Presence Of Medical Devices Research Articles

Prevalence of Candida species and their Susceptibility to Triazoles in Clinical Isolates from a Tertiary Care Hospital

In the recent past, the incidence of Candidiasis has witnessed a concerning upsurge, resulting in a significant healthcare challenge. These infections are further exacerbated by factors like the widespread use of broad-spectrum antimicrobials, chemotherapy-induced neutropenia, and the presence of medical devices. The present study is designed to address the critical need for identifying the Candida species responsible for clinical infections and assessing their susceptibility to key antifungal drugs Fluconazole, Voriconazole, and Itraconazole. Two hundred clinical samples from Rohilkhand Medical College & Hospital, Bareilly were analyzed. Using Vitek-2 Compact (Biomerieux, France), the Candida spp. and the antifungal drug sensitivities were identified for Fluconazole and Voriconazole. E-test was done to identify Itraconazole sensitivity. This study found that C. albicans accounted for 21.5% while Non-albicans Candida (NAC) constituted 78.5%. Prolonged medication was the most common factor making susceptible for Candidiasis (43.5%), followed by indwelling biomedical devices (23%), Diabetes mellitus (16%), surgical causes (5.5%), trauma (5%), pregnancy (5%), and HIV (2%). Antifungal susceptibility testing showed that 68.5%, 72%, and 69.5% of Candida spp. isolates were sensitive to Fluconazole, Voriconazole, and Itraconazole, respectively. In conclusion, non-albicans Candida infections are increasing due to predisposing conditions, and some of these species are inherently resistant to the routinely used antifungal drugs. The study emphasizes the importance of identifying Candida spp. and their susceptibility to antifungals. This can limit the indiscriminate use of antifungal drugs, aid in selecting appropriate treatments, and reduce treatment costs, hospital stays, and patient morbidity and mortality.

Focusing on Gordonia Infections: Distribution, Antimicrobial Susceptibilities and Phylogeny.

The immunosuppression conditions and the presence of medical devices in patients favor the Gordonia infections. However, the features of this aerobic actinomycete have been little explored. Strains (n = 164) were characterized with 16S rDNA and secA1 genes to define their phylogenetic relationships, and subjected to broth microdilution to profile the antimicrobial susceptibilities of Gordonia species that caused infections in Spain during the 2005-2021 period. Four out of the eleven identified species were responsible for 86.0% of the infections: Gordonia sputi (53.0%), Gordonia bronchialis (18.3%), Gordonia terrae (8.5%) and Gordonia otitidis (6.1%). Respiratory tract infections (61.6%) and bacteremia (21.9%) were the most common infections. The secA1 gene resolved the inconclusive identification, and two major clonal lineages were observed for G. sputi and G. bronchialis. Species showed a wide antimicrobial susceptibility profile. Cefoxitin resistance varies depending on the species, reaching 94.2% for G. sputi and 36.0% for G. terrae. What is noteworthy is the minocycline resistance in G. sputi (11.5%), the clarithromycin resistance in G. bronchialis secA1 lineage II (30.0%) and the amoxicillin-clavulanate and cefepime resistance in G. terrae (21.4% and 42.8%, respectively). G. sputi and G. bronchialis stand out as the prevalent species causing infections in Spain. Resistance against cefoxitin and other antimicrobials should be considered.

Barriers and facilitators for physical activity on acute geriatric and rehabilitation wards: a survey study

ABSTRACT Objectives During hospitalisation, physical inactivity is common among older patients and is associated with adverse outcomes, e.g. functional decline. This study identified barriers and facilitators of physical activity with geriatric patients during hospital admission. Methods This is a cross-sectional descriptive study, on two acute geriatric units and one rehabilitation unit, using a researcher-administered survey methodology in patients 70 years or older. A new questionnaire was developed based on a literature review, and was administered bedside and face-to-face with the older patients. Results 72 patients, mean age 83.6 years, completed the questionnaire. 88.9% of the participants found physical activity important during hospitalisation. The main patient-related determinants were fear of falling and symptoms of current illness (e.g. pain). The main environmental-related determinants were the presence of medical devices, and the availability of walking aids. Half of the patients felt motivated by the hospital staff, and one out of six participants felt discouraged. Receiving more assistance for walking and having access to other types of physical activity was expected to increase physical activity. Additionally, motivation from family would be a facilitator for 44.4% of the participants. Conclusion Promoting physical activity on acute geriatric units will require interventions at different levels. Most importantly, focusing on interpersonal motivators and positive reinforcement by hospital staff could be beneficial strategies to increase the physical activity of older hospitalised patients.

Nosocomial infections and associated risk factors at two tertiary healthcare facilities in Lusaka and Copperbelt Provinces, Zambia

BackgroundNosocomial infections are a serious public health problem affecting both developed and developing countries. They are caused mainly by multi-drug-resistant pathogens that limit treatment options, leading to high morbidity and mortality, longer hospital stays and increased costs of health care. This study aimed to evaluate nosocomial infections, risk factors and causative pathogens at two large teaching hospitals in Zambia. Material and methodsA yearlong hospital-based cross-sectional study was conducted from April 2020 to April 2021 at two large tertiary-level hospitals in Zambia. Hospitalised and out-patients with previous hospital contact were screened for nosocomial infections, followed by the collection of specimens (skin swabs, urine or sputum) for bacteriological culture and Polymerase Chain Reaction (PCR) amplification of 16S rRNA gene fragments. Nosocomial infections were defined according to the World Health Organization case definitions. Frequencies were estimated, and the association between the outcome variable (positive culture) and categorical predictor variables were analysed using the Chi-square test. ResultsEight hundred and forty-one clinical specimens (skin swabs, urine or sputum) were collected and analysed, 640 from the University Teaching Hospital in Lusaka and 201 from the Ndola Teaching Hospital in Ndola. Of these, 71.2% were from male, with only 28.8% from female patients. The median age was 50 years old. Catheter-associated urinary tract infections (57%) were the most common, followed by those from pressure sores (38.7%). The most frequently observed pathogens included Escherichia coli (17.8%), Pseudomonas aeruginosa (13.7%), Klebsiella pneumonia (5.6%) and Proteus vulgaris (5.5%). ConclusionsThe hospital infection rate at the two urban tertiary hospitals was very high. Age over 65 years, male gender, presence of medical devices, presence of a wound, longer hospital stays, previous hospital contacts and low systolic blood pressure were associated with the risk of developing nosocomial infections. Despite improved infection control following the COVID-19 waves, nosocomial infections have remained a significant public health threat.

Detection of Biofilm Formation in Classical and Hypervirulent Klebsiella pneumoniae

Klebsiella pneumoniae has considered as a relevant healthcare-associated pathogen, its risk of infections is increasing in the presence of medical devices. K. pneumoniae is known for its ability to form biofilm on biotic and abiotic surfaces. Biofilm of K. pneumoniae assists in bacterial protection from host immune responses and antibiotics. Hypervirulent Klebsiella pneumoniae (hvKp) emerges as a new pathotype, which first appeared in Asian Pacific Rim but spread globally. Thus, this study aimed to investigate the ability of K. pneumoniae including hvKp and potential hvKp isolates to form biofilm. One hundred isolates of K. pneumoniae were collected from different hospitals in Baghdad city. These isolates were identified by phenotypic characterization on selective agar plates, biochemical tests, VITEK II, and molecular identification. Biofilm formation was tested in these isolates by two methods, congo red and Tissue Culture Plate method. In congo red method, 33% of the isolates were biofilm producer and (63%) can form biofilm by TCP method divided as: 14% strong, 15 moderate, 34% weak, and 37% non-biofilm producer. The hvKp and potential hvKp isolates showed a variable ability to form biofilm as classical K. pneumoniae.

Infecciones por enterococos

Enterococci are facultative anaerobic gram-positive bacteria that are arranged in chains or pairs. The most relevant species are Enterococcus faecalis and Enterococcus faecium. They are normal colonizers of the digestive system. They can survive on surfaces and in hospital settings for an extended period of time. Frequent contact with hospitals, comorbidities, prior antibiotic use, and presence of medical devices are associated with a greater risk of infection. They can give rise to multiple clinical syndromes and are more common in healthcare-associated infections than community infections. Of note are urinary tract infections, intra-abdominal infections, venous catheter-related bacteremias, endocarditis, meningitis, and surgical wound infections. The presence of endocarditis must be evaluated in all enterococci bacteremias; the NOVA and DENOVA scores are useful for doing so. Enterococcus faecalis tend to be sensitive to ampicillin, which is the treatment of choice. In cases of endocarditis or complicated bacteremia, it is recommended to combine them with ceftriaxone or gentamicin. Enterococcus faecium tend to be resistant to ampicillin and the treatment of choice is vancomycin. Treatment of vancomycin-resistant enterococci is not well-defined and represents a challenge; the main options are daptomycin at high doses or linezolid. Adequate control of the source of the infection is fundamental in the management of enterococcal infections.

Patient-Level Barriers and Facilitators to Early Mobilization and the Relationship With Physical Disability Post–Intensive Care

Background Early mobilization (EM) is associated with reduced physical disability post–intensive care (PD PIC). Yet, contextual factors facilitate or impede delivery of EM in the intensive care unit (ICU). Only 45% of ICUs in the United States routinely practice EM despite its recognized benefits. Objectives To analyze the evidence on the relationship between critical care EM, PD PIC, and personal (patient-level) factors, using the theoretical lens of the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). Method The Whittemore and Knafl methodology for integrative reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guidelines were followed. Qualitative, quantitative, and mixed-methods studies (n = 38) that evaluated EM and 1 or more domains of the World Health Organization ICF were included. Quality was appraised using the Mixed-Methods Appraisal Tool. Study characteristics were evaluated for common themes and relationships. The ICF domains and subdomains pertaining to each study were synthesized. Results Early mobilization delivery was influenced by personal factors. Deeper sedation level, the presence of delirium, higher patient acuity, the presence of medical devices, and patient weight were identified barriers to EM delivery. Patient engagement in EM was associated with improved delivery. Patients who enjoyed rehabilitation were more likely to demonstrate improvement in functional impairment than those who did not enjoy rehabilitation. Discussion Early mobilization is associated with reduced PD PIC, yet numerous contextual factors affect the delivery of EM in the ICU. Further study of patient-level factors and EM must explore the relationship between patient engagement, baseline demographics, and functional status at ICU admission, patient-level considerations for decisions to mobilize, and EM in the ICU. This research is critical to improving the delivery of EM in the ICU and reducing PD PIC.

Multi-center study on overall clinical complexity of patients with prolonged disorders of consciousness of different etiologies

ABSTRACT Aim: to assess overall clinical complexity of patients with acquired disorders of consciousness (DoC) in vegetative state/unresponsive wakefulness syndrome (VS/UWS) vs. minimally conscious state- MCS) and in different etiologies.. Design: Multi-center cross-sectional observational study. Setting: 23 intensive neurorehabilitation units. Subjects: 264 patients with DoC in the post-acute phase: VS/UWS = 141, and MCS = 123 due to vascular (n = 125), traumatic (n = 83) or anoxic (n = 56) brain injury. Main Measures: Coma Recovery Scale-Revised, and Disability Rating Scale (DRS); presence of medical devices (e.g., for eating or breathing); occurrence and severity of medical complications. Results: patients in DoC, and particularly those in VS/UWS, showed severe overall clinical complexity. Anoxic patients had higher overall clinical complexity, lower level of responsiveness/consciousness, higher functional disability, and higher needs of medical devices. Vascular patients had worse premorbid clinical comorbidities. The two etiologies showed a comparable rate of MC, higher than that observed in traumatic etiology. Conclusion: overall clinical complexity is significantly higher in VS/UWS than in MCS, and in non-traumatic vs. traumatic etiology. These findings could explain the worse clinical evolution reported in anoxic and vascular etiologies and in VS/UWS patients and contribute to plan patient-tailored care and rehabilitation programmes.

An observational study of older patient specialling in acute hospital settings.

During hospitalisation, older people can quickly become disoriented and agitated. In these instances, 'specialling', involving close monitoring and observation of the person to prevent accidents, injuries and clinical deterioration is often required. Despite the widespread practice of older patient specialling, there is no evidence of the best model, or any clear guidelines around the essential requirements for this practice. This study aimed to examine specialling practices for hospitalised older patients in acute aged care wards. Quantitative and qualitative data were obtained in an observational study of specialling practices for hospitalised older patients. Two validated observational tools were used to collect data on nursing care provided during specialling and patient responses to specialling over a three-month period. A total of 58 observations were undertaken of specialling practices for 12 hospital patients aged 65years and over in four acute aged care wards. Delirium was the most common reason for older patient specialling. Most specialling was undertaking by Assistants in Nursing. Specialling interactions and responses were mainly positive. Positive specialling practices occurred when the staff special was familiar with the older patient and the ward in which specialling occurred. Specialling practices differed in relation to, the type of care required, the presence of the patients' personal possessions in their immediate surroundings, the presence of medical devices, patient acuity and general ward busyness. These findings suggest that specialling practices differ according to patient need and that the staff member's familiarity with the ward and their patients are important factors in positive older patient specialling. The specialling role needs much clearer definition, including the type of educational preparation and workload support that is appropriate to ensure safe and quality care.

A 2-year point-prevalence surveillance of healthcare-associated infections and antimicrobial use in Ferrara University Hospital, Italy

BackgroundHealthcare-Associated Infections (HAIs) represent one of the leading issues to patient safety as well as a significant economic burden. Similarly, Antimicrobial Use (AMU) and Resistance (AMR) represent a growing threat to global public health and the sustainability of healthcare services.MethodsA Point Prevalence Survey (PPS) following the 2016 ECDC protocol for HAI prevalence and AMU was conducted at Ferrara University Hospital (FUH). Data were collected by a team of trained independent surveyors in 2016 and 2018. Risk factors independently associated with HAI were assessed by a multivariate logistic regression model.ResultsOf the 1102 patients surveyed, 115 (10.4%) had an active HAI and 487 (44.2%) were on at least 1 systemic antimicrobial agent. Factors independently associated with increased HAI risk were a “Rapidly Fatal” McCabe score (expected fatal outcome within 1 year), presence of medical devices (PVC, CVC, indwelling urinary catheter or mechanically assisted ventilation) and a length of hospital stay of at least 1 week. The most frequent types of HAI were pneumonia, bloodstream infections, and urinary tract infections. Antimicrobial resistance to third-generation cephalosporins was observed in about 60% of Enterobacteriaceae.ConclusionsThe survey reports a high prevalence of HAI and AMU in FUH. Repeated PPSs are useful to control HAIs and AMU in large acute-care hospitals, highlighting the main problematic factors and allowing planning for improvement actions.

Feasibility of Routine Data Collection on Intensive Care Unit Performance and Activity in Resource Limited Settings

Background: Routine collection and analysis of data allows a critical care department to highlight the outcomes of the interventions done and to identify the grounds for improvement. Data on characteristic and outcomes of patients admitted in intensive care units (ICUs) are lacking. Methods: A software (ICU e-monitoring®) was designed to enter for each patient demographic data, SAPS3 on admission, Nine Equivalent Manpower Use Score, presence of medical devices and episodes of hospital acquired infections. We report data collected during 2014 with comparison to data collected with the same methodology in 2008 [1]. Objective: To determine the standardized mortality ratio, the mean length of ICU stay, mean length of mechanical ventilation and ICU acquired infection incidence rate. Study design: Descriptive Place of study: Medical ICU, Pakistan Institute of Medical Sciences Islamabad Results: A total of 196 admissions were recorded during the year 2014 vs 354 in 2008. 47.2% were males and 52.8% were females. Mean age was 32.1 years ± 15.3 SD (37.7 ± 18.9 SD in 2008). A total of 65 (33%) deaths were recorded during the year and standardized mortality ratio was found to be 0.71 vs 1.09 in 2008. Mean Length of stay was 15.9 Days ± 12.9 SD (9.3 days ± 8.9 in 2008) and mean duration of mechanical ventilation was found to be 12.04 Days (8.7 in 2008). Overall ventilator associated pneumonia (VAP) rate was 42.3 cases per 1000 ventilator days. Rate of Catheter Related Blood Stream Infections (CRBSI) was found to be 17.2 cases per 1000 CVC days. Conclusion: Major changes in our patient population characteristics were seen between 2008 and 2013: number of patients and standardized mortality was decreased while incidence of VAP and CRBSI was increased. It is possible to collect meaningful data on ICU performance and activity in resource limited settings.

Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry

ObjectiveTo describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalisation. MethodFollow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. ResultsData from 835 patients with a mean age of 76.8years (SD: 12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD: 2.5) and high dependence (Barthel 37.5, SD: 31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR: 1.41; 95% CI: 1.22–1.63), more telephone interventions by case managers (OR: 1.12; 95% CI: 1.02–1.24) and imaging tests (OR: 1.37; 95% CI: 1.17–1.60), together with greater caregiver burden (OR: 1.31; 95% CI: 1.08–1.59), the presence of medical devices at home (OR: 1.69; 95% CI: 1.00–2.87) and received less “Case Management” intervention. ConclusionsThe patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety.

Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry.

To describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization. Follow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. Data from 835 patients with a mean age of 76.8years (SD:12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD:2.5) and high dependence (Barthel 37.5, SD:31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR:1.41; 95%CI: 1.22-1.63), more telephone interventions by case managers (OR:1.12; 95%CI: 1.02-1.24) and imaging tests (OR:1.37; 95%CI: 1.17-1.60), together with greater caregiver burden (OR:1.31; 95%CI: 1.08-1.59), the presence of medical devices at home (OR:1.69; 95%CI: 1.00-2.87) and received less "Case Management" intervention. The patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety.

Food for thought. Malnutrition risk associated with increased risk of healthcare-associated infection

Infection and malnutrition are interconnected. UK and Irish guidelines recommend the Malnutrition Universal Screening Tool (MUST) for nutritional risk screening. Patients with a MUST score of ≥2 are considered at high risk of malnutrition and referral for nutritional assessment is recommended. To explore the association between healthcare-associated infection (HCAI) and the MUST score categories of patients. This was a cross-sectional study in May 2017 on ten representative wards in our institution. Patient demographics, MUST score, presence of medical devices, HCAI and antimicrobial use were collected. Of 240 patients, the HCAI prevalence was 10.4% (N=25) and 26% (N=63) were at high risk of malnutrition (MUST score ≥2). Patients with HCAI were more likely to have had surgery (odds ratio (OR): 5.5; confidence interval (CI): 2.1-14.3; P<0.001), a central vascular catheter (OR: 10.0; CI: 3.6-27.2; P<0.001), or a urinary catheter in situ (OR: 7.5; CI: 2.8-20.0; P<0.001), and to have a high risk of malnutrition (OR: 4.3; CI: 1.7-11.2; P<0.001). A higher MUST score remained a significant predictor of a patient having HCAI on multivariate regression analysis (CI: 0.2-0.6; P<0.001). Patients at risk of malnutrition when assessed with the MUST were more likely to have HCAI. However, prospective studies are required to investigate the temporal association between MUST and HCAI and which interventions best address malnutrition risk and HCAI reduction in different settings.

Pressure ulcers' incidence, preventive measures, and risk factors in neonatal intensive care and intermediate care units.

Epidemiological studies on pressure ulcers (PUs) in hospitalised infants are scarce. Spain lacks comprehensive research studies providing data on the prevalence or incidence in this population. This work was developed to determine the incidence of PUs in hospitalised infants admitted to intensive and intermediate care units, along with relevant risk factors and preventive measures. A prospective study appraising the incidence of PUs in infants was performed. The risk factors and preventive measures were evaluated using a multivariate logistic regression model. A sample of 268 infants was included. The cumulative incidence of PUs was 12.70% (95% confidence interval, CI95% = [8.95%-17.28%]). The cumulative incidence in the intermediate care units was 1.90% (CI95% = [0.39%-5.45%]), while it was 28.18% (CI95% = [20.02%-37.56%]) in the intensive care units. The PUs were categorised as stage I, 57.10%; stage II, 31.70%; and stage III, 11.10%. The multivariate analysis found the following to be risk factors: low scores in the Spanish version of the Neonatal Skin Risk Assessment Scale (e-NSRAS) (Relative Risk (RR) 0.80; CI95% = [0.66-0.97]), the use of non-invasive mechanical ventilation (RR 12.24; CI95% = [4.02-37.32]), and the length of stay (RR 1.08; CI95% = [1.02-1.15]), suggesting a direct impact of these factors on PU development in infants. Kangaroo care influenced the prevention of PUs (RR 0.26; CI95% = [0.09-0.71]). The infants admitted in intermediate care units suffered PUs. In the case of intensive care units, the incidence is even higher. The risk increases with the length of stay, while the presence of medical devices, particularly non-invasive mechanical ventilation, is the main causal relationship. Kangaroo care has been shown to be an important preventive measure.

The Impact of Pediatric Pressure Injury Prevention Bundle on Pediatric Pressure Injury Rates: A Secondary Analysis.

The primary aim of this study was to explore the relationship between a pediatric pressure injury prevention bundle (PPIPB) implemented by pediatric hospitals across the nation and pressure injury (PI) rates over a 6-year period. A secondary aim of this study was to identify whether any one risk factor addressed in the PPIPB had a greater effect on PI occurrences than any other factor. Nonexperimental, retrospective correlation analysis of secondary data. Analysis of data from 99 pediatric hospitals participating in the national initiative Solutions for Patient Safety (SPS). Data were extracted from the SPS, an initiative designed to reduce PI rates in pediatric hospitals. We analyzed data related to nursing interventions implemented to ameliorate 5 factors associated with PI development. They were presence of medical devices, moisture, immobility, skin integrity, and absence of pressure redistribution with some support surfaces. Paired t test and correlation analysis were used to determine the relationship between the use of a PPIPB and PI incidence per 1000 patient-days. Findings indicated a 57% reduction in PI incidence when the PPIPB was used. A significant inverse relationship between the PPIPB and PI incidence was found. None of the 5 risk factors addressed by the PPIPB had a stronger correlation with PI occurrences than any other factor. Study findings strongly suggest the use of a PPIPB decreases PI incidence in pediatric hospitals and should be considered when implementing a PI prevention program.

Effect of arm position, presence of medical devices, and off-centering during acquisition of scout image on automatic tube voltage selection and current modulation in pediatric chest CT.

PurposeTo evaluate the patients’ morphologic factors affecting radiation dose in pediatric chest CT.Materials and methodsFrom November 2013 to May 2015, 315 pediatric chest CT scans were obtained using a CT scanner, and classified into 5 groups according to the patients’ age. For each age group, the chest CT scans were divided into two subgroups. A cut-off value used was the 75th percentile of size-specific dose estimates (SSDE), age-specific diagnostic reference level (DRL): less than the 75th percentile of SSDE (Group A, n = 238) and greater than the 75th percentile of SSDE (Group B, n = 77). All CT scans were performed with the same protocol using automatic tube voltage selection and current modulation techniques. The morphologic factors of the patients including body mass index (BMI), arm angles, presence of medical devices in the scan field, and degree of off-centering within the CT gantry were compared between groups A and B.ResultsGroup B showed narrower arm angles on scout and coronal reformatted images, higher frequency of the presence of devices and higher BMI than group A (P < 0.001, P < 0.001; P = 0.018, and P < 0.001, respectively). In multivariate analysis, narrower arm angles, the presence of devices on the scout images and higher BMI were independently associated with higher SSDE (P = 0.001, P = 0.037, and P < 0.001, respectively).ConclusionsDuring acquisition of the scout images, arms-down position and the presence of medical devices were associated with a high radiation dose above age-specific DRLs in pediatric chest CT, regardless of repositioning before the actual scanning. In addition, off-centering had no clinical impact on radiation dose in the routine practice.

The safety of a novel early mobilization protocol conducted by ICU physicians: a prospective observational study

BackgroundThere are numerous barriers to early mobilization (EM) in a resource-limited intensive care unit (ICU) without a specialized team or an EM culture, regarding patient stability while critically ill or in the presence of medical devices. We hypothesized that ICU physicians can overcome these barriers. The aim of this study was to investigate the safety of EM according to the Maebashi EM protocol conducted by ICU physicians.MethodsThis was a single-center prospective observational study. All consecutive patients with an unplanned emergency admission were included in this study, according to the exclusion criteria. The observation period was from June 2015 to June 2016. Data regarding adverse events, medical devices in place during rehabilitation, protocol adherence, and rehabilitation outcomes were collected. The primary outcome was safety.ResultsA total of 232 consecutively enrolled patients underwent 587 rehabilitation sessions. Thirteen adverse events occurred (2.2%; 95% confidence interval, 1.2–3.8%) and no specific treatment was needed. There were no instances of dislodgement or obstruction of medical devices, tubes, or lines. The incidence of adverse events associated with mechanical ventilation or extracorporeal membrane oxygenation (ECMO) was 2.4 and 3.6%, respectively. Of 587 sessions, 387 (66%) sessions were performed at the active rehabilitation level, including sitting out of the bed, active transfer to a chair, standing, marching, and ambulating. ICU physicians attended over 95% of these active rehabilitation sessions. Of all patients, 143 (62%) got out of bed within 2 days (median 1.2 days; interquartile range 0.1–2.0).ConclusionsEM according to the Maebashi EM protocol conducted by ICU physicians, without a specialized team or EM culture, was performed at a level of safety similar to previous studies performed by specialized teams, even with medical devices in place, including mechanical ventilation or ECMO. Protocolized EM led by ICU physicians can be initiated in the acute phase of critical illness without serious adverse events requiring additional treatment.

Rare Yeast Infections: Risk Factors, Clinical Manifestations, Treatment, and Special Considerations

Rare yeasts include Trichosporon, Malassezia, Saprochaete, Kodamaea, Rhodotorula, Saccharomyces, Pseudozyma, Sporobolomyces, Exophiala, Lacazia, Emmonsia, and Wickerhamomyces (Pichia). In this review, we focus on the taxonomy, microbiology, risk factors, clinical manifestations, and treatment of rare yeasts. Most rare yeasts are commonly encountered in the environment but infrequently cause infection in humans. Many of these organisms cause superficial skin infections in normal hosts. Most serious infections occur in immunocompromised hosts and/or in the presence of medical devices, especially intravascular catheters, and usually present as fungemia. Recent advances in DNA sequencing have led to taxonomic reclassification of some species which may not be reflected in older literature. The gold standard for diagnosis of rare yeast infections is still microscopy and culture based; however, molecular-based methods of diagnosis such as DNA sequencing or matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF-MS) are promising for speciation. Antifungal susceptibility varies by organism, but most favorable outcomes reported have been with amphotericin B or voriconazole. In general, mortality tends to be high. Advances in health care and improved molecular diagnostics are expanding the species of rare yeasts that are being recognized as human pathogens. Further research is needed to improve our understanding of the pathogenicity of these organisms so as to optimize therapy and improve outcomes.

Perceived barriers to anthropometric measurements in critically ill children.

Anthropometric measurements are vital for safe care in pediatric intensive care units. To identify barriers to anthropometric measurements and determine if perceptions of barriers differ between ordering providers and nurses. A 21-item survey to elicit perceptions of barriers to obtaining anthropometric measurements was distributed via e-mail to societies with members who provide care in pediatric intensive care units. Most of the 258 eligible respondents (46% ordering providers) were from North America (90%). Although 84% agreed that anthropometric measurements are important, only 3% knew if these measurements were obtained upon admission to their unit. Estimates of patients' measurements by parents or caregivers were commonly used (72%) when actual measurements were not obtained. Leading barriers were presence of medical devices (57%), use of extracorporeal life support (54%), and unstable hemodynamic status (52%). More ordering providers than nurses considered osteopenia/fragile bones as a barrier to weight measurement (46% vs 29%; P = .007) and traumatic brain injury a barrier to measurement of head circumference (42% vs 24%; P = .002). More nurses than ordering providers perceived dialysis (21% vs 9%; P = .01) and obesity (26% vs 15%; P = .04) as barriers to measurement of stature. Ordering providers more than nurses perceived nurses' workload (51% vs 33%; P < .001) and lack of importance (43% vs 20%; P < .001) as barriers. Barriers to obtaining anthropometric measurements exist in pediatric intensive care units; ordering providers and nurses have different perceptions of what constitutes a barrier.