Individual Nurse Productivity in Preparing Patients for Discharge Is Associated with Patient Likelihood of 30-Day Return to Hospital

Objective: Applied to value-based health care, the economic term “individual productivity” refers to the quality of an outcome attributable through a care process to an individual clinician. This study aimed to (1) estimate and describe the discharge preparation productivities of individual acute care nurses and (2) examine the association between the discharge preparation productivity of the discharging nurse and the patient’s likelihood of a 30-day return to hospital [readmission and emergency department (ED) visits]. Research Design: Secondary analysis of patient-nurse data from a cluster-randomized multisite study of patient discharge readiness and readmission. Patients reported discharge readiness scores; postdischarge outcomes and other variables were extracted from electronic health records. Using the structure-process-outcomes model, we viewed patient readiness for hospital discharge as a proximal outcome of the discharge preparation process and used it to measure nurse productivity in discharge preparation. We viewed hospital return as a distal outcome sensitive to discharge preparation care. Multilevel regression analyses used a split-sample approach and adjusted for patient characteristics. Subjects: A total 522 nurses and 29,986 adult (18+ y) patients discharged to home from 31 geographically diverse medical-surgical units between June 15, 2015 and November 30, 2016. Measures: Patient discharge readiness was measured using the 8-item short form of Readiness for Hospital Discharge Scale (RHDS). A 30-day hospital return was a categorical variable for an inpatient readmission or an ED visit, versus no hospital return. Results: Variability in individual nurse productivity explained 9.07% of variance in patient discharge readiness scores. Nurse productivity was negatively associated with the likelihood of a readmission (−0.48 absolute percentage points, P\u3c0.001) and an ED visit (−0.29 absolute percentage points, P=0.042). Conclusions: Variability in individual clinician productivity can have implications for acute care quality patient outcomes

Pharmacological evaluation polysaccharide complex flowers tansy

From flowers tansy extracted polysaccharide complex. Installed its qualitative and quantitative composition, have developed a technique standardizing the content of reducing sugars. By thin layer chromatography and high pressure liquid chromatography after acid hydrolysis installed monosaccharide composition: glucose, xylose, arabinose, galactose and mannose. It is proved that the polysaccharide has a high content of uronic acid, which allows it to include the class of pectin. The investigation of gastroprotective activity of polysaccharide in the prophylactic administration at model destruction of the gastric mucosa to indomethacin. Introduction polysaccharide prevents various types of erosive and ulcerative destruction. According to anti-ulcer activity of the drug is superior to ranitidine and comparable to omeprazol

The Role of Vesicles in Transporting of Cholera Toxin

The review reports on the secretion pathways of the main virulence factor of Vibrio cholerae, cholera toxin, both through the two-stage Sec-dependent type 2 secretion system and with the help of vesicles of the outer membrane of V. cholerae. The ways of toxin transfer into the host organism, depending on its form, are discussed. The well-studied free soluble cholera toxin is secreted extracellularly and transmitted in a GM1-dependent manner through cholesterolrich lipid rafts. The transfer of cholera toxin associated with vesicles has advantages over free toxin, because substances inside the outer membrane vesicles are protected from external proteases and host antibodies by the membrane that forms the vesicle. Vesicular transporting of cholera toxin into the target cell occurs via clathrin-dependent, caveolin-dependent and lipid raft-dependent endocytosis. The specific transport route is determined by the structure of the vesicles. Clathrindependent endocytosis is described for V. cholerae strains cultivated at low osmolarity of the medium, whose outer membrane vesicles contain the cholera toxin subunit A inside. Lipid raft-dependent endocytosis is characteristic of vesicles in which cholera toxin is located on the surface. In addition, endocytosis of V. cholerae outer membrane vesicles through structures known as caveolae is presented

Mitoxantrone Quantification by HPLC-MS/MS in Caco-2 Culture Media

Mitoxantrone is a marker substrate of breast cancer resistance protein (BCRP). BCRP is involved in a number of pharmacokinetic drug-drug interactions. The transporter’s possible saturability makes it advisable to use low concentrations of mitoxantrone for in vitro studies. Consequently, mitoxantrone quantification requires   a method with high sensitivity.The aim of the study was to develop and validate a procedure for mitoxantrone quantification in Caco-2 culture media by HPLC-MS/MS.Materials and methods.  The  authors  used  an  Ultimate  3000  HPLC  system  and a TSQ Fortis triple quadrupole mass spectrometer by Thermo Fisher Scientific and a Selectra C18 column (4.6×100 mm, 5 μm, 100 Å) by United Chemical Technologies. The elution ran in a gradient mode with a mobile phase of 1% formic acid solution and methanol. Experimental parameters were as follows: eluent flow rate, 0.3 mL/min; separation column temperature, 35 °C; injection volume, 5  μL; ana lysis time, 10 min; approximate mitoxantrone retention time, 5.51 min. The sample preparation involved protein precipitation from the culture medium with methanol, followed by centrifugation at 13,000 g for 10 min. The detection was performed using electrospray ionisation in the positive ion mode. Detection parameters were   as follows: electrospray voltage, 3700 V; sheath gas flow rate, 50 L/min; auxiliary    gas flow rate, 10 L/min; sweep gas flow rate, 1 L/min; ion-transfer tube temperature, 300 °C; and evaporator temperature, 350 °C. The detection was set at mass transitions of m/z 455 to 88.2 and m/z 455 to 358.1, with the collision energy for these transitions amounting to 25 V and 18 V, respectively. The source fragmentation was at 0, and the CID gas pressure was at 2 mTorr.Results. The analytical procedure showed selectivity, high sensitivity (limit of detection, 10 nmol/L; lower limit of quantification, 50 nmol/L), accuracy, precision, and linearity in the concentration range of 50–1000 nmol/L. The authors observed no carryover or matrix effects. A simulation of real-life storage conditions demonstrated high stability of mitoxantrone samples. Thus, the analytical procedure enables preclinical evaluation of medicinal product effects on the functional activity of BCRP, based on assessing the transcellular mitoxantrone transport in the presence of a test product.Conclusion. The authors developed and validated the analytical procedure for mitoxantrone quantification in Caco-2 culture media by HPLC-MS/MS

Assessment of the Variation Range of Agglutinability in <i>Vibrio cholerae</i> Strains Isolated in the Course of Monitoring Studies

The aim of the study was to retrospectively analyze the range of variability of antigenic properties and genotypic characteristics of Vibrio cholerae R-variant strains atypical in terms of agglutinability.Materials and methods. 169 strains of V. cholerae R-variant with atypical agglutinability have been studied using the “AmpliSens® Vibrio cholerae-FL” test-system. The determination of O1 antigen was carried out using the “Ig-V. cholerae О1/О139 – ELISA/dot-ELISA” reagent kit.Results and discussion. A retrospective analysis of the complex of phenoand genotypic characteristics of strains isolated from surface water bodies in the territories of three former Soviet republics and 13 constituent entities of the Russian Federation in the course of 30-year monitoring and identified upon isolation as nontoxigenic V. cholerae R-variant strains has been performed. Upon re-identification, it was found that the strains belong to both epidemically dangerous (3.0 %) and non-dangerous strains (97.0 %). The range of variability was expressed in their distribution into three groups and consisted in retaining of agglutinability only with cholera RO serum in the first group (34.5 % of strains); the loss of this trait, but the acquisition of the ability to agglutinate in different combinations with O1, Ogawa or Inaba sera – in the second (16.7 %); and also in the loss of agglutinability with all diagnostic cholera sera – in the third (48.8 %). The presence of the wbeT gene in the compared V. cholerae classical R-variant strain does not exclude the presence of the genomic region for O1 antigen biosynthesis in other R-strains, possibly in a modified form, which can be clarified in further molecular-genetic studies. Alternatively, such strains are likely to be attributed to V. cholerae nonO1/nonO139. Strains of V. cholerae R-variant with different amounts of surface antigen (optical density range – from 0.088±0.002 to 1.226±0.003) have been identified. The data obtained can be used for monitoring of cholera in laboratories of regional and federal levels

Effects of glyprolines on free-radical oxidation in the brain neocortex of white rats in mild traumatic brain injury

The aim of the study was to compare the effect of glyproline peptides RGRGP (Arg-Gly-Arg-Gly-Pro), RGP (Arg-GlyPro), PRPGP (Pro-Arg-Pro-Gly-Pro) and PGPL (Pro-Gly-Pro-Leu) peptide substances at various concentrations on the free radical oxidation intensity of the brain tissues of Wistar males after intraperitoneal administration of peptide solutions after traumatic brain injury.Material and methods. The brain tissue of Wistar males aged 2–3 months (n = 126) were used in the experiment. RGRGP, RGP, PRPGP, and PGPL peptides were provided by Academician N.F. Myasoyedov. Traumatic brain injury (TBI) was modeled by free fall of a load. From the second to the fifth day of the experiment, the animals were injected intraperitoneally with peptides. On the sixth day, the animals were taken out of the experiment. The activity of free radical oxidation was determined in freshly prepared homogenates of sections of the cerebral cortex by chemiluminescence (CL).Results. TBI significantly enhance free-radical oxidation intensity of the neocortex in brain tissue of Wistar rats, and the studied peptides affect it in different ways - from a decrease in CL intensity (the minimum value in TBI + RGP 0.1 group) to its increase (the maximum value in TBI + RGPGP 0.1 group). The effect depends on the dose of glyproline.Conclusions. The results obtained, based on the analysis of the free radical oxidation intensity of tissues, mainly indicate a different degree of correction of tissue homeostasis indicators. It can be assumed that Arg-Pro-Gly peptide can be the basis for the development of new drugs for post-stress rehabilitation after injuries of various levels and genesis

Влияние этилметилгидроксипиридина сукцината на функциональную активность транспортёра гликопротеина-Р в гематоэнцефалическом барьере крыс в норме и при гипоксической гипоксии

Relevance. Ethylmethylhydroxypyridine succinate (EMHPS) is a reference domestic drug with pronounced antioxidant and antihypoxic activity. P-Glycoprotein (Pgp) is an ATP-dependent transport protein localized in tissue barriers and protecting cells and organs from the effects of xenobiotics. Being expressed in the blood-brain barrier (BBB), Pgp limits the penetration of drugs and toxic substances into the brain tissue. Aim – to evaluate the effect of EMHPS on the functional activity of Pgp in the BBB of rats in normal conditions and in acute hypoxic hypobaric hypoxia in the experiment. Methods. The studies were carried out on male Wistar rats weighing 200–250 g, which were divided into 4 groups: group 1 (control, n = 30) – intact rats; Group 2 (control of hypoxia, n = 30) – rats, which were simulated hypoxia and before that they were once injected with water for injection; Group 3 (n = 30) – intact animals, which were injected intravenously with EMHPS at a dose of 50 mg / kg body weight; Group 4 (n = 30) – rats, which were injected intravenously with EMHPS at a dose of 50 mg/kg body weight before modeling hypoxia. 30 minutes after injection, animals of groups 2 and 4 were simulated acute hypoxic hypoxia for 30 minutes by ascending to an altitude of 8000 m with an ascent and descent speed of 50 m/s. 3 h after descent animals of groups 2 and 4 and 30 min after intravenous injection in animals of groups 1 and 3, the functional activity of Pgp in the BBB was assessed by the penetration of fexofenadine, a marker substrate of Pgp, into the brain tissue. For this, fexofenadine was injected into the tail vein of rats at a dose of 10 mg/kg of body weight. After 5, 10, 15, 30, 45, 60 minutes after administration, they were euthanized, at least 4 ml of blood was taken from the abdominal aorta into heparinized tubes and the cortex of the frontal lobes of the brain. The concentration of fexofenadine in biosamples was analyzed by HPLC-UV according to original methods. Results. In the course of the study, it was shown that a single intravenous injection of EMHPS at a dose of 50 mg/kg of body weight causes an increase in the content of fexofenadine in the cerebral cortex of rats, which indicates a decrease in the activity of the Pgp transporter protein. Simulation of acute hypoxic hypoxia was also accompanied by an increase in the permeability of the transport protein substrate into the brain tissue. At the same time, the prophylactic administration of EMHPS before hypoxic exposure did not significantly affect the BBB permeability, which remained significantly higher than the control and did not differ from the permeability during isolated hypoxic exposure. Conclusions: EMHPS with a single intravenous injection at a dose of 50 mg/kg body weight reduces the activity of Pgp in the BBB in normal conditions and does not significantly affect the penetration of the transporter substrate – fexofenadine into the brain tissue in acute hypoxic hypoxiaАктуальность. Этилметилгидроксипиридина сукцинат (ЭМГПС) – референтный отечественный лекарственный препарат, обладающий выраженной антиоксидантной и антигипоксической активностью. Гликопротеин-Р (Pgp) – АТФ-зависимый белок-транспортёр, локализующийся в тканевых барьерах и осуществляющий защиту клеток и органов от воздействия ксенобиотиков. Экспрессируясь в гематоэнцефалическом барьере (ГЭБ), Pgp ограничивает проникновение лекарственных и токсических веществ в ткань мозга. Цель – оценить влияние ЭМГПС на функциональную активность Pgp в ГЭБ крыс в норме и при острой гипоксической гипобарической гипоксии в эксперименте. Методы исследования. Исследования выполнены на крысах-самцах Wistar, массой 200–250 г, которые были разделены на 4 группы: 1-я группа (контроль, n = 30) – интактные крысы; 2-я группа (контроль гипоксии, n = 30) – крысы, которым моделировали гипоксию и перед этим однократно в/в вводили воду для инъекций; 3-я группа (n = 30) – интактные животные, которым в/в однократно вводили ЭМГПС в дозе 50 мг/кг массы; 4-я группа (n = 30) – крысы, которым перед моделированием гипоксии в/в однократно вводили ЭМГПС в дозе 50 мг/кг массы. Через 30 минут после инъекции у животных 2- и 4-й групп моделировали острую гипоксическую гипоксию в течение 30 минут путём их подъёма на высоту 8000 м со скоростью подъёма и спуска 50 м/с. Через 3 ч после спуска у животных 2- и 4-й групп и через 30 мин после в/в инъекции у животных 1- и 3-й групп оценивали функциональную активность Pgp в ГЭБ по проникновению в ткань мозга фексофенадина – маркерного субстрата Pgp. Для этого крысам в хвостовую вену вводили фексофенадин в дозе 10 мг/кг массы. Через 5, 10, 15, 30, 45, 60 мин после введения их подвергали эвтаназии, забирали не менее 4 мл крови из брюшной аорты в гепаринизированные пробирки и кору лобных долей головного мозга. Концентрацию фексофенадина в биообразцах анализировали методом ВЭЖХ-УФ по оригинальным методикам. Результаты. В ходе исследования было показано, что внутривенное однократное введение ЭМГПС в дозе 50 мг/кг массы вызывает повышение содержания фексофенадина в коре больших полушарий головного мозга крыс, что свидетельствует о снижении активности белка-транспортёра Pgp. Моделирование острой гипоксической гипоксии также сопровождалось повышением проницаемости субстрата белка-транспортёра в ткань мозга. При этом профилактическое введение ЭМГПС перед гипоксическим воздействием существенно не влияло на проницаемость ГЭБ, которая оставалась существенно выше контроля и не отличалась от проницаемости при изолированном гипоксическом воздействии. Выводы. ЭМГПС при однократном внутривенном введении в дозе 50 мг/кг массы снижает активность Pgp в ГЭБ в норме и не оказывает существенного влияния на проникновение в ткань мозга субстрата транспортёра – фексофенадина при острой гипоксической гипоксии

Разработка ВЭЖХ-методики количественного анализа фексофенадина в плазме крови

The article describes a method of quantitative analysis of III generation gistamine antagonist - fexofenadine in human bLood plasma by HPLC with UV detection at 220 nm. The analysis was performed in isocratic mode using Stayer chromatography system and a reversed-phase column Phenomenex Synergi 4u PoLar-RP 80A (250 х 4,6, 4 |±m) and a mobile phase (acetonitriLe-water-gLaciaL acetic acid-triethyLamine in the ratio 267-128-4,7-7) at pH 6,1. The retention time of fexofenadine was 14,70±0,04 min. Fexofenadine extraction from pLasma carried using acetonitriLe (2 mL pLasma and 4 mL acetonitriLe) by shaking on Shaker apparatus at 400 voL/min for 15 minutes, centrifuging at 3 500 rpm. for 15 minutes and evaporation of the supernatant on a vacuum rotary evaporator at 50 °C. The recovery was 84,14%. The deveLoped method is characterized by sensitivity, specificity, ease of impLementation, reproducibiLity and Linearity in the range of pLasma concentrations during oraL administration of 180 mg of fexofenadine (ALLegra coated tabLets, 180 mg, Sanofi-Aventis, USA) heaLthy voLunteers.Описана методика количественного анализа гистаминолитика III поколения - фексофенадина в плазме крови людей методом ВЭЖХ с УФ-детектированием при длине волны 220 нм. Анализ выполнялся в изократическом режиме на хроматографической системе Stayer с применением обращенно-фазной колонки Phenomenex Synergi 4u PoLar-RP 80A (250x4,6 мм) с размером частиц сорбента 4 мкм и подвижной фазы (ацетонитрил-вода-кислота уксусная ледяная-триэтиламин в соотношении 267:128:4,7:7) с pH 6,15. Время удерживания фексофенадина составило 14,91±0,25 мин. Экстракция фексофенадина из плазмы крови осуществлялась ацетонитрилом (2 мл плазмы и 4 мл ацетонитрила) путём встряхивания на приборе Shaker при 400 об/мин 15 мин, центрифугирования при 3 500 об/мин 15 мин и упаривания супернатанта на роторно-вакуумном испарителе при 50 °С. Коэффициент экстракции фексофенадина составил 84,14%. Разработанная методика характеризуется чувствительностью, специфичностью, простотой выполнения, воспроизводимостью и линейностью в интервале плазменных концентраций после перорального применения 180 мг вещества (таблетки, покрытые оболочкой Аллегра, 180 мг, Sanofi-Aventis, США) здоровыми добровольцами

ОКАЗАНИЕ ЭКСТРЕННОЙ НЕЙРОХИРУРГИЧЕСКОЙ ПОМОЩИ НА ТЕРРИТОРИИ ВОРОНЕЖСКОЙ ОБЛАСТИ

BACKGROUND. Сraniocerebral injury is the most common type of trauma in Russian Federation especially among working age persons. These patients require unification of surgical tactics, intensive care and continuity of treatment in order to increase of effectiveness of treatment. Purpose of the study is evaluation of emergency neurosurgical aid efficiency in Voronezh region in terms of introduction of threelevel health care system.MATERIAL AND METHODS. Neurosurgical service functioning of Voronezh Clinical Center for Disaster Medicine has been evaluated. It included treatment and transportation of patients with a brain injury during 2012–2014.CONCLUSION. Admittance of patients with severe craniocerebral injury at the hospital with neurovisualization and telecommunication equipment improves neurosurgical aid efficiency of the Center for Disaster Medicine. It is possible due to effective patient’s data transmission and shortening of time before surgical intervention. The decrease of number of groundless neurosurgical team’s rides has been registered. АКТУАЛЬНОСТЬ. Черепно­мозговая травма (ЧМТ) относится к наиболее распространенному виду травм в Российской Федерации, особенно у лиц трудоспособного возраста. Для повышения эффективности оказания медицинской помощи этим пациентам необходима унификация хирургической тактики, интенсивной терапии и преемственность лечения на различных этапах. Цель работы: проанализировать эффективность оказания экстренной нейрохирургической помощи на территории Воронежской области в условиях внедрения трехуровневой системы оказания медицинской помощи.МАТЕРИАЛ И МЕТОДЫ. Проведен анализ работы нейрохирургической службы Воронежского областного клинического центра медицины катастроф по лечению и транспортировке пациентов с нейротравмой за период с 2012 по 2014 г.ЗАКЛЮЧЕНИЕ. Госпитализация пациентов с тяжелой ЧМТ в стационар, оснащенный оборудованием для нейровизуализации и доступом к телекоммуникационной сети, повышает качество нейрохирургической помощи специалистами Центра медицины катастроф за счет оперативной передачи данных пациента и сокращения сроков начала оперативного вмешательства. При этом отмечено снижение числа необоснованных выездов нейрохирургической бригады.