Components Of Bundles Research Articles

P-423. High Burden of Intestinal Colonization with Carbapenem-Resistant Organisms (CRO) at two Greek Intensive Care Units

Abstract Background Screening for CRO intestinal colonization is part of the recommended interventions to limit their spread. We estimated the burden of carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) intestinal colonization at two Greek ICUs: Attikon University Hospital (AUH) and Tzaneio General Hospital of Piraeus (TGHP). Methods From October 2022, all ICU patients were screened for intestinal colonization by CRO; patients admitted post-surgery on a daily basis were excluded. The first isolate per patient was recorded as a colonization event, categorized as positive either at admission (< 3 days from ICU admission) or during ICU stay ( >=3 days). Admission prevalence rates per 100 admissions (APR) and incidence rates of ICU-acquired intestinal colonization per 1,000 patient-days (IR) were calculated. Rates from the 1st, 2nd and 3rd study semester were compared and incidence rate ratios were determined. Results APR and IR of ICU-acquired CRE, CRAB, and CRPA intestinal colonization are presented in Table 1. APR for CRO colonization remained stable, during the study period, with the exception of CRE at TGHP, which exhibited a significant increase (p=0.02). APR were significantly higher at TGHP for all 3 study periods apart from CRE in the first study semester (figure 1). IR of ICU-acquired CRE colonization were also significantly higher at TGHP, in all 3 semesters, possibly due to the higher colonization pressure (figure 2). The IR of ICU-acquired CRE and CRPA colonization remained essentially unchanged over the study period at each hospital. However, a significant reduction in the incidence density of ICU-acquired CRAB colonization was observed (figure 2). Conclusion Our study highlights the high burden of CRO colonization in Greek ICUs, which varies even across settings within the same region. CRE colonization presents the greater challenge, closely followed by CRAB, which however showed a significant reduction in ICU-acquired CRAB colonization during the last year. Active surveillance remains a crucial component of prevention bundles and can guide targeted prevention strategies. Disclosures All Authors: No reported disclosures

Current Trends in Planning, Preparation and Delivering Regulatory Submissions in India & USA

The drug markets on the planet have various prerequisites for the enrolment of a drug item. To fit the prerequisites according to the administrative organizations, an idea of basic specialized report was actualized by ICH. Getting ready administrative entries in the drug business can be an extremely upsetting encounter because of the enormous measure of work and the need to explore and comprehend administrative accommodation necessities. This paper means to help administrative experts by giving data and exhortation to arranging and setting up an administrative accommodation. The paper centres around the conveyance of accommodation information bundles, since these are commonly the duty of administrative experts. The paper will cover the Regulatory necessities for entries, Components of accommodation information bundles, arranging an accommodation and best practices for getting ready accommodation information bundles.

Lactate levels increase significantly in the second stage of spontaneous and induced labor

Lactate is frequently observed as a component of sepsis bundles, however, there is a paucity of data for normal ranges in labor. Because of this, our aim was to survey maternal lactate levels in uncomplicated labor. This was a prospective convenience sampling of patients at term presenting with spontaneous labor and for induction at a single academic center. Blood was collected at admission, complete cervical dilation, and every 30 minutes during the second stage of labor for up to 3 hours or until delivery. Samples were processed and transported on ice to an on-site laboratory within 30 minutes for analysis of plasma lactate using enzymatic oxidation and colorimetric assay (Roche Lactate Gen.2). The primary outcome was change in lactate level over time during the second stage of labor. Statistical analysis included a mixed effects repeated measures model, with chorioamnionitis as a fixed effect and time as a random effect with p < 0.05 considered significant. From January 7, 2021, through December 30, 2021, 38 patients were enrolled. Eight patients withdrew after the baseline level was drawn. Lactate was obtained for 23 patients at complete dilation, and for 14 patients during maternal pushing. Beginning at the second stage, mean lactate was 2.76 mmol/L (95% CI 2.01, 3.51). Lactate significantly increased with time (p < 0.001) with mean change in lactate level 1.9 mmol/L over 30 minutes of observation (Figure 1a). Lactate level was increased in patients with chorioamnionitis compared to uninfected laboring patients, but this difference was not statistically significant (p = 0.67) (Figure 1b). Lactate increases significantly in the second stage of uncomplicated spontaneous or induced labor from a baseline considered outside the normal range in nonpregnant individuals. Obstetricians should use caution in interpreting abnormal lactate levels in otherwise uncomplicated laboring patients with or without chorioamnionitis.

998: RISK FACTORS FOR DYSGLYCEMIA IN THE ICU DURING THE COVID-19 PANDEMIC

Introduction: Glycemic control is an important component of quality improvement bundles within the ICU. Dysglycemia among intensive care unit (ICU) patients has been associated with greater morbidity and mortality. The COVID-19 pandemic has been shown to influence hypoglycemia in patients presenting to the emergency department. The purpose of this study is to evaluate risk factors for dysglycemia during the COVID-19 pandemic in critically ill ICU patients on subcutaneous insulin. Methods: Single-center, retrospective quality improvement study of adult critically ill patients admitted to the ICU in 2020. Patients were included if they were on subcutaneous insulin and primarily managed by an intensive care unit multidisciplinary team. Patients were excluded with active endocrinology consultation or receiving intravenous insulin infusion. Rates of hyperglycemia (blood glucose (BG) greater than or equal to 180 mg/dL), severe hyperglycemia (BG > 300 mg/dL), hypoglycemia (less than or equal to 70 mg/dL), or severe hypoglycemia (BG < 54 mg/dL) were evaluated. Basic patient demographics, including history of diabetes, steroid use, COVID-19 diagnosis were obtained. Regression analysis was performed adjusting for age, past medical history of diabetes, use of corticosteroid medications, COVID-19 diagnosis and use of a self-adjusting insulin calculator. Results: There were 244 adult ICU patients and 2,198 patient days evaluated in this study. History of diabetes was associated with greater odds of hyperglycemia (odds ratio (OR) 2.09 (1.57-2.78), p< 0.01), severe hyperglycemia (OR 1.82 (1.02-3.24), p=0.04), and lower risk for severe hypoglycemia (OR 0.24 (0.07-0.81), p=0.02). Corticosteroid use was associated with greater risk of hyperglycemia (OR 3.04 (2.31-3.99), p< 0.01) and severe hyperglycemia (OR 4.54 (2.59-7.95), p< 0.01), with no significant difference in hypoglycemia. COVID-19 diagnosis was associated with greater hyperglycemia (OR 1.49 (1.11-2), p=0.007) and hypoglycemia (OR 3.93 (1.32-11.73), p=0.01). Conclusions: In our quality improvement analysis, dysglycemia was found to be more prevalent in patients with corticosteroid use, history of diabetes and patients with a COVID-19 diagnosis. Larger studies would be beneficial to confirm these results.

Caldesmon controls stress fiber force-balance through dynamic cross-linking of myosin II and actin-tropomyosin filaments

Contractile actomyosin bundles are key force-producing and mechanosensing elements in muscle and non-muscle tissues. Whereas the organization of muscle myofibrils and mechanism regulating their contractility are relatively well-established, the principles by which myosin-II activity and force-balance are regulated in non-muscle cells have remained elusive. We show that Caldesmon, an important component of smooth muscle and non-muscle cell actomyosin bundles, is an elongated protein that functions as a dynamic cross-linker between myosin-II and tropomyosin-actin filaments. Depletion of Caldesmon results in aberrant lateral movement of myosin-II filaments along actin bundles, leading to irregular myosin distribution within stress fibers. This manifests as defects in stress fiber network organization and contractility, and accompanied problems in cell morphogenesis, migration, invasion, and mechanosensing. These results identify Caldesmon as critical factor that ensures regular myosin-II spacing within non-muscle cell actomyosin bundles, and reveal how stress fiber networks are controlled through dynamic cross-linking of tropomyosin-actin and myosin filaments.

Impact of Training on Central Line Associated Blood Stream Infection Maintenance Bundle on Central Line Associated Blood Stream Infection Rates - A Retro-prospective Study in a Selected Hospital, Hyderabad

Background: Central line-associated bloodstream infections (CLABSI) are a very common cause of healthcare-associated infections (HAI). CLABSIs will not only increase mortality and morbidity but also increases length of stay (LOS) and financial burden to ICU patients. Infection control practices play a major role in preventing CLABSI. Research indicates that quality improvement initiatives have helped in reducing CLABSI rates. CLABSI rates have been successfully reduced in ICU settings however, there is still significant variability in practice due to poor adherence to evidence-based CLABSI maintenance bundle components. However, nurses frequently struggle to follow evidence-based preventive practices, thus it is necessary to understand better the behavioral influences on implementing CLABSI prevention measures. Additionally, it has been emphasized that implementation studies must consider or quantify the potential impact on CLABSI rates. Before taking up the study, we have noticed increase in CLABSI rates for 1month Period, for which the Retrospective data was collected and analyzed to understand the gaps to implement CLABSI maintenance bundle components. Therefore, this study helped us identifying gaps in maintenance bundle and observed infections rates before and after study Aim: To evaluate the effect of central line (CL) bundle compliance on central line-associated bloodstream infections (CLABSIs) To evaluate the knowledge and practices of physicians and nurses working in all ICUs and wards regarding the components of central line maintenance bundles (ref table I) Design: Used a retro prospective study, to reduce the CLABSI rates and to increase awareness on maintenance bundle components in intensive care units (ICU) and wards. we have initiated a structured training program to all nurses and doctors. Two tools were prepared. one is to assess the knowledge of nurses and doctors working in ICUs and wards on CLABSI. The second tool consists of components related to central line maintenance bundle to evaluate the effectiveness in reducing incidence of CLABSI. A total 489 Registered nurses and 10 intensivists and 15 ward doctors were included in the current study. Phase I was the pre-interventional period during this period audits were conducted, we observed lacunae in implementing CLABSI Maintenance bundle. Phase II was the intervention period lasting for 2 month, during this period, the entire nursing staff and doctors working in ICUs and Wards underwent a continuous teaching and training. Phase III was the post-intervention period- In this period questionnaire was given in September and again in December. This was to check for the impact of training on knowledge and awareness level which will further lead better implementation of the practices. Observed CLABSI rate reduced from17.2. to 6.8 per 1000 central line days. Result: Knowledge assessment- Comparison data between June 2021 and September 2021 mean knowledge score significantly higher in September (9.1) than June (6.4) .similarly, December (9.9) score significantly higher than June and September to determine the difference between the mean of various observations in the pre and post intervention period with 95% confidence interval, the difference in the knowledge level and CLABSI rate in the pre and post intervention period was found significant(p&lt;0.001) .During this 6 months period(July 2021 to December 2021) there were a total of 1120 patients on central lines, for all the patients line care was observed after implementation of structured training programme. The rate of CLABSI significantly declined from 17.2 per 1000 catheter days to 6.8 per 1000 catheter days. Conclusion: This study clearly indicated that the educational interventions in structured formats are imperative when imparting trainings in Infection control practices and should be implemented frequently to bridge the gap between knowledge and practice. With the dynamics of infection control and the challenges faced in its implementation continuing this type of trainings will ensure all use evidence-based interventions. Recommendations: Continues Training program should be carried out for nurses and doctors related to implementation of CLABSI Bundle. Keywords: CLABSI, Catheter hub care, Hand hygiene, Training, Maintenance bundle, Teaching, Implementing, Structured program.

Chlorhexidine gluconate (CHG) foam improves adherence, satisfaction, and maintains central line associated infection rates compared to CHG wipes in pediatric hematology-oncology and bone marrow transplant patients

CHG-based hygiene methods are often a component of daily hygiene bundles to prevent central line-associated blood stream infections (CLABSIs) in pediatric hematology-oncology patients; however, adherence with 2% CHG wipes was inconsistent within our institution, risking infection for immunocompromised patients. A new 4% CHG foam method offers an alternative and is applied while bathing, as opposed to wipes used 1 h after bathing. An initial cohort of 24 high-risk oncology and bone marrow transplant (BMT) patients agreed to use 4% CHG foam in place of wipes, and then answered surveys to describe their experiences. Ninety-two percent preferred foam over wipes and were more likely to use the foam moving forward. CHG foam was then made available as an option to all patients in need of central line care upon admission to the hospital. Hygiene bundles in the electronic medical record were reviewed to measure baseline adherence rates. Random audits by nursing administration prospectively assessed CHG adherence. CLABSI data were collected prospectively with routine quality metric reports. Results were analyzed using run charts and u-charts, respectively. Hematology-Oncology unit adherence rates remained at a higher rate of adherence, and BMT unit adherence rates increased from an average of 55%–81.6% (p < 0.001). Primary CLABSIs remained rare events (average <1/1000 CVL days). On cost analysis, utilizing CHG foam results in an annual savings estimate of $40,000 for a 24-bed unit. In conclusion, 4% CHG foam provides a cost-effective and patient-preferred option for daily hygiene that maintains CLABSI preventative efforts.

Telecoms Deflators: A Story of Volume and Revenue Weights

Fast-changing technology products present inherent measurement challenges in relation to ensuring that deflators adequately adjust for quality change to allow a like-for-like comparison of volumes of output. Telecommunications services present significant challenges in this area not just because of rapid changes in prices and volumes, but also because the different services provided (text, voice, data) are displaying increasing substitutability. This paper builds on previous work by the authors to provide improved alternatives for telecoms services deflators, calculated for the UK, focussing on whether using revenue-weights or whether using volume weights for fixed components of contract bundles delivers more reasonable results. Our new options deliver declines in the deflator series of between 58% and 84% between 2010 and 2017. These are far faster declines than the deflator calculated by the existing method but considerably reduce the range calculated in earlier work.

The dynamic changes of tracheary elements in an intraspecific quinoa (Chenopodium quinoa) graft

Vascular connection is key to successful graft. Little study has been devoted to the behavior of tracheary elements (TEs), the basic component of vascular bundles, during vascular connection between scion and rootstock. Here we report the structural changes of TEs at the graft interface between two quinoa cultivars, Qaidam White-1 (QW1) and Qaidam Red-1 (QR1). Our results showed that TEs in ungrafted plants developed following an ontogenetic sequence, i.e., the annular vessel, helical vessel, scalariform vessel, reticulate vessel, and pitted vessel. However, this process was greatly accelerated in grafted plants, resulting in quick developmental transition of TE wall patterning. At the early stage of intraspecific grafting (e.g., 5 days after grafting), the membrane-like cellular patches were heavily accumulated at the graft interface but quickly retreated within 2–4 days, suggesting an early emergency response to grafting. The TE length in both scion and rootstock was significantly shorter (more than 50% on average, nTE = 747) than the ungrafted plants in the same period. These short TEs were gradually integrated into a long, continuous conduit, thereby enabling the functional vasculature at the graft union. In addition, the pit size was gradually reduced, for example, for the surface area of outer pit aperture, from 12.73 ± 3.15 to 5.40 ± 0.30 μm2, or for the surface area of inner pit aperture, from 9.34 ± 3.33 to 1.96 ± 1.04 μm2, in 18 days (npits = 2830). Taken together, the morphological changes of TEs and cellular responses to grafting in the intraspecific grafts seemed to be conservative to other homografts and heterografts, implying that these behavioral changes are highly adaptive to the scion–rootstock interaction.

Construction of symplectic vector bundles on projective space [formula omitted

The moduli spaces of symplectic vector bundles of arbitrary rank on projective space P3 are far from being well-understood. By now the only type of such bundles having satisfactory description are the so-called tame symplectic instantons. It is shown by U. Bruzzo, D. Markushevich and the first author in two papers from 2012 and 2016 that the moduli spaces of tame symplectic instantons are irreducible generically reduced algebraic spaces of dimension prescribed by the deformation theory. In the present paper we construct an infinite series of smooth irreducible moduli components of symplectic vector bundles of an arbitrary even rank 2r,r≥1, obtained by an iterative use of the monad construction applied to tame symplectic instantons. As a particular case we obtain an infinite series of irreducible moduli components of stable rank 2 vector bundles on P3. We show that this series contains as a subseries a large part of an infinite series of moduli components constructed by the authors and S. Tikhomirov in 2019. We also prove that, for any integers n,r, where r≥1 and n≥r+147, there exists a moduli component, not necessarily unique, of our series such that symplectic bundles from this component have rank 2r and second Chern class n.

Dissecting the phenotypic components and genetic architecture of maize stem vascular bundles using high-throughput phenotypic analysis.

SummaryHigh‐throughput phenotyping is increasingly becoming an important tool for rapid advancement of genetic gain in breeding programmes. Manual phenotyping of vascular bundles is tedious and time‐consuming, which lags behind the rapid development of functional genomics in maize. More robust and automated techniques of phenotyping vascular bundles traits at high‐throughput are urgently needed for large crop populations. In this study, we developed a standard process for stem micro‐CT data acquisition and an automatic CT image process pipeline to obtain vascular bundle traits of stems including geometry‐related, morphology‐related and distribution‐related traits. Next, we analysed the phenotypic variation of stem vascular bundles between natural population subgroup (480 inbred lines) based on 48 comprehensively phenotypic information. Also, the first database for stem micro‐phenotypes, MaizeSPD, was established, storing 554 pieces of basic information of maize inbred lines, 523 pieces of experimental information, 1008 pieces of CT scanning images and processed images, and 24 192 pieces of phenotypic data. Combined with genome‐wide association studies (GWASs), a total of 1562 significant single nucleotide polymorphism (SNPs) were identified for 30 stem micro‐phenotypic traits, and 84 unique genes of 20 traits such as VBNum, VBAvArea and PZVBDensity were detected. Candidate genes identified by GWAS mainly encode enzymes involved in cell wall metabolism, transcription factors, protein kinase and protein related to plant signal transduction and stress response. The results presented here will advance our knowledge about phenotypic trait components of stem vascular bundles and provide useful information for understanding the genetic controls of vascular bundle formation and development.

Predicting Postpartum Hemorrhage After Vaginal Birth by Labor Phenotype.

Postpartum hemorrhage (PPH) is an important contributor to maternal morbidity and mortality. Predicting which laboring women are likely to have a PPH is an active area of research and a component of quality improvement bundles. The purpose of this study was to identify phenotypes of labor processes (ie, labors that have similar features, such as duration and type of interventions) in a cohort of women who had vaginal births, estimate the likelihood of PPH by phenotype, and analyze how maternal and fetal characteristics relate to PPH risk by phenotype. This study utilized the Consortium for Safe Labor dataset (2002-2008) and examined term, singleton, vaginal births. Using 16 variables describing the labor and birth processes, a latent class analysis was performed to describe distinct labor process phenotypes. Of 24,729 births, 1167 (4.72%) women experienced PPH. Five phenotypes best fit the data, reflecting labor interventions, duration, and complications. Women who had shorter duration of admission after spontaneous labor onset (admitted in latent or active labor) had the lowest rate of PPH (3.8%-3.9%). The 2 phenotypes of labor progress characterized by women who had complicated prolonged labors (spontaneous or induced) had the highest rate of PPH (8.0% and 12.0%, respectively). However, the majority of PPH (n = 881, 75%) occurred in the phenotypes with fewer complications. Prepregnancy body mass index did not predict PPH. Overall, the odds of PPH were highest among nulliparous women (odds ratio [OR], 1.52; 95% CI, 1.30-1.77), as well as Black women (OR, 1.39; 95% CI, 1.13-1.73) and Hispanic women (OR, 1.85; 95% CI, 1.56-2.20). Within phenotypes, maternal race and ethnicity, nulliparity, macrosomia, hypertension, and depression were associated with increased odds of PPH. Women who were classified into a lower-risk labor phenotype and still experienced PPH were more likely to be nulliparous, a person of color, or diagnosed with hypertension.

Chlorhexidine Gluconate Utilization for Infection Prevention in the NICU: A Survey of Current Practice.

Central-line-associated bloodstream infection (CLABSI) contributes to significant morbidity and mortality in the neonatal intensive care unit (NICU). Disinfection of skin is part of bundled cares aimed at prevention of CLABSI. While considered an essential component of insertion and maintenance bundles, the optimal solution to disinfect neonatal skin remains controversial. The purpose of this project was to survey neonatal nurse practitioners and nursing leaders across NICUs regarding the current use of chlorhexidine gluconate (CHG) in term and preterm infants. This descriptive study involved the collection of survey data to determine NICU practices related to the use of CHG in their infant population. The sample was composed of nursing directors of NICUs and neonatal nurse practitioners who completed an electronic survey via a provided link. Chlorhexidine was reported to be used in 53 (82.81%) of the NICUs and was the primary agent used to prepare the skin for central vascular catheter insertion (53.23%) followed by povidone-iodine (45.16%), and 70% isopropyl alcohol (1.61%). Gestational age or birth weight restrictions for CHG use were reported in 43 (82.69%) NICUs. Trends in the data demonstrated nursing's role in using CHG in the NICU. Adverse events reported from CHG included burns, redness, dermatitis, and other irritations. Concerns included risk of absorption, burns, skin irritation, lack of evidence, and overall safety. Systematic monitoring by nurse leaders is needed to identify evidence related to skin disinfection and CHG in neonates. Targeted education for nursing staff related to directed to developmental maturation of the skin, safe use of CHG, review of best evidence, rationale for usage of CHG, and potential iatrogenic effects is recommended. Research is needed to evaluate the impact of educational offerings and surveillance for adverse events on CLABSI rates.

Q-ball high-resolution fiber tractography of language associated tracts: quantitative evaluation of applicability for glioma resections.

To date, fiber tractography (FT) is predominantly based on diffusion tensor imaging (DTI). High angular resolution diffusion imaging (HARDI)-based reconstructions have become a focus of interest, enabling the resolution of intravoxel fiber crossing. However, experience with high resolution tractography (HRFT) for neurosurgical applications is still limited to a few reports. This prospectively designed feasibility study shares our initial experience using an analytical q-ball approach (QBI) for FT of language-associated pathways in comparison with DTI-FT, focussing on a quantitative analysis and evaluation of its applicability in clinical routine. Probabilistic QBI-, and DTI-FT were performed for the major components of the language-associated fiber bundles (superior longitudinal fasciculus, inferior fronto-occipital fasciculus, medial/inferior longitudinal faciculus) in 11 patients with eloquent gliomas. The data was derived from a routine DWI sequence (b=1000s/mm2, 64 gradient directions). Quantitative analysis evaluated tract volume (TV), tract length (TL) and tract density (TD). Results were correlated to tumor and edema size. Quantitative analysis showed larger TV and TL of the overall fiber object using QBI-FT compared with DTI-FT (TV: 16.45±1.85 vs. 10.07±1.15cm3; P<0.0001; TL: 81.95±6.14 vs. 72.06±6.92 mm; P=0.0011). Regarding overall TD, DTI delivered significantly higher values (40.57±6.59 vs. 60.98±15.94 points/voxel; P=0.0118). Bland-Altman analysis illustrated a systematic advantage to yield lager TV and TL via QBI compared with DTI for all reconstructed pathways. The results were independent of tumor or edema volume. QBI proved to be suitable for an application in the neurosurgical setting without additional expense for the patient. Quantitative analysis of FT reveals larger overall TV, longer TL with lower TD using QBI compared with DTI, suggesting the better depiction of marginal and terminal fibers according to neuroanatomical knowledge. This emphasizes the known limitation of DTI to underestimate the dimensions of a pathway. Rather than relying on DTI, sophisticated HRFT techniques should be considered for preoperative planning and intraoperative guidance in selected cases of eloquent glioma surgery.

What are the effects of care bundles on the incidence of ventilator-associated pneumoniain paediatric and neonatal intensive care units? A systematic review.

The purpose of this review was to ascertain the impact of ventilator bundles on the incidence of ventilator-associated pneumonia in mechanically ventilated neonates and children in intensive care units. A systematic review was conducted. Key computerised databases (CINAHL, Medline, Embase and Cochrane) as well as additional sources, with no publication date limitations, were extensively searched in January 2018. Inclusion criteria focused on ventilator bundles used in mechanically ventilated neonates and children aged from 0 to 18 years. After identification and inclusion, all studies were critically appraised for quality. Data were analysed and narratively synthesised. Eight studies of observational and nonrandomised interventional methods design were included in the review. However, the validity of five of the eight studies which were reviewed was considered substandard. In addition, there were variations in the care bundles elements studied. Nevertheless, all these studies demonstrated that the incidences of VAP in mechanically ventilated neonates and children were found to be significantly reduced by the use of ventilator bundles. This systematic review determines that ventilator bundles impact positively on the incidence of VAP in critically ill neonates and children in the neonatal intensive care unit and paediatric intensive care unit. However, the variations in the bundle elements and insufficient valid evidence necessitates further research in the area to validate the findings and to ensure standardisation of clinical practice. Prevention of VAP is aimed at avoiding the risk of aspiration in the lungs, colonisation of respiratory tract with pathogenic microorganisms and contamination of respiratory equipment. Moreover, the implementation of evidence-based interventions grouped together is fundamental to improve patient outcomes. It is recommended that a further bona fide research is required to standardise the components of paediatric ventilator bundles.

Care bundles in the management of a COPD exacerbation.

Chronic obstructive pulmonary disease (COPD), the umbrella term used to describe chronic lung diseases that cause limitations in lung airflow, is predicted to be the third leading cause of death by 2030. COPD is said to affect 3 million people in the UK, resulting in approximately 30 000 deaths each year. Related healthcare costs continue to escalate, not least because of increasing readmission rates associated with COPD emergencies. The use of care bundles to streamline care is becoming more popular in an attempt to tackle this issue. An integrative literature review was carried out to examine the effectiveness of the use of care bundles. The findings highlighted inconsistencies in the components of bundles, leading to inherent difficulties in assessing which specific component of the bundles led to positive outcomes. The results of this attempt to establish the effectiveness of care bundles in reducing readmission rates and quality of care were inconclusive. The authors recommend further research to investigate the individual components in the bundles and to introduce internationally agreed care bundles for the management of COPD.

Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis

BackgroundCentral line-associated bloodstream infections (CLABSIs) are associated with increased mortality, prolonged hospitalisation and increased healthcare costs. Care bundles have reduced CLABSIs in adult intensive care units (ICUs) but replication in...

The Structural Role of Elastic Fibers in the Cornea Investigated Using a Mouse Model for Marfan Syndrome.

PurposeThe presence of fibrillin-rich elastic fibers in the cornea has been overlooked in recent years. The aim of the current study was to elucidate their functional role using a mouse model for Marfan syndrome, defective in fibrillin-1, the major structural component of the microfibril bundles that constitute most of the elastic fibers.MethodsMouse corneas were obtained from animals with a heterozygous fibrillin-1 mutation (Fbn1+/−) and compared to wild type controls. Corneal thickness and radius of curvature were calculated using optical coherence tomography microscopy. Elastic microfibril bundles were quantified and visualized in three-dimensions using serial block face scanning electron microscopy. Transmission electron microscopy was used to analyze stromal ultrastructure and proteoglycan distribution. Center-to-center average interfibrillar spacing was determined using x-ray scattering.ResultsFbn1+/− corneas were significantly thinner than wild types and displayed a higher radius of curvature. In the Fbn1+/− corneas, elastic microfibril bundles were significantly reduced in density and disorganized compared to wild-type controls, in addition to containing a higher average center-to-center collagen interfibrillar spacing in the center of the cornea. No other differences were detected in stromal ultrastructure or proteoglycan distribution between the two groups. Proteoglycan side chains appeared to colocalize with the microfibril bundles.ConclusionsElastic fibers have an important, multifunctional role in the cornea as highlighted by the differences observed between Fbn1+/− and wild type animals. We contend that the presence of normal quantities of structurally organized elastic fibers are required to maintain the correct geometry of the cornea, which is disrupted in Marfan syndrome.

Reducing Clostridium difficile in the Inpatient Setting: A Systematic Review of the Adherence to and Effectiveness of C. difficile Prevention Bundles.

BACKGROUND Clostridium difficile infection (CDI) is the most common infectious cause of nosocomial diarrhea, and its prevention is an urgent public health priority. However, reduction of CDI is challenging because of its complex pathogenesis, large reservoirs of colonized patients, and the persistence of infectious spores. The literature lacks high-quality evidence for evaluating interventions, and many hospitals have implemented bundled interventions to reduce CDI with variable results. Thus, we conducted a systematic review to examine the components of CDI bundles, their implementation processes, and their impact on CDI rates. METHODS We conducted a comprehensive literature search of multiple computerized databases from their date of inception through April 30, 2016. The protocol was registered in PROSPERO, an international prospective register of systematic reviews. Bundle effectiveness, adherence, and study quality were assessed for each study meeting our criteria for inclusion. RESULTS In the 26 studies that met the inclusion criteria for this review, implementation and adherence factors to interventions were variably and incompletely reported, making study reproducibility and replicability challenging. Despite contextual differences and the variety of bundle components utilized, all 26 studies reported an improvement in CDI rates. However, given the lack of randomized controlled trials in the literature, assessing a causal relationship between bundled interventions and CDI rates is currently impossible. CONCLUSION Cluster randomized trials that include a rigorous assessment of the implementation of bundled interventions are urgently needed to causally test the effect of intervention bundles on CDI rates. Infect Control Hosp Epidemiol 2017;38:639-650.

Care Bundles: Increasing Consistency of Care.

Care bundling is a strategy for reliably delivering quality, evidence-based care for patients undergoing treatments known to be accompanied by potential risks. This article reviews the purpose, types, and components of care bundles, as well as the process for development and implementation.