Biofilm formation by Streptococcus pneumoniae strains and effects of human serum albumin,ibuprofen, N-acetyl-l-cysteine,amoxicillin, erythromycin,and levofloxacin

Streptococcus pneumoniae ability to produce biofilms may induce persistent infections and difficulties for eradication in vivo. We investigated the ability of 11 pneumococcal strains (serotypes 3, 6B, 9V, 19F, and 23F) to form biofilms on polystyrene plates at 16 and 24 h. The extent of biofilm was greater at 24 h in 10 strains, being the highest magnitude for serotype 3 strains. Human serum albumin at 25?000 μg/mL and ibuprofen at 128 μg/mL significantly reduced biofilm formation in 7 and 5 strains, respectively. Amoxicillin, erythromycin, and levofloxacin at supra-MIC concentrations were very active against planktonic cells of 3 selected strains but lower on biofilm-associated organisms in 2 strains and null against the third. Although N-acetyl-l-cysteine had very little activity against both planktonic and biofilm-forming organisms, when combined with the 3 antibiotics, a slightly enhanced activity against biofilm-embedded organisms in 1 strain and combined with amoxicillin in another one was observed.     

Pressure injury prevention and management practices among nurses: A realist case study

The prevention and management of a pressure injury is a nurse‐sensitive quality indicator in hospitals. Prevention and management of pressure injury practices have been found to be suboptimal despite the availability of interventions. Currently, there is a poor understanding of the mechanisms behind these interventions. The aim of the study was to explain a realistic portrayal of nurses' current practices to prevent and manage pressure injuries in one public hospital in Singapore. A realistic case study design was adopted. Twenty‐four nurses were recruited. Audio‐recorded interviews were transcribed verbatim to facilitate thematic analysis. Prevention and management was generally facilitated through the timely escalation of care, effective communication, support from the wound nurses, and bridging of the knowledge‐practice gap. However, factors such as nurses' intrinsic characteristics and organisational support may affect the outcomes of these facilitators. Overall, nurses strive to achieve patient safety, where pressure injuries are prevented to the best of their abilities. This study provides causal links between contextual factors, mechanisms of the prevention and management, and the outcomes achieved. Further refinement and testing of the specific mechanisms are needed and will contribute to a better understanding of how nurses prevent and manage pressure injuries.     

Enzymes for Leather Processing: Effect on Pickling and Chroming

Recently, increasing attention has been paid to the application of enzymes in a wide variety of leather production processes. The aim of the present study was to investigate the action of enzymatic pickling on derma’s collagen and the influence of this action on subsequent processes and properties of chromed and finished leather. The application of active in acidic medium proteolytic enzymes in the pickling process led to an additional impact on derma structure: collagen was more strongly affected and the porosity of the pelt dermis was reduced, but the hide became more thermally stable. The enzymatically pickled pelt bonded more chromium and reached higher shrinkage temperature while chroming; dyes penetrated deeper; such leather bonded more fatliquors. On the other hand, the action of enzymes worsened the physical–mechanical properties of the leather, as the experimental leather was weaker than the conventional one. The first was characterised by weaker grain layer and had significantly higher relative elongation. Therefore, as some properties improve and others worsen during such a process, the application of every enzyme should be carefully investigated and optimized to produce a leather with defined properties.     

Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination?

OBJECTIVES: Learning to perform physical examination of the abdomen is a challenge for medical students. Medical educators need to find engaging, effective tools to help students acquire competence and confidence in abdominal examination techniques. This study evaluates the added value of ultrasound training when Year 1 medical students learn abdominal examination. METHODS: The study used a randomised trial with a wait-list control condition. Year 1 medical students were randomised into 2 groups: those who were given immediate ultrasound training, and those for whom ultrasound training was delayed while they received standard instruction on abdominal examination. Standardised patients (SPs) used a clinical skills assessment (CSA) checklist to assess student abdominal examination competence on 2 occasions - CSA-1 and CSA-2 - separated by 8 weeks. Students also estimated SP liver size for comparison with gold-standard ultrasound measurements. Students completed skills confidence surveys. RESULTS: Proficiency in abdominal examination technique acquired from traditional instruction boosted with ultrasound training showed no advantage at CSA-1. However, at CSA-2 the delayed ultrasound training group showed significant improvement. Students uniformly underestimated SP liver sizes and the estimates were not affected by ultrasound training. Student confidence in both groups improved from baseline to CSA-1 and CSA-2. CONCLUSIONS: Ultrasound training as an adjunct to traditional means of teaching abdominal examination improves students' physical examination technique after students have acquired skills with basic examination manoeuvres.     

A novel measurement instrument for pressure‐injury risk assessment competence: Theoretical procedures,simulation, and psychometric quality

This study developed a measuring instrument of pressure‐injury risk assessment competence for nursing education adopting theoretical procedures based on competence structuration to support the psychometric quality. The objective of this study is testing the psychometric properties of the instrument using simulation strategy and to determine the instrument's standardisation and normalisation. A methodological study was designed. The instrument was developed by a content‐validated theoretical construct administered to 155 undergraduate nursing students from universities in the northeast and south of Brazil using simulation. The instrument was applied over three phases: before the lecture on pressure‐injury risk assessment competence, after scenario of simulation experience, and after debriefing experience. The instrument comprised 32 items. The factorial analysis found that three domains explained 64.6% and 62.18% of the total variance in post‐scenario and debriefing cases. The perfect and very high discrimination index of the instrument indicated minimal differences in measured latent trait levels. It also found that reliability was excellent (0.973 and 0.967). Moreover, an equation applicable to instruments using study's theoretical procedure was proposed. The instrument was found to be a valid, accurate, and reliable educational tool for pressure‐injury risk assessment competence.     

An intervention study to evaluate nursing management of peripheral intravascular devices.

This study examined the impact that implementation of guidelines for the management of peripheral intravascular devices had on nurses' knowledge and practice as well as patient outcome. A pre- and posttest nonequivalent experimental study was conducted in a Hong Kong tertiary care teaching hospital. The results showed that the percentage of correct answers for all questions was significantly higher at the posttest. The overall results also showed significant practice improvement in terms of the flushing agent used, documentation, and site dressing. There also was a decrease in the incidence of extravasation and phlebitis. It was concluded that evidence-based practice is important for improving patient outcomes. Compliance with the guidelines served as an important measure for the prevention of intravascular device-related complications.