The experiences of nurses and midwives who provide surgical abortion care: A qualitative systematic review.

AIM: To synthesize qualitative evidence on nurses' and midwives' experiences in the provision of surgical abortion care. We address three specific questions: (a) what are the experiences of nurses and midwives in surgical abortion care? (b) what are their responses and coping strategies? (c) what are the deficiencies in surgical abortion care? DESIGN: Qualitative studies were synthesized using Thomas and Harden's qualitative thematic synthesis method. DATA SOURCES: Electronic databases, including PubMed, Embase, CINAHL, PsycINFO, Scopus and Web of Science were searched. Grey literature using ProQuest was searched. The databases were searched from inception to 5 August 2020. REVIEW METHODS: The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation and Research type) search tool was used in the literature search. Data synthesis was conducted using the three-stage thematic synthesis method described by Thomas and Harden. RESULTS: 966 studies were identified in the initial search and 18 studies were included. Four analytical themes were generated: 'Providing abortion care requires high emotional labour'; 'Professionalism of abortion care providers'; 'Initiatives in professional development' and 'Improving directions for high-quality abortion care'. CONCLUSION: Nurses and midwives indicated that they require support to enhance psychological health and improve professional skills. Hospital managers should organize regular debriefing or structured group workshops for exchange of practical experiences and strengthening emotional support. More research is required to establish comprehensive training related to abortion care for nurses and midwives. The findings demonstrate that optimization of abortion services should start from hospital management models, pain management and bereavement care. IMPACT: Understanding the experiences of nurses and midwives in abortion provision will inform future clinical practice in surgical abortion care, which would be helpful in improving the professionalism and confidence of abortion providers. Our findings have implications for the training, development of policies and standards for surgical abortion care for nurses and midwives.

Prevalence of antimicrobial resistance and virulence genes in Klebsiella pneumoniae and Congenetic Raoultella Isolates from captive giant pandas.

To study antimicrobial resistance and virulence genes of Klebsiella pneumoniae and Raoultella strains isolated from captive giant pandas. Non-duplicate fecal samples were collected from 128 giant pandas during 2017-2019. All isolated microbial strains were tested for antimicrobial drug susceptibility using BD verification panels. Four extended-spectrum ß-lactamase resistance genes, nine virulence genes and six capsular serotype genes were detected using PCR. 42 K. pneumoniae and nine Raoultella strains were isolated from different giant pandas. Antibiotic resistance rates were 1.9%-23.5%, except for ampicillin, and 7.8% of the isolates were multidrug-resistant to 7-10 antibiotic classes. This is the first time that a multidrug-resistant R. ornithinolytica strain has been isolated from captive giant pandas. The blaTEM, blaCTX-M, blaSHV and blaDHA genes were detected in four MDR ESBL- K. pneumoniae strains. The rmpA, iutA, ybtS, iroN and iroB genes were positively detected in 11.7% of the isolates. Capsular serotype (K2, K5, K54 and K57) genes were all detected in four K. pneumoniae strains, and one was identified as hypervirulent. This study showed that MDR ESBL- K. pneumoniae, hypervirulent K. pneumoniae, MDR R. ornithinolytica and the colistin-resistant strain may pose risks to captive giant pandas and their keepers, and that the diversity of antibiotic resistance and virulence genes in Klebsiella and Raoultella should be monitored regularly.

Virulence genes and antimicrobial resistance in Enterococcus strains isolated from dogs and cats in Northeast China.

This study aimed to characterize the antimicrobial resistance and virulence of Enterococcus from dogs and cats in Northeast China and evaluate its zoonotic risk based on a total of 469 enterococci strains from 610 samples, including 238 strains of E. faecium and 128 strains of E. faecalis. The isolation rate from police dog samples was 93.79%, pet dog samples was 69.90% and pet cat samples was 76.67%. The differences in the prevalence of E. faecalis among different hosts were statistically significant (P<0.05). The assays showed that most of the virulence genes detected were existed in E. faecalis and police dogs carried the least number of virulence genes. The correlation between enterococcal surface protein (esp) and aggregation substance (asa1) was determined. Enterococci are most resistant to tetracycline and erythromycin, 68.92% of the isolates were classified as multiple drug resistant. Significant differences (P<0.01) were found between E. faecium and E. faecalis in the resistance rates of nine antimicrobials. Four positive and four negative correlations were found between virulence genes and antimicrobial resistance. The results show that Enterococcus colonization and excretion in dogs and cats were related to animal species and living environments. Some correlation between virulence factors and antimicrobial resistance was obtained. This study confirmed the presence of strains carrying multiple virulence factors and antimicrobial resistance at the same time, suggesting a public health risk for dogs and cats as reservoirs of enterococci.