Developing a risk prediction model for 30-day unplanned hospitalization in patients receiving outpatient parenteral antimicrobial therapy

ObjectivesOutpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat a wide range of infections. However, there is risk of hospital readmissions. The study aim was to develop a prediction model for the risk of 30-day unplanned hospitalization in patients receiving OPAT.MethodsUsing a retrospective cohort design, we retrieved data on 1073 patients who received OPAT over 2 years (January 2015 to January 2017) at a large teaching hospital in Sheffield, UK. We developed a multivariable logistic regression model for 30-day unplanned hospitalization, assessed its discrimination and calibration abilities, and internally them validated using bootstrap resampling.ResultsThe 30-day unplanned hospitalization rate was 11% (123/1073). The main indication for hospitalization was worsening or nonresponse of infection (52/123, 42%). The final regression model consisted of age (adjusted odds ratio (aOR), 1.18 per decade; 95% confidence interval (CI), 1.04–1.34), Charlson comorbidity score (aOR, 1.11 per unit increase; 95% CI, 1.00–1.23), prior hospitalizations in past 12 months (aOR, 1.30 per admission; 95% CI, 1.17–1.45), concurrent intravenous antimicrobial therapy (aOR, 1.89; 95% CI, 1.03–3.47) and endovascular infection (aOR, 3.51; 95% CI, 1.49–8.28). Mode of OPAT treatment was retained in the model as a confounder. The model had adequate concordance (c-statistic 0.72; 95% CI 0.67–0.77) and calibration (Hosmer-Lemeshow p 0.546; calibration slope 0.99; 95% CI 0.78–1.21), and low degree of optimism (bootstrap optimism corrected c-statistic, 0.70).ConclusionsWe identified a set of six important predictors of unplanned hospitalization based on readily available data. The prediction model may help improve OPAT outcomes through better identification of high-risk patients and provision of tailored care.     

超临界CO_2提取经前方挥发油及其化学成分药理分析

目的对超临界提取法提取的经前方(JF)中挥发油成分进行分析,并研究主要挥发油成分对大鼠痛经模型的药理学作用。方法实验用气-质联用法(GC-MS)来分析超临界提取的经前方挥发油中所含的各个有效成分。同时分别检测挥发油成分对缩宫素所造成的小鼠痛经扭体模型、镇痛模型的不同治疗效果。结果检出40个色谱峰并且鉴定出35个化合物。对于注射缩宫素引起的小鼠扭体实验以及镇痛模型中高剂量组疗效较好。结论该工艺可以较好的提取经前方中挥发油的主要药效成分。并且挥发油提取物对于痛经、镇痛模型有较好的药理疗效。     

Der Anatom Johann Samuel Eduard d''Alton (1803–1854) — Leben und Wirken in Halle (Saale)

After the death of Johann Friedrich Meckel (1781–1833), Eduard d'Alton was appointed to be his successor. From 1834 to 1854, he was Professor of Anatomy and head of the “Anatomisches Theater” at the University of Halle. In the literature we can only find little details about him. The aim is to investigate his life and work. Before he came to Halle, he was first professor at the Academy of Arts in Berlin. Then few years later he received the professorship of anatomy and physiology at the Friedrich-Wilhelm-University in Berlin. During his work as anatomist and physiologist in Halle he was rector twice, in 1845 and 1846. d'Alton worked very accurately and highly engaged. He supported the students' education very conscientiously but, since he was strict and exacting at the same time, he was not very popular. His extraordinary drawings of human and comparative anatomy earned him great recognition. In 1850, he published the “Handbuch der menschlichen Anatomie”. d'Alton was mainly engaged in comparative anatomy, embryology and teratology and performed experimental embryological tests. In 1853, he published a catalogue of teratological preparations many of which can still be found in the Anatomical Collections in Halle.     

The physical properties of bovine pericardium: a study of the effects of stretching during chemical treatment in glutaraldehyde

The uniaxial stress/strain response of bovine pericardium up to a stress of 1 N/mm2 was studied. The tissue was chemically modified in 0.5% buffered glutaraldehyde for 24 hours under various conditions of constraint. Four groups were studied: an unrestricted control group, a group held at their original length, a group stretched to a stress of 0.04 N/mm2, and a group stretched to a stress of 0.4 N/mm2 during treatment. Histological examination revealed changes in structural organization of the collagen, which explained the alterations in the stress/strain response. A significant alteration in mechanical properties after glutaraldehyde treatment was observed, with considerable loss of extensibility for the prestretched tissues. A valve made from such a prestretched tissue may be stenotic and possibly subject to early failure.     

Use of a decellularised dermis scaffold and human bronchial epithelial cells to tissue engineer airway mucosa suitable for tracheal transplantation

Background

Tracheal reconstruction relies on the use of a split skin graft to re-epithelialise the mucosal layer. Since split skin grafts are made up of a keratinising stratified epithelial layer, sloughing occurs within the airway with mucus retention and subsequent airway obstruction. The delivery of a graft with the same mucociliary function as the native airway would overcome these limitations and greatly improve the safety and effectiveness of this type of surgery. We aimed to generate a transplantable tissue-engineered respiratory epithelial graft with mucociliary function.