Self-contamination following removal of two personal protective equipment suits: a randomized, controlled, crossover simulation trial.

BACKGROUND: Healthcare personnel are often at high risk of contamination when participating in airway management and other aerosol-generating procedures. AIM: To explore the differences in self-contamination after removal of gown and coverall personal protective equipment (PPE) using an ultraviolet-fluorescent solution. METHODS: This prospective, randomized, controlled crossover trial was set in a third-level university health centre in Buenos Aires, Argentina between August and October 2020. The study included 60 anaesthesia personnel volunteers, and no participants were excluded from the study. A two-period/two-intervention design was chosen; each intervention comprised audio-guided placement of PPE, full-body spraying of fluorescent solution, audio-guided removal of PPE, and self-contamination assessment through ultraviolet light scanning. The primary outcome was the mean within-participant difference (any traces) between PPE suits. Statistical significance was tested using t-tests for paired data. The allocation ratio was 25/35 (gown followed by coverall/coverall followed by gown). FINDINGS: Self-contamination after removal of coveralls was greater than that after removal of gowns, with a mean within-participant difference of 11.45 traces (95% confidence interval 8.26-14.635; P<0.001). Significant differences were found for the number of self-contaminated body zones, small fluorescent traces and large fluorescent traces. Removal of a gown was associated with a markedly lower risk of self-contamination. CONCLUSIONS: Quick one-step removal of a gown and gloves may reduce self-contamination in the arm/hand area. Fluorescent solutions can help to identify self-contamination and compare outcomes between available PPE suits. Repeated training sessions and enhanced knowledge on self-contamination following removal of PPE are paramount. CLINICAL TRIAL REGISTRATION NUMBER: NCT04763304 (on ClinicalTrials.gov).

Distinction between planned and unplanned readmissions following discharge from a Department of Internal Medicine.

Readmission rate is often used as an indicator for the quality of care. However, only unplanned readmissions may have a link with substandard quality of care. We compared two databases of the Geneva University Hospitals to determine which information is needed to distinguish planned from unplanned readmissions. All patients readmitted within 42 days after a first stay in the wards of the Department of Internal Medicine were identified. One of the databases contained encoded information needed to compute DRGs. The other database consisted of full-text discharge reports, addressed to the referring physician. Encoded reports allowed the classification of 64% of the readmissions, whereas full-text reports could classify 97% of the readmissions (p < 0.001). The concordance between encoded reports and full-text reports was fair (kappa = 0.40). We conclude that encoded reports alone are not sufficient to distinguish planned from unplanned readmissions and that the automation of detailed clinical databases seems promising.

Comparison between planned and unplanned readmissions to a department of internal medicine.

The objective of this study was to assess the respective frequency of planned and unplanned early readmissions after discharge from an internal medicine department, and to identify and compare risk factors for these two types of readmissions. Readmissions within 31 days of discharge were identified as planned or unplanned based on analysis of discharge summaries. Time-failure methods were used to describe the risk of readmissions over time and to assess relationships between patient and index stay characteristics and risk of readmission. Of 5828 patients discharged alive, 730 (12.5%) were readmitted within 31 days. There were slightly more planned than unplanned readmissions (393 vs. 337). The difference in time-to-event functions was significant (P=0.04). The risk of planned readmission was increased for men, younger patients, and for patients discharged with a diagnosis of coronary heart disease, cardiac arrhythmia, and neoplastic disease. Increased risk of unplanned readmission was associated with index length of stay longer than 3 days, an increased number of comorbidities, and with a diagnosis of neoplastic disease. Planned readmissions constitute more than half of early readmissions to our internal medicine department. Therefore, a crude readmission rate is unlikely to be a useful indicator of quality of care. Several patient characteristics influence the risk of unplanned readmission, suggesting that case-mix adjustments are necessary when readmission rates are compared between institutions or tracked over time.

Direct stimulatory effects of insulin-like growth factor-I (IGF-I) on nuclear RNA polymerase II activity and overall protein synthesis in immature rat Sertoli cells.

A large body of evidence support the existence of an intratesticular Insulin-like Growth Factor I (IGF-I) system that can be viewed as a positive regulator of testicular functions. IGF-I may act at the testis level as a paracrine and autocrine differentiating factor. In the present study the role of IGF-I on Sertoli cell protein synthesis at transcriptional level has been investigated by evaluating the effect of IGF-I on nuclear RNA polymerase II activity as well as on total protein synthesis. Sertoli cells isolated from midpubertal rats and cultured in the presence of physiological doses of IGF-I showed a significant increase in nuclear RNA polymerase II activity (+80%) which appears to be correlated with a 50% increase in overall protein synthesis and a 40% increase in Androgen Binding Protein (ABP) production. These data provide the first evidence for a conceivable role of IGF-I in the modulation of Sertoli cell development through a direct action at the transcriptional level resulting in augmented protein synthesis.

Influence of thyroid hormone on Sertoli cell protein metabolism in the prepubertal pig.

In order to better understand the role of thyroid hormones in testis development, the influence of tri-iodothyronine on protein metabolism of immature pig Sertoli cells has been investigated. Sertoli cells were isolated enzymatically from 2- to 3-week-old piglet testes and cultured in the presence or absence of tri-iodothyronine. Protein labelling was evaluated in Sertoli cell monolayers incubated in medium containing a tracer dose of [3H]leucine. The results demonstrate that thyroid hormone can directly stimulate the process of protein synthesis in immature porcine Sertoli cells, without significantly affecting the protein degradation rate; moreover thyroid hormone exposure results in a significant decrease of intracellular ATP level. The evidence that tri-iodothyronine can increase Sertoli cell protein synthesis, supplies additional evidence about the fundamental role of thyroid hormone in the regulation of growth and differentiation of the mammalian testis through a direct action on the Sertoli cells.

Tri-iodothyronine directly affects rat Sertoli cell proliferation and differentiation.

The addition of physiological concentrations (1 nM) of tri-iodothyronine (T3) to the culture medium of Sertoli cells from prepubertal (8-day-old) rats stimulated both protein synthesis (+55%) and lactate (+50%) production, while it inhibited DNA synthesis (-30/35%) and aromatase activity (-45/50%); insignificant T3-dependent effects were observed in cultured Sertoli cells from midpubertal (28-day-old) rats. These data suggest an age-dependent role for thyroid hormone in promoting and maintaining Sertoli cell differentiation at puberty; more-over, the hormone is involved in the regulation of Sertoli cell proliferation. The present study validates the role of Sertoli cells as a specific target for T3 action at the testis level; it also demonstrates the existence of an early and critical direct influence of thyroid hormone on Sertoli cell proliferation and functional maturation.

Tri-iodothyronine effects on Sertoli cell protein turnover in the prepubertal pig.

The direct effect of Tri-iodothyronine (T3: 0.1-100 nM) on protein turnover was studied using primary cultures of Sertoli cells isolated from immature piglet testis. The results demonstrate that T3 significantly increases protein synthesis without altering the protein degradation rate. These data and previous ones, showing the presence of specific T3 receptors in Sertoli cell nuclei, indicate that T3 plays a fundamental role in the early regulation of porcine Sertoli cell growth and maturation.

Tri-iodothyronine effects on Sertoli cell protein turnover in the prepubertal pig.

The direct effect of Tri-iodothyronine (T(3): 0.1-100 nM) on protein turnover was studied using primary cultures of Sertoli cells isolated from immature piglet testis. The results demonstrate that T(3) significantly increases protein synthesis without altering the protein degradation rate. These data and previous ones, showing the presence of specific T(3) receptors in Sertoli cell nuclei, indicate that T(3) plays a fundamental role in the early regulation of porcine Sertoli cell growth and maturation.