Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting.

BACKGROUND: Although not an inevitable part of ageing, frailty is an increasingly common condition in older people. Frail older patients are particularly vulnerable to the adverse effects of hospitalisation, including deconditioning, immobility and loss of independence (Chong et al, J Am Med Dir Assoc 18:638.e7-638.e11, 2017). The 'Systematic Approach to improving care for Frail older patients' (SAFE) study co-designed, with public and patient representatives, quality improvement initiatives aimed at enhancing the delivery of care to frail older patients within an acute hospital setting. This paper describes quality improvement initiatives which resulted from a co-design process aiming to improve service delivery in the acute setting for frail older people. These improvement initiatives were aligned to five priority areas identified by patients and public representatives. METHODS: The co-design work was supported by four pillars of effective and meaningful public and patient representative (PPR) involvement in health research (Bombard et al, Implement Sci 13:98, 2018; Black et al, J Health Serv Res Policy 23:158-67, 2018). These pillars were: research environment and receptive contexts; expectations and role clarity; support for participation and inclusive representation and; commitment to the value of co-learning involving institutional leadership. RESULTS: Five priority areas were identified by the co-design team for targeted quality improvement initiatives: Collaboration along the integrated care continuum; continence care; improved mobility; access to food and hydration and improved patient information. These priority areas and the responding quality improvement initiatives are discussed in relation to patient-centred outcomes for enhanced care delivery for frail older people in an acute hospital setting. CONCLUSIONS: The co-design approach to quality improvement places patient-centred outcomes such as dignity, identity, respectful communication as well as independence as key drivers for implementation. Enhanced inter-personal communication was consistently emphasised by the co-design team and much of the quality improvement initiatives target more effective, respectful and clear communication between healthcare personnel and patients. Measurement and evaluation of these patient-centred outcomes, while challenging, should be prioritised in the implementation of quality improvement initiatives. Adequate resourcing and administrative commitment pose the greatest challenges to the sustainability of the interventions developed along the SAFE pathways. The inclusion of organisational leadership in the co-design and implementation teams is a critical factor in the success of interventions targeting service delivery and quality improvement.

Opt-out bloodborne virus screening: a cross-sectional observational study in an acute medical unit.

OBJECTIVE: Recent treatment developments for HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV) have greatly improved prognoses. Current screening practices are mainly risk based and are suboptimal. Improved efforts are critically needed to identify persons with these viruses. The aims of this study were to assess the feasibility of an opt-out bloodborne virus (BBV) screening programme in an acute medical unit (AMU) and to describe the prevalence of HIV, HBV and HCV in this population. DESIGN AND SETTING: This was a cross-sectional observational study in the AMU of a tertiary referral hospital in Galway, a city in the west of Ireland. PARTICIPANTS: 1936 patients entered the study; 54% were male, mean age was 53.1 years (SD 19.6). During the study period, all patients attending the AMU aged ≧16 years who were having bloods drawn and who had the ability to verbally consent for an additional blood sample met the inclusion criteria for the study. RESULTS: Over 44 weeks, 1936/4793 (40.4%) patients consented to BBV panel testing. Diagnosed prevalence rates for HIV, HBV and HCV were 0.5/1000, 2/1000 and 1.5/1000, respectively. There was one HIV-positive result; the patient was already engaged in care. Four patients tested positive for HBV surface antigen; one new diagnosis, one previously lost to follow-up and two already engaged in care. Three patients had active HCV infection; two had been lost to follow-up and are now linked back into services. CONCLUSION: BBV testing uptake of 40.4% is higher than previous studies in AMU settings that used opt-in strategies, but lower than expected, possibly due to not incorporating testing into routine practice. The diagnosed prevalence of HBV is notable as little data currently exist about its prevalence in Ireland. These data are valuable in order to inform further prevention strategies for these infections in low-prevalence settings.

Metal-Catalyzed Photooxidation of Flavones in Aqueous Media.

Soluble model compounds, such as flavones, are frequently employed in initial and mechanistic studies under homogeneous conditions in the search for effective bleaching catalysts for raw cotton. The relevance of model substrates, such as morin and chrysin, and especially their reactivity with manganese catalysts [i.e. in combination with 1,4,7-triazacyclononane (tacn) based ligands] applied in raw cotton bleaching with H2O2 in alkaline solutions is examined. We show that morin, used frequently as a model, is highly sensitive to oxidation with O2, by processes catalyzed by trace metal ions, that can be accelerated photochemically, although not involve generation of 1O2. The structurally related chrysin is not susceptible to such photo-accelerated oxidation with O2. Furthermore, chrysin is oxidized by H2O2 only in the presence of a Mn-tacn based catalyst, and does not undergo oxidation with O2 as terminal oxidant. Chrysin mimics the behavior of raw cotton's chromophores in their catalyzed oxidation with H2O2, and is likely a mechanistically relevant model compound for the study of transition metal catalysts for dye bleaching catalysts under homogeneous conditions.

The role of carboxylato ligand dissociation in the oxidation of chrysin with H2O2 catalysed by [Mn2(III,IV)(µ-CH3COO)(µ-O)2(Me4dtne)](PF6)2.

The aqueous and non-aqueous chemistry of the complex [Mn2(III,IV)(µ-CH3COO)(µ-O)2(Me4dtne)](PF6)2 (where Me4dtne = 1,2-bis(4,7-dimethyl-1,4,7-triazacyclonon-1-yl)ethane), which has been demonstrated as an exceptionally active catalyst in the bleaching of raw cotton and especially wood pulp at high pH (>11), is explored by UV/vis absorption, Raman and EPR spectroscopies and cyclic voltammetry. The data indicate that dissociation of the µ-acetato bridge is essential to the catalyst activity and rationalises the effect of sequestrants such as DTPA on its performance.

Off-line reaction monitoring of the oxidation of alkenes in water using drop coating deposition Raman (DCDR) spectroscopy.

The application of drop coating deposition Raman (DCDR) spectroscopy to the field of reaction progress monitoring is addressed in this contribution. Although, DCDR spectroscopy has seen recent application in the study of biological fluids, its application in other areas has not yet been explored. Here we apply the technique to the catalysed oxidation of alkenes to epoxides in aqueous solutions at concentrations <10 mM. The effect of surface characteristics, background interferences, homogeneity of distribution of analytes, drying time, as well as instrumental limits of detection and calibration are discussed. We demonstrate that reproducible spectra can be obtained routinely, with relatively little variance, with short acquisition times and samples volumes of 2-10 µl and as little as 1 µg of analyte. The utility of the technique compared with online reaction monitoring by (1)H NMR and Raman spectroscopy is demonstrated in the excellent correlation between data obtained off and on-line.

Modification of the deoxy-myoglobin/carbonmonoxy-myoglobin UV-vis assay for reliable determination of CO-release rates from organometallic carbonyl complexes.

The deoxy-myoglobin (deoxy-Mb)/carbonmonoxy-myoglobin (Mb-CO) UV-vis assay is the principal method used for quantifying the rates of CO release from CO-releasing molecules (CO-RMs) that might possess therapeutic benefits. Some issues emerge when the Mb-CO assay is utilized for testing CO-RMs with novel structures, which are comprehensively discussed here for the first time. Two methods for processing raw UV-vis spectroscopic data generated from the assay are presented in this paper.

Evidence for cobalt-cobalt bond homolysis and wavelength-dependent CO loss in (µ2-alkyne)Co2(CO)6 complexes.

Time-resolved infrared spectroscopy was used to probe the photochemistry of three (µ(2)-alkyne)Co(2)(CO)(6) complexes. The data indicate the formation of a triplet diradical species, with lifetimes in the range 38-71 ps. Theoretical calculations support these experimental findings. No evidence for the CO loss species, (µ(2)-alkyne)Co(2)(CO)(5), was observed, and this is rationalized by the low quantum yield for this process at the excitation wavelengths used.

Optically induced cis-trans isomerisation of (eta6-cis-stilbene)Cr(CO)3.

The femto- and picosecond time resolved spectroscopy of (eta(6)-cis-stilbene)Cr(CO)(3) provides evidence for three optically accessible excited states one leading to cis-trans isomerisation of the coordinated stilbene ligand and another which results in a slow release of CO.

Evaluating nurses' implementation of an infant-feeding counseling protocol for HIV-infected mothers: The Ban Study in Lilongwe, Malawi.

A process evaluation of nurses' implementation of an infant-feeding counseling protocol was conducted for the Breastfeeding, Antiretroviral and Nutrition (BAN) Study, a prevention of mother-to-child transmission of HIV clinical trial in Lilongwe, Malawi. Six trained nurses counseled HIV-infected mothers to exclusively breastfeed for 24 weeks postpartum and to stop breastfeeding within an additional four weeks. Implementation data were collected via direct observations of 123 infant feeding counseling sessions (30 antenatal and 93 postnatal) and interviews with each nurse. Analysis included calculating a percent adherence to checklists and conducting a content analysis for the observation and interview data. Nurses were implementing the protocol at an average adherence level of 90% or above. Although not detailed in the protocol, nurses appropriately counseled mothers on their actual or intended formula milk usage after weaning. Results indicate that nurses implemented the protocol as designed. Results will help to interpret the BAN Study's outcomes.

MHz unidirectional rotation of molecular rotary motors.

A combination of cryogenic UV-vis and CD spectroscopy and transient absorption spectroscopy at ambient temperature is used to study a new class of unidirectional rotary molecular motors. Stabilization of unstable intermediates is achieved below 95 K in propane solution for the structure with the fastest rotation rate, and below this temperature measurements on the rate limiting step in the rotation cycle can be performed to obtain activation parameters. The results are compared to measurements at ambient temperature using transient absorption spectroscopy, which show that behavior of these motors is similar over the full temperature range investigated, thereby allowing a maximum rotation rate of 3 MHz at room temperature under suitable irradiation conditions.

Absence of opioid withdrawal symptoms in patients receiving methadone and the protease inhibitor lopinavir-ritonavir.

A study was designed to determine the interactions, both clinical and pharmacokinetic, between methadone and lopinavir-ritonavir. Results demonstrated a 36% reduction in the methadone area under the plasma concentration-time curve after the introduction of lopinavir-ritonavir, with no coincident symptoms of opioid withdrawal and no requirement for methadone dose adjustment.