Current state of technical transfusion medicine practice for out-of-hospital blood transfusion in Canada.

BACKGROUND AND OBJECTIVES: Canadian out-of-hospital blood transfusion programmes (OHBTPs) are emerging, to improve outcomes of trauma patients by providing pre-hospital transfusion from the scene of injury, given prolonged transport times. Literature is lacking to guide its implementation. Thus, we sought to gather technical transfusion medicine (TM)-specific practices across Canadian OHBTPs. MATERIALS AND METHODS: A survey was sent to TM representatives of Canadian OHBTPs from November 2021 to March 2022. Data regarding transport, packaging, blood components and inventory management were included and reported descriptively. Only practices involving Blood on Board programme components for emergency use were included. RESULTS: OHBTPs focus on helicopter emergency medical service programmes, with some supplying fixed-wing aircraft and ground ambulances. All provide 1-3 coolers with 2 units of O RhD/Kell-negative red blood cells (RBCs) per cooler, with British Columbia trialling coolers with 2 units of pre-thawed group A plasma. Inventory exchanges are scheduled and blood components are returned to TM inventory using visual inspection and internal temperature data logger readings. Coolers are validated to storage durations ranging from 72 to 124 h. All programmes audit to manage wastage, though there is no consensus on appropriate benchmarks. All programmes have a process for documenting units issued, reconciliation after transfusion and for transfusion reaction reporting; however, training programmes vary. Common considerations included storage during extreme temperature environments, O-negative RBC stewardship, recipient notification, traceability, clinical practice guidelines co-reviewed by TM and a common audit framework. CONCLUSION: OHBTPs have many similarities throughout Canada, where harmonization may assist in further developing standards, leveraging best practice and national coordination.

The adoption of care robots in home care-A survey on the attitudes of Finnish home care personnel.

AIMS AND OBJECTIVES: This article examines the attitudes of Finnish home care registered nurses, licensed vocational nurses and other health and social care personnel towards the introduction and use of care robots in home care. BACKGROUND: The significance of care robotics has been highlighted in recent years. However, personnel-related social psychological barriers to the introduction of care robots have been given very little study. DESIGN: Cross-sectional study conducted by questionnaire. The theoretical framework of the study is based on Ajzen's theory of planned behaviour and the research discussion about attitudes towards robots. METHODS: The research data were collected in five municipalities in different parts of Finland in 2016, and the questionnaire was answered by a total of 200 home care workers. The research data were analysed using exploratory factor analysis, Pearson product-moment correlation, one-way analysis of variance and linear regression analysis. RESULTS: The results are consistent with Ajzen's theory and previous studies on the acceptance of information systems in health care. Personnel behavioural intentions related to the introduction of robot applications in home care are influenced by their personal appreciation of the usefulness of robots, the expectations of their colleagues and supervisors, as well as by their own perceptions of their capacity to learn to use care robots. In particular, personnel emphasised the value of care robots in providing reminders and guidance, as well as promoting the safety of the older people. CONCLUSIONS: The study shows that an intimate human-robot relationship can pose a challenge from the perspective of the acceptance of care robots. RELEVANCE TO CLINICAL PRACTICE: From the perspective of the introduction of care robots in home care, personnel training and the construction of a positive working atmosphere play a key role. In addition, the introduction of robots requires further consideration of a number of ethical issues.

Attitudes towards care robots among Finnish home care personnel - a comparison of two approaches.

STUDY'S RATIONALE: The significance of care robotics has been highlighted in recent years. AIMS AND OBJECTIVE: The article examines the adoption of care robots in home care settings, and in particular Finnish home care personnel's attitudes towards robots. The study compares the importance of the Negative Attitudes towards Robots Scale advanced by Nomura and specific positive attitudes related to the usefulness of care robots for different tasks in the home care. METHODOLOGICAL DESIGN: A cross-sectional study conducted by questionnaire. The research data were gathered from a survey of Finnish home care personnel (n = 200). RESEARCH METHODS: Exploratory factor analysis, Pearson's correlation coefficient and linear regression analysis. MEASURES: The Negative Attitudes towards Robots Scale (NARS), by Nomura, with a specific behavioural intention scale based on Ajzen's theory of planned behaviour, and a measure of positive attitudes towards the usefulness of care robots for different tasks in home care and the promotion of independent living of older persons. RESULTS: The study shows that NARS helps to explain psychological resistance related to the introduction of care robots, although the scale is susceptible to cultural differences. Care personnel's behavioural intentions related to the introduction of robot applications are influenced also by the perception of the usefulness of care robots. STUDY LIMITATIONS: The study is based only on a Finnish sample, and the response rate of the study was relatively small (18.2%), which limits the generalisability of the results. CONCLUSIONS: The study shows that the examination of home care personnel's attitudes towards robots is not justified to focus only on one aspect, but a better explanation is achieved by combining the perspectives of societal attitudes, attitudes related to psychological reactions and the practical care and promotion of the independent living of older people.

Interactive CaringTV® supporting elderly living at home.

BACKGROUND: Interactive CaringTV® is a Finnish innovation that was developed by Laurea University of Applied Sciences in 2006. CaringTV was developed through action research during three research projects. The aim of interactive CaringTV is to support the health and well-being of elderly people living in their own homes. METHOD: The Safe Home project was based on action research, userdriven methods, and a case study. User-driven methods were applied in planning, implementing and evaluating the programme and eServices e.g. testing and evaluating peer support, including eConsultation as the methods for supporting clients´ coping with life in their own homes. Costeffectiveness and process modelling were studied through the case study. RESULTS: The user-driven approach and the collected data formed the basis for the interactive programme. The online CaringTV programme included content to: support everyday life for the elderly, safety, and activities of daily living, support social relationships, participate in rehabilitation and physical exercises, manage self-care, and health issues. Active participation in the CaringTV programme provided functional ability and everyday coping as well as a meaningful activity in everyday life. CONCLUSION: CaringTV is an interactive platform to support elderly in their everyday life and help them cope at home. User-driven methods enable participants´ active involvement in planning interactive and online programmes and eServices via CaringTV. The ultimate goal of the CaringTV is to support elderly´s health, wellbeing and interaction. CaringTV empowers elderly people to take responsibility for their own health care as part of healthy ageing.

Use of conventional surfactant media as surrogates for FaSSIF in simulating in vivo dissolution of BCS class II drugs.

The usefulness of selected conventional surfactant media to enhance dissolution of BCS class II drugs similarly to fasted state simulated intestinal fluid (FaSSIF) and to predict the absorption of drugs in vivo was evaluated. Dissolution behavior of danazol (Danol), spironolactone (Spiridon) and N74 (phase I compound) was compared between FaSSIF, containing physiological levels of sodium taurocholate (STC) and lecithin, and dissolution media containing various concentrations of anionic surfactant, sodium lauryl sulfate (SLS) or non-ionic surfactant, polysorbate (Tween) 80. Although these media differed largely in their solubilization ability, micelle size, diffusivity and surface tension, similar dissolution enhancing levels were achieved between FaSSIF and drug-specific concentrations of conventional surfactants. The dissolution enhancement was shown, however, to be important only for danazol and N74, molecules that are characterized by high hydrophobicity. An in vivo pharmacokinetic dog study was carried out with N74. Comparison of observed plasma profiles with simulated profiles obtained using compartmental absorption and transit model (CAT) indicated that 0.1% SLS medium was the best to predict in vivo plasma profiles and pharmacokinetic parameters (C(max) and AUC). This study demonstrates the potential of substituting FaSSIF with more simple and cost-effective conventional surfactant media. Use of in vivo prognostic amounts of synthetic surfactants in dissolution testing could largely assist in industrial drug development as well as in quality control purposes.

Solvent-mediated solid phase transformations of carbamazepine: Effects of simulated intestinal fluid and fasted state simulated intestinal fluid.

Solvent-mediated transformations of carbamazepine (CBZ) anhydrate form III were investigated in Simulated Intestinal Fluid, a simple USP buffer medium, and in FaSSIF, which contains sodium taurocholate (STC) and lecithin, important surfactants that solubilize lipophilic drugs and lipids in the gastrointestinal tract. Raman spectroscopy (in situ) was utilized to reveal the connection between the changes in solid phase composition and dissolution rate while simultaneously detecting the solid state and the dissolved amount of CBZ. Initial dissolution rate was clearly higher in FaSSIF, while the solid phase data revealed that the crystallization of CBZ dihydrate was inhibited in both the dissolution media, albeit by different mechanisms. In SIF this inhibition was related to extensive needle growth, which impeded medium contact with the solid surface by forming a sterical barrier leading to retarded crystallization rates. Morphological changes from the needle-like dihydrate crystals to plate-like counterparts in FaSSIF, combined with the information that the transformation process was leveled off, evidenced strong hydrogen bonding behavior between the CBZ and STC molecules. These results underline the importance of biologically representative dissolution media in linking the in vitro dissolution results of solids that are capable of hydrate formation to their in vivo dissolution behavior.

Simultaneous measurement of liquid-phase and solid-phase transformation kinetics in rotating disc and channel flow cell dissolution devices.

Solvent-mediated solid-phase transformations may occur during dissolution tests which complicates the evaluation of dissolution rates in cases of metastable drugs. The purpose of this study was to determine the effects of solvent-mediated transformations of theophylline anhydrate (TP (A)) on the intrinsic dissolution rate in simulated gastric fluid at pH 1.2. A combined method set-up for simultaneous measurement of the dissolved quantity of drug and the solid form composition was constructed from in situ Raman spectroscopy and UV-vis-spectrophotometry. Transformation kinetics in the traditional USP rotating disc (RD) dissolution apparatus was compared with the recently introduced channel flow cell (CFC). Solid-phase data, supported by scanning electron micrographs taken off-line, explained the changes in the intrinsic dissolution rates due to hydrate formation. Kinetic modelling showed that first order kinetics fitted the data in CFC, but the conversion in RD was strongly S-shaped. These differences were related to dissimilar hydrodynamic conditions and diffusion characteristics in the two dissolution testing devices. In situ solid-phase measurement during dissolution testing can largely improve the understanding of the dissolution results of metastable drugs. This information is valuable in drug candidate selection as well as in explaining and controlling the behaviour of drug substances in the final drug products.