Active case finding for carbapenemase-producing Enterobacteriaceae in a teaching hospital: prevalence and risk factors for colonization.

Background: Over the past decade, the prevalence of carbapenemase-producing Enterobacteriaceae (CPE) has increased. Whilst basic infection prevention and control practices reduce the risk of transmission, cases of unrecognized carriage pose a potential risk of transmission.

Aim: To estimate the prevalence of CPE and explore risk factors associated with colonization within a large teaching hospital with an established CPE outbreak.

Evaluating the case for trivalent or quadrivalent influenza vaccines.

Influenza viruses circulate widely throughout the world and it is estimated that they affect between 5 and 15% of the population annually. Since 1977, four viruses co-circulate - two A Viruses (H1N1 and H3N2) and two B viruses (B Yamagata and B Victoria). Type A viruses generally cause up to two thirds of annual infections, although single country studies have shown that B infections may be the predominant virus in the one year in four.

Regional Cerebrovascular Responses to Hypercapnia and Hypoxia.

A limited number of studies using differing imaging approaches suggest that there are regional variation in the cerebrovascular response to hypercapnia and hypoxia. However there are limitations to these studies. In particular, it is not clear if existing studies of hypoxia have fully accounted for the confounding effects of the changes in arterial PCO2 on cerebral perfusion that, if uncontrolled, will accompany the hypoxic stimulus.

Achilles Tendon in Diabetes.

Introduction: Diabetes mellitus is one of the most common metabolic problems and is characterized by persistent hyperglycaemia. Exposure to chronic hyperglycaemia can affect many tissues including the Achilles Tendon, which is one of the largest tendons in the body. The current literature on the effects of hyperglycaemia on tendons is sparse, though evidence on rat models does suggest a process of chronic degeneration, which is increased in the presence of neuropathy and deformity.

A Longitudinal Study of Symptoms of Oropharyngeal Dysphagia in an Elderly Community-Dwelling Population.

Dysphagia has been estimated to affect around 8-16 % of healthy elderly individuals living in the community. The present study investigated the stability of perceived dysphagia symptoms over a 3-year period and whether such symptoms predicted death outcomes. A population of 800 and 550 elderly community-dwelling individuals were sent the Sydney Swallow Questionnaire (SSQ) in 2009 and 2012, respectively, where an arbitrary score of 180 or more was chosen to indicate symptomatic dysphagia.

Neuralgic amyotrophy is not the most common neurologic disorder of the shoulder: a 78-month prospective study of 60 neurologic shoulder patients in a specialist shoulder clinic.

Background: Neuralgic amyotrophy (NA) was first described in 1948. Traditional literature describes a painful attack with sudden onset, followed by paresis, with varied outcomes. Recent studies have suggested NA is currently underdiagnosed.

Global sharing, local innovation: Four schools, four countries, one curriculum.

Background: Many internal and external obstacles, must be overcome when establishing a new medical school, or when radically revising an existing medical curriculum.

Aims: Twenty-five years after the Flinders University curriculum was introduced as the first graduate-entry medical programme (GEMP) in Australia, we aim at describing how it has been adopted and adapted by several other schools, in Australia and in Europe (UK, Ireland, and Portugal).

Method/results: This paper reports on the experience of four schools establishing a new medical school or new curriculum at different times and in different settings.

Two-week wait false alarms? A prospective investigation of 2WW head and neck cancer referrals.

Objectives i) To prospectively explore patients' experience through the two-week wait (2WW) referral process; ii) To compare the relative true malignancy diagnostic rate between general medical practitioners (GMPs) and general dental practitioners (GDPs) over a six-month period; iii) To compare management of 2WW referral cases between GMPs and GDPs before the referral and during the 2 weeks in regards to symptomatic support, investigations in primary care, and information communicated to patients and secondary care clinicians; iv) To investigate the benign conditions that comprise 2WW referrals by finding out the final diagnoses of all cases included in the study.Method The patient inclusion criteria were all 2WW referral patients who attended consultation clinics during the six-month study period in Royal Cornwall Hospital NHS Trust. We prospectively distributed patient questionnaires and clinician's referral assessment forms.

Residents as teachers: Near peer learning in clinical work settings: AMEE Guide No. 106.

This AMEE Guide provides a framework to guide medical educators engaged in the design and implementation of "Resident as Teacher" programs. The suggested approaches are based on established models of program development: the Program Logic model to guide program design, the Dundee three-circle model to inform a systematic approach to planning educational content and the Kirkpatrick pyramid, which forms the backbone of program evaluation. The Guide provides an overview of Resident as Teacher curricula, their benefits and impact, from existing literature supplemented by insights from the authors' own experiences, all of whom are engaged in teaching initiatives at their own institutions.

ERK and AKT phosphorylation status in lung cancer and emphysema using nanocapillary isoelectric focusing.

Background: Emphysema is an independent risk factor for the development of lung cancer in smokers. Activation of oncogenic signalling proteins AKT and ERK by phosphorylation has an established role in the development of lung cancer and has also been implicated in the pathogenesis of emphysema. The aim of this study was to compare the protein level and phosphorylation status of AKT and ERK in paired lung cancer and emphysema tissue using a highly sensitive phosphoprotein analysis approach.

Synovial Fluid Findings and Demographic Analysis of Patients With Coexistent Intra-articular Monosodium Urate and Calcium Pyrophosphate Crystals.

Objectives: The aim of this study was to investigate the characteristics of arthritis in which monosodium urate (urate) and calcium pyrophosphate (CPP) crystals coexisted in synovial fluid (SF) to aid patient management and set a baseline from which to investigate the pathophysiological basis of an unusual coexistence of 2 disorders.

Methods: Synovial fluid analyses of 33,000 patients were reviewed, identifying those containing urate and/or CPP crystals. Synovial fluid cell count and differential cell count, together with patient age and gender, were retrieved from a computerized database spanning 22 years of SF analysis.

Dystonia Associated with Idiopathic Slow Orthostatic Tremor.

Background: We aimed to characterize the clinical and electrophysiological features of patients with slow orthostatic tremor.

Case Report: The clinical and neurophysiological data of patients referred for lower limb tremor on standing were reviewed. Patients with symptomatic or primary orthostatic tremor were excluded.

Peer-supported review of teaching: an evaluation.

Peer-supported review (also called peer observation) of teaching is a commonly implemented method of ascertaining teaching quality that supplements student feedback. A large variety of scheme formats with rather differing purposes are described in the literature. They range from purely formative, developmental formats that facilitate a tutor's reflection of their own teaching to reaffirm strengths and identify potential areas for development through to faculty- or institution-driven summative quality assurance-based schemes.

The immune-modulatory effects of a mixed herbal formula on dendritic cells and CD4+ T lymphocytes in the treatment of dust mite allergy asthma and perennial allergic rhinitis.

Objective: Asthma and allergic rhinitis are chronic inflammatory diseases of the conducting nasal airway. Traditional Chinese medicine has long been used for supplemental therapy of allergic diseases, especially asthma and allergic rhinitis. We previously reported the effects of a mixed herbal formula in patients with allergic rhinitis.