Effect of pharmacy-led interventions during care transitions on patient hospital readmission: A systematic review.

BACKGROUND: The Centers for Medicare and Medicaid (CMS) established the Hospital Readmissions Reduction Program (HRRP) to reduce reimbursement payments to hospitals with excessive patient readmissions. Because of this program, hospitals have developed transitions of care (TOC) programs to improve patient outcomes. OBJECTIVES: To identify and uniformly summarize the impact of pharmacy-led TOC interventions on 30-day readmission rates since the implementation of CMS HRRP. METHODS: This study followed an a-priori protocol that was registered to International Prospective Register of Systematic Reviews. A systematic search was conducted using PubMed, EMBASE, International Pharmaceutical Abstracts, and CINAHL from January 1, 2013 through January 14, 2022. Studies were included if they met the following criteria: pharmacy-led intervention, 30-day readmission outcomes, patients at least 18 years old, original research performed in the United States, and English language only articles. Descriptive statistics were used to summarize study characteristics, outcomes, and elements of the study interventions. RESULTS: A total of 1964 abstracts were screened with 123 studies being included in the review. A total of 110 (89.4%) studies showed a decrease in readmission rates. The largest decrease in readmission rates was 44.5% (range 0.2%-44.5%, median = 7.4%) and the most common pharmacy-led intervention was patient counseling (n = 119, 96.7%) followed by medication reconciliation (n = 111, 90.2%). High-risk patient populations were commonly targeted with 52 studies (42.3%) focusing on CMS HRRP related diagnoses. CONCLUSION: Most pharmacist-led TOC interventions contributed to lower rates of 30-day readmission. Future studies should investigate the types of interventions that most significantly impact readmission rates.

Safe Practice Recommendations for the Use of Copy-Forward with Nursing Flow Sheets in Hospital Settings.

BACKGROUND: In early 2016 the Partnership for Health IT Patient Safety released safe practice recommendations for the use of copy-paste for electronic health record (EHR) documentation. These recommendations do not directly address nurses' use of copy-forward to document patient assessments in flow sheet software in hospital settings. Similar to clinicians' use of copy-paste and copy-forward with progress notes, concerns exist about patient safety issues from the use of potential inaccurate or outdated information to achieve increased efficiency of documentation. METHODS: A multiple-methods approach-which included a literature review, litigation search, stakeholder analysis, and consensus opinion from experts from multiple disciplines-was employed. RESULTS: Four recommendations correspond closely with copy-paste guidance for EHR documentation from the Partnership: (1) Provide a mechanism to make copied-forward content easily identifiable, (2) Ensure that the provenance of copied-forward content is readily available, (3) Ensure adequate staff training and education regarding the appropriate and safe use of copy-forward in flow sheet software, if available, and (4) Ensure that copy-forward practices are regularly monitored, measured, and assessed. A fifth additional recommendation is made to improve the efficiency of data entry mechanisms, which may reduce patient safety risk. Emerging promising areas for innovation are to optimize interface usability and flow sheet content, use templates, use digital photographs, and eliminate work-flow steps with better methods for authentication and data entry. CONCLUSIONS: A thoughtful and measured approach to safe use of copy-forward in flow sheets by nurses in hospital settings is expected to result in improvements in efficiency of documentation, work flow, and accuracy of information.

Exploring Nurses' Perception of Dynamic Patient Events.

OBJECTIVE: The study aim was to describe nurses' perceptions of dynamic patient events (DPEs) impact on workflow and patient care. BACKGROUND: The process of determining optimal nurse staffing has challenged nurse leaders for decades. METHODS: This study took place on 3 inpatient units in 3 hospitals at a large academic medical center. A qualitative design that included focus groups composed of RNs with a minimum of 1-year experience was used. RESULTS: The most commonly identified DPEs were patient travel, code blues, rapid emergency response events, and requirement for an unplanned 1-on-1 sitter. The impact of DPEs influences the nurse's perception on job satisfaction, workflow, patient's safety/satisfaction, and delayed/missed care. CONCLUSION: It is incumbent upon nursing leaders to understand DPEs and anticipate how these events impact nursing workload, staffing, and care delivery.

COMmunity-Based Nutrition RISK Screening in Older Adults Living Independently (COMRISK): Feasibility, Acceptability, and Appropriateness of Community Partnership Models in Alberta, Canada.

This feasibility study of routine nutrition risk screening in community-dwelling older adults using a partnership between health care and community-based organizations (CBO) aimed to (1) evaluate the ability of community-based partnerships to provide screening for nutrition risk, and appropriately refer at-risk individuals for follow-up care and (2) determine the barriers to and facilitators of screening. Adults 65 years of age and older were screened by staff in two primary care and one CBO setting using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN)-8 nutrition risk screening tool. Screeners, organization administrators, and registered dietitians responded to surveys regarding SCREEN-8 administration, referral processes, and partnership interactions. All found the SCREEN-8 initiative feasible, acceptable, and appropriate. Sustainability requires strengthening of community resources, referral processes, and telephone assessments. The partnership added value despite limitations in communications. We conclude that broader implementation of this program using community-based partnerships has the potential to aid in the prevention of malnutrition in older adults.

Dendro[C(60)]fullerene DF-1 provides radioprotection to radiosensitive mammalian cells.

In this study, the ability of the C(60) fullerene derivative DF-1 to protect radiosensitive cells from the effects of high doses of gamma irradiation was examined. Earlier reports of DF-1's lack of toxicity in these cells were confirmed, and DF-1 was also observed to protect both human lymphocytes and rat intestinal crypt cells against radiation-induced cell death. We determined that DF-1 protected both cell types against radiation-induced DNA damage, as measured by inhibition of micronucleus formation. DF-1 also reduced the levels of reactive oxygen species in the crypt cells, a unique capability of fullerenes because of their enhanced reactivity toward electron-rich species. The ability of DF-1 to protect against the cytotoxic effects of radiation was comparable to that of amifostine, another ROS-scavenging radioprotector. Interestingly, localization of fluorescently labeled DF-1 in fibroblast was observed throughout the cell. Taken together, these results suggest that DF-1 provides powerful protection against several deleterious cellular consequences of irradiation in mammalian systems including oxidative stress, DNA damage, and cell death.

Antioxidant single-walled carbon nanotubes.

Single-walled carbon nanotubes (SWCNTs) and ultrashort SWCNTs (US-SWCNTs) were functionalized with derivatives of the phenolic antioxidant, butylated hydroxytoluene (BHT). By using the oxygen radical absorbance capacity (ORAC) assay, the oxygen radical scavenging ability of the SWCNT antioxidants is nearly 40 times greater than that of the radioprotective dendritic fullerene, DF-1. In addition, ORAC results revealed two divergent trends in the antioxidant potential of SWCNTs, depending on the type of functionalization employed. When existing pendant sites on US-SWCNTs were further functionalized by either covalent or noncovalent interactions of the existing pendant sites with a BHT derivative, the amount of BHT-derivative loading proportionately increased the overall antioxidant activity. If, however, functionalization occurred via covalent functionalization of a BHT-derivative directly to the SWCNT sidewall, the amount of BHT-derivative loading was inversely proportional to the overall antioxidant activity. Therefore, increasing the number of pendant sites on the SWCNT sidewalls by covalent functionalization led to a concomitant reduction in ORAC activity, suggesting that the nanotube itself is a better radical scavenger than the BHT-derivatized SWCNT. Cytotoxicity assays showed that both nonfunctionalized and BHT-derivatized SWCNTs have little or no deleterious effect on cell viability. Therefore, SWCNTs may be attractive agents for antioxidant materials and medical therapeutics research.

Functionalization density dependence of single-walled carbon nanotubes cytotoxicity in vitro.

The cytotoxic response of cells in culture is dependant on the degree of functionalization of the single-walled carbon nanotube (SWNT). After characterizing a set of water-dispersible SWNTs, we performed in vitro cytotoxicity screens on cultured human dermal fibroblasts (HDF). The SWNT samples used in this exposure include SWNT-phenyl-SO(3)H and SWNT-phenyl-SO(3)Na (six samples with carbon/-phenyl-SO(3)X ratios of 18, 41, and 80), SWNT-phenyl-(COOH)(2) (one sample with carbon/-phenyl-(COOH)(2) ratio of 23), and underivatized SWNT stabilized in 1% Pluronic F108. We have found that as the degree of sidewall functionalization increases, the SWNT sample becomes less cytotoxic. Further, sidewall functionalized SWNT samples are substantially less cytotoxic than surfactant stabilized SWNTs. Even though cell death did not exceed 50% for cells dosed with sidewall functionalized SWNTs, optical and atomic force microscopies show direct contact between cellular membranes and water-dispersible SWNTs; i.e. the SWNTs in aqueous suspension precipitate out and selectively deposit on the membrane.

The role of surfactant adsorption during ultrasonication in the dispersion of single-walled carbon nanotubes.

The ionic surfactant-assisted dispersion of single-walled carbon nanotubes in aqueous solution has been studied by Raman and fluorescent spectroscopy during ultrasonic processing. During the process, an equilibrium is established between free individuals and aggregates or bundles that limits the concentration of the former that is possible. This equilibrium is a function of free sodium dodecyl sulfate concentration. At surfactant concentrations below this value, fluorescence is shifted to a lower energy due to an increase in micropolarity from water association at the nanotube surface. The mechanism of dispersion is postulated as the formation of gaps or spaces at the bundle ends in the high shear environment of the ultrasonicated solution. Surfactant adsorption and diffusion then propagate this space along the bundle length, thereby separating the individual nanotube. The former is found to be controlling, with the use of a derived kinetic model for the dispersion process and extraction of the characteristic rate of nanotube isolation.

Functionalization of SWNTs to facilitate the coordination of metal ions, compounds and clusters.

The carboxylate residues of the open ends of aryl-tert-butyl and arylsulfonic acid side-walled functionalized single walled carbon nanotubes (SWNTs) have been investigated for the complexation conditions of the iron-molybdenum cluster [H(x)PMo(12)O(40)CH(4)Mo(72)Fe(30)(O(2)CMe)(15)O(254)(H(2)O)(98)] ("FeMoC"). A range of alternative donor groups for the attachment of FeMoC have been investigated for piranha etched SWNTs, dodecyl side-walled functionalized SWNTs (DD-SWNTs) and ultra-short SWNTs (US-SWNTs), including include pyridines, thiols and phosphines, using coupling reactions to either the carboxylate or hydroxide residues of the SWNTs' open ends. The functionalized SWNTs have been characterized by XPS, uptake of Fe(3+) and, where appropriate, MAS (31)P NMR. The efficacy of binding is dependent on the presence and identity of the ligand moiety. TEM and AFM of the SWNT-FeMoC conjugates show the presence of a 2-3 nm spherical feature on the tip of individual SWNTs.

Nanoscopically flat open-ended single-walled carbon nanotube substrates for continued growth.

Continued growth is a way of growing nanotubes targeted to produce continuous and chirality-controlled single-walled carbon nanotube (SWNT) materials. This growth method strongly depends on efficient preparation of open-ended SWNT substrates. Nanoscopically flat open-ended SWNT substrates have been prepared by cutting the SWNT spun fiber with a focused ion beam cutting technique and followed by etching schemes for cleaning amorphous carbon and opening the ends of the SWNTs. The open ends were effectively characterized through selective etch back of open SWNT ends by carbon dioxide gas at 950 degrees C. High density continued growth was demonstrated from these nanoscopically flat open-ended substrates.

Single wall carbon nanotube amplification: en route to a type-specific growth mechanism.

With the desire to mass produce any specific n,m type of single wall carbon nanotube (SWNT) from a small sample of the same material, we disclose here the preliminary work directed toward that goal. The ultimate protocol would involve taking a single n,m-type nanotube sample, cutting the nanotubes in that sample into many short nanotubes, using each of those short nanotubes as a template for growing much longer nanotubes of the same type, and then repeating the process. The result would be an amplification of the original tube type: a parent SWNT serving as the prolific progenitor of future identical SWNT types. As a proof-of-concept, we use here a short SWNT seed as a template for vapor liquid solid (VLS) amplification growth of an individual long SWNT. The original short SWNT seed was a polymer-wrapped SWNT, end-carboxylated, and further tethered with Fe salts at its ends. The Fe salts were to act as the growth catalysts upon subsequent reductive activation. Deposition of the short SWNT-Fe tipped species upon an oxide surface was followed by heating in air to consume the polymer wrappers, then reducing the Fe salts to Fe(0) under a H2-rich atmosphere. During this heating, the Fe(0) can etch back into the short SWNT so that the short SWNT acts as a template for new growth to a long SWNT that occurs upon introduction of C2H4 as a carbon source. Analysis indicated that the templated VLS-grown long SWNT had the same diameter and surface orientation as the original short SWNT seed, although amplifying the original n,m type remains to be proven. This study could pave the way for an amplified growth process of SWNTs en route to any n,m tube type synthesis from a starting sample of pure nanotubes.

A study of the formation, purification and application as a SWNT growth catalyst of the nanocluster [HxPMo12O40[subset]H4Mo72Fe30(O2CMe)15O254(H2O)98].

The synthetic conditions for the isolation of the iron-molybdenum nanocluster FeMoC [HxPMo12O40 [subset]H4Mo72Fe30(O2CMe)15O254(H2O)98], along with its application as a catalyst precursor for VLS growth of SWNTs have been studied. As-prepared FeMoC is contaminated with the Keplerate cage [H4Mo72Fe30(O2CMe)15O254(H2O)98] without the Keggin [HxPMo12O40]n- template, however, isolation of pure FeMoC may be accomplished by Soxhlet extraction with EtOH. The resulting EtOH solvate is consistent with the replacement of the water ligands coordinated to Fe being substituted by EtOH. FeMoC-EtOH has been characterized by IR, UV-vis spectroscopy, MS, XPS and 31P NMR. The solid-state 31P NMR spectrum for FeMoC-EtOH (delta-5.3 ppm) suggests little effect of the paramagnetic Fe3+ centers in the Keplerate cage on the Keggin ion's phosphorous. The high chemical shift anisotropy, and calculated T1 (35 ms) and T2 (8 ms) values are consistent with a weak magnetic interaction between the Keggin ion's phosphorus symmetrically located within the Keplerate cage. Increasing the FeCl2 concentration and decreasing the pH of the reaction mixture optimizes the yield of FeMoC. The solubility and stability of FeMoC in H2O and MeOH-H2O is investigated. The TGA of FeMoC-EtOH under air, Ar and H2 (in combination with XPS) shows that upon thermolysis the resulting Fe : Mo ratio is highly dependent on the reaction atmosphere: thermolysis in air results in significant loss of volatile molybdenum components. Pure FeMoC-EtOH is found to be essentially inactive as a pre-catalyst for the VLS growth of single-walled carbon nanotubes (SWNTs) irrespective of the substrate or reaction conditions. However, reaction of FeMoC with pyrazine (pyz) results in the formation of aggregates that are found to be active catalysts for the growth of SWNTs. Activation of FeMoC may also be accomplished by the addition of excess iron. The observation of prior work's reported growth of SWNTs from FeMoC is discussed with respect to these results.

Visualization of individual single-walled carbon nanotubes by fluorescent polymer wrapping.

Manipulating optical properties of single-walled nanotubes (SWNTs) is necessary for the development of nanoscale optical devices and probes for biomedical research. In life sciences it will make possible the direct observation of SWNTs inside living cells using optical microscopes. In the nanotechnology field it will enable the development of nanosensors with fluorescent reporting. However, the direct fluorescent labeling of SWNTs is obstructed by their strong light quenching qualities. Besides, chemical functionalization of SWNTs needed for the covalent attachment of fluorescent dyes could change favorable properties of nanotubes. Here we report that optical properties of SWNTs can be manipulated without their covalent modification by wrapping them with fluorescently labeled polymer poly(vinylpyrrolidone) (PVP-1300). Fluorescent PVP-1300 forms a monomolecular approximately 2.5 nm thick layer coiling around individual SWNTs and nanotube bundles. PVP casing is fluorescent although it is only several nanometers thick. This makes individual SWNTs observable by a fluorescent microscope. The spare polymer strands left over after wrapping around the relatively shorter nanotubes form junctions between SWNTs tying them together into new configurations, primarily Y- and psi-type junctions. The ability to use a single fluorescent polymer strand to fasten nanotubes together can be useful in assembly of nanotube-made devices. In PVP-covered SWNTs multiple fluorophores are attached to each single nanotube making them unique composite fluorophores attractive as parts of biological fluorescent probes and in the development of the new materials in photonics and nanotechnology.

Optical signatures of the Aharonov-Bohm phase in single-walled carbon nanotubes.

We report interband magneto-optical spectra for single-walled carbon nanotubes in high magnetic fields up to 45 tesla, confirming theoretical predictions that the band structure of a single-walled carbon nanotube is dependent on the magnetic flux phi threading the tube. We have observed field-induced optical anisotropy as well as red shifts and splittings of absorption and photoluminescence peaks. The amounts of shifts and splittings depend on the value of phi/phi(0) and are quantitatively consistent with theories based on the Aharonov-Bohm effect. These results represent evidence of the influence of the Aharonov-Bohm phase on the band gap of a solid.

Band gap fluorescence from individual single-walled carbon nanotubes.

Fluorescence has been observed directly across the band gap of semiconducting carbon nanotubes. We obtained individual nanotubes, each encased in a cylindrical micelle, by ultrasonically agitating an aqueous dispersion of raw single-walled carbon nanotubes in sodium dodecyl sulfate and then centrifuging to remove tube bundles, ropes, and residual catalyst. Aggregation of nanotubes into bundles otherwise quenches the fluorescence through interactions with metallic tubes and substantially broadens the absorption spectra. At pH less than 5, the absorption and emission spectra of individual nanotubes show evidence of band gap-selective protonation of the side walls of the tube. This protonation is readily reversed by treatment with base or ultraviolet light.