Look-alike, sound-alike (LASA) drugs in India.

Poor drug regulation in India is not a recent problem. The Indian drug market is full of look-alike, sound-alike (LASA) drugs which have not yet caught the attention of the media or the medical community. This viewpoint highlights the problem of LASA drugs and poor prescription practices and proposes solutions for involving all stakeholders in this unaddressed issue which is a huge public health problem in India.

Look-alike sound-alike (LASA) medication errors in Thai hospitals / Errores de medicación por sonido similar (LASA) en hospitales tailandeses

Look-alike sound-alike (LASA) drugs cause a high proportion of medication errors in hospitals. Drug lists available in hospitals are diverse and complicated. Presently, each hospital has its own LASA drug list and unique management strategies to minimize and prevent LASA errors. Objective: This study aimed to explore the prevalence of LASA drug lists, types of LASA drugs, and categories of medication errors in hospitals in Thailand. Methods: For this crosssectional study, questionnaires were developed and distributed along with a letter to 500 government hospitals (selected from a total of 1,309 hospitals) in Thailand via mail from April to June 2021. Data were analyzed using descriptive statistics (frequencies and percentages). Results: A total of 128 hospitals participated in this study (response rate: 25.60%), including 12 tertiary hospitals (9.38%), 33 secondary hospitals (25.78%), 24 large primary hospitals (18.75%), 51 small primary hospitals (39.84%), and eight private hospitals (6.25%). A total of 2,510 pairs of LASA drugs were identified, which included 1,674 (66.69%) tablets/capsules (Simvastatin 10-Simvastatin 20 pair had the highest frequency), 427 injections (17.01%) (Ceftriaxone-Ceftazidime pair had the highest frequency), 85 liquid dosage forms (3.39%) (Milk of magnesia-alum milk pair had the highest frequency), 74 special techniques in medicine (2.95%) (Seretide evohaler®-Seretide accuhaler® pair had the highest frequency), 49 external used drugs (1.95%) (Clotrimazole cream-Clobetasol cream pair had the highest frequency), and 28 powder dosage forms (1.12%) (ORS for pediatrics-ORS for adult pair had the highest frequency). Conclusion: Despite relevant awareness among healthcare professionals, LASA medication errors occur in hospitals. The most frequent similarities among LASA drugs were detected in their names/pronunciations, and the most common errors belonged to Category B.(AU)

STOPP-START Criteria Used to Identify the Elderly Population Prone to Potentially Inadequate Prescribing in a Colombian Cohort.

BACKGROUND: Elderly people have multiple comorbidities that often require treatment with multiple medications. Having strategies to lessen the risks associated with pharmacological interactions and potentially inadequate prescribing (PIP) is of major importance. The STOPP- START criteria are useful in identifying PIP along with other tools, such as LASA (look alike/sound alike) drugs and high-risk medications (HRM). OBJECTIVE: We aimed to clinically and sociodemographically characterize the population with PIP according to the STOPP-START criteria in hospitalized elderly patients over 6 months in a third-level hospital in Colombia, South America. We also aimed to calculate the prevalence of PIP, LASA drugs and HRM and to identify other problems related with medication. Finally, we proposed an algorithm for the identification of PIP in this population. METHODS AND MATERIALS: This was a descriptive, cross-sectional study in hospitalized patients older than 60 years during the first semester of 2021 to identify PIP according to STOPP- START criteria. An analysis of clinical and sociodemographic variables was conducted, as well as the construction of an algorithm to identify PIP in the elderly in a semiautomated way. Data were collected and analyzed using the software SPSS 2021, using descriptive statistics and measures of central tendency. RESULTS: The prevalence of PIP in the study population was 25%. Furthermore, 60% of patients had one problem related to medication, and 27% used at least one LASA drug or HRM. CONCLUSION: This study allows one to characterize, for the first time, the Colombian population prone to PIP, as well as the construction of an algorithm that identifies PIP in a semiautomated way.

Labeling of medications in anesthesia: colors and letters that save lives

Medication errors are the cause of severe lesions and complications, particularly with regards to injectable medications. During anesthesia, several drugs are administered simultaneously and quite easily the wrong medication may be administered, leading to morbidity and mortality. Different strategies have been devised to reduce error, including the use of color and letters to facilitate the identification of the various medications and improving safety in anesthesia.

Los errores asociados a la administración de medicamentos son una causa de graves lesiones y complicaciones sobre todo con los medicamentos inyectables. En un acto anestésico se administran distintos medicamentos y de manera simultánea, en el que fácilmente se puede administrar un medicamento errado causando morbilidad y mortalidad. Se han establecido diferentes estrategias para disminuir el error, entre estas el uso de colores y letras para facilitar su identificación y mejorar la seguridad en anestesia.

Structural and Functional Characterization of ß-lytic Protease from Lysobacter capsici VKM B-2533T.

The crystal structure of the Lysobacter capsici VKM B-2533T ß-lytic protease (Blp), a medicinally promising antimicrobial enzyme, was first solved. Blp was established to possess a folding characteristic of the M23 protease family. The groove of the Blp active site, as compared with that of the LasA structural homologue from Pseudomonas aeruginosa, was found to have amino acid differences. Biochemical analysis revealed no differences in the optimal reaction conditions for manifesting Blp and LasA bacteriolytic activities. At the same time, Blp had a broader range of action against living and autoclaved target cells. The results suggest that the distinction in the geometry of the active site and the charge of amino acid residues that form the active site groove can be important for the hydrolysis of different peptidoglycan types in target cells.

Segurança dos medicamentos "look alike", "sound alike" - Desenvolvimento de competências especializadas em enfermagem na área de enfermagem à pessoa em situação crítica / Desenvolvimento de competências especializadas em enfermagem na área de enfermagem à pessoa em situação crítica: Segurança dos medicamentos "look alike", "sound alike" / Safety of medicines "look alike", "sound alike" - Development of nursing expertise in the area of nursing care to the person in critical condition

O presente relatório surge no culminar da realização do Curso de Mestrado em Enfermagem Médico-Cirúrgica na Área de Especialização de Enfermagem à Pessoa em Situação Crítica (PSC) da Escola Superior de Saúde do Instituto Politécnico de Leiria. Através de uma metodologia reflexiva, é descrito o percurso para o desenvolvimento e aquisição das competências comuns e específicas do Enfermeiro Especialista em Enfermagem à PSC. Na primeira parte do documento estão expostas as aprendizagens e o trabalho desenvolvido ao longo dos ensinos clínicos decorridos nos contextos de Serviço de Urgência (SU), Unidade de Cuidados Intensivos (UCI) e Emergência Extra-Hospitalar. Estruturado de forma integrativa e à luz dos Regulamentos das competências comuns e específicas do Enfermeiro Especialista à PSC, tendo sempre por base a melhor evidência científica, guias e normas de boas práticas. Este Relatório dá ênfase à importância da Melhoria Contínua da Qualidade dos Cuidados de Enfermagem, o seu impacto em todos os domínios de competência descritos e na promoção da excelência dos cuidados de enfermagem à PSC. Também o cuidado especializado e fundamentado à PSC e sua Família e/ou Pessoa significativa é uma temática central a este percurso. Na segunda parte, é descrito o trabalho de investigação intitulado "Segurança dos Medicamentos Look Alike, Sound Alike (LASA) no SU", realizado através de um estudo de investigação longitudinal prospetivo quantitativo. Neste foram implementadas medidas de segurança relativas aos Medicamentos LASA de modo a prevenir a ocorrência de Erros LASA no SU, tendo sempre por base a Norma nº 020/2014 da Direção-Geral da Saúde (DGS) "Medicamentos com nome ortográfico, fonético ou aspeto semelhantes".

This report is the culmination of the completion of the Master's Degree in Medical-Surgical Nursing in the Specialisation Area of Nursing in Critical Care of the School of Health of the Polytechnic Institute of Leiria. Through a reflective methodology, the pathway for the development and acquisition of the common and specific competencies of the Nurse Specialist in Nursing in Critical Care is described. The first part of the document describes the learning experiences and the work developed during the clinical training sessions held in the context of the Emergency Service (ER), Intensive Care Unit (ICU) and Extra-hospital Emergency. It is structured in an integrative way and in the light of the Regulations of the common and specific competences of the Specialist Nurse to the CSP, always based on the best scientific evidence, guides and standards of good practice. This Report emphasises the importance of the Continuous Quality Improvement of Nursing Care, its impact on all domains of competence described and on the promotion of excellence in nursing care to HCP. Specialised and reasoned care to the HCP and his/her Family and/or Significant Person is also a central theme of this journey. In the second part, the research study entitled "Safety of Look Alike, Sound Alike (LASA) Medications in the ER" is described. In this study, safety measures concerning LASA Medicines were implemented in order to prevent the occurrence of LASA Errors in the ER, always based on the Standard No. 020/2014 of the Directorate-General for Health (DGS) "Medicines with similar orthographic, phonetic or sound-alike names".

Joint pain liniments and gum lotion in the eye - A consecutive case series of mistaken identity.

Purpose: Patient safety errors can arise due to similarity in packaging of medications. We aimed to describe the clinical features of patients presenting with accidental application of joint pain liniments and gum lotion in the eye due to confusion arising from similarity in packaging. Methods: This was a retrospective case series with eight consecutive patients presenting from December 2020 to August 2021 with history of accidental application of joint pain liniments or gum lotion in the eye instead of eye drops. All patients underwent visual acuity assessment and slit-lamp examination with fluorescein staining of the cornea to look for corneal involvement and was reassessed till complete resolution. Results: Of the eight patients, three were males and five were females. Seven had accidentally applied joint pain liniment, while one had applied gum lotion into the eye. Five of them had corneal involvement ranging from punctate erosions to near-total epithelial defects. Two patients needed referral to a tertiary center and hospital admission. Treatment duration ranged from 2 days to 1 month. Two patients were lost to follow-up. Conclusion: This study highlights patient safety errors arising from confusion of medication due to similar labeling and packaging of different drugs. While there was no permanent morbidity, such confusions lead to needless discomfort and waste of time, money, and effort for the patient as well as the health-care system.

Effects of patient-reported outcome assessment order.

BACKGROUND: In clinical trials and clinical practice, patient-reported outcomes are almost always assessed using multiple patient-reported outcome measures at the same time. This raises concerns about whether patient responses are affected by the order in which the patient-reported outcome measures are administered. METHODS: This questionnaire-based study of order effects included adult cancer patients from five cancer centers. Patients were randomly assigned to complete questionnaires via paper booklets, interactive voice response system, or tablet web survey. Linear Analogue Self-Assessment, Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events, and Patient-Reported Outcomes Measurement Information System assessment tools were each used to measure general health, physical function, social function, emotional distress/anxiety, emotional distress/depression, fatigue, sleep, and pain. The order in which the three tools, and domains within tools, were presented to patients was randomized. Rates of missing data, scale scores, and Cronbach's alpha coefficients were compared by the order in which they were assessed. Analyses included Cochran-Armitage trend tests and mixed models adjusted for performance score, age, sex, cancer type, and curative intent. RESULTS: A total of 1830 patients provided baseline patient-reported outcome assessments. There were no significant trends in rates of missing values by whether a scale was assessed earlier or later. The largest order effect for scale scores was due to a large mean score at one assessment time point. The largest difference in Cronbach's alpha between the versions for the Patient-Reported Outcomes Measurement Information System scales was 0.106. CONCLUSION: The well-being of a cancer patient has many different aspects such as pain, fatigue, depression, and anxiety. These are assessed using a variety of surveys often collected at the same time. This study shows that the order in which the different aspects are collected from the patient is not important.

Evaluation of kinetic stability and anti-staphylococcal activity of recombinant LasA protein produced in Escherichia coli.

OBJECTIVES: Staphylococcus aureus has become a major clinical concern due to the growing prevalence of multi-drug resistant (MDR) strains. Enzybioticts are peptidoglycan hydrolases that are recently introduced as an alternative agent to confront the MDR strains with a more effective mechanism than conventional antibiotics. In this regard, our study aimed to evaluate the kinetic stability of LasA protease as a potent enzybiotic in the specific destruction of the S. aureus cell wall. MATERIALS AND METHODS: The catalytic domain of the Codon-optimized LasA gene was sub-cloned into pET28a vector, and BL21 DE3 cells were used for protein expression. Recombinant LasA protein was affinity purified by Ni-NTA column and staphylolytic activity of the LasA protein against methicillin-resistant strains was evaluated by disk diffusion and MIC test. The kinetic stability was evaluated in different temperatures during 48 hr. RESULTS: Our results revealed that LasA protein can completely prevent the growth of Methicillin-resistant S. aureus (MRSA) strain and inhibit the examined strain at the amount of 4 µg. furthermore, the catalytic domain of LasA protein can tolerate higher temperatures as well. CONCLUSION: With regard to the failure of conventional antibiotics in treatment of MRSA infections, novel agents to combat multidrug-resistant strains are needed. The present study shows that LasA protein can eradicate MRSA strains, so it can be promising for the treatment of antibiotic-resistant staphylococci infection. The kinetic stability of LasA has also confirmed the possibility of industrial-scale manufacturing for the subsequent use of the enzyme clinically.

Antivirulence Properties of a Low-Molecular-Weight Quaternized Chitosan Derivative against Pseudomonas aeruginosa.

The co-occurrence of increasing rates of resistance to current antibiotics and the paucity of novel antibiotics pose major challenges for the treatment of bacterial infections. In this scenario, treatments targeting bacterial virulence have gained considerable interest as they are expected to exert a weaker selection for resistance than conventional antibiotics. In a previous study, we demonstrated that a low-molecular-weight quaternized chitosan derivative, named QAL, displays antibiofilm activity against the major pathogen Pseudomonas aeruginosa at subinhibitory concentrations. The aim of this study was to investigate whether QAL was able to inhibit the production of relevant virulence factors of P. aeruginosa. When tested in vitro at subinhibiting concentrations (0.31-0.62 mg/mL), QAL markedly reduced the production of pyocyanin, pyoverdin, proteases, and LasA, as well as inhibited the swarming motility of three out of four P. aeruginosa strains tested. Furthermore, quantitative reverse transcription PCR (qRT-PCR) analyses demonstrated that expression of lasI and rhlI, two QS-related genes, was highly downregulated in a representative P. aeruginosa strain. Confocal scanning laser microscopy analysis suggested that FITC-labelled QAL accumulates intracellularly following incubation with P. aeruginosa. In contrast, the reduced production of virulence factors was not evidenced when QAL was used as the main polymeric component of polyelectrolyte-based nanoparticles. Additionally, combination of sub-MIC concentrations of QAL and tobramycin significantly reduced biofilm formation of P. aeruginosa, likely due to a synergistic activity towards planktonic bacteria. Overall, the results obtained demonstrated an antivirulence activity of QAL, possibly due to polymer intracellular localization and QS-inhibition, and its ability to inhibit P. aeruginosa growth synergizing with tobramycin.

Standardised computed tomographic assessment of left atrial morphology and tissue thickness in humans.

AIMS: Left atrial (LA) remodelling is a common feature of many cardiovascular pathologies and is a sensitive marker of adverse cardiovascular outcomes. The aim of this study was to establish normal ranges for LA parameters derived from coronary computed tomographic angiography (CCTA) imaging using a standardised image processing pipeline to establish normal ranges in a previously described cohort. METHODS: CCTA imaging from 193 subjects recruited to the Budapest GLOBAL twin study was analysed. Indexed LA cavity volume (LACVi), LA surface area (LASAi), wall thickness and LA tissue volume (LATVi) were calculated. Wall thickness maps were combined into an atlas. Indexed LA parameters were compared with clinical variables to identify early markers of pathological remodelling. RESULTS: LACVi is similar between sexes (31 ml/m2 v 30 ml/m2) and increased in hypertension (33 ml/m2 v 29 ml/m2, p = 0.009). LASAi is greater in females than males (47.8 ml/m2 v 45.8 ml/m2 male, p = 0.031). Median LAWT was 1.45 mm. LAWT was lowest at the inferior portion of the posterior LA wall (1.14 mm) and greatest in the septum (median = 2.0 mm) (p < 0.001). Conditions known to predispose to the development of AF were not associated with differences in tissue thickness. CONCLUSIONS: The reported LACVi, LASAi, LATVi and tissue thickness derived from CCTA may serve as reference values for this age group and clinical characteristics for future studies. Increased LASAi in females in the absence of differences in LACVi or LATVi may indicate differential LA shape changes between the sexes. AF predisposing conditions, other than sex, were not associated with detectable changes in LAWT.Clinical trial registration:http://www.ClinicalTrials.gov/NCT01738828.

Thyroid Function and Physical Activity: A Population-Based Cohort Study.

Background: Thyroid hormones are important metabolic regulators exerting effects in multiple systemic functions including muscular and cardiorespiratory function. Thyroid hormones may influence physical activity levels. However, there are currently no studies evaluating the association between thyroid function and physical activity levels in the general population. Methods: In a population-based cohort study between 2006 and 2013, we assessed the cross-sectional and longitudinal (with a mean follow-up time of 5 years) association of serum thyrotropin (TSH) and free thyroxine (fT4) with physical activity (metabolic equivalent task [MET] hours per week). Information on physical activity was collected using a validated questionnaire (Longitudinal Aging Study Amsterdam, median 22.50 MET hours per week). The association of TSH and fT4 with physical activity was examined using linear regression models in the cross-sectional and longitudinal analyses, adjusted for age, sex, lifestyle factors, and cardiovascular disease. In sensitivity analyses, we examined the association between thyroid function and physical activity including only participants within the reference range of thyroid function. We additionally examined moderate and vigorous physical activity separately as outcomes. Results: We included 2470 participants for the cross-sectional analysis (mean age 57.3 years, 58% women) and 1907 participants for the longitudinal analysis (mean age 56.9 years). There was no association between TSH (mIU/L) or fT4 (ng/dL) and physical activity (ß = 0.65, 95% confidence interval [CI, -1.67 to 2.98] and ß = 2.76, [CI -7.15 to 12.66], respectively) on cross-sectional analysis. Similarly, in the longitudinal analyses, we observed no association of TSH (ß = 1.16, [CI -1.31 to 3.63]) or fT4 (ß = -6.63, [CI -17.06 to 3.80]) with physical activity. Conclusions: We did not observe an association between the endogenous thyroid hormone level and total physical activity. Further studies need to be performed to evaluate whether thyroid hormone replacement therapy is associated with physical activity.

Effect of LTRA in L-ASA Challenge for Aspirin-Exacerbated Respiratory Disease Diagnosis.

BACKGROUND: Aspirin-exacerbated respiratory disease (AERD) consists of asthma, chronic rhinosinusitis with polyps, and hypersensitivity to aspirin and/or nonsteroidal anti-inflammatory drugs (NSAIDs). Nasal Lysine Aspirin Challenge is an effective tool for the diagnosis of hypersensitivity to aspirin and/or NSAIDs in patients with AERD. However, there is no unified international consensus version to perform nasal provocation tests (NPTs). OBJECTIVE: To investigate the effect of a leukotriene receptor antagonist (LTRA), montelukast, on the lysine-acetylsalicylate (L-ASA) nasal challenge. METHODS: We included 86 patients divided into 3 samples: group A (AERD without LTRA), group B (AERD with LTRA), and the control group (NSAID-tolerant asthmatics). NPT with L-ASA was performed with 25 mg of L-ASA every 30 minutes 4 times followed by rhinomanometry and spirometric measurements and evaluation of symptoms using a novel clinical scale. RESULTS: In group A, 94.5% of patients (35 of 37) developed a positive response to NPT (drop >40% in total nasal flow), whereas only 46% of group B subjects (13 of 28) showed a positive response to the nasal challenge (P < .001). Control subjects did not show any response to the L-ASA challenge. A novel clinical score demonstrated accuracy in classifying the hypersensitivity to aspirin and/or NSAIDs when patients avoid LTRA (33 of 37). CONCLUSION: Patients with AERD without LTRA showed a greater positive response to the L-ASA challenge than those taking this drug; therefore, LTRA treatment should be discontinued before the challenge for optimal diagnostic accuracy.

Estratégias de enfermagem para prevenir o erro de medicação look-alike sound-alike / Nursing strategies to prevent look-alike sound-alike medication error

No âmbito o 3.º Curso de Mestrado em Enfermagem de Associação ministrado pela Escola Superior de Saúde (ESS) do Instituto Politécnico de Portalegre (IPP) na área de especialização, Enfermagem médico cirúrgica a Pessoa em Situação Crítica, surge o presente relatório. Este relatório traduz o trabalho desenvolvido e as aprendizagens adquiridas ao longo dos estágios realizados na Unidade de Acidentes Vasculares Cerebrais (UAVC) e na Unidade de Cuidados Intensivos Polivalente (UCIP) do Centro Hospitalar de Setúbal (CHS). A materialização destas atividades e os aportes teóricos obtidos durante a formação teórica, proporcionaram oportunidades de formação e aprendizagem aplicadas na prática diária de prestação de cuidados que contribuíram para o desenvolvimento de competências de Enfermeiro Especialista em Enfermagem Médico-Cirúrgica e Mestre em Enfermagem, visando uma melhoria da qualidade dos cuidados e a excelência no exercício da profissão. Ao longo dos estágios realizados e com base na metodologia de Projeto, foi desenvolvido um Projeto de Intervenção em Serviço (PIS) com a finalidade de promover a qualidade dos cuidados de enfermagem na área da segurança do doente e da medicação look-alike sound alike (LASA), através da implementação de estratégias com o objetivo de prevenir os erros associados aos medicamentos LASA. Paralelamente, este relatório comtempla uma análise e reflexão crítica fundamentada, sobre o processo de aquisição e desenvolvimento de competências de Mestre em Enfermagem, bem como competências comuns e especificas do Enfermeiro Especialista em Enfermagem Médico-cirúrgica a Pessoa em Situação Crítica e de que forma os aportes teóricos e os estágios realizados contribuíram para a sua aquisição.

This essay relates to the 3rd Association Nursing Masters Course, with Specialization in Medical and Surgical Nursing for people in Critical Condition offered by the Health School of the Polytechnic Institute of Portalegre. This survey analyses the work developed and the lessons learned during the internships carried out at the Stroke Unit (UAVC) and the Multipurpose Intensive Care Unit (UCIP) of na Hospital Center on the south bank of the Tagus River. The daily participation in health care procedures provided training and learning opportunities for the employment of the theoretical knowledge obtained during the Course and contributed for an improvement of skill acquisition and development in the Masters Degree in Nursing, as well as the specific skills of the Specialist Nurse in Medical-Surgical Nursing for People in Critical Condition and Master's Degree in Nursing, aiming quality of nursing care and excellence in the practice of the profession. Based on the Project methodology, in Service Intervention Project was carried out with strategies to prevent errors associated with look-alike sound-alike (LASA) medications and to promote nursing quality in the area of patient safety during administration of LASA medication. Simultaneously, this essay includes a substantiated analysis and critical reflection on the process of skill acquisition and development in the master's degree in nursing, as well as the specific skills of the Specialist Nurse in Medical-Surgical Nursing for People in Critical Condition and how theoretical knowledge and internships contributed to its refinement.

A drug identification model developed using deep learning technologies: experience of a medical center in Taiwan.

BACKGROUND: Issuing of correct prescriptions is a foundation of patient safety. Medication errors represent one of the most important problems in health care, with 'look-alike and sound-alike' (LASA) being the lead error. Existing solutions to prevent LASA still have their limitations. Deep learning techniques have revolutionized identification classifiers in many fields. In search of better image-based solutions for blister package identification problem, this study using a baseline deep learning drug identification (DLDI) aims to understand how identification confusion of look-alike images by human occurs through the cognitive counterpart of deep learning solutions and thereof to suggest further solutions to approach them. METHODS: We collected images of 250 types of blister-packaged drug from the Out-Patient Department (OPD) of a medical center for identification. The deep learning framework of You Only Look Once (YOLO) was adopted for implementation of the proposed deep learning. The commonly-used F1 score, defined by precision and recall for large numbers of identification tests, was used as the performance criterion. This study trained and compared the proposed models based on images of either the front-side or back-side of blister-packaged drugs. RESULTS: Our results showed that the total training time for the front-side model and back-side model was 5 h 34 min and 7 h 42 min, respectively. The F1 score of the back-side model (95.99%) was better than that of the front-side model (93.72%). CONCLUSIONS: In conclusion, this study constructed a deep learning-based model for blister-packaged drug identification, with an accuracy greater than 90%. This model outperformed identification using conventional computer vision solutions, and could assist pharmacists in identifying drugs while preventing medication errors caused by look-alike blister packages. By integration into existing prescription systems in hospitals, the results of this study indicated that using this model, drugs dispensed could be verified in order to achieve automated prescription and dispensing.

Psychological Resilience in the Context of Disability: A Study With Turkish and Moroccan Young-Old Immigrants Living in the Netherlands.

BACKGROUND AND OBJECTIVES: The disability paradox postulates that some individuals with severe functional limitations demonstrate psychological resilience, that is, good mental health and quality of life. Resilience to disabilities has been linked to psychological (e.g., mastery) and social factors (e.g., social provisions). It is, however, less clear whether cultural factors can provide additional resources for resilience building in older immigrants. We investigated the extent to which sociodemographic, psychosocial, and cultural factors contributed to psychological resilience to disabilities among immigrants of Turkish and Moroccan descent in the Netherlands. RESEARCH DESIGN AND METHOD: The sample included 478 older immigrants aged 55-65 years. Data were analyzed using latent profile analysis and multinomial logistic regressions. RESULTS: Five categories were identified: (a) High physical and emotional functioning; (b) High physical but poor emotional functioning; (c) Low physical but high emotional functioning (resilient); (d) Low physical and emotional functioning; and (e) Low physical and very low emotional functioning. Resilient functioning (reference category) was associated with poorer Dutch language proficiency, lower levels of loneliness, greater mastery, and more religious coping. DISCUSSION AND IMPLICATIONS: Findings provide support for the disability paradox and highlight social provisions, mastery, and religiosity/spirituality as important resources for psychological resilience in older labor migrants. Poor Dutch language proficiency is discussed as a potential factor contributing to severe functional limitations in the resilient category.

The ConsuMEER study: a randomised trial towards the effectiveness of protein-rich ready-made meals and protein-rich dairy products in increasing protein intake of community-dwelling older adults after switching from self-prepared meals towards ready-made meals.

The risk of undernutrition in older community-dwelling adults increases when they are no longer able to shop or cook themselves. Home-delivered products could then possibly prevent them from becoming undernourished. This single-blind randomised trial tested the effectiveness of home-delivered protein-rich ready-made meals and dairy products in reaching the recommended intake of 1·2 g protein/kg body weight (BW) per d and ≥25 g of protein per meal. Community-dwelling older adults (n 98; mean age 80·4 (sd 6·8) years) switched from self-prepared to home-delivered hot meals and dairy products for 28 d. The intervention group received ready-made meals and dairy products high in protein; the control group received products lower in protein. Dietary intake was measured at baseline, after 2 weeks (T1), and after 4 weeks (T2). Multilevel analyses (providing one combined outcome for T1 and T2) and logistic regressions were performed. Average baseline protein intake was 1·09 (se 0·05) g protein/kg BW per d in the intervention group and 0·99 (se 0·05) g protein/kg BW per d in the control group. During the trial, protein intake of the intervention group was 1·12 (se 0·05) g protein/kg BW per d compared with 0·87 (se 0·03) g protein/kg BW per d in the control group (between-group differences P < 0·05). More participants of the intervention group reached the threshold of ≥25 g protein at dinner compared with the control group (intervention T1: 84·8 %, T2: 88·4 % v. control T1: 42·9 %, T2: 40·5 %; P < 0·05), but not at breakfast and lunch. Our findings suggest that switching from self-prepared meals to ready-made meals carries the risk of a decreasing protein intake, unless extra attention is given to protein-rich choices.

Effect of Satureja khuzistanica essential oil (SKEO) extract on expression of lasA and lasB genes in Pseudomonas aeruginosa.

BACKGROUND AND OBJECTIVES: Expressions of lasA and lasB genes of Pseudomonas aeruginosa are associated with bacterium pathogenicity. The present study was aimed to assess the effect of Satureja khuzistanica essential oil (SKEO) extract on expression of lasA and lasB genes in P. aeruginosa. MATERIALS AND METHODS: Pseudomonas aeruginosa isolates were cultured in Mueller Hinton broth containing sub-inhibitory concentrations of SKEO and total RNA extracted using Trizol method. cDNA was synthesized using random Hexamer primer and finally the expression of lasA and lasB genes carried out by real-time PCR. RESULTS: The MICs of SKEO extract for PA9, PA10, PA11, PA13, PA41 and PA42 isolates were 8, 8, 8, 9, 7 and 12 µg/ml, respectively. Statistical analysis for 6 isolates revealed that the reduction in expression of lasA and lasB genes under SKEO treatment was significant (P<0.05). CONCLUSION: The insignificantly increasing of lasB gene expression may lead to low virulent strains, for probably reason that the strain's exotoxin A are destroyed in the high amount of protease. In conclusion, using of SKEO in burned patients infected with P. aeruginosa may be effective; however, it is better to assess the spectrum activity of SKEO, pharmacokinetics, potency and its toxicity in human cells.

Relative importance of four functional measures as predictors of 15-year mortality in the older Dutch population.

BACKGROUND: Decreased physical function is known to raise mortality risk. Little is known about how different physical function measures compare in predicting mortality risk in older men and women. The objective of this study was to compare four, objective and self-reported, physical function measures in predicting 15-year mortality risk in older men and women. METHODS: Data were used from the Longitudinal Aging Study Amsterdam (LASA), an ongoing cohort study in a population-based sample of the older Dutch population, sampled from municipal records. The 1995-96 cycle, including 727 men and 778 women aged 65-88 years, was considered as the baseline. Mortality was followed up through September 1, 2011. Physical function measures were: lower-body performance (chair stands test, walk test and tandem stand); handgrip strength (grip strength dynamometer); lung function (peak expiratory flow rate); functional limitations (self-report of difficulties in performing six activities of daily living). Cox proportional hazard models were used to determine the predictive value of each physical function measure for 15-year mortality risk, adjusted for demographic, lifestyle and health variables as potential confounders. RESULTS: 1031 participants (68.5%) had died. After adjustments for confounders, in models assessing single functional measures, peak flow was the strongest predictor of all-cause mortality in men (HR 1.76, CI 1.38-2.26, CI) and lower-body performance in women (HR 1.97,CI 1.40-2.76, CI). In a model including all four functional measures only peak flow was statistically significant in predicting mortality in both genders (men HR 1.54,CI 1.18-2.01 and women HR 1.45,CI 1.08-1.94). In women, lower-body performance (HR 1.66, CI 1.15-2.41) followed by grip strength (HR 1.38, CI 1.02-1.89), and in men, functional limitations (HR 1.43, CI 1.14-1.8) were the other significant predictors of all-cause mortality. CONCLUSION: Both objective and self-reported measures of physical functioning predicted all-cause mortality in a representative sample of the older Dutch population to different extents in men and women. Peak flow contributed important unique predictive value for mortality in both men and women. In women, however, lower-body performance tests had better predictive ability. A second-best predictor in men was self-reported functional limitations. Peak flow, and possibly one of the other measures, may be used in clinical practice for assessment in the context of time constraints.

Errores de medicamentos LASA en anestesiología en Uruguay / LASA medication errors in anesthesiology in Uruguay

El error en la administración de fármacos es una causa frecuente de incidentes críticos en el perioperatorio. Se definen como medicamentos LASA (del inglés, look alike, sound alike) a aquellos medicamentos que se parecen físicamente o que sus nombres suenan parecido. Objetivo: conocer la situación de probable riesgo a la que se exponen los pacientes en Uruguay durante las cirugías con anestesia a causa de errores de medicación LASA (subgrupo LA). Material y método: se documentaron fotográficamente las ampollas involucradas en las confusiones con medicamentos LASA de uso anestésico que causaron o pudieron causar la muerte del paciente al inyectarse accidentalmente. La identificación de las ampollas confundidas se realizó mediante una encuesta anónima a una muestra representativa de los anestesiólogos de Uruguay (n=70). Se analizaron dos tipos de confusiones: las casi inyecciones y las inyecciones accidentales. Resultados: el atracurio es el fármaco que se confunde con mayor frecuencia; los 10 fármacos más confundidos (27,0% de los 37 analizados) están implicados en 80,6% de las confusiones y en 88,4% de las inyecciones accidentales. Se fotografiaron las ampollas LASA para esos 10 fármacos y 48 de los 56 pares de fármacos confundidos. Conclusión: en Uruguay existen ampollas LASA de uso anestésico que generan riesgo potencial y real de confusiones, dado su aspecto similar, al 86,2% de los anestesiólogos. El 88,4% de esos accidentes podrían disminuirse si se identifican claramente las ampollas de 10 fármacos.

Medication errors are a frequent cause of critical incidents in the preoperative and postoperative stages. LASA drugs (look alike, sound alike) are defined as those which physically resemble others, or whose names sound similar. Objective: to learn about the probable risk Uruguayan patients are exposed to when undergoing surgeries with anesthesia, due to LASA medication errors (LA subgroup). Method: pictures of ampoules involved in LASA medication errors for anesthetic use that cause or could have caused the patients' death when accidentally injected were taken. Identification of the confused ampoules was made by means of an anonymous survey in a representative sample of Uruguayan anesthesiologists (n=70). Two kinds of confusions were analysed: accidental injections and cases where injections were almost given. Results: atracurio is the most frequently confused drug; the 10 most regularly confused drugs (27.0% out of the 37 analysed) are involved in 80.6% of confusions and in 88.4% of accidental injections. Pictures were taken of LASA ampoules for these 10 drugs and 48 of the 56 pairs of drugs confused. Conclusion: there are LASA ampoules for anesthetic purposes in Uruguay that represent a potential and real risk of being confused, due to their being similar to others, by 86.2% of anesthesiologists. 88,4% of these accidents could be reduced if the ampoules of these 10 drugs were clearly identified.

O erro na administração de fármacos é uma causa frequente de acidentes críticos no período peri operatório. Os medicamentos chamados LASA (abreviatura em inglês, Look Alike, Sound Alike) são aqueles cujo aspecto, nome fonético ou ortográfico são semelhantes. Objetivo: conhecer a situação de provável risco a que estão expostos os pacientes durante as cirurgias com anestesia devido a erros por medicamentos LASA (subgrupo LA) no Uruguai. Material e método: fez-se um registro fotográfico das ampolas que foram usadas nos episódios de confusão com medicamentos LASA de uso anestésico que causaram ou puderam causar a morte do paciente por ser injetados acidentalmente. A identificação das ampolas confundidas foi feita através de um questionário anónimo submetido a uma amostra representativa de anestesistas no Uruguai (n=70). Foram analisados dois tipos de erros: as quase injeções e as injeções acidentais. Resultados: o atracúrio é o fármaco que é confundido com mais frequência; os 10 fármacos mais confundidos (27,0% dos 37 analisados) estão presentes em 80,6% das confusões e em 88,4% das injeções acidentais. As ampolas LASA desses 10 fármacos e 48 dos 56 pares de fármacos confundidos foram fotografados. Conclusão: no Uruguai existem ampolas LASA de uso anestésico que geram risco potencial e real de confusões, devido ao aspecto similar, para 86,2% dos anestesistas. 88,4% desses acidentes poderiam ser reduzidos se as ampolas desses 10 fármacos fossem claramente identificadas.