Mcmahonspencer8176

Background Prior to implementing an antibiotic stewardship intervention for asymptomatic bacteriuria (ASB), we assessed institutional barriers to change using the Organizational Readiness to Change Assessment. Methods Surveys were self-administered on paper in inpatient medicine and long-term care units at 4 Veterans Affairs facilities. Participants included providers, nurses, and pharmacists. The survey included 7 subscales evidence (perceived strength of evidence) and six context subscales (favorability of organizational context). Responses were scored on a 5-point Likert-type scale. Results One hundred four surveys were completed (response rate = 69.3%). Overall, the evidence subscale had the highest score; the resources subscale (mean 2.8) was significantly lower than other subscales (P less then .001). Scores for budget and staffing resources were lower than scores for training and facility resources (P less then .001 for both). Pharmacists had lower scores than providers for the staff culture subscale (P = .04). The site with the lowest scores for resources (mean 2.4) also had lower scores for leadership and lower pharmacist effort devoted to stewardship. Conclusions Although healthcare professionals endorsed the evidence about nontreatment of ASB, perceived barriers to antibiotic stewardship included inadequate resources and leadership support. These findings provide targets for tailoring the stewardship intervention to maximize success.Cancer is a public health problem and the main cause of human mortality and morbidity worldwide. selleck products Complete removal of tumors and metastatic lymph nodes in surgery is significantly beneficial for the prognosis of patients. Tumor-targeted, near-infrared fluorescent (NIRF) imaging is an emerging field of real-time intraoperative cancer imaging based on tumor-targeted NIRF dyes. Targeted NIRF dyes contain NIRF fluorophores and specific binding ligands such as antibodies, peptides and small molecules. The present article reviews recently updated tumor-targeted NIRF dyes for the molecular imaging of malignant tumors in the preclinical stage and clinical trials. The strengths and challenges of NIRF agents with tumor-targeting ability are also summarized. Smaller ligands, near infrared II dyes, dual-modality dyes and activatable dyes may contribute to quicker, deeper, stronger imaging in the nearest future. In this review, we highlighted tumor-targeted NIRF dyes for fluorescence-guided surgery and their potential clinical translation.Pulmonary formulations have been attracting much attention because of their direct effects on respiratory diseases, but also their non-invasive administration for the treatment of systemic diseases. When developing such formulations, they are typically first investigated in mice. As there are various pulmonary administration methods, the researcher has to decide on the best quantitative method for their preclinical investigations among candidate methods, both for total delivery and distribution within the lung lobes. In this study, we investigated the deposition and distribution of siRNA loaded PLGA nanoparticles (NPs) in the different lung lobes via three widely used pulmonary administration methods intratracheal instillation, intratracheal spraying and intranasal instillation. The NPs were radiolabeled with 111In, administered and a single photon emission computed tomography (SPECT/CT) whole body scan performed. Quantitative image volume of interest (VOI) analysis of all inhalation related organs was performed, plus sub-organ examinations using dissection and gamma counting. Intratracheal instillation and intratracheal spraying deposited >95% and >85% of radiolabeled NPs in the lung, respectively. However, the lung lobe distribution of the NPs was inhomogeneous. Intranasal instillation deposited only ~28% of the dose in the lungs, with even larger inhomogeneity and individual variation between animals. Furthermore, there was a high deposition of the NPs in the stomach. Intratracheal instillation and intratracheal spraying deposit a large number of NPs in the lungs, and are thus useful to test therapeutic effects in preclinical animal studies. However, the inhomogeneous distribution of formulation between lung lobes needs to be considered in the experimental design. Intranasal instillation should not be used as a means of pulmonary administration.Background & aims Smooth muscles of the lower esophageal sphincter (LES) and skeletal muscle of the crural diaphragm (esophagus hiatus) provide the sphincter mechanisms at the esophagogastric junction (EGJ). We investigated differences in the 3-dimensional (3D) pressure profile of the LES and hiatal contraction between normal subjects and patients with achalasia esophagus. Methods We performed a prospective study of 10 healthy subjects (controls; 7 male; mean age, 60±15 years; mean body mass index, 25 ± 2) and 12 patients with a diagnosis of achalasia (7 male; mean age, 63 ±13 years; mean body mass index, 26 ± 1), enrolled at a gastroenterology clinic. Participants underwent 3D high-resolution manometry (3DHRM) with a catheter equipped with 96 transducers (for the EGJ pressure recording). A 0.5mm metal ball was taped close to the transducer number 1 of the 3DHRM catheter. EGJ pressure was recorded at end-expiration (LES pressure) and at the peak of forced inspiration (hiatal contraction). Computed tomography l diaphragm muscle in patients with achalasia esophagus. Further studies are needed to define the nature of hiatal and crural diaphragm dysfunction in patients with achalasia of the esophagus.Background & aims Incomplete resection of neoplastic colorectal polyps can result in post-colonoscopy colorectal cancer. We performed a systematic review and meta-analysis to determine the incomplete resection rate (IRR) of colorectal polyps and associated factors. Methods We searched MEDLINE, EMBASE, EBM Reviews, and CINAHL to identify full-text articles that reported IRRs of polyps 1-20 mm, published until March 2019. Exclusion criteria were studies of inflammatory bowel disease cohorts, referrals for difficult polypectomy, polyp sizes greater than 20 mm, and endoscopic submucosal resection and/or dissection as polypectomy approaches. IRRs were calculated based on findings from biopsies taken at polypectomy sites or assessments of margins of resected polyps. The primary outcome was IRR for snare removal of polyps 1-20 mm. Secondary outcomes included IRR for polyps 1-10 mm and 10-20 mm, IRR for hot and cold snare removal of polyps 1-10 mm and 10-20 mm, IRR of snare removal with or without submucosal injection, and IRR for forceps and cold snare removal of polyps 1-5 mm.