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Abstract Background Healthcare professionals in palliative care are found to be confronted with moral challenges on a frequent basis. CURA is a low-threshold instrument for dialogical ethical reflection that was developed to deal with these challenges. A previous study identified the need of healthcare professionals to be trained to introduce CURA in their organization, initiate and facilitate reflections with CURA, and contribute to the implementation of CURA. The aim of this study was to develop and evaluate a training for professionals to become ‘CURA-ambassadors’. Methods The training was developed in a participatory way in two cycles. We trained 72 healthcare professionals. The training was evaluated by means of a questionnaire and six semi-structured interviews. Results The study resulted in a blended learning training combining training sessions with an e-module and with practicing with organizing and facilitating CURA in daily healthcare practice. The main objectives of the training are to enable CURA-ambassadors to introduce CURA within their organization, initiate and facilitate ethical reflections using CURA, and contribute to the implementation of CURA. Participants were generally positive about the training program and the trainers. Technical difficulties related to the e-module were mentioned as main point of improvement. Discussion The training program can generate ownership, responsibility, and competency among CURA-ambassadors, which are essential foundations for implementing complex interventions in healthcare practice. The training program received positive evaluations shortly after completing the program. This study adds to our understanding of what is needed for healthcare professionals to use CURA, in order to support them in dealing with moral challenges and to foster their moral resilience. Further research is needed to assess whether participants experience the training as sufficient and effective when using and implementing CURA structurally in their organizations over a longer period of time.

Abstract Background Understanding the financial consequences of endemically prevalent pathogens within the porcine respiratory disease complex (PRDC) and the effects of interventions assists decision-making regarding disease prevention and control. The aim of this systematic review was to identify what economic studies have been carried out on infectious endemic respiratory disease in pigs, what methods are being used, and, when feasible, to identify the economic impacts of PRDC pathogens and the costs and benefits of interventions. Results By following the PRISMA method, a total of 58 studies were deemed eligible for the purpose of this systematic review. Twenty-six studies used data derived from European countries, 18 from the US, 6 from Asia, 4 from Oceania, and 4 from other countries, i.e., Canada, Mexico, and Brazil. Main findings from selected publications were: (1) The studies mainly considered endemic scenarios on commercial fattening farms; (2) The porcine reproductive and respiratory syndrome virus was by far the most studied pathogen, followed by Mycoplasma hyopneumoniae, but the absence or presence of other endemic respiratory pathogens was often not verified or accounted for; (3) Most studies calculated the economic impact using primary production data, whereas twelve studies modelled the impact using secondary data only; (4) Seven different economic methods were applied across studies; (5) A large variation exists in the cost and revenue components considered in calculations, with feed costs and reduced carcass value included the most often; (6) The reported median economic impact of one or several co-existing respiratory pathogen(s) ranged from €1.70 to €8.90 per nursery pig, €2.30 to €15.35 per fattening pig, and €100 to €323 per sow per year; and (7) Vaccination was the most studied intervention, and the outcomes of all but three intervention-focused studies were neutral or positive. Conclusion The outcomes and discussion from this systematic review provide insight into the studies, their methods, the advantages and limitations of the existing research, and the reported impacts from the endemic respiratory disease complex for pig production systems worldwide. Future research should improve the consistency and comparability of economic assessments by ensuring the inclusion of high impact cost and revenue components and expressing results similarly.

Abstract Background Perioperative preventive measures are important to further reduce the rate of periprosthetic joint infections (PJI) in patients undergoing total hip arthroplasty (THA). During THA surgery, joint capsule sutures are commonly placed to optimize exposure and reinsertion of the capsule. Bacterial contamination of these sutures during the procedure poses a potential risk for postoperative infection. In this exploratory study, we assessed the contamination rate of capsule sutures compared to the contamination of the remains of exchanged control sutures at the time of closure. Methods In 100 consecutive patients undergoing primary THA capsule sutures were exchanged by sterile sutures at the time of capsule closure. Both the original sutures and the remainder of the newly placed (control) sutures were retrieved, collected and cultured for ten days. Types of bacterial growth and contamination rates of both sutures were assessed. Results Sutures from 98 patients were successfully collected and analyzed. Bacterial growth was observed in 7/98 (7.1%) of the capsule sutures versus 6/98 (6.1%) of the control sutures, with a difference of 1% [CI -6–8]. There was no clear pattern in differences in subtypes of bacteria between groups. Conclusions This study showed that around 7% of capsule sutures used in primary THA were contaminated with bacteria and as such exchange by new sutures at the time of capsule closure could be an appealing PJI preventive measure. However, since similar contamination rates were encountered with mainly non-virulent bacteria for both suture groups, the PJI preventive effect of this measure appears to be minimal.