Disinfection of human musculoskeletal allografts in tissue banking: a systematic review

Musculoskeletal allografts are typically disinfected using antibiotics, irradiation or chemical methods but protocols vary significantly between tissue banks. It is likely that different disinfection protocols will not have the same level of microorganism kill; they may also have varying effects on the structural integrity of the tissue, which could lead to significant differences in terms of clinical outcome in recipients. Ideally, a disinfection protocol should achieve the greatest bioburden reduction with the lowest possible impact on tissue integrity. A systematic review of three databases found 68 laboratory and clinical studies that analyzed the microbial bioburden or contamination rates of musculoskeletal allografts. The use of peracetic acid–ethanol or ionizing radiation was found to be most effective for disinfection of tissues. The use of irradiation is the most frequently published method for the terminal sterilization of musculoskeletal allografts; it is widely used and its efficacy is well documented in the literature. However, effective disinfection results were still observed using the BioCleanse? Tissue Sterilization process, pulsatile lavage with antibiotics, ethylene oxide, and chlorhexidine. The variety of effective methods to reduce contamination rate or bioburden, in conjunction with limited high quality evidence provides little support for the recommendation of a single bioburden reduction method.     

Disinfection of human cardiac valve allografts in tissue banking: systematic review report

Cardiovascular allografts are usually disinfected using antibiotics, but protocols vary significantly between tissue banks. It is likely that different disinfection protocols will not have the same level of efficacy; they may also have varying effects on the structural integrity of the tissue, which could lead to significant differences in terms of clinical outcome in recipients. Ideally, a disinfection protocol should achieve the greatest bioburden reduction with the lowest possible impact on tissue integrity. We conducted a systematic review of methods applied to disinfect cardiovascular tissues. The use of multiple broad spectrum antibiotics in conjunction with an antifungal agent resulted in the greatest reduction in bioburden. Antibiotic incubation periods were limited to less than 24 h, and most protocols incubated tissues at 4 °C, however one study demonstrated a greater reduction of microbial load at 37 °C. None of the reviewed studies looked at the impact of these disinfection protocols on the risk of infection or any other clinical outcome in recipients.     

Disinfection of human skin allografts in tissue banking: a systematic review report

The use of skin allografts to temporarily replace lost or damaged skin is practiced worldwide. Naturally occurring contamination can be present on skin or can be introduced at recovery or during processing. This contamination can pose a threat to allograft recipients. Bacterial culture and disinfection of allografts are mandated, but the specific practices and methodologies are not dictated by standards. A systematic review of literature from three databases found 12 research articles that evaluated bioburden reduction processes of skin grafts. The use of broad spectrum antibiotics and antifungal agents was the most frequently identified disinfection method reported demonstrating reductions in contamination rates. It was determined that the greatest reduction in the skin allograft contamination rates utilized 0.1 % peracetic acid or 25 kGy of gamma irradiation at lower temperatures.     

Reproductive tissue banking: Scientific principles

edited by A.M. Karow and J.K. Critser, Academic Press, 1997, 472 pp, $99.00. © 1998 Wiley-Liss, Inc.     

Homograft banking in Singapore: two years of cardiovascular tissue banking in Southeast Asia

Established in 2008, the National Cardiovascular Homograft Bank (NCHB) has been instrumental in creating an available supply of cardiovascular tissues for implantation in Singapore. This article introduces its collaboration with Singapore General Hospital Skin Bank Unit. The procedure of homograft recovery, processing, cryopreservation and quality assurance are presented. Since its establishment, the NCHB has followed the guidelines set by the Ministry of Health Singapore and the American Association of Tissue Banks. A total of 57 homografts had been recovered and 40 homografts were determined to be suitable for clinical use. The most significant reasons for non-clinical use are positive microbiological culture or unsuitable graft condition. Crucial findings prompted reviews and implementation of new procedures to improve the safety of homograft recipients. These include (1) a change in antibiotic decontamination regime from penicillin and streptomycin to amikacin and vancomycin after a review and (2) mandating histopathogical examination since the discovery of cardiac sarcoidosis in a previously undiagnosed donor. Further, the NCHB also routinely performs dengue virus screening, for donors suspected of dengue infection. Cultural factors which affect the donation rate are also briefly explored. By 2010, 31 homografts had been implanted into recipients with congenital or acquired heart valve conditions. More than half of these recipients were children. Post-operative outcomes had been encouraging, with no report of adverse events attributed to implanted homografts.     

Sexual systems in gymnosperms: A review

The aim of this study was to update figures for the presence of dioecy among the gymnosperms and investigate its correlation with climate, growth form, pollination and seed dispersal syndromes, and risk of extinction. Dioecy was found in almost 65% of contemporary gymnosperm species, a higher percentage than previous estimates. It dominates in 8 of the 12 families. As in angiosperms, dioecious gymnosperms are particularly common in climbers and are more commonly found in tropical climates. Analysis of the degree of threat using IUCN red list categories showed that the proportion of threatened species is higher in dioecious than in monoecious species only in temperate climate. The high sensitivity of dioecious species to environmental changes associated with human activity in temperate climate may explain this phenomenon. The monophyly of extant gymnosperms and the relatively small number of species (about 1000) create the possibility of treating them as a model group in investigating the evolution of sexual systems.     

Rare earth elements in soil and plant systems - A review

The rare earth elements (REEs) form a chemically uniform group and include yttrium (Y), lanthanum (La) and the lanthanides cerium (Ce), praseodymium (Pr), neodymium (Nd), promethium (Pm), samarium (Sm), europium (Eu), gadolinium (Gd), terbium (Tb), dysprosium (Dy), holmium (Ho), erbium (Er), thulium (Tm), ytterbium (Yb), and lutetium (Lu). Their average abundance in the Earth’s crust range from 66μg g⁻¹ in Ce to 0.5μg g⁻¹ in Tm and ?0.1μg g⁻¹ in Pm. Recent great improvements in more routine analytical technique, the use of REEs as fertilisers, at least in East Asian agriculture, and the importance of these elements as indicators in both pedological and physiological processes and reactions have contributed to an increased interest in these previously less considered elements in environmental sciences. This review of recent and current literature deals with REEs in primary and secondary soil minerals, concentrations in surface soils, factors influencing adsorption, solubility and transport in soils, including weathering and transformations of REE minerals, and vertical distribution in soil profiles. Reviewed and discussed are also concentrations, distribution and localisation of REEs in plants and plant organs, soil-plant relationships and interactions, effects on plant growth and crop production and their importance in plant physiology and biochemistry. The REEs are found, usually several elements together, as phosphates, carbonates and silicate minerals finely dispersed especially in magmatic and metamorphic rocks. REE concentrations in surface soils of humid climates, such as the A(E)-horizons of Podzols and Laterites, are usually lower than in the parent material, due to higher weathering and leaching rates than of the average soil constituents. Some fractionation may occur due to the formation of more element-specific secondary minerals. Transfer from soil to plant is usually low, but extreme accumulators are found, e.g., among several species of ferns. Roots have generally higher concentrations than shoots. Possible uptakemechanisms of REEs are discussed. Uptake is positively, though often weakly, correlated with soil acidity and easily soluble concentrations of the elements, but rarely well related to their total concentrations in the soil. Under certain conditions, low concentrations of at least some REEs seem to favour plant growth and productivity, but the physiological mechanisms are still not well understood. Some considerations concerning the boundary between essential and non-essential micro nutrients are discussed.     

Advances of radiation sterilisation in tissue banking

Under the auspices of the IAEA tissue banking programme on “Radiation Sterilisation of Tissue Graft” conducted from 1985 to 2004, many scientists and surgeons were involved in various regional research and development (R&D) projects mainly in dealing with radiation dose selection, radiation effects on human tissues and quality system in radiation sterilisation. New findings on radiation effects, tissue processing and preservation were shared during the regional and interregional meetings and workshops. Many tissue banks started to use radiation (25 kGy) to sterilize tissue grafts for tissue safety and efficacy and still continue to use it. The IAEA Code of Practice for Radiation Sterilization of Tissues Allografts developed in 2007 offered simpler methods to conduct radiation dose setting and dose validation experiments for tissue grafts. Advances in dose selection and dose mapping are continued under the quality management system when banks need to be certified to continue their operation. The combination of good tissue processing and preservation as well as good radiation practice will ensure the tissue products are properly sterilised thus safe and of high quality. Experience in meeting challenges in using radiation sterilisation and achievements reported by the tissue bankers are shared here.     

Donation transplants and tissue banking in Mexico

Knowledge about transplants in Mexico goes back to the Aztec period.Today the need for organ and tissue transplants in Mexico is high; theestimatednumber is 100,000 patients, but there are only 2 donors per million population,for corneas. The organ, tissue and cell transplantation law which was modifiedin 2,000, establishes that when a person dies, he will be a potential donor oforgans and tissues. This new law will give hope to many patients, since it isexpected to increase significantly the amount of organs and tissues fortransplants. At present Mexico has 178 hospitals that are authorized to carryout organ and tissue transplants, and 53 Tissue Banks.     

40 years of tissue banking in Estonia

A survey is given of the development of tissue banking in Estonia during40 years, in which we address methods of tissue preservation, application ofpreserved skeletal tissues in orthopaedics as well as issues of clinical andexperimental research in this area. Preparation and use of demineralized andmorselized bone allografts has been significant during the last ten years.Progress of endoprosthetic joint surgery has essentially increased the need forbone transplantation in orthopaedics.     

Reproductive performance of African indigenous small ruminants under various management systems: A review

Empirical data for a series of reproductive traits from a range of sources (National Agricultural Research Systems and individual studies) in different agro-ecological zones and under several systems of management are presented and discussed. Goats and sheep give birth for the first time at about 17 months. Litter sizes of goats average 1.38 kids and litter sizes of sheep 1.16 lambs. Intervals between births are about 10 months. Total lifetime production of young is better in goats than in sheep. African small ruminants have the capacity to breed all the year round. Better performance is achieved in traditional systems where breeding is uncontrolled than on research stations, although litter sizes generally appear to be larger on stations than in the traditional systems. Better management of the reproductive process could lead to greatly improved output of young.     

Computerized clinical decision support systems for chronic disease management: A decision-maker-researcher partnership systematic review

Background

The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations).

Methods

We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes.

Results

Of 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported.

Conclusions

A small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes.     

Combined biological hydrogen-producing systems: A review

Possible ways for combining various biological processes of biohydrogen production are described. Some of these processes are being intensively studied now, whereas others are theoretically feasible, but have not been studied. A special focus is on the factors that influence the efficiency of coupled systems.     

Floating drug delivery systems: A review

The purpose of writing this review on floating drug delivery systems (FDDS) was to compile the recent literature with special focus on the principal mechanism of floatation to achieve gastric retention. The recent developments of FDDS including the physiological and formulation variables affecting gastric retention, approaches to design single-unit and multiple-unit floating systems, and their classification and formulation aspects are covered in detail. This review also summarizes the in vitro techniques, in vivo studies to evaluate the performance and application of floating systems, and applications of these systems. These systems are useful to several problems encountered during the development of a pharmaceutical dosage form. Published: October 19, 2005     

Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

Background

In the past forty years, many gains have been made in our understanding of the concept of research utilization. While numerous studies exist on professional nurses' use of research in practice, no attempt has been made to systematically evaluate and synthesize this body of literature with respect to the extent to which nurses use research in their clinical practice. The objective of this study was to systematically identify and analyze the available evidence related to the extent to which nurses use research findings in practice.

Methods

This study was a systematic review of published and grey literature. The search strategy included 13 online bibliographic databases: Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE, HAPI, Web of Science, SCOPUS, OCLC Papers First, OCLC WorldCat, ABI Inform, Sociological Abstracts, and Dissertation Abstracts. The inclusion criteria consisted of primary research reports that assess professional nurses' use of research in practice, written in the English or Scandinavian languages. Extent of research use was determined by assigning research use scores reported in each article to one of four quartiles: low, moderate-low, moderate-high, or high.

Results

Following removal of duplicate citations, a total of 12,418 titles were identified through database searches, of which 133 articles were retrieved. Of the articles retrieved, 55 satisfied the inclusion criteria. The 55 final reports included cross-sectional/survey (n = 51) and quasi-experimental (n = 4) designs. A sensitivity analysis, comparing findings from all reports with those rated moderate (moderate-weak and moderate-strong) and strong quality, did not show significant differences. In a majority of the articles identified (n = 38, 69%), nurses reported moderate-high research use.

Conclusions

According to this review, nurses' reported use of research is moderate-high and has remained relatively consistent over time until the early 2000's. This finding, however, may paint an overly optimistic picture of the extent to which nurses use research in their practice given the methodological problems inherent in the majority of studies. There is a clear need for the development of standard measures of research use and robust well-designed studies examining nurses' use of research and its impact on patient outcomes. The relatively unchanged self-reports of moderate-high research use by nurses is troubling given that over 40 years have elapsed since the first studies in this review were conducted and the increasing emphasis in the past 15 years on evidence-based practice. More troubling is the absence of studies in which attempts are made to assess the effects of varying levels of research use on patient outcomes.     

The tissue banking in cancer and stem cell research

The Sapio Award was established in 1999 by the Sapio Group along with several Italian universities and research centers to recognize Italian scientists who have made a major contribution to the discovery or development of novel technologies in the fields of biotechnology, social and health services, nonotechnology and biosecurity in agricultural production and scientific distribution. The 2006 edition of the award meeting centered around the issues of tissue banks and biorepositories and translational medicine. The organizing committee divided this edition into a pre-meeting held in Milan on October 18, 2006 and a master meeting on October 19, 2006, held at the ISS in Rome. A summary of these meetings is given.     

Overview on radiation and tissue banking in Latin America

The International Atomic Energy Agency (IAEA) played an important role in the establishment of new tissue banks and the improvement of already existing ones in Latin America. The Agency strongly supported, through regional, interregional and national technical cooperation projects, providing equipment, expert missions and training for the production and application of human tissues for transplantation. From 1999 to 2005 five regional courses were given in Buenos Aires under the modality of 1-year distance learning training courses and 1-week face to face courses. The courses were organized by the IAEA, through the National Atomic Energy Commission (CNEA) and the Faculty of Medicine of Buenos Aires University as Post Graduate Specialization Course. In 2005 the Latin American countries joined with Spain and Portugal, and created the Ibero American Network Council of Donation and Transplant (Red Consejo Iberoamericano de Donación y Trasplantes—RCIDT). The objective of this network is to cooperate among twenty-one Ibero American countries in organizational and legislative aspects, training of professionals, and ethical and social issues related to the donation and transplantation of organs, tissues and cells. The members of this Network work actively to harmonize the regulations and the control of donation and transplantation of human organs, tissues and cells. At present, in Latin America, more than 220 facilities of tissues banks are operating and tissue allografts are being produced by single and multi-tissue banks. The efforts made by the governments and professionals from the region allow the tissue banks to operate under quality systems and introduce new technologies.