Background Infection remains a severe complication following a total hip replacement. If infection is suspected when revision surgery is being performed, additional gentamicin is often added to the cement on an ad hoc basis in an attempt to reduce the risk of recurrent infection.Methods and results In this in vitro study, we determined the effect of incorporating additional gentamicin on the mechanical properties of cement. We also determined the degree of gentamicin release from cement, and also the extent to which biofilms of clinical Staphylococcus spp. isolates form on cement in vitro. When gentamicin was added to unloaded cement (1–4 g), there was a significant reduction in the mechanical performance of the loaded cements compared to unloaded cement. A significant increase in gentamicin release from the cement over 72 h was apparent, with the amount of gentamicin released increasing significantly with each additional 1 g of gentamicin added. When overt infection was modeled, the incorporation of additional gentamicin did result in an initial reduction in bacterial colonization, but this beneficial effect was no longer apparent by 72 h, with the clinical strains forming biofilms on the cements despite the release of high levels of gentamicin.Interpretation Our findings indicate that the addition of large amounts of gentamicin to cement is unlikely to eradicate bacteria present as a result of an overt infection of an existing implant, and could result in failure of the prosthetic joint because of a reduction in mechanical performance of the bone cement.
The QOL-B is the first disease-specific HRQoL questionnaire for bronchiectasis. Quittner et al (ATS, 2009) have provided preliminary data on reliability and validity of the questionnaire. It has not been used in bronchiectasis populations outside of the USA.
Aim
To assess HRQoL using the disease-specific QOL-B questionnaire and explore the relationship between FEV1% predicted, age, gender, time from 1st Pseudomonas aeruginosa isolate and QOL-B.
Methods
This study is part of a larger study exploring adherence to treatment in bronchiectasis. Patients with bronchiectasis (confirmed by HRCT) were recruited if they had a positive sputum culture for P aeruginosa and were using nebulised antibiotics. Patients self-completed the QOL-B (eight domains, each scored 0–100, low-highHRQoL). Spirometry was performed according to ATS/ERS guidelines. Stepwise multiple regression analyses were completed for each QOL-B domain using four independent variables: age, gender, FEV1% and time from 1st P aeruginosa isolate.
Results
71 patients were recruited: 22M/49F; mean (SD) age 65 (8) yrs; FEV1 60 (25) % predicted; mean time since first P aeruginosa isolate 51 (41) months. QOL-B domains showed impairment in HRQoL, mean (range): physical functioning 31 (0–100); vitality 37 (0–78); health perceptions 39 (8–92); social functioning 42 (0–100); role functioning 46 (0–100); respiratory functioning 53 (8–100); treatment burden 56 (11–89); and emotional functioning 73 (8–100). Males had significantly lower (p=0.046) physical functioning than females, mean (SD) 22.8 (23) vs 36.58 (27) respectively; however gender did not explain the variance in any of the QOL-B domains. Age, FEV1% and time from 1st P aeruginosa isolate together explained 5.5–26.9% of variance (r2) in domain scores. Age was related to health perceptions (r2=12.1%), treatment burden (r2=11.5%), social (r2=15.6%), role (r2=10.7%) and respiratory (r2=16%) functioning domains. FEV1% was related to physical (r2=18.8%) and role (r2=8.7%) functioning domains. Time from 1st P aeruginosa isolate was related to vitality (r2=11%), physical (r2=6.9%), social (r2=5.6%) and emotional (r2=5.5%) functioning domains.
Conclusion
HRQoL is impaired in patients with bronchiectasis. Older age is associated with better HRQoL. Higher FEV1% is associated with better physical and role functioning. Vitality, physical, social and emotional functioning improves with increased time from 1st P aeruginosa isolate.
IntroductionCPD is likely to be an important element of the revalidation process. Engaging in self-directed learning as an undergraduate student will help individuals develop the relevant skills to direct their own future learning within the CPD framework.Module descriptionThree self-directed learning units were introduced to the Level 4 Pharmacotherapy Module of the MPharm programme at Queen‟s University Belfast.EvaluationA short questionnaire was administered to students to determine the extent to which they had engaged in self-directed learning and the value of this learning. Fifty seven percent of students had engaged in the self-directed learning and reported positively regarding the experience. The remaining 43% who failed to engage did not view self-directed learning as a priority.Future plansTo ensure that graduates are produced who are capable of engaging in self-directed learning and thus CPD, self-directed learning should be introduced at an earlier level in the undergraduate curriculum.
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