Modified poly(L-lysine)-based structures as novel antimicrobials for diabetic foot infections, an in-vitro study

Background: Wound infections occur as sequelae to skin trauma and cause significant hospitalizations, morbidity and mortality. Skin traumas arise more frequently in those with diabetes or cardiovascular disease and in these settings, may be chronic with poorer outcomes including lower limb amputation. Treatment of chronic wound infection is challenging due to antibiotic resistance and biofilm formation by bacteria including S. aureus and P. aeruginosa, which are among the most frequent causative pathogens. Managing these challenging infections requires new molecules and modalities. Methods: We evaluated antimicrobial and anti-biofilm activity of star-shaped poly(L-lysine) (PLL) polymers against S. aureus and P. aeruginosa strains and clinical isolates recovered from wounds including diabetic foot wounds (DFW) in a Dublin Hospital in 2019. A star-shaped PLL polypeptide series, specifically G2(8)PLL20, G3(16)PLL10, G4(32)PLL5 with variation in polypeptide chain length and arm-multiplicity, were compared to a linear peptide, PLL160 with equivalent number of lysine residues. Results: All PLLs, including the linear polypeptide, were bactericidal at 1mM against S. aureus 25923 and P. aeruginosa PAO1, with log reduction in colony forming units/ml between 2.7-3.6. PLL160 demonstrated similar killing potency against 20 S. aureus and five P. aeruginosa clinical isolates from DFW, mean log reductions: 3.04 ± 0.16 and 3.96 ± 0.82 respectively after 1 hour incubation. Potent anti-biofilm activity was demonstrated against S. aureus 25923 but for clinical isolates, low to moderate loss of biofilm viability was shown using PLL160 and G3(16)PLL10 at 50 mM (S. aureus) and 200 mM (P. aeruginosa) with high inter-isolate variability. In the star-shaped architecture, antimicrobial activity was retained with incorporation of 5-mer hydrophobic amino-acid modifications to the arms of the polypeptides (series G3(16)PLL20-coPLT5, G3(16)PLL20-coPLI5, G3(16)PLL20-coPLP5). Conclusion: These polypeptides offer structural flexibility for clinical applications and have potential for further development, particularly in the setting of diabetic foot and other chronic wound infections.

Veterinary Professionals’ Understanding of Common Feline Behavioural Problems and the Availability of “Cat Friendly” Practices in Ireland

Veterinary behavioural medicine (VBM) is an integral aspect of veterinary practice. However, Golden and Hanlon (Ir. Vet. J. 71:12, 2018) found that the majority of professionals surveyed felt they had received inadequate VBM education and were commonly asked to give advice on feline behavioural problems. The purpose of this study was to explore understanding of feline VBM and the availability of “cat friendly” provisions in clinical practice in Ireland. An online survey comprised 21 questions on professional role and experience, vignettes of common feline behavioural problems, and “cat friendly” practice management. Using a Likert Scale, participants were requested to score whether the advice depicted in vignettes supported best outcome based on the definition by Shalvey et al. (Ir. Vet. J. 72:1, 2019). The survey was distributed via professional organisations, social media, and at the University College Dublin Hospital Conference. Forty-two veterinary practitioners (VPs) and 53 veterinary nurses (VNs) completed the survey. The majority of veterinary professionals agreed with our classification of best outcome, but some areas of disagreement and uncertainty were identified. In addition, there were significant differences between VPs and VNs regarding spraying (p = 0.033), self-mutilation (p = 0.016), and resource-based aggression (p = 0.013). Relatively few “cat friendly” measures were implemented in respondents’ clinics. Our findings support the need for increased education in feline VBM, in particular, implementation of cat friendly practice initiatives.

295 Characteristics of Older Hip Fracture Adults Admitted to a Dublin Hospital

Background Hip fractures are common in older adults and are associated with increased mortality and morbidity resulting in medical and socioeconomic burden for healthcare system and patient alike. Methods A retrospective study was conducted on patients admitted to a Dublin hospital for hip fracture repair between October 2018 and February 2019. Data on sociodemographic characteristics such as; gender; age; pre-admission residence; fracture history; bone protection medication use; pre-fracture mobility; discharge mobility and destination; length of stay and mortality rate was collected. Results 50 patients admitted between 01/10/19 and 31/01/2019. 2:1 female to male. Average age 78 ranging from 48-93. 88% admitted from home. 44% had previous fractures. Vertebral (36%), wrist (23%) and pelvic (23%) most common fractures. 27% of these were on bone protection medication on admission. 41% were taking Calcium and Vit D or Vitamin D only. 70% of participants were independently mobile pre-fracture. 94% required some form of mobility aid on discharge. The average length of stay was 32 days ranging from 2 to 160 days. 38% went home whilst 36% were discharged to rehabilitation. 88% were discharged on bone protection medication - 70% received IV Zoledronic acid as inpatients, 14% commenced Prolia 6 monthly injections and 4% on oral bisphosphonates. Mortality rate was 6% Conclusion Hip fractures have a negative effect on a person’s mobility. Whilst many guidelines for the assessment and treatment of osteoporosis recommend intervention be considered in men and women who have sustained a fragility fracture, it is clear from this study that an osteoporosis care gap exists and further work is required to better identify, assess and treat patients following their first fracture in the hope of reducing further fractures, particularly hip and vertebral fractures.

34 A Review of the Implementation of a Stroke Education Programme in a Dublin Teaching Hospital in 2018

Background Aim: To commence Stroke education in a specific Dublin Hospital to improve the assessment of management of Stroke patients. Methods Seven 1 day study days were organised in 2018. These study days were multidisciplinary team (MDT) led with theory in the morning session delivered by the Stroke Clinical Nurse Specialist (CNS) followed by MDT led workshops in the afternoon. Stroke education was delivered to Emergency Department (ED) doctors on each rotation. Whiteboard education sessions were carried out for nurses on Medicine for the Elderly Ward/Stroke Unit. Results A total of 103 health professionals were trained over the 7 study days. Stroke Study Day attendances consisted of 69 RGN/CNMs 26 student nurses (21 intern nurses who are now staff nurses working in the hospital), 2 Allied Health Professionals, 1 CNS and 5 from Practice development. 32 ED doctors were trained over 3 separate induction days. Weekly scenario based sessions with nurses on the Stroke Ward. Conclusion Staff applying the learned knowledge and competencies to Stroke patients has significantly improved following the commencement of the education. 100% of staff who attended the Stroke study day stated that the training improved their knowledge and skills. 100% of staff would recommend the Stroke Study Day to other colleagues. We aim to continue the study days and whiteboard sessions with health professionals in all wards in 2019.

Does admission via an Acute Medical Unit influence hospital mortality? 12 years’ experience in a large Dublin Hospital

Background: Following an emergency medical admission, patients may be admitted an acute medical assessment unit (AMAU) or directly into a ward. An AMAU provides a structured environment for their initial assessment and treatment. Methods: All emergency admissions (66,933 episodes in 36,271 patients) to an Irish hospital over an 12-year period (2002-2013) were studied with 30-day in-hospital mortality as the outcome measure. Univariate Odds Ratios, by initial patient allocation, and the fully adjusted Odds Ratios were calculated, using a validated logistic regression model. Results: Patients, by design, were intended to be admitted initially to the AMAU (<= 5 day stay). Capacity constraints dictated that only 39.8% of patients were so admitted; the remainder bypassed the AMAU to a ward (60.2%). All patients remained under the care of the admitting consultant/team. We computed the risk profile for each group, using a multiple variable validated model of 30-day in-hospital mortality; the model indicated the same risk profile between these groups. The univariate OR of an in-hospital death by day 30 for a patient initially allocated to the AMAU, compared with an initial ward allocation was 0.76 (95% CI: 0.71, 0.82- p<0.001). The fully adjusted risk for patients was 0.67 (95% CI: 0.62, 0.73- p<0.001). Conclusion: Patients, with equivalent mortality risk, allocated initially to AMAU or a more traditional ward, appeared to have substantially different outcomes.