Concordance of respiratory care plans generated by protocols from different hospitals: a comparative study

OBJECTIVE: To assess whether respiratory care protocols from different hospitals result in similar care plans for identical patients, we asked: 1. Does applying respiratory care protocols from different hospitals to standardized patient vignettes produce identical care plans? 2. If there are differences in the care plans produced, what is the extent of the difference, and for which modalities are the differences greatest? 3. Does installing the protocol in a computerized information management system to generate the respiratory care plan improve the level of agreement? 4. Do protocols from different hospitals agree with regard to indications for respiratory care treatments and use of the Clinical Practice Guidelines from the American Association for Respiratory Care? METHODS: Protocols were compared by applying each of 4 hospitals' protocols to 15 patient vignettes that we developed, with various respiratory problems. With each vignette, 3 experienced respiratory therapist evaluators developed respiratory care plans, using both a manual (paper-based) and a computer-aided approach. RESULTS: The overall degree of agreement among the 4 protocols was moderate (kappa 0.60, 95% confidence interval 0.46-0.71). The degree of concordance differed for the individual respiratory care modalities; concordance was generally highest for oxygen, aerosol delivery, and pulse oximetry, and was lower for bronchopulmonary hygiene and hyperinflation. Concordance regarding indications for therapy also differed among the modalities; concordance was greatest for the indications for incentive spirometry, bronchodilator use, and pulse oximetry. The concordance of care plans developed with the computer-aided approach resembled that of the manual approach (kappa 0.62, 95% confidence interval 0.45-0.77). CONCLUSIONS: Our results suggest moderate agreement between care plans generated with respiratory care protocols from different hospitals. The sources of differences included differences in the indications for therapy, different degrees of protocol compliance with the American Association for Respiratory Care Clinical Practice Guidelines, and subjectivity in the indications for therapy. This study identifies opportunities to lessen regional variation in respiratory care, by encouraging uniform application of protocols and evidence-based guidelines.     

Impact of the Diet on the Formation of Oxidative Stress and Inflammation Induced by Bacterial Biofilm in the Oral Cavity

The diet is related to the diversity of bacteria in the oral cavity, and the less diverse microbiota of the oral cavity may favor the growth of pathogenic bacteria of all bacterial complexes. Literature data indicate that disturbances in the balance of the bacterial flora of the oral cavity seem to contribute to both oral diseases, including periodontitis, and systemic diseases. If left untreated, periodontitis can damage the gums and alveolar bones. Improper modern eating habits have an impact on the oral microbiome and the gut microbiome, which increase the risk of several chronic diseases, including inflammatory bowel disease, obesity, type 2 diabetes, cardiovascular disease and cancer. The subject of our consideration is the influence of the traditional diet on the formation of oxidative stress and inflammation caused by bacterial biofilm in the oral cavity. Through dental, biomedical and laboratory studies, we wanted to investigate the effect of individual nutrients contained in specific diets on the induction of oxidative stress inducing inflammation of the soft tissues in the oral cavity in the presence of residual supra- and subgingival biofilm. In our research we used different types of diets marked as W, T, B, F and noninvasively collected biological material in the form of bacterial inoculum from volunteers. The analyzed material was grown on complete and selective media against specific strains of all bacterial complexes. Additionally, the zones of growth inhibition were analyzed based on the disc diffusion method. The research was supplemented with dental and periodontological indicators. The research was supplemented by the application of molecular biology methods related to bacterial DNA isolation, PCR reactions and sequencing. Such selected methods constitute an ideal screening test for the analysis of oral bacterial microbiota. The obtained results suggest that certain types of diet can be an effective prophylaxis in the treatment of civilization diseases such as inflammation of the oral cavity along with periodontal tissues and gingival pockets.     

The hyperdense crescent sign

Abdominal Radiology -     

Positive and negative effects of glitazones in carcinogenesis: Experimental models vs. clinical practice

Diabetes increases cancer risk, which may be modulated by careful choice of treatment. Experimental reports showed efficacy of glitazones in various in vitro and in vivo models of carcinogenesis, but procarcinogenic effects in some models were reported too, and, similarly, data on cancer incidence in glitazone users are inconsistent. This review summarizes oncostatic effects of glitazones in preclinical and clinical studies and brings a brief summary of their impact on cancer risk in diabetic patients, with a focus on the association between pioglitazone use and bladder cancer.     

Modified Histopathological Protocol for Poly-ɛ-Caprolactone Scaffolds Preserving Their Trabecular,Honeycomb-like Structure

Poly-ɛ-caprolactone (PCL) is now widely studied in relation to the engineering of bone, cartilage, tendons, and other tissues. Standard histological protocols can destroy the carefully created trabecular and honeycomb-like architecture of PCL scaffolds, and could lead to scaffold fibers swelling, resulting in the displacement or compression of tissues inside the scaffold. The aim of this study was to modify a standard histopathological protocol for PCL scaffold preparation and evaluate it on porous cylindrical PCL scaffolds in a rat model. In 16 inbred Wag rats, 2 PCL scaffolds were implanted subcutaneously to both inguinal areas. Two months after implantation, harvested scaffolds were first subjected to μCT imaging, and then to histopathological analysis with standard (left inguinal area) and modified histopathological protocols (right inguinal area). To standardize the results, soft tissue percentages (STPs) were calculated on scaffold cross-sections obtained from both histopathological protocols and compared with corresponding µCT cross-sections. The modified protocol enabled the assessment of almost 10× more soft tissues on the scaffold cross-section than the standard procedure. Moreover, STP was only 1.5% lower than in the corresponding µCT cross-sections assessed before the histopathological procedure. The presented modification of the histopathological protocol is cheap, reproducible, and allows for a comprehensive evaluation of PCL scaffolds while maintaining their trabecular, honeycomb-like structure on cross-sections.     

Dipicolinate Complexes of Oxovanadium(IV) and Dioxovanadium(V) with 2-Phenylpyridine and 4,4′-Dimethoxy-2,2′-bipyridyl as New Precatalysts for Olefin Oligomerization

Polyolefins are used in everyday life, including in the production of many types of plastic. In addition, polyolefins account for over 50% of the polymers produced in the world. After conducting the oligomerization reactions of 2-propen-1-ol, 2-chloro-2-propen-1-ol, and norborene, polyolefins are obtained. In this report, two complexes of oxovanadium(IV) and dioxovanadium(V) with dipicolinate, 2-phenylyridine, and 4,4′-dimethoxy-2,2′-bipyridyl as precatalysts for 2-propen-1-ol, 2-chloro-2-propen-1-ol, and norborene oligomerizations are prepared. We present for the first time the new dipicolinate complex compound of oxovanadium(IV) with 4,4′-dimetoxy-2,2′-bipyridyl. Both complexes were tested for catalytic activity in the oligomerization reactions of 2-propen-1-ol, 2-chloro-2-propen-1-ol, and norbornene. Both synthesized complexes showed high catalytic activity in these oligomerization reactions, except for the oligomerization of norbornene.     

Eosinophilic gastroenteritis and graft‐versus‐host disease induced by transmission of Norovirus with fecal microbiota transplant

Fecal microbiota transplantation (FMT) was performed to decolonize gastrointestinal tract from antibiotic‐resistant bacteria before allogeneic hematopoietic cells transplantation (alloHCT). AlloHCT was complicated by norovirus gastroenteritis, acute graft‐versus‐host disease, and eosinophilic pancolitis. Norovirus was identified in samples from FMT material. Symptoms resolved after steroids course and second norovirus‐free FMT from another donor.