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Cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) are characterized by increasingly frequent acute pulmonary exacerbations that reduce life quality and length. Human airways are home to a rich polymicrobial environment, which includes members of the obligately anaerobic genus

BackgroundAntimicrobial resistance (AMR) is an ever-increasing global health concern. One crucial facet in tackling the AMR epidemic is earlier and more accurate AMR diagnosis, particularly in the dangerous and highly multi-drug resistant ESKAPE pathogen,Pseudomonas aeruginosa.ObjectivesWe aimed to develop two SYBR Green-based mismatch amplification mutation assays (SYBR-MAMAs) targeting GyrA T83I (gyrA248), and GyrA D87N, D87Y, and D87H (gyrA259). Together, these variants cause the majority of fluoroquinolone (FQ) AMR inP. aeruginosa.MethodsFollowing assay validation, thegyrA248 andgyrA259 SYBR-MAMAs were tested on 84 clinicalP. aeruginosaisolates from Queensland, Australia, 45 of which demonstrated intermediate/full ciprofloxacin resistance according to antimicrobial susceptibility testing.ResultsOur two SYBR-MAMAs correctly predicted an AMR phenotype in the majority (84%) of isolates with intermediate/full FQ resistance. Importantly, all FQ-sensitive strains were predicted to have a sensitive phenotype. Whole-genome sequencing confirmed 100% concordance with SYBR-MAMA genotypes.ConclusionsOur GyrA SYBR-MAMAs provide a rapid and cost-effective method for same-day identification of FQ AMR inP. aeruginosa. An additional SYBR-MAMA targeting the GyrB S466Y/S466F variants would increase FQ AMR prediction to 91%. Clinical implementation of our assays will permit more timely treatment alterations in cases where decreased FQ susceptibility is identified, leading to improved patient outcomes and antimicrobial stewardship.

Cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) are characterised by increasingly frequent acute pulmonary exacerbations that reduce life quality and length. Human airways are home to a rich polymicrobial environment, including members of the obligately anaerobic genus, Prevotella. Despite their commonness, surprisingly little is known about the prevalence, role, genomic diversity, and antimicrobial resistance (AMR) potential of Prevotella species/strains in healthy and diseased airways. Here, we used comparative genomics to develop a real-time PCR assay to permit rapid Prevotella spp. quantification from cultures and clinical specimens. Assay specificity was validated across a panel of Prevotella and non-Prevotella species, followed by PCR screening of CF and COPD respiratory-derived cultures. Next, 35 PCR-positive isolates were subjected to whole-genome sequencing. Of eight identified species, P. histicola, P. melaninogenica, P. nanceiensis, P. salivae and P. denticola overlapped between participant cohorts. Phylogenomic analysis revealed considerable interhost but limited intrahost diversity, suggesting patient-specific lineages in the lower airways, probably from oral cavity aspirations. Correlation of phenotypic AMR profiles with AMR gene presence identified excellent correlation between tetQ presence and decreased doxycycline susceptibility, and ermF presence and decreased azithromycin susceptibility and clindamycin resistance. AMR rates were higher in the CF isolates, reflecting greater antibiotic use in this cohort. All tested Prevotella isolates were tobramycin-resistant, providing a potential selection method to improve Prevotella culture retrieval rates. Our addition of 35 airway-derived Prevotella genomes to public databases will enhance ongoing efforts to unravel the role of this diverse and enigmatic genus in both chronic respiratory diseases and healthy lungs.Data summaryThirty-five Prevotella spp. genomes generated in this study are available in the Sequence Read Archive (SRA) and GenBank databases under BioProject accession PRJNA742126.

Background: Respiratory Acute Discharge Service (RADS) is a novel early discharge service with nurse-led community based recovery in selected patients with acute exacerbations of chronic obstructive pulmonary disease.Aim: This pilot study aimed to determine the efficacy and safety of the programme in an Australian tertiary hospital.Methods: All patients who were recruited to RADS at Sunshine Coast University Hospital over a 6 months period from June to November 2018 were included. The co-primary outcomes were length of hospital days saved and rate of readmission within 30 days from discharge.Results: A total of 166 patients (median age 74 years (interquartile range 70-80 years)) was recruited to the programme over the study period. The mean forced expiratory volume in one second (FEV1%) of the patients was 42% (standard deviation 19). The median length-of-stay prior to discharge on the RADS programme was 1 day (range 0-5), compared to a previous average of 5.8 days in our health service. Patients were on the programme for a median of 4 days (range 1-6). A total of 613 hospital bed days was saved over the study period, with significant cost savings. Forty-one (24.7%) patients represented to hospital within 30 days, the majority (64%) were due to recurrent symptoms. The rate of 30-day all-cause mortality for the study population was 1 (0.6%).Conclusion: Early supported discharge care model with nurse-led community based recovery after an acute exacerbation of chronic obstructive pulmonary disease in selected patients is safe, and has the potential to provide greater flow through the hospital systems with cost effective care.

In the post-World War II period obstetrics transformed the nature of its work, partly in response to the challenge of natural childbirth. The transformation is traced by focusing on obstetrics’understanding of pain in childbirth. In reformulating its field of power obstetrics reconstituted its patient-object to take into consideration the patient's subjectivity which, as a result of the natural childbirth movement, had asserted itself, escaping from the confines in which obstetrics had tried to contain it, and reclaiming for a fleeting instant the pain which signaled a woman's active participation in birth.

Aim. This paper reports a systematic review of non-pharmacological interventions for fatigue in adults with three common autoimmune conditions. Background. A considerable proportion of people with multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus experience compromised quality of life due to fatigue. Recent reviews of pharmacotherapies for fatigue in these conditions remain inconclusive, and systematic evidence for effectiveness of non-pharmacological interventions was unavailable. Our paper addresses this gap. Methods. The literature search used the key words fatigue, energy, multiple sclerosis, rheumatoid arthritis and systemic lupus. It included 19 electronic databases and libraries, three evidence-based journals, two internet search engines, was dated 1987–2006, and limited to English. Non-pharmacological experimental studies about fatigue comprising more than five adults were included. Meta-analysis was not possible due to diverse interventions and outcome measures, therefore studies were analysed by types of interventions used to reduce fatigue. Results. Of 653 hits, 162 papers were reviewed, and 36 met the inclusion criteria. Thirty-three primary studies reported 14 randomized controlled trials and 19 quasi-experimental designs. Most interventions were tested with people with multiple sclerosis. Exercise, behavioural, nutritional and physiological interventions were associated with statistically significant reductions in fatigue. Aerobic exercise was effective, appropriate and feasible for reducing fatigue among adults with chronic autoimmune conditions. Electromagnetic field devices showed promise. The diversity of interventions, designs, and using 24 different instruments to measure fatigue, limited comparisons. Conclusion. Low impact aerobic exercise gradually increasing in intensity, duration and frequency may be an effective strategy in reducing fatigue in some adults with chronic auto-immune conditions. However, fatigue is a variable and personal experience and a range of behavioural interventions may be required. Well-designed studies testing these promising strategies and consensus on outcome fatigue measures are needed.

The meaning of health as expanding consciousness is explored through stories of seven women who developed multiple sclerosis or rheumatoid arthritis during their lives. Using Newman’s hermeneutic-dialectic approach, unstructured interviews were conducted over a 2-year period. Analysis and interpretation of narratives concerning person-environment interactions revealed turning points and separate choice points before four new ways of living including finding simple pleasures, being positive, gaining self-control, and self-differentiation, were found. Support for Newman’s stages of expanding consciousness and more comprehensive descriptions of self-transcendence in space and time are presented. Implications for theory development and theory-guided practice are offered.

Considering personal life stories as the context for health transitions can enhance understanding of what is meaningful in living with chronic illness. Informed by Margaret Newman's theory of Health as Expanding Consciousness, this interpretive study described the life patterns of three women with rheumatoid arthritis as a process of expanding consciousness. The women's stories revealed transcendence of self-boundaries and personal transformation as new ways of living, including "simple pleasures" and "being positive." Through understanding life patterns within caring nursing partnerships, transitions in an entire life story can be appreciated as complex processes involving transcendence and transformation.

The personal journey to caring actions informed by theory (praxis) that the author shares in this paper emerged from frustration with accepted nursing practice and changed her perspective on nursing encounters. She describes aspects of her doctoral research, in which she used Newman’s theory of health as expanding consciousness (HEC) to explore life patterns and underlying patterns of 7 women living with chronic illness. The mutual, caring relationships that she developed with these women show how a focus on pattern, transformation, and wholeness can make a difference in nursing. Aspects of this caring praxis are illuminated.

Molecular Templates is developing engineered toxin bodies (ETBs), potent recombinant immunotoxins that combine the specificity of an antibody fragment with the powerful direct cytotoxicity of the Shiga-like toxin A subunit (SLTA). ETBs can induce their own internalization, route through the cell in a predictable manner, enzymatically and irreversibly destroy ribosomes to shutdown protein synthesis and induce apoptosis of tumor cells. This mechanism of action is distinct from that of other therapeutics, making ETBs an attractive treatment for patients who have become resistant to chemotherapy and other treatments. Safety and efficacy in refractory non-Hodgkin’s lymphoma patients has been observed in a phase I study with Molecular Template’s first-generation CD20-targeting compound, MT-3724. CD38 is a surface receptor that is highly expressed on malignant plasma cells. CD38 is a clinically validated target of monoclonal antibodies for treatment of multiple myeloma and is known to persist after failure of antibody treatment. MT-4019 is a CD38-targeted next-generation ETB, utilizing a modified SLTA. The SLTA subunit of the next-generation ETB scaffold has been modified through proprietary genetic engineering to systematically and comprehensively reduce B cell and CD4+T cell epitopes, as well as to dampen the innate response by decreasing binding to TLR-4. This de-immunized next-generation scaffold retains the potency and specificity of an ETB containing an unmodified SLTA. Pre-clinical studies in rodents and non-human primate models have demonstrated the tolerability of MT-4019, along with a decreased anti-drug antibody response. Additionally, in the non-human primate model, MT-4019 showed reduced neutrophil and monocyte activation as compared to an ETB with an unmodified SLTA subunit, indicating that SLTA modification also exhibits a diminished innate immune response. Molecular Template’s ETB technology has resulted in potent, targeted therapeutic agents that have a unique mechanism of action in the field of oncology. MT-3724, a first-generation CD20-targeted ETB, has shown promising clinical results in the refractory setting for non-Hodgkin’s lymphoma. The next-generation scaffold, as exemplified in the CD38-targeted MT-4019, retains potent and specific direct cell kill activities, and additionally reduces the innate and adaptive immune response to the therapeutic. MT-4019 is a promising lead and is under further development to enable clinical studies in multiple myeloma. Citation Format: Garrett L. Robinson, Sangeetha Rajagopalan, Brigitte Brieschke, Jane Neill, Jennifer Erdman, Rodney Flores, Jensing Liu, Jack P. Higgins, Erin K. Willert. MT-4019: a de-immunized engineered toxin body targeting CD38 for multiple myeloma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2659. doi:10.1158/1538-7445.AM2017-2659

Molecular Templates has developed engineered toxin bodies (ETBs), potent recombinant immunotoxins that combine the specificity of an antibody fragment with the powerful direct cytotoxicity of the Shiga-like toxin A subunit to specifically destroy target expressing cells. The use of other immunotoxins and antibody-drug conjugates is limited to targets with tumor-specific cell surface expression that efficiently internalize. The ETB scaffold has been designed to overcome this limitation and promote forced internalization of ETBs, a property that expands the potential targets to receptors with poor internalization kinetics. An additional benefit to ETBs is the mechanism of action (MOA) which is unique to that of other oncology treatments. CD20, a receptor that does not undergo rapid internalization, is a well characterized target for agents used to treat non-Hodgkin's lymphoma (NHL). Thus, successful CD20-targeted clinical strategies include monoclonal antibodies (mAbs) and radiolabeled mAbs that act on the cell surface. Molecular Templates’ lead compound, MT-3724, is a CD20-targeted ETB that has been engineered to force the rapid internalization of the immunotoxin after binding to CD20. MT-3724 has potent direct cell kill activity on CD20 positive lymphoma cells and is the first immunotoxin to CD20 to enter the clinic. The on-going phase I study being conducted at Memorial Sloan-Kettering Cancer Center, MD Anderson Cancer Center, and New York University Langone Medical Center has shown promising safety and efficacy in highly refractory NHL patients. Once MT-3724 is delivered to appropriate cells, the Shiga toxin A subunit inhibits protein synthesis and promotes apoptosis of tumor cells. The difference in MOA allows for activity in the refractory setting, where resistance to other treatments has emerged, and may also allow for combination therapy. Pre-clinical studies with immunomodulatory drugs (IMiDs), PI3K and Bcl-2 inhibitors that are used in treatment of NHL have shown promising results when combined with MT-3724. MT-3724 is a promising novel agent in the treatment of NHL and other CD20 positive hematological malignancies. Data around the internalization kinetics, enzymatic activity, and combination with other agents will be presented. Citation Format: Garrett L. Robinson, Sangeetha Rajagopalan, Brigitte Brieschke, Jennifer Erdman, Jane Neill, Rodney E. Flores-Lefranc, Julia Foree, William Null, Jensing Liu, Jack P. Higgins, Erin K. Willert. MT-3724, an engineered toxin body targeting CD20 for non-Hodgkin's lymphoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1483.

Molecular Templates is developing engineered toxin bodies (ETBs), potent recombinant immunotoxins that combine the specificity of an antibody fragment with the powerful direct cytotoxicity of the Shiga-like toxin A subunit to specifically kill target expressing cells. Once delivered to appropriate cells, the Shiga toxin A subunit inhibits protein synthesis and promotes apoptosis of tumor cells. Bacterial or plant derived toxin moieties have the potential to induce an immune response, commonly limiting repeat dosing of immunotoxins. Our next-generation ETB scaffold has been modified to overcome this limitation through genetic engineering to systematically and comprehensively reduce B and CD4+T cell epitopes. Molecular Templates has developed a proprietary epitope class switching technology designed to both reduce the anti-drug response and promote the anti-tumor response by replacing naturally occurring CD4+ T cell epitopes with CD8+ T cell epitopes. We have found that a combination of surface remodeling and epitope class switching combined in one protein results in powerful reductions in the anti-drug response against ETBs after repeat administration. This de-immunized next-generation scaffold retains the potency and specificity of the unmodified ETB. Additionally, the engineering of CD8+ T cell epitopes on the ETB scaffold can allow for foreign antigen presentation in complex with MHC class I on the tumor cell surface. This antigen presentation may recruit activated cytotoxic T lymphocytes (CTLs) to the tumor microenvironment thereby adding an additional mechanism of action to the direct cell kill activity of the ETBs. The second generation ETB scaffold has been combined with multiple target binding domains, including scFvs that target CD38, PD-L1 and HER2. CD38 is a validated target for multiple myeloma, and our CD38 targeted ETB has shown potent activity in vitro and in vivo. Pre-clinical studies have shown effective combination of the CD38 targeted ETB with standard of care agents such as IMiDs. Additionally, we have developed a PD-L1 targeted ETB that can be used against various PD-L1 expressing malignancies including Hodgkin's lymphoma and melanoma. HER2 is a well characterized target in breast cancer that persists in many patients after HER2 targeted treatment relapse; a novel MOA to this target may impart additional clinical benefit. The potency, reduced immunogenicity, unique mechanism of action and immune modulating activities of ETBs in this second generation scaffold allows for these agents to fit in well in a refractory setting as well as in combination with other agents in the growing field of immuno-oncology. Citation Format: Sangeetha Rajagopalan, Garrett L. Robinson, Brigitte Brieschke, Jennifer Erdman, Jane Neill, Jack P. Higgins, Erin K. Willert. Next-generation engineered toxin bodies: CD38, PD-L1 and HER2 targeted ETBs. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 595.

Background: Stress can come in many forms and NICU is an environment where there may be many types of stress such as nursing a critically ill baby, increased workload, taking on other roles, coping with the death and dealing with parents. Purpose: To explore and describe staff nurses’ (SN) positive experiences while working in a Neonatal Intensive Care Unit (NICU) in one of Malaysia Method: A qualitative interpretative approach using a convenience sample of four staff nurses; described using pseudonyms, from NICU in one Malaysian hospital participated in an interview conducted in English, followed by answering a semi-structured questionnaire in Malay. Responses were translated into English prior to thematic analysis using the method of Braun and Clarke [1]. Results: Two major themes emerged, learning opportunities; describes the new knowledge and skills staff nurses had developed, and feelings of satisfaction; describes sources contributing to staff nurses’ satisfaction while working in NICU. Conclusions: The findings revealed that staff nurses’ positive experiences of gaining knowledge, developing new skills, opportunity to further study in post-basic courses and being appointed as a team leader upon their achievements.

Background Previous small studies suggested SBOT may be ineffective in relieving breathlessness after exercise in COPD. Methods 34 COPD patients with FEV1 Results Average oxygen saturation fell from 95.0% to 91.3% after exercise. The mean time to subjective recovery was 3.3 minutes with no difference between treatments. The mean Borg breathlessness score was 1.5/10 at rest, rising to 5.1/10 at the end of exercise (No breathlessness = 0, worst possible breathlessness = 10). Oxygen therapy had no discernable effect on Borg scores even for 14 patients who desaturated below 90%. 15 patients had no preferred treatment, 7 preferred oxygen, 6 preferred the fan, 3 preferred air via a mask and 3 preferred room air. Conclusions This study provides no support for the idea that COPD patients who are not hypoxaemic at rest derive noticeable benefit from oxygen therapy after exercise. Use of air from a mask or from a fan had no apparent physiological or placebo effect.

Obstructive sleep apnea (OSA) affects approximately 2-4% of the general population and may be more prevalent in obese adults. However, sleep apnea remains consistently under-diagnosed in the general population as well as in hospital wards. Nurse awareness of OSA during routine monitoring could allow specific observations of hospitalised adults to identify those at high risk and ensure appropriate referral. This integrative literature review analysed major risk factors for OSA and identified screening tools that nurses could utilise in hospital wards. The most important risk factors relevant to nursing practice in hospital settings were obesity, hypertension and sleep position. The most suitable screening tool was the Berlin Questionnaire, while there was some evidence to support measuring waist circumference. A nursing assessment flow chart was developed based on the literature reviewed. This paper highlights a role for nurses in recognising patients at risk of OSA and minimising complications in hospitalised adults.

Through a critical review of nursing and medical literature, this article argues that nephrology nurses have embraced Kt/V at the expense of other core elements of nephrology nursing care. The focus on quality care as technical expertise may dominate at the expense of interpersonal care. Nurses need to challenge the influence Kt/V has on other aspects of nephrology nursing care.

The cell surface glycoprotein CD38 is highly expressed on the surface of several B cell lineage cancers, such as the plasma cell malignancy multiple myeloma, some lymphomas and chronic lymphocytic leukemia (CLL), where it is a marker of unfavorable prognosis. CD38 is a transmembrane receptor and ectoenzyme that is absent or expressed at a low level on most resting leukocytes under normal conditions, making this an appealing target for directed therapy for hematological malignancies. Recent clinical trials with antibodies to CD38 have shown promise in multiple myeloma. While these antibodies rely on the recruitment of an immune response for cytotoxicity, we have developed an engineered toxin body (ETB) comprising a CD38 binding scFv and a modified Shiga-like Toxin A subunit capable of specifically recognizing and directly killing CD38 expressing cells. The CD38 targeted ETB has a different mechanism of action than current treatments for multiple myeloma (such as immunomodulatory agents, protease inhibitors and chemotherapies). Our CD38 targeted ETB has shown to be well tolerated in mice and displays dose dependent efficacy in a CD38 positive tumor setting. The CD38 targeted ETB significantly reduced tumor burden and increased survival over a 40-fold dose range in a disseminated Daudi xenograft, early treatment model. In this setting, the mean tumor burden at day 28 was reduced to 29% of control for the lowest dose group (0.05 mg/kg) and less than 1% of control for the two higher doses (0.5 and 2 mg/kg). Median survival of the control, untreated group was 34 days; the low dose group had extended median survival to 59.5 days and, at the day 60 study end, 90 or 100% of mice were alive in the higher two dosing groups. Our results show that the CD38 targeted ETB is a promising targeted therapeutic agent against CD38 positive cancer cells and is currently under further development. Citation Format: Garrett L. Robinson, Sangeetha Rajagopalan, Brigitte Brieschke, Jennifer Erdman, Jane Neill, Rodney Flores, Julia Foree, William Null, Jensing Liu, Jack P. Higgins, Erin K. Willert. In vivo efficacy of a CD38-specific engineered toxin body. [abstract]. In: Proceedings of the AACR Special Conference on Hematologic Malignancies: Translating Discoveries to Novel Therapies; Sep 20-23, 2014; Philadelphia, PA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(17 Suppl):Abstract nr A15.

The potential of immunotoxins in oncology has been largely limited due to problems with immunogenicity as well as a limited number of appropriate targets. Advances in genetic engineering and molecular biology have been applied to overcome these limitations. Molecular Templates has developed engineered toxin bodies (ETBs), a next-generation recombinant immunotoxin scaffold based on the Shiga-like toxin A subunit specifically directed to cancer cells via antibody fragment binding domains. ETBs have been de-immunogenized through the systematic and comprehensive removal of B- and T-cell epitopes. Data from the repeat administration of ETBs in animal models demonstrates the dramatically reduced immunogenicity of these ETBs and supports the potential for their use in solid tumor settings. The ETB scaffold was also engineered to force the internalization of receptors that typically do not internalize. This property of forced internalization expands the universe of possible targets; the company's lead compound, MT-3724, is the first immunotoxin to CD20 to enter the clinic and is currently in a phase I study for refractory NHL. MT-3724 rapidly internalizes and potently kills CD20+ lymphoma cells. Additionally, we have taken advantage of the immunotoxin's localization to the cytosol to engineer in a novel immuno-oncology mechanism of action: MHC class I antigens derived from human cytomegalovirus (HCMV) have been genetically fused to the immunotoxin scaffold in order to mark these cells as targets for cytotoxic T lymphocyte (CTL) mediated cell lysis. We have detected these foreign protein derived antigens displayed on the surface of ETB-intoxicated cancer cells in context with MHC class I molecules. Because antigen presentation does not require de novo protein synthesis, this mechanism of action is complementary to the inactivation of ribosomal function by ETBs. Since a large portion of the populace has a robust population of high-affinity effector T-cells targeting HCMV, the presentation of these antigens on ETB-intoxicated cancer cells may recruit a CTL response to tumor cells that is not dependent on genetically engineering host T-cells or blocking checkpoint inhibitors. The recruitment of a CTL response has the potential to act additively or synergistically to the direct cell kill activity of the ETB and may expand the potential efficacy of these immunotoxins. Citation Format: Erin K. Willert, Garrett L. Robinson, Sangeetha Rajagopalan, Brigitte Brieschke, Jennifer Erdman, Jane Neill, Rodney Flores, Julia Foree, William Null, Jensing Liu, Jack P. Higgins. Engineered toxin bodies: A next-generation immunotoxin scaffold with novel immuno-oncology functionality. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2477. doi:10.1158/1538-7445.AM2015-2477

Aim. To review research on early oral feeding following elective, open colorectal surgery. Background. Fasting following gastrointestinal surgery is a traditional surgical practice, based on fears of causing postoperative complications if oral intake begins before bowel function returns, but fasting following elective surgery is questionable as a best practice. Methods. Searches in Journals@Ovid CINAHL, MEDLINE, PubMed, Web of Science and The Cochrane Library for primary studies, published during 1995–2004, used the keywords: ‘surgery’, ‘postoperative’, ‘elective, ‘colorectal’, ‘bowel, ‘colon’, ‘oral’, ‘enteral’, ‘feeding’, ‘early’, ‘traditional’. Studies of adults undergoing elective, open colorectal surgery who were allowed fluids and food before bowel function returned (early feeding) were included. Outcomes of interest were safety, tolerability, duration of gastrointestinal ileus and length of hospital stay. Critical appraisal of randomized and controlled studies was undertaken following inclusion. Results. Fifteen studies comprising 1352 patients were reviewed. All studies concluded early feeding was safe, based on complications rates. Total complications were 12·5% (range 0–25%) for 935 early feeding patients, with no increased risk of anastomotic leak, aspiration pneumonia, or bowel obstruction. For all studies an average of 86% patients (range 73–100%) tolerated early feeding. Studies demonstrating faster resolution of postoperative ileus or shorter hospitalization were associated with multimodal perioperative care, including early mobilization, epidural analgesia and comprehensive patient education. Appraisal of five randomized trials revealed no blinding and inadequate randomization. Conclusions. This review supports early oral feeding after elective, open colorectal surgery and challenges the traditional practice of fasting patients until return of bowel function. Early feeding was safe, well-tolerated and easy to implement. Reduced length of ileus and shorter hospitalization may occur with multimodal protocols. Relevance to clinical practice. Nurses can highlight this new evidence for other health professionals, advocate development of clinical protocols featuring early feeding and participate in multi-disciplinary, multi-method research regarding benefits of early feeding.

In Newman’s theory, disease is one of many manifestations of underlying pattern and its existence provides meaningful information about person-environment interactions. Underlying patterns manifest differently over time, so clues to their understanding can be found within life stories. Further interpretation subsequent to illustrating expanding consciousness for seven women living with multiple sclerosis or rheumatoid arthritis suggested six underlying patterns expressed in theoretical terms as energy~fatigue, giving~receiving, rejecting~accepting, vulnerability~resilience, control~release, and being silent~speaking out. Discussion and comparison with the North American Nursing Diagnosis Association’s dimensions for assessment of human response patterns illustrates how nurses caring for women could identify and use underlying patterns in practice.

Providing rural and remote clinical experiences for undergraduate nursing students could help address future recruitment in these areas, but adequate financial support for students during clinical placements is also necessary. Strategies to address nursing shortages to date have emphasised funding for rural re-entry programs, or supporting students from rural backgrounds to attend university courses. Assisting current undergraduate nursing students, especially those from urban backgrounds, to experience living and working in rural areas has been overlooked as a potential recruitment strategy. Ongoing qualitative evaluation of a clinical placement program shows students respond positively and with increased interest in returning to rural nursing after graduation. Unfortunately, many are disadvantaged financially by the added expense of their rural clinical rotation. Finding ways to support students from both urban and non-urban backgrounds to undertake rural and remote clinical placements should be an important strategic and funding priority.

A simple model of the gastrointestinal tract is obtained by placing ethyl acetate in contact with water at pH 2 and pH 8 in separate test tubes. The ethyl acetate corresponds to the lipid material lining the tract while the water corresponds to the aqueous contents of the stomach (pH 2) and intestine (pH 8). The compounds aspirin, paracetamol and 3-aminophenol are used as exemplars of acidic, neutral and basic drugs respectively to illustrate the influence which pH has on the distribution of each class of drug between the aqueous and organic phases of the model. The relative concentration of drug in the ethyl acetate is judged by applying microlitre-sized samples of ethyl acetate to a layer of fluorescent silica which, after evaporation of the ethyl acetate, is viewed under an ultraviolet lamp. Each of the three drugs, if present in the ethyl acetate, becomes visible as a dark spot on the silica layer. The observations made in the model system correspond well to the patterns of drug absorption from the ga...

Summary. Twenty-eight per cent of women investigated during pregnancy were carriers of group B streptococci (GBS). The use of broth enrichment was the most significant factor in determining GBS carriage rates. GBS carriage decreased during pregnancy. Transmission of GBS from mother to baby was related to vaginal carriage but rectal carriage in pregnancy was the best predictor of maternal carriage at term. Rectal and vaginal swabs taken at 28 and 36 weeks correctly predicted 92% of intrapartum GBS carriage. Although accurate prediction of intrapartum GBS carriage is possible, mass screening for GBS in pregnancy is unlikely to be cost-effective in those countries with a low incidence of neonatal GBS sepsis.