A clinical algorithm for wound biofilm identication

Broj publiciranih referenci koje ukazuju na prisutnost biofi lma u kroničnim ranama je u porastu. Sve je veći broj dokaza koji potvrđuju da biofilm značajno sudjeluje u nezacijeljivanju rane i u bakterijskim infekcijama. Iz navedenih razloga postavlja se pitanje nedostatka postupnika o dokazima prisutnosti biofilma u rani. Namjera je ovog rada specifi cirati vidljive dokaze i indirektno dati kliničke smjernice tretmana biofilma u rani, te predložiti određeni postupnik za olakšanje kliničkog prepoznavanja biofi lma da bi se potom promijenilo ciljano liječenje vrijeda.Recognition of the existence of biofilm in chronic wounds is increasing among wound care practitioners, and a growing body of evidence indicates that biofilm contributes significantly to wound recalcitrance. While clinical guidelines regarding the involvement of biofilm in human bacterial infections have been proposed, there remains uncertainty and lack of guidance towards biofilm presence in wounds. The intention of this report is to collate knowledge and evidence of the visual and indirect clinical indicators of wound biofilm, and propose an algorithm designed to facilitate clinical recognition of biofilm and subsequent wound management practices

What determines duration of palliative care before death for patients with advanced disease? A retrospective cohort study of community and hospital palliative care provision in a large UK city

Objective For patients with advanced cancer, several randomised controlled trials have shown that access to palliative care at least 6 months before death can improve symptoms, reduce unplanned hospital admissions, minimize aggressive cancer treatments and enable patients to make choices about their end of life care, including exercising the choice to die at home. This study determines in a UK population the duration of palliative care before death and explores influencing factors. Design This retrospective cohort study analysed referrals to three specialist palliative care services; a hospital based inpatient palliative care team, and two community based services (hospices). For each patient referred to any of the above services we identified the date of first referral to that team and calculated the median interval between first referral and death. We also calculated how referral time varied by age, sex, diagnosis and type of palliative care service. Participants 4,650 patients referred to specialist palliative care services in Leeds UK between April 2012 and March 2014. Results Median age of the sample was 75 years. 3,903 (84.0%) patients had a diagnosis of cancer. Age, diagnosis and place of referral were significant predictors of duration of palliative care before death. Age was independently associated (J = 2672078, z = -392046.14, r = .01) with duration of palliative care regardless of diagnosis. Patients over 75 years have 29 fewer days of palliative care than patients under 50. Patients with non-cancer diagnoses have 13 fewer days of palliative care than patients with cancer. Additionally, patients referred to hospital palliative care receive 24.5 fewer days palliative care than those referred to community palliative care services. Conclusions The current timing of referral to palliative care may limit the benefits to patient in terms of improvements in end of life care, particularly for older patients and patients with conditions other than cancer

Creativity, Virtue and the Challenges from Natural Talent, Ill-Being and Immorality

We praise and admire creative people in virtually every domain. We also sometimes blame, condemn or withhold praise from those who fail creatively. This article outlines and develops my virtue theoretic account of exemplary creativity that makes sense of how and why we think in this way. If we are interested in a robust account of creative excellence we need to look at the underlying psychological mechanisms that enable individuals to be imaginative, surprising or original (and those which undermine them). I will suggest that what it is to be a creatively excellent person depends – amongst other things - upon certain admirable character traits such as curiosity, courage and perseverance. Creative virtues are admirable character traits that ground creative excellence and contribute to individual flourishing. Once the view is laid out the rest of the paper will be devoted to addressing apparent objections to this view emerging from the psychological and philosophical literature: challenges based on claims concerning a) the idea that it is natural talent not character that matters for creativity b) if being creative is significantly linked to mental illness then being creative promotes ill-being rather than well-being or flourishing and c) potential and apparent conflicts between moral and creative virtues

Transcendence at the Table: a Transfigurational Experience for Ecclesia while Breaking Bread Together

The Church has been slowly losing its identity. This loss of identity has a strong connection to the failure of the church to tend and till faith relationships, as well as pass the faith story on to children and others. There has been a loss of emphasis on the table as a place of significance in church, community, and home. To break bread together is to reclaim the spoken story of Jesus’ transfigurational power. The hope for growth in a stronger identity lies in believing in the Truth of a present and powerful Jesus who could transfigure lives, offer forgiveness and hope, and for those who allow him to live his life through them, the power to experience healing, joy, and peace. The Christian faith is the gathering of those anointed by the Holy Spirit and committed to Jesus, the ecclesia, the Church. The early church was a community of ecclesia, a Holy Spirit infused, worshiping community with a strong identity and a certain mission in the world, to proclaim the power and salvation hope of Jesus

The Night of the Divorce

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Waiting for Snow

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All Souls Day

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Is palliative care support associated with better quality end-of-life care indicators for patients with advanced cancer? A retrospective cohort study.

OBJECTIVES: This study aimed to establish the association between timing and provision of palliative care (PC) and quality of end-of-life care indicators in a population of patients dying of cancer. SETTING: This study uses linked cancer patient data from the National Cancer Registry, the electronic medical record system used in primary care (SystmOne) and the electronic medical record system used within a specialist regional cancer centre. The population resided in a single city in Northern England. PARTICIPANTS: Retrospective data from 2479 adult cancer decedents who died between January 2010 and February 2012 were registered with a primary care provider using the SystmOne electronic health record system, and cancer was certified as a cause of death, were included in the study. RESULTS: Linkage yielded data on 2479 cancer decedents, with 64.5% who received at least one PC event. Decedents who received PC were significantly more likely to die in a hospice (39.4% vs 14.5%, P<0.005) and less likely to die in hospital (23.3% vs 40.1%, P<0.05), and were more likely to receive an opioid (53% vs 25.2%, P<0.001). PC initiated more than 2 weeks before death was associated with avoiding a hospital death (≥2 weeks, P<0.001), more than 4 weeks before death was associated with avoiding emergency hospital admissions and increased access to an opioid (≥4 weeks, P<0.001), and more than 33 weeks before death was associated with avoiding late chemotherapy (≥33 weeks, no chemotherapy P=0.019, chemotherapy over 4 weeks P=0.007). CONCLUSION: For decedents with advanced cancer, access to PC and longer duration of PC were significantly associated with better end-of-life quality indicators

Fungal Growth on Wetblue: Methods to Measure Impact on Leather Quality

Wild and known fungal species were selected to inoculate a standardized wetblue leather and various methods were then employed to quantify the concomitant damage associated with mold growth. Fungi were isolated from commercially tanned samples of contaminated wetblue and pure strains were sourced from ATCC cultures. Test cuttings of wetblue leather were inoculated with the selected cultures and incubated along with matched control cuttings for a period of 90 days. Unknown wild strains were later identified using DNA sequencing techniques. Microscopic observations of all treated versus control samples did not show any difference in grain structure or skin morphology, indicating little or no breakdown of intact and tanned collagen structures. Various staining and analytical assay techniques indicated significant reduction in fatty material content in the treated samples compared with the untreated controls. RESUMENEspecies de hongos silvestres y conocidos fueron seleccionadas para inocular un cuero wet-blue estandarizado y varios métodos fueron luego empleados para cuantificar el daño concomitante asociado con el crecimiento del moho. Los hongos fueron aislados de muestras comerciales contaminadas de wetblue curtido y de cepas puras procedentes de cultivos ATCC. Muestras de cuero wetblue fueron inoculados con los cultivos seleccionados e incubados junto con idénticas muestras de control por un período de 90 días. Cepas silvestres desconocidas fueron identificadas posteriormente mediante técnicas de secuenciación de ADN. Observaciones microscópicas de todas las muestras tratadas en comparación con las muestras de control no mostraron ninguna diferencia en la estructura de la flor o en la morfología de la piel, lo que indica poca o ninguna interrupción de las estructuras de colágeno curtido. Varias técnicas de tinción y ensayos analíticos indican una reducción significativa en el contenido de materia grasa en las muestras tratadas en comparación con los controles no tratados