Attitudes to cross infection, nebuliser hygiene and antimicrobial resistance in people with cystic fibrosis: Results of an international survey.

BACKGROUND: Respiratory infection is a major cause of disease severity in people with cystic fibrosis (PwCF). This project aimed to establish the CF community's opinion regarding cross infection (CI), nebuliser hygiene, antimicrobial resistance, personal impact of microbiological findings and the role of the microbiology laboratory. METHODS: A questionnaire was completed anonymously (n = 280; PwCF (n = 128), parents (n = 123); friends/family/carers/charity personnel (n = 29)) from 13 countries. Readability scores (Flesch Reading Ease (FRE), Flesch Kincaid Grade Level (FKGL)) were determined for CI/IP&C information from six national CF charities and 21 scientific abstracts. RESULTS: Respondents (72.5%) indicated knowledge of laboratory aspects of CF microbiology was important, however implications of microbiological findings on personal health/well-being were of higher importance (p < 0.0001). Cross infection/infection prevention & control (CI/IP&C) was of highest importance (95.6% respondents) with 27.3% indicating they were not given adequate information, particularly in older respondents (50 y+) (p = 0.006) versus young adults (16-29 y) and respondents from the Middle East versus N. America (p = 0.022) and Europe (p = 0.045). Responses highlighted how CI/IP&C health literacy could be enhanced. Respondents (77.3%), particularly females (p < 0.0001), indicated they would increase the frequency of nebuliser disinfection following guidance on infection risks/best practice, therefore an educational video was prepared. CI/IP&C readability scores (mean ± sd) from CF charities (FRE 52.5 ± 10.8; FKGL 9.7 ± 2.3) were more readable (p < 0.0001) than scientific abstracts (FRE 13.3 ± 11.1; FKGL 16.9 ± 2.3), however not meeting the targets (FRE≥60 and FKGL≤8). CONCLUSION: There is a requirement for further CI/IP&C evidence-based guidance, policies/guidelines, education awareness, best practice in the home environment and multi-modal communication, enabling the CF community to make informed choices on lifestyle behaviours.

Improving health literacy of passengers of cruise ships: readability of passenger-facing COVID-19 information provided by commercial cruise lines-an infodemiology study.

Readability of COVID-19 information from 35 cruise lines was examined. Mean Flesch Reading Ease and Flesch-Kincaid Grade Level scores (±standard error of mean) were 46.6 ± 1.3 (target ≥60) and 10.9 ± 0.3 (target ≤ 8.0), respectively. Two (6%) cruise lines met readability reference targets. Readability tools may aid in preparing more easily read passenger-facing health-related information on existing infections, including COVID-19, other respiratory infections, as well as gastroenteritis (e.g. norovirus), as well as providing a methodology for improving the readability of information prepared for newly emerging infectious diseases.

Improving health literacy of antibiotic use in people with cystic fibrosis (CF)-comparison of the readability of patient information leaflets (PILs) from the EU, USA and UK of 23 CF-related antibiotics used in the treatment of CF respiratory infections.

Background: Antibiotic adherence is poor amongst people with cystic fibrosis (CF). Low-quality patient information leaflets (PILs), which accompany prescription antibiotics, with poor readability may contribute to poor antibiotic adherence, with the potential for antimicrobial resistance (AMR) development. The aim of this study was to examine the readability of antibiotic PILs used to treat CF lung infections. Methods: CF-related antibiotics (n = 23; seven classes: aminoglycosides, ß-lactams, fluoroquinolones, macrolides/lincosamides, oxazolidinones, tetracyclines, trimethoprim/sulfamethoxazole) were investigated. Readability of PILs (n = 141; 23 antibiotics) from the EU (n = 40), USA (n = 42) and UK (n = 59) was calculated. Results: Mean [± standard error of mean (SEM)] values for the Flesch Reading Ease (FRE) for EU, USA and UK were 50.0 ±â€Š1.1, 56.2 ±â€Š1.3 and 51.7 ±â€Š1.1, respectively (FRE target ≥60). Mean (± SEM) values for the Flesch Kinkaid Grade Level (FKGL) for the EU, USA and UK were 9.0 ±â€Š0.2, 7.5 ±â€Š0.2 and 9.6 ±â€Š0.2, respectively (FKGL target ≤8). US PILs were significantly shorter (P < 0.0001) in words (mean ±â€ŠSEM = 1365 ±â€Š52), than either UK or EU PILs, with fewer sentences (P < 0.0001), fewer words per sentence (P < 0.0001) and fewer syllables per word. The mean ( ±â€ŠSEM) reading time of UK PILs (n = 59) was 12.7 ±â€Š0.55 mins . Conclusions: Readability of antibiotic PILs is poor. Improving PIL readability may lead to improved health literacy, which may translate to increased antibiotic adherence and AMR avoidance. Authors preparing written materials for the lay/patient CF community are encouraged to employ readability calculators, so that final materials are within recommended readability reference parameters, to support the health (antibiotic) literacy of their readers.

Improving health literacy of antifungal use-Comparison of the readability of antifungal medicines information from Australia, EU, UK, and US of 16 antifungal agents across 5 classes (allylamines, azoles, echinocandins, polyenes, and others).

Adherence to antifungals is poor in high endemic regions where antifungal resistance is high. Poor readability of prescription/over-the-counter (OTC) antifungals may contribute to poor adherence, due to the patient not fully understanding the purpose, importance, and dosage of their antifungal medicine. As there are no reports on the readability of antifungals, this study examined the readability of patient-facing antifungal information. Antifungals (n = 16; five classes [allylamines, azoles, echinocandins, polyenes, and others-flucytosine and griseofulvin]) were selected. Readability of four sources of information, (i) summary of product characteristics, (ii) patient information leaflets (PILs), (iii) OTC patient information, and (iv) patient web-based information, was calculated using Readable software, to obtain readability scores [(i) Flesch Reading Ease [FRE], (ii) Flesch-Kinkaid Grade Level [FKGL], (iii) Gunning Fog Index, and (iv) Simple Measure of Gobbledygook (SMOG) Index) and text metrics [word count, sentence count, words/sentence, and syllables/word]. PILs, web-based resources, and OTC patient information had good readability (FRE mean ± sd = 52.8 ± 6.7, 58.6 ± 6.9, and 57.3 ± 7.4, respectively), just falling short of the ≥ 60 target. For FKGL (target ≤ 8.0), PILs, web-based resources, and OTC patient information also had good readability (mean ± sd = 8.5 ± 1.0, 7.2 ± 0.86, and 7.8 ± 0.1, respectively). Improved readability scores observed correlate with reduced words, words/sentence and syllables/word. Improving readability may lead to improved patient health literacy. Healthcare professionals, academics, and publishers preparing written materials regarding antifungals for the lay/patient community are encouraged to employ readability calculators to check the readability of their work, so that the final material is within recommended readability reference parameters, to support the health literacy of their patients/readers.

Yeast and mould infections can be difficult-to-treat, due to resistance. Our study shows that patient information on antifungals is fairly easy-to-read. Such information helps the patient know how best to take the medicine and help avoid resistance. Authors should always try to write clearly for patients.

Antimicrobial Resistance (AMR).

Antimicrobial resistance (AMR) has now emerged as a chronic public health problem globally, with the forecast of 10 million deaths per year globally by 2050. AMR occurs when viruses, bacteria, fungi and parasites do not respond to antimicrobial treatments in humans and animals, thus allowing the survival of the microorganism within the host. The prominent cause contributing to the current crisis remains to be the overuse and misuse of antimicrobials, particularly the inappropriate usage of antibiotics, increasing the global burden of antimicrobial resistance. The global consumption and usage of antibiotics are therefore closely monitored at all times. This review provides a current overview of the implications of strategies used by international governmental organisations, including the UN's 17 Sustainable Development Goals (SDGs), to address the problem of antibiotic resistance, as well as the "One Health Approach," a system incorporating a multidisciplinary effort to achieve the best possible health outcome by acknowledging the clear connections between humans, animals and their shared environment. The importance of public awareness and health literacy of lay audiences still needs to be further emphasised as part of global and local action plans. Antimicrobial resistance continues to be a major global public health dilemma of the 21st century. Already this topic is receiving substantial political input from the G7 countries and continues to be on the agenda of numerous political conferences. The consequences of failure to adequately address AMR are profound, with estimations of a return to the pre-antibiotic era, where everyday infections relating to childbirth, surgery and open fractured limbs could be potentially life-threatening. AMR itself represents a microcosm of factors, including social anthropology, civil unrest/war, diasporas, ethnic displacement, political systems, healthcare, economics, societal behaviour both at a population and individual level, health literacy, geoclimatic events, global travel and pharmaceutical innovation and investment, thus finding a solution that adequately addresses AMR and which helps stem further AMR emergence is complicated. Success will involve individuals, communities and nations all working together to ensure that the world continues to possess a sufficient armamentarium of effective antimicrobials that will sustain human and animal health, both now and in the future.

Embedding Scientific Communication and Digital Capabilities in the Undergraduate Biomedical Science Curriculum.

Introduction: Scientific communication, particularly the dissemination of research findings to both the scientific community and the general public, are skills required of graduates embarking on post-graduate studies and employment within the biomedical sciences sector. The aims of this action research project were to i) co-design an online scientific communication and digital capabilities resource, constructively aligned to the learning objectives of a final year undergraduate investigative research project; ii) ensure resource flexibility for future adaptation by others iii) embed authentic scientific communication learning assessments, namely, the preparation of a lay summary and visual abstract and iv) promote students' awareness of developed digital capabilities and transferable skills through written reflection. Materials and Methods: Student engagement, self-efficacy, experiences and performance and staff perceptions (n = 15) were evaluated by a mixed methods approach. Qualitative data was gathered from focus sessions, free text responses within questionnaires and content analysis of students' written reflections (n = 104). Quantitative data from 5-point Likert responses within student questionnaires (n = 31) and analysis of student scientific and lay writing (n = 146) using the readability parameters Flesch-Kincaid Grade Level and Flesch Reading Ease were analysed using non-parametric statistical methods. Results: A learning resource was co-designed with students, staff, local, national and international contributors and valued by both students and staff, enabling students to prepare scientific communication outputs of a professional standard by application of digital, analytical and scientific communication skills. Students prepared lay summaries which were statistically (p < 0.0001) more readable than their paired scientific abstracts. Significant correlations between easier readability of lay summaries and awarded marks for the written elements of the module were noted. Students reported their digital and communication capabilities increased significantly (p < 0.0001) throughout, from limited to good/excellent and reflected on the numerous transferable skills developed during preparation of assessments, with 75% reflecting on their digital capabilities. Discussion: Undergraduate students developed, appreciated and used varied scientific communication and digital skills to articulate research findings. The embedding of such activities throughout all levels of higher education will enable students to develop their digital and scientific skills and reflect on the development of such transferable skills for application in their future careers.

Time-to-first-isolation of methicillin-resistant Staphylococcus aureus (MRSA) in cystic fibrosis (CF): An underutilised metric in infection control?

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a significant pathogen in people with cystic fibrosis (PwCF). There is a paucity of reports on MRSA infection dynamics within CF. It was the aim to examine the utility of Time-To-FirstIsolation (TTFI) metric and to correlate this with patient gender and CF transmembrane conductance regulator (CFTR) mutation type. METHODS: The microbiology of respiratory specimens from 100 adult (≥18 years) PwCF was examined (50 females; 50 males; mean age 24.6 years ±6.25 (SD)) from birth to present, equating to 2455 patient years. TTFI was determined in relation to (i) presence/absence of MRSA, (ii) CFTR mutation type and (iii) PwCF gender. RESULTS: MRSA was noted in 23% patients (10 female/13 males); (i) F508del/F508del homozygous (43.5%) and (ii) F508del/other heterozygous (56.5%). No non-F508del CFTR mutations types were noted. The median and mean TTFI was 137 months and 127.4 months respectively, shortest time was 23 months, longest time 211 months. There was no statistical significance in TTFI in relation to CFTR mutation group (p = 0.39) or gender (p = 0.71). CONCLUSIONS: TTFI is useful and applicable to the chronic infection model, where patients with a specific underlying disease are predisposed to acquire infections and where these infections are likely to become chronic. Intelligence offered by TTFI provides a window of opportunity to target IPC interventions, to help prevent MRSA acquisition. CF multidisciplinary teams, microbiologists and infection prevention specialists should utilise such TTFI data from their respective centres to help inform and plan intervention strategies to help prevent MRSA acquisition.

Infection Dynamics of Aspergillus fumigatus in Adults with Cystic Fibrosis (CF).

OBJECTIVE: Aspergillus fumigatus (A. fumigatus) has emerged as a significant pathogen in patients with cystic fibrosis (CF) and currently is within the top five isolated organisms reported in several international CF patient registries. A. fumigatus has been attributed to disease progression, although its role remains controversial. There is a paucity of reports on its infection dynamics, it was the aim of this study to examine time to first laboratory reports of A. fumigatus acquisition and to correlate this with patient gender and cystic fibrosis transmembrane conductance regulator (CFTR) mutation type. METHODS: One hundred adult (≥ 18 years) CF patients were examined (50 females, 50 males; mean age 24.6 years ± 6.25 (SD), median age 24 years; maximum age 76 years). CFTR mutation groups consisted (i) F508del/F508del homozygous (n = 45), (ii) F508del/other heterozygous (n = 45) and (iii) others (n = 10). CFTR mutation type, patient gender, presence/absence of A. fumigatus and time (months) to first isolation of A. fumigatus were examined. RESULTS: Microbiological data was examined from 100 patients from birth to present (31/12/2021), equating to 2455 patient years. A. fumigatus was isolated from 66/100 (66%) adult CF patients; (i) F508del/F508del homozygous (82%; 37/45), (ii) F508del/other heterozygous (56%; 25/45) and (iii) others (40%; 4/10). Within the F508del/other heterozygous group, 14 mutations were noted on the second allele, with R560T and R117H collectively accounting for 36% of the second mutations. Four unique allele/allele mutations were noted in the Other Mutations category. There was a trend to a higher A. fumigatus acquisition in F508del/F508del homozygous patients than with F508del/other patients (p = 0.0529). Of the 66 patients who were positive for A. fumigatus, 35(53%) were male and 31(47%) were female. The median and mean time to first isolation of A. fumigatus in all A. fumigatus-positive patients was 119.5 months and 128 months, respectively, shortest time was 12 months, longest time 288 months. There was a statistical significance in time-to-first isolation in relation to CFTR mutation group (p = 0.0272), whereby F508del homozygous individuals had their first isolation of A. fumigatus at 116.8 ± 7.9 months (mean ± standard error of the mean (SEM)) and F508del heterozygous patients had their first isolate of A. fumigatus at 150.4 months ± 13.7 months (mean ± SEM), approximately 2.75 years after their F508del homozygous peers. There was no significant difference (p = 0.12) in time to first acquisiton between males and females, whereby males had their first A. fumigatus isolate at 118 ± 9.4 months, whereas females had their first A. fumigatus isolate at 140 ± 10.8 months. The highest rate of first A. fumigatus isolation was from 4 years until 16 years and by the age of 16 years, approximately 85% of A. fumigatus-positive patients had recorded their first A. fumigatus isolate. CONCLUSION: To minimise the risk of first acquisition of A. fumigatus, it is important that infection prevention educational messaging is delivered in the paediatric clinic, to enhance health literacy around A. fumigatus acquisition.

What is the Perceived Role of the Dietitian Amongst People with Cystic Fibrosis? Results of an International survey.

Cystic fibrosis (CF) is a chronic condition requiring continued input from the CF dietitian as an integral part of the CF multidisciplinary team. In recent years, the longer life expectancy experienced by people with CF (PwCF) means that nutrition advice and therapy are evolving from a focus on nutrition support to prevention and management of comorbidities. Little has been reported regarding the perceived role of the CF dietitian amongst PwCF. We report the responses to 11 questions that were part of a larger international survey distributed to members of national CF charities in 2018-2019. These questions evaluated PwCFs' perspectives on (i) the importance of the CF diet, (ii) how often PwCF obtain dietary/nutritional advice from their dietitian, (iii) the perceived reliability of information given by the dietitian, (iv) other sources of CF information and their perceived reliability, and (v) how CF nutrition/diet, as well as CF-related diabetes, ranked as research priorities. There were 295 respondents from 13 countries. Almost half of the respondents (46.8%) contacted their CF dietitian on a frequent/more regular basis, compared to medical/scientific journals/medical/scientific search engines. The CF dietitian was considered a reliable source of information, as 84% of the respondents indicated that the information provided was very/generally reliable. At a time when CF care and expectations are changing rapidly, PwCF are in need of trusted and reliable information to make positive changes in lifestyle and habits. Dietitians working with PwCF should appreciate the pivotal and valued role they perform as purveyors of robust evidence-based information to this chronic disease population.

Cystic fibrosis: Infection prevention & control recommendations for universities, colleges and institutes of further and higher education - A practical guide.

BACKGROUND: The avoidance of cross-infection remains of critical importance to prevent the transmission of cystic fibrosis (CF)-related microbial pathogens to persons/people with cystic fibrosis (PwCF). To date, there has been a paucity of infection prevention and control (IPC) guidance relating to infection risk at higher educational institutions. With improvements in treatments, more PwCF are now attending universities/colleges and educational institutions now seek CF-specific guidance on IPC from clinical CF teams/centres. METHODS: Real world infection-related questions from university students, educators, university support staff and the CF multidisciplinary team were received and collated from various stakeholders, including individual consultations and focus group sessions with two local universities. Subsequently, evidence-based recommendations were compiled from existing peer-reviewed literature and from cystic fibrosis organisations. Glossaries were constructed relating to clinical, microbiological and educational/pedagogical terminology to aid with the understanding amongst these stakeholder groups. RESULTS: This review addresses CF-related IPC recommendations across five areas of university/college life, including (i) on campus estate, (ii) teaching (lectures/tutorials/small study group work/group assignments), (iii) laboratory practicals, (iv) field trips/study visits/work placements and (v) residential accommodation and lists practical recommendations to help prevent the transmission of infections to PwCF students. CONCLUSIONS: It is important that the educational institutional environment is safe permitting the PwCF student to enjoy their educational experience and journey through higher education, culminating in achievement of their educational goals, employment and independent living. The guidance presented in this review is intended to equip educational establishments in creating their own bespoke and robust IPC policies relating to PwCF students.

Polymyxin Resistance and Heteroresistance Are Common in Clinical Isolates of Achromobacter Species and Correlate with Modifications of the Lipid A Moiety of Lipopolysaccharide.

The Achromobacter genus includes opportunistic pathogens that can cause chronic infections in immunocompromised patients, especially in people with cystic fibrosis (CF). Treatment of Achromobacter infections is complicated by antimicrobial resistance. In this study, a collection of Achromobacter clinical isolates, from CF and non-CF sources, was investigated for polymyxin B (PmB) resistance. Additionally, the effect of PmB challenge in a subset of isolates was examined and the presence of PmB-resistant subpopulations within the isolates was described. Further, chemical and mass spectrometry analyses of the lipid A of Achromobacter clinical isolates enabled the determination of the most common structures and showed that PmB challenge was associated with lipid A modifications that included the addition of glucosamine and palmitoylation and the concomitant loss of the free phosphate at the C-1 position. This study demonstrates that lipid A modifications associated with PmB resistance are prevalent in Achromobacter and that subresistant populations displaying the addition of positively charged residues and additional acyl chains to lipid A can be selected for and isolated from PmB-sensitive Achromobacter clinical isolates. IMPORTANCE Achromobacter species can cause chronic and potentially severe infections in immunocompromised patients, especially in those with cystic fibrosis. Bacteria cannot be eradicated due to Achromobacter's intrinsic multidrug resistance. We report that intrinsic resistance to polymyxin B (PmB), a last-resort antimicrobial peptide used to treat infections by multiresistant bacteria, is prevalent in Achromobacter clinical isolates; many isolates also display increased resistance upon PmB challenge. Analysis of the lipopolysaccharide lipid A moiety of several Achromobacter species reveals a penta-acylated lipid A, which in the PmB-resistant isolates was modified by the incorporation of glucosamine residues, an additional acyl chain, loss of phosphates, and hydroxylation of acyl chains, all of which can enhance PmB resistance in other bacteria. We conclude that PmB resistance, particularly in Achromobacter isolates from chronic respiratory infections, is a common phenomenon, and that Achromobacter lipid A displays modifications that may confer increased resistance to polymyxins and potentially other antimicrobial peptides.

Group Assessments to Help Build Online Learning Communities in Biomedical Science Distance Learning Programmes.

Introduction: Biomedical Science distance learning courses offer flexibility in study while in employment. Asynchronous and self-learning approaches are common within such courses and often student-student interaction is limited. The aims of this study were to establish learning communities, develop confidence in participating in online teamwork and foster an appreciation of transferable skills including digital capabilities through remote group activities. Materials and Methods: Two cohorts of students (n = 20/n = 21) were enrolled in a microbiology module of an IBMS accredited MSc distance learning course. Groups of 4-5 students produced a digital output relating to current global infection-related issues, namely, assignment 1, production of a slide deck, which peers could use as learning resources and assignment 2, a voiceover PowerPoint debate, and infographic, voting assessment and peer/self-marking. Students also prepared reflections using written format and a FlipGrid video-recording. A qualitative content analysis was conducted on reflections from all students. Students completed a pre- and post-assignment survey focused on the development of transferable skills for the biomedical sector. Results: Students' skills and confidence increased following completion of the group assignment, as evident from the pre- and post-questionnaire responses, namely, possession of digital skills and digital creation abilities (29% v 83%), applying for jobs which require digital skills (54% v 89%), talking about examples of using digital media during job interviews (21% v 78%) and demonstration of creativity during assignment tasks (33% v 90%). Critical thinking was more commonly demonstrated during the debate in comparison to the slide deck activity (p = 0.001). The importance of developing digital skills, was higher following completion of the group activities (p = 0.03). Students reflected on the value of the group activities in relation to knowledge acquisition (85%, 86%), collegiality (70%, 71%), digital skills development (80%, 90%), the fact that the activities were enjoyable (70%, 67%) and the development of peer interaction and support (50%, 67%) in relation to assignment 1 and 2, respectively. Discussion: Increasingly digital technologies are being used in the healthcare sector resulting in updated HCPC Standards of Proficiency. This study highlights that virtual group activities promote the establishment of supportive learning communities and the development of transferable skills including digital capabilities for application within the biomedical science workplace.

Using plain language to communicate with clinical trials participants: Comparison of readability calculators.

It is important that patient-facing clinical trial information is easily understood by potential trial participants, active trial participants, family members, friends and carers. The readability of a document refers to its typographic and linguistic characteristics that allow the text to be read and comprehended and it is recommended that healthcare providers aim that all information disseminated to the lay public be at a suitable readability level. Whilst there are established readability calculators for literature, there is no standard for health information. Several readability calculators are available that aid in the analysis of a text, URL or website's readability, however, to date there has been no head-to-head comparison of these. Five readability calculators were compared, including four online realtime calculators, (i) Readable (www.readable.com), (ii) www.webfx.com, (iii) www.datayze.com and (iv) www.online-utility.org, as well as the PC-based analyzer Microsoft Word (Microsoft Corp., USA). Three categories of text information were analysed, including (i) childrens' fairy tales (n = 20) (ii) scientific reports (n = 20) from BBC News websites and (iii) scientific abstracts (n = 20). This study demonstrated that varying scores were obtained by using different readability calculators. Based on these data in combination with issues including availability and ease-of-use, we advocate the use of Readable or Microsoft Word software to aid in the preparation of patient-facing clinical trial information. Clinical trial networks should now consider the need for standardisation of readability calculators and provide guidance to stakeholders so that readability of materials may be improved in a standardised and uniform manner.

The Microbiology of Non-aeruginosa Pseudomonas Isolated From Adults With Cystic Fibrosis: Criteria to Help Determine the Clinical Significance of Non-aeruginosa Pseudomonas in CF Lung Pathology.

Introduction: There is a paucity of reports on non-aeruginosa Pseudomonas (NAPs) in cystic fibrosis, hence this study wished 1). to examine the diversity/frequency of NAPs in an adult CF population, 2) to compare/contrast the microbiology and genomics of NAPs to P. aeruginosa and 3) to propose clinical and laboratory criteria to help determine their clinical significance in CF lung pathology. Materials and Methods: Microbiological data was examined from 100 adult patients with cystic fibrosis from birth to present (31/12/2021), equating to 2455 patient years. 16S rDNA phylogenetic relatedness of NAPs was determined, as well as bioinformatical comparison of whole genomes of P. aeruginosa against P. fluorescens. Results: Ten species were isolated from this patient cohort during this time period, with three species, i.e., P. fluorescens, P. putida and P. stutzeri, accounting for the majority (87.5%) of non-aeruginosa reports. This is the first report of the isolation of P. fragi, P. nitroreducens, P. oryzihabitans and P. veronii in patients with cystic fibrosis. The mean time to first detection of any non-aeruginosa species was 183 months (15.25 years) [median = 229 months (19.1 years)], with a range from 11 months to 338 months (28.2 years). Several of the NAPs were closely related to P. aeruginosa. Discussion: NAPs were isolated infrequently and were transient colonisers of the CF airways, in those patients with CF in which they were isolated. A set of ten clinical and laboratory criteria are proposed to provide key indicators, as to the clinical importance of the non-aeruginosa species isolated.

Improving health literacy with mumps, measles and rubella (MMR) vaccination: comparison of the readability of MMR patient-facing literature and MMR scientific abstracts.

Background: Historically, there have been many factors that have influenced mumps, measles and rubella (MMR) vaccine uptake, including media bias, social/economic determinants, parental education level, deprivation and concerns over vaccine safety. Readability metrics through online tools are now emerging as a means for healthcare professionals to determine the readability of patient-facing vaccine information. The aim of this study was to examine the readability of patient-facing materials describing MMR vaccination, through employment of nine readability and text parameter metrics, and to compare these with MMR vaccination literature for healthcare professionals and scientific abstracts relating to MMR vaccination. Materials and methods: The subscription-based online Readable program (readable.com) was used to determine nine readability indices using various readability formulae: Established readability metrics (n = 5) (Flesch-Kinkaid Grade Level, Gunning Fog Index, SMOG Index, Flesch Reading Ease and New Dale-Chall Score), as well as Text parameters (n = 4) (sentence count, word count, number of words per sentence, number of syllables per word) with 47 MMR vaccination texts [patient-facing literature (n = 22); healthcare professional-focused literature (n = 8); scientific abstracts (n = 17)]. Results: Patient-facing vaccination literature had a Flesch Reading Ease score of 58.4 and a Flesch-Kincaid Grade Level of 8.1, in comparison with poorer readability scores for healthcare professional literature of 30.7 and 12.6, respectively. MMR scientific abstracts had the poorest readability (24.0 and 14.8, respectively). Sentence structure was also considered, where better readability metrics were correlated with significantly lower number of words per sentence and less syllables per word. Conclusion: Use of these readability tools enables the author to ensure their research is more readable to the lay audience. Patient co-production initiatives would help to ensure that not only can the target audience read the literature, but that they understand the content. Increased patient-centric focus groups would give better insights into reasons for MMR-associated vaccine hesitation and vaccine refusal.

Nebulizer Cleaning Practices and Adherence to Nebulized Therapies in People With Cystic Fibrosis When Traveling.

BACKGROUND: Nebulized therapies form an important component of treatment in people with cystic fibrosis (CF). It is important for people with CF to continue to take their nebulized medications when traveling. METHODS: A self-completing anonymous questionnaire was developed, as part of a quality improvement project, to support people with CF educational needs when traveling. The questionnaire was prepared to gain an insight into (1) adherence to nebulized therapies when traveling and (2) nebulizer cleaning and disinfection practices while traveling. Polar questions (yes/no response) were mainly employed as well as free text and closed questions. RESULTS: There were 68 respondents to the survey, including 31 males, 33 females, and 4 respondents who did not enter their sex. Respondents who declared their age (n = 63) ranged from 17-71 y (median = 30 y; with 94% of respondents in age range 20-39 y). When traveling, 38% (25/66) of respondents indicated that nebulized therapy was not performed during travel. The most common method of nebulizer maintenance while traveling was washing with soap and water (43%), followed by boiling water (18%), as well as the employment of 5 other methods of nebulizer maintenance. Some respondents (2%) indicated that they did not perform any method of nebulizer maintenance while traveling until they returned home. CONCLUSIONS: This study identified that nebulizer care and hygiene are less than optimal when traveling as well as identifying a worrying trend of taking a "nebulizer vacation." People with CF need to be aware of risks to their health in being nonadherent with their nebulized medication(s) while traveling as well as risks of acquiring a new pathogen through suboptimal cleaning/disinfection/drying management of their nebulizer. CF multidisciplinary teams should emphasize the importance of sustaining nebulized treatments when traveling and practicing effective nebulizer washing, disinfection, and drying procedures.