Impact of single-room contact precautions on hospital-acquisition and transmission of multidrug-resistant Escherichia coli: a prospective multicentre cohort study in haematological and oncological wards

ObjectivesColonization and infection with third-generation cephalosporin-resistant Escherichia coli (3GCR-EC) are frequent in haematological and oncological patients. In this high-risk setting, German guidelines recommend single-room contact precautions (SCP) for patients with 3GCR-EC that are non-susceptible to fluoroquinolones (F3GCR-EC). However, this recommendation is controversial, as evidence is limited.MethodsWe performed a prospective, multicentre cohort study at four haematology and oncology departments assessing the impact of SCP on hospital-acquired colonization or bloodstream infection (BSI) with F3GCR-EC. Two sites performed SCP for F3GCR-EC patients including single rooms, gloves and gowns (SCP sites), and two did not (NCP sites). Active screening for 3GCR-EC was performed and isolates were characterized with molecular typing methods including whole genome sequencing and core genome multiple locus sequence typing to assess patient-to-patient transmission. Potential confounders were assessed by competing-risk regression analysis.ResultsWithin 12 months, 1386 patients at NCP sites and 1582 patients at SCP sites were included. Hospital-acquisition of F3GCR-EC was observed in 22/1386 (1.59%) and 16/1582 (1.01%) patients, respectively (p 0.191). There were 3/1386 (0.22%) patients with BSI caused by F3GCR-EC at NCP sites and 4/1582 (0.25%) at SCP sites (p 1.000). Patient-to-patient transmission occurred in three cases at NCP and SCP sites each (p 1.000). The number of patients needed to screen in order to prevent one patient-to-patient transmission of F3GCR-EC was determined to be 3729.ConclusionsUse of SCP had no significant impact on hospital-acquisition or patient-to-patient transmission of F3GCR-EC in this high-risk setting.     

Electronic measurement of plantar contact area during walking using an adaptive thresholding method for Medilogic® pressure-measuring insoles

BackgroundPressure-measuring insoles have the potential to measure plantar contact area (PA) during walking. However, they are not widely used for this purpose because of the need for a reliable process that can convert the insole output into PA. The purposes of this study were to: (1) develop an adaptive-threshold method for pressure-measuring insoles that can improve the accuracy of the PA measurements during walking, and (2) experimentally assess the accuracy and generalizability of this method.MethodsA sample of 42 healthy, ambulatory, young adults (age = 24.3 ± 3.2 years, mass = 67.2 ± 16.9 kg, height = 1.63 ± 0.08 m) completed 10 trials walking on an elevated walkway while wearing Medilogic^® pressure-measuring insoles (sizes 35–45). A total of six insole sizes were considered. Insole data were converted to PA using three unique adaptive-thresholds that were based on percentages of the maximum sum of digital values (MSDV) during an analyzed step. Three values were considered: 0.1%, 0.2%, and 0.3% of the MSDV. Additionally, a fixed-threshold, which is typically used to estimate PA, was assessed. These two techniques, applied to the insole worn on the left foot, were compared with PA obtained from high-resolution reference footprints obtained from optical pedography of the right foot and processed using digital image processing algorithms. An assumption of PA symmetry between the left (insole) and right (barefoot) feet was made and comparisons were conducted over the entire stance phase of walking. The generalizability of the algorithm was assessed by comparing PA errors from insoles with respect to the optical pedography results based on insole size criteria.ResultsThe adaptive-thresholds of 0.1%, 0.2%, and 0.3% of MSDV produced mean errors of 7.31 ± 17.44%, −8.62 ± 15.01%, and −20.45 ± 14.18%, respectively. Using the 2-digital value fixed-threshold produced a mean error of 20.88 ± 22.44%. The best performing adaptive-threshold varied among insole sizes.ConclusionIt was observed that the fixed-threshold technique produced large magnitudes of errors. The proposed adaptive-thresholds of 0.1% and 0.2% of the MSDV reduced PA error to ±10% during walking. The adaptive-threshold method consistently reduced PA error vs. the fixed-threshold for each insole size.     

Contact sensitivity reactions in the oral mucosa

In clinical practice, it is commonly assumed that occlusal splints have therapeutic value in the treatment of temporomandibular disorders (TMD), but the evidence based on randomized controlled trials is scarce. This study evaluated the short-term (10-week) efficacy of a stabilization splint in subjects with recurrent secondary otalgia and active TMD treatment need using a randomized, controlled, double-blind design. Thirty-six subjects were randomly allocated to the two treatment groups: the stabilization splint and the control splint group. After 10 weeks' treatment, the intensity of secondary otalgia, measured on a VAS scale (from 0 to 100 mm), decreased statistically significantly in the stabilization splint group (t 2.12; P 0.006), but not in the control group. Improvement in active TMD treatment need in subjects showing moderate or severe signs and symptoms of TMD was reported significantly more often in the stabilization splint group than in the control splint group (χ² 5.71; P .017). A statistically significant decrease in the Helkimo clinical dysfunction index was seen in the subjects with stabilization splint (Z -2.63; P .009), but not in the subjects with control splint. The results indicate that the use of a stabilization splint is beneficial with regard to secondary otalgia and active TMD treatment need.     

A New Measure for Assessing the Public Health Response to a Middle East Respiratory Syndrome Coronavirus Outbreak

Contact monitoring is an essential component of the public health response to a Middle East respiratory syndrome coronavirus outbreak, and is required for an effective quarantine to contain the epidemic. The timeliness of a quarantine is associated with its effectiveness. This paper provides a conceptual framework to describe the process of contact monitoring, and proposes a new measure called the “timely quarantined proportion” as a tool to assess the adequacy of a public health response.     

外阴接触性皮炎的发生及正确评估

女性外阴瘙痒是皮肤科及妇产科门诊的常见症状,外阴接触性皮炎是最常引起外阴瘙痒症状的原因之一。文中就外阴皮肤对于接触性刺激及过敏的敏感性,刺激性接触性皮炎(irritant contact dermatitis,ICD)及过敏性接触性皮炎(allergic contact dermatitis,ACD)的发病情况,外阴药物接触性皮炎及如何正确认识和评估外阴接触性皮炎等方面进行综述。     

Selegiline Transdermal System (STS): Assessments of Dermal Safety in Human

The selegiline transdermal system (STS) is being developed to treat major depressive disorder. In a Phase I clinical study, the STS (20 mg/20 cm²) produced mild dermal irritability and demonstrated a low potential for contact allergenicity. In Phase III multicenter studies in major depression, over 1800 patients have been evaluated for dermal safety to reveal an overall rate of application site reactions (ASRs) with STS of 21.8% compared with a placebo rate of 9.7%. Discontinuation rates due to dermal adverse events in clinical studies were low (3.5%). Overall, the STS demonstrated good tolerability regarding ASRs and the potential for delayed contact hypersensitivity.