'Speaking Up' for patient safety and staff well-being: a qualitative study.

BACKGROUND: Freedom To Speak Up Guardians (FTSUGs) and Confidential Contacts (CCs) were appointed nationally following the Mid Staffordshire inquiry to listen to and support staff who were unable to address concerns through normal channels of communication. AIM: Explore perceptions of an FTSUG and CCs through shared experiences and personal stories. OBJECTIVES: (1) Explore perceptions of an FTSUG and CCs. (2) Consider how individuals can be best supported. (3) Improve staff knowledge on speaking up. (4) Understand factors influencing reflections around patient safety. (5) Share exemplars of good practice through use of personal stories to promote a culture of openness to raise concerns. METHOD: A focus group of eight participants, namely the FTSUG and CCs working within one large National Health Service (NHS) trust, was used to gather data. Data were collated and organised using a created table. Thematic analysis enabled each theme to emerge and be identified. CONCLUSION: (1) An innovative approach to the introduction, development and implementation of an FTSUG and CC roles and responsibilities in healthcare. (2) To gain insight into the personal experiences of a FTSUG and CCs working within one large NHS trust. (3) To be supportive of culture change with committed leadership responsiveness.

Microneedling in Combination With 15% Trichloroacetic Acid Peel Versus 25% Pyruvic Acid Peel in the Treatment of Acne Scars.

BACKGROUND: Acne scars are a permanent disfiguring sequel of acne. OBJECTIVE: To compare the efficacy of microneedling with 15% trichloroacetic acid (TCA) peel versus microneedling with 25% pyruvic acid peel in the management of postacne scars. MATERIAL AND METHODS: Thirty patients with atrophic acne scars were randomized into 2 groups receiving microneedling on both sides of the face at 0,6, and 12 weeks and 15% TCA on one side and 25% pyruvic acid on other side at 3,9, and 15 weeks. Acne scar scoring performed using the Echelle D'Evaluation Clinique des Cicatrices D'Acne (ECCA) and visual analogue scales by patient and physician were used to grade improvement at all visits and at 21 weeks. RESULTS: The mean ECCA score on the TCA side declined from 151.17 ± 26.90 to 138.83 ± 30.56 and on the pyruvic side declined from 151.83 ± 27.53 to 141.33 ± 28.92 after 21 weeks (statistically significant: p-value <.05). Comparing the ECCA on the TCA and pyruvic sides at 21 weeks was not significant. VAS showed moderate-to-marked improvement after 3 months in both groups. CONCLUSION: In our study, the combination modality showed early reduction in rolling and boxcar compared with icepick scars. These peels led to improvement in overall texture of the skin, hence more patient satisfaction. On comparing ECCA, a significant difference was not observed.

Persistent peripheral presence of Staphylococcus aureus promotes histone H3 hypoacetylation and decreases tyrosine hydroxylase protein level in rat brain tissues.

OBJECTIVE: Growing evidences suggest systemic pathogen-induced neuroimmune interaction is a major risk factor for several neurological disorders. Our goal was to investigate whether asymptomatic peripheral carriage of Staphylococcus aureus, a widespread opportunistic pathogen, could modulate selective molecular features in brain tissues. METHODS: To address this, a peripheral infection model was developed by challenging Wistar rats repeatedly with a clinical strain of S. aureus. Animals infected with S. aureus (10 CFU for three times in 10 days) showed significant changes in acetylation profile of selective lysine (K) residues K9 (H3K9), K14 (H3K14) and K27 (H3K27) of histone H3 in the hippocampus and prefrontal cortex (PFC). RESULTS: Although S. aureus was restricted peripherally, the infection induced hypoacetylation of H3K9, H3K14 and H3K27 in the hippocampus and H3K27 in the PFC. Histone H3 hypoacetylation in the hippocampus and PFC was also detected when rats were challenged with an engineered invasive strain of E. coli K12, SK3842. This confirmed that modulation of epigenetic landscape in distal brain tissues may not be specific to S. aureus. Moreover, the tyrosine hydroxylase protein, the rate limiting enzyme in dopamine synthesis pathway whose gene-expression is regulated by H3 acetylation at the promoter, was remarkably reduced in the brain tissues of the infected hosts. CONCLUSION: The results indicate that commensals like S. aureus, in spite of being largely restricted to the peripheral tissues, could modulate the homeostasis of molecular features in brain tissues whose maintenance is critical for preserving normal neurological functions.