Background: Candida auris (C. auris) is an emerging multidrug-resistant fungal pathogen linked to multiple healthcare-associated outbreaks in the United States. Combined treatment and containment costs typically range from $40,000 to $100,000 per case. C. auris colonizes multiple anatomical sites - including the gastrointestinal (GI) tract - and persists for days to weeks on environmental surfaces, even under routine disinfection protocols. These properties render conventional infection prevention and control (IPC) approaches insufficient. Fecal incontinence (FI) is highly prevalent in critically ill and non-ambulatory patients and creates a continuous, high-bioburden vehicle for GI shedding, environmental contamination, and onward C. auris transmission. Methods: Narrative review of contemporary peer-reviewed literature, U.S. Centers for Disease Control and Prevention (CDC) surveillance data, and published cost analyses addressing C. auris epidemiology, environmental persistence, GI colonization, and the role of FI containment in pathogen control. Searches were conducted in PubMed and CDC publications. Closed-loop automated stool management (ASM) was evaluated as a candidate component of multimodal IPC bundles. Results: Reported U.S. C. auris clinical cases rose by 95% between 2020 and 2021, and 4,514 new clinical cases were reported in 2023. A multicenter U.S. analysis of 192 hospitalizations (2017-2022) reported a 34% crude mortality rate, with 20% of cases representing bloodstream infections (47% mortality). More than 90% of clinical isolates demonstrate fluconazole resistance, and emergent echinocandin resistance has been documented. FI affects approximately 19 million U.S. adults and is reported in 33-40% of intensive care unit patients and 20-46% of long-term acute care residents; conventional management - adult diapers, absorbent pads, and indwelling balloon catheters (IBCs) - exhibits leakage rates of 40-78% and consumes 174-348 minutes of nursing time per patient per day. The Qoramatic Automated Stool Management system, a closed-loop device using low-grade intermittent negative-pressure suction with automated irrigation, achieved 100% successful fecal diversion with a 1.8% leakage rate in pivotal evaluation, reduced daily nursing time to approximately 6.8 minutes (initial) and 0.4 minutes (follow-up), and eliminated mucosal pressure-related injury. Conclusion: FI is an underappreciated but mechanistically important driver of C. auris environmental contamination and cross-transmission. Conventional FI management offers only partial, leakage-prone containment that sustains environmental bioburden. Closed-loop automated stool diversion may represent a practical, clinically safe, and operationally effective intervention to interrupt transmission pathways and merits consideration as a fundamental component of multimodal IPC bundles in high-acuity and long-term care settings where C. auris burden is greatest.
Background: Traditional medical oaths, including the Hippocratic Oath, have long symbolised ethical commitment in medicine, yet their largely unchanged content no longer aligns with contemporary clinical, legal, and cultural realities. Practices such as abortion, medically assisted dying, and culturally responsive care expose tensions between static ethical declarations and modern expectations. Aim: This commentary critiques the limitations of traditional oaths and proposes a revised framework that incorporates ethical flexibility, cultural safety, and meaningful accountability. Discussion: Historical and modern oaths contain rigid prohibitions that conflict with legally accepted and clinically justified practices in many jurisdictions. Their lack of enforceability further diminishes their practical relevance. Additionally, the absence of cultural safety perpetuates monocultural ethical assumptions that inadequately serve diverse patient populations. Comparative examples from reproductive health, medically assisted dying, and culturally diverse care contexts illustrate how contemporary practice outpaces existing ethical declarations. Conclusion: To remain relevant, medical oaths must evolve. Integrating ethical flexibility, cul-tural safety, and enforceable accountability can transform these declarations from symbolic ar-tefacts into meaningful guides for equitable and context-sensitive clinical practice.
Aim: The project aimed to investigate the impact of dietary interventions, specifically the African heritage diet (AHD), on managing chronic conditions among African immigrants. It sought to reduce chronic diseases like hypertension, diabetes, and obesity and promote adherence to healthy dietary regulations by addressing ethnic food behaviors through culturally appropriate food guidelines. Subject and Methods: Over 12 weeks, participants engaged in an intervention program emphasizing education on cooking techniques, salt intake, and the historical context of African meals. The project collaborated with dietitians to analyze the caloric content of indigenous African family diets and developed culturally relevant guidelines. Pre- and post-questionnaires were administered to evaluate knowledge, attitudes, and experience. Results: • Blood Pressure: 80% of participants experienced an average decrease of 20 mmHg in systolic blood pressure, and 100% saw a 5-mmHg reduction in diastolic blood pressure. • Diabetes: Slight decreases were noted in fasting blood glucose, with 50% of participants showing an average 1% reduction in hemoglobin A1C levels. • BMI: Improvements were recorded in BMI. • Knowledge and Attitude: Pre- and post-questionnaires demonstrated enhanced knowledge, attitudes, and overall experience. Conclusion: The dietary intervention effectively addressed health disparities and empowered individuals to self-manage, alleviating chronic disease burdens in underserved communities. However, the results suggest a more robust, longer-term intervention to sustain and enhance these outcomes.
Background: Neonates admitted to the Neonatal Intensive Care Unit (NICU) often undergo numerous painful procedures and interventions that, if inadequately managed, can lead to adverse neurodevelopmental outcomes and increased stress responses. Managing pain in neonates is thus essential, but the most effective approach remains unclear. While both pharmacological and non-pharmacological strategies are widely used, a systematic comparison is needed to determine which is more beneficial. Objective: To evaluate and compare the effectiveness of pharmacological versus non-pharmacological pain management strategies in neonates admitted to the NICU. Methods: A comprehensive search of PubMed, Cochrane Library, EMBASE, and CINAHL databases was conducted for studies published between January 2000 and October 2024. Studies were selected based on predefined inclusion criteria, including randomized controlled trials (RCTs) and observational studies that compared pharmacological with non-pharmacological pain management in neonates. Data extraction and quality assessment were independently performed by two reviewers using standardized tools. Results: From 1200 articles only 25 studies met the inclusion criteria. Pharmacological interventions such as oral sucrose, paracetamol, and opioids were effective in reducing pain scores during acute painful procedures. Non-pharmacological strategies, including skin-to-skin contact, breastfeeding, and facilitated tucking, were equally effective and had the advantage of fewer adverse effects. Conclusion: Both pharmacological and non-pharmacological approaches are effective in managing neonatal pain in the NICU setting. Given the non-invasive nature and low risk of side effects associated with non-pharmacological methods, they should be considered as the first line of treatment. Further studies are needed to establish standardized protocols for combining these methods to optimize pain management.
