Scoping review of systematic reviews of nursing interventions in a neonatal intensive care unit or special care nursery

AIM(S)

To identify, synthesise and map systematic reviews of the effectiveness of nursing interventions undertaken in a neonatal intensive care unit or special care nursery.

DESIGN

This scoping review was conducted according to the JBI scoping review framework.

METHODS

Review included systematic reviews that evaluated any nurse-initiated interventions that were undertaken in an NICU or SCN setting. Studies that reported one or more positive outcomes related to the nursing interventions were only considered for this review. Each outcome for nursing interventions was rated a 'certainty (quality) of evidence' according to the Grading of Recommendations, Assessment, Development and Evaluations criteria.

DATA SOURCES

Systematic reviews were sourced from the Cochrane Database of Systematic Reviews and Joanna Briggs Institute Evidence Synthesis for reviews published until February 2023.

RESULTS

A total of 428 articles were identified; following screening, 81 reviews underwent full-text screening, and 34 articles met the inclusion criteria and were included in this review. Multiple nursing interventions reporting positive outcomes were identified and were grouped into seven categories. Respiratory 7/34 (20%) and Nutrition 8/34 (23%) outcomes were the most reported categories. Developmental care was the next most reported category 5/34 (15%) followed by Thermoregulation, 5/34 (15%) Jaundice 4/34 (12%), Pain 4/34 (12%) and Infection 1/34 (3%).

CONCLUSIONS

This review has identified nursing interventions that have a direct positive impact on neonatal outcomes. However, further applied research is needed to transfer this empirical knowledge into clinical practice.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Implementing up-to-date evidence on effective nursing interventions has the potential to significantly improving neonatal outcomes.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement in this scoping review.

Drug survival of biologics in psoriasis: An Australian multicentre retrospective study

BACKGROUND

Drug survival, which refers to the time from treatment initiation to discontinuation, provides a surrogate measure of the effectiveness of a biologic in a real-world setting (J Invest Dermatol, 2015, 135, 1). The aim of this study was to determine the drug survival of biologics that are currently available in Australia. We also analysed the treatment efficacy of these biologics and reasons for discontinuation.

METHODS

Retrospective data from outpatient Dermatology biologic clinics in Westmead Hospital and Royal Prince Alfred Hospital (Sydney, Australia) from April 2006 to December 2020 were collected. Kaplan-Meier analysis was used to calculate drug survival.

RESULTS

A total of 306 patients who underwent 566 treatment courses were analysed. Guselkumab was observed to have the longest drug survival, with cumulative drug survival rates of 94.2% ± 4.0 at 1- and 5-years. This was followed by ixekizumab which had a 1-year survival rate of 87.2% ± 4.5 and 5-year survival rate of 59.4% ± 9.5. Ixekizumab and guselkumab were also noted to have superior treatment efficacy compared with other biologics, with PASI-75 rates of 94.9% and 93.8%, respectively. The most common reasons for treatment discontinuation were a lack of initial efficacy to treatment and a loss of efficacy over time despite an initial response, respectively.

CONCLUSION

To our knowledge, this is the first Australian study to report on outcomes of multiple new biologics that are currently in use for the treatment of chronic plaque psoriasis. Overall, this study provides insight into patterns of care from a local experience that may help guide the management of moderate-to-severe psoriasis.

P-350 Endometrial receptivity analysis (ERA) and microbiome testing for recurrent implantation failure (RIF): a matched case control study

Study question

Does the use of ERA, EMMA (endometrial microbiome metogenomic analysis) or ALICE (analysis of infectious chronic endometritis) improve implantation rate and clinical pregnancy?

Summary answer

The use of ERA significantly improves the clinical pregnancy rate in women with recurrent implantation failure, no difference was observed for EMMA or ALICE.

What is known already

The ability of ERA to utilise endometrial tissue transcriptomics to detect asynchronous cycles is controversial. Retrospective studies have demonstrated significantly lower implantation rates for the non-receptive cohort and improved pregnancy rates by personalising the embryo transfer (pET). An RCT reported comparable clinical outcomes for pET and standard FET.

There have also been multiple reports of the endometrium being dominated by Lactobacillus, prevalence of this species without bacterial vaginosis leads to positive outcomes in IVF. That said, there is a scarcity of good quality evidence to advocate the use of antibiotics and/or probiotics to treat dysbiosis or pathogens in the subfertile population.

Study design, size, duration

From Jan 2017 to August 2021 202 patients underwent one or more of ERA (n = 202), EMMA (n = 101), and/or ALICE (n = 97) at CARE Fertility UK. The cycle subsequent to the test was compared to 404 age matched control cycles.

Participants/materials, setting, methods

This study included patients from all 22 clinics across CARE Fertility UK. Rates of positive pregnancy test and clinical pregnancy were compared between patients with normal and abnormal test results using Chi-squared statistic. Binary logistic regression analysis and odds ratios were used to test for improvements in clinical outcomes by adjusting for the following covariates: age, BMI, parity, 2 or more previous implantation failures, donor eggs and frozen embryos.

Main results and the role of chance

ERA testing resulted in a normal result in 42.3% of patients, 30.6% were pre-receptive and 17% were early receptive. EMMA resulted in a normal result in 36% of patients, 22% were abnormal, 17% had ultra-low biomass and 25% mild dysbiosis. Only 4% of patients using the ALICE tested positive, therefore this was not included in any modelling due to low event rates. The implantation rate and clinical pregnancy rates showed no statistical significance between those with an abnormal result vs. those who had a normal test. When comparing those tested to matched controls and adjusting for the above covariates, the use of the ERA test was significantly associated with improved implantation rate (OR 3.08, 95% CI 1.57-6.03, p = 0.001) and clinical pregnancy rate (OR 2.7, 95% CI 1.38-5.28, p = 0.004). The use of the EMMA test did not improve implantation (OR 0.42, 95% CI 0.051-3.437, p = 0.418) or clinical pregnancy rate (OR 0.48, 95% CI 0.039-5.89, p = 0.566). When comparing those with an abnormal ERA (i.e. presumed intervention) to matched controls the ERA test was significantly associated with improved clinical pregnancy (OR 5.4, 95% CI 2.007-14.85, p < 0.001). On the other hand, EMMA was not associated with any improvements (p = 1.0).

Limitations, reasons for caution

The data collection process had limitations since minimal information was available for patients who underwent previous cycles at other clinics. The number of patients with receptive ERA and abnormal EMMA is small (n = 25) vs. those with a normal EMMA and ERA (n = 10). Therefore, a significant limitation is sample size.

Wider implications of the findings

ERA can be more confidently offered to patients and has been demonstrated to significantly improve clinical pregnancy rates. Further research is needed before we can determine whether EMMA or ALICE is a useful test, particularly when considering very few patients show evidence of chronic endometritis.

Trial registration number

Not applicable

Novel combination biologic therapy for recalcitrant psoriasis and psoriatic arthritis in a medically complex patient

For patients who do not achieve adequate disease control on biologic monotherapy, or monotherapy with an oral-systemic agent such as methotrexate, combination biologic therapy may be considered. To the best of our knowledge, we report the first case assessing the safety and efficacy of the combination of an interleukin-23 (IL-23) inhibitor (risankizumab) with a tumour necrosis factor-α (TNF-α) inhibitor (golimumab) in the treatment of psoriasis and psoriatic arthritis. After twelve months of treatment with risankizumab and golimumab, our patient experienced a significant improvement in his psoriasis and psoriatic arthritis without any adverse effects to date.

Chagas disease in the United Kingdom: A review of cases at the Hospital for Tropical Diseases London 1995-2018. The current state of detection of Chagas disease in the UK

BACKGROUND

Chagas disease (CD), is a parasitic disease endemic in Latin America. Presentation in non-endemic areas is either in the asymptomatic indeterminate phase or the chronic phase with cardiac and/or gastrointestinal complications.

METHODS

The Hospital for Tropical Diseases (HTD) based in central London, provides tertiary care for the management of CD. We reviewed all cases managed at this centre between 1995 and 2018.

RESULTS

Sixty patients with serologically proven CD were identified. Most were female (70%), with a median age at diagnosis of 41 years. Three quarters of the patients were originally from Bolivia. 62% of all patients were referred to the HTD by their GP. Nearly half of the patients were asymptomatic (47%). Twelve patients had signs of cardiac involvement secondary to CD. Evidence of gastrointestinal damage was established in three patients. Treatment was provided at HTD for 31 patients (47%). Most patients (29) received benznidazole, five of them did not tolerate the course and were switched to nifurtimox. Of the seven patients receiving this second line drug, five completed treatment, whilst two interrupted it due to side effects.

CONCLUSIONS

Despite the UK health system having all the resources required to diagnose, treat and follow up cases, there is lack of awareness of CD, such that the vast majority of cases remain undiagnosed and therefore do not receive treatment. We propose key interventions to improve the detection and management of this condition in the UK, especially in pregnant women and neonates.

Clinical and Diagnostic Features of 413 Patients Treated for Imported Strongyloidiasis at the Hospital for Tropical Diseases, London

This study describes the clinical features of a cohort of imported cases of strongyloidiasis and the performance of standard diagnostic techniques for this condition. A total of 413 cases were identified, of whom 86 had microscopically proven infection. In proven cases, 23% had normal eosinophil counts, 19% had negative Strongyloides-specific serology, and 9.3% had normal blood counts and were seronegative. Serological testing was less sensitive for returning travelers (46.2%) than for migrants (89.7%). Immunosuppression, including human T-cell lymphotropic virus 1, was significantly associated with proven infection after controlling for age, presence of symptoms, duration of infection, and eosinophilia (OR 5.60, 95% CI 1.54-20.4). Patients with proven infection had lower serology values than those diagnosed with strongyloidiasis on the basis of positive serology and eosinophilia alone (P = 0.016). Symptomatic patients were significantly younger, had a shorter presumed duration of infection, and lower serology values. These data suggest a correlation between immunologic control of strongyloidiasis and the amplitude of the humoral response.

Case of Nigeria-Acquired Human African Trypanosomiasis in United Kingdom, 2016

Human African trypanosomiasis has not been reported in Nigeria since 2012. Nevertheless, limitations of current surveillance programs mean that undetected infections may persist. We report a recent case of stage 2 trypanosomiasis caused by Trypanosoma brucei gambiense acquired in Nigeria and imported into the United Kingdom.

Spiny keratoderma: case series and review

BACKGROUND

Spiny keratoderma is a rare, possibly under-reported, condition characterized by discrete keratotic plugs arising from the palms, soles, or both. It has been associated with malignancies though there is debate as to whether spiny keratoderma is a true paraneoplastic phenomenon. It has also been linked to a variety of non-neoplastic conditions, and several cases appear to be familial.

METHODS

We describe two additional cases of this rare entity and review the literature.

RESULTS

Thirty-seven cases of spiny keratoderma, including ours, have been reported in the literature. Average age at presentation was 63 years. Earliest age of onset was 11 months. A variety of ethnicities were represented. Ten cases were associated with malignancies. Six cases appeared to be inherited in an autosomal dominant fashion. Several cases were reported in healthy individuals as an incidental finding though it is possible that an associated malignancy or systemic disease will declare itself with time. Treatment is generally unsatisfying with keratotic spines often recurring on cessation. Interestingly, in some patients, the spines resolve after treatment of an underlying malignancy.

CONCLUSIONS

This small case series provides an opportunity to revisit the fascinating phenomena of spiny keratoderma, its possible associations, and implications for follow-up. Due to the association with cancer, all patients presenting with spiny keratoderma should undergo baseline age-appropriate malignancy screening, thence 1-2 times yearly, or as symptoms arise.

Surviving psychiatry on-calls

Introduction

Out of hours, there is only one on-site junior doctor. First year psychiatry trainees (CT1s) and GP trainees may have no prior experience in psychiatry. On-call shifts are therefore potentially daunting for new trainees.

Objectives

Expand the resources available for trainees when on-call.

Methods

We issued questionnaires to CT1s asking if they would have appreciated more information about on-call scenarios and in what format.

Based on the questionnaire results we implemented some changes. These were:

The handout was given to new trainees in February 2016 and in August 2016. The video was shown to new trainees in August 2016. Trainees provided feedback on the resources.

Results

Of 24 CT1s, 15 (63%) were “neutral” or “disagreed” that they had felt prepared for on-calls.

CT1s wanted additional resources, especially a paper handout or phone download.

Feedback on the “pocket-guide” from trainees in February 2016 (n = 8) was positive (62.5% reported increased confidence in on-call situations). Feedback is also being collected from trainees who received the guide in August 2016.

Trainees in August 2016 (n = 36) liked the video – no trainees “disagreed” with statements asking if the video had been useful.

The video improved the confidence of trainees about on-call situations by an average of 2.8 points.

Conclusions

We have expanded available resources relating to on-calls and improved confidence. Further improvements would include making resources more easily available in downloadable formats.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Smartphone patient monitoring post-laser resurfacing

BACKGROUND/OBJECTIVES

Patients should be monitored post-laser resurfacing for reassurance and the early detection of adverse events. Smartphone monitoring in the post-laser resurfacing setting is an efficient and convenient tool that is well accepted by patients and dermatologists. The objective was to identify the benefits and barriers of, and patient attitudes towards, smartphone monitoring in the post-laser resurfacing setting.

METHODS

A retrospective audit of 123 laser resurfacing patients was undertaken to determine the characteristics of this population. A web-based survey was used to determine patients' attitudes towards smartphone monitoring.

RESULTS

The commonest indications for laser resurfacing were acne scarring and photoageing rejuvenation. 88% of patients either had no adverse outcomes or expected post-laser resurfacing side-effects such as erythema. 12% developed adverse effects requiring intervention. The survey showed that all patients who had used the smartphone monitoring service felt it was a positive initiative for post-laser patients. Of note, most patients not using the smartphone review service were simply unaware of its existence. Biases may have been introduced as staff were less likely to promote the review service to patients undergoing lower intensity procedures.

CONCLUSIONS

Smartphone monitoring post-laser resurfacing is an efficient and convenient alternative to face-to-face review for both patients and dermatologists. As technology improves and patients' expectations increase we expect more patients will request teledermatology reviews in order to easily and rapidly access medical advice.

Hyperreactive Malarial Splenomegaly Syndrome--Can the Diagnostic Criteria Be Improved?

Hyperreactive Malarial Splenomegaly Syndrome (HMSS) was described and defined before sensitive tests for malaria were available. We present a series of seven individuals who were referred to our clinics with possible HMSS. Chronic malaria was demonstrated in those successfully treated but not in those who failed to respond to therapy. This observation suggests that the newer molecular malaria assays have a role to play in the identification of individuals who are likely to respond to treatment for HMSS in non-endemic regions.

Clinical Features of Imported Loiasis: A Case Series from the Hospital for Tropical Diseases, London

We retrospectively analyzed the background, clinical features, and treatment response of 50 cases of imported loiasis who presented between 2000 and 2014 to the Hospital for Tropical Diseases (HTD), London, United Kingdom. Of them, 29 were migrants from, and 21 were visitors to, countries where the disease is endemic. Clinical features differed between these groups. Migrants experienced fewer Calabar swellings (odds ratio [OR] = 0.12), more eye worm (OR = 3.4), more microfilaremia (OR = 3.5), lower filarial antibody levels, and lower eosinophil counts (P < 0.05 for all tests). Among 46 patients who were started on treatment at HTD, 33 (72%) received diethylcarbamazine (DEC) monotherapy as first-line treatment, and among 26 patients who were followed up after treatment, seven (27%) needed a second course of treatment. There were 46 courses of treatment with DEC, and 20 (43%) of them had reactions. All patients with microfilaremia > 3,000 microfilariae/mL and all those with an elevated C-reactive protein (CRP) (≥ 5 mg/L) before treatment had reactions (P = 0.10 and P = 0.01, respectively). These data suggest that monotherapy with DEC may not be the optimal treatment for patients with loiasis, particularly for those with a high microfilarial load.

Audit of a sexual health website email link for general practitioners

The aim of this review was to evaluate an 'Email a Clinician' link on a medically reviewed sexual health website, which was established to allow general practitioners (GPs) to communicate remotely with sexual health clinic specialists. The website was developed in consultation with GPs and extensively promoted throughout the relevant professional primary health-care networks. Despite this, the email link appeared to fail in its objective of facilitating GP access to specialist sexual health physician opinion within five working days. An audit examining use of the email link was conducted for a one-year period, during which time 324 emails were received. Results showed that the bulk of the emails (93.2%) were spam, and only 6.8% were genuine enquiries. Of the 22 genuine emails, 21 (95%) originated from the general public and there were no enquiries from the GPs, who were the target audience of the website, resulting in removal of the email link from the site. Direct survey of local GPs to evaluate reasons for non-utilization of the link was not possible. However, discomfort with the technology, time added to existing workload, lack of direct perceived benefit and lack of immediate response have been cited as contributing factors that may limit widespread adoption of other telemedicine services. As a new generation of recently graduated GPs enters the Australian workforce, who might be expected to be skilled and comfortable with electronic medical communication, the option of a direct email link to a sexual health clinic, with a faster turnaround time, may be worth re-visiting in the future.

Development of novel protein scaffolds as alternatives to whole antibodies for imaging and therapy: status on discovery research and clinical validation

Recent advances in combinatorial protein engineering have made it possible to develop antibody-based and non-Ig protein scaffolds that can potentially substitute for most whole antibody-associated properties. In theory, many different natural human protein backbones are suitable to be used as recombinant templates for engineering : antibody-derived scaffolds, carrier proteins that display a single binding interface, backbones that provide a rigid core structure suitable for grafting loops or protein scaffolds allowing the incorporation of variable loops in a favorable 3D configuration. In practice however, only a few have yielded the necessary properties to be translated into 'druggable Biologicals'. Amongst these properties, potential broad specificities towards any kind of target, ease of production, small size, good tolerability and low immunogenicity are essential and will be discussed in this review. Intellectual property is another key issue for the development of these protein scaffolds; although circumventing antibody-associated patents is often a major if not primary goal, clear advantages compared to whole antibodies must be presented to translate scaffold discovery into successful therapeutic drug candidates. In this review, a particular emphasis will be given to the most validated scaffolds that have reached the clinical development phase. Although the question of their immunogenicity is still open, preliminary clinical data do not point to any particular adverse immunogenic reactions although these are highly dependent on dosage, administration route and therapeutic indication. Finally, some of the emerging Biotechs developing protein scaffolds have been associated during the last two years with successful acquisitions by Big Pharmas and we will speak on the perspective positions of these proteins within the global Biologicals market.

A critical analysis of the literature on the Internet and consumer health information

A critical review of the published literature investigating the Internet and consumer health information was undertaken in order to inform further research and policy. A qualitative, narrative method was used, consisting of a three-stage process of identification and collation, thematic coding, and critical analysis. This analysis identified five main themes in the research in this area: (1) the quality of online health information for consumers; (2) consumer use of the Internet for health information; (3) the effect of e-health on the practitioner-patient relationship; (4) virtual communities and online social support and (5) the electronic delivery of information-based interventions. Analysis of these themes revealed more about the concerns of health professionals than about the effect of the Internet on users. Much of the existing work has concentrated on quantifying characteristics of the Internet: for example, measuring the quality of online information, or describing the numbers of users in different health-care settings. There is a lack of qualitative research that explores how citizens are actually using the Internet for health care.

Complicated lichenoid drug eruption

We report a case of severe lichenoid drug eruption with multiple possible causative agents. A hepatitis C-positive male presented with a short history of painful erosions of the vermilion, lichenoid lesions on the buccal mucosa and glans penis, and erosions and lichenification of the scrotum. In addition, he had a pruritic polymorphic eruption over the scalp, trunk and limbs, comprising psoriasiform and eczematous lesions. He had received combination therapy of pegylated interferon-alpha-2a and ribavirin, along with granulocyte colony-stimulating factor for interferon-induced leucopenia, and propranolol for portal hypertension. The former three agents were ceased 3 weeks prior to presentation, but he remained on propranolol at the initial dermatology consultation. The polymorphous clinical picture was consistent with lichenoid drug eruption, which was confirmed on histology. The papulosquamous eruption responded quickly to 2 weeks of oral prednisone 25 mg daily, which was tapered to 1 mg over 3 months and then ceased. The mucosal lesions were slow to improve and required the addition of tacrolimus 0.03% solution t.d.s. for complete resolution.

The continuous performance test: a window on the neural substrates for attention?

Attention is a complex process whose disturbance is considered a core deficit in a number of disorders [e.g., Attention Deficit Hyperactivity Disorder (ADHD), schizophrenia]. In 1956, Rosvold and colleagues [J. Consult. Psychol. 20 (1956) 343.] demonstrated that the continuous performance test (CPT) as a measure of sustained attention was highly sensitive to brain damage or dysfunction. These findings have been replicated with various populations and with various versions of the CPT. The CPT is now cited as the most frequently used measure of attention in both practice and research. Across studies, results are consistent with models of sustained attention that involve the interaction of cortical (frontal, temporal, parietal), subcortical (limbic, basal ganglia), and functional systems including the pathways between the basal ganglia, thalamus, and frontal lobes. Right hemisphere involvement (asymmetric response) is also evident across multiple studies. As such, the CPT demonstrates sensitivity to dysfunction of the attentional system whether this is due to diffuse or more focal damage/dysfunction or in conjunction with any specific disorder. CPT performance can be viewed as symptom specific (attentional disturbance), but it is not disorder specific (e.g., ADHD). Implications for neuropsychological interpretation of CPT results are presented.

Effects of stimulants on the continuous performance test (CPT): implications for CPT use and interpretation

An increasing number of treatment plans for individuals with attention-deficit/hyperactivity disorder (ADHD), as well as other disorders, include stimulant medication. The purpose of this study was to investigate the effects of stimulant medications on attention and impulsivity as measured by continuous performance tests (CPTs). The effect of other stimulants (e.g., caffeine, nicotine) on CPT performance was examined as well. Although various versions of the CPT were used in the studies reviewed, the research supports improvements in CPT performance with stimulant treatment. Implications for the use of CPTs in evaluating the effects of medications on attention are discussed. Also presented are implications for control of common substances like nicotine or caffeine when CPT is used and interpreted as a measure of attention.

The continuous performance test: a window on the neural substrates for attention?

Attention is a complex process whose disturbance is considered a core deficit in a number of disorders [e.g., Attention Deficit Hyperactivity Disorder (ADHD), schizophrenia]. In 1956, Rosvold and colleagues [J. Consult. Psychol. 20 (1956) 343.] demonstrated that the continuous performance test (CPT) as a measure of sustained attention was highly sensitive to brain damage or dysfunction. These findings have been replicated with various populations and with various versions of the CPT. The CPT is now cited as the most frequently used measure of attention in both practice and research. Across studies, results are consistent with models of sustained attention that involve the interaction of cortical (frontal, temporal, parietal), subcortical (limbic, basal ganglia), and functional systems including the pathways between the basal ganglia, thalamus, and frontal lobes. Right hemisphere involvement (asymmetric response) is also evident across multiple studies. As such, the CPT demonstrates sensitivity to dysfunction of the attentional system whether this is due to diffuse or more focal damage/dysfunction or in conjunction with any specific disorder. CPT performance can be viewed as symptom specific (attentional disturbance), but it is not disorder specific (e.g., ADHD). Implications for neuropsychological interpretation of CPT results are presented.

Hyaluronic acid skin fillers: adverse reactions and skin testing

BACKGROUND

Hyaluronic acid (HA) fillers have been proposed as alternatives to other temporary skin fillers, such as bovine collagen, for treating facial skin lines and for providing lip augmentation. Several types of commercial HA fillers are now available in many countries. They include Restylane, which is produced by microbiologic engineering techniques, and Hylaform, which is HA extract derived from rooster combs. They have been approved for use in several countries, but not currently in the United States. There are no recommendations to perform pretreatment skin testing by the manufacturers.

OBJECTIVE

Our purpose is to describe and comment on our experiences with Hylaform and Restylane fillers. Observation of any side effects and skin testing results were documented.

METHODS

Between September 1996 and September 2000, 709 patients were treated with Hylaform and Restylane and were followed up clinically for at least 1 year. Three of these patients (0.42%) developed delayed skin reactions. Three other patients were referred for evaluation of their skin reactions from other practitioners. Five of these 6 patients agreed to skin testing of their forearms.

RESULTS

In the 5 patients tested, challenge intradermal skin testing was positive in 4 patients; the reactions started approximately 8 weeks after injection.

CONCLUSIONS

There was a slight incidence of delayed inflammatory skin reactions to two HA fillers. Both of these reactions occurred after the first and repeat injections. Challenge skin testing was positive in 4 of 5 tested patients.

Substitution of antibodies and receptors with molecularly imprinted polymers in enzyme-linked and fluorescent assays

A new technique for coating microtitre plates with molecularly imprinted polymers (MIP), specific for low-molecular weight analytes (epinephrine, atrazine) and proteins is presented. Oxidative polymerization was performed in the presence of template; monomers: 3-aminophenylboronic acid (APBA), 3-thiopheneboronic acid (TBA) and aniline were polymerized in water and the polymers were grafted onto the polystyrene surface of the microplates. It was found that this process results in the creation of synthetic materials with antibody-like binding properties. It was shown that the MIP-coated microplates are particularly useful for assay development. The high stability of the polymers and good reproducibility of the measurements make MIP coating an attractive alternative to conventional antibodies or receptors used in enzyme linked immunosorbent assay (ELISA).

Evaluation of the BacT/Alert automated blood culture system for detecting bacteria and measuring their growth kinetics in leucodepleted and non-leucodepleted platelet concentrates

BACKGROUND AND OBJECTIVE

To evaluate the BacT/Alert automated blood culture system for the detection of bacteria in platelet concentrates, and to determine bacterial growth kinetics in leucodepleted and non-leucodepleted units.

MATERIALS AND METHODS

Apheresis (Cobe Leucocyte Reduction System [LRS]) and pooled buffy coat-derived (Optipress) platelet concentrates (PCs) were tested. Six organisms were used for spiking the PCs: Clostridium perfringens, Bacillus cereus, Group B Streptococcus, Staphylococcus epidermidis, Staphylococcus aureus and Escherichia coli. Units were inoculated to give a final concentration of approximately equal to 1 and 50 colony-forming units (CFU)/ml. On days 0, 2 and 5, BacT/Alert standard aerobic and anaerobic bottles were inoculated with a 5-ml fill volume and bacteria were enumerated.

RESULTS

The BacT/Alert Automated blood culture system gave rapid determination times of spiked units, with all positives detected within 48 h and 98.1% detected within 24 h. In general, as the inoculum concentration increased, the detection time decreased. Rapid growth was obtained with all organisms tested except for B. cereus, which failed to grow on four occasions. Bacterial numbers on day 2 ranged from 10(5) to 10(11) CFU/ml and on day 5 ranged from 10(4) to 10(12) CFU/ml. Growth was not significantly greater in leucodepleted units.

CONCLUSIONS

The study confirmed that PCs are an excellent growth medium for bacteria. Rapid and substantial growth was obtained with all organisms under test. Leucodepletion does not appear to enhance bacterial proliferation. The BacT/Alert automated blood culture system could rapidly detect contamination of units. Bacterial screening using an automated blood culture system is therefore a potential option.