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To develop a simulator of the external auditory canal and tympanic membrane that enables surgical trainees to practise their otomicroscopy skills, which is particularly valuable at a time where there is limited patient contact because of the coronavirus disease 2019 lockdown.
A simulator of the external auditory canal and tympanic membrane was made using a cardboard bowl, a 2 ml syringe and a latex glove. The simulator was used to practise otomicroscopy skills, including microsuction, foreign body removal, myringotomy and grommet insertion. Five doctors in the ENT department participated, ranging from core surgical training year two doctor to specialty doctor.
The simulator provides an effective tool on which surgical trainees can practise, develop and maintain a variety of otomicroscopy skills.
This inexpensive, easy and quick-to-make simulator enables trainees to practise their otomicroscopy skills on an approximately accurate model during a time when there is minimal clinical opportunity to develop these skills, particularly because of the coronavirus disease 2019 pandemic.
Staphylococcus aureus is a common cause of healthcare-associated infections in neonates.
To examine the impact of methicillin-susceptible S. aureus (MSSA) decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance.
We retrospectively identified neonates admitted to a tertiary care neonatal intensive care unit (NICU) from April 1, 2011, through September 30, 2014. We compared rates of MSSA-positive cultures and infections before and after implementation of an active surveillance culture and decolonization intervention for MSSA-colonized neonates. We used 2 measurements to identify the primary outcome, NICU-attributable MSSA: (1) any culture sent during routine clinical care that grew MSSA and (2) any culture that grew MSSA and met criteria of the National Healthcare Safety Network’s healthcare-associated infection surveillance definitions. S. aureus isolates were tested for mupirocin susceptibility. We estimated incidence rate ratios using interrupted time-series models.
Before and after the intervention, 1,523 neonates (29,220 patient-days) and 1,195 neonates (22,045 patient-days) were admitted to the NICU, respectively. There was an immediate reduction in the mean quarterly incidence rate of NICU-attributable MSSA-positive clinical cultures of 64% (incidence rate ratio, 0.36 [95% CI, 0.19–0.70]) after implementation of the intervention, and MSSA-positive culture rates continued to decrease by 21% per quarter (incidence rate ratio, 0.79 [95% CI, 0.74–0.84]). MSSA infections also decreased by 73% immediately following the intervention implementation (incidence rate ratio, 0.27 [95% CI, 0.10–0.79]). No mupirocin resistance was detected.
Active surveillance cultures and decolonization may be effective in decreasing S. aureus infections in NICUs.
Infect. Control Hosp. Epidemiol. 2016;37(4):381–387
To characterize the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) transmission and infections in a level IIIC neonatal intensive care unit (NICU) and identify barriers to MRSA control.
Setting and Design.
Retrospective cohort study in a university-affiliated NICU with an MRSA control program including weekly nares cultures of all neonates and admission nares cultures for neonates transferred from other hospitals or admitted from home.
Medical records were reviewed to identify neonates with NICU-acquired MRSA colonization or infection between April 2007 and December 2011. Compliance with hand hygiene and an MRSA decolonization protocol were monitored. Relatedness of MRSA strains were assessed using pulsed-field gel electrophoresis (PFGE).
Of 3,536 neonates, 74 (2.0%) had a culture grow MRSA, including 62 neonates with NICU-acquired MRSA. Nineteen of 74 neonates (26%) had an MRSA infection, including 8 who became infected before they were identified as MRSA colonized, and 11 of 66 colonized neonates (17%) developed a subsequent infection. Of the 37 neonates that underwent decolonization, 6 (16%) developed a subsequent infection, and 7 of 14 (50%) that remained in the NICU for 21 days or more became recolonized with MRSA. Using PFGE, there were 14 different strain types identified, with USA300 being the most common (31%).
Current strategies to prevent infections—including active identification and decolonization of MRSA-colonized neonates—are inadequate because infants develop infections before being identified as colonized or after attempted decolonization. Future prevention efforts would benefit from improving detection of MRSA colonization, optimizing decolonization regimens, and identifying and interrupting reservoirs of transmission.
Infection prevention guidelines do not endorse Chlorhexidine gluconate (CHG) use in neonates who are less than 2 months old. A survey of US neonatology program directors revealed that most neonatal intensive care units use CHG, often with some restrictions. Prospective studies are needed to further address concerns regarding the safety of CHG in patients in the neonatal intensive care unit.
Postnatal depression has detrimental effects on the child's cognitive and emotional development.
To assess the benefits of treating postnatal depression for mother–infant interaction and child development.
A systematic search was made of 12 electronic bibliographic databases for randomised controlled trials and controlled clinical trials on treatment of mothers with postnatal depression, where outcomes were assessed in children; findings were assessed.
Only eighttrials met the inclusion criteria. Of those included, interventions varied widely but all involved therapies directed at the mother–infant relationship. One study with intensive and prolonged therapy showed cognitive improvement, whereas two others with briefer interventions improved maternal–infant relationships but did not affect the child's cognitive or behavioural development. All five studies assessing only mother–infant relationships showed improvements.
Cognitive development in children of depressed mothers, along with better mother–infant relationships, might be improved with sustained interventions. Trials assessing treatments for postnatal depression would benefit from looking more closely at benefits for children as well as mothers, using validated objective measures.
Compositional changes in chromites are shown to be related to the degree of alteration of the grains to ‘ferritchromit’. The chromium content of late stage pyroxenites and tremolites may be related to the development of the ‘ferritchromit’. Analysed grains from the chrome ores are shown to have a different chemistry to the accessory chromites in the peridotites.
Two methods using nujol and hexachloro-butadiene mulls are described to analyse the water content of powdered granite samples. The nujol mull analyses were carried out on a Unicam SP 100 spectrometer using the silica content of the rock as an internal standard. The hexachlorobutadiene mull analyses were done by a twin-path Unicam SP 200 spectrometer, using hexachlorobutadiene as the internal standard. The broader and more pronounced V1 vibrational mode (3450 cm−1) is ratioed to a standard of known composition. Comparisons are also made between absorption due to free water (V1 = 3450 cm−1) and combined water (V3 = 3680 cm−1) in aplites, biotite granite, and chlorite schists.
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