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"Metz, Terrence"
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Prevention of Catheter‐Related Infections and Complications: A Narrative Literature Review of Vascular Care and Maintenance
Objectives: This review assessed the burden of catheter‐related infections (CRI), existing gaps in catheter care, and prevention recommendations for catheter‐related bloodstream infections (CRBSIs). The review further discusses how the emergence of coronavirus disease (COVID‐19) influenced CRBSI rates and prevention strategies in the post‐COVID‐19 era. Methods: A targeted literature search was conducted of Embase, Ovid MEDLINE, and EBM Reviews. Where applicable, supplemental hand searches were performed to identify evidence for gaps in the targeted search results. The authors reviewed each study and selected those for inclusion based on the population, intervention, comparison, outcomes, and study design (PICOS) criteria. Relevant studies were assessed for inclusion in the present review. Results: Both “active” methods (scrubbing, flushing, and locking) and “passive” methods (disinfection caps) have consistently been shown to reduce CRBSI risk when assessed individually. These practices have markedly improved CRBSI rates over the past two decades, although there are ongoing gaps in catheter care and adherence to best practices. COVID‐19 reversed the trend towards improving CRBSI rates, and persistent challenges for nurse staffing and training have resulted in a failure to return to pre‐COVID‐19 CRBSI rates in the current post‐COVID‐19 era. These challenges are further compounded by limited rigorous comparative evidence assessing the relative efficacy of individual CRBSI prevention methods. Conclusions: Improving adherence to hub disinfection, along with catheter care and maintenance protocols, is essential for the prevention of CRIs. Further, innovative approaches for simplifying protocols and “forcing function” may increase compliance with CRBSI prevention strategies. In our practice, we routinely use disinfection caps in addition to standard scrubbing and flushing, alongside increased training and monitoring procedures. Additional studies are needed to assess which individual or combination prevention strategies are most efficacious and feasible in the post‐COVID‐19 era.
Journal Article
Fetus in fetu: use of intraoperative ultrasound for safe excision of a rare entity
A prenatally diagnosed abdominal mass at 36 weeks and 0 days was further characterised by postnatal ultrasound and MRI to be likely a rare case of fetus in fetu in an otherwise healthy male. Due to close proximity to both the coeliac axis and superior mesenteric artery (SMA), surgical excision was delayed for several months. Interim CT with intravenous contrast performed at 2 months of age demonstrated the SMA travelling through the posterior aspect of the mass. Surgery proceeded at 2 months of age. Intraoperative ultrasound was used to definitively identify both the coeliac axis and SMA in order to facilitate a safe excision. The patient recovered well with an uneventful discharge to home on postoperative day 8. Pathology confirmed the diagnosis of fetus in fetu.
Journal Article
Image-guided percutaneous core needle biopsy of soft-tissue masses in the pediatric population
Background
A paucity of literature describes the use of imaged-guided percutaneous core needle biopsy for the diagnosis and characterization of pediatric soft-tissue masses and lesions.
Objective
To retrospectively determine whether image-guided percutaneous core needle biopsy is adequate for diagnosing and characterizing benign and malignant pediatric soft-tissue masses and lesions.
Materials and methods
We identified children (≤18 years old) who underwent US- or CT-guided percutaneous core needle biopsy of a soft-tissue mass or other lesion between January 2012 and March 2014. Using medical records, we documented the following data: age and gender, site of the mass or lesion, size and number of biopsy specimens, whether the biopsy procedure was diagnostic, whether sufficient tissue was obtained for necessary ancillary testing (e.g., cytogenetic evaluation), and whether there was a procedural complication within 1 week.
Results
One hundred eight soft-tissue masses or lesions were biopsied under imaging guidance in 84 children; 39 (46%) were girls. Mean age ± standard deviation (SD) was 12.1 ± 5.1 years (range 6 months to 18 years). Of these procedures, 105/108 (97%) were diagnostic; 82/108 (76%) were US-guided; 87/108 (81%) were performed using a 17-gauge introducer needle/18-gauge biopsy instrument. The mean number ± SD of core needle biopsy specimens obtained was 8.9 ± 5.0. For newly diagnosed malignancies, adequate tissue was obtained for ancillary testing in 28/30 (93%) masses. One minor complication was documented.
Conclusion
Image-guided percutaneous core needle biopsy of pediatric soft-tissue masses is safe, has a high diagnostic rate, and provides sufficient tissue for ancillary testing.
Journal Article
Preparation and characterization of novel polymeric microcapsules for live cell encapsulation and therapy
This article describes the preparation and in vitro characterization of novel genipin cross-linked alginate-chitosan (GCAC) microcapsules that have potential for live cell therapy applications. This microcapsule system, consisting of an alginate core with a covalently cross-linked chitosan membrane, was formed via ionotropic gelation between calcium ions and alginate, followed by chitosan coating by polyelectrolyte complexation and covalent cross-linking of chitosan by naturally derived genipin. Results showed that, using this design concept and the three-step procedure, spherical GCAC microcapsules with improved membrane strength, suppressed capsular swelling, and suitable permeability can be prepared. The suitability of this novel membrane formulation for live cell encapsulation was evaluated, using bacterial Lactobacillus plantarum 80 (pCBH1) (LP80) and mammalian HepG2 as model cells. Results showed that capsular integrity and bacterial cell viability were sustained 6 mo postencapsulation, suggesting the feasibility of using this microcapsule formulation for live bacterial cell encapsulation. The metabolic activity of the encapsulated HepG2 was also investigated. Results suggested the potential capacity of this GCAC microcapsule in cell therapy and the control of cell signaling; however, further research is required.
Journal Article
Artificial cell microcapsules for oral delivery of thalidomide for use in Crohn's disease: Design, preparation, and in-vitro analysis
A delivery method for the oral administration of thalidomide for lowering tumor necrosis factor alpha (TNT-α), and thus Crohn's disease-related inflammation in the proximal small intestine, using two separate engineered polymer microcapsules is explored in this thesis. Membrane formation of both alginate-polylysine-alginate (APA) and alginate-chitosan (AC) capsules are discussed and thalidomide encapsulation procedures have been described. In-vitro tests have been used to monitor capsule degradation and drug release in a simulated gastrointestinal environment. Also, culture and use of RAW 264.7 mouse macrophage cells for the simulation of the human intestine is described. Results show two separate methods of drug delivery by the APA and AC capsules. APA capsules release thalidomide in a timed-release fashion whereas AC capsules release the drug in a burst manner. These results implicate the benefits of the use of both capsules to target separate sites along the small intestine. Also the cultured macrophage studies conclude that the proposed encapsulation therapy does indeed lower TNF-α levels and could therefore be of benefit for the lowering of inflammation associated with Crohn's disease. However, further animal study is needed before full potential of this approach can be realized.
Dissertation
A New Method for Targeted Drug Delivery Using Polymeric Microcapsules: Implications for Treatment of Crohn's Disease
Recent research and clinical evidence suggest that thalidomide could potentially be used to treat inflammation associated with Crohn's disease. However, systemic side effects associated with large doses of this drug have limited its widespread use. Treatment with thalidomide would prove more efficacious if the drug could be delivered directly to target areas in the gut, thereby reducing systemic circulation. Microcapsule encapsulation could enable direct delivery of the drug. To assess the latter, we designed and tested drug-targeting release characteristics of alginate-poly-L-lysine-alginate (APA) microcapsules in simulated gastrointestinal environments. The results show that APA capsules enabled delivery of thalidomide in the middle and distal portions of the small intestine. We also compared the APA membrane formulation with an earlier designed alginate chitosan (AC) membrane thalidomide formulation. The results show that both APA and AC capsules allow for successful delivery of thalidomide in the gut and could prove beneficial in the treatment of Crohn's disease. However, further research is required.
Journal Article
Assessing the impact of an intensive dietitian-led telehealth intervention focusing on nutritional adequacy, symptom control and optional supplemental jejunal feeding, on quality of life in patients with pancreatic cancer: a randomised controlled trial protocol
Background
Pancreatic cancer is the third leading cause of cancer-related death in Australia, with a persistently poor 5-year survival rate of around 13%. Symptoms arising from the disease and chemotherapy such as epigastric pain, anorexia, bloating and fat-malabsorptive diarrhoea cause poor oral intake and weight loss, and reduce an individual’s quality of life and ability to tolerate anti-cancer treatment. The primary aim of this study is to determine if an early, intensive telehealth nutrition intervention can improve quality of life compared to usual care for people undergoing treatment for pancreatic cancer.
Methods
This multicentre randomised controlled trial will recruit adults newly diagnosed with borderline resectable, locally advanced or metastatic pancreatic cancer from multiple health services across Victoria (metropolitan and regional). The control group will receive usual nutrition care, which is site-dependent. The intervention group will receive weekly telehealth dietetic consultations for six months, targeting nutritional adequacy through dietary education and counselling, oral nutrition supplement drinks and dietetics-led symptom management advocacy, including appropriate dosing of pancreatic enzymes. Escalation to supplemental jejunal tube feeding may occur if clinically required in the intervention arm. The primary outcome is quality of life (EORTC-QLQ C30 summary score); secondary outcomes include survival, chemotherapy dosing changes, and nutrition status markers including body composition. Outcomes will be measured at baseline, and three- and six-months.
Discussion
The findings of this study will provide evidence of the impact that intensive nutrition therapy, including counselling, provision of oral nutrition supplement drinks and the option for jejunal feeding, has on quality of life and health outcomes in pancreatic cancer. The consistent dietetic approach with the use of telehealth consultations to reduce malnutrition and aid symptom management challenges the current model of care.
Trial registration
31st January 2024, Australian and New Zealand Clinical Trial Registry (Trial ID/No. ACTRN12624000084583).
Journal Article