An Ounce of Prevention Is Equivalent to How Much Decolonization Exactly?
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ABSTRACT:
SUBMITTER: Woodworth MH
PROVIDER: S-EPMC8315230 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description: Not available
| S-EPMC7745179 | biostudies-literature
Project description:IntroductionThe U.S. lags in the nationwide implementation of primary prevention interventions that have been shown to be efficacious. However, the potential population health benefit of widespread implementation of these primary prevention interventions remains unclear.MethodsThe meta-analytic literature from October 2013 to March 2014 of primary prevention interventions published between January 2000 and March 2014 was reviewed. The authors then estimated the number of deaths that could have been averted in the U.S. in 2010 if all rigorously studied, efficacious primary prevention interventions for which population attributable risk proportions could be estimated were implemented nationwide.ResultsA total of 372,054 (15.1%) of all U.S. deaths in 2010 would have been averted if all rigorously studied, efficacious primary prevention interventions were implemented. Two in three averted deaths would have been from cardiovascular disease or malignancy.ConclusionsA substantial proportion of deaths in the U.S. in 2010 could have been averted if efficacious primary prevention interventions were implemented nationwide. Further investment in the implementation of efficacious interventions is warranted to maximize population health in the U.S.
| S-EPMC5512568 | biostudies-literature
Project description:Colonization with health care-associated pathogens such as Staphylococcus aureus, enterococci, Gram-negative organisms, and Clostridium difficile is associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused on S. aureus decolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent for S. aureus nasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well as Candida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.
| S-EPMC4786886 | biostudies-literature
Project description:Numbers of non-indigenous species--species introduced from elsewhere - are increasing rapidly worldwide, causing both environmental and economic damage. Rigorous quantitative risk-analysis frameworks, however, for invasive species are lacking. We need to evaluate the risks posed by invasive species and quantify the relative merits of different management strategies (e.g. allocation of resources between prevention and control). We present a quantitative bioeconomic modelling framework to analyse risks from non-indigenous species to economic activity and the environment. The model identifies the optimal allocation of resources to prevention versus control, acceptable invasion risks and consequences of invasion to optimal investments (e.g. labour and capital). We apply the model to zebra mussels (Dreissena polymorpha), and show that society could benefit by spending up to US$324 000 year(-1) to prevent invasions into a single lake with a power plant. By contrast, the US Fish and Wildlife Service spent US$825 000 in 2001 to manage all aquatic invaders in all US lakes. Thus, greater investment in prevention is warranted.
| S-EPMC1691180 | biostudies-literature
Project description:Fecal microbiota transplantation (FMT) yields variable intestinal decolonization results for multidrug-resistant organisms (MDROs). This study showed significant reductions in antibiotic duration, bacteremia, and length of stay in 20 patients colonized/infected with MDRO receiving FMT (compared with pre-FMT history, and a matched group not receiving FMT), despite modest decolonization rates.
| S-EPMC8075030 | biostudies-literature
Project description:PurposeDespite ongoing debate about best practices for managing incidentally detected findings in brain research studies using magnetic resonance imaging (MRI), this issue has not been investigated from a health economics viewpoint. We applied a decision-analytic approach to assess the benefit of various strategies for functional MRI (fMRI) studies using intracranial aneurysms (IA) as a model.MethodsA decision tree and Markov model were created to simulate the impact on the lifetime costs and quality-adjusted life-years (QALY) of four different strategies for review of scans for the presence of IA. To populate the decision model, we used current evidence from the literature and results from a survey of experts.ResultsReview of the anatomical scans by a nonspecialist is not cost-effective in any of the subgroups of participants. Full clinical examination of women with a positive family history before enrollment in a study is cost-effective. Cost-effectiveness of reviewing scans obtained from women without a family history and men with a positive family history of IA depends on the willingness-to-pay (λ) for a QALY: at λ of $50,000/QALY, review of scans by a specialist is cost-effective, whereas at λ of $100,000/QALY, a full clinical workup is the best option. Compared with not reviewing any scans, a customized strategy for each subgroup of participants results in an incremental cost-effectiveness ratio of $12,503 for λ=$50,000/QALY and $32,767 for λ=$100,000/QALY.ConclusionTailored strategies based on the characteristics of research participants and λ for one QALY are needed to address the problem of incidental findings in research fMRI studies.
| S-EPMC10517630 | biostudies-literature
Project description:The development of powerful sequencing techniques has allowed, albeit with some biases, the identification and inventory of complex microbial communities that inhabit different body sites or body fluids, some of which were previously considered sterile. Notably, milk is now considered to host a complex microbial community with great diversity. Milk microbiota is now well documented in various hosts. Based on the growing literature on this microbial community, we address here the question of what milk microbiota is. We summarize and compare the microbial composition of milk in humans and in ruminants and address the existence of a putative core milk microbiota. We discuss the factors that contribute to shape the milk microbiota or affect its composition, including host and environmental factors as well as methodological factors, such as the sampling and sequencing techniques, which likely introduce distortion in milk microbiota analysis. The roles that milk microbiota are likely to play in the mother and offspring physiology and health are presented together with recent data on the hypothesis of an enteromammary pathway. At last, this fascinating field raises a series of questions, which are listed and commented here and which open new research avenues.
| S-EPMC7034295 | biostudies-literature
Project description:We show that n thermal fermionic alkaline-earth-metal atoms in a flat-bottom trap allow one to robustly implement a spin model displaying two symmetries: the Sn symmetry that permutes atoms occupying different vibrational levels of the trap and the SU(N) symmetry associated with N nuclear spin states. The symmetries make the model exactly solvable, which, in turn, enables the analytic study of dynamical processes such as spin diffusion in this SU(N) system. We also show how to use this system to generate entangled states that allow for Heisenberg-limited metrology. This highly symmetric spin model should be experimentally realizable even when the vibrational levels are occupied according to a high-temperature thermal or an arbitrary nonthermal distribution.
| S-EPMC6604830 | biostudies-literature
Project description:Geoenergy and geoengineering applications usually involve fluid injection into and production from fractured media. Accounting for fractures is important because of the strong poromechanical coupling that ties pore pressure changes and deformation. A possible approach to the problem uses equivalent porous media to reduce the computational cost and model complexity instead of explicitly including fractures in the models. We investigate the validity of this simplification by comparing these two approaches. Simulation results show that pore pressure distribution significantly differs between the two approaches even when both are calibrated to predict identical values at the injection and production wells. Additionally, changes in fracture stability are not well captured with the equivalent porous medium. We conclude that explicitly accounting for fractures in numerical models may be necessary under some circumstances to perform reliable coupled thermohydromechanical simulations, which could be used in conjunction with other tools for induced seismicity forecasting.
| S-EPMC8243940 | biostudies-literature
Project description:BACKGROUND:Skin and soft tissue infections (SSTIs) due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA) can lead to a number of significant known medical outcomes including hospitalization, surgical procedures such as incision and drainage (I&D), and the need for decolonization procedures to remove the bacteria from the skin and nose and prevent recurrent infection. Little research has been done to understand patient and caregiver-centered outcomes associated with the successful treatment of MRSA infection. OBJECTIVE:This study aimed to uncover MRSA decolonization outcomes that are important to patients and their parents in order to create a set of prototype measures for use in the MRSA Eradication and Decolonization in Children (MEDiC) study. METHODS:A 4-hour, human-centered design (HCD) workshop was held with 5 adolescents (aged 10-18 years) who had experienced an I&D procedure and 11 parents of children who had experienced an I&D procedure. The workshop explored the patient and family experience with skin infection to uncover patient-centered outcomes of MRSA treatment. The research team analyzed the audio and artifacts created during the workshop and coded for thematic similarity. The final themes represent patient-centered outcome domains to be measured in the MEDiC comparative effectiveness trial. RESULTS:The workshop identified 9 outcomes of importance to patients and their parents: fewer MRSA outbreaks, improved emotional health, improved self-perception, decreased social stigma, increased amount of free time, increased control over free time, fewer days of school or work missed, decreased physical pain and discomfort, and decreased financial burden. CONCLUSIONS:This study represents an innovative HCD approach to engaging patients and families with lived experience with MRSA SSTIs in the study design and trial development to determine meaningful patient-centered outcomes. We were able to identify 9 major recurrent themes. These themes were used to develop the primary and secondary outcome measures for MEDiC, a prospectively enrolling comparative effectiveness trial. TRIAL REGISTRATION:ClinicalTrials.gov NCT02127658; https://clinicaltrials.gov/ct2/show/NCT02127658.
| S-EPMC7434081 | biostudies-literature