Successful Disinfection of Needleless Access Ports: A Matter of Time and Friction

BackgroundThere is controversy as to whether the design of the needleless access port or the method used to clean it prior to access impacts successful disinfection. The authors studied the disinfection effectiveness for needleless access ports.MethodThe ports of 4 models of needleless access ports were inoculated with bacteria. The ports were disinfected for 15 seconds with 70% alcohol alone or 3.15% chlorhexidine/70% alcohol (Chlorascrub, PDI, Orangeburg, NY). Saline flush solutions were collected and cultured.ResultsDisinfection with either 70% alcohol alone or with 3.15% chlorhexidine/70% alcohol for 15 seconds was effective.ConclusionsAll models of needleless access ports were effectively disinfected using these two methods.     

Needleless Connectors: Improving Practice,Reducing Risks

PurposeTo assess the knowledge gap of healthcare workers about practice with needleless connectors.BackgroundCatheter-related bloodstream infection (CR-BSI) and lumen occlusion can be directly related to practices of cleaning needleless connectors, IV administration set management, and flushing and clamping methods.Review of Relevant LiteratureFive publications report outbreaks of CR-BSI from hospitals in the US and Australia. A significant increase in CR-BSI rates after an organizational change of products was observed. No randomized controlled trials are available from the USA comparing types or designs of needleless connectors.Device instructions state some devices can be locked with normal saline. Two randomized clinical trials assessed outcomes with catheter lock solution. Both reported higher rates of occlusion with the use of normal saline only and one documented a higher rate of CR-BSI.MethodsAn invitation to participate in a survey with 22 questions was sent electronically to approximately 4000 healthcare workers with a response from 554 in clinical practice.ResultsThe specific type of needleless connector being used was unknown by 25% and correct clamping sequence was chosen by 52.8% of respondents. The majority, 94.3% reported that they always clean these devices before each use, however there are differences in technique.ConclusionsThere is a significant gap of knowledge about the specific needleless connectors being used, the most appropriate cleaning, flushing, and clamping sequence for the specific device.Implications for PracticeStaff education should focus on the connections between needleless connectors, CR-BSI and lumen occlusion. Frequent product training on needleless connectors, the specific type in use and correct techniques are necessary.     

Ultra-rapid flow cytometry assay for colistin MIC determination in Enterobacterales,Pseudomonas aeruginosa and Acinetobacter baumannii

ObjectivesBoth EUCAST and CLSI recommend broth microdilution for antimicrobial susceptibility testing of colistin, but this method is cumbersome and takes 16-24 h to give results. Our objective was to evaluate a rapid quantitative colistin MIC susceptibility assay based on flow cytometry analysis (FASTcolistin MIC) in comparison with standard broth microdilution assay.MethodsOne hundred and sixteen Gram-negative bacilli (78 Enterobacterales, 28 Pseudomonas aeruginosa and 10 Acinetobacter baumannii) were studied in parallel using standard broth microdilution following EUCAST recommendations and FASTcolistin MIC kit. In the last one, a bacteria suspension (0.5 MacFarland) was prepared, diluted in Muller-Hinton broth, incubated in the susceptibility panel containing different colistin concentrations (range 0.125-64 mg/L) with a fluorescent probe and incubated 1 h at 35ºC. After that, a flow cytometry analysis using CytoFLEX (Beckmam) was performed. Using a dedicated software (BioFAST) an automated MIC result was obtained after 1.5 h. Performance evaluation was performed according to the ISO standard 20776-2. Reproducibility and repeatability, categorical (CA) and essential agreement (EA), and lot-to-lot variation and operator-to-operator variability, as well as time to results were determined.ResultsOverall, 100% CA (CI 97-100%) and 95.7% EA (CI 90-98%) was obtained with high repeatability (100%; CI 80-100%)and reproducibility (97%; (CI 83-99%)). Absence of lot-to-lot variations or differences in the operators' performance was observed.ConclusionsFASTcolistin MIC is an accurate, reliable and ultra-rapid method (1 h incubation versus 24 h) for susceptibility testing of colistin of common Gram-negative bacilli recovered in clinical laboratories.     

Disinfectant effectiveness against SARS-CoV-2 and influenza viruses present on human skin: model-based evaluation

ObjectivesDisinfection effectiveness against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on human skin remains unclear because of the hazards of viral exposure. An evaluation model, which has been previously generated using human skin obtained from forensic autopsy samples, accurately mimics in vivo skin conditions for evaluating the effectiveness of disinfection against the virus. Using this model, we evaluated disinfection effectiveness against viruses on human skin.MethodsEthanol (EA), isopropanol (IPA), chlorhexidine gluconate (CHG) and benzalkonium chloride (BAC) were used as target disinfectants. First, disinfectant effectiveness against SARS-CoV-2 and influenza A virus (IAV) was evaluated in vitro. Disinfectant effectiveness against SARS-CoV-2 and IAV on human skin was then evaluated by titrating viruses present on the skin after applying each disinfectant on the skin for 5–60 seconds.ResultsBoth, SARS-CoV-2 and IAV on human skin were completely inactivated within 5 seconds by 40%–80% EA and 70% IPA (log reduction values (LRVs) were >4). However, SARS-CoV-2 and IAV were barely inactivated by 20% EA (LRVs were <1). In vitro evaluation showed that, compared with EA and IPA, CHG and BAC were significantly inferior in terms of disinfection effectiveness. Conversely, the disinfection effectiveness of CHG and BAC against SARS-CoV-2 was higher on human skin than in vitro, and increased with increases in their concentration and reaction time (LRVs of 0.2% CHG/0.05% BAC were >2, and LRVs of 1.0% CHG/0.2% BAC were >2.5).ConclusionsProper hand hygiene practices using alcohol-based disinfectants such as EA/IPA effectively inactivate SARS-CoV-2 and IAV on human skin.     

Genotype-phenotype associations in a large PTEN Hamartoma Tumor Syndrome (PHTS) patient cohort

BackgroundPathogenic PTEN germline variants cause PTEN Hamartoma Tumor Syndrome (PHTS), a rare disease with a variable genotype and phenotype. Knowledge about these spectra and genotype-phenotype associations could help diagnostics and potentially lead to personalized care. Therefore, we assessed the PHTS genotype and phenotype spectrum in a large cohort study.MethodsInformation was collected of 510 index patients with pathogenic or likely pathogenic (LP/P) PTEN variants (n = 467) or variants of uncertain significance. Genotype-phenotype associations were assessed using logistic regression analyses adjusted for sex and age.ResultsAt time of genetic testing, the majority of children (n = 229) had macrocephaly (81%) or developmental delay (DD, 61%), and about half of the adults (n = 238) had cancer (51%), macrocephaly (61%), or cutaneous pathology (49%). Across PTEN, 268 LP/P variants were identified, with exon 5 as hotspot. Missense variants (n = 161) were mainly located in the phosphatase domain (PD, 90%) and truncating variants (n = 306) across all domains. A trend towards 2 times more often truncating variants was observed in adults (OR = 2.3, 95%CI = 1.5–3.4) and patients with cutaneous pathology (OR = 1.6, 95%CI = 1.1–2.5) or benign thyroid pathology (OR = 2.0, 95%CI = 1.1–3.5), with trends up to 2–4 times more variants in PD. Whereas patients with DD (OR = 0.5, 95%CI = 0.3–0.9) or macrocephaly (OR = 0.6, 95%CI = 0.4–0.9) had about 2 times less often truncating variants compared to missense variants. In DD patients these missense variants were often located in domain C2.ConclusionThe PHTS phenotypic diversity may partly be explained by the PTEN variant coding effect and the combination of coding effect and domain. PHTS patients with early-onset disease often had missense variants, and those with later-onset disease often truncating variants.     

Relating microarray component testing and reported food allergy and food-triggered atopic dermatitis: a real-world analysis

BackgroundHigh epitope diversity has been associated with increased IgE-mediated food allergy severity.ObjectiveTo characterize associations between results from an automated microarray system and self-reported food allergy and food-triggered atopic dermatitis (AD).MethodsFamilies with food allergic children were identified from a Jewish community in Lakewood, New Jersey, with immediate family members without food allergy or food-triggered AD serving as controls for the identified children. Sets of microarray components analyzed were to milk (Bos d 4, Bos d 5, Bos d 8, Bos d lactoferrin), egg (Gal d 1, Gal d 2, Gal d 3, Gal d 5), and peanut (Ara h 1, Ara h 2, Ara h 3, Ara h 6).ResultsSeventy-three patients from 23 families were recruited. Culprit foods included milk (n = 20), egg (n = 10), and peanut (n = 6) for food allergy and milk (n = 10) and egg (n = 7) for food-triggered AD. Odds of having had a self-reported related food allergy or food-triggered AD reaction significantly increased with a higher number of detectable microarray components to that food. Ara h 1, Ara h 2, and Ara h 6 were individually associated with reported peanut allergy, and Bos d 4 was individually associated with reported milk allergy. The number of egg components significantly increased the odds of having related food-triggered AD.ConclusionHigh diversity of food allergen components relates well to self-reported history of food allergy and food-associated AD.     

Reducing Bloodstream Infection Risk in Central and Peripheral Intravenous Lines: Initial Data on Passive Intravenous Connector Disinfection

BackgroundAlthough few facilities focus on it, bloodstream infection (BSI) risk from peripheral intravenous catheters (PIVs) may exceed central line-related risk. Over a 6-year period, Methodist Hospitals substantially reduced BSIs in patients with central lines but not in patients with PIVs. A practice audit revealed deficiencies in manual disinfection of intravenous connectors, thereby increasing BSI risk. Methodist thus sought an engineered approach to hub disinfection that would compensate for variations in scrubbing technique.MethodsOur institution involved bedside nurses in choosing new hub disinfection technology. They selected 2 devices to trial: a disinfection cap that passively disinfects hubs with isopropyl alcohol and a device that friction-scrubs with isopropyl alcohol. After trying both, nurses selected the cap for use in the facility's 3 intensive care units. After no BSIs occurred during a 3-month span, we implemented the cap throughout the hospital for use on central venous catheters; peripherally inserted central catheters; and peripheral lines, including tubing and Y-sites.ResultsComparing the postintervention period (December 2011-August 2013) to the preintervention span (September 2009-May 2011), the BSI rate dropped 43% for PIVs, 50% for central lines, and 45% overall (PIVs + central lines). The central line and overall results are statistically significant. The PIV BSI rate drop is attributable to cap use alone because the cap was the only new intervention during the postimplementation period. The other infection reductions appear to be at least partly due to cap use.ConclusionsOur institution achieved substantial BSI reductions, some statistically significant, by applying a disinfection cap to both PIVs and central lines.     

In vitro susceptibility of ceftaroline against clinically important Gram-positive cocci,Haemophilus species and Klebsiella pneumoniae in Taiwan: Results from the Antimicrobial Testing Leadership and Surveillance (ATLAS) in 2012–2018

Background/PurposeCeftaroline, with a unique activity against methicillin-resistant Staphylococcus aureus (MRSA), was not launched in Taiwan before 2019. The in vitro susceptibility data of ceftaroline against important Taiwanese pathogens are lacking.MethodsThe in vitro susceptibility of ceftaroline against important pathogens collected from 2012 through 2018 were extracted from the Antimicrobial Testing Leadership and Surveillance program. Broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) to ceftaroline against all isolates.ResultsDuring the study period, the in vitro data regarding isolates of S. aureus (n = 2049), Staphylococcus epidermidis (n = 185), Streptococcus pneumoniae (n = 334), Streptococcus pyogenes (n = 170), Haemophilus influenzae (n = 75), Haemophilus parainfluenzae (n = 10) and Klebsiella pneumoniae (n = 680) regardless of hospital sites of collection were analyzed. Among the S. aureus isolates studied, 19.4% showed MICs of 1 mg/L to ceftaroline, and 4.4% showed in vitro susceptible-dose dependent to ceftaroline (all MICs, 2 mg/L). Most of other Gram-positive cocci, all H. influenzae and H. parainfluenzae isolates were susceptible to ceftaroline. By contrast, about one-third (35.9%) of K. pneumoniae isolates, irrespective of infection sources, exhibited non-susceptibility to ceftaroline (MIC range, 0.015–256 mg/L; MIC₅₀ and MIC₉₀ values, 0.12 and 256 mg/L, respectively).ConclusionsFrom the pharmacodynamic perspectives, the ceftaroline dosage of 600 mg as a 2-h intravenous infusion every 8 h is effective against all S. aureus and other Gram-positive isolates regardless of acquisition sites in Taiwan. Before ceftaroline is prescribed in treatment of the patient with Gram-negative infection, a cautious evaluation about patient's healthcare-associated factor is warranted.     

A comparison of safety and outcomes with cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus bloodstream infections

BackgroundMethicillin-susceptible Staphylococcus aureus (MSSA) is a frequent cause of bloodstream infections (BSI). Treatment with nafcillin (NAF) has been preferred to cefazolin (CFZ). However, comparable outcomes have been found with CFZ with possibly lower risk for side-effects. This study compared safety and effectiveness of NAF versus CFZ for MSSA BSI.MethodsThis single center retrospective study evaluated adults admitted with MSSA BSI who received NAF or CFZ. Patients receiving ≥24 h of antibiotics were included for safety analyses. Patients receiving NAF or CFZ for ≥75% of a 14 day minimum treatment course were assessed for clinical effectiveness. The primary safety outcome was incidence of renal toxicity with multiple secondary safety endpoints. Clinical success was defined as symptom resolution, repeat negative cultures, lack of additional therapy for presumed failure, and lack of recurrence within 30 days.ResultsA total of 130 patients receiving NAF (n = 79) or CFZ (n = 51) were included for safety analysis. Of those, 90 met criteria for effectiveness assessment (NAF n = 40, CFZ n = 50). Baseline characteristics were well matched. NAF was associated with a higher incidence of nephrotoxicity compared to CFZ (25% vs. 2%, RR 1.31, 95% CI 1.15–1.5, p < 0.001), allergic reactions (p = 0.01) and a trend for hepatotoxicity (p = 0.08). Clinical success was achieved in 82% NAF and 94% CFZ treated patients (p = 0.1).ConclusionCFZ was associated with less nephrotoxicity and no difference in clinical success compared to NAF for MSSA BSI. A prospective study comparing NAF to CFZ for MSSA BSI should be conducted to elucidate differences in therapies.     

Understanding clinical communication about mood disturbance symptoms among breast cancer patients: A mixed methods analysis

ObjectivesWe aimed to characterize the relationships between breast cancer patient mood symptom severity and demographic/medical factors with clinical communication about mood, and to explore mood discussion content.Methods134 breast cancer patients (mean age=58.3; 14% minority; 13% metastatic) had oncology clinic visits audio-recorded, transcribed, and coded for mood communication. Patient Care Monitor assessed mood symptoms (anxiety/depression presence/severity). Logistic regressions measured associations between mood, demographic/medical factors, and communication. Thematic analysis characterized discussion topics.ResultsOver half of patients (55%; n = 73) reported mood symptoms. Worse mood symptoms were associated with younger age and current treatment (p’s < 0.05). 19% of clinic visits (n = 26/134) contained mood discussions. Discussions were more common for younger women and those with non-metastatic disease (p’s < 0.05). Odds of discussing mood increased with symptom severity (OR=4.52, p = 0.018). Cancer-related anxiety and medication management were among the most common topics discussed.ConclusionsCommunication about mood occurred infrequently, with women currently undergoing treatment, with metastatic disease, or with mild mood symptoms at potentially increased risk for inadequate discussion. Both patient-focused and provider-focused interventions to improve clinical communication about mood symptoms could be beneficial.Practice implicationsClinicians hold a key role in supporting cancer patients’ well-being by using and encouraging effective communication about patients’ mood.     

Achieving Zero Central Line-Associated Bloodstream Infections: Connector Design Combined with Practice in the Long-Term Acute Care Setting

Reducing central line-associated bloodstream infections (CLABSI) to zero is especially challenging in long-term acute care (LTAC) hospitals because patients usually have the line in place at admission. The central venous line may have been in place from days to weeks before admission. The LTAC thus has no control over the site selection, catheter selection, insertion protocol, and care and maintenance the catheter received before admission. Using comprehensive practice-based evidence for clinical practice improvement, our LTAC used different needleless connectors during a 3-year period to achieve zero CLABSIs. The sample data offers a rare opportunity to compare different needleless connectors and in a wide sample of complex patient diagnoses. Needleless connector design in combination with nursing care and management can achieve zero CLABSI,s even in the challenging LTAC environment.     

In vitro susceptibility of common Enterobacterales to eravacycline in Taiwan

BackgroundNew tetracycline derivatives exhibit broad-spectrum antimicrobial activities. This study aimed to assess the in vitro activity of eravacycline against common Enterobacterales.MethodsClinical Enterobacterales isolates were collected between 2017 and 2021. The minimum inhibitory concentration (MIC) was determined using a broth microdilution test.ResultsWe identified Klebsiella pneumoniae (n = 300), Escherichia coli (n = 300), Klebsiella oxytoca (n = 100), Enterobacter cloacae complex (n = 100), Citrobacter freundii (n = 100), and Proteus mirabilis (n = 100). All P. mirabilis strains were resistant to eravacycline. Excluding P. mirabilis, the susceptibility rates to eravacycline, omadacycline, and tigecycline were 75.2%, 66.9%, and 73%, respectively. The MIC₅₀ and MIC₉₀ (mg/L) of eravacycline were 0.5 and 4 for K. pneumoniae, 0.5 and 1 for E. coli, 0.5 and 1 for K. oxytoca, 0.5 and 2 for E. cloacae complex, and 0.25 and 1 for C. freundii. In cefotaxime non-susceptible and meropenem susceptible Enterobacterales, excluding P. mirabilis, the susceptibility rates of eravacycline, omadacycline, and tigecycline were 69.7%, 57.1%, and 66.2%. We found decreased susceptibility rates of three new tetracycline derivatives against meropenem non-susceptible Enterobacterales (eravacycline: 47.1%, omadacycline: 39.4%, and tigecycline: 39.4%). Eravacycline showed a high susceptibility rate against cefotaxime non-susceptible and meropenem susceptible K. oxytoca (100%), C. freundii (93.2%), E. coli (85.9%), and meropenem non-susceptible E. coli (100%).ConclusionThis study provides the MIC and susceptibility rate of eravacycline for common Enterobacterales. Eravacycline could be a therapeutic choice for cefotaxime non-susceptible or meropenem non-susceptible Enterobacterales, especially K. oxytoca, C. freundii, and E. coli.     

Potentially conjugative plasmids harboring Tn6636, a multidrug-resistant and composite mobile element,in Staphylococcus aureus

ObjectivesThis study aimed to provide detailed genetic characterization of Tn6636, a multidrug-resistant and composite mobile element, in clinical isolates of Staphylococcus aureus.MethodsA total of 112 ermB-positive methicillin-susceptible S. aureus (MSSA) and 224 ermB-positive methicillin-resistant S. aureus (MRSA) isolates collected from 2000 to 2015 were tested for the presence of Tn6636. Detection of the plasmids harboring Tn6636 was performed by S1 nuclease digestion pulsed-field gel electrophoresis (PFGE) analysis, conjugation test, and whole genome sequencing (WGS).ResultsPrevalence of Tn6636 in MSSA is higher than that in MRSA. Ten MSSA isolates and 10 MRSA isolates carried Tn6636. The 10 MSSA isolates belonged to three sequence types (ST), including ST7 (n = 6), ST5 (n = 3), and ST59 (n = 1). The 10 MRSA isolates belonged to ST188 (n = 8) and ST965 (n = 2). Analysis of plasmid sequences revealed that Tn6636 was harbored by six different mosaic plasmids. In addition to resistance genes, some plasmids also harbored toxin genes.ConclusionThe presence of multi-resistant Tn6636 in plasmids of both MSSA and MRSA with various STs suggests its broad dissemination. Results indicate that Tn6636 has existed for at least 16 years in Taiwan. The mosaic plasmids harboring Tn6636 can be transferred by conjugation. Ongoing surveillance of Tn6636 is essential to avoid continued spreading of resistant plasmids.     

The coated antiseptic tip (CAT) syringe

Abstract

Catheter-related blood stream infections (CR-BSI) account for 30% of healthcare acquired infection (HAI). Colonization of connector hubs and contaminated syringes are thought to increase the risk of CR-BSI. The Coated Antiseptic Tip (CAT) syringe was developed to decontaminate connector hubs, thereby reducing the risk of CR-BSI. Needleless valves (n?=?20) and three-way connectors (n?=?20) were contaminated with common critical care pathogens. At hourly intervals, CAT syringes were inserted into the connector hubs and normal saline was injected through the connector. This was repeated with control (non-coated) syringes. The internal surface of the connector hubs were swabbed at t?=?0, t?=?1?h and t?=?4?h, inoculated onto blood agar plates and analysed by a blinded microbiologist. Growth was counted as the number of colony forming units. Baseline swabbing demonstrated 100% bacterial hub colonization in both connectors. The CAT syringe showed a significant reduction in CFU growth at 0 and 1?h compared with control syringes (p?<?0.05). At 4?h, the CAT syringe completely eliminated bacterial growth in both of the connector hubs. The CAT syringe can effectively disinfect both three-way and needleless connectors.     

Antibacterial efficacy of handrubbing for 15 versus 30 seconds: EN 1500-based randomized experimental study with different loads of Staphylococcus aureus and Escherichia coli

ObjectivesCompliance with the World Health Organization ‘how to handrub’ action is suboptimal. Simplifying the hand-hygiene action may improve practice. However, it is crucial to preserve antibacterial efficacy. We tested the non-inferiority of 15 versus 30 seconds handrubbing for Staphylococcus aureus and Escherichia coli contamination at different loads, using hand-size customized alcohol-based handrub (ABHR) volumes.MethodsIn an EN1500-based study, 18 health-care workers (HCWs) with extensive experience in hand hygiene rubbed hands with a hand-size customized volume of isopropanol 60% v/v. They repeated the following sequence: hand contamination (E. coli or S. aureus; broth containing 10⁸ or 10⁶ CFU/mL); baseline fingertips sampling; handrubbing (15 or 30 seconds); re-sampling. The main outcome was log₁₀ CFU corrected reduction factor (cRF) on HCWs' hands, applying a generalized linear mixed model with a random intercept for subject.ResultsThe median cRF was 2.1 log₁₀ (interquartile range 1.50–3.10). After fitting the model, cRF was significantly higher for S. aureus compared with E. coli but there was no significant effect for duration of handrubbing or contamination fluid concentration. Fifteen seconds of handrubbing was non-inferior to 30 (–0.06 log₁₀, 95% CI –0.34 to 0.22; EN1500 0.60 log₁₀ non-inferiority margin). This was confirmed in all pre-specified subgroups.ConclusionAmong experienced HCWs using a hand-size customized volume of ABHR, handrubbing for 15 seconds was non-inferior to 30 seconds in reducing bacterial load, irrespective of type of bacteria or contamination fluid concentration. This provides further support for a shorter, 15-seconds, hand-hygiene action.     

Linezolid as salvage therapy for central nervous system infections due to methicillin-resistant Staphylococcus aureus at two medical centers in Taiwan

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA)-associated central nervous system infections are potentially devastating. Linezolid has good penetration into cerebrospinal fluid and brain tissue. In clinical practice, linezolid may be used to treat central nervous system infections caused by MRSA resulting from glycopeptide intolerance or treatment failure. However, the clinical experience of linezolid in treating MRSA related central nervous system infections is scarce.MethodsFrom 2006 to 2016, patients aged ≥20 years who had central nervous system infections caused by MRSA treated with linezolid for more than 24 hours were retrospectively included from two medical centers. The demographic details, treatment response, side effects, and relapse of infection were reviewed.ResultsSixty-six patients with proven CNS infection caused by MRSA were treated with linezolid. The mean age was 53.3 years. The diagnoses in this cohort consisted of brain abscesses (n = 19, 28.8%), spinal epidural abscess (n = 18, 27.3%), meningitis only (n = 12, 18.2%), meningitis with brain epidural abscess (n = 9, 13.6%), and spine device-related infection (n = 5, 7.6%). The main reasons to prescribe linezolid were glycopeptide treatment failure (51.5%) and glycopeptide allergy (48.5%). Ninety-one percent of patients were treated with linezolid for more than 14 days. The in-hospital mortality rate was 13.6%. The relapse rate after treatment was 16.7%. Drug-related adverse events (mainly cytopenia) were observed in 27.3% of patients, but none of the adverse events was fatal.ConclusionsIn our retrospective study, linezolid demonstrated promising effect as a salvage therapy for central nervous system infection caused by MRSA, whether due to drug allergy or glycopeptide treatment failure.     

Re-examining phone counseling for smoking cessation: Does the evidence apply to low-SES smokers?

IntroductionA 2019 Cochrane review concluded telephone counseling is an effective intervention for smoking cessation. However, the review did not assess the role of socioeconomic status (SES) indicators on the effectiveness of telephone counseling.MethodsWe reviewed 65 U.S. studies from the Cochrane review. We abstracted data on education, income, employment status and insurance status, and examined associations with targeted recruitment, intervention uptake, attrition, and cessation outcomes.ResultsExcept for education, SES indicators were seldom reported or used in analysis: 61 studies reported education, 24 reported insurance status, 23 reported employment status, and 17 reported income. Nine studies exclusively recruited low-SES samples. Thirteen studies examined associations between SES and smoking cessation. Among these, two reported lower education predicted greater cessation and two reported higher education predicted greater cessation. Other studies found higher income (n = 2) or employment type (n = 1) predicted cessation.ConclusionsEvidence supporting telephone counseling for cessation is less clear when applied to low-SES smokers. Future research should directly assess intervention effectiveness in this priority population.Practice implicationsGiven the evidence, it may be hard to justify future studies not focusing on low-SES populations. Innovative counseling solutions from providers helping low-income smokers quit should be evaluated to inform best practice.     

Exercise interventions in Alzheimer’s disease: A systematic review and meta-analysis of randomized controlled trials

AimsTo assess the potential multi-domain benefits of exercise interventions on patients with Alzheimer’s disease (AD), as well as to determine the specific effects of different exercise modalities (aerobic, strength, or combined training).MethodsA systematic search was conducted in PubMed and Web of Science until March 2021 for randomized controlled trials assessing the effect of exercise interventions (compared with no exercise) on patients with AD. Outcomes included cognitive function (mini-mental state examination [MMSE] test), physical function (e.g., 6-minute walking test [6MWT]), functional independence (Barthel index), and neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]). A random-effects meta-analysis was conducted.Results28 studies (total n = 1337 participants, average age 79–90 years) were included in the systematic review, of which 21 could be meta-analyzed. Although considerable heterogeneity was found, exercise interventions induced several significant benefits, including in Barthel index (n = 147 patients, mean difference [MD]=8.36 points, 95% confidence interval [CI]=0.63–16.09), 6MWT (n = 369, MD=84 m, 95% CI=44–133)), and NPI (n = 263, MD=−4.4 points, 95% CI=−8.42 to −0.38). Benefits were also found in the MMSE test, albeit significance was only reached for aerobic exercise (n = 187, MD=2.31 points, 95% CI 0.45–4.27).ConclusionsExercise interventions appear to exert multi-domain benefits in patients with AD.     

Hemolysis in needleless connectors for phlebotomy

Needleless connectors have been developed recently as a means of reducing transmission of AIDS and other blood-borne diseases by accidental needle sticks. However, the potential for hemolysis induced by fluid stresses within the connector remained to be determined. The influence of needleless connectors on hemolysis was evaluated in simulated clinical blood draws. Blood from five volunteers was drawn with vacuum tubes and syringes through 16, 18, and 22 gauge needles and PosiFlow (Becton Dickinson, Franklin Lakes, NJ) and Clave (ICU Medical, San Clemente, CA) needleless connectors. Hemolysis was measured in the samples by a spectrophotometric technique. Results showed that hemolysis increased when needleless connectors were used. The PosiFlow connector produced more hemolysis than the Clave device. Curiously, erythrocyte damage was greatest for connectors used with 18 gauge needles. Hemolysis was larger for samples drawn with vacuum tubes than with syringes. However, no combinations of connector, needle size, or blood draw device resulted in mean hemolysis values large enough to interfere with clinical assays.