There is an emergence of literature describing effective sensory modulation (SM) interventions to de-escalate violence and aggression among mental health inpatients. However, the evidence is limited to adult settings, with the effect of SM in youth acute settings unknown. Yet, before SM may be used as a de-escalation intervention in youth acute settings, multidisciplinary staff need to be educated about and supported in the clinical application of SM. In the current study, an online SM education package was developed to assist mental health staff understand SM. This was blended with action learning sets (ALS), small group experiential opportunities consisting staff and consumers to learn about SM resources, and the support of SM trained nurses. The aims of the study were to evaluate the effectiveness of this SM education intervention in (a) transferring knowledge of SM to staff, and (b) translating this knowledge into practice in a youth acute inpatient mental health unit. A mixed methods research design with an 11-item pre- and post-education questionnaire was used along with three-month follow-up focus groups. The SM education improved understanding about SM (all 11-items p ≤ 0.004, r ≥ 0.47). Three-months after SM education, four themes evident in the focus group data emerged about the practice and process of SM; (1) translating of learning into practice, (2) SM in practice, (3) perceptions of SM benefits, and (4) limitations of SM. A blended SM education process enhanced clinical practice in the unit, yet participants were mindful of limitations of SM in situations of distress or escalating agitation.

Direct plating of simulated stool specimens on MacConkey agar (MCA) with 10-g ertapenem, meropenem, and imipenem disks allowed the establishment of optimal zone diameters for the screening of carbapenem-resistant Gram-negative rods (CRGNR) of <24 mm (ertapenem), <34 mm (meropenem), and <32 mm (imipenem). Screening of stool specimens is recommended by the Centers for Disease Control and Prevention as well as the Institut national de santé publique du Québec to identify carriers of carbapenem-resistant Gram-negative rods (CRGNR) and initiate appropriate infection control measures (1, 2). Lolans and colleagues reported that an ertapenem zone diameter of Յ27 mm on MacConkey agar (MCA) was highly sensitive for the detection of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae in rectal swab specimens (3). However, the zone diameter interpretive criteria for imipenem and meropenem placed directly on MCA have not yet been established. This study compares the performances of the screening method using MCA and 10-g carbapenem disks (ertapenem, meropenem, and imipenem) and defines the optimal inhibition zone diameters for detecting CRGNR using simulated stool specimens.Thirty-nine clinical isolates have been well characterized, phenotypically and genotypically, as described in Table 1. Twenty carbapenemase-producing isolates (17 Enterobacteriaceae and 3 nonfermenters) were selected based on the presence of genes coding for different carbapenemases. Nineteen non-carbapenemase-producing Enterobacteriaceae (18 extended-spectrum ␤-lactamase [ESBL]-or plasmid-mediated AmpC [pAmpC] lactamase-producing isolates) and a susceptible wild-type Escherichia coli strain were also selected as negative controls. The MICs of ceftazidime, cefotaxime, ertapenem, meropenem, and imipenem were determined by the microdilution method according to the Clinical and Laboratory Standards Institute (4).A stool specimen obtained from a normal volunteer was used to prepare all the simulated clinical specimens. To ensure that the specimen did not harbor any ␤-lactam-resistant bacteria, screening tests were performed using ChromID ESBL, CHROMagar KPC, and MCA with ertapenem, meropenem, and imipenem disks. Each plate was inoculated with 100 l of liquefied stool and incubated 24 h aerobically at 35°C. There was no growth on the two selective chromogenic agar plates. For the MCA, inhibition diameters around the antibiotic disks were 29 mm, 39 mm, and 35 mm for ertapenem, meropenem, and imipenem, respectively.Dilutions of the 39 isolates were mixed with aliquots of stool. The simulated fecal material was inoculated onto the screening MCA medium to obtain final challenge concentrations of 10 4 to 10 1 CFU/ml for each strain. The fecal inoculum was spread on MCA by rotation using a rake spreader, and disks of the carbapenems were individually placed onto MCA. After incubation, the diameters of the inhibition zones around each carbapenem disk were measured.The results of all inhibition diameters obtained with the 4 dilutions tested for each...

Neonates are highly susceptible to infections owing to their immature cellular and humoral immune functions, as well the need for invasive devices. There is a wide practice variation in the choice and duration of antimicrobial treatment, even for relatively common conditions in the NICU, attributed to the lack of evidence-based guidelines. Early decisive treatment with broad-spectrum antimicrobials is the preferred clinical choice for treating sick infants with possible bacterial infection. Prolonged antimicrobial exposure among infants without clear indications has been associated with adverse neonatal outcomes and increased drug resistance. Herein, we review and summarize the best practices from the existing literature regarding antimicrobial use in commonly encountered conditions in neonates.

Introduction The use of restrictive interventions is one of the most controversial practices in medicine. They are utilized in an inpatient setting to manage agitated or aggressive behaviour or to ensure that an individual receives the necessary treatments. However, restrictive interventions remove autonomy and adverse events can be associated with their practice. Youth‐specific inpatient units (IPUs) are now being established and it is imperative that the use of restrictive interventions is reduced. In order to inform and facilitate prevention and reduction strategies, this study aimed to determine the prevalence and determinants of restrictive interventions (restraint, seclusion and medication without consent) in a youth specialist mental health IPU. Methods This study was set at a 16‐bed youth specialist acute IPU of Orygen Youth Health, a specialist youth mental health service that provides inpatient care for those aged 18 to 25 years within a catchment area of west and north‐western regions of Melbourne, Australia. A retrospective file audit was conducted of all the admissions to the unit from 01 January 2015 to 30 June 2015. Results Over the 6‐month study period, 159 young people were admitted and this accounted for 188 admissions. Over half (54.3%) of admissions were involuntary and restrictive intervention were used in 17.6% of admissions. Specifically, 15.7% (N = 25) of young people experienced restraint, 10.1% (N = 16) were secluded, and 8.1% (N = 12) experienced medication without consent. Absent insight and involuntary status on admission were associated with restrictive interventions. Conclusion As youth mental health services develop, interventions aimed at reducing restrictive interventions are needed.

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