Falls and consequent injuries in hospitalized patients: effects of an interdisciplinary falls prevention program

Background  

Patient falls in hospitals are common and may lead to negative outcomes such as injuries, prolonged hospitalization and legal liability. Consequently, various hospital falls prevention programs have been implemented in the last decades. However, most of the programs had no sustained effects on falls reduction over extended periods of time.     

Light absorbing properties of indocyanine green (ICG) in solution and after adsorption to the retinal surface — an ex-vivo approach

BACKGROUND: To evaluate potential differences in light absorbing properties and stability of indocyanine green (ICG) adsorbed to the retinal surface and of ICG dissolved in water and balanced salt solution. METHODS: The retina of four human donor eyes was prepared by removing the vitreous from the retinal surface. The inner surface of the specimen was covered with two to three drops of a 0.05% or 0.15% ICG solution respectively. After 1 min, the dye was removed by careful irrigation using BSS plus. The retinal specimens were then investigated by diffuse reflection spectroscopy (UV/VIS/NIR Spectrometer Lambda 900/Perkin Elmer equipped with a PELA-1020 integrating sphere accessory) and their absorption evaluated by the Kubelka-Munk function. To control the sensitivity of the setting, diffuse reflectance spectra of ICG adsorbed to a cellulose membrane and Al(2)O(3) were measured. For comparison, absorption spectra of ICG dissolved in water and BSS plus solution were measured in relation to ICG concentration and time using an UV/VIS/NIR Spectrometer Lambda 900/Perkin Elmer. RESULTS: On the retinal surface, absorption spectra exhibited a steep increase of absorption beginning at 620 nm, with a maximum at 736 nm (0.05%) and a shoulder at 745 (0.15%) and a second maximum at approximately 800 nm for both concentrations. Repeated measurement of the retinal surface 13 days after the ICG exposure revealed no changes in the position of the maxima as compared to the initial measurements. Light absorbing properties of ICG on cellulose or Al(2)O(3) are similar to those seen on the retinal surface with respect to the pattern and location of absorption maxima. In contrast, ICG dissolved in water or BSS plus disclosed variations in absorption characteristics depending on dye concentration, solute and time of measurement. CONCLUSIONS: Absorption characteristics and stability of ICG bound to the retinal surface could be of relevance when investigating potential pathomechanisms of ICG related toxicity, which might be related not only to intraoperative but also to postoperative light exposure of patients after intravitreal use of ICG.     

Management of asthma in patients supervised by primary care physicians or by specialists.

French asthma patients may be supervised by general practitioners (GPs) and/or specialists. Therefore, this study examined asthma management in patients exclusively supervised by specialists (SPE), GPs, (GP) and both (GP+SPE group), and compared the findings. Asthma patients were consecutively recruited in 348 pharmacies. Each patient completed a questionnaire providing data on personal characteristics, asthma management, perception of disease and asthma supervision. Asthma control was measured using the Asthma Control Test. Questionnaires were linked to computerised records of medications which had been dispensed before inclusion in the study. From the 1,256 patients (mean age = 36.1 yrs, 54.3% females), 11.4, 36.6, and 52.0% were placed in the SPE, GP, and GP+SPE groups, respectively. During the previous 4 weeks, most patients in the SPE group were properly controlled (52.2 versus 26.4 and 21.5% in GP and GP+SPE groups, respectively). The SPE group made more use of fixed combinations of long-acting beta agonist and inhaled corticosteroid, while receiving less short-acting beta agonists, antitussives and antibiotics. Striking differences in symptoms and asthma management were observed according to the type of asthma supervision. The current results strongly support the need to improve the management of asthma in primary care, and the coordination of care between general practitioners and specialists.     

Cortical plasticity: effect of high and low intensity conditioning electrical stimulations (100 Hz) on SEPs to painful finger stimulation.

OBJECTIVE: To study the effect of high-frequency (100 Hz) repetitive conditioning electrical stimulation (CES, 10 min) on human somatosensory evoked potentials (SEPs) to evaluate if short-term cortical plasticity could be induced. METHODS: Painful electrical stimulations were applied to thumb (D1) and little finger (D5) fingertips, respectively. The 124-channel EEG was recorded from 10 healthy male volunteers. Peak stages around 34, 45, 212, 331 ms were analyzed with focal maximum amplitude (FA) and area magnitude (AM) of scalp field potential, topography, and equivalent current dipole source localisation, comparing before and after two-level CES (high- vs. low-level) applied to the He-Gu acupoint. RESULTS: After a high-level CES, the positive FA and AM of the current efflux showed a significant increase at the early phase 34 ms, and significantly decreased at 45 ms in D1 SEPs. The negative FA and AM of the current influx were significantly increased at late phase 350 ms of the D5 SEPs. Only 36 ms, the z-axis position of dipole was significantly changed from (x: -15.9 mm, y: 29.6 mm, z: 43.9 mm) to (x: -12.9 mm, y: 29.4mm, z: 51.5mm) for the D5 SEPs. CONCLUSIONS: The high-level CES significantly attenuated the subsequent cortical activation (45 ms peak for D1 stimulation). Both low- and high-level CES significantly enhanced the late activities (226, 350 ms) in D5 stimulation. This may be explained by pain sensation change at the level of subcortical cingulate cortex induced by the site-dependent post-effect of CES. SIGNIFICANCE: This study showed cortical plasticity induced by conditioning somatosensory stimulation.     

Spray coated pellets as carrier system for mucoadhesive drug nanocrystals.

High pressure homogenization can be employed to produce drug nanocrystals with a number of advantages, like improved solubility behaviors, better drug targeting or even increased mucoadhesiveness. To obtain a controlled drug delivery system it is necessary to transform the resulting nanosuspension into a solid dosage form. The present study shows the feasibility to use a mucoadhesive nanosuspension of poorly soluble hydrocortisone acetate produced by high pressure homogenization as layering dispersion in a fluidized bed process, followed by the application of an enteric coating to achieve a controlled drug release. To point out the advantages of drug nanocrystals the new fomulation was compared with a formulation containing micronized drug. Both formulations were characterized with regard to their particle size and crystallinity by using laser diffractometry, photon correlation spectroscopy and X-ray diffraction. The pellet morphology was characterized by using the environmental scanning electron microscopy (ESEM). In the in vitro dissolution tests an accelerated dissolution velocity and an increased drug release could be shown for the pellets containing drug nanocrystals.