Tools for detection of Mycoplasma amphoriforme: a primary respiratory pathogen?

Mycoplasma amphoriforme is a recently described organism isolated from the respiratory tracts of patients with immunodeficiency and evidence of chronic infection. Novel assays for the molecular detection of the organism by real-time quantitative PCRs (qPCRs) targeting the uracil DNA glycosylase gene (udg) or the 23S rRNA gene are described here. The analytical sensitivities are similar to the existing conventional M. amphoriforme 16S rRNA gene PCR, with the advantage of being species specific, rapid, and quantitative. By using these techniques, we demonstrate the presence of this organism in 17 (19.3%) primary antibody-deficient (PAD) patients, 4 (5%) adults with lower respiratory tract infection, 1 (2.6%) sputum sample from a patient attending a chest clinic, and 23 (0.21%) samples submitted for viral diagnosis of respiratory infection, but not in normal adult control subjects. These data show the presence of this microorganism in respiratory patients and suggest that M. amphoriforme may infect both immunocompetent and immunocompromised people. Further studies to characterize this organism are required, and this report provides the tools that may be used by other research groups to investigate its pathogenic potential.

Medical students as health workers during the COVID-19 pandemic.

BACKGROUND: We describe efforts at one tertiary university teaching hospital to rapidly recruit, train and deploy medical students into paid clinical support worker roles during the COVID-19 pandemic. METHODS: Recruitment was conducted by means of a single email outlining the emergent clinical situation and specifying role descriptions, terms and conditions, and temporary staff enrolment paperwork. Applicants could begin work provided they were in good standing and received departmental orientation. Student representatives liaised with teaching faculty and participating departments. Roles were modified in response to student and departmental feedback. RESULTS: Between 25 December 2020 and 9 March 2021, 189 students contributed 1335 shifts, providing 10 651 hours of clinical care in total. The median number of shifts worked per student was 6 (mean: 7; range: 1-35). Departmental leaders attested that the student workers eased the burden on hospital nursing teams. CONCLUSION: Medical students contributed usefully and safely to the provision of healthcare within well-defined and supervised clinical support worker roles. We propose a model of working which could be adapted in the event of future pandemics or major incidents. The pedagogical value to medical students of working in clinical support roles warrants closer evaluation.

A randomized crossover study to determine the effect of a 30° head-up versus a supine position on the functional residual capacity of term parturients.

BACKGROUND: Airway management continues to pose challenges to the obstetric anesthesiologist. Functional residual capacity (FRC), which acts as an oxygen reservoir, is reduced from the second trimester onwards and is exacerbated in the supine position. Mechanisms to increase FRC may delay the onset of hypoxemia during periods of apnea. Values for changes in FRC in term parturients in semierect positions are unknown. We hypothesized that the FRC of healthy term parturients would increase significantly in the 30° head-up position in comparison with the supine position. METHODS: Twenty-two healthy term parturients were recruited. Initial screening spirometry was performed to exclude undiagnosed respiratory disease. FRC was measured using the helium dilution technique in the supine, 30° head-up, and sitting erect positions. Subjects were randomized to sequence of position testing order. Noninvasive systolic blood pressure, heart rate, and oxygen saturation were measured twice in each testing position. RESULTS: Results from 20 subjects were analyzed. The spirometry results for all subjects were within predicted normal reference intervals. FRC measurements differed significantly (P<0.001) among all positions. FRC increased by a mean of 188 mL (95% confidence interval 18 to 358 mL) from the supine to the 30° head-up position (P=0.03). There were no significant differences in vital signs among testing positions (P>0.16). CONCLUSIONS: We have demonstrated that the FRC of healthy term parturients increases significantly in the 30° head-up position in comparison with supine.

No such thing as a free lunch?

BACKGROUND: High-quality, out-of-classroom interactions between students and teachers help to develop communities of learning. In medicine, they contribute to the professionalisation of students. METHODS: We designed a novel student-faculty member lunch scheme for first-year medical students at our institution. Students received a free lunch in groups of six with a faculty member 'hosting' and paying for lunch, with the cost reimbursed by the medical school. Focus groups with students were used to evaluate the impact of the intervention. RESULTS: Approximately half of all Year-1 students signed up for the scheme (n = 153). Twenty faculty members hosted one or more lunches. Focus group analysis revealed that attendees felt more positively about individual faculty members and the institution as a result of participation, and that it helped the process of induction and transition into medical school, but that it suffered from a lack of continuing contact. Out-of-classroom interactions between students and teachers help to develop communities of learning CONCLUSIONS: This intervention encouraged positive student-faculty member interactions, albeit with a relatively small group of students. It did not seem to encourage longitudinal staff-student relationships, however, which is a key limitation.

A structured tool for delivering feedback on medical student clinical clerkings.

This article was migrated. The article was marked as recommended. Introduction: The initial history and examination is a fundamental aspect of clinical practice. Most medical students cultivate this skill through regular undertaking of 'clerkings' during their clinical placements. We designed a written, structured, proforma-based approach to delivery of feedback on student clerkings which also promoted the undertaking of a 'complete clerking' encouraging students to maintain a whole-system holistic approach. Within this paper, we present our findings following its introduction at a London teaching hospital. Methods: Sixty-one medical students on their first clinical attachment within acute medicine were asked to submit at least one full medical clerking for objective appraisal using the structured clerking feedback proforma by a clinical teaching fellow. Students completed a 'pre' and 'post' assessment using Likert Scales at the time of receiving their clerking feedback. Structured interviews of randomly selected students and senior medical educators were also undertaken. Results: Following introduction of the structured feedback proforma, there was a significant increase across all indices of student-perceived utility and satisfaction compared to previously received feedback (which was mostly ad-hoc verbal). Using Likert Scales (1 to 10: 1 representing least effect and 10 representing greatest effect) student assessment of usefulness was 9.0 (versus 6.34 for previous feedback); likelihood of influencing future practice was 8.8 (versus 6.47); extent to which it reinforced the message of a complete clerking was 9.5 (versus 6.13) and extent to which the feedback would encourage them to undertake complete clerkings was 9.0. Free text comments and subsequent interviews of randomly selected students and senior medical educators reinforced the positive perception of this approach. Conclusions: The introduction of a structured clerking feedback proforma can improve the quality and utility of the feedback delivered to medical students on their acute medical clerkings and can promote and reinforce the value of maintaining a whole-system holistic approach.

The effect of inhaled tiotropium bromide on lung mucociliary clearance in patients with COPD.

STUDY OBJECTIVE: To assess the effects of tiotropium on lung mucociliary clearance in COPD. DESIGN: Randomized, double-blind, placebo-controlled, parallel-group study. SETTING: Outpatients of an urban-area university teaching hospital. PATIENTS: Thirty-four patients with COPD aged 40 to 75 years classified equally into two groups. INTERVENTION: Single (18 microg) daily dose of tiotropium inhalation capsules or of placebo for 21 days. METHODS: Six-hour tracheobronchial clearance of inhaled 99mTc-labeled polystyrene particles using a 48-h retention measurement to determine the "nontracheobronchial" deposition fraction. RESULTS: Test radioaerosol penetration into the lungs increased significantly (p < 0.003) as did FEV1 (p < 0.006) in the tiotropium-treated patients, but measured mucociliary clearance was not significantly changed despite the increased pathway length for clearance (mean +/- SE area under the tracheobronchial retention curve changed from 442 +/- 22 to 453 +/- 20%/h). Smaller (nonsignificant) decreases of radioaerosol penetration and FEV1 occurred in the placebo group together with a small (nonsignificant) decrease in the area under the retention curve. CONCLUSION: Twenty-one days of inhaled tiotropium, 18 microg/d, as a dry powder does not retard mucus clearance from the lungs.

Effect of aromatics on lung mucociliary clearance in patients with chronic airways obstruction.

BACKGROUND: Complementary and alternative medicine have become an increasingly topical theme in respiratory medicine. Aromatics are a commonly used ingredient in a number of proprietary medicines. It is well established that lung mucus clearance is impaired in patients with chronic airways obstruction. This study investigated whether aromatics delivered by inunction could be objectively shown to enhance lung clearance. METHODS: We studied 12 patients with chronic bronchitic with a mean standard error (SE) age of 67 (2) years (mean [SE] tobacco consumption history of 64 [12] pack-years). We used a randomized, single-blinded, placebo-controlled crossover trial within patient design assessing the effect of 7.5 g of aromatics inunction (compared to a "no-treatment baseline" and to a petrolatum "placebo") on lung mucus clearance measured by a standard radioaerosol technique. RESULTS: Aromatic treatment significantly enhanced clearance at two time points 30 (p < 0.05) and 60 (p < 0.02) minutes postradioaerosol inhalation but had no demonstrable further effect over the following 5 hours despite further application of the inunction. The clearance improvement (relative to a baseline) observed during the first hour of testing was significantly correlated (p < 0.01) with the concentration level of aromatics. CONCLUSION: Our data, thus, provide objective evidence of a positive effect of aromatics inunction on mucus clearance in chronic airways obstruction.