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Issue 96 - 11 June 2009


1. Evaluation of detection of extended-spectrum beta-lactamases among Escherichia coli and Klebsiella spp. isolates by VITEK 2 AST-N029 compared to the agar dilution and disk diffusion methods.
By Nyberg, Sofia D et al. Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5:p355-362
A total of 123 clinical Escherichia coli and Klebsiella spp. isolates were included in the study in order to evaluate VITEK 2 AST-NO29 (Nordic) card for detection of extended-spectrum beta-lactamases (ESBL) and to compare the results with genotypic ESBL verification. The results were also compared to alternative phenotypic methods, i.e. agar dilution and disk diffusion. The strains that were ESBL-positive according to AST-N029 were further analysed with the ESBL test card, VITEK 2 AST-N041. Using genotype as reference, Vitek 2 AES had the highest accuracy of the tested methods in classifying the strains as ESBL-positive or -negative (91.1%). When VITEK 2 gave ESBL as the only option for E. coli or K. pneumoniae, 44 of 45 (97.8%) strains had an ESBL gene.VITEK2 achieved an accuracy of 94.9% and disk diffusion 95.9% compared to the agar dilution method as the phenotypic reference method for the E. coli and K. pneumoniae strains. For the K. oxytoca strains VITEK 2 achieved the highest accuracy (84.0%) of the methods used in this work. [ABSTRACT FROM AUTHOR]

2. Effect of high dose oral zinc in mice with severe infection with Streptococcus pneumoniae
by Hembre, Berit S et al. Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5:p363-367
Zinc is important for normal function of the immune system and inflammation increases the demand for zinc. We hypothesized that high doses of zinc given during acute pneumococcal illness would alter the severity of infection. 24 six-week-old BALB/c mice were anaesthetized and infected intranasally with Streptococcus pneumoniae. Zinc intake was controlled by administering zinc through an intragastric tube. One group was given normal doses (5 µg/d) and the other group high doses of zinc (225 µg/d). We counted the number of bacteria from venous blood at 24 and 48 h, and from heart puncture and nasal wash at 72h after intranasal challenge. Mice given excess zinc had 2.65 µmol/l, i.e. 25% higher (p=0.05) mean plasma zinc concentration compared to those given normal amounts. 75% of mice in both groups developed pneumococcal bacteraemia. There were no differences in the numbers of S. pneumoniae colony forming units (CFUs) in blood or nasal wash between the groups. Thus, high doses of zinc did not alter the severity of systemic pneumococcal infection in mice.[ABSTRACT FROM AUTHOR]

3. Emergence of a new clone carrying Panton-Valentine leukocidin genes and staphylococcal cassette chromosome mec type V among methicillin-resistant Staphylococcus aureus in Greece
by Chini, Vassiliki et al. Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5:p368-372
Clonal analysis and PCR screening for the presence of Panton-Valentine leukocidin (PVL) genes was performed among 694 methicillin-resistant Staphylococcus aureus (MRSA) cases collected during a 2-y period in Greece. The detection rate of PVL-positive MRSA is high, both in the community and in hospital. Clonal analysis revealed the predominance among the PVL-positive strains of the clonal complex CC80 (ST80-IV) and the emergence of ST377 clone
carrying agr1 allele and SCCmec type V. [ABSTRACT FROM AUTHOR]

4. Comparison of the interferon- ? release assay and the tuberculin skin test for contact investigation of tuberculosis in BCG-vaccinated health care workers
by Susan Shin-Jung Lee et al. Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5:p373-380
Health care workers are at increased risk of Mycobacterium tuberculosis infection. The tuberculin skin test (TST) is frequently false positive in BCG-vaccinated health care workers. QuantiFERON-TB GOLD (QFT-G) is a sensitive and specific interferon-? release assay unaffected by BCG vaccination. This study compared TST and QFT-G in the diagnosis of latent TB infection in BCG-vaccinated health care workers.39 health care workers exposed to a smear-positive TB patient were enrolled. Initial TST was positive in 33 (84.6%) cases, but only 4 (10.2%) cases using QFT-G. TST conversion occurred in 2/6 (33.3%),compared to 4/32(12.5%), cases using QFT-G. A higher proportion of QFT converters was associated with intimate contact, although not reaching statistical significance Face-to-face contact >1 h was significantly associated with QFT-G conversion =0.7 IU/ml (OR 8.63, 95%CI 1.08-69.07, p=0.04). Agreement between TST and QFT-G was 18.0%, (?: -0.03). Concordance between TST and QFT (=0.35 IU/ml) conversion was 40.0%(?=-0.40), and 60.0%(?=0.00) if QFT =0.7 IU/ml was used. Agreement increased with increasing TST cut-offs. TST is not useful in contact investigation among BCG-vaccinated health care workers, in an area with intermediate burden of TB. QFT may provide additional information for the diagnosis and strategic management of preventive treatment of LTBI in BCG-vaccinated health care workers in a country with intermediate burden of TB. [ABSTRACT FROM AUTHOR]

5. Infections and obesity: A multinational epidemiological study
by Thjodleifsson, Bjarni et al. Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5:p381-386
Viral infections have been associated with the aetiology of obesity in animal models. This study investigates the association between 7 serological markers of infections and body mass index (BMI) in a population based sample. Individuals (n=985, mean age 42±7 (28-55) y, mean BMI 25.5±4.2) from Iceland, Sweden and Estonia underwent a structured interview and blood sampling. IgG antibodies were measured against Helicobacter pylori and the cagA protein, hepatitis A virus, Toxoplasma gondii, herpes simplex virus 1, Chlamydia pneumoniae, Epstein-Barr virus and cytomegalovirus. High-sensitive C-reactive protein (CRP) was measured as a marker of systemic inflammation. A significant positive association between being overweight (BMI>25 kg/m2) and IgG antibodies was found for Helicobacter pylori (OR 1.86, CI 1.34-2.60) and Chlamydia pneumoniae (OR 1.39, CI 1.03-1.88) and combined seropositivity had synergistic effect (OR 2.54 (1.62-3.97)). CRP was positively related to BMI (p<0.0001), whereas no significant association was found between CRP and IgG antibodies against Helicobacter pylori and/or Chlamydia pneumoniae and CRP. The results suggest that infections with Chlamydia pneumoniae and Helicobacter pylori are both significantly and synergistically associated with overweight and this association is not related to indicators of systemic inflammation. [ABSTRACT FROM AUTHOR]

6. BCG scar and tuberculin reactivity in children and adults
by Fjällbrant, Harald et al. Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5:p387-392
Bacille Calmette-Guérin (BCG) vaccination generally leads to scar formation and tuberculin skin test (TST) reactivity. This study aimed at analysing these 2 parameters and their correlation in a setting with a low prevalence of tuberculosis. Retrospectively, we analysed 314 children and 390 adults living in Sweden and known from records or individual recall to have undergone BCG vaccination. A BCG scar was present in 161 (51%) of the children and in 340(87%) of the adults. Among children with a scar, 94 (58%) were TST-positive (=6 mm) compared to 23 (15%) of 154 children lacking a visible scar. Among adults with a scar, 258 (76%) were TST- positive compared to 23 (46%) of 50 with no scar. Out of 152 non-vaccinated adults, 142 (94.4%) were TST-negative. When 175 TST-negative health care students were BCG-vaccinated in a prospective part of the study, 174 (99%) were found to develop a scar. In essence, the study showed a positive correlation between scar presence and TST reactivity. Furthermore, BCG vaccination of adults in the present setting resulted in consistent scar formation, while scar prevalence in previously vaccinated children was low. [ABSTRACT FROM AUTHOR]

7. Infections and antibiotic prescribing in Swedish nursing homes: A cross-sectional study
by Pettersson, Eva et al. Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5:p393-398
The aim of this study was to present and assess the treatment of infections in Swedish nursing homes. It included 58 nursing homes with 3002 residents. During 3 months, nurses in the nursing homes recorded all infections requiring a physician's opinion. Of the 889 infectious episodes, 84% were treated with antibiotics. Many of the antibiotics were issued after indirect contact with the physician (38%). Indications for antibiotics were in 55% of the cases urinary tract infections (UTI), in 17% skin and soft-tissue infections and in 15% respiratory tract infections (RTI). The most common antibiotics were penicillins (38%), followed by quinolones (23%) and trimethoprim (18%). For the major indication, lower UTI in women, half of the cases were not treated according to the recommendations. The main concerns were length of treatment and overprescribing of quinolones. For the second major diagnosis, pneumonia, the high use of doxycycline could be questioned. Continuing education on infections and their treatment in nursing homes is needed. Training should preferably include both physicians and nurses as a high proportion of antibiotics is issued without direct contact with the physician. [ABSTRACT FROM AUTHOR

8. Ethanol lock therapy to treat tunnelled central venous catheter-associated blood stream infections: Results from a prospective trial
by Broom, Jennifer et al. Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5:p399-406
In order to assess the efficacy of 70% ethanol locks in addition to antibiotic therapy to treat tunnelled central venous catheter-associated bloodstream infections, a pilot study of 19 patients was performed prospectively using ethanol locks for 5 d in addition to antibiotic therapy to treat tunnelled central venous catheter-associated bacteraemia. 12 patients had mono-microbial infections and 7 had polymicrobial isolates. 17 of 19 patients completed ethanol lock therapy. 15 of 17 patients completing ethanol lock therapy had no recurrence of the original organism and retained their catheter for a median of 36 and an average of 47 d following initiation of ethanol lock therapy. These results demonstrate the safety and potential efficacy of this technique against a broad range of potentially virulent organisms. The intervention was acceptable to both staff and patients with no significant side-effects. These preliminary results from our prospective pilot study suggest that ethanol lock therapy is safe and easily integrated into clinical practice, and may have utility in treating central venous catheter-associated infections, avoiding removal of catheters in patients requiring long-term venous access. [ABSTRACT FROM AUTHOR]

9. Slow progression of HIV-1 infection in a cohort of antiretroviral naïve hotel workers in Dar es Salaam, Tanzania as defined by their CD4 cell slopes
by Bakari, Muhammad et al. Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5:p407-413
Data on slow progression following HIV-1 infection in Africa are sparse. From a study on the natural history of HIV-1 infection in Dar es Salaam, Tanzania, an analysis of immunological and clinical data from 237 HIV-1 seropositive individuals was performed. Annual CD4 cell determinations were carried out by flow cytometry. None was on antiretroviral treatment. CD4+ cell slopes were obtained by fitting a linear regression model. A study population of 50 individuals with >3 CD4 cell determinations and followed for >5 y had a mean follow-up of 72.7 months, and mean 5.7 CD4+ cell determinations. With a criterion of maintaining a CD4 cell count =500 cells/µl, 8 of the 50 (16.0%) were long-term non-progressors (LTNP). With a definition of maintaining a CD4+ cell slope = -10 (a loss of 10 or less cells per y), 13 (26.0%) were long-term slow progressors (LTSP). 11 of them (84.6%) had a baseline CD4 cell count <500 cells/µl and 5(38.5%) had a baseline CD4 cell count less than 350 cells/µl. An analysis of the selection bias introduced during slope determination is presented. With no selection, 24 (23.3%) would have documented slow CD4 progression among those enrolled for 5 or more y regardless of CD4 determinations.

10. Candida albicans versus non-albicans bloodstream infection in patients in a tertiary hospital: An analysis of microbiological data
by Samonis, George et al. Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5:p414-419
Considerable changes in the relative frequency of systemic infections due to various Candida species as well as their in vitro susceptibility patterns have been noted in several parts of the world. We performed an analysis of microbiological data of patients with candidaemia at the University general (tertiary) hospital of Heraklion, Greece. During the study period (March 2001 to July 2006) 140 patients had candidaemia. Among them, 64/140 (46%) had candidaemia due to C. albicans and 76/140 (54%) due to non-albicans species (19/76, 25%, C. glabrata; 30/76, 40%, C. tropicalis; 20/76, 26%, C.parapsilosis; 2/76, 3%, C. lusitaniae; 3/76, 4%, C. krusei; and 2/76, 3%, C. guilliermondii). 75 isolates were tested for in vitro susceptibility to antifungal agents with E-test. No isolate was found to be resistant to amphotericin. From 34 C. albicans isolates, 5 (15%) were not susceptible to itraconazole, and 1 (3%) to fluconazole. The C. guilliermondii and the C. lusitaniae isolates were not susceptible to itraconazole. All 11 C. glabrata isolates were not susceptible to ketoconazole and itraconazole, with only 5 (45%) to fluconazole. In line with results of other relevant studies, we documented that a considerable proportion of Candida bloodstream infections were due to non-albicans Candida species. [ABSTRACT FROM AUTHOR]

11. IgM and avidity of IgG antibodies in primary HHV-6 infections
by Salonen, Matteus J. H et al. Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5:p420-423
Primary HHV-6 infection could be diagnosed by enzyme immunoassay from a single serum using IgG avidity test based on results obtained from 43 patients, 26 with seroconversion and 17 with variable antibody levels. The avidity was less than 30% in all patients with seroconversion. HHV-6 IgM appeared non-specific. [ABSTRACT FROM AUTHOR]

12. Escherichia coli: An unknown and infrequent cause of community acquired pneumonia
by Ruiz, Luis Alberto et al.Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5: p424-427
Our aim was to describe the incidence, clinical characteristics and outcome of community acquired pneumonia (CAP) caused by Escherichia coli through the analysis of a cohort of patients with this condition. This study includes all the patients who were admitted to our hospitals because of CAP caused by E. coli, diagnosed with highly reliable microbiological techniques, such as blood culture, bronchoscopic protected specimen brush (PSB) or
transthoracic needle aspiration (TNA). 29 patients were enrolled, representing 0.4% of CAP cases admitted. Main symptoms were fever and dyspnoea. 18 patients were classified into class IV and class V of the Pneumonia Severity Index (PSI). Diagnosis was based on blood culture in 24 cases, PSB in 4 cases and by TNA in 1 case. Three of the patients died, the longer time evolution of the symptoms being the only factor related to higher mortality (p<0.05). Mean hospitalization time was 7.1±3.1 d, and correlated with severity at admission (r=0.43; p<0.003). This study demonstrates that CAP caused by E. coli is infrequent. It has an unspecific presentation and mortality rate is 10.3%, associated with longer time before admission to hospital. [ABSTRACT FROM AUTHOR]

13. Breakthrough VZV infection after immunization, presenting as herpes zoster
by Schade, Rogier P et al. Scandinavian Journal of Infectious Diseases, May 2008, Vol 40 Issue 5:p428-430
An immunocompromized, VZV-vaccinated child had a breakthrough infection with VZV, acquired at a day-care centre during a chickenpox outbreak. Interestingly, the infection manifested as herpes zoster of 1 dermatome. Typing showed wild-type virus, which suggests that exogenous reinfection with a new strain may present as herpes zoster. [ABSTRACT FROM AUTHOR]

Journals – Table of Contents

14. From Canadian Nurse April 2009, Volume 105 Number 4
President's Message
14A. A difficult month
CEO Outlook
14B. Speak out about the value of nursing
14C. In conversation with David Benton
14D. Working better with unregulated health workers; Nurses to be included in CBS consultations
14E. Political instability devastates health systems in two countries
14F. Announcing the Nursing Innovations Exchange; CNA signals its support for environmental health project
14G. Supporting your practice - CNA's new tools & resources; Association supports high standards of burn nursing care
Gaining Insite
14H. Harm reduction in nursing practice
Special Feature
. Comparing notes on workload patient care and the use of IT
Nurse to know
14J. Activist builds on nursing's privilege and potential
The Last Word
14K. Treatment and harm reduction professionals need to make peace

15. From the Journal of Advanced Nursing (JAN) Volume 65, Number 6, June 2009
The importance of small talk with young children
15B. A decision theory perspective on why women do or do not decide to have cancer screening: systematic review (p 1130-1140)
15C. Prevention and treatment of incontinence-associated dermatitis: literature review (p 1141-1154)
15D. Contraception and women over 40 years of age: mixed-method systematic review (p 1155-1170)
15E. Qualitative case study methodology in nursing research: an integrative review (p 1171-1181)
15F. Intermediate-acting vs. long-acting insulin for type 1 diabetes mellitus; Printed educational materials: effects on professional practice and healthcare outcomes; Absorbent products for moderate–heavy urinary and/or faecal incontinence in women and men; Debridement for surgical wounds (p 1182-1186)
15G. Nurse and parent partnership during children's vaccinations: a conversation analysis (p 1187-1194)
15I. Research use in clinical practice – extent and patterns among nurses one and three years postgraduation (p 1195-1206)
15J. Nurse prescriber–patient consultations: a case study in dermatology (p 1207-1217)
15K. Evidence-based practice-focused interactive teaching strategy: a controlled study (p 1218-1227)
15L. Bone mineral density and perceived menopausal symptoms: factors influencing low back pain in postmenopausal women (p 1228-1236)
15M. Comparison of two different oxygen delivery methods in the early postoperative period: randomized trial (p 1237-1247)
15N. Midlife African-American women's protective and risky practices related to HIV (p 1248-1258)
15O. Medication errors in an intensive care unit (p 1259-1267)
15P. Position of peripheral venous cannulae and the incidence of thrombophlebitis: an observational study (p 1268-1273)
15Q. Rotating shift-related changes in hormone levels in intensive care unit nurses (p 1274-1282)
15R. Emergency department nurses' understanding and experiences of implementing discharge planning (p 1283-1292)
15S. Evaluation of contextual influences on the medication administration practice of paediatric nurses (p 1293-1299)
15T. A caring relationship with people who have cancer (p 1300-1308)
Research Methodology
15U. The Internet as a research site: establishment of a web-based longitudinal study of the nursing and midwifery workforce in three countries (p 1309-1317)
Learning for holistic care: addressing practical wisdom (phronesis) and the spiritual sphere (p 1318-1327)
15W. Knowing in nursing: a concept analysis (p 1328-1341)
15X. Social isolation in older adults: an evolutionary concept analysis (p 1342-1352)

Conferences, training and seminars

16. National Maori Cancer Forum 2009 - Revolution of Cancer Care for Maori and Whanau
Date: 12-14 August 2009
Venue: The Heritage Hotel  Rotorua
More information:

17. Respiratory Educators Conference 2009
24 & 25 September 2009
Venue: Wellington
The conference will showcase breathlessness - Asthma and COPD
More information:

18. International Conference on Aging and Spirituality
Date: Sunday 30 August to Wednesday 2 September 2009
Venue: University of Auckland School of Engineering, 20 Symonds St., Auckland City
Evidence-based models of medical care have paved the way for people to live much longer, healthier, physical lives.  But has the quality of spiritual guidance and care offered to older people kept pace?  Are older people’s spiritual needs being adequately met in healthcare and social systems around the world? The 2009 International Conference on Aging and Spirituality will bring together researchers, aged care practitioners, and anyone with an interest in
helping older people find deepest meaning and fulfillment in life

News – National

19. Celebrate With Matariki Festival At Te Papa
Wednesday, 10 June 2009, 10:57 am
Press Release: Te Papa 
Celebrate Family And Friends With The Matariki Festival At Te Papa, 25 June – 12 July 2009. In early June the star cluster Matariki (the Pleiades or the Seven Sisters) will reappear in our dawn skies, staying for almost 12 months. The Mäori New Year begins with the first new moon after Matariki’s reappearance and, from 25 June, Te Papa is bringing this special celebratory period to all people of Aotearoa New Zealand with an 18-day Matariki Festival

20. Six swine flu cases in Wellington
The Press - 10 June 2009
Three new cases of swine flu have been confirmed in Wellington today. The total number of cases in the city is now six. All of the affected individuals have been quarantined. Two of the new cases are close contacts of the man and woman who were confirmed as positive for Influenza A H5N1 yesterday. They had arrived in New Zealand on May 31 from Los Angeles

21. Alzheimer's Society backs GPS shoe breakthrough
Radio New Zealand - 10 June 2009
The Alzheimer's Society in Rotorua supports putting technology into a shoe to track sufferers who wander off. A shoe-maker and a technology company in the United States are developing a miniature global positioning system, or GPS, that can be fitted into a shoe.

22. Ash attacks firms over cheaper cigarettes
The Press - 10 June 2009
Cigarette companies are using "loopholes" in legislation to cut prices and reverse smokers' quit rates, anti-smoking groups say. Action on Smoking and Health (Ash) director Ben Youdan said the recent lowering of the price of some brands at the bottom end of the tobacco market was an "underhand and cynical attempt to discourage people from quitting smoking".

23. $1.2m for improving care for Maori cancer victims
Otago Daily Times - 10 June 2009

23. Doctor, midwife clashed during fatal birthing, tribunal told
New Zealand Herald - Tuesday Jun 09, 2009
The relationship between midwives and doctors came under the spotlight at a Health Practitioners Disciplinary Tribunal hearing in Invercargill today which is considering a charge of professional misconduct against United States doctor Enrique Tomeu.

News International

24. Five with swine flu in intensive care
Sydney morning Herald - June 11, 2009 
Five people with swine flu have been placed in intensive care in Victoria and residents at three nursing homes are being tested for the potentially deadly virus. A Department of Human Services (DHS) spokesman told The Age he could not say how old the five patients were or whether they had an underlying health condition that may have given them complications when they were infected with the virus.

25. WHO consulting countries on local swine flu spread
Sydney Morning Herald - June 11, 2009
The World Health Organisation consulted the countries worst hit by swine flu Wednesday to assess if there is "undisputable" evidence the virus was being spread among locals, a spokeswoman said. "I can confirm that the DG (director-general) is consulting with the ministries of health of seven or eight of the most affected countries to try to see if there is undisputable evidence of community spread," WHO spokeswoman Fadela Chaib told AFP.

26. Vioxx should have stayed on sale, claims Merck researcher
The Australian - 11 June 2009
A SENIOR Merck & Co research scientist and star witness for the pharmaceutical giant believed the anti-arthritis drug Vioxx should not have been taken off  the market because many patients would benefit from the drug. Alise Reicin, who worked on the clinical trials of Vioxx from 1997, told the Federal Court she recommended to her bosses in 2004 against recalling the drug amid concerns over its cardiovascular safety.,25197,25618336-23289,00.html

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