The application of antimicrobial stewardship knowledge to nursing practice: A national survey of United Kingdom pre-registration nursing students

AIM

To assess student nurses understanding and skills in the application of antimicrobial stewardship knowledge to practice.

DESIGN

Quantitative.

METHODS

Cross-sectional survey.

RESULTS

Five hundred and twenty three student nurses responded across 23 UK universities. Although students felt prepared in competencies in infection prevention and control, patient-centred care and interprofessional collaborative practice, they felt less prepared in competencies in which microbiological knowledge, prescribing and its effect on antimicrobial stewardship is required. Problem-based learning, activities in the clinical setting and face-to-face teaching were identified as the preferred modes of education delivery. Those who had shared antimicrobial stewardship teaching with students from other professions reported the benefits to include a broader understanding of antimicrobial stewardship, an understanding of the roles of others in antimicrobial stewardship and improved interprofessional working.

CONCLUSION

There are gaps in student nurses' knowledge of the basic sciences associated with the antimicrobial stewardship activities in which nurses are involved, and a need to strengthen knowledge in pre-registration nurse education programmes pertaining to antimicrobial management, specifically microbiology and antimicrobial regimes and effects on antimicrobial stewardship. Infection prevention and control, patient-centred care and interprofessional collaborative practice are areas of antimicrobial stewardship in which student nurses feel prepared. Interprofessional education would help nurses and other members of the antimicrobial stewardship team clarify the role nurses can play in antimicrobial stewardship and therefore maximize their contribution to antimicrobial stewardship and antimicrobial management.

IMPLICATIONS FOR THE PROFESSION

There is a need to strengthen knowledge from the basic sciences, specifically pertaining to antimicrobial management, in pre-registration nurse education programmes.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPACT

What Problem Did the Study Address? Nurses must protect health through understanding and applying antimicrobial stewardship knowledge and skills (Nursing and Midwifery Council 2018); however, there is no research available that has investigated nurses understanding and skills of the basic sciences associated with the antimicrobial stewardship activities in which they are involved. What Were the Main Findings? There are gaps in student nurses' knowledge of the basic sciences (specifically microbiology and prescribing) associated with the antimicrobial stewardship activities in which nurses are involved. Problem-based learning, and activities in the clinical setting, were reported as useful teaching methods, whereas online learning, was seen as less useful. Where and on Whom Will the Research Have an Impact? Pre-registration nurse education programmes.

REPORTING METHOD

The relevant reporting method has been adhered to, that is, STROBE.

The global distribution of special needs dentistry across dental school curricula

INTRODUCTION

Special needs dentistry (SND) is an emerging dental specialty, with ongoing developments in education and clinical practice focused towards the tailored management of individuals with special needs (SN). Patients with SN have a higher prevalence of oral diseases and unmet dental needs compared to the general population. Although inadequate training and experience in managing patients with SN has been highlighted as a significant barrier to accessing care, there is limited data about the extent of SND teaching at the entry-to-practice or higher levels.

METHODS

This work is the first to map SND curricula globally, across 180 countries and 1265 dental schools.

RESULTS

Although 74.62% of dental schools were found in developing economies, the distribution of programs that reported SND in their courses was highly skewed towards developed countries. In terms of advanced degrees, beyond basic entry-to-practice training, the USA delivered 60% of the SND programs, followed by Canada (15.56%), UK (13.33%), and Australia (8.89%). The term SND appeared in 33.95% of entry-to-practice level program curricula and was less commonly used in transitioning economies. Only 112 SND-specialized practitioners enter the workforce globally each year from developed economies, and all but three advanced degrees are found in G7 countries.

CONCLUSION

By exploring the impact of economic status on its distribution, this paper highlighted the lack of SND representation in dental curricula, especially amongst programs in transitioning or developing economies. Education of both general dentists and specialists is critical as a collaborative effort is needed to manage the growing population of patients with SN.

STAR-0215 is a Novel, Long-Acting Monoclonal Antibody Inhibitor of Plasma Kallikrein for the Potential Treatment of Hereditary Angioedema

Hereditary angioedema (HAE) is a rare autosomal dominant disorder caused by a deficiency in functional C1 esterase inhibitor, a serpin family protein that blocks the activity of plasma kallikrein. Insufficient inhibition of plasma kallikrein results in the overproduction of bradykinin, a vasoactive inflammatory mediator that produces both pain and unpredictable swelling during HAE attacks, with potentially life-threatening consequences. We describe the generation of STAR-0215, a humanized IgG1 antibody with a long circulating half-life (t1/2) that potently inhibits plasma kallikrein activity, with a >1000-fold lower affinity for prekallikrein and no measurable inhibitory activity against other serine proteases. The high specificity and inhibitory effect of STAR-0215 is demonstrated through a unique allosteric mechanism involving N-terminal catalytic domain binding, destabilization of the activation domain, and reversion of the active site to the inactive zymogen state. The YTE (M252Y/S254T/T256E) modified fragment crystallizable (Fc) domain of STAR-0215 enhances pH-dependent neonatal Fc receptor binding, resulting in a prolonged t1/2 in vivo (∼34 days in cynomolgus monkeys) compared with antibodies without this modification. A single subcutaneous dose of STAR-0215 (≥100 mg) was predicted to be active in patients for 3 months or longer, based on simulations using a minimal physiologically based pharmacokinetic model. These data indicate that STAR-0215, a highly potent and specific antibody against plasma kallikrein with extended t1/2, is a potential agent for long-term preventative HAE therapy administered every 3 months or less frequently. SIGNIFICANCE STATEMENT: STAR-0215 is a YTE-modified immunoglobulin G1 monoclonal antibody with a novel binding mechanism that specifically and potently inhibits the enzymatic activity of plasma kallikrein and prevents the generation of bradykinin. It has been designed to be a long-lasting prophylactic treatment to prevent attacks of HAE and to decrease the burden of disease and the burden of treatment for people with HAE.

A Screening Program for SARS-CoV-2 among University of Hawai'i at Mānoa Residence Hall Students during the COVID-19 Pandemic

The University of Hawai'i at Mānoa (UHM) created a COVID-19 pandemic team to collaborate, plan, and mitigate the spread of COVID-19 across the campus. The purpose of this study was to identify asymptomatic and pre-symptomatic cases of SARS-CoV-2 among unvaccinated UHM residence hall students during 3 distinct intervals (semesters) within the COVID-19 pandemic. Supervised self-administered nasal swab testing samples were collected from unvaccinated UHM residence hall students and sent to a clinical laboratory for COVID-19 RT-PCR testing to detect SARS-CoV-2. Positive cases were contacted and placed in isolation while contact tracing was initiated. The screening program performed 2219 tests on 725 unique persons with the identification of COVID-19 infections in 38 asymptomatic unvaccinated students and an additional 10 cases through contact tracing. A positive correlation existed between the screening program case numbers and the state of Hawai'i 7-day average positive cases as demonstrated with a Pearson coefficient of 0.79 and P<.001. The COVID-19 positivity rate was greater during Spring Semester 2022 compared to both Spring Semester 2021 (P<.001) and Fall Semester 2021 (P <.001). This program served as a component ofa larger strategy to mitigate the effects of the COVID-19 pandemic on the UHM campus. Additional benefits of the program included opportunities to increase COVID-19 awareness, enact health policy measures, evolve to meet changing pandemic demands, and maintain a safe UHM campus.

Impact of the COVID-19 Pandemic on Academic Productivity in Oncology: A Journal-, Conference- and Author-level Analysis

PURPOSE/OBJECTIVE(S)

The objective of this study was to determine the impact of the COVID-19 pandemic on academic productivity in oncology as measured by conference abstracts, journal publications and individual authorship trends.

MATERIALS/METHODS

Using a reference time frame of 2018 to 2022, we obtained data on the number of abstracts and articles submitted and published from a selection of oncology conferences and journals. To assess individual authorship patterns, we randomly selected 200 articles from 2018 (i.e., the 'index paper') and tracked publications over subsequent years for the first or last authors. Linear time-trend analyses and independent two-sample t-tests were used to assess changes in academic productivity over time, and univariable and multivariable linear regression were used to analyze individual factors predictive of publication rates, including gender, continent, specialty, MD vs. non-MD, and career status (early if within 5 years of training completion vs. late for all others).

RESULTS

Data on submitted and published abstracts were available from 5 and 7 conferences, respectively. Both abstract categories demonstrated decreasing values over time but not statistically significant: conference submissions decreased from 15,308 in 2018 to 13,623 in 2022, (p = 0.11), and published abstracts decreased from 13,111 to 11,848, respectively (p = 0.16). Journal submissions were available from 6 journals and increased from 14,142 in 2018 to a peak of 20,241 in 2020 (2018 vs. 2020: p<0.001), and then declined to 15,650 in 2021. Journal publications from 10 journals showed no clear trends over time (p = 0.64). For the author-level analysis, of the 200 authors randomly selected, the majority were male (66.5%), from North America (55.5%), with an MD degree (80.9%, 131/162) and late career (86.6%, 129/149). Most common specialties included surgery (29%), radiation oncology (18.5%), epidemiology/public health (11%) and medical oncology (10%). For articles authored per year, there was no linear trend detected (p = 0.51), although mean number of publications per author peaked in 2020/2021 (papers/year for 2018-2022: 18.1, 18.1, 20.1, 21.2, 19.6). On univariable analysis, factors significantly associated with increasing publication rates were male gender, last author position on index paper, late career status, MDs, speciality of surgery or public/health epidemiology, and authors from Asia (all p<0.01). On multivariable analysis, factors remaining significantly predictive were late career status, MDs, specialty of surgeons or public health/epidemiologists, and authors from Asia (all p<0.01).

CONCLUSION

Conference submissions and publications trended downward from 2018 to 2022. Journal submissions peaked overall in 2020, but did not translate to increases in journal publication rates. Disparities in publication trends were found, based on speciality and geographic regions, including a negative impact on early-career researchers.

Exploring the psychological effects of sharps injuries sustained by healthcare workers

Much of the research into sharps injuries sustained by healthcare workers focuses on prevalence and incidence and to a lesser extent the financial implications of such injuries. An under-researched area is the psychological effects of such injuries. This article reports the findings of a narrative literature review that aimed to synthesise the evidence on this subject. Electronic databases and the grey literature were searched with no date limits set and 27 articles were included in the review. Findings suggested that healthcare workers may experience a range of psychological issues following a sharps injury, including post-traumatic stress disorder, anxiety and depression. There was also evidence to suggest that the necessary psychological follow-up care is often inadequate, so improvements are required in this area. Further research is necessary to enhance understanding of the psychological effects of sharps injuries on healthcare workers and to ensure they receive appropriate support.

PGFinder, a novel analysis pipeline for the consistent, reproducible, and high-resolution structural analysis of bacterial peptidoglycans

Many software solutions are available for proteomics and glycomics studies, but none are ideal for the structural analysis of peptidoglycan (PG), the essential and major component of bacterial cell envelopes. It icomprises glycan chains and peptide stems, both containing unusual amino acids and sugars. This has forced the field to rely on manual analysis approaches, which are time-consuming, labour-intensive, and prone to error. The lack of automated tools has hampered the ability to perform high-throughput analyses and prevented the adoption of a standard methodology. Here, we describe a novel tool called PGFinder for the analysis of PG structure and demonstrate that it represents a powerful tool to quantify PG fragments and discover novel structural features. Our analysis workflow, which relies on open-access tools, is a breakthrough towards a consistent and reproducible analysis of bacterial PGs. It represents a significant advance towards peptidoglycomics as a full-fledged discipline.

Investigating the incidence and type of sharps injuries within the nursing student population in the UK

AIMS

To identify the incidence and type of sharps injuries within a UK nursing student population.

BACKGROUND

Evidence suggests that nursing students sustain sharps injuries across the world, but there is a lack of data from the UK. Design: Questionnaire survey.

METHODS

A survey was administered to a volunteer sample of nursing students (n=1015) in a university, following which the survey was distributed to nursing students nationwide using snowball sampling via social media. Datasets from 1015 nursing students were available for analysis.

RESULTS

Sharps injuries were most likely to occur with glass ampoules, when preparing injections and to occur in the second year of the programme. Contributing factors to sharps injury were identified, with inexperience being the primary cause. Some nursing students reported psychological impacts after sustaining the sharps injury.

CONCLUSION

Sharps injuries are common among nursing students, and can have many psychological consequences for an individual.

The lysosomal endopeptidases Cathepsin D and L are selective and effective proteases for the middle-down characterization of antibodies

Mass spectrometry is gaining momentum as a method of choice to de novo sequence antibodies (Abs). Adequate sequence coverage of the hypervariable regions remains one of the toughest identification challenges by either bottom-up or top-down workflows. Methods that efficiently generate mid-size Ab fragments would further facilitate top-down MS and decrease data complexity. Here, we explore the proteases Cathepsins L and D for forming protein fragments from three IgG1s, one IgG2, and one bispecific, knob-and-hole IgG1. We demonstrate that high-resolution native MS provides a sensitive method for the detection of clipping sites. Both Cathepsins produced multiple, albeit specific cleavages. The Abs were cleaved immediately after the CDR3 region, yielding ~ 12 kDa fragments, that is, ideal sequencing-sized. Cathepsin D, but not Cathepsin L, also cleaved directly below the Ab hinge, releasing the F(ab')2. When constrained by the different disulfide bonds found in the IgG2 subtype or by the tertiary structure of the hole-containing bispecific IgG1, the hinge region digest product was not produced. The Cathepsin L and Cathepsin D clipping motifs were related to sequences of neutral amino acids and the tertiary structure of the Ab. A single pot (L + D) digestion protocol was optimized to achieve 100% efficiency. Nine protein fragments, corresponding to the VL, VH, CL, CH1, CH2, CH3, CL + CH1, and F(ab')2, constituted ~ 70% of the summed intensities of all deconvolved proteolytic products. Cleavage sites were confirmed by the Edman degradation and validated with top-down sequencing. The described work offers a complementary method for middle-down analysis that may be applied to top-down Ab sequencing. ENZYMES: Cathepsin L-EC 3.4.22.15, Cathepsin D-EC 3.4.23.5.

The experience and psychological impact of a sharps injury on a nursing student population in the UK

AIMS

The aims of this study were to explore the experience and psychological impact of sustaining a sharps injury within a nursing student population in the UK. Design: A qualitative approach was taken, using two methods to gather data, namely a Twitter chat and interviews.

METHODS

A Twitter chat was orchestrated to investigate the experiences of sharps injury with nursing students and registered nurses nationwide (n=71). Interviews were conducted with nursing students from a university in the UK who had sustained a sharps injury (n=12) to discover their experiences and the impact of the injury. Findings were then synthesised and examined.

RESULTS

Some nursing students reported psychological impacts after sustaining the sharps injury, which affected both their professional and personal life. The qualitative findings were synthesised into eight themes.

CONCLUSION

Sharps injuries can have many psychological impacts on the individual nursing student and necessary support should be available.

Conductance-Based Interface Detection for Multi-Phase Pipe Flow

Sediment and flow depth monitoring in sewers is important for informing flow models and for predicting and mitigating against sewer blockage formation and surcharge. In this study, a novel sensor based on conductance measurement has been developed and tested under a laboratory environment and validated by a finite-element model. The relative conductance is measured between pairs of adjacent electrodes to provide a conductance profile along the sensor length. A piecewise linear relationship between conductance and electrode length was derived and the interface positions between sediment, water, and air can be determined from the profile. The results demonstrated that the root mean square error of the model and the measured interface level are within 1.4% and 2.6% of sensor’s measurement range. An error distribution of interface height shows that all anticipated errors are within the resolution of the electrode length increments. Furthermore, it was found that the conductivity of the measured medium is proportional to the gradient of the linear relationship of conductance and electrode length. It could therefore prove a valuable new tool for the accurate quantification of sediment and flow levels in sewer conduits, coastal environments, drainage systems for transport networks, and other industrial or academic applications.

Metabolism of bioconjugate therapeutics: why, when, and how?

Bioconjugation of therapeutic agents has been used as a selective drug delivery platform for many therapeutic areas. Bioconjugates are prepared by the covalent linkage of active compounds (small or large molecule) to a carrier molecule (lipids, proteins, peptides, carbohydrates, and polymers) through a chemical linker. The linkage of the active component to a carrier molecule enhances the therapeutic window through a targeted delivery and by reducing toxicity. Bioconjugates also possess improved pharmacokinetic properties such as a long half-life, increased stability, and cleavage by intracellular enzymes/environment. However, premature cleavage of the bioconjugates and the resulting metabolites/catabolites may produce undesirable toxic effects and, hence, it is critical to understand cleavage mechanisms, metabolism of bioconjugates, and translatability to human in the discovery stages. This article provides a comprehensive overview of linker cleavage pathways and catabolism/metabolism of antibody-drug conjugates, glycoconjugates, polymer-drug conjugates, lipid-drug conjugates, folate-targeted small molecule-drug conjugates, and drug-drug conjugates.

Phase 1 Study of Edasalonexent (CAT-1004), an Oral NF-κB Inhibitor, in Pediatric Patients with Duchenne Muscular Dystrophy

Background:

Edasalonexent is an orally administered small molecule designed to inhibit NF-κB, which is activated from infancy in Duchenne muscular dystrophy and is central to causing muscle damage and preventing muscle regeneration.

Objective:

Evaluate the safety, tolerability, pharmacokinetics and exploratory pharmacodynamics of three doses of edasalonexent in ambulatory males ≥4 to <8 years of age with genetically confirmed Duchenne muscular dystrophy.

Methods:

This was a 1-week, open-label, multiple-dose study with 3 sequential ascending doses (33, 67 and 100 mg/kg/day) of edasalonexent administered under different dietary conditions to 17 males with a mean age of 5.5 years.

Results:

All doses of edasalonexent were well tolerated, with no serious adverse events, no drug discontinuations and no dose reductions. The majority of adverse events were mild, and the most common adverse events were gastrointestinal (primarily diarrhea). Edasalonexent was rapidly absorbed with peak levels observed 2–6 hours after dosing and exposures appeared to increase nearly proportionally to dose for the 2 lower and all 3 doses under low-fat and high-fat meal conditions, respectively. Only minor plasma accumulation of edasalonexent was observed with 7 days of dosing. After treatment with edasalonexent for 7 days, levels of NF-κB-regulated genes and serum proteins were decreased.

Conclusions:

This first report of edasalonexent oral administration for one week in male pediatric patients with Duchenne muscular dystrophy showed that treatment was well tolerated and inhibited NF-kB pathways.

Survival of patients with subglottic squamous cell carcinoma

Objective

Subglottic squamous cell carcinoma is a rare subsite of laryngeal cancer that behaves more aggressively and portends a worse prognosis. Using a population-based cancer registry, our objective was to report overall survival (os) and laryngectomy-free survival (lfs) in patients diagnosed with subglottic squamous cell carcinoma, and to determine whether primary laryngectomy results in improved survival.

Methods

This retrospective population-based study considered patients with a new diagnosis of squamous cell carcinoma in the province of Ontario over a 15-year period (1995-2009). The Ontario Cancer Registry was examined for patients with the diagnosis of interest during the period of interest. Linked population-based databases were used to obtain patient demographics, comorbidity measures, staging, survival, and primary treatment with laryngectomy.

Results

Of 4927 patients identified to have laryngeal carcinoma, 89 were defined as having primary subglottic carcinoma (1.8%). In the subglottic cohort, 68 patients were men (76.4%), and mean age at diagnosis was 68 years (interquartile range: 60-77 years). The 5-year os was 47.2%, and the 5-year lfs was 31.5%. In 13 patients (15%), the primary treatment was laryngectomy, which, compared with primary radiation, did not predict for improved os. No differences in os or lfs were observed during the 15-year study period (os p = 0.42, lfs p = 0.83).

Conclusions

The survival of patients with subglottic carcinoma is poor and has remained stable over time (1995-2009). Compared with primary radiation, primary treatment with laryngectomy does not appear to improve os.

The impact of sharps injuries on student nurses: a systematic review

AIMS AND OBJECTIVES

The purpose of this review was to discover the impact of sharps injuries in the student nurse population.

BACKGROUND

Much is known and reported about sharps injuries in registered nurses, but there has been a lack of published evidence regarding sharps injuries within the student nurse population.

METHOD

A systematic review of nursing, health and psychology databases was conducted. The limits set were publications between 1980 and 2014 in the English language. Studies were identified then, following a rigorous critical and quality appraisal with validated tools, were selected for the systematic review.

RESULTS

A total of 40 articles met the inclusion criteria, reporting studies conducted in 18 countries. Psychological and physical impacts of sharps injuries in student nurses were reported, such as fear, anxiety and depression, although these impacts were not quantified using a validated instrument.

CONCLUSION

The impact of sharps injuries can be severe, both psychological and physical. This systematic review shows that further research is needed into this, especially in under-researched areas such as the UK, to establish the impact of sharps injuries within this population. Further research would also aid the education and prevention of this harmful problem. The review also emphasises the psychological issues relating to sharps injuries, the impact these can have on individuals and the support and counselling that student nurses require after injury.

RELEVANCE TO PRACTICE

These findings highlight the potential psychological issues that can result from sharps injuries in this population.

SPH modelling of depth-limited turbulent open channel flows over rough boundaries

A numerical model based on the smoothed particle hydrodynamics method is developed to simulate depth-limited turbulent open channel flows over hydraulically rough beds. The 2D Lagrangian form of the Navier-Stokes equations is solved, in which a drag-based formulation is used based on an effective roughness zone near the bed to account for the roughness effect of bed spheres and an improved sub-particle-scale model is applied to account for the effect of turbulence. The sub-particle-scale model is constructed based on the mixing-length assumption rather than the standard Smagorinsky approach to compute the eddy-viscosity. A robust in/out-flow boundary technique is also proposed to achieve stable uniform flow conditions at the inlet and outlet boundaries where the flow characteristics are unknown. The model is applied to simulate uniform open channel flows over a rough bed composed of regular spheres and validated by experimental velocity data. To investigate the influence of the bed roughness on different flow conditions, data from 12 experimental tests with different bed slopes and uniform water depths are simulated, and a good agreement has been observed between the model and experimental results of the streamwise velocity and turbulent shear stress. This shows that both the roughness effect and flow turbulence should be addressed in order to simulate the correct mechanisms of turbulent flow over a rough bed boundary and that the presented smoothed particle hydrodynamics model accomplishes this successfully.