Mandatory influenza vaccination programs for health care personnel in NACHRI-associated children's hospitals vs. non-children's hospitals

We conducted a national study of children's hospitals and neighboring general medical-surgical hospitals to examine their employee vaccination policies. Survey questions addressed health care personnel (HCP) influenza vaccination policies for the 2009-2010 (seasonal, H1N1) and 2010-2011 (H1N1 + seasonal = combined) influenza seasons at each hospital, assessment of primary objectives behind hospitals' influenza vaccination policies, and information about influenza vaccination policies for inpatient children. We conducted standard univariate and bivariate statistical analyses. The study sample included 136 hospitals: 71 children's hospitals (response rate = 59%) and 65 matched non-children's hospitals (39%). Children's hospitals were significantly more likely than non-children's institutions to have mandatory H1N1 influenza vaccination policies for their HCP in 2009-10 (27% vs. 13%, p = 0.03). There were no differences in HCP influenza vaccination policies otherwise: 25% in both groups with mandatory seasonal vaccination programs in 2009-10, and 19% in both groups with mandatory combined influenza programs in 2010-11. Children's hospitals were significantly more likely to have policies in place strongly encouraging inpatient children to have influenza vaccination than were non-children's hospitals (47% vs 5%; p < 0.001). Among children's and non-children's hospitals alike, the primary intentions of HCP influenza vaccination policies were to reduce transmission of influenza from employees to patients (89% overall) and to reduce transmission of influenza from patients to employees (70%). This study--the first known national assessment of hospitals' policies regarding influenza--suggests that HCP mandatory vaccination is uncommon, even in child-focused hospitals where the patient population is known to be at disproportionately high risk for complications from the illness.     

An intervention to manage patient-reported symptoms during cancer treatment

Patients with cancer receiving therapy may face a variety of complicated and stressful symptoms. Oncology nurses can advocate for patients by performing their roles as educators and comanagers of cancer-related side effects. In addition, symptom-focused education provided by oncology nurses can enable patients to administer self-care more effectively.     

A natural experimental evaluation of the effect of universal infant free school meals on key stage 1 pupil's dietary intake in northeast England: a pilot study

BackgroundIn 2013, a government-commissioned review of school food recommended that all key stage 1 pupils in England should receive free school meals. In 2014, Universal Infant Free School Meals (UIFSM) were implemented, costing £450 million. There has been no evaluation of this policy change on pupil's diets. We assessed the effect of UIFSM on pupil's lunch and total daily intake.MethodsWe used cross-sectional surveys in 2008–09 (before) and 2017–18 (after UIFSM) in two primary schools in Newcastle (school A in most deprived ward; school B in least deprived ward) and a validated, prospective 4-day food diary. All pupils (4–7 years) were eligible to participate with written parental consent (2008–09: n=112; 2017–18 n=84). A linear regression model explored the effect of year, school, level of deprivation (pupil postcode), and the interactions between these factors on mean change in percent energy non-milk extrinsic sugars (%E NMES), calcium, yoghurt, and cake; analyses were adjusted for gender. Ethical approval for this study was granted by Newcastle University.FindingsAt lunchtime, we found evidence of a decrease in pupils mean ENMES before and after UIFSM (mean change –4·6% [95% CI –6·3 to –2·9]), which was reflected in total daily intake (–3·8% [–5·2 to –2·7]). We found a year and school interaction on mean calcium: pupils in School B had a similar mean intake before and after UIFSM; in school A, calcium intake had increased (difference between schools in calcium change –120 mg [95% CI –179 to –62]); no evidence was found of an effect in total daily intake. After UIFSM, mean portions of yoghurt decreased in school B and increased in school A (–0·25 portions [–0·46 to –0·04]); mean portions of cake increased in School B and remained similar in school A (0·23 [0·43–0·42]).InterpretationWithin the limitations of this study (repeat cross-sectional survey; only two schools) there is evidence that UIFSM contributed to a reduction in ENMES. Schools should consider implementation of healthier policies (eg, removing the daily cake choice).FundingDepartment of Health and Social Care's Policy Research Programme (Public Health Research Consortium), Newcastle University.     

Accuracy of Two Malaria Rapid Diagnostic Tests (RDTS) for Initial Diagnosis and Treatment Monitoring in a High Transmission Setting in Uganda

Malaria rapid diagnostic tests (RDTs) may improve fever management in areas without microscopy. We compared the accuracy of histidine-rich protein 2 (HRP2) and Plasmodium lactate dehydrogenase (pLDH)-based RDTs, using expert microscopy as a gold standard, for initial diagnosis, treatment monitoring, and diagnosis of recurrent malaria in a cohort of children followed longitudinally in a high-transmission area in Uganda. For 305 initial fever episodes, sensitivity was 98% for HRP2 and 87% for pLDH, whereas specificity was 55% and 96%, respectively. The HRP2 gave 51% false-positive results on Day 28, whereas pLDH gave no false positives after Day 7. For 59 recurrent fever episodes during follow-up, sensitivity was 100% for HRP2 and 91% for pLDH, whereas specificity was 33% and 100%, respectively. The HRP2-based RDTs are useful for initial diagnosis of malaria caused by superior sensitivity; however, as a result of superior specificity, pLDH-based RDTs are more appropriate to monitor treatment and diagnose recurrent malaria.     

Image-Guided Selective Nerve Blocks in the Spine

Selective nerve block (SNB) in the spine is a diagnostic and therapeutic imaging procedure. It consists of placing a needle under fluoroscopic guidance in the epiradicular space, which is formed by extensions of the anterior and posterior epidural membranes. Injection of nonionic contrast will confirm the correct position of the needle. This is followed by injection of a long-acting local anesthetic and/or corticosteroid. Pain reproduction followed by pain relief is recorded. This technique enables one to identify a symptomatic nerve, produce pain relief for a variable period of time, and help select surgical candidates.