Capturing the Use of Dietary Supplements in Electronic Medical Records: Room for Improvement.

Of importance to federal agencies that administer health care facilities is capturing patient use of dietary supplements (DS) to avoid potential drug - supplement interactions. Digital technologies, such as use of the electronic medical record and the electronic health record (EHR) are key to monitoring health care. The particular electronic software package and the health care professional using this software influences how this documentation is recorded. A survey was conducted to determine how information on DS is being collected, recorded, and processed in EHR across federal agencies. Four federal agencies providing direct health care services to large numbers of men and women in the US were surveyed on current practices regarding the recording and processing of information on DS use either on outpatient or inpatient basis. A point of contact for each of the following federal agencies was identified, and a 13-question survey was sent to each for completion: NIH Clinical Center, Department of Defense (DoD) Military Nutrition Committee, Veterans Health Administration (VHA) Office of Specialty Care Services, and the Indian Health Service (IHS), Office of Information Technology. All four agency representatives completed the survey. No agency used the same EHR software reporting system. Most EHR have searchable fields that are in a structured format, but some information is free text and allowed entry by multiple members of the health-care team. Three different medication formulary or drug knowledge databases were utilized across the agencies. Most agencies using EHR management systems have adequately described procedures for entering and charting information on DS. The responsibility for charting, however, varies across agencies whether captured by the admitting doctor, nurse, dietitian, or pharmacist. Direct linkage between the pharmacy system and the drug knowledge database is a feature of the EHR for several but not all federal agencies. An unmet need still exists in the EHR to implement DS/drug interaction checks as many DS products have multiple active ingredients and when taken with other DS or prescription drugs increase the likelihood of an adverse event. Establishing common EHR practices could facilitate monitoring the use and potential interactions of DS with prescribed drugs.

Probing dynamic cell-substrate interactions using photochemically generated surface-immobilized gradients: application to selectin-mediated leukocyte rolling.

Model substrates presenting biochemical cues immobilized in a controlled and well-defined manner are of great interest for their applications in biointerface studies that elucidate the molecular basis of cell receptor-ligand interactions. Herein, we describe a direct, photochemical method to generate surface-immobilized biomolecular gradients that are applied to the study of selectin-mediated leukocyte rolling. The technique employs benzophenone-modified glass substrates, which upon controlled exposure to UV light (350-365 nm) in the presence of protein-containing solutions facilitate the generation of covalently immobilized protein gradients. Conditions were optimized to generate gradient substrates presenting P-selectin and PSGL-1 (P-selectin glycoprotein ligand-1) immobilized at site densities over a 5- to 10-fold range (from as low as ∼200 molecules µm(-2) to as high as 6000 molecules µm(-2)). The resulting substrates were quantitatively characterized via fluorescence analysis and radioimmunoassays before their use in the leukocyte rolling assays. HL-60 promyelocytes and Jurkat T lymphocytes were assessed for their ability to tether to and roll on substrates presenting immobilized P-selectin and PSGL-1 under conditions of physiologically relevant shear stress. The results of these flow assays reveal the combined effect of immobilized protein site density and applied wall shear stress on cell rolling behavior. Two-component substrates presenting P-selectin and ICAM-1 (intercellular adhesion molecule-1) were also generated to assess the interplay between these two proteins and their effect on cell rolling and adhesion. These proof-of-principle studies verify that the described gradient generation approach yields well-defined gradient substrates that present immobilized proteins over a large range of site densities that are applicable for investigation of cell-materials interactions, including multi-parameter leukocyte flow studies. Future applications of this enabling methodology may lead to new insights into the biophysical phenomena and molecular mechanism underlying complex biological processes such as leukocyte recruitment and the inflammatory response.

Quantitative photochemical immobilization of biomolecules on planar and corrugated substrates: a versatile strategy for creating functional biointerfaces.

Methods for the generation of substratespresenting biomolecules in a spatially controlled manner are enabling tools for applications in biosensor systems, microarray technologies, fundamental biological studies and biointerface science. We have implemented a method to create biomolecular patterns by using light to control the direct covalent immobilization of biomolecules onto benzophenone-modified glass substrates. We have generated substrates presenting up to three different biomolecules patterned in sequence, and demonstrate biomolecular photopatterning on corrugated substrates. The chemistry of the underlying monolayer was optimized to incorporate poly(ethylene glycol) to enable adhesive cell adhesion onto patterned extracellular matrix proteins. Substrates were characterized with contact angle goniometry, AFM, and immunofluorescence microscopy. Importantly, radioimmunoassays were performed to quantify the site density of immobilized biomolecules on photopatterned substrates. Retained function of photopatterned proteins was demonstrated both by native ligand recognition and cell adhesion to photopatterned substrates, revealing that substrates generated with this method are suitable for probing specific cell receptor-ligand interactions. This molecularly general photochemical patterning method is an enabling tool for the creation of substrates presenting both biochemical and topographical variation, which is an important feature of many native biointerfaces.