Current issues in reprocessing of medical and surgical instruments.

By the very nature of reusability, processing for reusable medical devices has been and continues to be risk prone. Healthcare systems have historically been slow to embed best practice quality control elements into everyday reprocessing workflow. The identification of weak points and an openness to change are necessary to allow for a proactive culture of safety. Infection preventionists can play key roles in establishing and maintaining related quality control and oversight.

Identificación oportuna del sangrado anormal postparto: método gravimétrico para cuantificar sangrado. Proyecto de mejora / Timely detection of abnormal postpartum bleeding: use of the gravimetric method to quantify bleeding. Improvement project

Resumen: Introducción: La hemorragia postparto es una entidad que no se detecta oportunamente con la estimación visual del sangrado. Material y métodos: Se implementó un protocolo estandarizado de cuantificación gravimétrica del sangrado postparto en pacientes sometidas a cesárea. Un estudio prospectivo, comparativo, no aleatorizado determinó el cumplimiento del protocolo, frecuencia proporcional del sangrado postparto anormal, basal y postintervención de mejora; y asociación entre metodologías de evaluación del sangrado y clasificación del sangrado. Pruebas z, Fisher, p < 0.05 significativa. Resultados: El cumplimiento del protocolo estandarizado fue 53% (± 0.18). En el grupo postintervención de mejora, la frecuencia del sangrado anormal postparto se incrementó en 30% con respecto al grupo basal (p < 0.05). Se demostró asociación significativa entre la cuantificación gravimétrica del sangrado postparto, y el sangrado postparto anormal. Conclusión: La implementación del protocolo de cuantificación gravimétrica del sangrado postparto fue posible, permitió mejorar la capacidad de identificación del sangrado postparto anormal en pacientes sometidas a cesárea.

Abstract: Introduction: Postpartum hemorrhage is a complication, that is not timely detected with the visual estimation of bleeding. Material and methods: A standardized protocol for the gravimetric quantification of postpartum bleeding was implemented to improve the ability to identify abnormal bleeding in patients undergoing caesarean section. A prospective, comparative, non-randomized study evaluated the improvement intervention. Compliance with the protocol, classification of postpartum bleeding before and after intervention; and the association between methodologies for assessing bleeding and postpartum bleeding classification were determined. Fisher z tests, p < 0.05 significant. Results: Compliance with the standardized protocol was 53% (± 0.18). In the post-intervention group, the frequency of abnormal postpartum bleeding increased by 30% with respect to the baseline group (p < 0.05). A significant association was demonstrated between gravimetric quantification of postpartum bleeding and abnormal postpartum bleeding. Conclusion: The implementation of the protocol for the gravimetric quantification of postpartum bleeding was possible. It improved the ability to identify abnormal postpartum bleeding in patients undergoing cesarean section.

Rates of discontinuation and non-publication of trials for the pharmacologic treatment of alcohol use disorder.

Objective: With approximately 15 million individuals in the United States meeting criteria for Alcohol Use Disorder (AUD), advancing effective medication-assisted treatment options is crucial. This advancement stems from the publication of clinical trial (CT) results. The primary objective of this study was to assess the rates of discontinuation and non-publication of results in CTs focused on the pharmacologic treatment of AUD and to assess associated factors. Design: A cross-sectional study was completed after acquiring trials focused on AUD within the ClinicalTrials.gov database. Inclusion criteria for CTs were the use of a pharmaceutical intervention with an outcome measure of alcohol intake or craving, conducted between October 2008 through September 2018. The primary outcome measures were the frequency of trial discontinuation and non-publication. Discontinuation was assessed as the listed status on ClinicalTrials.gov. Publications were identified through verification of listings on ClinicalTrials.gov, or via searches of PubMed, Embase, and Google Scholar. If publications were not found, correspondence to trial contacts were sent. Data analysis occurred on December 5th, 2020. Results: Of 235 trials returned from the search, 87 met inclusion criteria. Our study found that 12.6% (11) of CTs involving pharmaceutical treatments for AUD were prematurely terminated, and 39.1% (34) had no published results. Recruitment and lower cutoff of targeted age groups were significantly associated with discontinuation and non-publication, respectively. Conclusions: Scientific evidence advances faster when all results are known-furthering the progress of positive studies, while avoiding duplicative efforts to test the same hypotheses with the same methods, thereby reducing scientific waste. Given the number of unpublished AUD trials, potentially useful information regarding treatment for individuals with AUD may be inaccessible to clinicians while also adding to the abundance of research waste.Key pointsQuestion: What are the rates of discontinuation or non-publication of clinical trials for pharmacological treatments for AUD and associated factors?Findings: Among 87 trials, 11 (12.6%) were prematurely terminated and 34 (39.1%) did not reach publication, with trials that included participants 21 years and older more likely to reach publication than those with younger participants.Meaning: Low publication rates of CTs for pharmacological treatments of AUD may (1) stunt the advancement of AUD research, (2) decrease the value in funding AUD research from government entities, and (3) needlessly expose participants to potentially harmful interventions.

Use of person-centred language among scientific research focused on childhood obesity.

BACKGROUND: Stigma towards children with obesity can begin as early as 3 years old, leading to increased risk for poorer mental health outcomes and lower quality of life. This includes discriminatory language used by peers and adults, which may be compounded by use within the medical community and in published research. OBJECTIVES: Our primary objective was to investigate adherence to person-centred language (PCL) in childhood obesity-related medical publications. METHODS: We searched PubMed for childhood obesity-related articles from 2018 through 2020, from journals frequently publishing childhood-obesity-related research. Articles were randomized and searched for a list of predetermined, stigmatizing terms. RESULTS: Of the sample of 300 articles, only 21.7% were adherent to PCL guidelines. The most frequent labels found were 'obese' appearing in 70.33% of articles and 'overweight' in 63.7%. Labels such as 'chubby', 'large', and 'fat' were less common, but still appeared in the medical literature. CONCLUSIONS: A majority of childhood obesity-related articles did not adhere to PCL guidelines. Given the negative effects of stigma among children with obesity, it is imperative to advocate for PCL use within the medical community. Increased stringency by journal editors and publishers may be the next step in this process.

Deviations in criminal filings of child abuse and neglect during COVID-19 from forecasted models: An analysis of the state of Oklahoma, USA.

BACKGROUND: The COVID-19 pandemic has contributed to risk factors for child abuse and neglect and disrupted conventional abuse surveillance. OBJECTIVE: The goal of this study was to assess how counts of criminal charges have been affected by COVID-19 social distancing measures and related policy changes. PARTICIPANTS AND SETTING: This study used publicly available court filings pertaining to child abuse and neglect from Jan 1, 2010 to June 30, 2020. METHODS: Autoregressive integrated moving average (ARIMA) algorithms were constructed with case data from January 2010 to January 2020 to forecast trends in criminal charges for February to June 2020. These forecasted values were then compared to actual charges filed for this time period. RESULTS: Criminal cases filed between February and June 2020, had an overall 25.7 percent lower average than forecasted. All individual months had progressively lower cases than forecasted with the exception of March. June had the largest deviation from forecasted with 60.1 percent fewer cases than predicted. CONCLUSIONS: Although risk factors for child abuse have increased due to COVID-19, these findings demonstrate a declining trend in child abuse charges. Rather than a decreasing incidence of child abuse and neglect, it is more likely that less cases are being reported. The results warrant immediate action and further investigation in order to address the dangers this pandemic poses for children in abusive situations.

Reprocessing Flexible Endoscopes in the Otolaryngology Clinic.

Reprocessing a flexible endoscope is a complex multistep process. Attention to detail is essential for patient safety. Physicians need to empower their staff to function as guardians and advocates for best practices in endoscope reprocessing. Current best practice standards and guidelines for flexible endoscope reprocessing in the United States have been led by the Society of Gastroenterology Nurses and Associates, the Association for the Advancement of Medical Instrumentation, the Association of periOperative Registered Nurses, American Society for Gastrointestinal Endoscopy, and Multisociety Guideline. This article focuses on important aspects and current best practices for flexible endoscope cleaning and high-level disinfection.

Gravitational waves: search results, data analysis and parameter estimation: Amaldi 10 Parallel session C2.

The Amaldi 10 Parallel Session C2 on gravitational wave (GW) search results, data analysis and parameter estimation included three lively sessions of lectures by 13 presenters, and 34 posters. The talks and posters covered a huge range of material, including results and analysis techniques for ground-based GW detectors, targeting anticipated signals from different astrophysical sources: compact binary inspiral, merger and ringdown; GW bursts from intermediate mass binary black hole mergers, cosmic string cusps, core-collapse supernovae, and other unmodeled sources; continuous waves from spinning neutron stars; and a stochastic GW background. There was considerable emphasis on Bayesian techniques for estimating the parameters of coalescing compact binary systems from the gravitational waveforms extracted from the data from the advanced detector network. This included methods to distinguish deviations of the signals from what is expected in the context of General Relativity.

Alterations in the salivary proteome associated with periodontitis.

AIM: To identify changes in the salivary proteome associated with active periodontitis. MATERIALS AND METHODS: Quantitative proteomics (two-dimensional sodium dodecyl sulphate polyacrylamide gel electrophoresis) was used to investigate whole saliva from individuals with severe periodontitis and their proteomic profiles before and after periodontal treatment were compared. RESULTS: A comparison of 128 proteins across all saliva samples identified 15 protein spots with altered abundance. The predominant alteration observed was an increase in the abundance of the S100 proteins S100A8/A9/A6. Of the remaining proteins with altered abundance, haptoglobin, prolactin inducible protein and parotid secretory protein have previously been associated with host defence. CONCLUSION: These results highlight the predominant involvement of S100 proteins in the host response during periodontitis, identify host defence components that have not been linked previously to this disease and suggest new potential biomarkers for monitoring disease activity in periodontitis.

"If it hurts you, then it is not a joke": adolescents' ideas about girls' and boys' use and experience of abusive behavior in dating relationships.

This study examined adolescents' ideas about girls' and boys' use and experience of physical and psychological abuse in heterosexual dating relationships. Canadian high school students who were enrolled in Grades 9 and 11 took part in single-gender focus groups. Eight themes emerged from the analysis. The themes highlight the importance teenagers place on context for defining specific behaviors as abusive. They also underscore gender differences in the criteria adolescents use to make these judgments, in the forms of abusive behavior teenagers typically use in a dating relationship, and in the reasons for youths' declining use of physical abuse and increasing use of psychological abuse. These views have important implications for future research and for programs targeting adolescent dating violence.

JAM-C is a component of desmosomes and a ligand for CD11b/CD18-mediated neutrophil transepithelial migration.

Neutrophil (PMN) transepithelial migration is dependent on the leukocyte beta(2) integrin CD11b/CD18, yet the identity of epithelial counterreceptors remain elusive. Recently, a JAM protein family member termed JAM-C was implicated in leukocyte adhesive interactions; however, its expression in epithelia and role in PMN-epithelial interactions are unknown. Here, we demonstrate that JAM-C is abundantly expressed basolaterally in intestinal epithelia and localizes to desmosomes but not tight junctions. Desmosomal localization of JAM-C was further confirmed by experiments aimed at selective disruption of tight junctions and desmosomes. In assays of PMN transepithelial migration, both JAM-C mAbs and JAM-C/Fc chimeras significantly inhibited the rate of PMN transmigration. Additional experiments revealed specific binding of JAM-C to CD11b/CD18 and provided evidence of other epithelial ligands for CD11b/CD18. These findings represent the first demonstration of direct adhesive interactions between PMN and epithelial intercellular junctions (desmosomes) that regulate PMN transepithelial migration and also suggest that JAM-C may play a role in desmosomal structure/function.