A Quality Improvement Approach to Perineal Skin Care: Using Standardized Guidelines and Novel Diaper Wipes to Reduce Diaper Dermatitis in NICU Infants.

BACKGROUND: Diaper dermatitis (DD) causes discomfort and emotional distress and creates possible sources of infection among newborn intensive care unit infants. Diaper dermatitis remains prevalent despite studies documenting an understanding of prevention and treatment modalities. Standardizing perineal skin care guidelines could reduce DD. PURPOSE: Implement perineal skin care guidelines, while introducing novel diaper wipes, to decrease the incidence of DD by 20% within a 1-year period. METHODS: Our unit reviewed evidence-based literature to develop a standardized perineal care guideline for prevention and treatment, encompassing the use of novel, preservative-free diaper wipes with grapefruit seed extract. The outcome measures were the incidence and duration of DD. Process compliances were monitored. The balancing measure was the rate of fungal skin infection while using preservative-free wipes. FINDINGS: Between July 2017 and March 2019, 1070 infants were admitted for 1 or more days, with 11% of those being born at less than 30 weeks of gestational age. After guideline implementation in January 2018, the incidence of DD decreased by 16.7%. The incidence of severe cases dropped by 34.9%, with 3.5 days per 100 patient-days shortened duration. Process compliance was achieved. Neonates tolerated the novel wipes without increased fungal skin infection. IMPLICATIONS FOR PRACTICE: The Perineal Skin Care Guidelines could reduce the rate and duration of DD. Newborn intensive care unit infants tolerated the novel diaper wipes. IMPLICATIONS FOR RESEARCH: Additional research on wipes containing other types of extracts or ingredients.

Glucose transporter 1 deficiency in the idiopathic generalized epilepsies.

OBJECTIVE: We examined whether glucose transporter 1 (GLUT1) deficiency causes common idiopathic generalized epilepsies (IGEs). METHODS: The IGEs are common, heritable epilepsies that usually follow complex inheritance; currently little is known about their genetic architecture. Previously considered rare, GLUT1 deficiency, due to mutations in SLC2A1, leads to failure of glucose transport across the blood-brain barrier and inadequate glucose for brain metabolism. GLUT1 deficiency was first associated with an encephalopathy and more recently found in rare dominant families with epilepsy and paroxysmal exertional dyskinesia (PED). Five hundred four probands with IGEs and 470 controls underwent SLC2A1 sequencing. Glucose transport was assayed following expression of SLC2A1 variants in Xenopus oocytes. All available relatives were phenotyped, and SLC2A1 was sequenced. RESULTS: Functionally validated mutations in SLC2A1 were present in 7 of 504 (1.4%) probands and 0 of 470 controls. PED, undiagnosed prior to study, occurred in 1 proband and 3 of 13 relatives with mutations. The IGEs in probands and relatives were indistinguishable from typical IGE. Three cases (0.6%) had mutations of large functional effect and showed autosomal dominant inheritance or were de novo. Four (0.8%) cases had a subtle functional effect; 2 showed possible dominant inheritance, and 2 did not. These alleles leading to subtle functional impairment may contribute to complex, polygenic inheritance of IGE. INTERPRETATION: SLC2A1 mutations contribute to approximately 1% of IGE both as a dominant gene and as a susceptibility allele in complex inheritance. Diagnosis of GLUT1 deficiency has important treatment (ketogenic diet) and genetic counseling implications. The mechanism of restricted glucose delivery differs from the current focus on IGEs as ion channel disorders.

The effect of PEO block lengths on the size and stability of complex coacervate core micelles.

We report on a series of polyion complexes from mixtures of poly(ethylene oxide)-block-poly(N,N-diethylaminoethylmethacrylate) (PEO-PDEAMA) and poly(ethylene oxide)-block-poly(aspartic acid) (PEO-PAsp). As expected, the micelle size, polydispersity and stability are dependant on the relative and absolute lengths of the polyelectrolyte chains. However, we also demonstrate that whilst the length of the charged polyelectrolyte blocks is important, the length of the PEO chains is an equally relevant variable in determining both the size and stability of the final micelles as well as the degree of charge neutralisation at which micellisation occurs. We also show that the kinetics of formation can result in very different stability of the final micelles.

Discovery and identification of new D13S317 primer binding site mutations.

During the course of conventional testing of CODIS standards at the Alabama Department of Forensic Sciences, a sample with a heterozygous null genotype at D13S317 was discovered using the PowerPlex 1.1 kit (Promega, Madison, WI). The loss of both alleles was confirmed when the sample was amplified using PowerPlex 1.2 primers and resulted in a 9, 10 genotype at this locus. To determine the cause of the silent alleles, the ADFS designed D13S317 primers which encompassed the PowerPlex 1.1 D13S317 primer binding sites and sequenced the region. Both alleles showed the presence of two substitutions (T-->A and G-->T) at positions 1 and 5 (5'-->3') of the reverse primer (positions 196 and 200 of the sequence in GenBank accession number ). Since the mutations were identical on both alleles, they may be assumed to be of ancestral origin.

Why do parents choose not to immunise their children?

AIMS: To ascertain the reasons why some parents choose not to immunise their children and where these parents obtained their immunisation information. METHODS: Seventy general practitioners (GPs) in Christchurch who kept a record of children whose parents declined immunisation were asked to recruit these parents. Half of the GPs were able to invite the 76 parents of children declining immunisation to take part in this study. Twenty one (28%) of these parents agreed to completing a structured questionnaire. RESULTS: Parents in this sample were highly educated and had used information from a variety of sources in making their decision not to immunise. Almost half of the parents had not discussed immunisation with their lead maternity carer. They viewed information from the Ministry of Health as biased. They were concerned about vaccine safety and efficacy and the effects of immunisation on their child's immune system. CONCLUSIONS: Parents who choose not to immunise their children are distrustful of information provided by the Ministry of Health. General practitioners are the main source of immunisation information for these parents and they must be able to provide accurate, unbiased information regarding the risks and benefits of immunisation.