Efficacy of a topical concentrated surfactant gel on microbial communities in non-healing diabetic foot ulcers with chronic biofilm infections: A proof-of-concept study

Matthew Malone1,2,3 | Michael Radzieta1,3 | Saskia Schwarzer1,2 | Slade O. Jensen1,3,4 | Lawrence A. Lavery5

1 South West Sydney Limb Preservation and Wound Research, South West Sydney Local Health District, Sydney, Australia

2 High Risk Foot Service, Liverpool Hospital, South West Sydney LHD, Sydney, Australia

3 Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia

4 Antimicrobial Resistance and Mobile Elements Group, Ingham Institute of Applied Medical Research, Sydney, Australia

5 Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas

Abstract

       This proof-of-concept study sought to determine the effects of standard of care (SOC) and a topically applied concentrated surfactant gel (SG) on the total microbial load, community composition, and community diversity in nonhealing diabetic foot ulcers (DFUs) with chronic biofilm infections. SOC was provided in addition to a topical concentrated SG, applied every 2 days for 6 weeks. Wound swabs were obtained from the base of ulcers at baseline (week 0), week 1, mid-point (week 3), and end of treatment (week 6). DNA sequencing and real-time quantitative polymerase chain reaction (qPCR) were employed to determine the total microbial load, community composition, and diversity of patient samples. Tissue specimens were obtained at baseline and scanning electron microscopy and peptide nucleic acid fluorescent in situ hybridisation with confocal laser scanning microscopy were used to confirm the presence of biofilm in all 10 DFUs with suspected chronic biofilm infections. The application of SG resulted in 7 of 10 samples achieving a reduction in mean log10 total microbial load from baseline to end of treatment (0.8 Log10 16S copies, ±0.6), and 3 of 10 samples demonstrated an increase in mean Log10 total microbial load (0.6 log10 16S copies, ±0.8) from baseline to end of treatment. Composition changes in microbial communities were driven by changes to the most dominant bacteria. Corynebacterium sp. and Streptococcus sp. frequently reduced in relative abundance in patient samples from week 0 to week 6 but did not disappear. In contrast, Staphylococcus sp., Finegoldia sp., and Fusobacterium sp., relative abundances frequently increased in patient samples from week 0 to week 6. The application of a concentrated SG resulted in varying shifts to diversity (increase or decrease) between week 0 and week 6 samples at the individual patient level. Any shifts in community diversity were independent to changes in the total microbial loads. SOC and a topical concentrated SG directly affect the microbial loads and community composition of DFUs with chronic biofilm infections.

KEYWORDS

diabetic foot ulcer, biofilm, Poloxomer-188, concentrated surfactant gel.

Key messages

• standard of care (SOC) and the use of a topical concentrated surfactant gel (SG) reduced the total microbial load of diabetic foot ulcers with chronic biofilm infections on average by 0.8 Log10 (range = 0–1.6 Log10)

• SOC in addition to the use of a topical concentrated SG caused reductions in the most abun dant sub-operational taxonomic units: Corynebacterium sp. and Streptococcus sp.

• Staphylococcus sp. was not affected by treatment and typically increased in its relative abundance post-treatment

• SOC and a topical concentrated SG caused shifts in microbial community diversity

Telemedicine Evaluation of Acute Burns Is Accurate and Cost-Effective

Jeffrey R. Saffle, MD, FACS, Linda Edelman, PhD, Louanna Theurer, BS, Stephen E. Morris, MD, FACS, and Amalia Cochran, MD, FACS

Background: As the number of US burn centers has declined, access to burn care is increasingly limited. Inexperience in burn wound assessment by referring physicians often results in overtriage or undertriage. In an effort to improve access to burn care in our region, we instituted a program of telemedicine evaluation of acute burns.

Methods: We created a telemedicine network linking our burn center to three hospitals located 298 to 350 air miles away. Participants agreed to perform telemedicine consultation for acutely burned patients admitted to their emergency departments. We compared consults and referrals from these facilities during the period July 2005 to August 2007 (TELE) to those during a 2-year period before instituting telemedicine (PRE-TELE).

Results: During the TELE period, 80 patients were referred, of whom 70 were seen acutely by telemedicine, compared with 28 PRE-TELE referrals. The groups did not differ in age or burn size. Only 31 patients seen by telemedicine received emergency air transport (44.3%), compared with 100% of PRE-TELE patients (p ＜0.05). Nine other TELE patients were transported by family; 30 other patients were treated locally. Ten remaining patients were transported without telemedicine evaluation. TELE patients transported by air had somewhat larger burn sizes (9.0% vs. 6.5% total body surface area; p ＝NS) and longer length of stay (13.0 days vs. 8.0 days; p ＝NS) than PRE-TELE patients. Burn size estimates by burn center physicians made either by telemedicine or direct inspection correlated closely but both differed significantly from those of referring physicians. Providers and patients expressed a high level of satisfaction with the telemedicine experience.

Conclusions: Acute evaluation of burn patients can be performed accurately by telemedicine. This can reduce undertriage or overtriage for air transport, improve resource utilization, and both enhance and extend burn center expertise to many rural communities at low cost.

Key Words: Telemedicine, Burns, Air Transport, Triage.

Telehealth readiness and its influencing factors among Chinese clinical nurses: A cross-sectional study

Tian Yu-tong , Zhang Yan * , Liu Zhen , Xu Bing , Cheng Qing-yun School of Nursing and Health, Zhengzhou University, China

ABSTRACT

Aim/objective: This study aimed to assess telehealth readiness among clinical nurses in China and explore the factors that affect their telehealth readiness and the relationships of telehealth readiness and telehealth practice related variables.

Background: Telehealth is a new service model that uses information and communication technology to provide professional health care services for resource-poor areas. With the global spread of COVID-19, nurses urgently need to adapt and apply telehealth technology to replace conventional face-to-face treatment. However, nurseled telehealth services in China are currently only in the pilot phase and the readiness of clinical nurses needs to be assessed to facilitate successful telehealth implementation.

Design: A cross-sectional, multicentre study was undertaken with the questionnaire survey method.Methods: Data were collected in October-December 2020 used online questionnaires. A convenience sample of 3386 nurses from 19 hospitals in China completed the Chinese version of Telehealth Readiness Assessment Tools.

Results: The mean score of the telehealth readiness was in the category between 61 and 80 points (mean 61.23, SD 11.61). The percentages of nurses meeting the following levels of telehealth readiness were as follows: low (49.9%), moderate (42.0%) and high (8.1%). Significantly higher domain scores were recorded for nurses in the unmarried, head of responsible nursing group. Moreover, there were positive correlations between telehealth readiness level and service experience, service willingness, mode cognition, manpower allocation and policy guidance.

Conclusions: There are still many factors hindering the successful implementation of telehealth. Nursing educators should formulate telehealth education curriculum and service standards to improve the telehealth readiness of nurses.

Keywords:Telehealth .Readiness. Nursing students. Nurses.  Nursing.  Quantitative context analysis.

Rapid Telehealth Implementation during the COVID-19 Global Pandemic: A Rapid Review

Cristian Lieneck 1,* , Joseph Garvey 2 , Courtney Collins 2 , Danielle Graham 2 , Corein Loving 2

and Raven Pearson 2

1 School of Health Administration, Texas State University, San Marcos, TX 78666, USA

2 School of Health Sciences, Southern Illinois University-Carbondale, Carbondale, IL 62901, USA; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (J.G.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (C.C.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (D.G.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (C.L.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (R.P.)

*Correspondence: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。; Tel.: +1-512-245-6362

Received: 16 October 2020; Accepted: 26 November 2020; Published: 29 November 2020

Abstract: The implementation and continued expansion of telehealth services assists a variety of health care organizations in the delivery of care during the current COVID-19 global pandemic. However, limited research has been conducted on recent, rapid telehealth implementation and expansion initiatives regarding facilitators and barriers surrounding the provision of quality patient care. Our rapid review evaluated the literature specific to rapid telehealth implementation during the current COVID-19 pandemic from three research databases between January 2020 and May 2020 and reported using preferred reporting items for systematic reviews and meta-analyses (PRISMA). The results indicate the rapid implementation and enhanced use of telehealth during the COVID-19 pandemic in the United States surrounding the facilitators and barriers to the provision of patient care, which are categorized into three identified themes: (1) descriptive process-oriented implementations,(2) the interpretation and infusion of the CARES Act of 2020 telehealth exemptions related to the relaxation of patient privacy and security (HIPAA) protocols, and (3) the standard of care protocols and experiences addressing organizational liability and the standard of care. While the study limitation of sample size exists (n = 21), an identification of rapid telehealth implementation advancements and challenges during the current pandemic may assist health care organizations in the delivery of ongoing quality care during the COVID-19 pandemic.

Keywords: telehealth; telemedicine; COVID-19; coronavirus; implementation.

Antimicrobial TiN-Ag Coatings in Leather Insole for Diabetic Foot

Sandra M. Marques 1,2,* , Isabel Carvalho 2,3 , Teófilo R. Leite 4 , Mariana Henriques 2 and Sandra Carvalho 1,3

1 CFUM-UP, Physics Department, University of Minho, 4800-058 Guimarães, Portugal; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

2 CEB, Centre of Biological Engineering, LIBRO-Laboratório de Investigação em Biofilmes Rosário Oliveira, Campus of Gualtar, University of Minho, 4710-057 Braga, Portugal; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (I.C.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (M.H.)

3 CEMMPRE, Department of Mechanical Engineering, University of Coimbra, 3030-788 Coimbra, Portugal

4 ICC-Indústrias e Comércio de Calçado S.A., Sol-Pinheiro, 4810-718 Guimarães, Portugal; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。* Correspondence: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Abstract: This work reports on TiN-Ag antimicrobial coatings deposited by d.c. magnetron sputtering on leather used for insoles on the footwear industry, studies involving the antimicrobial properties of Ag-based functionalized leathers by sputtering techniques are shown. The X-ray diffraction (XRD) results suggested the presence of crystalline fcc-TiN phase for the sample without silver, and also a fcc-Ag phase in the samples containing silver. According to the Scanning Electron Microscopy (SEM) analysis, the coatings were homogeneous and dispersed Ag clusters were detected on the surface of samples with silver content above 8 at. %. The Inductively coupled plasma—optical emission spectrometry (ICP-OES) analysis showed that the ionization of silver over time depends on the morphology of the coatings. The samples did not present cytotoxicity and only samples with incorporated silver presented antibacterial and antifungal activity, highlighting the potential of the TiN-Ag insole coatings for diseases such as diabetic foot.

Keywords: Ag nanoparticles; sputtering; leather; diabetic foot; antimicrobial properties

Analysis of risk factors for multidrug-resistant organisms in diabetic foot infection

Xi Yan1†, Jin‑fang Song2,3*†, Liang Zhang4 and Xia Li2

Abstract

Background: To study the bacteriological characteristics, risk factors, and treatment of multi-drug resistance (MDR) organisms in patients with diabetic foot infection.

Methods: Patients with diabetic foot ulcer admitted to hospital from June 2018 to December 2019 (n =180) were selected as clinical subjects. Demographic information, routine blood test, wound culture and sensitivity were col‑lected. Risk factors of MDR bacteria were analyzed.

Results: Among 180 patients with diabetic foot ulcer, 146 were positive in bacterial culture, with 84 positive in MDR bacteria. A total of 182 strains were isolated, with 104 strains being multi-drug resistant. Body mass index, glycosylated hemoglobin, fasting blood glucose, triglyceride, course of ulcer, size of ulcer, peripheral neuropathy, peripheral vascu‑lar disease, osteomyelitis, peripheral blood leukocyte count, percentage of neutrophils, and previous use of antibiotics were the related factors of infection of MDR bacteria in diabetic foot ulcer patients (P<0.05). The leukocyte count and neutrophil ratio of MDR-bacilli were lower than those of non MDR-bacilli (P<0.05).

Conclusion: The risk of MDR bacteria in diabetic foot infection is high. It is necessary to evaluate the risk of multid‑rug-resistant bacteria by characterizing the course of disease, metabolic control, local ulcer and other aspects in order to formulate an efective treatment plan. The decrease of leukocyte count and neutrophil ratio may be related to damage of the host immune response.

Keywords: Diabetic foot ulcers, Diabetic food infection, Multidrug-resistant bacteria.