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J Forensic Leg Med ; 71: 101933, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32342903


This review assesses the use of point-of-care testing (POCT) in establishing a cause of death in the autopsy setting. A search was performed of the PubMed, Medline, Embase, ScienceDirect and Scopus databases using the terms point-of-care, autopsy, post-mortem, cause of death and forensics. This search revealed some evidence for the efficacy of POCT for autopsy derived samples in the detection of viruses, sepsis and abnormal glucose levels. Other potential applications for forensic POCT include drug abuse screening, detection of alcoholic and diabetic acidoketosis and carbon monoxide poisoning. Additional studies are needed to evaluate to the accuracy of POCT compared to standard laboratory testing and to more fully understand post-mortem derived sample errors.

Int J Neurosci ; 129(10): 1013-1023, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31092102


The effective treatment of many diseases requires the use of multiple treatment strategies among which neuromodulation is playing an increasingly important role. Neuromodulation devices that act to normalize or modulate nerve activity through the targeted delivery of electrical stimuli will be the focus of this review. These devices encompass deep brain stimulators, vagus nerve stimulators, spinal cord simulators and sacral nerve stimulators. Already neuromodulation has proven successful in the treatment of a broad range of conditions from Parkinson's disease to chronic pain and urinary incontinence. Many of these approaches seek to exploit the activities of the autonomic nervous system, which influences organ function through the release of neurotransmitters and associated signalling cascades. This review will outline existing and emerging applications for each of these neuromodulation devices, proposed mechanisms of action and clinical studies evaluating both their safety and therapeutic efficacy.

Terapia por Estimulação Elétrica/métodos , Terapia por Estimulação Elétrica/tendências , Estimulação Elétrica Nervosa Transcutânea/métodos , Estimulação Elétrica Nervosa Transcutânea/tendências , Ensaios Clínicos como Assunto/métodos , Estimulação Encefálica Profunda/métodos , Estimulação Encefálica Profunda/tendências , Epilepsia/fisiopatologia , Epilepsia/terapia , Humanos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Estimulação da Medula Espinal/métodos , Estimulação da Medula Espinal/tendências , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Estimulação do Nervo Vago/métodos , Estimulação do Nervo Vago/tendências
BMJ Open ; 8(11): e022921, 2018 11 25.
Artigo em Inglês | MEDLINE | ID: mdl-30478113


OBJECTIVE: To assess developments over time in the capture, curation and use of quality and safety information in managing hospital services. SETTING: Four acute National Health Service hospitals in England. PARTICIPANTS: 111.5 hours of observation of hospital board and directorate meetings, and 72 hours of ward observations. 86 interviews with board level and middle managers and with ward managers and staff. RESULTS: There were substantial improvements in the quantity and quality of data produced for boards and middle managers between 2013 and 2016, starting from a low base. All four hospitals deployed data warehouses, repositories where datasets from otherwise disparate departmental systems could be managed. Three of them deployed real-time ward management systems, which were used extensively by nurses and other staff. CONCLUSIONS: The findings, particularly relating to the deployment of real-time ward management systems, are a corrective to the many negative accounts of information technology implementations. The hospital information infrastructures were elements in a wider move, away from a reliance on individual professionals exercising judgements and towards team-based and data-driven approaches to the active management of risks. They were not, though, using their fine-grained data to develop ultrasafe working practices.

Administração Hospitalar , Gestão de Riscos/métodos , Governança Clínica/organização & administração , Inglaterra , Conselho Diretor/organização & administração , Administração Hospitalar/métodos , Sistemas de Informação Hospitalar/organização & administração , Humanos , Gestão de Riscos/organização & administração , Medicina Estatal/organização & administração
Stud Health Technol Inform ; 228: 23-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27577334


Health systems around the world are investing increasing effort in monitoring care quality and safety. Dashboards can support this process, providing summary data on processes and outcomes of care, making use of data visualization techniques such as graphs. As part of a study exploring development and use of dashboards in English hospitals, we interviewed senior managers across 15 healthcare providers. Findings revealed substantial variation in sophistication of the dashboards in place, largely presenting retrospective data items determined by national bodies and dependent on manual collation from a number of systems. Where real time systems were in place, they supported staff in proactively managing quality and safety.

Eficiência Organizacional , Segurança do Paciente , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Inglaterra , Hospitais , Entrevistas como Assunto
Biotechnol J ; 11(8): 1088-99, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27213717


Proteins that are modified by chemical conjugation require at least two separate purification processes. First the bulk protein is purified, and then after chemical conjugation, a second purification process is required to obtain the modified protein. In an effort to develop new enabling technologies to integrate bioprocessing and protein modification, we describe the use of disulfide-bridging conjugation to conduct PEGylation during protein refolding. Preliminary experiments using a PEG-mono-sulfone reagent with partially unfolded leptin and unfolded RNAse T1 indicated that the cysteine thiols underwent disulfide-bridging conjugation to give the PEGylated proteins. Interferon-ß1b (IFN-ß1b) was then expressed in E.coli as inclusion bodies and found to undergo disulfide bridging-conjugation during refolding. The PEG-IFN-ß1b was isolated by ion-exchange chromatography and displayed in vitro biological activity. In the absence of the PEGylation reagent, IFN-ß1b refolding was less efficient and yielded protein aggregates. No PEGylation was observed if the cysteines on IFN-ß1b were first modified with iodoacetamide prior to refolding. Our results demonstrate that the simultaneous refolding and disulfide bridging PEGylation of proteins could be a useful strategy in the development of affordable modified protein therapeutics.

Dissulfetos/química , Polietilenoglicóis/química , Proteínas/química , Proteínas/isolamento & purificação , Cromatografia por Troca Iônica , Cisteína/química , Interferon beta-1b/química , Interferon beta-1b/isolamento & purificação , Modelos Moleculares , Estrutura Molecular , Redobramento de Proteína , Ribonuclease T1/química , Ribonuclease T1/isolamento & purificação
Future Med Chem ; 6(16): 1829-46, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25407370


PEGylation is the covalent conjugation of PEG to therapeutic molecules. Protein PEGylation is a clinically proven approach for extending the circulation half-life and reducing the immunogenicity of protein therapeutics. Most clinically used PEGylated proteins are heterogeneous mixtures of PEG positional isomers conjugated to different residues on the protein main chain. Current research is focused to reduce product heterogeneity and to preserve bioactivity. Recent advances and possible future directions in PEGylation are described in this review. So far protein PEGylation has yielded more than 10 marketed products and in view of the lack of equally successful alternatives to extend the circulation half-life of proteins, PEGylation will still play a major role in drug delivery for many years to come.

Sistemas de Liberação de Medicamentos , Desenho de Fármacos , Polietilenoglicóis/química , Polietilenoglicóis/metabolismo , Proteínas/química , Proteínas/uso terapêutico , Humanos , Proteínas/metabolismo