher scores for handwashing (P<0.01), as did nurses holding positive feelings about the atmosphere in their NICU (P=0.04). Junior nurses scored less well on a knowledge questionnaire than senior nurses (P<0.01). Nurses who had been employed in the neonatal unit for less than one year also scored less well (P<0.01). Differences in technique were noted when comparing the beginning and end of long shifts. These differences were not noted at the beginning and end of standard shifts.     

Winter air-mass-based synoptic climatological approach and hospital admissions for myocardial infarction in Florence, Italy

The aim of this study was to evaluate the relationship between the risk of hospital admission for myocardial infarction (MI) and the daily weather conditions during the winters of 1998-2003, according to an air-mass-based synoptic climatological approach. The effects of time lag and 2-day sequences with specific air mass types were also investigated. Studies concerning the relationship between atmospheric conditions and human health need to take into consideration simultaneous effects of many weather variables. At the moment few studies have surveyed these effects on hospitalizations for MI. Analyses were concentrated on winter, when the maximum peak of hospitalization occurred. An objective daily air mass classification by means of statistical analyses based on ground meteorological data was carried out. A comparison between air mass classification and hospital admissions was made by the calculation of a MI admission index, and to detect significant relationships the Mann-Whitney U test, the analysis of variance, and the Bonferroni test were used. Significant increases in hospital admissions for MI were evident 24h after a day characterized by an anticyclonic continental air mass and 6 days after a day characterized by a cyclonic air mass. Increased risk of hospitalization was found even when specific 2-day air mass sequences occurred. These results represent an important step in identifying reliable linkages between weather and health.     

Evaluation of professional exposure to antiblastic chemotherapeutic agents in a Tuscan hospital environment

The aim of this study, carried out from 1997 to 2000, was to evaluate the exposure to antiblastic drugs of hospital staff (38 nurses of 7 oncological Day Hospital care in Tuscany). To evaluate the internal exposure was used biological monitoring, in particular was determined the concentration of urinary cyclophosfamide (CF); pad was made to evaluate the skin contamination. The contamination of working surfaces was determinate, by wipe-test, to verify the decontamination procedures; were used, as markers, CF and 5-fluorouracil (5-FU). We assessed the permeability thorough gloves usually used by the staff and the degradative activity to these drugs by agents used to decontaminate the working surfaces. The results shows, in urine, value lower than the detection limits, although was found a diffused contamination of the working environment. The results confirmed that NaClO is the best product to decontaminate working surfaces and nitrile gloves the ones with less permeability.     

Smoking among nurses in Turkey: comparison with other countries

The purpose of this study was to obtain baseline information on smoking among nurses. An attempt was made to contact, in person, all 301 nurses working for the university hospital in Sivas, Turkey, and when contacted they were asked to complete an anonymous questionnaire. Each unit of the hospital was visited three times, and 239 (79%) nurses were reached who all completed the questionnaire. Of the 239 respondents, 107 (45%) were current smokers, reflecting a substantially higher prevalence compared to that among the adult female population. The quit ratio was 22.5%. Of 127 ever-smoker nurses who responded to the related item, 90% started smoking during or after nursing education. This pattern of smoking initiation was different from the pattern in developed countries where nurses had already started smoking before beginning that training. Nurses with a high school education had a significantly higher prevalence of ever-smoking. Most respondents frequently or sometimes saw doctors smoking in rooms for nurses and in rooms for doctors in inpatient services. In-depth qualitative studies are needed to determine the reasons for the different smoking-initiation pattern.     

A survey of the role of the dietitian in preparing patients for home enteral feeding

Teaching home enteral feeding is a complex process involving many activities not traditionally performed by dietitians. This survey was undertaken to investigate (a) tasks performed by the dietitian in preparing patients to receive home enteral feeding, (b) the effect of various demographic factors on the dietitian's role, (c) the amount of dietitian time spent preparing a patient for discharge on home enteral feeding, and (d) the types of home enteral feedings currently in use. A questionnaire was tested for reliability and validity, then mailed to 1,168 nutrition support dietitians. Results of the survey indicated that, more often than nurses or physicians, dietitians were responsible for calculating nutrient and fluid needs, selecting formula, determining the home feeding schedule, teaching the patient to prepare blenderized formulas, and teaching the patient to recognize formula intolerance. Dietitians were less often responsible than nurses for psychomotor skills such as teaching the patient to administer the formula, operate the pump, and flush the feeding tube. Dietitians seemed to have a larger role in hospitals with more than 499 beds, in teaching hospitals, and in hospitals with a nutrition support team. Dietitians reported a smaller role when they reported to a contract foodservice company and when their job duties were divided so that more time was spent in clinical dietetics than in nutrition support. However, dietitians in all demographic groups performed all tasks. The average amount of dietitian time spent preparing patients for discharge on home enteral feeding was 168 minutes (2.8 hours) per patient. More patients received gastric feedings (76%) than intestinal feedings (22%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Endogenous bacterial contamination of enteral tube feeding systems during administration of feeds to hospital patients

The use of sterile, prepackaged enteral feeds has helped to reduce the risk of exogenous microbial contamination of enteral feeds but there is increasing evidence that endogenous contamination with bacteria from the patient's own flora may occur. The purpose of this study was to compare the levels and types of micro-organisms present in residual feed in nutrient containers and giving sets when either 500 or 1000 ml prefilled, ready-to-hang nutrient containers were used to administer 1000 and 2000 ml quantities of feed to patients on hospital wards over 24 h using a single giving set over this period. Forty-one adult patients were randomly allocated to receive either 1000 or 2000 ml of sterile undiluted, whole protein feed over 24 h from 1000 ml prefilled containers (Nutrison Steriflo, Cow and Gate Nutricia Ltd) or from 500 ml prefilled bottles (Osmolite, Abbott Laboratories Ltd). One giving set was used over 24 h for each patient. Samples of feed from the nutrient containers and the distal end of each giving set were sent for microbiological analysis immediately after removal from the patient. Control experiments demonstrated that there were no micro-organisms in the unopened feed containers and that none was introduced during the feed sampling procedure. The percentage of days on which feed samples from the nutrient containers were contaminated was $lt; 10% for feeds administered at a rate of 1000 ml over 24 h and $lt; 23% for those administered at a rate of 2000 ml over 24 h irrespective of system, which may be attributed to increased handling of systems and reuse of the giving set. However, the percentage of days on which samples from the giving sets were contaminated was 43% for all systems. In fact, on an average of 33% of days it was found that the only feed sample that was contaminated was that collected from the giving set. Counts for these samples were $lt;10³ cfu/ml and the main bacteria isolated included Klebsiella spp., Enterobacter spp., Escherichia coli, Streptococcus faecalis and Pseudomonas aeruginosa. These results further implicate retrograde spread of the patient's own flora as a possible source of microbial contamination of feed in the giving sets of enteral feeding systems.     

Degradation of DDT by goldfish

Summary Goldfish were fed DDT for three weeks, then exposed to phenobarbital solution for one week to study the possibility of microsomal enzyme induction and therefore possibly enhanced insecticide excretion. Analysis of DDT, DDE and DDD were made at intervals up to six weeks. Forty percent of the DDT fed was incorporated during the feeding. It was recovered mainly as DDE (68 to 96%). Significant differences between pesticide levels of phenobarbital treated and control fish were not found.     

Knowledge and attitudes of health care professionals with respect to AIDS and the risk of occupational transmission of HIV in 2 Moroccan hospitals

We carried out a survey of 266 health care workers at two hospitals, in Rabat and Casablanca, to evaluate the level of knowledge, attitudes and behavior of these individuals with respect to AIDS. We also analyzed working conditions presenting a risk of occupational transmission of HIV, with the aim of developing appropriate preventive measures. We carried out a cross-sectional study, using a standardized questionnaire. The study population consisted of 91 doctors (34.2%), 106 nurses (39.8%), 12 laboratory technicians (8. 8%) and 47 support staff (17.6%) working in various departments. The mean age was 32.7 years. This study population was young, with 83% less than 40 years old and more than half having worked in the hospital for less than ten years. We found that the personnel knew a great deal about the usual means of transmission of HIV, but much less about possible occupational contamination. One person in two was unaware of the ways in which HIV in the hospital environment can be inactivated (bleach - 70% alcohol) and only 18.4% knew that HIV is sensitive to heat. Half the study population thought that the systematic exclusion of patients with HIV was essential and two thirds suggested that every patient admitted to the hospital should undergo systematic HIV testing. Anxiety when caring for seropositive patients was expressed by 56% of doctors and 62% of paramedical workers and 85% thought that health workers were at high risk of contamination during their work. The frequency of occupational injuries was found to be high and such accidents were rarely declared (declaration rate 7%). Protection measures were not in place in more than 50% of cases and too little information and resources were available to increase the awareness of the health care workers. These data show that greater efforts should be made to educate and inform health workers by means of the occupational medicine units recently set up for the benefit of the staff.     

Experimental study of hub contamination: effect of a new connection device: the I system.

Experimental studies of hub contamination of intravenous catheters were done comparing the standard connection method (Luer-Lock connector) with a newly invented connection method (I system). Immersion of the connection sites into a bacteria-containing solution showed no bacterial contamination of the medium in any tubing. The second experiment investigated whether bacterial contamination would occur during a tubing change procedure. A high incidence of bacterial contamination was seen with the Luer-Lock connector, but no bacterial contamination occurred with the I system. These experiments suggest that the use of Luer-Lock connectors is associated with a high risk of bacterial contamination during tubing change, but the I system can prevent contamination during tubing change, which cannot be avoided with Luer-Lock connector.