Nursing the system. Key users are sometimes "out of the loop"

Among those with a particular interest in hospital information systems are those who teach nursing students at the college level. To get their views, Southern Hospitals interviewed four Nurse Scholars involved with nursing and research projects for universities across the South. In 1989, Atlanta-based vendors HealthQuest and HBO & Company of Georgia established the Nurse Scholars Program in an effort to help academia stay abreast of technology. It provides nurse educators with comprehensive instruction in emerging technologies and uses of automated patient care systems. The scholars are encouraged to share their new knowledge with students, faculty, practitioners and administrators so that future nurse executives will better understand and communicate what they need and want from information systems.     

Short-term rehospitalizations in young adults with schizophrenia treated with once-monthly paliperidone palmitate or oral atypical antipsychotics: a retrospective analysis

Objective: To compare rehospitalizations in patients with schizophrenia treated with paliperidone palmitate (PP1M) vs oral atypical antipsychotics (OAAs), with a focus on young adults (18–35 years).

Methods: The Premier Healthcare database (January 2009–December 2016) was used to identify hospitalizations of adults (≥18 years) with schizophrenia treated with PP1M or OAA between September 2009 and October 2016 (index hospitalizations). Rehospitalizations were assessed at 30, 60, and 90 days after each index hospitalization in young adults and in all patients. Proportions of index hospitalizations resulting in rehospitalization were reported and compared between groups using odds ratios (ORs) and 95% confidence intervals (CIs).

Results: A total of 8578 PP1M and 306,252 OAA index hospitalizations were included. Hospitalized young adults treated with PP1M (n?=?3791) were more likely to be seen by a psychiatrist (94.0% vs 90.0%), and had a longer length of stay (12.5 vs 8.6 days) compared to hospitalized young adults treated with OAA (n?=?96,502). Following their discharge, young adults receiving PP1M during an index hospitalization had a 25–27% lower odds of rehospitalization within 30, 60, and 90 days compared to young adults receiving OAAs (all p?<?.001). Similarly, when observing all patients, those receiving PP1M during an index hospitalization had 19–22% lower odds of rehospitalization within 30, 60, and 90 days compared to those receiving OAAs (all p?<?.001).

Conclusions: Following a hospitalization for schizophrenia, PP1M treatment was associated with fewer 90-day rehospitalizations among young adults (18–35 years) relative to OAA treatment. This finding was also observed in other hospitalized adults with schizophrenia.     

Biocompatible Microemulsion Modifies the Pharmacokinetic Profile and Cardiotoxicity of Doxorubicin

Doxorubicin (DOX) is an anthracycline antibiotic with a broad antitumor spectrum. However, the clinical use of DOX is limited because of its cardiotoxicity, a dose‐dependent effect. Colloidal drug delivery systems, such as microemulsions (MEs), allow the incorporation of drugs, modifying the pharmacokinetic (PK) profile and toxic effects. In this study, we evaluated the PK profile and cardiotoxicity of a new DOX ME (DOX‐ME). The PK profile of DOX‐ME was determined and compared with that of the conventional DOX after single‐dose administration (6 mg/kg, intravenous) in male Wistar rats (n = 12 per group). The cardiotoxicity of DOX formulations was evaluated by serum creatine kinase MB (CKMB) activity in both animal groups before and after drug administration. The plasma DOX measurements were performed by high‐performance liquid chromatography with fluorescence detection, and the CKMB levels were assayed using the CKMB Labtest® kit. The ME system showed a significant increase in plasma DOX concentrations and lower distribution volume when compared with conventional DOX. Serum CKMB activity increased after conventional DOX administration but was unchanged in the DOX‐ME group. These results demonstrate modifications in drug access to susceptible sites using DOX‐ME. DOX‐ME displayed features that make it a promising system for future therapeutic application.     

Effect of cessation of highly active antiretroviral therapy during a discordant response: implications for scheduled therapeutic interruptions.

Although treatment with combination antiretroviral therapy leads to a reduction in the level of plasma viremia and an improvement in CD4 T cell count for most patients, for a minority of patients, an improvement in CD4 T cell count occurs despite the failure of treatment to suppress viral replication. Recent reports suggest that these discordant improvements in CD4 T cell count may last for months to years and are associated with improved clinical outcomes. In a retrospective observational study, we evaluated the effect of therapy cessation on 8 patients with discordant immunologic responses to therapy and found that improved CD4 T cell responses are dependent upon ongoing drug pressure. If antiretroviral agents that are likely to resuppress the virus are not available, we suggest that patients continue the therapy associated with immunologic improvement to maximize the clinical benefit of the discordant response.     

Feasibility of infectious prion digestion using mild conditions and commercial subtilisin

Two serine protease enzymes, subtilisin 309 and subtilisin 309-v, were used to digest brain homogenates containing high levels of prion infectivity using mildly alkaline conditions to investigate prion decontamination methods. To establish that PrP^res infectivity was eliminated, we utilized the Rocky Mountain Laboratory (RML) mouse-adapted scrapie model system for bioassay. Only one digestion condition (subtilisin 309 at 138 mAU/ml, 55 °C and 14 h digestion time pH 7.9) was considered to be highly relevant statistically (P < 0.001) compared to control, with 52% of challenged mice surviving until the end of the study period. In contrast, treatment of PrP^res by autoclaving at 134 °C or treatment with hypochlorite at a concentration of 20,000 ppm completely protected mice from prionosis. Further, in vitro assays suggest that potential proteolytic based PrP^res decontamination methods must use high enzyme concentration, pH values >9.0, and elevated temperatures to be a safely efficacious, thereby limiting applicability on delicate surgical instruments and use in the environment.     

Identification of a nucleotide binding site in HIV-1 integrase

HIV-1 integrase is essential for viral replication and can be inhibited by antiviral nucleotides. Photoaffinity labeling with the 3′-azido-3′-deoxythymidine (AZT) analog 3′,5-diazido-2′,3′-dideoxyuridine 5′-monophosphate (5N₃-AZTMP) and proteolytic mapping identified the amino acid 153–167 region of integrase as the site of photocrosslinking. Docking of 5N₃-AZTMP revealed the possibility for strong hydrogen bonds between the inhibitor and lysines 156, 159, and 160 of the enzyme. Mutation of these residues reduced photocrosslinking selectively. This report elucidates the binding site of a nucleotide inhibitor of HIV-1 integrase, and possibly a component of the enzyme polynucleotide binding site.     

Whole blood versus plasma spots for measurement of HIV-1 viral load in HIV-infected African patients

The increasing availability of antiretroviral drugs to HIV-infected populations in developing countries highlights the need to develop field-friendly practical methods for HIV-1 viral load measurements to monitor the effects of treatment. We compared use of whole-blood spots versus plasma dried on filter paper to quantify HIV-1 viral load in 51 African patients with HIV-1. The mean log10 HIV-1 viral loads were 4.22 for dried plasma spots (DPS) and 4.20 for dried whole-blood spots (DBS). The difference between the pairs of log10 viral load for DPS and DBS were significantly correlated with their mean (Spearman's r=0.31, p=0.03). This correlation between the difference and mean of viral load was no longer evident for values of log10 DPS that were less than 5 (r=0.01, p=0.93). For the 38 paired values with log10DPS of less than 5, the mean difference (log10DPS-log10DBS) was -0.04 (SD 0.29). Dried whole blood stored on filter paper at room temperature shows potential as a field-friendly alternative to plasma for measurement of HIV-1 viral load.     

Risk factors of endoleak following endovascular repair of abdominal aortic aneurysm. A multicentric retrospective study

Endoleak (EL) represents the most common complication following endovascular abdominal aortic aneurysm repair (EVAR). Unfortunately, the long-term results of EVAR and its durability have been questioned, and EL are variably associated with a risk of late failure. The aim of this retrospective study was to identify risk factors for this complication of aneurysm-endograft complex in patients who underwent EVAR. A group of 104 consecutive patients (99 men, 5 women; median age, 74 years; range, 50-89 years) were enrolled in the study. Both preoperative and follow-up imaging studies were obtained using helical computed tomography scanning at 1, 6, 12, 24, 36 months after EVAR and blindly reviewed by a surgeon and a radiologist. Twenty-seven (25.9%) patients developed EL during follow-up, of which 10 (37%) were primary (<30 days from EVAR), and 17 (63%) were secondary EL. Age and smoking did not affect the EL onset, while a body mass index >25 and a history or presence of arterial hypertension represented significant (p<0.05) risk factors. Moreover, both greatest diameter and maximum length of the aneurysm were significantly higher (p<0.01) in patients who developed EL. No relationship was found with the anatomical features of the aortic neck (i.e. length and diameter), and between the initial size of the aneurysm and the dimension at the time of EL. In conclusion, in our study, being overweight, arterial hypertension and the initial size of the aneurysm represent risk factors for EL development.     

Impact of adherence to statins on coronary artery disease in primary prevention

AIMS: To evaluate the impact of adherence to statins on nonfatal coronary artery disease (CAD). Statins reduce cardiovascular morbidity and mortality after 1-2 years of continuous treatment. Studies have shown that <40% of patients take > or =80% of prescribed doses 1 year after starting therapy and that approximately half discontinue medication within 6 months of starting therapy. METHODS: A cohort of 20 543 patients was reconstructed using the Régie de l'assurance maladie du Québec databases. Patients aged 50-64 years, without cardiovascular disease, and newly treated with statins between 1998 and 2000 were eligible. A nested case-control design was used to study nonfatal CAD. Every case was matched with 20 randomly selected controls. The adherence level was defined as the percentage of the prescribed medication doses used over a specified period and classified as > or =90% or <90%. Rate ratios (RR) of nonfatal CAD were determined through conditional logistic regression adjusted for age, sex, socioeconomic status, diabetes and hypertension. RESULTS: The mean patient age was 58 years, 45% had hypertension and 19% had diabetes. Men represented 37% of the cohort. Among patients followed for >1 year, adherence of > or =90% was associated with fewer nonfatal CAD events (RR 0.81; 0.67, 0.97) compared with adherence <90%. In the multivariate model, male gender (RR 1.37; 1.16, 1.63), welfare recipients (RR 1.24; 1.04, 1.48), newly diagnosed hypertension (RR 3.54; 2.62, 4.77) and newly diagnosed diabetes mellitus (RR 1.97; 1.20, 3.24) were risk factors for CAD. CONCLUSION: The incidence of nonfatal CAD events decreases when >90% of the prescribed medications is used over at least 1 year.