How Can We Improve How Delirium is Managed in Acute Care?

In the acute care population, does assessing the patient\u27s risk factors for delirium upon admission and daily, as well as implementing evidence based preventative measures based upon risk factors, reduce the incidence and duration of delirium compared to the patient that is not screened for risk factors and does not have preventative measures implemented?https://knowledgeconnection.mainehealth.org/nurseresidency/1083/thumbnail.jp

Within-host competition does not select for virulence in malaria parasites; studies with Plasmodium yoelii

In endemic areas with high transmission intensities, malaria infections are very often composed of multiple genetically distinct strains of malaria parasites. It has been hypothesised that this leads to intra-host competition, in which parasite strains compete for resources such as space and nutrients. This competition may have repercussions for the host, the parasite, and the vector in terms of disease severity, vector fitness, and parasite transmission potential and fitness. It has also been argued that within-host competition could lead to selection for more virulent parasites. Here we use the rodent malaria parasite Plasmodium yoelii to assess the consequences of mixed strain infections on disease severity and parasite fitness. Three isogenic strains with dramatically different growth rates (and hence virulence) were maintained in mice in single infections or in mixed strain infections with a genetically distinct strain. We compared the virulence (defined as harm to the mammalian host) of mixed strain infections with that of single infections, and assessed whether competition impacted on parasite fitness, assessed by transmission potential. We found that mixed infections were associated with a higher degree of disease severity and a prolonged infection time. In the mixed infections, the strain with the slower growth rate was often responsible for the competitive exclusion of the faster growing strain, presumably through host immune-mediated mechanisms. Importantly, and in contrast to previous work conducted with Plasmodium chabaudi, we found no correlation between parasite virulence and transmission potential to mosquitoes, suggesting that within-host competition would not drive the evolution of parasite virulence in P. yoelii

Integrating precision cancer medicine into healthcare—policy, practice, and research challenges

Abstract Precision medicine (PM) can be defined as a predictive, preventive, personalized, and participatory healthcare service delivery model. Recent developments in molecular biology and information technology make PM a reality today through the use of massive amounts of genetic, ‘omics’, clinical, environmental, and lifestyle data. With cancer being one of the most prominent public health threats in developed countries, both the research community and governments have been investing significant time, money, and efforts in precision cancer medicine (PCM). Although PCM research is extremely promising, a number of hurdles still remain on the road to an optimal integration of standardized and evidence-based use of PCM in healthcare systems. Indeed, PCM raises a number of technical, organizational, ethical, legal, social, and economic challenges that have to be taken into account in the development of an appropriate health policy framework. Here, we highlight some of the more salient issues regarding the standards needed for integration of PCM into healthcare systems, and we identify fields where more research is needed before policy can be implemented. Key challenges include, but are not limited to, the creation of new standards for the collection, analysis, and sharing of samples and data from cancer patients, and the creation of new clinical trial designs with renewed endpoints. We believe that these issues need to be addressed as a matter of priority by public health policymakers in the coming years for a better integration of PCM into healthcare

Update on use of aldesleukin for treatment of high-risk metastatic melanoma

Rodabe N Amaria,1 Alexandre Reuben,2 Zachary A Cooper,2,3 Jennifer A Wargo2,3 1Department of Melanoma Medical Oncology, 2Department of Surgical Oncology, 3Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA Abstract: High-dose interleukin-2 has been used for the treatment of metastatic melanoma since 1998 based on data proving durable complete responses in up to 10% of treated patients. The immunomodulatory effects of this critical cytokine have been instrumental in the development of immunotherapy for melanoma and other cancers. However, with the advent of new therapies, its use as a front-line agent has come into question. Nonetheless, there is still a role for interleukin-2 as monotherapy, as well as in combination with other agents and in clinical trials. In this article, we review preclinical and clinical data regarding interleukin-2, its pharmacology and mechanism of action, its toxicity profile, and its use in ongoing and planned clinical trials. We also explore the future of this agent within the treatment landscape for melanoma. Keywords: aldesleukin, melanoma, immunotherap

Burn Disaster-Management Planning: A Preparedness Tool Kit

It is vital that preburn center emergency providers have the knowledge and equipment needed to treat burn-injured patients should there be an extended delay in transporting the patients to a burn center as may be the case during a mass-casualty incident or weather-related emergency. Since 2007 a collaborative effort has been underway to build an emergency-response tool kit that provides to and draws from local, state, and federal resources. This tool kit is designed to fill knowledge deficits regarding burn treatment as well as address gaps in stockpiled treatment materials. This tool kit was implemented in four modules: provide equipment, provide guidance, provide education, and provide drill. Module one ensures that equipment needed for treating burn injuries is available to emergency providers. Module two ensures that policies and procedures congruent with the practice of the regional burn center are in place. Module three ensures that preburn center providers are provided education on modern burn care. Module four is to drill. The sum of the effort by the authors is the establishment of a tool kit that enhances the capabilities of preburn center emergency providers. Implementation has led to improved collaborative relationships, increased the awareness of available resources, and reduced knowledge deficit regarding burn care among preburn center providers. This tool kit provides greater continuity of care for all burn patients affected by a delay in transport to a burn center, and its modular structure makes it adaptable to other regions as a whole or in part

Latest advances and future perspectives in Armillaria

The basidiomycete genus Armillaria s.l. (Armillaria s.s. and Desarmillaria) has a worldwide distribution and plays a central role in the dynamics of numerous woody ecosystems, including natural forests, tree plantations for timber production, orchards, vineyards and gardens. Early studies have shown that all Armillaria species are capable of degrading dead woody substrates, causing white rot. Moreover, most species exhibit a parasitic ability, and can be considered as facultative necrotrophs. Although over the years extensive research has been conducted on the phylogeny, biology and ecology of different Armillaria species, numerous theoretical and applied questions remain open. Recently published studies have provided new perspectives, the most significant of which we present in this review. First, new investigations have highlighted the importance of a multilocus approach for depicting the phylogeny of the genus Armillaria. Second, the importance of clonality and sexuality for the different species is now better described, enabling a more accurate prediction of population dynamics in various environments. Third, genome sequencing has provided new insights into genome evolution and the genetic basis of pathogenicity and wood degradation ability. Fourth, several new studies have pointed out the possible influence of climate change on Armillaria distribution, biology and ecology, raising questions regarding the future evolution of Armillaria species and their effect on ecosystems. In this review, we also give a state-of-the-art overview of the control possibilities of parasitic Armillaria species. Finally, we outline some still open questions in Armillaria research, the investigation of which will strongly benefit from recent methodological advances