No abstract

Background Excessive and inappropriate use of antibiotics is the most important driver of antimicrobial resistance. The aim of the HAPPY PATIENT project is to evaluate the adaptation of European Union (EU) recommendations on the prudent use of antimicrobials in human health by evaluating the impact of a multifaceted intervention targeting different categories of healthcare professionals (HCPs) on common community-acquired infectious diseases, especially respiratory and urinary tract infections. Methods/design HAPPY PATIENT was initiated in January 2021 and is planned to end in December 2023. The partners of this project include 15 organizations from 9 countries. Diverse HCPs (doctors, nurses, pharmacists, and pharmacy technicians) will be audited by the Audit Project Odense (APO) method before and after an intervention in four different settings: general practice, out of hours services, nursing homes and community pharmacies in four high antibiotic prescribing countries (France, Poland, Greece, and Spain) and one low prescribing country (Lithuania). About 25 individuals from each professional group will be recruited in each country, who will register at least 25 patients with community-acquired infections during each audit period. Shortly before the second registration participants will undertake a multifaceted intervention and will receive the results from the first registration to allow the identification of possible quality problems. At these meetings participants will receive training courses on enhancement of communication skills, dissemination of clinical guidelines with recommendations for diagnosis and treatment, posters for the waiting rooms, and leaflets for patients. The results of the second registration will be compared with those obtained in the first audit. Discussion HAPPY PATIENT is an EU-funded project aimed at contributing to the battle against antibiotic resistance through improvement of the quality of management of common community-acquired infections based on interventions by different types of HCPs. It is hypothesized that the use of multifaceted strategies combining active intervention will be effective in reducing inappropriate prescribing and dispensing of antibiotics. Study registration EU Health programmes project database https://webgate.ec.europa.eu/chafea_pdb/health/projects/900024/summary; date of registration: 1 January 2021.

The unsaturated cobalamin binding capacity of transcobalamin and haptocorrin was studied in cerebrospinal fluid (CSF) and plasma (P) from 37 reference individuals. These comprised 27 males and 10 females who underwent minor surgery in spinal anaesthesia. The 5th and 95th percentiles were as follows: P‐Transcobalamin 300 ‐ 870 pmol/l (median 550 pmol/l) CSF‐Transcobalamin 90 ‐ 540 pmol/l (median 194 pmol/l) P‐Haptocorrin 75 ‐ 290 pmol/l (median 159 pmol/l) CSF‐Haptocorrin 10 ‐ 41 pmol/l (median 21 pmol/l) No sex difference was found between the levels of haptocorrin or transcobalamin in plasma or cerebrospinal fluid. A positive correlation between P‐Transcobalamin and CSF‐Transcobalamin was found, whereas no correlation between P‐Haptocorrin and CSF‐Haptocorrin values was found. The plasma/CSF ratios of transcobalamin, haptocorrin, albumin and IgG indicated that the binders may be synthetized into the cerebrospinal fluid or are actively being transported into the cerebrospinal fluid.

Transcobalamin (TC) and haptocorrin (HC) are present in normal seminal plasma in substance concentrations ten- to twenty-fold that in blood. The results are given in range and (median). The substance concentration of seminal plasma TC is 3.6-21.9 (8.4) nmol l-1 and of seminal plasma HC 1.4-8.6 (3.0) nmol l-1. Compared to normals the substance concentration of TC is significantly lowered in post-vasectomy seminal plasma 2.2-2.9 (5.3) nmol l-1. The Stokes radius and the isoelectric points of seminal plasma TC are identical to TC in blood.