BACKGROUND: Multidrug-resistant (MDR) bacteria pose a significant challenge to the treatment of infectious diseases. Of particular concern are members of the Klebsiella pneumoniae species complex (KpSC), which are frequently associated with hospital-acquired infections and have the potential to spread outside hospitals via wastewaters. In this study, we aimed to investigate the occurrence and phylogenetic relatedness of MDR KpSC from patients with urinary tract infections (UTIs), hospital sewage, municipal wastewater treatment plants (mWWTPs) and surface waters and to evaluate the clinical relevance of the KpSC subspecies. METHODS: A total of 372 KpSC isolates resistant to third-generation cephalosporins and/or meropenem were collected from patients (n = 130), hospital sewage (n = 95), inflow (n = 54) and outflow from the mWWTPs (n = 63), river upstream (n = 13) and downstream mWWTPs (n = 17) from three cities in the Czech Republic. The isolates were characterized by antimicrobial susceptibility testing and whole-genome sequencing (Illumina). The presence of antibiotic resistance genes, plasmid replicons and virulence-associated factors was determined. A phylogenetic tree and single nucleotide polymorphism matrix were created to reveal the relatedness between isolates. RESULTS: The presence of MDR KpSC isolates (95%) was identified in all water sources and locations. Most isolates (99.7%) produced extended-spectrum beta-lactamases encoded by blaCTX-M-15. Resistance to carbapenems (5%) was observed mostly in wastewaters, but carbapenemase genes, such as blaGES-51 (n = 10), blaOXA-48 (n = 4), blaNDM-1 (n = 4) and blaKPC-3 (n = 1), were found in isolates from all tested locations and different sources except rivers. Among the 73 different sequence types (STs), phylogenetically related isolates were observed only among the ST307 lineage. Phylogenetic analysis revealed the transmission of this lineage from patients to the mWWTP and from the mWWTP to the adjacent river and the presence of the ST307 clone in the mWWTP over eight months. We confirmed the frequent abundance of K. pneumoniae (K. pneumoniae sensu stricto and K. pneumoniae subsp. ozaenae) in patients suffering from UTIs. K. variicola isolates formed only a minor proportion of UTIs, and K. quasipneumoniae was not found among UTIs isolates; however, these subspecies were frequently observed in hospital sewage communities during the first sampling period. CONCLUSION: This study provides evidence of the transmission and persistence of the ST307 lineage from UTIs isolates via mWWTPs to surface waters. Isolates from UTIs consisted mostly of K. pneumoniae. Other isolates of KpSC were observed in hospital wastewaters, which implies the impact of sources other than UTIs. This study highlights the influence of urban wastewaters on the spread of MDR KpSC to receiving environments.
- MeSH
- Anti-Bacterial Agents * pharmacology MeSH
- Bacterial Proteins genetics MeSH
- beta-Lactamases * genetics MeSH
- Phylogeny * MeSH
- Klebsiella Infections * microbiology epidemiology MeSH
- Urinary Tract Infections microbiology epidemiology MeSH
- Cross Infection microbiology epidemiology MeSH
- Klebsiella pneumoniae * drug effects genetics isolation & purification classification MeSH
- Humans MeSH
- Microbial Sensitivity Tests * MeSH
- Drug Resistance, Multiple, Bacterial * MeSH
- Hospitals * MeSH
- Wastewater * microbiology MeSH
- Sewage microbiology MeSH
- Whole Genome Sequencing MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
The two stork species that nest in Central Europe, Ciconia ciconia and Ciconia nigra, have been repeatedly shown to host the digenetic trematode Cathaemasia hians (Rudolphi, 1809) in their esophagus and muscular stomach. These host species differ in their habitat and food preferences, and the morphologic characters of C. hians isolates ex Ci. nigra and Ci. ciconia are not identical. These differences led to a previous proposal of two subspecies, Cathaemasia hians longivitellata Macko, 1960, and Cathaemasia hians hians Macko, 1960. We hypothesize that the Cathaemasia hians isolates ex Ci. nigra and Ci. ciconia represent two independent species. Therefore, in the present study, we performed the first molecular analyses of C. hians individuals that were consistent with the diagnosis of C. hians hians (ex Ci. nigra) and C. hians longivitellata (ex Ci. ciconia). The combined molecular and comparative morphological analyses of the central European Cathaemasia individuals ex Ci. nigra and Ci. ciconia led to the proposal of a split of C. hians into C. hians sensu stricto (formerly C. hians hians) and C. longivitellata sp. n. (formerly C. hians longivitellata). Morphological analyses confirmed that the length of the vitellaria is the key identification feature of the two previously mentioned species. Both Cathaemasia spp. substantially differ at the molecular level and have strict host specificity, which might be related to differences in the habitat and food preferences of the two stork species.
- MeSH
- DNA, Helminth genetics MeSH
- Species Specificity MeSH
- Phylogeny * MeSH
- Host Specificity * MeSH
- Birds parasitology MeSH
- Trematoda * anatomy & histology classification genetics MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Despite efforts to improve undergraduate clinical pharmacology & therapeutics (CPT) education, prescribing errors are still made regularly. To improve CPT education and daily prescribing, it is crucial to understand how therapeutic reasoning works. Therefore, the aim of this study was to gain insight into the therapeutic reasoning process. METHODS: A narrative literature review has been performed for literature on cognitive psychology and diagnostic and therapeutic reasoning. RESULTS: Based on these insights, The European Model of Therapeutic Reasoning has been developed, building upon earlier models and insights from cognitive psychology. In this model, it can be assumed that when a diagnosis is made, a primary, automatic response as to what to prescribe arises based on pattern recognition via therapy scripts (type 1 thinking). At some point, this response may be evaluated by the reflective mind (using metacognition). If it is found to be incorrect or incomplete, an alternative response must be formulated through a slower, more analytical and deliberative process, known as type 2 thinking. Metacognition monitors the reasoning process and helps a person to form new therapy scripts after they have chosen an effective therapy. Experienced physicians have more and richer therapy scripts, mostly based on experience and enabling conditions, instead of textbook knowledge, and therefore their type 1 response is more often correct. CONCLUSION: Because of the important role of metacognition in therapeutic reasoning, more attention should be paid to metacognition in CPT education. Both trainees and teachers should be aware of the possibility to monitor and influence these cognitive processes. Further research is required to investigate the applicability of these insights and the adaptability of educational approaches to therapeutic reasoning.
- MeSH
- Pharmacology, Clinical education MeSH
- Clinical Reasoning * MeSH
- Clinical Competence MeSH
- Drug Prescriptions standards MeSH
- Humans MeSH
- Medication Errors prevention & control MeSH
- Metacognition MeSH
- Education, Medical, Undergraduate MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
A sedentary lifestyle, characterised by a lack of physical activity, negatively influences Body Mass Index (BMI). BMI may be related to the prevalence of flat feet. This study aims to observe the occurrence of flat feet in young children and determine its association with BMI. Additionally, it aims to analyse foot loading in the forefoot, midfoot and rearfoot. Dynamographic records of children (N = 142; age = 10.3 ± 0.21 years) were collected during walking, and foot-type evaluations were conducted using a force plate. A normal foot type was observed in 44% of children (BMI 16.0 ± 2.3 kg/m2). Flat feet were observed in 54% of children (BMI 18.4 ± 4.3 kg/m2). A high foot arch was observed in only 2% of children (BMI 16.0 ± 1.3 kg/m2). Children with flat feet had higher BMI values than those with normal feet. The contact time and maximal vertical force in the forefoot and rearfoot were similar in children with normal and flat feet. Significantly higher pressure values were observed in the midfoot zone of children with flat feet. Regression analysis results showed that in children with flat feet, there is a decrease in forefoot loading and an increase in midfoot loading with increasing BMI. This trend was not observed in children with normal feet. We recommend incorporating exercise interventions at this age to prevent pain and promote willingness to engage in physical activity. Higher BMI values indicate an increased risk for the prevalence of flat feet.
- MeSH
- Walking physiology MeSH
- Child MeSH
- Body Mass Index * MeSH
- Humans MeSH
- Foot physiology anatomy & histology MeSH
- Flatfoot * epidemiology MeSH
- Sedentary Behavior MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Purpose: The aim of this study is to understand how healthcare practitioners experience organisational boundaries and silos in day-to-day operations. Based on a multi-dimensional scale of organisational boundaries, the study examines how organisational demarcation lines enable and constrain daily work tasks in the healthcare sector.Research design: The study is based on a quantitative and qualitative analysis of survey responses from 895 healthcare practitioners in Denmark.Results: The results indicate that tendencies toward organisational silos relate to systems and hierarchies (management-staff) rather than professions and departments. Moreover, the study identifies resource scarcity as an important undercurrent in the understanding of the respondents' perceptions of boundaries and silos.Conclusion: The study contributes to existing research by documenting the coordination and collaboration challenges linked to the multitude of demarcation lines in complex health organisations.
- MeSH
- Adult MeSH
- Cooperative Behavior MeSH
- Qualitative Research MeSH
- Middle Aged MeSH
- Humans MeSH
- Attitude of Health Personnel MeSH
- Surveys and Questionnaires MeSH
- Health Care Sector * organization & administration MeSH
- Health Personnel psychology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Denmark MeSH
BACKGROUND: We aimed to evaluate the predictors of sustainability of biologic drugs for paediatric patients with Crohn's disease (CD). METHODS: The Czech National Prospective Registry of Biologic and Targeted Therapy of Inflammatory Bowel Disease (CREdIT) was used to identify the biologic treatment courses in paediatric patients with CD. Mixed-effects Cox models and propensity score analyses were employed to evaluate predictors of treatment sustainability. RESULTS: Among the 558 observations of 473 patients, 264 were treated with adalimumab (47%), 240 with infliximab (43%), 41 with ustekinumab (7%), and 13 with vedolizumab (2%). Multivariable analysis revealed higher discontinuation risk with infliximab compared to adalimumab (HR = 0.600, 95%CI 0.389-0.926), both overall and in first-line treatment (HR = 0.302, 95%CI 0.103-0.890). Infliximab versus adalimumab was associated with shorter time to escalation (HR = 0.094, 95%CI 0.043-0.203). Propensity-score analysis demonstrated lower sustainability of infliximab (HR = 0.563, 95%CI 1.159-2.725). The time since diagnosis to treatment initiation (HR = 0.852, 95%CI 0.781-0.926) was the most important predictor. Baseline immunosuppressive therapy prolonged sustainability with infliximab (HR = 2.899, 95%CI 1.311-6.410). CONCLUSIONS: Given the results suggesting shorter sustainability, the need for earlier intensification and thus higher drug exposure, and the greater need for immunosuppression with infliximab than with adalimumab, the choice of these drugs cannot be considered completely equitable. IMPACT: Our study identified predictors of sustainability of biologic treatment in paediatric patients with Crohn's disease, including adalimumab (versus infliximab), early initiation of biologic treatment, and normalised baseline haemoglobin levels. Infliximab treatment was associated with earlier intensification, higher drug exposure, and a greater need for immunosuppression. Parents and patients should be fully informed of the disadvantages of intravenous infliximab versus adalimumab during the decision-making process. This study emphasises the importance of not delaying the initiation of biologic therapy in paediatric patients with Crohn's disease.
- MeSH
- Adalimumab * therapeutic use MeSH
- Biological Products therapeutic use MeSH
- Crohn Disease * drug therapy MeSH
- Child MeSH
- Antibodies, Monoclonal, Humanized therapeutic use MeSH
- Infliximab * therapeutic use MeSH
- Humans MeSH
- Adolescent MeSH
- Proportional Hazards Models MeSH
- Prospective Studies MeSH
- Registries * MeSH
- Propensity Score MeSH
- Ustekinumab therapeutic use MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Subspecialty fellowship directors are essential to the selection and mentorship of trainees. The purpose of this study is to evaluate the gender and racial/ethnic diversity of fellowship directors across fellowship programs in plastic and reconstructive surgery (PRS). METHODS: In December 2023, listings of fellowship programs/directors were surveyed from respective professional society websites across the 5 primary PRS fellowships: hand (American Society for Surgery of the Hand), craniofacial (American Society of Craniofacial Surgeons), microsurgery (American Society for Reconstructive Microsurgery), aesthetic (The Aesthetic Society), and burn (American Burn Association). Fellowship director demographics from each program were researched and identified. RESULTS: In total, 248 fellowship directors were identified: 94 hand, 34 craniofacial, 62 microsurgery, 38 aesthetic, and 20 burn. There was a significantly greater percentage of male versus female directors across all fellowships (87.5% versus 12.5%; P < 0.01). Men were noted to have a significantly higher average h-index score (20.4 versus 15.0; P = 0.045) but constituted a lower proportion of assistant professorships (32.3% versus 12.9%; P < 0.01). Relative to directors from racial/ethnic minority backgrounds, White directors constituted a significantly greater percentage of fellowship directors (72.9% versus 27.1%; P < 0.01) and had a greater number of years passed since completing their most recent training (21.7 versus 17.1; P = 0.030). CONCLUSIONS: Across PRS fellowship programs, women and racial/ethnic minorities are disproportionately underrepresented in leadership. Targeted initiatives to promote diversity in PRS fellowship directors should be considered as medicine works toward a surgical workforce more reflective of the patient population.
- Publication type
- Journal Article MeSH
An active and constructive process whereby individuals possess the ability to develop, implement, and flexibly maintain planned behavior in order to achieve a desired achievement goal is referred to as self-regulation. The aim of the present study is to examine the factorial structure and psychometric properties of the Self-Regulation Questionnaire, validated in the Czech educational context (SRQ-CZ). The other target is to identify any usage of self-regulation strategies which may differ as nationality, gender, age, education, and internal motivation to learn come into play. A total of 1,711 adult learners from Poland, Serbia, Slovakia, and the Czech Republic who were enrolled in a formal secondary or higher education system pursuing professions in the field of humanities, social and health care sciences participated in this study. A measurement-invariant four-factor model was obtained across all countries (min. CFI, TLI = 0.918, and 0.902, max. RMSEA = 0.059; ω between 0.625 and 0.838, and Cronbach's α between 0.622 and 0.837), including the Impulse Control, Goal Orientation, Self-Direction, and Decision Making subscales. Generally, the study confirmed a gradual increase in scores that measure positive self-regulatory qualities (Goal Orientation and Decision Making) and a decrease in unfavorable self-regulatory qualities (Impulse Control and Self-Direction) with higher age, education, and motivation, with no gender differences reported within countries. Moreover, scores on Goal Orientation and Decision Making dominated between countries. In conclusion, the SRQ-CZ demonstrated its suitability for cross-national comparisons, and personal characteristics appear to be important factors that distinguish those with high and low self-regulation.
- Publication type
- Journal Article MeSH
PURPOSE: Tryptophan (TRP) degradation through the kynurenine pathway is responsible for converting 95% of free TRP into kynurenines, which modulate skeletal muscle bioenergetics, immune and central nervous system activity. Therefore, changes in the kynurenines during exercise have been widely studied but not in the context of the effects of remote ischemic preconditioning (RIPC). In this study, we analyzed the effect of 14-day RIPC training on kynurenines and TRP in runners after running intervals of 20 × 400 m. METHODS: In this study, 27 semi-professional long-distance runners were assigned to two groups: a RIPC group performing 14 days of RIPC training (n = 12), and a placebo group, SHAM (n = 15). Blood was collected for analysis before, immediately after, and at 6 h and 24 h after the run. RESULTS: After the 14-day RIPC/SHAM intervention, post hoc analysis showed a significantly lower concentration of XANA and kynurenic acid to kynurenine ratio (KYNA/KYN) in the RIPC group than in the SHAM group immediately after the running test. Conversely, the decrease in serum TRP levels was higher in the RIPC population. CONCLUSION: RIPC modulates post-exercise changes in XANA and TRP levels, which can affect brain health, yet further research is needed.
- Publication type
- Journal Article MeSH
BACKGROUND: Critical care of patients on extracorporeal membrane oxygenation (ECMO) with acute brain injury (ABI) is notable for a lack of high-quality clinical evidence. Here, we offer guidelines for neurological care (neurological monitoring and management) of adults during and after ECMO support. METHODS: These guidelines are based on clinical practice consensus recommendations and scientific statements. We convened an international multidisciplinary consensus panel including 30 clinician-scientists with expertise in ECMO from all chapters of the Extracorporeal Life Support Organization (ELSO). We used a modified Delphi process with three rounds of voting and asked panelists to assess the recommendation levels. RESULTS: We identified five key clinical areas needing guidance: (1) neurological monitoring, (2) post-cannulation early physiological targets and ABI, (3) neurological therapy including medical and surgical intervention, (4) neurological prognostication, and (5) neurological follow-up and outcomes. The consensus produced 30 statements and recommendations regarding key clinical areas. We identified several knowledge gaps to shape future research efforts. CONCLUSIONS: The impact of ABI on morbidity and mortality in ECMO patients is significant. Particularly, early detection and timely intervention are crucial for improving outcomes. These consensus recommendations and scientific statements serve to guide the neurological monitoring and prevention of ABI, and management strategy of ECMO-associated ABI.
- MeSH
- Adult MeSH
- Consensus MeSH
- Humans MeSH
- Extracorporeal Membrane Oxygenation * methods standards MeSH
- Monitoring, Physiologic methods MeSH
- Critical Care standards methods MeSH
- Brain Injuries therapy MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Practice Guideline MeSH
