We have designed and built a perfusion system and perfusion chamber to allow investigation of the effects of anaesthetic agents on human cilia in vitro. Using this system, samples of human respiratory cilia can be maintained in a stable and controlled environment for several hours. We measured cilia beat frequency of nasal respiratory epithelium from 10 healthy volunteers; cilia beat frequency was constant over a 4-h period, and measurements were found to be in good agreement with previously published work [1]. In a separate study we investigated the effect of a sleep dose of propofol on cilia beat frequency in samples from six patients undergoing minor surgery; samples were obtained before and immediately after induction of anaesthesia with propofol 2-3 mg kg-1. There was no statistically significant difference in cilia beat frequency between data obtained before and after induction with propofol.

The effect of halothane on human ciliated nasal epithelium was studied in vitro. Samples from 24 healthy adult volunteers were exposed to halothane in varying concentrations and cilia beat frequency was measured using the transmitted light technique. Mean cilia beat frequency was measured at 30-min intervals. There was a significant decrease in cilia beat frequency at 2 h in samples that were exposed to halothane (mean 8.4 (SD 2.5) Hz, 9.18 (2.6) Hz and 6.99 (4.9) Hz) compared with air (10.8 (2.7) Hz, 11.6 (2.1) Hz and 12.1 (2.3) Hz) (P < 0.01). The coefficient of variation of cilia beat frequency measurements increased after exposure to halothane. There was no change in the cilia beat frequency of controls exposed to air over a 3-h period.

Background: Low-to-middle income countries (LMICs) experience a high burden of disease from both non-communicable and communicable diseases. Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice.Aim: To identify and categorize barriers and strategies to evidence implementation in LMICs from published evidence implementation studies.Methods: A descriptive analysis of key characteristics of evidence implementation projects completed as part of a 6-month, multi-phase, intensive evidence-based clinical fellowship program, conducted in LMICs and published in the JBI Database of Systematic Reviews and Implementation Reports was undertaken. Barriers were identified and categorized to the Donabedian dimensions of care (structure, process, and outcome), and strategies were mapped to the Cochrane effective practice and organization of care taxonomy.Results: A total of 60 implementation projects reporting 58 evidence-based clinical audit topics from LMICs were published between 2010 and 2018. The projects included diverse populations and were predominantly conducted in tertiary care settings. A total of 279 barriers to implementation were identified. The most frequently identified groupings of barriers were process-related and associated predominantly with staff knowledge. A total of 565 strategies were used across all projects, with every project incorporating more than one strategy to address barriers to implementation of evidence-based practice; most strategies were categorized as educational meetings for healthcare workers.Linking Evidence to Action: Context-specific strategies are required for successful evidence implementation in LMICs, and a number of common barriers can be addressed using locally available, low-cost resources. Education for healthcare workers in LMICs is an effective awareness-raising, workplace culture, and practice-transforming strategy for evidence implementation. BACKGROUNDLow-to-middle income countries (LMICs) experience a high burden of disease from both non-communicable and communicable diseases (Ojo et al., 2019). Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice (Edwards, Zweigenthal, & Olivier, 2019). In LMICs, where resources are scarce and burden of disease is high, justification to intervene in healthcare practice must be based on high-quality, evidence-based findings (Edwards et al., 2019). However, despite a growing body of research to inform clinical decision-making that considers the best available evidence (

This paper discusses possible approaches to improving diabetes care and developing effective education models in China based on the experience of diabetes education in Australia. The prevalence of diabetes mellitus in China is increasing rapidly. China is currently second on the list of the top 10 countries with the highest diabetes burden. Enormous impact of diabetes on China health system is daunting and the urgent action is needed. Diabetes education is the keystone of diabetes care and structured self-management education is considered to be the key to successful outcomes. Although many diabetes education programmes have been initiated in China, barriers have been identified for implementation of the programmes. These include: lack of public awareness of diabetes; lack of standards of practice for diabetes educators; and lack of evaluation programmes to assess their performance. We suggest four possible approaches to addressing the current problems of diabetes education in China.

Background: Limited by the structure of individual health care settings and patient recruitment, primary studies do not provide a comprehensive definition of independent risk factors for methicillin-resistant Staphylococcus aureus (MRSA) colonisation among adults on admission to acute care settings. A systematic review was performed to identify and evaluate the association between risk factors and MRSA colonisation. Methods: MEDLINE, EMABSE, and CINAHL databases were searched for prognostic studies published between 1990 and 2010 that examined the association between risk factors and MRSA colonisation. The summary statistic extracted or calculated for each factor was the odds ratio (OR), comparing patients with MRSA colonisation to non-MRSA carriers. Results: Fifteen prospective studies, including a total 16,467 patients, were eligible for inclusion in the meta-analyses. More than 30 independent risk factors were identified and aggregated. The risk factors associated with MRSA colonisation in the meta-analyses include hospitalisation within the last 24 months (OR 3.4309, 95% CI 2.9732-3.9590, p < 0.0001), previous admission to a long-term care facility (LTCF) or a rehabilitation facility within the last 18 months (OR 6.7004, 95% CI 4.2609-10.5364, p = 0.0001), antibiotic use within the past 12 months (OR 3.7694, 95% CI 3.2453-4.3781, p < 0.0001), the presence of skin lesion (OR 3.525, 95% CI 2.6194-4.7437, p < 0.0001), surgical intervention within the last 60 months (OR 2.9807, 95% CI 2.5261-3.5172, p < 0.0001), indwelling urinary catheter (OR 4.3898, 95% CI 3.4317-5.6156, p < 0.0001), intensive care unit (ICU) admission in the last 5 years (OR 3.8845, 95% CI 1.6605-9.0871, p = 0.0018), previous MRSA colonisation (OR 6.7329, 95% CI 2.4504-18.4995, p = 0.0019), intra-hospital transfer (OR 2.0955, 95% CI 1.6966-2.5881, p < 0.0001), male sex (OR 1.8167, 95% CI 1.5180-2.1742, p < 0.0001), comorbidity of chronic health evaluation class C or D (OR 3.025, 95% CI 2.1844-4.1891, p < 0.0001), and the presence of fatal illness (OR 1.7591, 95% CI 1.4259-2.1702, p < 0.0001). Conclusion: The identification of risk factors for MRSA colonisation on admission may contribute to improved effectiveness and efficiency of current MRSA prevention strategies and control MRSA spread and acquisition in acute care settings. The outcomes of this review may facilitate prediction model development to quickly identify potential MRSA carriers before admission. More and larger scale prospective studies on risk factors for MRSA carriage in community settings are needed to explore the spread of MRSA among health care setting, community and carrier families.