Finally, unit-wide MRSA screening cultures were obtained upon admission and bimonthly for 6 weeks (October 2, 2017, to November 9, 2017). Screened patients were followed for 12 months for clinical MRSA infection. RESULTS Forty-three (49%) of 88 preintervention patients were started on empiric vancomycin appropriately, compared with 59 (66%) of 90 postintervention patients (P = .02). There was a significant decrease in vancomycin use after intervention. Six (7.1%) of 85 patients screened positive for MRSA colonization. During the 12-month follow-up, no colonized patients developed clinical MRSA infections (positive predictive value, 0.0%). Of the 79 noncolonized patients, 2 developed a clinically significant infection (negative predictive value, 97.5%). CONCLUSION Guideline-focused education can improve vancomycin appropriateness in FN and should be bundled with education and feedback about local MRSA epidemiology and antibiotic use rates for maximal stewardship impact.Objectives The effects of trigger point dry needling (TDN) on myofascial trigger points (MTP) in Achilles tendinopathy (AT) are unknown. We conducted a study to test the feasibility of a large randomized controlled trial (RCT) to compare the effects of TDN to MT and exercise in a patient population with AT.Methods Twenty-two subjects were randomly assigned to a control (MT+Ex) or experimental group (TDN+MT+Ex) and completed eight treatment sessions over 4 weeks with follow up at 3 months. TDN was performed to MTPs in the gastrocnemius, soleus or tibialis posterior each session. The same MT and exercise program was conducted in both groups.Results Two of three criteria for feasibility were met. The attrition rate at 4-week and 3-month follow-up was 18.1% and 68%, respectively. Significant differences (p less then .05) reported for within group analysis for FAAM, NPRS, pain pressure threshold and strength in both groups at 4 weeks and 3 months. The GROC was significant for MT + Ex at 3 months. No between group differences were found.  The MCID for the FAAM, GROC was surpassed in both groups at 4 weeks and 3 months and NPRS for the MT + Ex group at 4 weeks.Discussion A large RCT to investigate the effects of TDN on MTP in AT is not feasible without modifications due to low recruitment and high attrition rate. Modifications to study design should give consideration for closed or national health-care system for access to large patient populations and reduced financial burden to subjects.Trial Registration ClinicalTrials.gov identifier NCT03261504F.Purpose The experiences of parents caring for the complex care needs of children with rare neurodevelopmental disorders are not well understood. Parents struggle to meet their children’s medical, behavioural, and social needs within and across health, social, and family systems. The purpose of this study was to explore the parents’ experience of caring for medical and social care needs for children with rare neurodevelopmental disorders.Methods Hermeneutic phenomenology was used for the data analysis. Fifteen parents participated in semi-structured interviews.Results Interpretive analysis revealed four insights (a) difference in children’s behaviours and disease manifestations led to misunderstanding and vulnerability within social domains, (b) social taboo and stigma were experienced with rarity, (c) fragmented disconnected care from health and social systems impacted families, and (d) incomprehension from friends and family occurs when managing daily care.Conclusion New interpretations and increased understanding of parents’ experiences are required in supporting parents caring for children with complex needs. Understanding parents’ experiences could reduce social isolation and exclusion, and mitigate appropriate and supportive practices and services within and across medical, social, and family systems.in English, German Zusammenfassung. Hintergrund Kinder mit Epidermolysis bullosa (EB) benötigen aufgrund wunder Hautstellen und Blasenbildung regelmäßig neue Verbände. Fragestellung / Ziel Mit der Frage nach den Erfahrungen von Eltern und von EB betroffenen Kindern mit Verbandsmaterialien sollen Ansatzpunkte zur effektiven Unterstützung der Familien erfasst werden. Methoden Im ersten Teil der sequenziellen Mixed-Methods-Studie wurden leitfadengestützte Interviews durchgeführt und mit qualitativer Inhaltsanalyse ausgewertet. Auf Grundlage der Ergebnisse wurde ein Fragebogen entwickelt und als Online-Erhebung realisiert. Nach der Auswertung mit deskriptiver Statistik wurden diese Ergebnisse mit den qualitativen Ergebnissen verbunden. Ergebnisse Im Prozess „Herausfinden was geht“ treten das Zuschneiden der Materialien und die Wichtigkeit von Flexibilität in den Vordergrund. Die Handlungssicherheit der Eltern zeigt sich vor allem beim Anbringen der Verbände sowie beim Auskennen mit den Materialien. Das Entfernen verklebter Verbände wird oft mit Schmerz assoziiert. Verschmutzte Verbände stellen das häufigste Problem im Alltag dar. Beide Aspekte beziehen sich auf die Tragbarkeit der Verbände. Bei der Integration der Verbände im Familienalltag spielen die Kostenübernahme und Fachkenntnisse bei der Organisation die wichtigste Rolle. Schlussfolgerungen Die Eltern entwickeln spezielle Kompetenzen zu EB, zu ihrem Kind und zu den Verbänden. Mit Beratung und Edukation übernimmt Pflege innerhalb der multiprofessionellen Begleitinterventionen eine zentrale Funktion zur Unterstützung und Entlastung der Familien.BACKGROUND Ultrafiltration (UF) in peritoneal dialysis (PD) is mainly driven by the osmotic gradient and peritoneal permeability, but other factors-such as intraperitoneal pressure (IPP)-also have an influence. METHODS To assess the clinical relevance of these marginal factors, we studied 41 unselected PD patients undergoing two consecutive 2 h, 2.27% glucose exchanges, first with 2.5 L and then with 1.5 L. Selleckchem PF-00835231 RESULTS IPP, higher in the 2.5 L exchange, had a wide interpatient range, was higher in obese and polycystic patients and their increase with infusion volume was higher for women regardless of body size. UF with 2.5 L correlated inversely with IPP and was higher for patients with polycystosis or hernias, while for 1.5 L we found no significant correlations. The effluent had higher glucose and osmolarity in the 2.5 L exchange than in the 1.5 L one, similar for both sexes. In spite of this stronger osmotic gradient, only 21 patients had more UF in the 2.5 L exchange, with differences up to 240 mL. The other 20 patients had more UF in the 1.