Published Evidence Research Articles

Biomarker testing and treatment patterns in US patients (pts) with advanced/metastatic non-small cell lung cancer (NSCLC) harboring MET amplification.

e21057 Background: Limited published evidence exists on pts with advanced stage NSCLC harboring MET amplification ( METamp), a rare oncogenic driver. We report here real-world biomarker testing and treatment patterns for these patients. Methods: This was a non-interventional, descriptive cohort study using ConcertAI electronic medical record data derived from US community oncology centers and linked with ASCO/CancerLinQ data. Eligible pts had stage IIIB–IV NSCLC and METamp. Study period: Jan 1, 2004 – Oct 31, 2021. Results: Of 8,454 lung cancer pts with minimum 1 molecular test including MET, 164 had METamp (1.9%). Pts were mainly identified from 2015 onwards and primarily in oncology in the Southern and Midwest regions (86.6%). Majority of pts were tested by tissue biopsy (67.1%), 20.7% by liquid biopsy and 12.2% not specified. At least 64.5% of pts were highly MET amplified (either gene copy number ≥8 or by liquid biopsy ++, +++). Other mutations screened for were ALK, ROS1 and EGFR (99.4%, 98.2% and 97.6%), with oncogenic ALK, ROS1 fusions and activating EGFR mutations in 0.6% and 13.1%, respectively. BRAF and KRAS were less frequently screened for (90.2% and 87.2%), with potential oncogenic alterations in 2.0% and 12.6%. Of 127 pts tested for PD-L1 (by immunohistochemistry), 63.0% were positive, and 72.5% had tumor proportion score ≥50. Eighteen pts had METamp detected after receiving an EGFR tyrosine kinase inhibitor (TKI), indicating METamp as a secondary oncogenic driver. RB1 loss and MYC amplification, as potential mechanisms of MET inhibition resistance, were not frequently screened for (30.5% and 46.3%). RB1 loss was identified in 2.0% and MYC amplification in 15.8%. Next generation sequencing was the most frequent diagnostic used overall. A total of 144 pts (87.8% of 164 pts) received first-line (1L) anticancer therapy; platinum-based chemotherapy 57/144 (39.6%), immune-checkpoint inhibitors 50/144 (34.7%) or EGFR TKI monotherapy 24/144 (16.7%), other 2/144 (1.4%) and MET TKIs (mainly crizotinib) were used in 11/144 pts (7.6%) in 1L, 14/78 (17.9) in second line and 7/42 (16.7%) in third line. Conclusions: In this cohort of pts identified in a US community oncology setting, biomarker screening even for rarer genetic alterations occurred. Concomitant genetic alterations to METamp were infrequent except for alterations of EGFR and KRAS. The frequency of pts with high level of METamp in the cohort may explain the lower frequency of other biomarkers, as high level of amplification indicates a cleaner MET profile. Overall MET inhibitor treatment was not common. Screening for novel and rare biomarkers such as METamp as a primary or secondary oncogenic driver is becoming increasingly important to enable efficacious targeted treatment.

A Study for QOL and Surgical Incision Pain in Patients Undergoing Totally Thoracoscopic Combined Aortic and Mitral Valve Replacement Surgery.

In recent years, based on traditional median sternotomy surgery, totally thoracoscopic for aortic and mitral valve replacement surgery is increasingly being performed despite little published evidence. This study investigated postoperative pain and short-term quality of life (QOL) of patients undergoing double valve replacement surgery. From November 2021 to December 2022, 141 patients with double valvular heart disease who underwent thoracoscopic group (N = 62) and median sternotomy group (N = 79) were included. Clinical data were recorded, and a visual analog scale (VAS) was used to measure postoperative pain intensity. The medical outcomes study (MOS) 36-item Short-Form Health Survey assessed short-term QOL after surgery. Sixty-two patients underwent total thoracic double valve replacement, and 79 patients underwent median sternotomy double valve replacement. Both groups were similar in terms of demographics and general clinical data, as well as the incidence of postoperative adverse events. The VAS scores of the thoracoscopic group were lower than those in the median sternotomy group. The hospital stay time was significantly shorter in the thoracoscopic group than in the median sternotomy group (30.2 ± 12 days vs. 36 ± 19 days, p = 0.03). The scores of bodily pains and some of the subscales in SF-36 were significantly different between the two groups (p < 0.05). Thoracoscopic combined aortic and mitral valve replacement surgery can reduce postoperative pain and improve short-term postoperative QOL, which has specific clinical application value.

Patient and specimen identification in a tertiary care pediatric hospital: Barcodes do not scan themselves.

Despite the safety improvements linked to the use of barcodes for patient and specimen identification, patient misidentification remains a leading cause of transfusion-associated reactions including fatalities. A wealth of evidence supports the use of barcodes in general, but there is less published evidence of real-world barcode compliance. This project investigates barcode scanning compliance for patient and specimen identification at a tertiary care pediatric/maternity hospital. Transfusion laboratory specimen collection noncompliance events between January 1, 2019, and December 31, 2019 were retrieved from the hospital laboratory information system. Data were analyzed including stratification of collections by collector role and collection event. A survey of blood collectors was conducted. Collection compliance for 6285 blood typing specimens was evaluated. Full barcode scanning identification of both patient and specimen was utilized in only 33.6% of total collections. The remaining two thirds of collections were overridden by the blood collector: no barcode scanning occurred in 31.3%, while the specimen accession label was scanned but not the patient armband in 32.3% of total collections. There were significant differences between phlebotomists and nurses, with more phlebotomists performing the full scanning and specimen scanning only, while more nurses obtained specimens without patient or specimen scanning (p < .001). Blood collectors identified hardware challenges and training gaps as key contributors to barcode noncompliance. Our study highlights an instance of poor barcode scanning compliance for patient and specimen identification. We formulated improvement strategies and launched a quality improvement project to address factors influencing noncompliance.

Anticoagulation Stability With Bivalirudin: Positioning the Horse Before the Cart.

To the Editor: We thank Dr. Seelhammer and colleagues for their interest in our article1 and for the opportunity to expound upon on several key points. With significantly increased use of bivalirudin over the past decade, we acknowledge the need for larger, multicenter collaboration to generate more definitive conclusions in the superiority of bivalirudin used in pediatric Berlin Heart recipients versus unfractionated heparin (UFH). The preferred use of bivalirudin has occurred largely in the absence of robust published evidence. It is our hope that the article is one of many that provides support of this change. We agree that anti-Xa monitoring should be considered over activated partial thromboplastin time (aPTT) in patients anticoagulated on UFH secondary to the impact of inflammation and disseminated intravascular coagulopathy on aPTT. Significant assay variability and center-specific ranges make application across centers challenging. Although inter-reagent differences in anti-Xa have been described,2 we expect more consistent results given that Berlin Hearts (over time) have more pronounced proinflammatory activation compared to other mechanical support devices—translating into greater difficulties with anticoagulation interpretation. This explains some of the discordance of our concurrently drawn aPTT and anti-Xa values, and the difference in our anticoagulation stability findings. We also recognize the limitation of aPTT with bivalirudin use as well and like many centers are working towards access to dilute thrombin time monitoring. We appreciate the request for additional information regarding renal impairment in the bivalirudin group, and have attached Figure 1 which displays the first 21 days of bivalirudin initiation with the infusion rates (mg/kg/hour) plotted alongside estimated glomerular filtration rate (eGFR)-normalized infusion rates for review.Figure 1.: Bivalirudin infusion rates over first 21 days of anticoagulation initiation.Regarding VAD-itis, compared to other devices, Berlin Hearts have a greater perturbation of immune homeostasis, translating into elevated risk for adverse events such as thromboembolism.3,4 These patients are accounted for by the action of treatment with corticosteroids used to attenuate the immune response, and the judgment of the multidisciplinary heart failure team based on elevated laboratory values as recommended by Advanced Cardiac Therapies Improving Outcomes Network’s harmonized protocol rather than any isolated immunologic variable. We are in agreement with Seelhammer et al. that differences in aspirin dosing intensity confers confoundment in thrombotic outcomes, and is accounted for within our limitations. As discussed, higher aspirin utilization with bivalirudin was secondary to the later adoption of the modified Stanford protocol5 and not due to the prevalence of VAD-itis. It is plausible that the UFH patients experienced the same phenomenon of VAD-itis, under-recognized during that era of management, and thus undertreated leading to a greater procoagulant milieu in those patients. At present, this is the only study to compare the use of bivalirudin to UFH in this patient population. Our hypothesis is that greater anticoagulation stability may translate into improved patient outcomes—the former of which we identified in our study. The latter will have to wait for larger, multicenter collaboration. We encourage other centers to publish their experiences in order to reposition the data in front of the practice at-large.

Aggressive intravenous fluid resuscitation for acute pancreatitis.

Academic Emergency MedicineAccepted Articles THE BRASS TACKS: CONCISE REVIEWS OF PUBLISHED EVIDENCE Aggressive Intravenous Fluid Resuscitation for Acute Pancreatitis Brit Long MD, Corresponding Author Brit Long MD [email protected] orcid.org/0000-0003-4770-8869 Brooke Army Medical Center, Department of Emergency Medicine, 3551 Roger Brooke Dr, Fort Sam Houston, TX, United States Correspondence Brit Long, MD, Present Address: 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234. Email: [email protected]Search for more papers by this authorMichael Gottlieb MD, Michael Gottlieb MD orcid.org/0000-0003-3276-8375 Department of Emergency Medicine, Rush University Medical CenterSearch for more papers by this author Brit Long MD, Corresponding Author Brit Long MD [email protected] orcid.org/0000-0003-4770-8869 Brooke Army Medical Center, Department of Emergency Medicine, 3551 Roger Brooke Dr, Fort Sam Houston, TX, United States Correspondence Brit Long, MD, Present Address: 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234. Email: [email protected]Search for more papers by this authorMichael Gottlieb MD, Michael Gottlieb MD orcid.org/0000-0003-3276-8375 Department of Emergency Medicine, Rush University Medical CenterSearch for more papers by this author First published: 20 April 2023 https://doi.org/10.1111/acem.14741 Supervising Editor: Shahriar Zehtabchi This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/acem.14741. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Accuracy of Continuous Glucose Monitoring in an Insulin-Treated Population Requiring Haemodialysis.

Continuous glucose monitoring (CGM) is revolutionizing diabetes care by giving both patients and the healthcare professionals unprecedented insights into glucose variability and patterns. It is established in National Institute for Health and Care Excellence (NICE) guidance as a standard of care for type 1 diabetes and diabetes in pregnancy under certain conditions. Diabetes mellitus (DM) is recognized as an important risk factor for chronic kidney disease (CKD). Around a third of patients receiving in-center haemodialysis as renal replacement therapy (RRT) have diabetes, either as a direct cause of renal failure or as an additional co-morbidity. Evidence of poor compliance with the current standard of care (self-monitoring of blood glucose [SMBG]) and overall greater morbidity and mortality, suggests this patient population as an ideal target group for CGM. However, there exists no strong published evidence showing the validity of CGM devices in insulin-treated diabetes patients requiring haemodialysis. We applied a Freestyle Libre Pro sensor to 69 insulin-treated diabetes haemodialysis (HD) patients on a dialysis day. Interstitial glucose levels were obtained, and time matched within 7 minutes to capillary blood glucose testing and any plasma blood glucose levels sent. Data cleansing techniques were applied to account for rapidly correcting hypoglycaemia and poor SMBG technique. Clarke-error grid analysis showed 97.9% of glucose values in an acceptable range of agreement (97.3% on dialysis days and 99.1% on non-dialysis days). We conclude that the Freestyle Libre sensor is accurate in measuring glucose levels when compared to glucose as measured by capillary SMBG testing and laboratory obtained serum glucose in patients on HD.

Erratum to: Does the use of supraglottic device in rabbits cause less injury than other airway management devices?

Unfortunately the original version of the article was missing the following statement. This Knowledge Summary has reviewed the available evidence on the use of a SGAD (v-gel®) in rabbit anaesthesia. Since writing a new design of a single use supraglottic airway device (SGAD) has been introduced; currently there is no published evidence on whether this new device has an impact on the risk of injury. This error was in both the HTML and PDF versions. This has now been updated in both the HTML and PDF versions, and can be found in the clinical bottom line and the evidence section.

D46. US Insurance Coverage of Lymphatic Microsurgical Preventing Healing Approach: A Critical Review

PURPOSE: Breast-cancer-related lymphedema (BCRL) is a chronic, debilitating condition that is associated with patients who have undergone axillary lymph node dissection (ALND). Recently, Lymphatic Microsurgical Healing Approach (LYMPHA), a prophylactic microsurgical lymphovenous bypass technique, has been developed to prevent BCRL with promising results. However, insurance coverage is often denied. We investigated current coverage policies for LYMPHA among the top insurance providers in the United States. METHODS: Insurers were selected by identifying 50 companies with the largest market share and cross-referencing them with companies with greatest enrollment per state. Cross-sectional evaluation was performed on publicly available LYMPHA policies through a web-based search or phone call. Coverage status, coverage criteria, and exclusion rationale were collected and analyzed using descriptive statistics. RESULTS: Of the 63 insurers queried, 42.9% (n=27) do not have any public policies regarding LYMPHA coverage. Of those that do have a coverage policy (57.1%; n=36), 75.0% (n=27) deny coverage and 25.0% review claims on a case-by-case basis. In 21 of the coverage denials, LYMPHA was considered investigational, not standard practice, or to have insufficient published evidence. CONCLUSION: LYMPHA is known to significantly decrease the rates of BCRL following mastectomy and ALND, yet over half of the major insurance providers in the United States currently deny coverage. Focus should shift towards sharing high-level evidence at the legislative level to increase insurance coverage and therefore access to lymphedema prevention for breast cancer patients.

Intravenous magnesium as an adjunct to standard of care for treatment of atrial fibrillation with rapid ventricular response.

Academic Emergency MedicineAccepted Articles THE BRASS TACKS: CONCISE REVIEWS OF PUBLISHED EVIDENCE “Intravenous Magnesium As An Adjunct To Standard Of Care For Treatment Of Atrial Fibrillation With Rapid Ventricular Response” Pierre-Carole Tchouapi MD, Pierre-Carole Tchouapi MD New YorkSearch for more papers by this authorKevin E. Anderson, Kevin E. Anderson New YorkSearch for more papers by this authorPaul Narayan Hein MD, Corresponding Author Paul Narayan Hein MD [email protected] orcid.org/0000-0001-5016-5338 New York Correspondence Paul Narayan Hein, MD, Department of Emergency Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, New York 11203. Email: [email protected], Tel: (858) 337-1747Search for more papers by this author Pierre-Carole Tchouapi MD, Pierre-Carole Tchouapi MD New YorkSearch for more papers by this authorKevin E. Anderson, Kevin E. Anderson New YorkSearch for more papers by this authorPaul Narayan Hein MD, Corresponding Author Paul Narayan Hein MD [email protected] orcid.org/0000-0001-5016-5338 New York Correspondence Paul Narayan Hein, MD, Department of Emergency Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, New York 11203. Email: [email protected], Tel: (858) 337-1747Search for more papers by this author First published: 06 April 2023 https://doi.org/10.1111/acem.14734 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/acem.14734. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Should Trazodone Be First-Line Therapy for Insomnia? A Clinical Suitability Appraisal.

Trazodone is one of the most commonly used prescription medications for insomnia; however, some recent clinical guidelines do not recommend its use for treating insomnia. This clinical appraisal critically reviews the scientific literature on trazodone as a first-line treatment for insomnia, with the focus statement "Trazodone should never be used as a first-line medication for insomnia." In addition, field surveys were sent to practicing physicians, psychiatrists, and sleep specialists to assess general support for this statement. Subsequently, a meeting with a seven-member panel of key opinion leaders was held to discuss published evidence in support and against the statement. This paper reports on the evidence review, the panel discussion, and the panel's and healthcare professionals' ratings of the statement's acceptability. While the majority of field survey responders disagreed with the statement, the majority of panel members agreed with the statement based on the limited published evidence supporting trazodone as a first-line agent as they understood the term "first-line agent".

S.A.R.S. COV-2 Spike Protein Derivates – ACE LINK - Graphene and Wireless Communications Radiation : Epidemiological -Chemico Physical and Toxicological Aspects -Scientific Evidence and other Interesting Documents

Aim of this work is to search and analyze scientific literature involved in the effect played by wireless communication radiation in the S.A.R.S.-COV-2 spike protein derivates pathological process. This make possible to verify if it is necessary to be considered as a toxicological co-factor Various published evidence finded graphene impurity in vial some C.O.V.I.D.-19 vaccine ( P. Campra) or in vaccinated blood ( Giovannini et al ) . But It is relevant to deeply investigate this phenomena using scientific evidence and other interesting documents ( scientific? ) from independed researcher useful to generate hypotesys to be confirmed . Crucial also to verify the subpopulation distribution of pathological event in vaccinated like pericarditys or central nervous system thrombosys as well as the use of some technological tool like smartphone in the various age classes. This method make possible to generate hypotesys to be better verified. Related the profile of some toxicological aspect of some C.O.V.I.D. -19 vaccine and in specifc way to the rare effect like pericarditis or trombosys are reported in this work some relevant literature involved in the effect played by the SPIKE PROTEINS and its link on epithelial tissue ACE receptor , the Graphene ( if present ) and under some magnetic field or electrical condition. An experimental hypotesys is submitted to the reseacher in order to produce a global conclusion of toxicological interest In this work is used a neutral approch without pre-concept.

A controlled evaluation of filter paper use during staining of sputum smears for tuberculosis microscopy.

Background: Some sputum smear microscopy protocols recommend placing filter paper over sputum smears during staining for Mycobacterium tuberculosis (TB) . We found no published evidence assessing whether this is beneficial. We aimed to evaluate the effect of filter paper on sputum smear microscopy results. Methods: Sputum samples were collected from 30 patients with confirmed pulmonary TB and 4 healthy control participants. From each sputum sample, six smears (204 smears in total) were prepared for staining with Ziehl-Neelsen (ZN), auramine or viability staining with fluorescein diacetate (FDA). Half of the slides subjected to each staining protocol were randomly selected to have Whatman grade 3 filter paper placed over the dried smears prior to stain application and removed prior to stain washing. The counts of acid-fast bacilli (AFB) and precipitates per 100 high-power microscopy fields of view, and the proportion of smear that appeared to have been washed away were recorded. Statistical analysis used a linear regression model adjusted by staining technique with a random effects term to correct for between-sample variability. Results: The inclusion of filter paper in the staining protocol significantly decreased microscopy positivity independent of staining with ZN, auramine or FDA (p=0.01). Consistent with this finding, there were lower smear grades in slides stained using filter paper versus without (p=0.04), and filter paper use reduced AFB counts by 0.28 logarithms (95% confidence intervals, CI=0.018, 0.54, p=0.04) independent of staining technique. In all analyses, auramine was consistently more sensitive with higher AFB counts versus ZN (p=0.001), whereas FDA had lower sensitivity and lower AFB counts (p<0.0001). Filter paper use was not associated with the presence of any precipitate (p=0.5) or the probability of any smear washing away (p=0.6) during the staining process. Conclusions: Filter paper reduced the sensitivity of AFB microscopy and had no detectable beneficial effects so is not recommended.

COMPARISON OF FUNCTIONAL OUTCOMES BETWEEN UNCEMENTED UNIPOLAR AND CEMENTED BIPOLAR HEMIARTHROPLASTY FOR INTRACAPSULAR NECK FEMUR FRACTURES IN ELDERLY

Background: Femoral neck fractures (FNF) are a growing problem in our ageing society and have been associated with high morbidity and mortality. Hemiarthroplasty is the most commonly used treatment for displaced femoral neck fractures in the elderly. There is limited evidence in the literature of functional outcome with cemented implants compared to AMP in aged more than 70 years. Hence an attempt is made to compare the outcome with unipolar vs cemented bipolar prosthesis for displaced fracture neck of femur in patients aged more than 70years. Ours is a prospective comparative st Materials And Method: udy conducted, involving 40 patients with short term follow up of one year. Elderly patients above 70 years of age, with displaced fracture neck of femur were included. 20 patients were operated with Austin Moore Prosthesis (AMP) and 20 with bipolar prosthesis. The functional hip score was assessed using Harris Hip Score (HHS). The statistical software SPSS 15.0 (Statistical Package for Social Sciences) was used for the analysis of our data. In our study, Result: mean duration of surgery in uncemented group was 70 minutes and mean duration of surgery in cemented group was 82 minutes. On the basis of HHS the results were at 6 weeks follow up we had 70.2 for uncemented group and 77.5 for cemented group and in the last follow up at 6 months, we found HHS 84.2 for uncemented group and 85.6 for cemented group. There were 3 complications in cemented as a cement reaction and 2 supercial infection one in cemented and other in uncemented group. Both cemented Conclusion: and uncemented prostheses can be recommended according to our study because they were equally good regarding functional outcome and health-related quality of life, contrary to the generalized and limited published evidence. The seeming advantages of shorter duration of surgery and potentially less blood loss with the uncemented implant are of little importance compared with the important ndings of equivalent functional results. Both implants may be used with good results after displaced femoral neck fractures.

Consensus on the use of iSGLT2 in the treatment of patients with type 2 diabetes mellitus

Although in recent years in Mexico the quality of diabetes mellitus (DM) care has improved and access to health services and medications has increased, there is a lack of adherence to the recommendations of the clinical guidelines, which could explain the poor glycemic control in many of the patients with DM. Sodium-glucose cotransporter type 2 (iSGLT2) inhibitors have been the last class of antidiabetic agents to receive approval from the Food and Drug Administration (FDA) and COFEPRIS (Mexico). In order to improve the use of SGLT2i in clinical practice in Mexico, this paper presents the recommendations issued by a panel of eleven Mexican experts based on the new published evidence for the treatment of patients with DM2.

Impacts of a dispersed unit structure on allied health professionals' experiences in an Australian public hospital setting.

The limited published evidence relating to the experiences and outcomes of a unit dispersement model is generally more negative than positive from an allied health perspective. The perceptions of allied health managers and leaders after the transition to a unit dispersement structure were explored in this study. The objectives were to review the impacts of this type of structure and the factors for health care organizations to consider before incorporating allied health professions into a clinical matrix structure. A qualitative study was conducted in a large regional multisite public hospital and health service located in Australia. Semistructured interviews and focus groups were conducted with 30 allied health frontline managers and leaders. Four negative impacts on the work experience of allied health professionals in a dispersement structure were identified through data analysis as: a negative impact on service delivery to patients, a detrimental effect on professional identity, reduced ability of allied health managers and leaders to do their role effectively, and a negative impact on morale, culture, and emotional well-being. Several key factors for public hospitals to consider before embarking on an organizational structure that includes allied health professionals were identified. The impacts of the unit dispersement structure on allied health professionals working within the organization under study were generally negative and did not deliver on the desired objectives. The findings reinforce the unique requirements pertaining to allied health professionals for optimal functioning. The learnings have implications for administrators in health care organizations embarking on organizational change that incorporates allied health professions in certain settings. The findings recommend that health care organizations consider several important factors before they introduce any structural change that would affect the delivery of allied health services.

Evaluation of the Abbott Panbio™ COVID-19 Ag Rapid Antigen Test for Asymptomatic Patients during the Omicron Wave

Rapid antigen testing (RAT) is a cost-effective and time-efficient method of identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and therefore a critical part of infection control strategies. There is no published evidence evaluating the use of RAT during the Omicron wave of the COVID-19 pandemic for asymptomatic patients or its performance between waves. All patients presenting to an Emergency Department over a two-week period without COVID-19 symptoms were screened for SARS-CoV-2 using both the Abbott Panbio RAT as well as the gold standard reverse transcriptase real-time polymerase chain reaction (PCR). The Abbott Panbio RAT sensitivity was 13% (95% CI 0.028, 0.336) for asymptomatic patients. The use of this test in asymptomatic patients during the Omicron wave had a statistically significant reduction in sensitivity compared with two reports of the same test in previous waves (13% vs. 86%, p &lt; 0.0001; 13% vs. 83%, p &lt; 0.0001). As SARS-CoV-2 continues to mutate, the sensitivity of RATs are altered and needs to be continually re-evaluated for each variant of concern if they are to be used as part of an infection control strategy.

Recommendations for the establishment and operation of a donor human milk bank.

In Europe, an increasing number of human milk banks (HMBs) collect donor human milk to feed preterm infants when their mother's milk is not available or not enough. Moreover, donor milk is a bridge to breastfeeding, with positive clinical and psychological advantages for both mother and infant. Italy, with 41 HMBs actively operating in 2022, has the highest number of HMBs in Europe. The process of human milk donation is complex, so activity of HMBs must be regulated according to well-established rules. The present recommendations have been prepared as a tool to standardize the organization, management, and procedures of HMBs operating in Italy and to determine the minimal essential requirements to establish new HMBs. This article covers all the aspects of human milk donation and human milk banking, including general recommendations, donor recruitment and screening, expression, handling and storage of donor human milk, milk screening, and milk treatment (pasteurization). A pragmatic approach was taken to drafting the recommendations. Items for which there was consensus or robust published evidence on which to base recommendations were included. When there were differences that could not be resolved by reference to published research, a statement of explanation based on the expert opinion of the authors (all members of the Italian Association of Human Milk Banks) was included. Implementation of these recommendations can contribute to promotion of breastfeeding.

Exploring Oral Function, Protein Intake, and Risk of Sarcopenia: A Scoping Review.

Sarcopenia is loss of both muscle mass and function with age and is associated with inadequate protein intake. However, evidence to suggest an association with oral health is less clear. To scope peer-reviewed published evidence (2000-2022) pertaining to oral function in relation to sarcopenia and/or protein intake in older people. CINAHL, Embase, PubMed, and Scopus were searched. Included were peer-reviewed studies measuring oral function (e.g., tooth loss, salivary flow masticatory function, strength of muscles of mastication, and tongue pressure) and a measure of protein intake and/or a measure of sarcopenia (appendicular muscle mass and function). Full article screening was conducted by 1 reviewer with a random 10% screened in duplicate by a second reviewer. Relevant content pertaining to study type, country of origin, measures of exposure, and outcomes and key findings was mapped and the balance of data showing a positive versus null association of oral health with outcomes charted. Of 376 studies identified, 126 were screened in full, yielding 32 included texts, of which 29 were original articles. Seven reported intake of protein and 22 reported measures of sarcopenia. Nine distinct oral health exposures were identified, with ≤4 studies relating to any one of these measures. Most data were cross-sectional in nature (27 studies) and from Japan (20 studies). The balance of data showed associations between tooth loss and measures of sarcopenia and protein intake. However, the balance of data pertaining to any association between chewing function, tongue pressure, or indices of oral hypofunction and sarcopenia was mixed. A broad range of oral health measures have been studied in relation to sarcopenia. The balance of data suggests that tooth loss is associated with risk, but data pertaining to the oral musculature and indices of oral hypofunction are mixed. The findings of this research will increase awareness among clinicians of the amount and nature of evidence pertaining to the relationship between oral health and risk of compromised muscle mass and function, including data showing that loss of teeth is associated with increased risk of sarcopenia in older people. The findings highlight to researchers the gaps in the evidence and where further research and clarification of the relationship between oral health and risk of sarcopenia is warranted.

The distribution, specimens and status of Chestnut Owlet Glaucidium (capense) castaneum and Albertine Owlet G. (c.) albertinum

Chestnut Owlet Glaucidium (capense) castaneum and Albertine Owlet G. (c.) albertinum are poorly known members of the African Barred Owlet Glaucidium capense complex, confined to the Albertine Rift of East Africa. Recent taxonomic treatments have seen them variously considered as subspecies of capense, as separate monotypic species or, in the case of castaneum, a polytypic species. A paucity of museum material and field knowledge of each, combined with oversight and misinterpretation of some primary literature, has contributed to this uncertainty. This study reassesses their status and corrects numerous errors, misunderstandings and contradictions concerning specimen material, distribution, morphology and voice. Only four specimens of castaneum are known, there are no documented observations of the bird in life and no acoustic recordings. There are seven specimens of albertinum in collections. No field sightings have ever been documented but several recordings attributed to albertinum exist. Despite its close similarity to the voice of capense, there is no published evidence that albertinum reacts to playback, unlike the remaining taxa of the complex. I conclude that castaneum is a modestly distinct subspecies of capense. In contrast, albertinum, which differs conspicuously from the others in the complex by its disproportionately short tail, and which may be parapatric with castaneum, merits treatment as a species.

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 7. The empowering effect of Care Groups

BackgroundWhile there is extensive published evidence regarding the effectiveness of the Care Group Approach in promoting community-wide health behavior change, there is no published evidence regarding its empowering effect on its participants. Our study aimed to understand if the Care Group Approach as applied in the Curamericas/Guatemala Maternal and Child Health Project in isolated rural mountainous communities in Guatemala produced evidence of empowerment among the female participants. This is the seventh of 10 papers describing the expanded Census-Based, Impact-Oriented (CBIO+) Approach in improving the health and well-being of mothers and children in the rural highlands of the Department of Huehuetenango, Guatemala.MethodsWe conducted semi-structured individual and group interviews with 96 female Care Group participants –including Level-1 Care Group Promoters, Care Group Volunteers, and Self-Help Group participants. The participants were from six communities – two from each of the three municipalities making up the Project Area. Data were analyzed both using deductive thematic and by exploring the following social constructs: perceived social status, self-efficacy, decision-making autonomy, and formation of social capital.ResultsThe findings supported the hypothesis that Care Group participation was an empowering process. The primary themes that emerged included increased respect accorded to women in the community, women’s willingness and ability to make decisions and their confidence in making those decisions, and the development of stronger bonds among Care Group members, with other community members, and with community leaders.ConclusionThrough increased theoretical and practical knowledge about important maternal and child health matters and through the social experience of obtaining this knowledge and sharing it with other community members, participation in the Care Group Approach empowered participants to make positive health behavior changes for themselves and for their children and families. This, in turn, led many participants to become more engaged in community activities for improved health and beyond, thereby enhancing social capital in the community. We conclude that the Care Group Approach, as applied in this setting, has made it possible for marginalized indigenous women living in a male-dominated society to become more empowered.