Multi-donor Fecal Microbial Transplantation for Critically Ill Patients: Rationale and Standard Operating Procedure

Patients in intensive care unit often lose a considerable fraction of their gut microbiome due to exposure of broad-spectrum antibiotics and other reasons. Dysbiosis often results in prolonged diarrhea and increase occurrence of multi-drug resistant pathogens in the colon with clinical consequences not yet well understood. Restoring the microbioma by faecal microbial transplantation (FMT) is a plausible therapeutic possibility, so far only documented in case reports and case series using very heterogeneous methodologies. Before FMT in critically ill can be tested in randomised controlled trials, there is a burning need to describe a standardized operating procedure (SOP) of the whole process, respecting the specifics of critically ill population, such as the risk of disrubted intestinal barrier and time critical nature of the procedure. We describe the SOP that has been developed for experimental use in critically ill patients by a multidisciplinary team of intensivists, gastroenterologist and microbiologist based on feedback from regulatory authority (State Institue of Drug Control of the Czech Republic). The hallmarks of these SOPs are multi-donor freshly frozen transplantate quaranteeded for 3 months consisting of 7 aliqutes from 7 unrelated healthy donors, and administered by rectal tube. In this paper we discuss the rationale for this SOP and the process of its development in details and release the full proposed SOP is in the form of online appendix.

Bayesian paired comparison with the bpcs package

This article introduces the R package (Bayesian Paired Comparison in Stan) and the statistical models implemented in the package. This package aims to facilitate the use of Bayesian models for paired comparison data in behavioral research. Bayesian analysis of paired comparison data allows parameter estimation even in conditions where the maximum likelihood does not exist, allows easy extension of paired comparison models, provides straightforward interpretation of the results with credible intervals, has better control of type I error, has more robust evidence towards the null hypothesis, allows propagation of uncertainties, includes prior information, and performs well when handling models with many parameters and latent variables. The package provides a consistent interface for R users and several functions to evaluate the posterior distribution of all parameters to estimate the posterior distribution of any contest between items and to obtain the posterior distribution of the ranks. Three reanalyses of recent studies that used the frequentist Bradley–Terry model are presented. These reanalyses are conducted with the Bayesian models of the package, and all the code used to fit the models, generate the figures, and the tables are available in the online appendix.

Coalition Governance in Western Europe

Coalition government is the most frequent form of government in Western Europe, but there is relatively little systematic knowledge about how this form of government has developed in recent decades. This volume analyses governments that have formed in the Western European countries since the Second World War and covers the full life cycle of coalition governments from the formation of party alliances before elections to coalition formation after elections, governing and policy-making when parties work together in office, and the stages that eventually lead to governments terminating. Since the early 1990s, many coalition governments form in a context of increased fragmentation of party systems, increased polarization, and the rise of populist parties. The volume captures these changes and examines their implications for the different stages of the coalition life cycle. A particular emphasis of the volume is on the study of how coalitions govern together even when they have different agendas. Do individual ministers decide, or the prime minister, or are the policy outputs of a government a result of a process of coalition compromise? Focusing on the coalition governance stage, we analyse the variation in the use of various control mechanisms across countries, for example showing that many coalition governments draft extensive contracts to control their partners in cabinet. The volume covers 16 West European countries and introduces the case of Croatia. Systematic cross-national data is available in an online appendix.

Challenges and opportunities in point-of-care ultrasound: A qualitative exploration of respiratory physiotherapists’ experiences of lung ultrasound training and its adoption in critical care

Introduction Diagnostic lung ultrasound (LUS) is gaining popularity among respiratory physiotherapists as an imaging modality to aid pulmonary assessments, guide intervention selection, and monitor the efficacy of chosen interventions. The ability of respiratory physiotherapists to incorporate LUS into their clinical practice is influenced by multiple factors to adoption and implementation. The aim of this study was to explore the experiences of senior respiratory physiotherapists who have attempted to adopt and implement LUS into their clinical practice in critical care. It is hoped these experiences will inform the development of educational and adoption strategies for the future implementation of LUS. Methods Following a national call out, eight senior critical care respiratory physiotherapists were purposively selected to be interviewed using semi-structured questions exploring their varied experiences of LUS adoption into clinical practice in critical care. The transcribed data were thematically analysed. Results Five main themes emerged from the participants’ responses: (i) support for physiotherapists using LUS, (ii) knowledge and understanding of LUS evidence, (iii) governance, (iv) physiotherapists’ motivation to use LUS, and (v) resources. Quotes for each of the five themes are given as exemplars. Conclusion Participants reported a range of factors that influenced their ability to adopt and implement LUS into practice several were enabling, and others were barriers to progress. Online Appendix 1 contains recommendations from the authors to help guide managers and clinicians wishing to adopt LUS into respiratory physiotherapy services and patient pathways.