Targeting current and future threats: recent methodological trends in environmental antimicrobial resistance research and their relationships to risk assessment

Antimicrobial resistance (AMR) is a growing public health threat. Improved surveillance of AMR's genetic indicators in environmental reservoirs should lead to a more comprehensive understanding of the problem at a global scale, as with SARS-CoV-2 monitoring in sewage. However, the "best" monitoring approach is unclear. Some scientific works have emphasized monitoring for the abundance of already-known antimicrobial resistance genes (ARGs);others have emphasized monitoring for the potential of new ARGs to arise. The goal of this study was to examine which methods were employed by highly-cited papers studying AMR in environmental engineering and agricultural systems, thus providing insight into current and future methodological trends for monitoring ARGs. We searched recent (2018-2020) literature documenting AMR in five environmental matrices: wastewater, surface water, drinking water, stormwater, and livestock manure. We selected the most highly-cited papers across these matrices (89 papers from 17 809 initial results) and categorized them as using targeted methods (e.g., qPCR), non-targeted methods (e.g., shotgun metagenomics), or both. More than 80% of papers employed targeted methods. Only 33% employed non-targeted methods, and the use of targeted versus non-targeted methods varied by environmental matrix. We posit that improving AMR surveillance in environmental reservoirs requires assessing risk, and that different monitoring approaches imply different objectives for risk assessment. Targeted methods are appropriate for quantifying known threats, particularly in environmental matrices where direct human exposure is likely (e.g., drinking water). However, long-term studies employing non-targeted methods are needed to provide an understanding of how frequently new threats (i.e., novel ARGs) arise.

Change from transrectal to transperineal ultrasound-guided prostate biopsy under local anaesthetic eliminates sepsis as a complication.

Transrectal ultrasound-guided (TRUS) biopsy of the prostate is associated with increased risk of post-procedural sepsis with associated morbidity, mortality, re-admission to hospital, and increased healthcare costs. In the study institution, active surveillance of post-procedural infection complications is performed by clinical nurse specialists for prostate cancer under the guidance of the infection prevention and control team. To protect hospital services for acute medical admissions related to the coronavirus disease 2019 (COVID-19) pandemic, TRUS biopsy services were reduced nationally, with exceptions only for those patients at high risk of prostate cancer. In the study institution, this change prompted a complete move to transperineal (TP) prostate biopsy performed in outpatients under local anaesthetic. TP biopsies eliminated the risk of post-procedural sepsis and, consequently, sepsis-related admission while maintaining a service for prostate cancer diagnosis during the COVID-19 pandemic.

Pediatric gastroenterology tool kit for telemedicine during the COVID-19 pandemic

Background/Significance: Telehealth (TH) services rapidly expanded during the COVID-19 pandemic. This rapid deployment precluded the opportunity for initial planning of implementation strategies. Purpose and Goals: To understand the needs of nurse practitioners and examine TH procedures and interventions designed to promote high quality, equitable health care for pediatric patients with gastrointestinal concerns. Methods: The Plan, Do, Study, Act model was used. Survey data from providers and families were collected and analyzed. They were further illuminated through iterative dialog across the research team to determine the quality and efficiency of TH. Findings: A toolkit of strategies for promoting the quality and efficiency of TH was created according to the three domains of health equity: availability, accessibility, and acceptability. We reached the following conclusions: No specific telehealth training and competencies have been established for NPs. Interpreters are needed for patients who have language barriers and hearing impairment. Scheduling flexibility and revenue needs should account for increased time needed for complex patients. Technology needs to be current for NPs and patients to prevent audiovisual failures. Reading level of introductory TH emails need to be at a 5th grade literacy level and should be available in different languages. Ideally families should have access to a scale at home since accurate weights are an integral part of the GI visit. Patient's location should be matched with location of clinic when scheduling appointments so that follow up care can be provided easily when visits are in person. Physical examination is limited and laboratory orders and stool/urine collections require a prescheduled appointment. Implications/Next Steps: Development and implementation of comprehensive education to address the above findings. Ongoing collaboration with virtual visit team and AAs to find systems to proactively arrange for interpreters and flexibility with allotted time for visits. Provide alternate methods to support families with audio/visual difficulties;IT/help desk telephone number and option of in-person visits. Introductory email that meets literacy standards now includes specific expectations, including: all patient visits need to be done in a private setting, presence of patient for the entire visit, and weight to be obtained before visit. Development and provision of alternative communication when audio connectivity fails, ie: flashcards to alert family and suggest solutions (signing in/out of appointment) to preserve full audio/visual visit capabilities. Develop algorithm to prioritize in person visits, based on acuity of presenting illness and complexity of patient.

Patient satisfaction during a pandemic-virtually impossible?

Introduction: Throughout the COVID-19 pandemic we conducted virtual urology clinics for the first time at our institution. We aimed to assess patient satisfaction with the virtual clinic format. Method: Patients who underwent virtual consultation were contacted by phone and surveyed about their appointment. Convenience, thoroughness, satisfaction, preference and reason for appointment were assessed via questionnaire Results: 77 randomly selected patients were contacted. 63 males (82%), 14 females (18%). Median age 61 years (range 16-86). 62 (80%) reviews, 12 (16%) new referrals, and 3 (4%) post-operative patients were surveyed. 55 (71%) were booked for repeat appointment, 13 (17%) for further investigations, 6 (8%) discharged, and 3 (4%) listed for surgery. 73 (95%) found it convenient, 3 (4%) were neutral and 1 (1%) found it inconvenient. 74 (96%) felt thoroughly assessed and 76 (99%) of patients had all their concerns addressed. 74 (96%) were satisfied with their review, 2 (3%) were neutral, and 1 (1%) was dissatisfied. Going forward, 50 (65%) would prefer virtual follow-up and 27 (35%) would prefer an inperson review. Conclusions: Virtual clinic is preferable to the majority of patients in our urology service and is deemed convenient, thorough and satisfactory by them. It should be facilitated going forward in appropriately selected patients.

Patient Satisfaction During a Pandemic – Virtually Impossible?

Introduction: During the COVID-19 pandemic we conducted virtual telephone clinics in lieu of physical clinics for the first time at our institution. This study aims to assess patient satisfaction with the virtual clinic format. Methods: Patients who underwent telephone virtual urology consultation were contacted subsequently by phone and surveyed on satisfaction of their virtual review. Convenience, thoroughness, satisfaction and preference were assessed via questionnaire, as well as reason for review. Results: 77 randomly selected patients were contacted, comprising 63 males (82%) and 14 females (18%) with a median age of 61 years (range 16–86). 62 (80%) reviews, 12 (16%) new referrals and 3 (4%) initial post-operative follow-up patients were surveyed. 55 (71%) were booked for further outpatient review, 13 (17%) had further investigations arranged, 6 (8%) were discharged, and 3 (4%) were listed for surgery. The majority of patients, 73 (95%), felt it was a convenient way to conduct clinic, 3 (4%) were neutral and 1 (1%) found it inconvenient. 74 (96%) felt they were thoroughly assessed and 76 (99%) of patients had their concerns addressed. 74 (96%) were satisfied with their phone consultation, 2 (3%) were neutral, and 1 (1%) was dissatisfied. Going forward, 50 (65%) would prefer phone follow-up and 27 (35%) would prefer a physical appointment. Conclusion: A virtual telephone clinic is preferable to the majority of patients in our general urology service and is deemed convenient, thorough and satisfactory by them. It should be facilitated going forward in appropriately selected patients.