Global action is needed to tackle the catastrophic threat of anti-microbial resistance, which in 20 years could see any one of us dying following minor surgery, England
The Centers for Disease Control and Prevention (CDC) and Maryland Department of Health and Mental Hygiene have confirmed that a patient who recently died of rabies in Maryland contracted the infection through organ transplantation done more than a year ago. The patient was one of four people who had received an organ from the same donor. This week, CDC laboratories tested tissue samples from the donor and from the recipient who died to confirm transmission of rabies through organ transplantation.
In early March, the Maryland Department of Health and Mental Hygiene initiated an investigation after the organ recipient died, which led to the rabies diagnosis. The investigation revealed that the organ recipient had no reported animal exposures, the usual source of rabies transmission to humans, and identified the possibility of transplant-related transmission of rabies, which is extremely rare.
The organ transplantation occurred more than a year before the recipient developed symptoms and died of rabies; this period is much longer than the typical rabies incubation period of 1 to 3 months, but is consistent with prior case reports of long incubation periods. CDC
Very low birth weight infants, those weighing less than 3.25 pounds, account for half of infant deaths in the United States each year, yet a new study released documents that these critically ill infants do not receive optimal nursing care, which can lead to hospital-acquired infections that double their death rate and may result in long-term developmental issues affecting the quality of their lives as adults.
These vulnerable infants are the highest risk pediatric patients in hospitals and account for half of all infant deaths in the country each year. These hospital-acquired infections afflicted 13.9 percent of these frail infants in 2009, the last year reported in the study.
The lead authors, based at the University of Medicine and Dentistry of New Jersey- School of Public Health and the University of Pennsylvania School of Nursing, studied very low birth weight infants cared for in 67 Neonatal Intensive Care Units (NICU).
‘One-third of NICU infants were understaffed, according to current guidelines. Understaffing varies further across acuity levels with the greatest fraction of understaffed infants (92 percent) requiring the most complex critical care, translating into a needed 25% increase in the numbers of nurses,’ wrote co-principal investigators Jeannette A. Rogowski, PhD, the University Professor in Health Economics at the UMDNJ-School of Public Health and Eileen T. Lake, PHD, RN, FAAN, associate director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.
The researchers noted that infection caused four to seven days of longer hospitalisation with associated increased costs, notably to Medicaid. ‘Under recent changes in Medicaid policy, hospitals will no longer be reimbursed for the costs associated with these infections,’ said Lake. ‘Sadly, because Medicaid is the largest payer for premature newborns, the additional costs may lead hospitals to further cut the nursing staff, leading to a cycle of infection and mortality that could impact even more of these fragile infants.’
‘These are the first data that demonstrate the extent of adherence to national staffing guidelines and the shortfall is dramatic,’ said Rogowski. ‘Fewer nursing hours could lead to less time devoted to cleaning and maintaining intravenous catheters used to deliver medications thus leading to the higher rates of infection.’ University of Pennsylvania School of Nursing
Abuse of the anaesthesia drug propofol is a ‘rapidly progressive form of substance dependence’ that is being more commonly seen among health care professionals, reports a study.
‘Propofol addiction is a virulent and debilitating form of substance dependence’ with a ‘rapid downhill course,’ write Drs. Paul Earley and Torin Finver of Georgia Health Professionals Program, Inc, Atlanta. Their study identifies some emerging characteristics and consequences of propofol abuse among health care professionals.
Data from an addiction centre specialising in substance abuse problems among health care professionals identified 22 patients treated for propofol abuse from 1990 to 2010. Propofol is a drug widely used to induce anaesthesia for surgery and sedation for other procedures. It is commonly used because it has a rapid onset and quick recovery time, with fewer side effects than other anaesthetics.
The number of health care professionals treated for propofol abuse increased steadily during the period studied, although increased recognition by addiction centre staff may have played a role. The patients were thirteen physicians, eight nurses, and one dentist. Most of the physicians and all of the nurses were anaesthesia providers, who had ready access to propofol.
Patients using propofol were more likely to be women, compared to health care professionals abusing alcohol or other drugs. Most propofol abusers had depression, along with a history of childhood sexual or physical abuse. In addition, most of the propofol-abusing health care professionals reported a family history of substance abuse, and a higher than expected number had family members with schizophrenia.
The patients generally started using propofol to get to sleep. However, they quickly developed characteristics of addiction, with propofol becoming a preferred drug of abuse. Most patients came for addiction treatment within a few months after starting to use propofol. Five patients came to treatment after a single propofol binge.
‘When humans abuse propofol, unintended side effects begin almost immediately,’ Drs. Earley and Finver write. About half of propofol abusers entered addiction treatment after dramatic events such as car crashes or other injuries. Some sustained facial injuries when they passed out immediately after injecting propofol.
Five patients were admitted into treatment when they were discovered unconscious. These characteristics reflect the ‘narrow window between desired effect and unconsciousness’ and the rapid loss of control over propofol use, according to the authors.
‘Propofol dependence is a rapidly progressive form of substance dependence seen in 1.6 percent of all health care addiction cases reporting to treatment,’ Drs. Earley and Finver conclude. Within the limitations of the data, the study suggests that propofol abuse by health care professionals is increasing
Location, location, location. A new Johns Hopkins Children
In a world first, a donated human liver has been ‘kept alive’ outside a human being and then successfully transplanted into a patient in need of a new liver.
So far the procedure has been performed on two patients on the liver transplant waiting list and both are making excellent recoveries.
Currently transplantation depends on preserving donor organs by putting them ‘on ice’
The European Society of Anaesthesiology (ESA) is to launch a safety starter kit containing a wide variety of essential resources to help raise safety standards in anaesthesiology across Europe. The kit will be distributed on a memory stick at this year
Chemists have developed a prototype medical dressing that detects the first signs of the lethal Toxic Shock Syndrome along with other burn wound infections and could potentially save the lives of children with serious burns.
Toxic Shock Syndrome (TSS) is a serious complication of burn infections and particularly dangerous in children under four due to their immature immune systems. Left untreated, a child with a relatively small burn who develops TSS can rapidly deteriorate within a few hours. If left untreated, fifty per cent of children with the full-blown disease can die.
Scientists at the University of Bath have been working with clinicians at the South West Paediatric Burns Centre at Frenchay Hospital in Bristol to create an advanced wound dressing that can detect key microbial pathogens including the bacteria which cause TSS.
They have now developed a prototype dressing that releases dye from nano-capsules triggered by the presence of disease-causing pathogenic bacteria. The dye fluoresces under ultraviolet (UV) light, alerting healthcare professionals that the wound is infected.
The nano-capsules mimic skin cells in that they only break open when toxic bacteria are present, not responding to the harmless bacteria that normally live on healthy skin.
Dr Toby Jenkins, Reader in Biophysical Chemistry at Bath, is leading the project. He explained: ‘Around 5,000 children a year in England and Wales are hospitalised or treated in hospital with serious burns, mostly scalds caused by tea and coffee.
‘The big problem for clinicians is the fast diagnosis of infection. Current methods take between 24 and 48 hours to get an answer as to whether the wound is infected.
‘However our burns dressing gives a simple colour change under UV light if a pathogenic, disease-causing bacteria is present in the burn, meaning clinicians can be alerted quickly to a potential infection.’
Dr Amber Young, Consultant Paediatric Anaesthetist at the South West Paediatric Burns Centre at Frenchay Hospital and Paediatric Clinical Lead South West UK Burn Care Network, is the clinical consultant on the project. She said: ‘At the moment when a child with a small burn develops a high temperature we have no easy way of knowing if the child has a serious bacterial infection, or simply a cough or cold.
‘We currently have to remove the dressing to test for infection, which may result in slower healing and potentially life-long scarring, and is very distressing for the child. This new dressing will mean we will be able to detect the early signs of infection so we can diagnose and treat the child quickly.
‘It could make a real difference to the lives of many thousands of children.’
The prototype has been tested on skin samples in the lab and is currently being optimised for stability and shelf-life. The researchers expect to start safety trials on healthy human volunteers in four years.
University of BathA tiny, EPFL-designed implantable device that can be positioned within the eye and controlled remotely may well revolutionise the treatment of glaucoma. The device should be through testing this year and on its way to the market in 2014 via Rheon Medical, an EPFL spin-off.
Glaucoma is the second leading cause of blindness globally, after cataracts. It is characterised by the presence of too much liquid between the cornea and the iris. This leads to a build-up of pressure within the eye, a situation that can destroy the optic nerve if it is not handled correctly.
Professor Nikos Stergiopulos’s team at the EPFL’s Laboratory of Hemodynamics and Cardiovascular Technology (LHTC) has developed an adjustable implantable ‘micro-tap’ that can drain surplus fluid in the eye. Clinical trials on this glaucoma drainage device should be starting before the end of the year and will be co-ordinated by Rheon Medical, an EPFL start-up. In addition to Prof. Stergiopulos, the project team is composed of LHTC members St
EPFL scientists have developed a tiny, portable personal blood testing laboratory: a minuscule device implanted just under the skin provides an immediate analysis of substances in the body, and a radio module transmits the results to a doctor over the cellular phone network. This feat of miniaturisation has many potential applications, including monitoring patients undergoing chemotherapy.
Humans are veritable chemical factories – we manufacture thousands of substances and transport them, via our blood, throughout our bodies. Some of these substances can be used as indicators of our health status. A team of EPFL scientists has developed a tiny device that can analyze the concentration of these substances in the blood. Implanted just beneath the skin, it can detect up to five proteins and organic acids simultaneously, and then transmit the results directly to a doctor
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