Whole genome sequencing reveals antimicrobial resistance determinants (AMR genes) of Salmonella enterica recovered from raw chicken and ready-to-eat leaves imported into England between 2014 and 2019.

AIMS: To compare the antimicrobial resistance (AMR) genes in a genetically diverse group of Salmonella enterica recovered from foods imported into England between 2014 and 2018. METHODS AND RESULTS: Whole genome sequence was used to detect AMR genes or chromosomal mutations associated with AMR in Salmonella recovered from edible leaves imported from Asia (n = 115) as compared to Salmonella (n = 231) isolated from raw chicken, 74% originated from South America. Among isolates from edible leaves, three (3%) showed resistance to at least one antimicrobial agent, two (2%) of which were multidrug resistant (MDR, resistance to three or more antimicrobial classes). Resistance to at least one antimicrobial agent was detected in 214 (93%) in the chicken isolates, with 164 (71%) showing MDR. Genetic diversity and AMR profiles were highly heterogeneous across the different serovars. CONCLUSIONS: Resistance was rare among the Salmonella isolates from edible leaves but common (including MDR) among those from raw chicken. SIGNIFICANCE AND IMPACT OF THE STUDY: Surveillance of AMR in imported foods is essential for monitoring the risk of transmission of resistance from the food chain to humans and provides added public health value to pre-existing controls of the food chain.

Unmet supportive care needs of breast, colorectal and testicular cancer survivors in the first 8 months post primary treatment: A prospective longitudinal survey.

OBJECTIVES: To explore the supportive care needs of cancer survivors, the characteristics of patients with high levels of unmet need, changes in unmet need after treatment ends and differences in unmet needs of breast, colorectal and testicular survivors. METHODS: The method used was a prospective longitudinal mailed survey. Unmet needs, measured by 25-item modified Cancer Survivors Unmet Needs survey at baseline (immediately post-treatment) and 8 months later, were analysed descriptively. RESULTS: Of 434 breast, 186 colorectal and 75 testicular patients responding at baseline, 56.2%, 65.6% and 50.7%, respectively, had no unmet needs, the top decile having ≥10 (breast) or seven (colorectal and testicular) different needs and seven different unmet needs. The most frequently reported unmet need (all groups) was fear of cancer recurrence. Unmet needs fell significantly at 8 months for breast patients. Some patients reported new needs. Needs were lowest amongst colorectal survivors and differed between the three groups. Higher levels of unmet needs (breast and colorectal) were associated with having had chemotherapy. CONCLUSION: Most survivors reported few unmet needs, but a small proportion have persisting or emerging needs. Routine or regular monitoring of unmet needs is required so that healthcare professionals can deliver personalised care based on individual needs, preferences and circumstances.

MDMA toxicity: management of acute and life-threatening presentations.

Since the 1980s, methylenedioxymethamphetamine (MDMA) has been a popular recreational drug, used particularly among those who attend raves and nightclubs. Over the past 3 years, the popularity of this drug has once again increased and there has been an associated rise in deaths. The pathophysiology of MDMA toxicity is complex and much remains to be understood. This article aims to increase readers' knowledge of patient presentations, the pathophysiology behind life-threatening toxicity, current treatments and the use of extracorporeal membrane oxygenation as a potential future treatment.

What's New in Diabetes Research?

The drive to discover new and innovative solutions for managing diabetes is international. The Diabetes UK Professional Conference, held in Glasgow in March 2016, presented many of these advances and developments, including new insights into diabulimia; the role of mindfulness in diabetes management; risk factors for Type 2 diabetes in the younger generations; and new discoveries in glucose monitoring and management. Through interviews conducted with the presenters of these topics, Dr. Nicola Davies explores the latest innovations in diabetes research.

Health promotion and information provision during long-term follow-up for childhood cancer survivors: A service evaluation.

Health promotion is an important component of long-term follow-up (LTFU) care for childhood cancer survivors (CCS). However, little information exists about how survivors perceive their own health promotion needs. As part of a service evaluation, 51 CCS who had previously attended the LTFU clinic took part in a single semistructured interview to seek their views on information they had received regarding late adverse effects (LAEs) of treatment, the purpose of LTFU, and the provision of health promotion information. Although most (93%) CCS were satisfied with the information received about LAEs, 37% desired further details. Over half (59%) believed that the purpose of LTFU was to screen for LAEs, whereas 31% felt that it was to check for relapse. No survivor reported health promotion to be an aim of LTFU; only 14% of CCS expected to receive healthy lifestyle advice, and fewer than 10% wanted dietary and physical activity advice. Most (88%) CCS felt that their hospital-based health care professional was best placed to give healthy lifestyle advice, but there was no consensus about the optimum timing for health promotion. CCS varied in their knowledge, needs, and wishes regarding LTFU care. The results of this evaluation strongly indicate that the profile of health promotion needs to be raised within our service and identifies issues that may be pertinent to similar services. Further research is needed to understand the views of CCS regarding health promotion and lifestyle behaviors, with the aim of tailoring and improving the delivery of effective health education to CCS.

Treating ST-elevation myocardial infarction.

Treatment of patients with acute ST-elevation myocardial infarction (STEMI) has moved from thrombolysis to primary percutaneous coronary intervention (PPCI) over the past 20 years. This is a result of evidence that the latter has superior long-term benefits for patients. However, there is little research on whether patients who present after the mandated time of less than 120 minutes from onset of signs and symptoms could benefit from primary thrombolysis followed by rescue percutaneous coronary intervention (PCI), referred to here as angiography. This article, which includes a case study, describes the pathophysiology of cardiovascular disease, acute coronary syndrome, and STEMI, and examines some of the literature that compares primary PCI to thrombolysis followed by angiography. It also highlights gaps in research, and encourages practitioners to consider administering thrombolysis to patients who do not present within 120 minutes of the onset of signs and symptoms of STEMI.

Views of childhood cancer survivors and their families on the provision and format of a treatment summary.

INTRODUCTION: Summaries of diagnosis, treatments, and their potential late adverse health effects (treatment summaries) are increasingly being provided routinely to survivors of childhood cancer. There is relatively little research into opinions of service users on the provision and format of treatment summaries. METHODS: Semistructured interviews were conducted with 24 survivors of childhood cancer, and 25 parents of 20 of these survivors (n=49) were asked to explore these issues. Survivors were aged 4 to 22 years, with a range of previous oncological diagnoses. The mean (range) interval since treatment completion was 4.5 (0.5 to 13) years. RESULTS: Twelve survivors (50%) and 16 parents (64%) fully supported the use of treatment summaries as: a memory aid, a reference tool for planned and emergency medical situations, life and financial planning, and to promote ownership of health. Four survivors felt they did not want, or did not need, a reminder of their medical past. Most participants (63% of survivors) desired a verbal explanation plus a written A4 paper treatment summary. However, other formats (wallet sized, audio guides) were suggested to address practical and individual needs raised by participants. CONCLUSIONS: Most service users would benefit from treatment summaries, although notably not all. The format and timing of the provision need to be carefully considered.

The effect of body image and mood on smoking cessation in women.

This article focuses on how nurses can encourage successful smoking cessation in women. Emphasis is placed on the effect of body image and mood on quitting and how knowledge of these barriers can equip nurses to provide appropriate support.

Alcohol misuse in adolescents.

Alcohol misuse in young people is of growing concern, even though alcohol consumption among adolescents has declined over recent years. Many 15 year olds have already consumed alcohol and adolsecents tend to consume large quantities of alcohol in one sitting. This article describes the problem of alcohol misuse in young people and the nurse's role in the prevention and treatment of alcohol misuse in this population. A stepped care, holistic approach is recommended, taking into consideration peer and family influence on alcohol misuse and the young person's motivation to change their behaviour.

Promoting healthy ageing: the importance of lifestyle.

The UK has a rapidly ageing population with increased healthcare needs. While the population can, on the whole, look forward to longer years of good health, many people will be living with one or more chronic conditions. However, modifiable lifestyle, such as a healthy diet and physical activity, can encourage healthy ageing and improve the quality of life of older people. Nurses are ideally placed to provide advice on nutrition and physical activity to older people in an effort to reduce the burden of age-related disease. This is likely to require new ways of working, with nurses being trained to recognise opportunities for health promotion with older patients, as well as how to plan for and conduct health promotion so that it becomes integral to practice.

Reducing inequalities in healthcare provision for older adults.

The UK has a rapidly ageing population with increasing healthcare needs. Yet social isolation and exclusion, resulting from stigma and age discrimination, means that many older people are faced with unequal access to health care, referral and treatment. Inequalities in health care are particularly prevalent among older people with mental health issues and those from black and minority ethnic backgrounds. Healthcare professionals need to encourage greater involvement of older people in health promotion and community-based healthcare services. Nurses are exemplars for health service delivery and are ideally placed to promote health care that is free from age-related discrimination.

Healthier lifestyles: behaviour change.

Unhealthy lifestyle choices such as smoking and poor diet are significant and preventable causes of long-term conditions. Nurses are well placed to encourage and support patients to make healthy choices. Through good communication, collaboration and goal-setting, behaviour change is possible. This article discusses evidence for the best ways to initiate and sustain behaviour change.

Preventing, identifying and managing delirium in nursing homes and acute settings.

Older people, particularly those in nursing homes, are vulnerable to delirium, which is a condition characterised by confusion. This article outlines the risk factors, prevention, identification and management of delirium in older people in nursing homes and acute settings. It uses a case study approach to encourage nurses to consider the challenges faced in these settings and how they could address delirium. The article also details the multicomponent interventions that can be used for prevention, as well as the available delirium assessment tools, with a focus on selecting tools based on the person's health status and the healthcare setting.

Improving self-management for patients with long-term conditions.

An increasing number of people are living with long-term conditions. These conditions cannot be cured, but can be managed through education, health promotion, medication, therapy and self-management. Self-management involves people taking responsibility for their own health and wellbeing, as well as learning to manage any long-term illnesses. Nurses play a pivotal role in providing advice, guidance, education and support to people living with long-term conditions. Self-management is important as it not only benefits the patient, but also provides wider opportunities for community and specialist nurses to use and develop their clinical and interpersonal skills.