Impact of the 2022 Infant Formula Shortage on Neonatal Intensive Care Units.

Objective: The aim of this study was to examine effects of the 2022 infant formula shortage as experienced by neonatal intensive care units (NICUs) in the United States, a previously unreported perspective. Methods: A mixed-method approach was utilized. Data were collected using an online survey of NICU medical directors. Quantitative data were analyzed with descriptive statistics and Student's t test. Thematic analysis was utilized to make sense of patterns within the qualitative data. Results: Responses from 139 medical directors were received. Both academic (41.7%) and community (58.3%) NICUs were represented among respondents. Thirty-nine percent of NICU medical directors reported an impact on their unit by the infant formula shortage. Within the qualitative data four themes were revealed as follows: alterations to discharge planning, policy modifications, suboptimal solutions, and extraordinary measures. These themes may inform strategies for mitigation of future infant formula shortages. Conclusions: NICUs were significantly impacted by the infant formula shortage with likely lasting effects. From the reported experiences, clear recommendations have been formed to minimize effects of future infant formula shortages.

Gastrointestinal Bleeding in the Neonate: Updates on Diagnostics, Therapeutics, and Management.

Gastrointestinal bleeding (GIB) is a relatively uncommon presentation in the NICU. GIB in neonates includes a broad spectrum of disease morbidity, from minor reflux symptoms and growth failure to severe, clinically significant anemia requiring critical care resuscitation. Over the last several years, multiple diagnostic tools including fecal calprotectin and bedside ultrasonography have emerged and demonstrated utility in the early recognition of sources for GIB in neonates. Further evidence has continued to show that traditional medical therapy with intravenous proton pump inhibitors is well-tolerated, and that upper endoscopy has limited diagnostic and therapeutic value. Finally, additional research and quality improvement investigations are warranted to determine how best to prevent, recognize, and manage GIB in critical neonates.

Variable Freshwater Influences on the Abundance of Vibrio vulnificus in a Tropical Urban Estuary.

To better understand the controls on the opportunistic human pathogen Vibrio vulnificus in warm tropical waters, we conducted a year-long investigation in the Ala Wai Canal, a channelized estuary in Honolulu, HI. The abundance of V. vulnificus, as determined by quantitative PCR (qPCR) of the hemolysin gene (vvhA), varied spatially and temporally by nearly 4 orders of magnitude (≤3 to 14,000 mL-1). Unlike in temperate and subtropical systems, temperatures were persistently warm (19 to 31°C) and explained little of the variability in V. vulnificus abundance. Salinity (1 to 36 ppt) had a significant, but nonlinear, relationship with V. vulnificus abundance with the highest vvhA concentrations (>2,500 mL-1) observed only at salinities from 7 to 22 ppt. V. vulnificus abundances were lower on average during the summer dry season, when waters were warmer but more saline. The highest canal-wide average abundances were observed during a time of modest rainfall, when moderate salinities and elevated concentrations of reduced nitrogen species and silica suggested a groundwater influence. Parallel quantification of the vcgC gene suggested that C-type strains, which are responsible for most human infections, comprised 25% of the total V. vulnificus on average, but their relative contribution was greater at higher salinities, suggesting a broader salinity tolerance. Generalized regression models suggested that up to 67% of sample-to-sample variation (n = 202) in log-transformed V. vulnificus abundance was explained using the measured environmental variables, and up to 97% of the monthly variation in canal-wide average concentrations (n = 13) was explained with the best subset of four variables. IMPORTANCE Our data illustrate that, in the absence of strong seasonal variation in water temperature in the tropics, variation in salinity driven by rainfall becomes a primary controlling variable on V. vulnificus abundance. There is thus a tendency for a rainfall-driven seasonal cycle in V. vulnificus abundance which is inverted from the temperature-driven seasonal cycle at higher latitudes. However, stochasticity in rainfall and its nonlinear, indirect effects on V. vulnificus concentration means that high abundances can occur at any location in the canal at any time of year, making it challenging to predict concentrations of this pathogen at a high temporal or spatial resolution. Much of the variability in canal-wide average concentrations, on the other hand, was explained by a few variables that reflect the magnitude of freshwater input to the system, suggesting that relative risk of exposure to this pathogen could be predicted as an average for the system.

Successful Implementation of a Multidisciplinary Chemotherapy Efficiency Initiative at a Community Hospital.

PURPOSE: Long wait times at chemotherapy infusion centers adversely affect patients' perception of quality of care and result in patient dissatisfaction. We conducted a quality improvement initiative at a busy community hospital to improve infusion center efficiency and reduce patient wait time, while maintaining patient safety and avoiding chemotherapy waste. METHODS: We used a coordinated and collaborative effort between providers, infusion center nurses, and pharmacists to ensure completion of orders, review of laboratory data, and prepreparation of chemotherapy 1 day ahead of each patient's scheduled infusion center appointment. Monthly Plan-Do-Study-Act cycles were conducted for 6 months beyond the pilot month to refine and sustain the intervention. RESULTS: The average patient cycle time, measured as time from patient check-in to check-out from the infusion chair, decreased from 252 minutes to 173 minutes in the last 4 months evaluated (30% decrease) after the intervention. Similarly, the average chemotherapy turnaround time, measured as time from chemotherapy request by nursing to pharmacy delivery, improved from 90 minutes to 27 minutes after the intervention (70% decrease). Infusion center capacity was unaffected by the intervention. The cost of wasted chemotherapy was minimal after the first postintervention month. Surveys revealed extremely high patient and employee satisfaction with the new system. CONCLUSION: A strategy involving prepreparation of chemotherapy on the day before the scheduled infusion is feasible to implement at a busy community hospital infusion center and is associated with significant improvement in infusion center efficiency as well as patient and employee satisfaction.

The protective effect of male circumcision on HIV infection in a sample of Kenyan men.

This article examines the association between male circumcision and HIV infection in a national sample. The analysis is based on the 2003 Kenya Demographic and Health Survey (KDHS), a nationally representative household-based population survey of adults, in which male respondents self-reported their circumcision status. In addition, in some households eligible for individual interview, blood samples were subsequently anonymously obtained for HIV testing, making this the first study linking socio-demographic information to HIV status at the national level. The study sample is limited to 3 413 men aged 15-54 years who gave valid information on their circumcision and HIV statuses. Nearly 5% of the men were HIV-positive, and 86% had been circumcised. HIV prevalence was significantly higher among the uncircumcised men (12%) than among the circumcised men (3%). This indication of the protective effect of male circumcision on HIV infection remained statistically significant (OR 0.15; 95%CI: 0.09-0.23) even after controlling for the effects of socio-demographic variables, age at first sexual intercourse, and use of paid sex. Based on these results, we recommend that HIV-prevention advocates and activists, scholars, bio-medical communities and political leaders find ways to include this oldest surgical procedure in their HIV/AIDS discourses and programmes in sub-Saharan Africa.