Appropriateness of antibiotic use in community hospitals in rural Newfoundland and Labrador.

Background: Surveillance of the appropriateness of antimicrobial prescribing can identify targets for quality improvement in antimicrobial stewardship. Our objective was to measure antibiotic prescription prevalence, indication, and appropriateness at three rural community hospitals in a 1-day point prevalence study. Methods: Inpatient antibiotic prescriptions given at three community hospitals on April 24, 2019 were provided by the hospital pharmacies. These prescriptions were analyzed using the Australian National Antimicrobial Prescribing Survey (NAPS) tool. Prescriptions were assessed by an infectious diseases physician and analyzed per prescription. Results: Eighty prescriptions given to 58 inpatients were included. Antibiotic treatment prevalence was 58/120 beds (48.3%), and overall appropriateness was 37/80 prescriptions (46.3%). The most prescribed antibiotics were ceftriaxone (17 [21.3%]; 47.1% appropriate), piperacillin-tazobactam (10 [12.5%]; 10.0% appropriate), and moxifloxacin (9 [11.3%]; 0% appropriate). The most common indications were respiratory tract infections (36 [45.0%]; 36.1% appropriate), skin and soft tissue infections (14 [17.5%]; 78.6% appropriate), and urinary tract infections (9 [11.3%]; 11.1% appropriate). Of the 80 prescriptions, 50 (62.5%) documented an indication, and 71 (88.8%) documented a stop or review date. Conclusions: We observed a high treatment prevalence and low appropriateness. Overall appropriateness was lower than in urban hospitals.

Historique: La surveillance de la pertinence des prescriptions d'antimicrobiens peut permettre de cibler des mesures d'amélioration de la qualité de la gestion antimicrobienne. Les chercheurs se sont donné l'objectif de mesurer la prévalence des prescriptions d'antibiotiques, leur indication et leur pertinence dans trois hôpitaux généraux ruraux au moyen d'une étude de prévalence ponctuelle d'un jour. Méthodologie: Tous les antibiotiques prescrits aux patients hospitalisés ont été remis aux chercheurs par la pharmacie de trois hôpitaux généraux le 24 avril 2019. Les chercheurs ont analysé ces prescriptions au moyen de l'outil du sondage australien de prescriptions nationales d'antimicrobiens (NAPS, selon l'acronyme anglais). Un infectiologue les a évaluées, et chacune a été analysée. Résultats: Les chercheurs ont inclus 80 prescriptions remises à 58 patients hospitalisés. La prévalence de traitement antibiotique s'élevait à 58 lits sur 120 (48,3 %), et la pertinence globale, à 37 prescriptions sur 80 (46,3 %). Les antibiotiques les plus prescrits étaient la ceftriaxone (17; 21,3 %), dont 47,1 % étaient appropriés; la pipéracilline-tazobactam (dix; 12,5 %), dont 10,0 % étaient appropriés; et la moxifloxacine (neuf; 11,3 %), dont 0 % était appropriés. Les indications les plus courantes étaient les infections respiratoires : 36 (45,0 %), dont 36,1 % étaient appropriées; les infections de la peau et des tissus mous : 14 (17,5 %), dont 78,6 % étaient appropriées; et les infections urinaires : neuf (11,3 %), dont 11,1 % étaient appropriées. Des 80 prescriptions, 50 (62,5 %) comportaient une indication, et 71 (88,8 %) comportaient une date d'arrêt ou de révision. Conclusion: Les chercheurs ont observé une forte prévalence de traitements et une pertinence basse. La pertinence globale était plus basse que dans les hôpitaux urbains.

Effects of beer based marinades on the plasmalogen content and composition of grilled ruminant meats.

Plasmalogens are important phospholipids essential for maintaining cardiovascular and brain health. Ruminant meats are excellent dietary sources of plasmalogens. Globally, grilling remains a popular technique for preparing meats. However, little is known concerning how marination affects retention and quality of plasmalogens in grilled ruminant meats. Here we present information on effects of two unfiltered beer-based marinades infused with herbs and spices on plasmalogens in grilled beef and moose meats. Although total plasmalogen contents of marinated grilled meats were lower compared to unmarinated controls; compositionally, wheat ale- and India session ale-based marinades retained higher levels of PUFA plasmalogen PC (phosphatidylcholine) and PE (phosphatidylethanolamine) species enriched with ω3 and ω6 fatty acids in grilled moose meats. In grilled beef, significantly higher levels of plasmalogen PC species enriched with monounsaturated fatty acids (MUFA) and PUFA were retained by Wheat ale-based marinade. Furthermore, strong positive correlations were observed between antioxidants, polyphenols, oxygenated terpenes and plasmalogens retained in the marinated grilled meats which contrasted negative correlations with total oxidation status of the marinated grilled meats. These findings appear to suggest that the phenolics, oxygenated terpenes and antioxidants present in the beer-based marinades preserved these plasmalogens in marinated meats against degradation during grilling. In view of the benefits associated with plasmalogens and essential fatty acid consumption, marination of beef and moose meats with unfiltered beer-based marinades could be useful for retaining MUFA and PUFA-enriched plasmalogens, as well as preserving the nutritional quality of grilled beef and moose meats.

Assessing unfiltered beer-based marinades effects on ether and ester linked phosphatidylcholines and phosphatidylethanolamines in grilled beef and moose meat.

Ruminant meats contain ester and ether-linked phosphatidylcholines-(PC) and phosphatidylethanolamines-(PE) enriched with ω3 and ω6 polyunsaturated fatty acids-(PUFA) essential for human health and nutrition. Oxidative degradation of these lipids during grilling compromises meat quality and safety. The effect of marinades containing unfiltered session ales, herbs and spices on these lipids in grilled beef and moose meat was investigated in current study. Marination preserved (P < 0.05) ester and ether linked PUFA-enriched PC and PE in moose, and PUFA-enriched ether PC and diacyl PE in beef against oxidative degradation. Furthermore, India ale-based marinated meats retained higher (P < 0.05) PUFA-enriched lysophosphatidylcholines-(LPC) and lysophosphatidylethanolamines-(LPE) compared to Wheat ale-based marinated meats. The preserved PUFA-enriched lipids were positively correlated with phenolics, oxygenated terpenes, and antioxidants present in the marinades, and negatively correlated to oxidation status. These findings appear to suggest that unfiltered beer-based marination could be a useful precooking technique to increase dietary access and consumption of essential fatty acids while preserving grilled meat nutritional quality and safety.

Dataset showing the relationship between terpenes, antioxidants and polyphenols in protecting ester and ether linked glycerophospholipids of grilled beef and moose meat marinated with unfiltered beer from oxidation.

This article presents the associated data set in the research article entitled "Assessing beer-based marinades effects on ether and ester linked phosphatidylcholines and phosphatidylethanolamines in grilled beef and moose meat" published in Meat Science [1], demonstrating the use of unfiltered beer-based marinades in improving the nutritional quality of grilled ruminant meat by suppressing the degradation of health-promoting ester and ether-linked PC and PE the most predominant glycerophospholipids (GPL) in meat. High throughput lipidomics analysis was conducted using high-resolution accurate mass tandem mass spectrometry (UHPLC-HRAMS/MS-MS) to profile the meat lipids following marination and grilling. The marinades were composed of a combination of unfiltered beers, fruits, herbs and spices. The data presented show the retention levels of ether as well as ester linked PC and PE molecular species; Pearson's correlations for the associations between antioxidants, phenolics, volatile oxygenated terpenes, oxidation status and preserved phospholipid species in the marinated grilled meats. There are many studies demonstrating cooking effects on fatty acid composition of meat phospholipids in the literature. However, information on how marination and grilling affects intact ether and ester linked PC and PE composition in grilled ruminant meats is limited. As such, this dataset provides useful information on the preservation of ruminant meat ester and ether-linked glycerophospholipid composition following marination with unfiltered beer-based marinades and meat preparation via grilling. Specifically, this data demonstrate the preservation of ether and ester linked PC and PE enriched with essential ω3 and ω6 fatty acids from degradation during grilling. For additional insights see [1] DOI: 10.1016/j.meatsci.2020.108271.

Novel unfiltered beer-based marinades to improve the nutritional quality, safety, and sensory perception of grilled ruminant meats.

Ruminant meat is considered an excellent source of proteins, dietary fatty acids and essential minerals. Grilling is a popular cooking method; however, the high temperatures employ could modify the grilled meat quality and safety. In this study, the effects of novel beer-based marinades infused with herbs and spices on the quality, safety, and sensory perception of grilled beef and moose meat is examined. Unmarinated meat showed high content of volatile lipid oxidation and Maillard reaction products compared to the marinated samples, which contained higher number and abundance of terpenes and sulfur based compounds. Strong relationships between Maillard products and heterocyclic amines formation, as well as between volatile terpenes and the lipophilic antioxidant activity, were observed in the grilled meats. The findings suggest the unfiltered beer-based marinades were effective in reducing lipid oxidation and Maillard reaction compounds formation, while improving the nutritional quality, safety and sensory preference of grilled ruminant meats.

Rapid determination of heterocyclic amines in ruminant meats using accelerated solvent extraction and ultra-high performance liquid chromatograph-mass spectrometry.

Cooking techniques such as grilling confer several benefits to meat during food preparation including improved palatability, digestibility, preservation, and safety, as well as enhancing the sensory characteristics and net nutritional gain. However, grilling can lead to the formation of harmful compounds such heterocyclic amines (HCAs). HCAs are potent carcinogenic and mutagenic nitrogen containing compounds produced during certain cooking conditions of protein rich foods. Dietary intake of HCAs is associated with increased risk factors for cancers in humans. As such, there is overwhelming interest in identifying improved methods for rapid and accurate determination of heterocyclic amines in food matrices that is sensitive and avoids exhaustive sample preparation steps. Herein, we describe an approach that involves first extracting HCAs by pressurized accelerated solvent extractor using methanol as solvent, followed by addition of internal standard and quantification of HCAs by ultra-high performance liquid chromatography-high resolution accurate mass spectrometric detection (UHPLC-HRAMS). This method is fast, accurate, reproducible and does not require exhaustive sample pre-treatments prior to UHPLC-HRAMS analysis compared to existing/traditional methods for HCA analysis. •The method is automated, fast and uses tunable pressurized liquid extractor to selectively extract HCAs•Method does not require exhaustive cleanup and preconcentration steps prior to UHPLC/HRAMS analysis of HCAs•Validation showed method to be accurate, precise, and useful for routine multi-sample HCA analyses.

Dataset on improved nutritional quality and safety of grilled marinated and unmarinated ruminant meat using novel unfiltered beer-based marinades.

Objective of this data isn brief article is to present the associated data set regarding the revised article entitled "Unfiltered beer based marinades reduced exposure to carcinogens and suppressed conjugated fatty acid oxidation in grilled meats" recommended for publication in Food Control [1]. Grill food safety and quality is a major concern globally. Here in we present data demonstrating the use of novel unfiltered beer based marinades in improving the nutritional quality and safety of grilled ruminant meat. Grilling can lead to the formation of harmful compounds and modify the functional lipids in meats via oxidation, thereby affecting the nutritional quality and safety of the finished product. Lipid oxidation is a deteriorative process involving the degradation of lipid double bonds and the formation of new compounds. Some of these compounds can result in reduced meat quality and off-flavours affecting the sensory, nutritional quality and safety of grilled meat. Unfiltered beers, herbs and spices are known to be excellent sources of antioxidants and polyphenols which can suppress oxidation of functional lipids in grilled meat. Novel unfiltered beer based marinades were developed and used to marinate ruminant meat (beef and moose) prior to grilling. The effect of marination on the fatty acid profile, including saturated, mono- and polyunsaturated fatty acids, of grilled meat was analyzed by gas chromatography/mass spectrometry (GC/MS). In this data in brief article, we include 3 tables containing the fatty acid composition of unmarinated and marinated grilled ruminant meats (beef and moose), a figure showing the percent distribution of grilled meat fatty acid classes, and 2 figures on Pearson's correlation for the associations between phenolic contents, oxidation status and total conjugated linolenic acid (CLA) content. To the best of our knowledge, there is a paucity of information in the literature on the fatty acid composition of wild Cervid meat following preparation by grilling. Grill food safety and nutritional quality is of significant interest to researchers and consumers in the scientific and general food science communities. This article provides data on the fatty composition of grilled moose meat and could be of value to fill the paucity of information currently available in the scientific community on the observed fatty acid composition of grill moose meat. Furthermore, the article presents data on the effects of beer based marinade formulations on the quality of the fatty acid composition of grilled ruminant meats (beef and moose). The growing awareness of the benefits of dietary fatty acids in enhancing personal and population health by reducing the risk factors for cardiovascular diseases and neurodegenerative disorders means that consumers demand meat products with improved fatty acid composition [2,3]. Cervids such as moose (Alces alces) are popular as superior sources of low-fat lean meat with balanced omega 6:3 essential fatty acids compared to traditional farm raised or domesticated meat animals due to the forage they consume as a normal part of their diet [2,4,5]. Furthermore, session ale beers is currently a global phenomenon derived from unique combinations of grains, hops, fruits and herbs to produce low alcohol by volume beers with unique flavors popular among consumers. Two unfiltered session beers were used as base ingredients to produce two novel marinades infused with unique combination of antioxidant rich herbs and spices as a suitable system for the production of grilled foods with enhanced nutritional and sensory characteristics. Whilst there are a limited number of studies in the literature that have used unfiltered beers to evaluate the effects of these beers on suppression of lipid oxidation in grilled meat, none to the best of our knowledge has evaluated the effect of antioxidant rich unfiltered beer based marinades on fatty acid composition of grilled meat systems [6] [7]. As such, this data set presents the concept of using craft beers (specifically session ales) infused with unique combination of herbs and spices to produce unfiltered beer base marinades with enhanced ability to improve grill food sensory attributes and quality, and demonstrates that novel formulations of popular unfiltered India session ale and wheat ale based marinades infused with unique combinations of herbs and spices could be used to marinate beef and moose meats prior to grilling to preserve meat lipids including anticarcinogenic linoleic acid and essential ω3 and ω6 fatty acids.

Dataset of the volatile compounds detected in unmarinated and marinated grilled ruminant meats with novel unfiltered beer-based marinades to improve their nutritional quality, safety, and sensory perception.

The objective of this data in brief article is to present the associated data set regarding the published paper Novel unfiltered beer-based marinades to improve the nutritional quality, safety, and sensory perception of grilled ruminant meats in Food Chemistry [1]. Grilling is a popular cooking method; however, the high temperatures required can modify grilled meat quality and safety. In this data set, we include 5 tables containing the volatile composition of unmarinated and marinated grilled ruminant meat (beef and moose). Novel unfiltered beer-based marinades infused with herbs and spices were used for meat marination, and the volatiles present in the meat following grilling extracted by solid phase microextraction and subsequently analysed by gas chromatography/mass spectrometry (SPME-GC/MS). The volatile profile includes alcohols, aldehydes, ketones, acids, esters, alkylfurans, nitrogenated compounds, terpenes (mono-, sesqui- and oxygenated terpenes), sulfur derivatives, benzene derivatives, and phenol derivatives. This dataset provides valuable information on meat volatile composition useful to understand certain aspects of the quality and safety of grilled meat following preparation with unfiltered beer-based marinades. For more insight please see [1].

Impact of Type 2 Myocardial Infarction (MI) on Hospital-Level MI Outcomes: Implications for Quality and Public Reporting.

BACKGROUND: The International Classification of Diseases (ICD) coding system does not recognize type 2 myocardial infarction (MI) as a separate entity; therefore, patients with type 2 MI continue to be categorized under the general umbrella of non-ST-segment-elevation myocardial infarction (NSTEMI). We aim to evaluate the impact of type 2 MI on hospital-level NSTEMI metrics and discuss the implications for quality and public reporting. METHODS AND RESULTS: We conducted a single-center retrospective analysis of 1318 patients discharged with a diagnosis of NSTEMI between July 2013 and October 2014. The Third Universal Definition was used to define type 1 and type 2 MI. Weighted Kaplan-Meier curves were used to analyze risk of mortality and readmission. Overall, 1039 patients met NSTEMI criteria per the Third Universal Definition; of those, 264 (25.4%) had type 2 MI. Patients with type 2 MI were older, were more likely to have chronic kidney disease, and had lower peak troponin levels. Compared with type 1 MI patients, those with type 2 MI had higher inpatient mortality (17.4% versus 4.7%, P<0.0001) and were more likely to die from noncardiovascular causes (71.7% versus 25.0%, P<0.0001). Despite weighting for patient characteristics and discharge medications, patients with type 2 MI had higher mortality at both 30 days (risk ratio: 3.63; 95% confidence interval, 1.67-7.88) and 1 year (risk ratio: 1.98; 95% confidence interval, 1.44-2.73) after discharge. Type 2 MI was also associated with a lower 30-day cardiovascular-related readmission (risk ratio: 0.49; 95% confidence interval, 0.12-2.06). CONCLUSIONS: NSTEMI metrics are significantly affected by type 2 MI patients. Type 2 MI patients have distinct etiologies, are managed differently, and have higher mortality compared with patients with type 1 MI. Moving forward, it may be appropriate to exclude type 2 MI data from NSTEMI quality metrics.

Meta-analysis of transfemoral TAVR versus surgical aortic valve replacement.

BACKGROUND: In the recently concluded PARTNER 2 trial, TF-TAVR cohort was shown to have lower risks of death or disabling strokes as compared to SAVR, whereas the outcomes with transthoracic TAVR were comparable with SAVR. METHODS: We searched PubMed, EMBASE, Web of Science, and Google Scholar for all comparison studies between TAVR and SAVR and mortality as an outcome, irrespective of surgical risk. Randomized controlled trials and propensity-score-matched cohort studies that used a transfemoral approach exclusively or stratified results by route of access and reported data for TF-TAVR patients were eligible for inclusion. Outcomes of interest included 30-day and 1-year mortality, and 30-day complications. If significant heterogeneity was found in the random effects meta-analyses, a sensitivity analysis which individually removed each study was conducted. RESULTS: Seven studies reported results on TF-TAVR. Compared with SAVR, TF-TAVR had comparable 30-day mortality (RR 0.79, 95% CI 0.58, 1.06), 1-year mortality (RR 0.91, 95% CI 0.78, 1.08) and 30-day risk of bleeding (RR 0.70, 95% CI 0.31, 1.57). However, TF-TAVR was associated with lower 30-day risks of atrial fibrillation (RR 0.28, 95% CI 0.17, 0.45), acute kidney injury (RR 0.38, 95% CI 0.20, 0.71), and myocardial infarction (RR 0.41, 95% CI 0.23, 0.75) at a cost of higher incidences of vascular complications (RR 6.10, 95% CI 2.92, 12.73) and pacemaker implantations (RR 3.29, 95% CI 1.41, 7.65). CONCLUSIONS: TF-TAVR is associated with lower 30-day risks of myocardial infarction compared to SAVR. Further studies are required to investigate the role of myocardial injury on overall TF-TAVR outcomes.