Advancing infection control in dental care settings: Factors associated with dentists' implementation of guidelines from the Centers for Disease Control and Prevention

Background and OverviewThe authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention's Guidelines for Infection Control in Dental Health-Care Settings—2003.MethodsIn 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists' demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling.ResultsResponding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied.ConclusionsImplementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education requirements and developing multiple modes of instruction may increase implementation of current and future Centers for Disease Control and Prevention guidelines.The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, Atlanta.The authors thank Jon Ruesch, who when this study was conducted was the director, Survey Center, American Dental Association, Chicago, for his effort in the collection of the data for this research project. Mr. Ruesch is now retired.     

三磷酸腺苷结合盒转运子A1基因多态性R219K与脂代谢及冠心病易感性的相关性

目的　探讨三磷酸腺苷结合盒转运子A1基因R2 19K单核苷酸多态性位点与脂代谢和冠状动脉粥样硬化性心脏病易感性的关系。方法　采用聚合酶链反应—限制片长多态性方法检测 133名正常人和 4 9名家族性高胆固醇血症患者三磷酸腺苷结合盒转运子A1基因相应片段的多态性。结果　家族性高胆固醇血症患者组三磷酸腺苷结合盒转运子A12 19K等位基因频率显著低于正常人群 (P =0 .0 0 0 1)。家族性高胆固醇血症患者组中 ,K等位基因携带者组 (RK基因型 +KK基因型组 )与RR基因型组比较 ,甘油三酯水平明显降低 (1.14± 0 .5 5mmol/L比 1.76± 0 .5 8mmol/L ,P =0 .0 0 1) ,高密度脂蛋白胆固醇水平有增高趋势 (1.39± 0 .5 4mmol/L比 1.2 1± 0 .32mmol/L ,P =0 .0 6 1)。结论　三磷酸腺苷结合盒转运子A1基因R2 19K多态性中 ,2 19K等位基因与家族性高胆固醇血症患者甘油三酯水平降低和高密度脂蛋白胆固醇水平增高相关联 ,可能对家族性高胆固醇血症患者不早发冠心病起保护作用     

首届国医大师李玉奇教授临床用药经验

首届国医大师李玉奇教授从医60余载,临床用药经验丰富,一方济之起沉疴重疾,尤善于脾胃病的诊治。李老深究药性、变通用药;双向调节、寒热平调;性平之味、平剂建功;奇妙法度、精研药量;内痈外治、用药独到;合理配伍、善用药对。     

基于“肺与大肠相表里”探索肺肠的共振机制

本文通对"肺与大肠相表里"相关古代文献的梳理、观察,并应用现代计算机数据挖掘手段,对所收集的肺肠合病的相关古代临床文献进行挖掘。对其中的病位、症状之间的关联进行分析。得出肺与大肠在生理和病理信息的表达上存在共振现象。并且这种共振现象是由其他脏腑共同参与作用。其中又与脾、肝关系最为密切。提示临床在肺肠合病的辨证时,应注重其他脏腑的影响。     

Ethnopharmacological study of plants from Pondoland used against diarrhoea

Ethnopharmacological relevance

Waterborne diseases such as diarrhoea are common world wide, including in Bizana, South Africa where the majority of rural dwellers depend largely on water from unprotected sources. The people from Bizana use medicinal plants as their first line of health care to cure and prevent diarrhoea.

Aim of the study

To record and document plants used for the treatment of diarrhoea in Bizana, to evaluate antibacterial and anti-inflammatory activities of selected plant extracts as well as to perform genotoxicity testing of evaluated plants.

Materials and methods

An ethnobotanical approach was used to select plants used for treating diarrhoea in Bizana for pharmacological assays using questionnaires. Nine plants were selected for bioassays based on their frequency index and the fact that they have never been evaluated against diarrhoea causing-microorganisms. The petroleum ether (PE), dichloromethane (DCM), 70% ethanol (EtOH), and water extracts were evaluated for antibacterial (Gram-positive Staphylococcus aureus, Gram-negative Escherichia coli and Shigella flexneri) activity using the microdilution technique, their ability to inhibit COX-1 and COX-2 enzymes. Genotoxicity was evaluated using the Salmonella microsome assay.

Results

This study revealed that 34 plant species belonging to 27 families are used for the treatment of diarrhoea in Bizana. The extracts showed good inhibitory activity with MIC values ranging from 0.39 to 12.5 mg/ml. The best activity was exhibited by DCM extracts of Rapanea melanophloeos, and EtOH extracts of Ficus craterostoma and Maesa lanceolata with MIC values of 0.098 mg/ml. The inhibitory activity against COX-1 enzyme was higher than COX-2, with 19 plant extracts for the former and 7 for the latter. All the tested plant extracts were not mutagenic at all concentrations tested against all tester strains of bacteria.

Conclusion

In view of the fact that the plants were selected based on their ethnobotanical usage for treating diarrhoea, the activities reported here goes a long way in validating the plants for traditional use.     

2009~2018年国家自然科学基金对儿科学研究资助情况回顾与展望

目的 对国家自然科学基金委员会立项资助的儿科研究课题进行回顾整理与数据分析,以了解学科重点支持领域和研究方向、热点的变化。方法 以中国国家自然科学基金数据库为基础,对2009~2018年儿科领域研究课题进行筛选,并对资助力度和研究方向变化进行分析。结果 2009~2018年国家自然科学基金委员会共资助1 017项儿科领域课题,其中面上项目485项（47.69%）,青年基金426项（41.89%）,地区项目73项（7.18%）,重点项目16项（1.57%）,优青项目6项（0.59%）,海外项目7项（0.69%）,其他项目4项（0.39%）。资助经费总额从2009年的842万元增加至2018年的6 625万元,增幅近7倍之多。以生殖系统/围产期医学/新生儿、神经系统和精神疾病、循环系统为一级学科代码申请立项的课题获资助力度最大。结论 近10年来国家自然科学基金委员会对儿科研究的资助力度持续增加,以面上项目和青年基金为主;研究获资助项目申请方向以新生儿、神经系统和精神、循环系统疾病为主。     

Die Rolle coagulasenegativer Staphylokokken in Mischinfektionen: Assoziationstestungen als in-vitro-Modell

Zusammenfassung Die Zunahme von Infektionen durch hochresistente grampositive Kokken hat in den letzten Jahren vornehmlich auf Intensivstationen zu erheblichen therapeutischen Problemen geführt. Hierbei ist eine Gruppe von Erregern in den Vordergrund getreten, die früher als harmlose Saprophyten galten: coagulasenegative Staphylokokken (CNS). In der vorliegenden Arbeit werden zunächst Daten zur Incidenz in verschiedenen Versorgungsbereichen unserer Klinik und zur Coincidenz mit anderen Erregern auf unserer Intensivstation vorgestellt. Es konnte gezeigt werden, daßS. aureus zwar der zahlenmäßig häufigste grampositive Erreger war, aber CNS sowohl aus Wundabstrichen der Intensivstation als auch aus Blutkulturen deutlich häufiger isoliert werden konnte. Ein gleichzeitiger Nachweis von CNS mitS. aureus und den neun häufigsten Enterobacteriaceae konnte in durchschnittlich 6% erbracht werden. Durch mögliche Interaktionen zwischen unterschiedlichen Erregern kann eine Veränderung der in Einzeltestung beobachteten Resistenzen auftreten. Um dies nachzuweisen, wurden sechs Erregerpaare einzeln und in Assoziation gegen Amoxicillin und Amoxicillin/Clavulansäure getestet. Unter Assoziation wurde das gemeinsame Wachstum zweier Keime unter kontrollierten Bedingungen in Boullionverdünnungsreihen oder einem Laborautomaten zur Resistenztestung (Cobas Bact) verstanden. In allen Fällen zeigte sich, daß die-Lactamasen der CNS in Assoziation die MHK der anderen Erreger deutlich erhöhte, was durch den Zusatz von Clavulansäure verhindert werden konnte. Eine Einzeltestung gibt also bei Mischinfekten mit Beteiligung von-Lactamasebildnern nur einen eingeschränkten Eindruck von der tatsächlichen Resistenzsituation.

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Role of coagulase negative staphylococci in mixed infections: associative testing as in vitro model

Summary Infections due to coagulase negative staphylococci (CNS) are of growing concern mainly in patients hospitalized in intensive care units (ICU). The ability of CNS to adhere and to grow on plastic devices and resistance to many antibiotics, including oxacillin, contributes to their pathogenicity. Using the computer assisted system of the Medical Microbiology Department, the incidences of different pathogens and the coincidence of CNS with other bacteria were evaluated in a surgical department.Staphylococcus aureus revealed to be the predominant pathogen; however, CNS showed an increasing incidence in wound specimens and blood cultures of patients on the ICU. Coincidence of CNS withS. aureus and the nine most frequent species of gram negative bacteria could be shown in 6%. To investigate the influence of-lactamases produced by CNS in mixed infections, association experiments were performed. Association means a controlled growth of two or even more bacteria in a susceptibility testing system, either a broth dilution method or an automated broth disk elution method (Cobas Bact). The association experiments showed a significant increase of amoxicillin MIC's of the pathogen associated with CNS. Addition of clavulanic acid restored activity of amoxicillin. It could be shown that in mixed infections CNS may contribute to the failure of antibiotic regimens by production of-lactamases.

     

Comparative effectiveness of heel-specific medical devices for the prevention of heel pressure ulcers: A systematic review

BackgroundPressure ulcers (PUs) impact on patient's quality of life and are costly for healthcare providers. Heels are a particular concern due to specific risk factors. Relative effectiveness of medical devices, e.g., dressings, off-loading devices, heel cushioning devices, to reduce PU development is unknown.MethodsSystematic review of the effectiveness of heel-specific medical devices for the prevention of heel PU (HPU)s. Database searches were performed from inception to June 2021 for RCTs. The primary outcome was incidence of new HPUs. Trials were assessed for risk of bias and data analysed with risk ratios, mean difference or hazard ratios as appropriate.ResultsFifteen RCTs (4724 participants) were identified.Dressings, as constant low pressure (CLP) devices vs standard care: eight trials (very low quality) showed no-significant difference in effectiveness (RR 0.31, 95%CI 0.10 to 1.01).Off-loading devices vs standard care: three trials (low quality), showed significant reduction in development of Category≥1 HPUs (RR 0.20, 95%CI 0.05 to 0.80) two trials (medium quality), showed significant reduction in development of Category≥2 HPUs (RR 0.08, 95%CI 0.01 to 0.67).Comparisons between off-loading devices: two trials (low quality) showed no clear difference in HPU incidence.In a paediatric post-surgical population, one trial of off-loading device and one of a dressing (CLP device), both versus standard care, showed no clear difference in HPU incidence (RR 0.19 95%CI 0.02 to 1.55 and RR 0.89 95%CI 0.56 to 1.42 respectively).ConclusionsOff-loading devices may reduce HPU incidence, from low-quality evidence. There is insufficient evidence to suggest that dressings reduce HPU incidence.     

Clinical Evaluation of the Cook Advance Enforcer 35 Focal-Force PTA Balloon Catheter for Treatment of Hemodialysis Fistula Stenoses: A Feasibility Study

Purpose

A prospective, single-center, single-arm feasibility study evaluated procedural and short-term performance of the Advance Enforcer 35 focal-force percutaneous transluminal angioplasty (PTA) balloon catheter in treating stenoses of mature native arteriovenous (AV) hemodialysis access circuits.