Electrochemical Discrimination of Salbutamol from Its Excipients in VentolinTM at Nanoporous Gold Microdisc Arrays.

The emergence of specific drug-device combination products in the inhalable pharmaceutical industry demands more sophistication of device functionality in the form of an embedded sensing platform to increase patient safety and extend patent coverage. Controlling the nebuliser function at a miniaturised, integrated electrochemical sensing platform with rapid response time and supporting novel algorithms could deliver such a technology offering. Development of a nanoporous gold (NPG) electrochemical sensor capable of creating a unique fingerprint signal generated by inhalable pharmaceuticals provided the impetus for our study of the electrooxidation of salbutamol, which is the active bronchodilatory ingredient in VentolinTM formulations. It was demonstrated that, at NPG-modified microdisc electrode arrays, salbutamol is distinguishable from the chloride excipient present at 0.0154 M using linear sweep voltammetry and can be detected amperometrically. In contrast, bare gold microdisc electrode arrays cannot afford such discrimination, as the potential for salbutamol oxidation and chloride adsorption reactions overlap. The discriminative power of NPG originates from the nanoconfinement effect for chloride in the internal pores of NPG, which selectively enhances the electron transfer kinetics of this more sluggish reaction relative to that of the faster, diffusion-controlled salbutamol oxidation. Sensing was performed at a fully integrated three-electrode cell-on-chip using Pt as a quasi-reference electrode.

Ethnographic study using Normalization Process Theory to understand the implementation process of infection prevention and control guidelines in Ireland.

OBJECTIVE: The aim of this study was to explore how infection prevention and control (IPC) guidelines are used and understood by healthcare professionals, patients and families. DESIGN: Ethnographic study with 59 hours of non-participant observation and 57 conversational interviews. Data analysis was underpinned by the Normalization Process Theory (NPT) as a theoretical framework. SETTING: Four hospitals in Ireland. PARTICIPANTS: Healthcare professionals, patient and families. RESULTS: Five themes emerged through the analysis. Four themes provided evidence of the NPT elements (coherence, cognitive participation, collective action and reflexive monitoring). Our findings revealed the existence of a 'dissonance between IPC guidelines and the reality of clinical practice' (theme 1) and 'Challenges to legitimatize guidelines' recommendations in practice' (theme 3). These elements contributed to 'Symbolic implementation of IPC guidelines' (theme 2), which was also determined by a 'Lack of shared reflection upon IPC practices' (theme 4) and a clinical context of 'Workforce fragmentation, time pressure and lack of prioritization of IPC' (theme 5). CONCLUSIONS: Our analysis identified themes that provide a comprehensive understanding of elements needed for the successful or unsuccessful implementation of IPC guidelines. Our findings suggest that implementation of IPC guidelines is regularly operationalised through the reproduction of IPC symbols, rather than through adherence to performance of the evidence-based recommendations. Our findings also provide insights into changes to make IPC guidelines that align with clinical work.

Patient involvement in the implementation of infection prevention and control guidelines and associated interventions: a scoping review.

OBJECTIVE: To explore patient involvement in the implementation of infection prevention and control (IPC) guidelines and associated interventions. DESIGN: Scoping review. METHODS: A methodological framework was followed to identify recent publications on patient involvement in the implementation of IPC guidelines and interventions. Initially, relevant databases were searched to identify pertinent publications (published 2013-2018). Reflecting the scarcity of included studies from these databases, a bidirectional citation chasing approach was used as a second search step. The reference list and citations of all identified papers from databases were searched to generate a full list of relevant references. A grey literature search of Google Scholar was also conducted. RESULTS: From an identified 2078 papers, 14 papers were included in this review. Our findings provide insights into the need for a fundamental change to IPC, from being solely the healthcare professionals (HCPs) responsibility to one that involves a collaborative relationship between HCPs and patients. This change should be underpinned by a clear understanding of patient roles, potential levels of patient involvement in IPC and strategies to overcome barriers to patient involvement focusing on the professional-patient relationship (eg, patient encouragement through multimodal educational strategies and efforts to disperse professional's power). CONCLUSIONS: There is limited evidence regarding the best strategies to promote patient involvement in the implementation of IPC interventions and guidelines. The findings of this review endorse the need for targeted strategies to overcome the lack of role clarity of patients in IPC and the power imbalances between patients and HCPs.

Point prevalence survey of indwelling urinary catheter use and appropriateness in patients living at home and receiving a community nursing service in Ireland.

BACKGROUND: Indwelling urinary catheters (IUC) are reported as the most common indwelling device in hospitals and residential/care home settings. AIM: The aim of this study was to assess the prevalence and appropriateness of IUCs in people living at home and receiving a community nursing service. METHODS: An IUC self-report questionnaire was sent to 66 community nurses in one community care area. A second questionnaire was completed by the researcher on each patient (n = 80) identified by the community nurses. Data were analysed using descriptive statistics and the chi-square test was used to test associations between patient demographics, catheter changes and nurses documentation. RESULTS: The self-report questionnaire was completed by 46 of the 52 areas (88% response rate). The overall prevalence of IUCs was 1.9% with a higher prevalence among men (70%) and in the over-85-years age group (31%). The mean age was 76 years (age range = 34-98 years) and duration of use was approximately four years. Routine IUC changes were carried out by community nurses (52%), in the acute hospital (25%) or by general practitioners (20%) and the type of catheter influenced person/location of catheter changes (P = 0.001). DISCUSSION: This study adds to the understanding of IUCs in patients at home and is the first to investigate if the IUC is appropriate in this setting. It prompted a review of current guidance and development of standard documentation for IUC management locally to ensure that the IUC in use is appropriate. It also suggests that there is a need for internationally accepted, appropriate indications for long-term IUC use to facilitate consistency and allow comparison across studies in future.

Philip Taylor Williamson.

A practitioner who involved himself in local and national veterinary associations and also served in the army, as a government vet, a media vet, as well as teaching veterinary nurses.

Evaluation of the safety and feasibility of rapid rituximab infusion.

AIM: To assess safety of rapid infusion by measuring infusion-related side effects and toxicities. METHODS: Participants received the first rituximab infusion according to the manufacturers' recommendations. If well-tolerated, they then received the second and subsequent infusions at a rate of 20% of the dose over the first 30 min and the remaining 80% over the next hour. Premedication was administered for all the infusions. RESULTS: A total of 243 infusions in 65 consecutive participants were evaluated. Six experienced a grade 1 reaction and one a grade 3 transfusion-related adverse event. Three of these participants were withdrawn from the rapid infusion study. The other four participants (grade 1 only participants) were re-challenged. The same premedication was used as in the first rapid infusion. On experiencing a grade 1 reaction, promethazine 12.5 mg i.v. was administered and infusion recommenced at 50% of the previous rate upon the resolution of symptoms. Three patients developed a grade 1 adverse event and one patient experienced no adverse reaction. The three patients who did not tolerate the second rapid infusion were withdrawn from this study. CONCLUSION: A rituximab infusion over 90-min was safe and feasible for participants who seek treatment at ambulatory cancer centre. The new regimen has been adopted as a standard practice with better resource utilization.

Speechreading and its association with reading among deaf, hearing and dyslexic individuals.

Reading and speechreading are both visual skills based on speech and language processing. Here we explore individual differences in speechreading in profoundly prelingually deaf adults, hearing adults with a history of dyslexia, and hearing adults with no history of a literacy disorder. Speechreading skill distinguished the three groups: the deaf group were better speechreaders than hearing controls, who were better than the group with a history of dyslexia. The dyslexic group, while within range of hearing controls in terms of reading, nevertheless showed a residual deficit in speech/language processing when tested with silent speech. Within-group correlations suggested different associations between speechreading subtasks, reading and language skills. In particular, in the deaf and dyslexic groups, but not in the hearing controls, speechreading skill correlated with reading ability.

Regulation of glycogen synthase kinase 3 in human platelets: a possible role in platelet function?

In this study we show that both glycogen synthase kinase 3 (GSK3) isoforms, GSK3alpha and GSK3beta, are present in human platelets and are phosphorylated on Ser(21) and Ser(9), respectively, in platelets stimulated with collagen, convulxin and thrombin. Phosphorylation of GSK3alpha/beta was dependent on phosphoinositide 3-kinase (PI3K) activity and independent of platelet aggregation, and correlated with a decrease in GSK3 activity that was preserved by pre-incubating platelets with PI3K inhibitor LY294002. Three structurally distinct GSK3 inhibitors, lithium, SB415286 and TDZD-8, were found to inhibit platelet aggregation. This implicates GSK3 as a potential regulator of platelet function.

Protein kinase B is regulated in platelets by the collagen receptor glycoprotein VI.

Phosphoinositide 3-kinase (PI3K) is a critical component of the signaling pathways that control the activation of platelets. Here we have examined the regulation of protein kinase B (PKB), a downstream effector of PI3K, by the platelet collagen receptor glycoprotein (GP) VI and thrombin receptors. Stimulation of platelets with collagen or convulxin (a selective GPVI agonist) resulted in PI3K-dependent, and aggregation independent, Ser(473) and Thr(308) phosphorylation of PKBalpha, which results in PKB activation. This was accompanied by translocation of PKB to cell membranes. The phosphoinositide-dependent kinase PDK1 is known to phosphorylate PKBalpha on Thr(308), although the identity of the kinase responsible for Ser(473) phosphorylation is less clear. One candidate that has been implicated as being responsible for Ser(473) phosphorylation, either directly or indirectly, is the integrin-linked kinase (ILK). In this study we have examined the interactions of PKB, PDK1, and ILK in resting and stimulated platelets. We demonstrate that in platelets PKB is physically associated with PDK1 and ILK. Furthermore, the association of PDK1 and ILK increases upon platelet stimulation. It would therefore appear that formation of a tertiary complex between PDK1, ILK, and PKB may be necessary for phosphorylation of PKB. These observations indicate that PKB participates in cell signaling downstream of the platelet collagen receptor GPVI. The role of PKB in collagen- and thrombin-stimulated platelets remains to be determined.