A Qualitative Study

[Posted 7/Jun/2022]

AUDIENCE: Nursing

KEY FINDINGS: The convictions and actions of the nurse-midwife in recommending vaccination to pregnant women are decisive. Strategies to improve vaccination rates should be directed to helping health professionals understand how their practice affects the final decision of pregnant women.

BACKGROUND: Aimed to identify how pregnant women perceive pertussis and influenza and the factors that influence their decision to be vaccinated. Suffering from influenza during pregnancy increases complications in the pregnant woman, foetus and newborn. Pertussis in children under six months of age causes severe complications. Maternal vaccination against influenza and pertussis is effective and safe. However, vaccination rates are insufficient.

DETAILS: Conducted a qualitative descriptive study, using semi-structured interviews. This research adheres to the COREQ guidelines and checklist. During the study carried out 18 semi-structured face-to-face interviews with pregnant women, using intentional sampling and thematic analysis. Identified an overarching theme, ‘factors that influenced participants’ decision to be vaccinated or not’, which was composed of four subthemes that were in turn made up of 12 categories. The factors that influenced participants’ decision to be vaccinated against influenza and pertussis were related to their knowledge of and their perception of risk for these diseases. Participants perceived the risk of pertussis to be greater, and they focused their concern on the newborn. The recommendations and convictions of nurse-midwives were the most important factors encouraging vaccination. Participants trusted their nurse-midwives and most reported that they would have been vaccinated if their midwife had recommended it. Other factors were linked to lack of information, fear and concerns about economic interests.

Copyright © John Wiley & Sons Ltd. All rights reserved.

Source: Maranon, A. A., Fernandez-Cano, M. I., Montero-Pons, L., et al. (2022). Understanding Factors That Influence The Decision To Be Vaccinated Against Influenza And Pertussis In Pregnancy: A Qualitative Study. J Clin Nurs. Published: May 6, 2022. DOI: 10.1111/jocn.16006.

[Posted 13/Jul/2026]

AUDIENCE: Infectious Disease, Internal Medicine

KEY FINDINGS: This review underscores the expanding pipeline of therapeutic strategies targeting Candida auris, ranging from repurposed medications and next-generation antifungal agents to vaccines, antimicrobial peptides, nanoparticle formulations, and innovative environmental control measures. Although no single therapy has emerged as a definitive solution, compounds such as ibrexafungerp (SCY-078), ATI-2307, and fosmanogepix, together with drug repurposing and bioinspired approaches, represent promising avenues for addressing multidrug-resistant C. auris infections. Continued translational research and clinical evaluation remain essential to establish safe and effective treatment options for this increasingly important fungal pathogen.

BACKGROUND: Candida auris has rapidly emerged as a multidrug-resistant fungal pathogen of global concern since its first identification in 2009. The organism is associated with healthcare-associated outbreaks, high transmissibility, frequent misidentification, and severe invasive infections, with reported mortality rates ranging from 35% to 72%. Resistance to currently available antifungal agents further complicates treatment, with approximately 90% of isolates resistant to fluconazole, around 30% resistant to amphotericin B, and fewer than 5% resistant to echinocandins. These challenges have accelerated efforts to identify novel antifungal therapies and alternative treatment strategies.

DETAILS: This publication is a comprehensive narrative review that summarizes advances in antifungal research targeting C. auris over the preceding decade. The authors evaluated emerging therapeutic approaches from a medicinal chemistry perspective, including drug repurposing, combination therapy, novel antifungal agents, natural products, metal-based compounds, nanoparticles, vaccines, antimicrobial peptides, and environmental decontamination strategies. The review also examined chemical and physicochemical characteristics of promising compounds, including lipophilicity and topological polar surface area, to identify structural features that may facilitate future antifungal drug development. The review highlights several promising therapeutic candidates with activity against multidrug-resistant C. auris. Drug repurposing identified multiple agents with antifungal or antibiofilm activity, including sertraline, miltefosine, iodoquinol, octenidine dihydrochloride, taurolidine, and bensulfuron methyl. Miltefosine demonstrated fungicidal and antibiofilm activity, while encapsulation within alginate nanoparticles reduced toxicity and improved survival in an infected Galleria mellonella model. The NDV-3A vaccine generated cross-reactive antibodies against C. auris and protected neutropenic mice, with additive efficacy when combined with micafungin.

Among novel antifungal agents, SCY-078 (ibrexafungerp), an orally available 1,3-ß-D-glucan synthesis inhibitor, demonstrated potent activity against C. auris, with an MIC90 of 1 mg/L and MIC50 and MIC90 values of 0.5 µg/mL and 1 µg/mL, respectively, across 100 isolates representing the four major clades. More than 150 strains with diverse resistance profiles were subsequently shown to be uniformly susceptible to SCY-078, and the agent remained active against pan-resistant isolates while also exhibiting antibiofilm activity.

Additional investigational therapies also demonstrated encouraging preclinical activity. The arylamidine T-2307 (ATI-2307) exhibited in vitro MIC values ranging from 0.125 to 4 µg/mL and improved survival while reducing kidney fungal burden in murine infection models following 3 mg/kg once-daily subcutaneous treatment. Other experimental approaches included antimicrobial peptides, ceragenins, fluorinated hydrazone derivatives, and novel chemical scaffolds designed to overcome existing resistance mechanisms.

Copyright © Skyscape. All rights reserved.

Source: Billamboz, M., Fatima, Z., Hameed, S., et al. Promising Drug Candidates and New Strategies for Fighting against the Emerging Superbug Candida auris. Microorganisms. 2021; 9(3): 634. Published: March 18, 2021. DOI: 10.3390/microorganisms9030634.

[Posted 9/Jul/2026]

AUDIENCE: Gastroenterology, Oncology

KEY FINDINGS: This prospective randomized tandem study demonstrates that AI-assisted colonoscopy significantly improves overall polyp detection, with the greatest benefit observed for diminutive and Paris type 0-IIa lesions. The enhanced detection was achieved without increasing procedure withdrawal time, supporting the feasibility of real-time AI integration into routine colonoscopic practice. Although false-positive alerts occurred, they were infrequent and readily distinguishable by experienced endoscopists. Given the single-center design, relatively small sample size, and absence of adenoma detection rate analysis, larger multicenter studies are warranted to confirm the clinical impact of AI-assisted colonoscopy on colorectal cancer prevention.

BACKGROUND: Colonoscopy remains the standard procedure for detecting and removing colorectal polyps, thereby reducing the incidence of colorectal cancer (CRC). However, lesions may be overlooked because of operator-dependent factors and the subtle appearance of small or flat polyps. Artificial intelligence (AI)-based computer-aided detection systems have been developed to provide real-time assistance during colonoscopy, but clinical evidence supporting their effectiveness in routine practice remains limited. This prospective randomized study evaluated whether AI-assisted colonoscopy improves polyp detection compared with conventional colonoscopy in a real-world clinical setting.

DETAILS: This prospective, randomized tandem cohort study was conducted at the Endoscopy Center of Nanfang Hospital, China, between April 2019 and September 2019. A total of 150 patients aged 18-70 years underwent same-day back-to-back colonoscopies performed by two experienced endoscopists, each with experience exceeding 3,000 colonoscopies. Participants were randomly assigned to undergo either conventional colonoscopy or AI-assisted colonoscopy first, followed immediately by the alternate procedure. The AI system employed a convolutional neural network based on the YOLO architecture and operated during withdrawal to identify suspected polyps in real time. The primary endpoint was the polyp detection rate (PDR), while secondary outcomes included the total number of detected polyps, detection of diminutive polyps (<6 mm), detection according to Paris classification, withdrawal time, and false-positive findings. Baseline demographic characteristics, bowel preparation quality, and withdrawal times were comparable between study groups. Mean withdrawal time was 370.15 ± 31.44 seconds with conventional colonoscopy and 373.17 ± 33.37 seconds with AI-assisted colonoscopy (p = 0.102). AI assistance significantly improved the PDR from 34.0% to 38.7% (p < 0.001). The total number of detected polyps increased from 80 with conventional colonoscopy to 105 with AI-assisted colonoscopy (p = 0.020). The benefit was primarily attributable to enhanced detection of diminutive polyps, with 91 lesions identified using AI compared with 69 during conventional examination (p < 0.001). Detection rates for patients with at least one diminutive polyp also increased from 30.0% to 34.7% (p < 0.001). In contrast, detection of polyps measuring >=6 mm did not differ significantly (11 vs 14; p = 0.319). AI-assisted colonoscopy also improved detection of Paris type 0-IIa polyps, increasing the number detected from 61 to 87 (p = 0.010) and the proportion of patients with at least one such lesion from 26.0% to 32.0% (p < 0.001). The AI system generated 52 false-positive alerts, averaging 0.35 false positives per colonoscopy, most commonly due to feces and mucosal folds, without prolonging withdrawal time.

Source: Luo, Y., Zhang, Y., Liu, M., et al. Artificial Intelligence-Assisted Colonoscopy for Detection of Colon Polyps: a Prospective, Randomized Cohort Study. Journal of Gastrointestinal Surgery. Journal of Gastrointestinal Surgery. 2021; 25(8): 2011-2018. Published: June 22, 2026. DOI: 10.1007/s11605-020-04802-4.

Multicenter Evaluation Reveals Persistent Gaps in Guideline-Concordant Care

[Posted 8/Jul/2026]

AUDIENCE: Infectious Disease, Internal Medicine

KEY FINDINGS: This multicenter evaluation demonstrates that antibiotic prescribing for acute sinusitis remains substantially higher than recommended by evidence-based guidelines, with nearly one-third of patients failing to meet prescribing criteria and fewer than half of prescriptions fully adhering to recommended antibiotic selection and duration. Prolonged symptom duration, cough, and incomplete documentation were significant drivers of inappropriate prescribing, while electronic encounters were associated with more judicious antibiotic use. These findings identify important opportunities for antimicrobial stewardship interventions aimed at improving prescribing decisions and optimizing treatment duration in ambulatory care.

BACKGROUND: Acute sinusitis is among the most common indications for antibiotic prescribing in ambulatory practice, despite national guidelines recommending antibiotic therapy only when specific clinical criteria suggest bacterial infection. Inappropriate antibiotic use contributes to adverse drug events, antimicrobial resistance, and unnecessary healthcare expenditures. This multicenter study evaluated the appropriateness of antibiotic prescribing for acute sinusitis, assessed concordance with guideline-recommended agent selection and treatment duration, and identified factors associated with inappropriate prescribing.

DETAILS: This retrospective multicenter cohort study included 1,000 randomly selected adult ambulatory encounters with a primary diagnosis of acute sinusitis between January 1, 2024, and March 31, 2024. Encounters were drawn from emergency departments, urgent care centers, and primary care clinics across seven geographic regions within a large healthcare system. Medical records were reviewed to determine whether patients met national guideline criteria for antibiotic therapy based on symptom duration, severe symptoms, treatment failure, or double worsening. Antibiotic selection and treatment duration were evaluated against institutional recommendations. Multivariable logistic regression was performed to identify predictors of inappropriate antibiotic prescribing, and 30-day repeat respiratory-related healthcare utilization was also assessed. Among the 1,000 encounters, 676 (67.6%) met guideline criteria for antibiotic therapy, whereas 324 (32.4%) did not. Antibiotics were prescribed in 892 (89.2%) encounters overall. Prescribing occurred in 93.5% of encounters meeting treatment criteria but also in 80.2% of encounters where criteria were not satisfied, indicating substantial antibiotic use beyond guideline recommendations. Overall, only 49.2% of antibiotic prescriptions were fully guideline concordant with respect to both agent selection and duration. Guideline-concordant drug selection occurred in 74.1% of prescriptions, while 64.5% met recommended treatment duration. The most frequently prescribed antibiotic was amoxicillin/clavulanate (60.9%), followed by doxycycline (19.1%), and the median treatment duration was 7 days. However, 35.4% of patients received therapy lasting longer than 7 days. Watch-and-wait prescribing was used in only 6.8% of antibiotic-treated encounters. Multivariable analysis demonstrated that the presence of cough (OR 2.15; 95% CI, 1.08-4.29; P = 0.03), symptom duration of 7-9 days compared with 6 days (OR 7.70; 95% CI, 3.24-18.31; P 0.001), and undocumented symptom duration (OR 5.01; 95% CI, 1.41-17.82; P = 0.013) were independently associated with inappropriate antibiotic prescribing. In contrast, electronic encounters were associated with significantly lower odds of inappropriate prescribing than in-person visits (OR 0.03; 95% CI, 0.01-0.09; P 0.001). Unplanned respiratory-related healthcare contact within 30 days occurred in 12.8% of patients and was more frequent among those who did not receive antibiotics (20.4% vs 11.9%; P = 0.013), although antibiotic prescribing was not independently associated with reduced repeat healthcare utilization after multivariable adjustment.

Source: Arensman Hannan, K., Ilges, D., Le, K. T., Cole K, et al. Ambulatory antibiotic prescribing for acute sinusitis: a multicenter, retrospective cohort study evaluating appropriateness. Antimicrobial Stewardship & Healthcare Epidemiology.. 2026; 6(1): e193. Published: June 25, 2026. DOI: 10.1017/ash.2026.10743.

[Posted 6/Jul/2026]

AUDIENCE: Nursing, Neonatology

KEY FINDINGS: This quality improvement evaluation suggests that medical-grade cyanoacrylate adhesive is a feasible and well-tolerated option for securing neonatal short peripheral catheters in routine clinical practice. Use of the adhesive was not associated with local skin injury, bleeding, or dressing displacement and did not increase application time. Although catheter dwell time was numerically longer and clinician-rated ease of use was favorable with cyanoacrylate fixation, no statistically significant differences were observed compared with conventional securement. Because infection-related outcomes were not assessed and the study was non-randomized with a limited sample size, larger prospective multicenter studies are needed to determine clinical effectiveness, infection outcomes, cost-effectiveness, and long-term safety.

BACKGROUND: Maintaining reliable peripheral intravenous (IV) access in neonates remains challenging because short peripheral catheters (SPCs) frequently fail due to infiltration, dislodgement, or occlusion, resulting in repeated cannulation and increased procedural burden. Conventional fixation methods may provide inadequate catheter stability, particularly in preterm infants with fragile skin. Medical-grade cyanoacrylate adhesive has been proposed as an adjunct to improve catheter securement, but evidence regarding its safety and feasibility in neonatal populations is limited. This quality improvement evaluation compared cyanoacrylate adhesive securement with conventional fixation for neonatal SPCs during routine clinical care.

DETAILS: This single-center quality improvement evaluation was conducted in the neonatal intensive care unit of University Hospital Lozenetz, Bulgaria, between March and August 2025. A total of 67 short peripheral catheter insertions were assessed, including 34 secured using conventional methods and 33 secured with medical-grade cyanoacrylate adhesive. The primary outcome was short-term safety, defined by the absence of bleeding, skin injury, or dressing displacement. Secondary outcomes included catheter dwell time, unplanned catheter removal, dressing application time, and clinician-rated ease of securement. Catheter and patient characteristics were prospectively documented during routine clinical practice, and outcomes were compared using non-parametric statistical analyses. Infection-related outcomes were not evaluated. Median dressing application time was identical in both groups at 5 minutes (p = 0.295). Median catheter dwell time was modestly longer with cyanoacrylate fixation (68.1 hours [IQR 46.3-101.7]) compared with conventional securement (64.0 hours [IQR 41.6-88.3]), although this difference was not statistically significant (p = 0.259). Overall, 76.1% of catheters underwent unplanned removal, with similar rates between the cyanoacrylate and conventional groups (78.8% vs 73.5%; p = 0.776). Infiltration or extravasation accounted for 70.1% of catheter removals, whereas phlebitis (1.5%), occlusion (3.0%), and accidental removal (1.5%) occurred infrequently. Clinician acceptance was favorable, with 83.6% of catheter securements rated as easy or very easy, and a greater proportion of "very easy" ratings was observed with cyanoacrylate fixation (21.2% vs 8.8%), although the difference was not statistically significant (p = 0.400). Importantly, no bleeding, skin injury, or dressing displacement was observed in either study group during the evaluation period.

Copyright © Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.

Source:XBoyadzhiev, S., Hoogendijk, E. O., van Rens, M., et al. Is cyanoacrylate fixation safe for neonatal IV access? A quality improvement evaluation of cyanoacrylate adhesive securement for short peripheral catheters. Journal of Neonatal Nursing. 2026; 32(3): 101796. Published: June, 2026. DOI: 10.1016/j.jnn.2026.101796.

Results From Phase 3 Studies of Bempedoic Acid

[Posted 29/Jun/2026]

AUDIENCE: Cardiology, Emergency Medicine, Internal Medicine

KEY FINDINGS: Bempedoic acid was well tolerated in patients aged >=75 years with efficacy and safety comparable with younger subgroups regardless of background statin usage. Bempedoic acid may be considered a viable strategy for managing hypercholesterolemia in adults, regardless of age.

BACKGROUND: Lowering low-density lipoprotein cholesterol (LDL-C) reduces the risk of major vascular events across all age groups. Authors analyzed phase 3 studies of bempedoic acid to characterize the safety and efficacy in patients aged >=75 years with and without a concomitant statin.

DETAILS: Post hoc analysis of bempedoic acid in high-risk patients with cardiovascular disease by age from phase 3 placebo-controlled, randomized clinical trials: two 52-week primary hyperlipidemia studies with maximal background statin ("max-statins pool"), and 1 cardiovascular outcomes trial ("statin-intolerant pool). Efficacy (LDL-C, non–high-density lipoprotein cholesterol, total cholesterol, high-sensitivity C-reactive protein) and safety were evaluated. The max-statins pool included 3009 (2010 bempedoic acid, 999 placebo) patients. The statin-intolerant pool included 13 970 patients (6992 bempedoic acid, 6978 placebo). In total 7022 patients were aged 18 to <65 years; 7372 were aged 65 to <75 years; 2585 were aged >=75 years. Placebo-corrected mean percentage change in LDL-C at week 12 in the max-statin pool with bempedoic acid was -18.4% (95% CI, -21.3 to -15.6) for patients aged 18 to <65 years, -18.6% (95% CI, -21.2 to -16.1) for 65 to <75 years, and -18.3% (95% CI, -22.2 to -14.5) for >=75 years. In the statin-intolerant pool, LDL-C change was -21.9% (95% CI, -23.1 to -20.7) for patients aged 18 to <65 years, -22.9% (95% CI, -24.0 to -21.8) for 65 to <75 years, and -24.5% (95% CI, -26.2 to -22.7) for >=75 years. Frequency of adverse events compared with placebo was similar across the ages, but more frequent among patients >=75 years regardless of background statin. Cardiovascular event reduction was statistically comparable across all ages.

Copyright © American Heart Association, Inc. All rights reserved.

Source:John Mancini, G. B., Lincoff, A. M., Goldberg, A. C., et al. Efficacy and Safety of Bempedoic Acid in Patients Aged >=75 Years Stratified by Varying Statin Exposure: Results From Phase 3 Studies of Bempedoic Acid. Journal of the American Heart Association. Published: June 23, 2026. DOI: 10.1161/JAHA.125.04789