Risk factors for Clostridioides difficile colonization among hospitalized adults: A meta-analysis and systematic review.

OBJECTIVE: To identify risk factors for asymptomatic Clostridioides difficile colonization among hospitalized adults utilizing a meta-analysis, which may enable early identification of colonized patients at risk of spreading C. difficile. DESIGN: Meta-analysis and systematic review. METHODS: We systematically searched MEDLINE, Scopus, Web of Science, and EMBASE from January 1, 1975, to February 15, 2020, for articles related to C. difficile colonization among hospitalized adults. Studies with multivariable analyses evaluating risk factors for asymptomatic colonization were eligible. RESULTS: Among 5,506 studies identified in the search, 19 studies met the inclusion criteria. Included studies reported 20,334 adult patients of whom 1,588 were asymptomatically colonized with C. difficile. Factors associated with an increased risk of colonization were hospitalization in the previous 6 months (OR, 2.18; 95% CI, 1.86-2.56; P < .001), use of gastric acid suppression therapy within the previous 8 weeks (OR, 1.42; 95% CI, 1.17-1.73; P < .001), tube feeding (OR, 2.02; 95% CI, 1.06-3.85; P = .03), and corticosteroid use in the previous 8 weeks (OR, 1.58; 95% CI, 1.14-2.17; P = .006). Receipt of antibiotics in the previous 3 months (OR, 1.37; 95% CI, 0.94-2.01; P = .10) was not associated with statistically significant effects on risk of colonization. CONCLUSIONS: C. difficile colonization was significantly associated with previous hospitalization, gastric acid suppression, tube feeding, and corticosteroid use. Recognition of these risk factors may assist in identifying asymptomatic carriers of C. difficile and taking appropriate measures to reduce transmission.

From symptom to cancer diagnosis: Perspectives of patients and family members in Alberta, Canada.

BACKGROUND: Significant intervals from the identification of suspicious symptoms to a definitive diagnosis of cancer are common. Streamlining pathways to diagnosis may increase survival, quality of life post-treatment, and patient experience. Discussions of pathways to diagnosis from the perspective of patients and family members are crucial to advancing cancer diagnosis. AIM: To examine the perspectives of a group of patients with cancer and family members in Alberta, Canada, on factors associated with timelines to diagnosis and overall experience. METHODS: A qualitative approach was used. In-depth, semi-structured interviews with patients with cancer (n = 18) and patient relatives (n = 5) were conducted and subjected to a thematic analysis. FINDINGS: Participants struggled emotionally in the diagnostic period. Relevant to their experience were: potentially avoidable delays, concerns about health status, and misunderstood investigation process. Participants emphasized the importance of their active involvement in the care process, and had unmet supportive care needs. CONCLUSION: Psychosocial supports available to potential cancer patients and their families are minimal, and may be important for improved experiences before diagnosis. Access to other patients' lived experiences with the diagnostic process and with cancer, and an enhanced supportive role of family doctors might help improve experiences for patients and families in the interval before receiving a diagnosis of cancer, which may have a significant impact on wellbeing.

Informatics tools for quality in anatomic pathology.

This article reviews three informatics tools developed as part of an overall quality program in an anatomic pathology laboratory. These tools include a tracking monitor for analyzing the entire testing process through pre-analytic, analytic, and postanalytic phases; the use of digital imaging in quality control of immunohistochemistry in the analytic phase; and a results-reporting monitor for flow of postanalytic data to patient data repositories.

CD52 antigen may be a therapeutic target for eosinophilic rhinosinusitis.

Allergic rhinosinusitis involves several types of inflammatory cells. The dominant inflammatory cells include mast cells, eosinophils, lymphocytes, and monocytes/macrophages. Since eosinophils are one type of inflammatory cell that is often related to allergy, we investigated in this study whether the eosinophils present in rhinosinusitis may be potential targets for CD52 antibody treatment. First, we found that circulating eosinophils in renal recipients were almost completely depleted after iv bolus of treatment with Campath-1H, a humanized antibody against CD52 antigen. Second, we showed morphologically that eosinophils, lymphocytes, and monocytes gave positive staining reactions for CD52. Third, using an automated clinical imaging system, we found that tissue sections of sinus contents with prominent eosinophils (eosinophilic rhinosinusitis) yielded significantly higher CD52 staining scores than those with lymphocytes as the dominant component (lymphocytic rhinosinusitis). These findings indirectly support the hypothesis that CD52 may be a target for treating eosinophilic rhinosinusitis with Campath 1H.