International Recommendations Research Articles

Implementation of a Microbiological Surveillance Protocol in a Portuguese Tertiary Care Academic Endoscopy Unit

Introduction: International societies recommend microbiological surveillance of endoscopes to reduce the incidence of endoscope-associated infections, particularly for duodenoscopes. However, surveillance protocols are not internationally standardized, both regarding sample collection, processing, and culture. This study aims to provide a framework protocol encompassing the experience of a tertiary large volume endoscopy center and the microbiology laboratory for collecting and culturing of endoscope samples for microbiological surveillance. Methods: A sample collection and processing protocol was designed as a result of a cooperation between the Endoscopy Center of the Gastroenterology Department and the Microbiology Laboratory of the Department of Clinical Pathology. This protocol reflects international recommendations in this topic and the human and technological resources of the involved departments. Results: The established protocol for collecting samples varies according to the type and model of endoscope. The specimens are collected as sterile saline liquid samples, as well as swabs (with and without transport media). Together with the collection of samples from the endoscope, samples from the final rinse water as well as the water bottle are also collected. For duodenoscopes and curvilinear echoendoscopes, we perform microbiological surveillance every 3 months; for gastroscopes and colonoscopes, at least, once a year; and for specific endoscopes, such as the pediatric or dual-channel therapeutic endoscopes, enteroscopes, or radial echoendoscopes, every 6 months. Conclusion: Endoscopy units should have detailed protocols for microbiological surveillance of endoscopes. These protocols should be drawn up by a multidisciplinary team that includes endoscopy nurses, gastroenterologists, microbiologists, and the antimicrobial stewardship team, following international recommendations, adapted to each institution resources.

Axial spondyloarthritis—current aspects

Axial spondyloarthritis (axSpA) is a frequent inflammatory rheumatic disease mainly affecting the axial skeleton causing inflammatory back pain. If chronic inflammation persists new bone formation may occur possibly leading to irreversible spinal stiffness. The disease has a strong genetic background with HLA-B27 as the major factor. For diagnostic purposes, imaging is of critical importance—especially conventional radiography and magnetic resonance imaging (MRI). While the former has advantages in the detection of bony changes such as the syndesmophytes, MRI is used to detect axial inflammation but also erosions in the sacroiliac joint. Treatment follows the treat-to-target strategy starting with non-steroidal anti-inflammatory drugs (NSAIDs) in the first line, and later, if high disease activity persists, therapy with biologic disease modifying anti-rheumatic drugs (bDMARDs) is according to international recommendations indicated. For the treatment of axSpA, important targets such as tumor necrosis factor alpha (TNFα) and interleukin (IL)-17 have been identified, and several of their inhibitors (i) including some biosimilars for the former have been approved. Recently, also inhibition of Janus kinases was shown to be efficacious. There is evidence that long term inhibition of inflammation with TNFi can reduce bone formation.

A detection and defense security system design for nuclear waste storage against stealth terrorists attack

Abstract The physical protection system (PPS) is one of the main systems used in nuclear facilities to protect these facilities from terrorist attacks, the possibility of bombing, sabotage, and theft. Installation of a security system for nuclear waste stores from the outside is necessary and very important for early detection and physiological deterrence greater than the internal security system. From this perspective, this work provides a solution for the protection of nuclear waste stores, which means detection and defense systems. This paper introduces an advanced security system and proposes a design for a detection and defense security system for nuclear waste storage against stealth terrorist attacks. The security system that is being suggested will have smart camera surveillance system, electric chock system, intense flashlight barrier, high-intensity sound barriers, and dual-side infrared rays. Three consecutive processes – detection, deterrence, and defense – will be operated around the building of the waste storage. The concept may be implemented by establishing an early detection system to detect any intrusion by terrorist attackers through a protected area surrounded by storage. The following step is deterring the attackers from completing their mission by installing advanced deterrence system and putting delay components along the path of their attack on the waste storage to complicate the mission. Then the defense system is operating to stop terrorist progress. Finally, the work make an evaluation process of the overall security system which has been designed by using EASI program to verify the accepted level of physical protection, maintain the validity and updates of security system components, and follow procedures, rules and requirements of the nuclear regulatory authority at the national level and meet the international IAEA concept and recommendations.

Contemporary algorithms for diagnosing obstructive coronary artery disease in real clinical practice

Background. Despite the high evidence level of the currently existing international recommendations on stable coronary heart disease (CHD) and chronic coronary syndrome, their implementation in domestic clinical practice is insufficient.The aim of the work. To analyze the choice of diagnostic tactics (non-invasive and invasive) in patients with suspected obstructive coronary heart disease in real clinical practice.Methods. The study included outpatients with suspected obstructive CHD, in whom the pre-test probability (PTP) of obstructive CHD was determined; if PTP = 5–15 %, clinical probability was assessed based on CHD risk factors. Based on the results of coronary angiography, the following groups were identified: group I – obstructive lesion of the coronary arteries (≥ 70 %) (n = 50); group II – non-obstructive lesion of the coronary arteries (< 70 %) (n = 32); group III – intact coronary arteries (n = 40). Results. According to the results of coronary angiography, the frequency of detection of obstructive lesion of the coronary arteries was 42 % (in patients without past medical history of myocardial infarction – 31 %). Before performing coronary angiography, non-invasive tests were performed in 2.5 % of cases. Pain in the chest was represented by typical angina in 74 % of patients, with no difference in frequency in all groups. PTP values were statistically significantly higher in the group with obstructive CHD (median – 32 %), however, in the other two groups, PTP values corresponded to a high risk of obstructive CHD (median – 27 % and 21 %, respectively). PTP was an independent predictor for obstructive CHD and subsequent myocardial revascularization.Conclusion. In the cohort of outpatients with suspected coronary heart disease we examined during invasive coronary angiography, the frequency of obstructive lesion of the coronary arteries remains low. Non-invasive tests were performed in isolated cases, while PTP was an independent predictor for obstructive CHD and subsequent myocardial revascularization. To increase the frequency of detection of obstructive coronary heart disease, we should adhere to the diagnostic algorithms of the European Society of Cardiology and make wider use of non-invasive imaging tests.

The phenotype of systemic lupus erythematosus as a factor in rational therapy choosing

Systemic lupus erythematosus (SLE) is characterized by a variety of clinical manifestations, which are defined as separate phenotypes of the disease. Despite the universality of immunopathological reactions, which are based on the formation of anti-nuclear antibodies and antibodies to native DNA, the spectrum and severity of immunological disorders in individual phenotypes are different. The role of type I interferons (IFN) in the SLE pathogenesis has now been proven. Hypersecretion of IFN-α and IFN-β leads to the production of antibodies against the components of the cell nucleus through activation of the native and adaptive immunity system. The current treatment strategy provides for achieving remission or low activity with immunosuppressants, including selective ones, such as biological agents. According to the updated international recommendations, anifrolumab, monoclonal antibodies against type I IFN, which has demonstrated high efficacy in the treatment of SLE with skin-mucous and joint lesions., can be used for the treatment of SLE along with rituximab and belimumab. The article presents our own clinical observation on the analysis of the effecacy and safety of anifrolumab in the treatment of a young patient with high-activity SLE and pronounced skin manifestations. It was shown that after the first injections of the drug, there was a rapid dynamics of skin and joint syndrome, the activity of SLE decreased from maximum to minimum according to the SELENA-SLEDAI index. The results obtained confirm the rationale of including anifrolumab in the treatment regimen in cases of insufficient previous therapy.

KV reference dosimetry in Australia and New Zealand: Survey results and trends.

To assess the number of radiotherapy kilovoltage (kV) units in service, their clinical utilization, and methodology and equipment used for absorbed dose determination across Australia and New Zealand. A survey was sent to 61 Australian and New Zealand radiotherapy providers in the second half of 2023. Fifty-seven responses were received, with 43 departments having kV units and providing beam quality data for 185 therapeutic kV beams 20-300kVp. Percentage depth dose curves were compared between five clinical beams with 100 kVp and 2.13-6.28mm Aluminum half value layers (HVLs), demonstrating large differences that can occur between beams with the same kVp. Eighteen departments provided clinical utilization data for their kV units, with a total of 4458 treatment courses and their corresponding kVp reported. All departments complied with national and international recommendations with respect to the equipment used for reference dosimetry of kV beams; 77% of ionization chambers used for absorbed dose determination were of Farmer-type, with the remaining 23% being plane parallel soft x-ray chambers. Methods of derivation of air-kerma calibration factors varied, with 73% of respondents using a draft document disseminated by the Australian Primary Standards laboratory, 23% using HVL alone, and 6% using other methods. The results of this survey provide a snapshot of kilovoltage radiation therapy use and the number of kV units across Australia and New Zealand. This data can be used as a point of reference for future investigations into clinical utilization and reference dosimetry methods across Australia and New Zealand or for comparisons with other countries, facilitating standardization of reference dosimetry practice for kilovoltage units.

The development of international wound debridement best practice recommendations: Consensus between nurses specialized in Wound, Ostomy and Continence Canada and the society of tissue viability

Debridement is an important component of wound management and can improve outcomes for patients. Debridement needs to be done by an appropriately trained health professional, but the scope of practice, credentials, training, competencies, and regulatory requirements regarding wound debridement can differ. Best Practice Recommendations were created to positively influence patient safety related to all methods of debridement, across the continuum of care, and to be implemented widely by nurses at all professional levels in Canada. AimTo further develop the Best Practice Recommendations for wound debridement, with an international perspective, by creating a consensus document to support the global adoption of evidence-based debridement practice for health professionals. MethodsA consensus meeting utilising Delphi methods was conducted between the authors to review the consensus statements. Once 80 % agreement was achieved, a wide range of wound care experts were identified by the authors and invited to participate in an external review of the statements. ResultsFifteen consensus statements about wound debridement were agreed upon and are presented in this paper. ConclusionsThese best practice recommendations have been reviewed by a wide range of practitioners from across the UK and Canada and aim to provide guidance on the standardisation of debridement practices for healthcare professionals.

An Evaluation of the Experimental Science Teaching Program for Primary Education from the Teachers’ Perspective: An Educational Design Research Journey

The concerns about ensuring scientific literacy for all are underpinned by international recommendations from organizations such as the UN and the OECD for science education. They advocate for science education from a contextualized, sequential, systematic, and active perspective on the students’ learning process, starting from the early years of schooling. It is based on these pedagogical principles that the research project the “Experimental Science Teaching Program” (PEEC) was founded. This article aims to disseminate an evaluation of the PEEC for primary education, which includes a science teaching curriculum proposal, teaching activities and resources (e.g., digital games), and assessment record instruments for learning. This program was developed using an Educational Design Research methodological approach based on iterative cycles, with the collaboration of a multidisciplinary team (e.g., teachers, researchers, and children). For a final evaluation of the PEEC components, we consulted the ten participating teachers through a questionnaire survey one year after the end of their official collaboration. The main results highlight the relevance and appropriateness of the proposals presented for the targeted age group and the assumptions and objectives of science education in terms of the curriculum, teaching resources, and digital assessment games. Teachers also mentioned continuing to use the PEEC resources after their participation in this study. These results underscore the need to expand and promote projects of this nature to contribute to more practical science education in Portugal and, consequently, to increase children’s levels of scientific literacy.

Determination of uranium isotopes in ground water by alpha spectrometry and associated age-dependent ingestion dose.

Determination of uranium isotopes in ground water plays a key role in assessment of geochemical condition of ground water and for estimating ingestion dose received by the general public because of uranium intake through drinking water. An attempt has been made in the present study to estimate isotopic composition and activity ratios (AR) of uranium isotopes by analysing the ground water samples using alpha spectrometry. Associated age-dependent ingestion dose was also calculated for the public of different age groups. 238U, 235U and 234U activity concentration was found to vary in the ranges of 5.85±1.19 to 76.67±4.16, < 0.90 to 3.15±0.84 and 6.52±1.25 to 107.02±4.92 mBq/L, respectively. 235U/238U AR varies from 0.038 to 0.068 with an average of 0.047 which is close to 0.046 implies that uranium in the ground water is from natural origin. Uranium concentration was found to vary in the range of 0.47±0.10μg/L to 6.20±0.34μg/L with a mean value of 3.01±0.23μg/L, which is much lower than national as well as international recommendation value. Annual ingestion dose to the public of all age groups for uranium intake through drinking water ranges from 0.60±0.11 to 19.50±1.03μSv/y.

Statistics of Periodicals in the Baltic States: Data Sources and Collections

Publishing is a significant part of the cultural, creative, and economic sectors. Its research, assessment, and forecasting require grounded, reliable, accurate, consistent, and comparable statistical data. Considering the lack of research in periodicals statistics and the relevance of publishing statistics, as well as the fact that in the Baltic countries, publishing statistics data are collected by institutions at the same level, the problem arises whether the national libraries’ applied foundational recommendations and legal documents, as well as data collection methodology, can ensure data validity, reliability, comprehensiveness, and comparability. This article aims to examine and compare the data collection practices of periodical statistics in the Baltic States. The research object includes the legal foundation of publishing statistics in Lithuania, Latvia, and Estonia, as well as the 2022 publishing statistics resources and official statistics data collections. UNESCO recommendations and International Organization for Standardization standards can be considered guidelines for such data collection and accounting. The legal foundation of publishing statistics consists of legal deposit laws, which must ensure the sources of statistical data. Even though publishing statistics data are collected by national libraries and the source of statistical data in all countries is legal deposits, the statistical data collections are not identical. Countries choose which data to collect, what criteria to apply, and in what form to present them. It is important to emphasize that data on the publishing industry are not presented in statistical collections, although their collection guidelines and presentation importance are highlighted in international recommendations and normative documents. Statistical data on electronic periodicals are provided only by Estonia. National libraries in the Baltic States are official statistics compilers, so summarized publishing statistics data are provided to national statistics institutions, opening new technological possibilities for data analysis and integration of new data. The collections of statistical data on newspapers and magazines can only be compared according to a few main criteria, as countries have chosen different statistical data presentation features, the main ones being the varying categorization and periodicity characteristics of newspapers and magazines.

Cultivating global antimicrobial stewardship: linguistic and cultural validation of the Australian National Antimicrobial Prescribing Survey appropriateness assessment definitions for Portugal.

Antimicrobial resistance is driven by inappropriate antimicrobial prescribing. The National Antimicrobial Prescribing Survey (NAPS) is an Australian-developed auditing platform to assist in the assessments of antimicrobial quality by antimicrobial stewardship programmes using consensus-based definitions. The NAPS has demonstrated to be transferable to other countries. Its adaptation to Portugal could improve knowledge about the quality of antimicrobial prescribing in the country. To translate, culturally adapt, and validate the Australian Hospital NAPS appropriateness assessment definitions of antimicrobial prescribing for Portugal. International recommendations on translation and adaptation of instruments were followed. Two panels of experts participated in the process, using Zoom® for discussions and interviews, and Google Forms® for assessing vignettes. A native English-speaking person proficient in Portuguese conducted the back-translation. SPSS v.28 and Excel® were used for validity calculation. The Portuguese version was well accepted, its implementation being perceived as desirable and feasible by the experts. Validation process showed a Fleiss' κ score of 0.483 (95% CI, 0.415-0.551, P < 0.005) for appropriateness, and an average agreement with the Australian NAPS team of 0.8 and 0.9, respectively, for appropriateness and reasons for inappropriateness. The Portuguese version of the Australian Hospital NAPS appropriateness assessment definitions of antimicrobial prescribing, the first to be translated from English, was deemed non-inferior to the original, was well accepted, considered to be desirable and feasible, and could inspire other countries, particularly other Portuguese-speaking countries, to adapt and validate them in their own contexts, reinforcing the possibility of transferring NAPS use beyond Australia.

Silent Neonatal Incubators, Prototype Nica+

Objectives: The purpose of this study was to evaluate and compare the noise levels in current incubator models and a prototype designed to improve acoustic comfort in neonatal incubators. Methods: Tests were carried out on three different models of incubators and a prototype called Neonatal Incubator Acoustic Comfort Class (NICA). The tests measured both internal and external sound pressure levels under laboratory conditions. The noise index has been taken as the A-weighted equivalent continuous sound pressure level (LAeq,T) for a time interval of 1 min. Results: The results obtained show variations between the different models of incubators, although, overall, they are high values (around 56/60 dBA). The results prove that premature newborns under normal conditions of using these incubators are exposed to noise levels above international recommendations. The new incubator design minimizes noise generation and generates noise levels lower than international recommendations. Conclusions: The results obtained from the prototype (NICA+) show the effectiveness of the proposed design in improving acoustic comfort in neonatal incubators. The data show that the noise levels generated by the prototype under normal operating conditions are significantly lower than international recommendations.

Concept of Assessment of Age-Friendly Residential Areas (AFRA): A Case Study of Gdańsk, Poland

(1) Background: Local governments are facing a considerable challenge to accurately verify cities, as well as to diagnose the condition of housing estates in the context of their friendliness to life of older people in order to be able to pursue a sustainable pro-ageing policy. In response to these needs, universal methodology for identifying age-friendly residential areas (AFRA) in cities was developed and tested. Thus, the main objective of the research was to develop an innovative methodological approach to the AFRA assessment, taking into account integrated functional-spatial and aesthetic indicators with particular emphasis on the ways of presenting results. (2) Methods: The methodology was based on the general, international assumptions of “ageing in place”, “age-friendly city”, “active ageing”, and an in-depth analysis of contemporary trends in this field, using international guidelines and recommendations, as in the case of survey data from the target international population and information provided by experts. (3) Results: The overall result of the project is a universal methodology for diagnosing housing estates in cities, taking into account infrastructural and landscape determinants in terms of their friendliness to older people, including a presentation of the usefulness of GIS tools to create thematic maps visualising the degree of friendliness. (4) Conclusions: This innovative approach to AFRA visualisation will expand the knowledge about the possibilities of diagnosing age-friendly spaces in the city that are conducted at the level of the city’s settlement units. The developed list of criteria influencing the friendliness of housing estates for older citizens can be useful for public entities in creating city and housing planning policies for private entities to manage their own investment plans and implement the concept of on-site ageing in their planning and for real estate agents to explore the real estate market for the needs of older clients.

French consensus procedure for neuropsychological assessment in multiple sclerosis

Cognitive impairment is one of the invisible symptoms of Multiple sclerosis (MS), which could be associated with depression, unemployment, reduced social interaction, inability to drive, and compromised quality of life. Moreover, the presence of cognitive impairment can be considered as a long-term prognostic factor and in the follow-up of disability. So, cognitive assessment is a crucial element in clinical follow-up of patients with MS (pwMS). International recommendations mention the use of the Brief International Cognitive Assessment in MS (BICAMS). The BICAMS, that has been recently validated in French is a brief non-exhaustive assessment, developed as a short screening battery, hence needing other supplemented tests. The present paper aims to propose a consensus, approved by expert French consensus from the Cognition group of the SF-SEP (http://sfsep.org [Société Francophone de la Sclérose en Plaques]), for cognitive assessment of pwMS suggesting the tools that should be used in order to apprehend the other cognitive impairments that could appear in MS.

Hidradenitis suppurativa: review of international clinical guidelines for the diagnosis and treatment of the disease

Background. Hidradenitis suppurativa hidradenitis is a chronic recurrent inflammatory skin disease that develops after puberty and is characterized by the appearance of recurrent painful nodes, abscesses, the formation of fistula passages and scars on skin areas rich in apocrine sweat glands. Treatment of purulent hidradenitis is aimed at suppressing inflammation, relieving pain, preventing the formation of fistulas and scars. The objectives of this review. Summarize the information in the published international clinical guidelines for the diagnosis and treatment of purulent hidradenitis, their comprehensive assessment and comparison with each other. Methods. In the period from December 2022 to February 2023, scientific articles were searched in the PubMed database of the National Center for Biotechnological Information. Inclusion criteria: scientific articles in English, without date restrictions; interdisciplinary publications of specialists in which dermatovenereologists participated. Results. The analysis of the existing relevant international clinical recommendations for the diagnosis and treatment of purulent hidradenitis indicates the absence of specific treatment schemes and algorithms, criteria for evaluating the effectiveness of therapy. In the treatment of purulent hidradenitis, the use of external keratolytics, antiseptics and antibiotics is recommended. Among systemic drugs, antibiotics, retinoids, immunosuppressive agents, hormonal drugs are used. The highest therapeutic efficacy in patients with purulent hidradenitis was shown by genetically engineered drugs that inhibit TNF-α and IL-17A. Conclusions. Patients with purulent hidradenitis require various treatment approaches, including a variety of surgical interventions, depending on the stage, severity, prescription of the disease and the general condition of the patient. The basic principle is the individual selection of the treatment method for a particular patient. In this regard, there is a need to develop domestic clinical guidelines for the management of patients with purulent hidradenitis.

Tailoring neoadjuvant systemic therapy in breast cancer: "The advent of a personalized approach"-The Breast-Gynecological and Immuno-Oncology International Cancer Conference (BGICC) consensus and recommendations.

The management of early breast cancer (BC) has witnessed an uprise in the use of neoadjuvant therapy and a remarkable reshaping of the systemic therapy postneoadjuvant treatment in the last few years, with the evolution of many controversial clinical situations that require consensus. During the 14th Breast-Gynecological and Immuno-Oncology International Cancer Conference held in Egypt in 2022, a panel of 44 BC experts from 13 countries voted on statements concerning debatable challenges in the neo/adjuvant treatment setting. The recommendations were subsequently updated based on the most recent data emerging. A modified Delphi approach was used to develop this consensus. A consensus was achieved when ≥75% of voters selected an answer. The consensus recommendations addressed different escalation and de-escalation strategies in the setting of neoadjuvant therapy for early BC. The recommendations recapitulate the available clinical evidence and expert opinion to individualize patient management and optimize therapy outcomes. Consensus was reached in 63% of the statements (52/83), and the rationale behind each statement was clarified.

Comparing Weights According to Weighing Cycles with Nonlinear Drift of the Comparator

Cycle weighing is used by metrologists around the world to eliminate drift in comparator readings when comparing the mass of reference weights. Various types of cycles and their descriptions are given in the International Recommendation on legal metrology OIML R111-1-2004 adopted in the Russian Federation as a national standard. They consider cycles under the assumption of linear drift of comparator readings. The article discusses weighing cycles that eliminate nonlinear drift of the comparator. Drift models are proposed in the form of exponential and multinomial laws, which are characterized by a fast dependence of readings at the beginning of the cycle and a slower one at the end of the cycle. The derivation of formulas for the difference between the mass of the verified and the original standard according to four comparator readings at equal time intervals is given. The formulas consist of two components: the first coincides with the formula for linear drift, and the second plays the role of a correction for the drift deviation from linearity. The formulas are also correct for linear drift, since in this case the second components become zero. Estimates of the differences in the mass of the compared weights, taking into account the nonlinearity of the comparator drift, make it possible to estimate the measurement uncertainty for linear and nonlinear drift and become relevant with a constant increase in weighing accuracy, especially when comparing high-precision mass standards.

A Contribution to the Integration of International, National and Local Cultural Heritage Protection in Planning Methodology: A Case Study of the Djerdap Area

The paper focuses on the question of how the application of a multilevel, integrated, and territorial approach can contribute to the protection of cultural heritage through planning instruments in Serbia. The principles of territorialization, integration and digitalization highlighted in the recent strategic documents of the Republic of Serbia are related to international recommendations and theoretical concepts and analyzed with regards to the possibilities of their implementation in planning methodology. The case study is the spatial plan for the Djerdap National Park, a special purpose area with already recognized international and national importance. The research suggests that the encompassed cultural heritage, except the Roman limes, is still recognized at the level of individual entities. The study emphasizes the importance of aligning all levels of governance to safeguard the whole spatial entity rather than focusing solely on its particular areas. The international and national significance of the planning area contributes to the strengthening of awareness of heritage and its institutional protection. However, the vitality of the area, which is key to its sustainable development, comes from the local level. Planning documents contribute to the integration of local values and local communities into development programs and projects.

Beyond the diagnosis of drug-resistant Tuberculosis in Norway: patients’ experiences before, during and after treatment

BackgroundThis study aims to explore the varied experiences of patients with drug-resistant tuberculosis in Norway. The study emphasizes challenges and implications of being diagnosed with drug-resistant tuberculosis, including the impact on psychosocial health during the diagnosis, disease, treatment, isolation and recovery phases.Norway is a low endemic country of tuberculosis. Most patients are immigrants, and some of them have recently arrived in the country. Patients undergoing treatment for drug-resistant tuberculosis endure prolonged and demanding treatment that could affect their psychosocial health.MethodsThis qualitative study conducted 16 in-depth interviews with individuals aged 18 years and above who were diagnosed with drug-resistant tuberculosis. All participants completed the treatment between 2008 and 2020. Fourteen participants were immigrants, and eight of them had resided in Norway for less than four years before diagnosis. Data analysis followed the six-phase reflexive thematic analysis framework, focusing on identifying patterns in participants’ experiences, thoughts, expectations and attitudes.ResultsThe narratives of the participants highlighted the complexities of navigating the diagnosis of drug-resistant tuberculosis, treatment, side effects and life after treatment. Immigrants encountered additional challenges, including language barriers and adapting to new social environments. All participants reported experiencing physical health issues that additionally affected their mental health and social activity. Several participants had a delayed or prolonged diagnosis that complicated their disease trajectory. Participants with suspected or confirmed contagious pulmonary tuberculosis underwent hospital isolation for periods ranging from weeks to six months. The participants reported mental health issues, social isolation and stigma, however few were offered follow-up by a psychologist. Many participants had persistent problems at the time of the interviews. Three main themes emerged from the analysis: Delayed and prolonged diagnosis; Psychosocial impact of isolation during treatment; The life after tuberculosis.ConclusionThis study highlights the enduring impact of drug-resistant tuberculosis on patients and the significance of timely diagnosis, psychosocial support and post-treatment follow-up. The participants universally faced serious implications of the disease, including stigma and isolation. Participants who experienced delayed diagnosis, reflected on missed early intervention opportunities. We recommend further research in low endemic countries to evaluate the international and local recommendations on psychosocial support.

Adherence to Antimicrobial Prophylaxis Guidelines in Endourologic Procedures: Frequency and Related Outcomes.

Background: Surgical antimicrobial prophylaxis (SAP), when used appropriately based on evidence-based guidelines, can reduce the rate of infectious complications following endourologic procedures without compromising patient outcomes. Objectives: To investigate the appropriateness of the current SAP used in endourologic surgeries based on international guidelines and report their associated outcomes (urinary tract infection [UTI] and blood stream infection [BSI]). Design: Prospective cross-sectional study. Methodology: The medical records of patients undergoing endourologic procedures were reviewed to assess healthcare providers' adherence to international guideline recommendations. Assessed parameters included indication, duration, choice, and dose of the antibiotics used in endourologic procedures in two medical centers in Amman/Jordan. Furthermore, patients were asked to conduct laboratory urine tests to determine the rate of infectious complications within one month post-procedure. Results: Three hundred and sixty-one patients were recruited for the study. The adherence rates to guidelines regarding indication, choice, and dose of pre-operative antibiotics were 90.3%, 2.8%, and 77.8%, respectively. The duration was concordant with guidelines in only 3.4% of participants. A total of 41.8% of patients completed follow-up. Among those, 4.6% developed bacterial UTIs, and 0.7% developed BSI. Conclusion: Adherence to SAP guidelines in endourologic procedures was far from optimal. Primary deviations in the implementation of guidelines' recommendations were pinpointed. These results are crucial for planning interventions that optimize SAP utilization.