Determining the Efficacy of Liquid Sporicides Against Spores of Bacillus subtilis on a Hard Nonporous Surface Using the Quantitative Three Step Method: Collaborative Study

A collaborative study was conducted to validate the quantitative Three Step Method (TSM), a method designed to measure the performance of liquid sporicides on a hard nonporous surface. Ten laboratories agreed to participate in the collaborative study; data from 8 of 10 participating laboratories were used in the final statistical analysis. The TSM uses 5 5 1 mm glass coupons (carriers) upon which spores have been inoculated and which are introduced into liquid sporicidal agent contained in a microcentrifuge tube. Following exposure to a test chemical and a neutralization agent, spores are removed from carriers in 3 fractions: passive removal (Fraction A), sonication (Fraction B), and gentle agitation (Fraction C). Liquid from each fraction is serially diluted and plated on a recovery medium for spore enumeration. Control counts are compared to the treated counts, and the level of efficacy is determined by calculating the log10 reduction (LR) of spores. The main statistical goals were to evaluate the repeatability and reproducibility of the LR values, to estimate the components of variance for LR, and to assess method responsiveness. AOAC Method 966.04Method II was used as a reference method. The scope of the validation was limited to testing liquid formulations against spores of Bacillus subtilis, a surrogate for virulent strains of B. anthracis, on a hard nonporous surface (glass). The test chemicals used in the study were sodium hypochlorite, a combination of peracetic acid and hydrogen peroxide, and glutaraldehyde. Each test chemical was evaluated at 3 levels of presumed efficacy: high, medium, and low. Three replications were required. The TSM was validated as it successfully met the statistical parameters for quantitative test methods. Satisfactory validation parameters, such as the repeatability standard deviation (Sr) and reproducibility standard deviation (SR), were obtained for control carrier counts and LR values. Both the TSM and the reference method were responsive to the efficacy levels of the test chemicals. For the 72 total TSM tests conducted, the mean ( standard error of the mean) log density of spores per control carrier was 6.86 ( 0.08); the Sr and SR were low at 0.15 and 0.27, respectively. Across the range of test chemicals, the Sr and SR estimates associated with LR were also acceptably low. The Sr rangedfrom 0.17 to 0.72 and the SR ranged from 0.34 to 1.43. Overall, the Sr and SR estimates associated with the efficacy data were within the ranges published for other quantitative methods and meet the performance characteristics necessary for validation.

Exploring patient attitudes to behaviour change before surgery to reduce peri-operative risk: preferences for short- vs. long-term behaviour change

Pre-operative intervention to improve general health and readiness for surgery is known as prehabilitation. Modification of risk factors such as physical inactivity, smoking, hazardous alcohol consumption and an unhealthy weight can reduce the risk of peri-operative morbidity and improve patient outcomes. Interventions may need to target multiple risk behaviours. The acceptability to patients is unclear. We explored motivation, confidence and priority for changing health behaviours before surgery for short-term peri-operative health benefits in comparison with long-term general health benefits. A total of 299 participants at three UK hospital Trusts completed a structured questionnaire. We analysed participant baseline characteristics and risk behaviour profiles using independent sample t-tests and odds ratios. Ratings of motivation, confidence and priority were analysed using paired sample t-tests. We identified a substantial prevalence of risk behaviours in this surgical population, and clustering of multiple behaviours in 42.1% of participants. Levels of motivation, confidence and priority for increasing physical activity, weight management and reducing alcohol consumption were higher for peri-operative vs. longer term benefits. There was no difference for smoking cessation, and participants reported lower confidence for achieving this compared with other behaviours. Participants were also more confident than motivated in reducing their alcohol consumption pre-operatively. Overall, confidence ratings were lower than motivation levels in both the short- and long-term. This study identifies both substantial patient desire to modify behaviours for peri-operative benefit and the need for structured pre-operative support. These results provide objective evidence in support of a 'pre-operative teachable moment', and of patients' desire to change behaviours for health benefits in the short term.

Abstract P1-02-08: Provista-002: A prospective, multi-center study to determine the effectiveness of a biomarker assay to distinguish benign from invasive breast cancer in women with BI-RADS 3, 4 and 5 imaging reports

This abstract was not presented at the symposium.

The end for the ‘Roman Sandal’: an observational study of methods of securing chest drains in a deployed military setting

Introduction

There is ongoing debate regarding the optimal method of securing chest drains in trauma patients. Various courses describe methods for chest drain insertion, but little has been published to identify the best method to secure the drain.

Aim

This article aims to examine differences in approach to securing chest drains and the security of the methods used.

Method

Whilst in a deployed medical treatment facility, 26 clinicians from various specialties and nationalities were asked to secure a pre-placed drain. A 32F drain was placed in a manikin and the clinicians were given a chance to prepare their equipment. They were given a choice of suture and their attempts were observed by one of the researchers. The attempts were timed and photographed. A second researcher, who had not observed the technique, then assessed the security of the drain.

Results

15/26 clinicians used a ‘Roman Sandal’ technique with 5/26 proving to be insecure. Other techniques used showed no failure. The rate of consultant‐secured failure was 12.5% compared to 40% for registrars and 33% for General Duties Medical Officers.

Conclusions

The type of suture used made no difference, but the traditional ‘Roman Sandal’ method was insecure. Knots tied close to the skin and those that bit into the drain were shown to be most effective.

The end for the 'Roman Sandal': an observational study of methods of securing chest drains in a deployed military setting

INTRODUCTION

There is ongoing debate regarding the optimal method of securing chest drains in trauma patients. Various courses describe methods for chest drain insertion, but little has been published to identify the best method to secure the drain.

AIM

This article aims to examine differences in approach to securing chest drains and the security of the methods used.

METHOD

Whilst in a deployed medical treatment facility, 26 clinicians from various specialties and nationalities were asked to secure a pre-placed drain. A 32F drain was placed in a manikin and the clinicians were given a chance to prepare their equipment. They were given a choice of suture and their attempts were observed by one of the researchers. The attempts were timed and photographed. A second researcher, who had not observed the technique, then assessed the security of the drain.

RESULTS

15/26 clinicians used a 'Roman Sandal' technique with 5/26 proving to be insecure. Other techniques used showed no failure. The rate of consultant-secured failure was 12.5% compared to 40% for registrars and 33% for General Duties Medical Officers.

CONCLUSIONS

The type of suture used made no difference, but the traditional 'Roman Sandal' method was insecure. Knots tied close to the skin and those that bit into the drain were shown to be most effective.

Validation of a Blood-Based Gene Expression Test for the Detection of Breast Cancer Using an Independent European Cohort

We report the development of a gene expression based blood test to detect breast cancer (BC). The test measures RNA species that undergo regulation as a response to the presence of a breast cancer lesion. We have previously presented data from a European/US cohort with accuracies from 75% - 82%. We now report findings from a multi-centre study where a calibration set of 282 subjects was used to create a model for the classification of breast cancer vs non-breast cancer using a European/US cohort. Validation of this model was performed using an independent set of 109 samples collected in 5 sites one of which was independent from the calibration set.MethodsIn a multicentre-study, blood samples were collected from women recruited in 4 groups 1) early stage BC (stage 0-1), 2) late stage BC (stage2+), 3) benign breast lesions, 4) without abnormal mammographic findings. Samples were collected in PAXgene™ tubes and shipped to a central laboratory where RNA extraction and quality control were performed. Gene expression analysis was performed using real time-RT PCR on an AB Prism 7900HT Fast instrument with a microfluidic card containing a BC-specific gene signature in a 96-gene assay format. Modelling was performed using Partial Least Square Regression providing an algorithm for application to gene expression data. Application of the algorithm to subjects in an independent cohort was used to obtain a test score for each subject. A positive test score classified a subject as positive for breast cancer, whilst a negative score classified a subject as negative for breast cancer. A total of 248 samples were used to develop the algorithm and 109 used as an independent validation set to describe it performance.ResultsThe model correctly predicted the class of 78/109 validation samples, resulting in an overall accuracy of 72%. Performance was similar for early and late stage cancer with a sensitivity of 74% for stage 0 and stage 1 breast cancer. No significant difference in diagnostic performance was seen between pre- (71%) and post-menopausal (70%) women indicating the clinical value of our test in younger women. When assessing the efficacy of ductal and lobular cancers only the test showed a sensitivity of73%. The effect of medications were assessed from the information gathered from the subject report forms. The majority of medications were for hypocholesterolaemia, hypertension, diabetes, and asthma. None of the medication groups noted appeared to have a detrimental effect on the ability for the test.ConclusionWe report the validation of the blood-based gene expression test in a European cohort from a multi-centre study. The test shows efficacy for the detection of early breast cancer for both lobular and ductal breast cancer in both pre- and postmenopausal women. The test may be of clinical benefit as an adjuvant to mammography particularly for pre-menopausal women where mammography is known to have limitations.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3025.

Performance of a blood-based gene-expression test, BCtect, for early breast cancer detection

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Background: We report the development of a gene expression based blood test to detect breast cancer (BC). Validation of the test has been performed in multiethnic populations (European/US and Indian). Here we report findings from a multi-centre validation study. Methods: In a multicentre-study, blood samples were collected from women recruited in 4 groups 1) early stage BC, 2) late stage BC, 3) benign breast lesions, 4) without abnormal mammographic findings. Samples were collected in PAXgene tubes and shipped to a central laboratory where RNA extraction and quality control were performed. Gene expression analysis was performed using TaqMan low density arrays containing a BC-specific gene signature in a 96-gene assay format. The overall gene expression pattern was converted to a test score which was used to classify the subject as positive or negative for BC. A total of 442 samples were used to develop an India specific algorithm and estimate its prediction efficacy. Samples were divided into a training cohort (N=292) and a test cohort (N=150). The performance of the test was determined from the class of the independent test cohort. Results: The model correctly predicted the class of 110/150 test samples, resulting in an overall accuracy of 73%. Performance was similar for early and late stage cancer and for benign and healthy (no mammographic findings). No significant difference in diagnostic performance was seen between pre- (57/75 correctly predicted) and post-menopausal (53/75 correctly predicted) women indicating the clinical value of our test in younger women. No statistical correlation between correct/false test score and body mass index was noted. Lesion size varied from 8mm diameter to 120mm. No statistical correlation of the test score was seen with lesion size in this cohort. Conclusions: The blood based gene expression test showed similar diagnostic performance between women with early and late stage BC, and the test was independent of the subject's BMI and menopausal status suggesting broad applicability of the test and indicating its clinical potential in younger women where mammography is of less value due to dense breast tissue. No correlation with lesion size was seen suggesting the lower limit of detection is below 8mm.

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Gold coast seaway smartrelease decision support system: optimising recycled water release in a sub tropical estuarine environment

Gold Coast Water is responsible for the management of the water, recycled water and wastewater assets of the City of the Gold Coast on Australia's east coast. Excess treated recycled water is released at the Gold Coast Seaway, a man-made channel connecting the Broadwater Estuary with the Pacific Ocean, on an outgoing tide in order for the recycled water to be dispersed before the tide changes and re-enters the Broadwater estuary. Rapid population growth has placed increasing demands on the city's recycled water release system and an investigation of the capacity of the Broadwater to assimilate a greater volume of recycled water over a longer release period was undertaken in 2007. As an outcome, Gold Coast Water was granted an extension of the existing release licence from 10.5 hours per day to 13.3 hours per day from the Coombabah wastewater treatment plant (WWTP). The Seaway SmartRelease Project has been designed to optimise the release of the recycled water from the Coombabah WWTP in order to minimise the impact to the receiving estuarine water quality and maximise the cost efficiency of pumping. In order achieve this; an optimisation study that involves intensive hydrodynamic and water quality monitoring, numerical modelling and a web-based decision support system is underway. An intensive monitoring campaign provided information on water levels, currents, winds, waves, nutrients and bacterial levels within the Broadwater. This data was then used to calibrate and verify numerical models using the MIKE by DHI suite of software. The Decision Support System will then collect continually measured data such as water levels, interact with the WWTP SCADA system, run the numerical models and provide the optimal time window to release the required amount of recycled water from the WWTP within the licence specifications.

Validity of the four European test strains of prEN 12054 for the determination of comprehensive bactericidal activity of an alcohol-based hand rub

A comprehensive bactericidal activity of an alcohol-based hand rub is essential for prevention of cross-transmission by the hands of healthcare workers. In Europe, however, only four test organisms are used to determine bactericidal activity according to prEN 12054. The susceptibility of the various bacterial species against the commonly used alcohols is thought to be similar, but so far this has never been studied. We therefore evaluated the bactericidal activity of an alcohol-based hand rub (Sterillium) within 30 s in compliance with prEN 12054 and in a time kill test against 13 Gram-positive, 18 Gram-negative bacteria and 14 antibiotic-resistant bacterial pathogens. Each strain was evaluated in quadruplicate. Counts of the four test bacteria of prEN 12054 were reduced by factors exceeding 10(5) within 30 s. In the time kill test, all 13 Gram-positive and all 18 Gram-negative bacteria were reduced more than 10(5)-fold within 30 s, not only against the ATCC test strains but also against corresponding clinical isolates. Comparable reductions were also observed against all 14 emerging bacterial pathogens. The four European test bacteria were found to be sufficient to determine a comprehensive bactericidal activity of a propanol-based hand rub.

Profile of postdischarge rehospitalizations and acute care visits for seven patient groups

The study's purpose was to examine postdischarge rehospitalizations and acute care visits in seven high risk, high volume, high-cost patient groups. Subjects were drawn from an urban tertiary teaching hospital. The total sample (N = 764) consisted of seven patient groups (drawn from five randomized clinical trials): very low birthweight (VLBW) infants (n = 79); women post-unplanned cesarean birth (n = 122) and their infants (n = 123); pregnant women with diabetes (n = 55); women post-hysterectomy surgery (n = 109); and elderly with medical cardiac Diagnostic Related Groups (DRGs) (n = 142) and elderly with surgical cardiac DRGs (n = 134). The VLBW infant and pregnant diabetic groups were predominantly African American, the elderly and hysterectomy groups predominantly Caucasian, and the cesarean group almost equally distributed. The lowest rate of rehospitalization (2%) occurred in the cesarean group, the highest (35%) in the pregnant diabetics. In four groups (cesarean and infants, hysterectomy and surgical elderly), 60%-100% of the rehospitalizations occurred within 4 weeks of discharge. Subjects requiring acute care visits ranged from 13% (hysterectomy) to 82% (VLBW infants). Acute care visits demonstrated greater distribution throughout the follow-up periods but also tended to concentrate in the first 4 weeks postdischarge.

The detection of adducts in human cervix tissue DNA using 32P-postlabelling: a study of the relationship with smoking history and oral contraceptive use

32P-Postlabelling was used to measure DNA adducts in the human cervix. Adduct levels were compared with patient smoking histories and contraceptive use. DNA adducts were found in 43 out of 58 samples. The number of adducts ranged from 0.2 to 59.5 adducts/10(8) nucleotides, though no significant difference was found to exist between the number of DNA adducts detected and the smoking history of each patient. In contrast, a significant difference at the 1% probability level was found between the adduct levels obtained from the cervical DNA of smokers who had used oral contraceptives and smokers who did not. Autoradiograms revealed a variety of adduct patterns. Some were found to have a diagonal zone of radioactivity which migrated from the origin of the TLC plate. Other autoradiograms revealed the presence of additional adduct spots located in the upper regions of the TLC plate, whereas others revealed the presence of these adduct spots alone. The origin of the adduct spots located in the upper regions of the TLC plate is unknown.

Response to fibronectin of mouse primordial germ cells before, during and after migration

The adhesive extracellular matrix glycoprotein fibronectin is thought to play a central role in cell migration during embryogenesis. In order to define this role, we have examined the response to fibronectin in cell culture of mouse primordial germ cells (PGCs) before, during and after their migration from the hindgut into their target tissue, the genital ridges. Using an explant culture system, we show that PGCs will emigrate from tissue fragments containing hindgut, and that fibronectin stimulates this migration. Adhesion assays show that the start of PGC migration is associated with a fall in adhesion to fibronectin. Double-labelling studies using in situ hybridization and histochemistry demonstrate that migrating PGCs do not contain detectable fibronectin mRNA, suggesting that they do not synthesize and secrete the fibronectin within their migratory substratum. Taken together, these findings are consistent with an important role for fibronectin in stimulating PGC migration. In addition, however, they suggest that the interaction between PGCs and fibronectin may be important in timing the start of migration, with the fall in adhesion allowing the PGCs to commence their migration towards the genital ridges.

Developing a program grant for use in model testing

Early discharge is becoming a practice as well as a goal for the acute care institution. It is essential that nursing investigate the effects of this shift in the care delivery site from the acute care institution to the home and community. Brooten et al. describe a research model designed to do just that. Transitional care, as this team calls it, may soon become familiar jargon in community health care.

The faculty advisor role: an imperative for student retention

The decline in applicants to schools of nursing emphasizes the importance of retaining those students who do enroll. The authors review factors affecting student attrition and retention in academic settings. They then present an ideal model for enhancing student retention through effective, individualized, and consistent student advising.

All Real Living is Meeting: The Task of International Education in a Nursing Curriculum

Our experience suggests two significant benefits of shaping an international education focus in a nursing curriculum. First, a genuine understanding and appreciation of a foreign health care system is strengthened by identification of and confrontation with the socio-political context in which it is embedded. The second, and perhaps most fundamental benefit, is not so easy to verbalize. This involves the participant's personal confrontation with another culture. What is external, the experience of a foreign culture, translates into an encounter with the foreign territory of one's own thinking. The participant is challenged to overcome the traditional limitations of professional discipline, experience and vision and to move toward notions of world community and human solidarity. It seems to us that the development of concepts, resources and methods to move American nursing in the direction of greater solidarity with the world health care community is a legitimate task for nursing education.

Breast-milk jaundice

The syndrome of breast-milk jaundice, which often results in cessation of breastfeeding, maternal anxiety, and guilt, may be increasing. Research to date on pregnanediol, increased lipase, and free fatty acids as the causes of breast milk jaundice is reviewed. Variations in current treatment are presented and nursing measures supportive of parents and continued breastfeeding are provided.

Stellate ganglion block in treatment of total blindness due to quinine

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