Quaternary Prevention

PURPOSE: To explore occupational and non-occupational risk and protective factors for the coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs). METHODS: Serum specimens and questionnaire data were obtained between October 7 and December 16, 2021 from COVID-19-vaccinated HCWs at a quaternary care hospital in Munich, Germany, and were analyzed in the RisCoin Study. RESULTS: Of 3,696 participants evaluated, 6.6% have had COVID-19 at least once...

BACKGROUND: This study aimed to evaluate the cost-effectiveness of a telehealth coaching intervention to prevent gestational diabetes mellitus (GDM) and to calculate the breakeven point of preventing GDM. METHODS: Data to inform the economic evaluation model was sourced directly from the large quaternary hospital in Brisbane, where the Living Well during Pregnancy (LWdP) program was implemented, and further supplemented with literature-based estimates where data had not been directly collected in the trial...

AIM: Hospital rapid response systems aim to stop preventable cardiac arrests, but defining preventability is a challenge. We developed a multidisciplinary consensus-based process to determine in-hospital cardiac arrest (IHCA) preventability based on objective measures. METHODS: We developed an interdisciplinary ward IHCA debriefing program at an urban quaternary-care academic hospital. This group systematically reviewed all IHCAs weekly, reaching consensus determinations of the IHCA's cause and preventability across three mutually exclusive categories: 1) unpredictable (no evidence of physiologic instability < 1 h prior to and within 24 h of the arrest), 2) predictable but unpreventable (meeting physiologic instability criteria in the setting of either a poor baseline prognosis or a documented goals of care conversation) or 3) potentially preventable (remaining cases)...

Cationic biocides play a crucial role in the disinfection of domestic and healthcare surfaces. Due to the rise of bacterial resistance towards common cationic disinfectants like quaternary ammonium compounds (QACs), the development of novel actives is necessary for effective infection prevention and control.  Toward this end, a series of 15 chimeric biscationic amphiphilic compounds, bearing both ammonium and phosphonium residues, were prepared to probe the structure and efficacy of mixed cationic ammonium-phosphonium structures...

OBJECTIVE: To describe a method of reducing the risk of sternal wound infection after sternotomy in children with a pre-existing tracheostomy. To report our outcomes using this method from 1 January, 2013 to 31 August, 2023. METHODS: We describe a method for temporarily occluding the tracheal stoma with a removable implant with the primary goal of reducing the risk of sternotomy wound infection by preventing soilage due to tracheostomal secretions. We then performed a retrospective review of all children who underwent temporary tracheostomal occlusion between 1 January, 2013 and 31 August, 2023 at our quaternary care children's hospital...

BACKGROUND: Persons who inject drugs and require surgery for infective endocarditis have 2 potentially lethal diseases. Current postoperative rehabilitation efforts seem ineffective in preventing loss to follow-up, injection drug use relapse (relapse), and death. OBJECTIVES: The purpose of this study was to characterize drug use, psychosocial issues, surgical outcome, and postoperative addiction management, as well as loss to follow-up, relapse, and mortality and their risk factors...

BACKGROUND: Recognition of clinically deteriorating hospitalized patients with activation of rapid response (RR) systems can prevent patient harm. Patients with limited English proficiency (LEP), however, experience less benefit from RR systems than do their English-speaking counterparts. OBJECTIVE: To improve outcomes among hospitalized LEP patients experiencing clinical deteriorations. DESIGN: Quasi-experimental pre-post design using quality improvement (QI) statistics...

OBJECTIVE: Our objective was to evaluate the usability of an automated clinical decision support (CDS) tool previously implemented in the pediatric intensive care unit (PICU) to promote shared situation awareness among the medical team to prevent serious safety events within children's hospitals. METHODS: We conducted a mixed-methods usability evaluation of a CDS tool in a PICU at a large, urban, quaternary, free-standing children's hospital in the Midwest. Quantitative assessment was done using the System Usability Scale, while qualitative assessment involved think-aloud usability testing...

Disinfectants and antibiotics are widely used for the prevention and control of bacterial infectious diseases. Frequent disinfection is thought to exacerbate antibiotic resistance. However, little is known about how disinfectants and antibiotics co-induce changes in the soil antibiotic resistance genes (ARGs). This study determined the ARG profiles and bacterial community dynamics between unamended soil and manure-amended soil exposed to benzalkonium chloride (C12 ) (BC, 10 mg kg-1 ) disinfectant and sulfamethazine (SMZ, 1 mg kg-1 ), using high-throughput quantitative PCR and 16 S rRNA gene sequencing...

INTRODUCTION: Violent traumatic injury, including firearm violence, can adversely impact individual and community health. Trauma-informed care (TIC) can promote resilience and prevent future violence in patients who have experienced trauma. However, few protocols exist to facilitate implementation of TIC for patients who survive traumatic injury. The purpose of the study is to characterize documentation of TIC practices and identify opportunities for intervention in a single academic quaternary care center...

Venous thromboembolism (VTE) is a preventable cause of significant morbidity and mortality in hospitalized patients world-wide. In Australia, the low-molecular weight heparins (LMWHs) enoxaparin or dalteparin are usually used as first-line prophylaxis for VTE, though there is uncertainty whether dalteparin has the same effectiveness as enoxaparin in real-world settings. This is relevant because dalteparin is less renally cleared and may be more cost effective than enoxaparin. The aim of this study was to explore VTE event incidence in a general cohort of hospitalized adult inpatients who were prescribed enoxaparin or dalteparin for VTE prophylaxis...

This review provides a comprehensive overview of mono-alkylation methodologies targeting crucial nitrogen moieties - amines, amides, and sulfonamides - found in organic building blocks and pharmaceuticals. Emphasizing the intersection of chemical precision with drug discovery, the central challenge addressed is achieving one-pot mono-selective short-chain N-alkylations (methylations, ethylations, and n-propylations), preventing undesired overalkylation. Additionally, sustainable, safe, and benign alternatives to traditional alkylating agents, including alcohols, carbon dioxide, carboxylic acids, nitriles, alkyl phosphates, quaternary ammonium salts, and alkyl carbonates, are explored...

BACKGROUND: Inter centre variation and trends in postnatal steroids (PNS) use among preterm infants for prevention or treatment of bronchopulmonary dysplasia (BPD) is known. Understanding intra-centre PNS use patterns facilitate implementation of centre specific change interventions to optimize outcomes. OBJECTIVES: (i) Quantify the proportion of infants who received PNS, and describe the timing, type, trends over time, regimen used, and deviations, (2) describe the clinical characteristics and unadjusted outcomes of infants who received PNS...

To inhibit viral infection, it is necessary for the surface of polypropylene (PP), a polymer of significant industrial relevance, to possess biocidal properties. However, due to its low surface energy, PP weakly interacts with other organic molecules. The biocidal effects of quaternary ammonium compounds (QACs) have inspired the development of nonwoven PP fibers with surface-bound quaternary ammonium (QA). Despite this advancement, there is limited knowledge regarding the durability of these coatings against scratching and abrasion...

Proteinaceous aggregates accumulate in neurodegenerative diseases such as Alzheimer's Disease (AD), inducing cellular defense mechanisms and altering the redox status. S100 pro-inflammatory cytokines, particularly S100B, are activated during AD, but recent findings reveal an unconventional molecular chaperone role for S100B in hindering Aβ aggregation and toxicity. This suggests a potential protective role for S100B at the onset of Aβ proteotoxicity, occurring in a complex biochemical environment prone to oxidative damage...

Natural gas hydrate has been a critical risk to the safety of offshore oil and gas well test and subsea transportation. Herein, the effect of three quaternary ammonium salt (QAS) surfactants with monoethylene glycol (MEG) to methane hydrate agglomeration in water-oil system was experimentally studied by a rocking cell. Based on the hydrate volume fraction and the slider trajectory, a classification method of the gas hydrate anti-agglomerants was established. All the QASs in this work show the capability of reducing hydrate agglomeration, among which N1 ,N3 -didodecyl-N1 ,N1 ,N3 ,N3 -tetramethylpropane-1,3-diaminium chloride (AA-2) has the best anti-agglomerating performance, and the slider moved at a large trajectory of 61-174 mm...

INTRODUCTION: Despite mounting consensus that end-of-life (EOL) care for patients with cancer should focus on improving quality of life, many patients continue to receive aggressive, disease-oriented treatment until death. Within this group, patients with increased frailty may be at higher risk of adverse treatment-related outcomes. We therefore examined the relationship between degree of frailty and receipt of aggressive EOL care among Medicare-insured patients with cancer in Ohio. MATERIALS AND METHODS: From the Ohio Cancer Incidence Surveillance System (OCISS) linked with Medicare claims, we identified patients diagnosed with breast, colorectal, lung, or prostate cancer who died between 2012 and 2016...

Nitrate pollution in groundwater is a global environmental problem that poses risks to human health. We investigate the health risks of nitrate in rural drinking groundwater in Rucun Township and surrounding areas of Wutai County, and provide a basis for healthy drinking water. By using statistical analysis software (SPSS19) and hydrogeochemical analysis software (AqQA), a qualitative and quantitative evaluation of nitrate health risks was conducted among populations of different ages and genders through water sample collection, chemical analysis, and construction of a human health risk model (HHRA)...

BACKGROUND: Between 2018 and 2022, a Belgian tertiary care hospital faced a growing issue with acquiring carbapenemase-producing organisms (CPO), mainly VIM-producing P. aeruginosa (PA-VIM) and NDM-producing Enterobacterales (CPE-NDM) among hospitalized patients in the adult intensive care unit (ICU). AIM: To investigate this ICU long-term CPO outbreak involving multiple species and a persistent environmental reservoir. METHODS: Active case finding, environmental sampling, whole-genome sequencing (WGS) analysis of patient and environmental strains, and implemented control strategies were described in this study...

OBJECTIVES: Diabetes mellitus has been a significant public health problem, associated with high rates of morbidity, disability, and mortality. Prediabetes is a crucial period for preventing and managing diabetes. 25(OH)D3 is an important risk factor for prediabetes. However, there is limited genetic knowledge of 25(OH)D3 in the Chinese population. This study was designed to identify genetic variants associated with 25(OH)D3 and explore the potential pathogenesis of prediabetes. METHODS: In this study, 451 individuals with prediabetes were recruited to determine the genetic variants associated with 25(OH)D3 through a genome-wide association study (GWAS)...