Population Pharmacokinetics of Alemtuzumab (Campath) in Pediatric Hematopoietic Cell Transplantation: Towards Individualized Dosing to Improve Outcome

BACKGROUND AND OBJECTIVE: Alemtuzumab (Campath®) is used to prevent graft-versus-host disease and graft failure following pediatric allogeneic hematopoietic cell transplantation. The main toxicity includes delayed immune reconstitution, subsequent viral reactivations, and leukemia relapse. Exposure to alemtuzumab is highly variable upon empirical milligram/kilogram dosing. METHODS: A population pharmacokinetic (PK) model for alemtuzumab was developed based on a total of 1146 concentration samples from 206 patients, aged 0.2-19 years, receiving a cumulative intravenous dose of 0.2-1.5 mg/kg, and treated between 2003 and 2015 in two centers. RESULTS: Alemtuzumab PK were best described using a two-compartment model with a parallel saturable and linear elimination pathway. The linear clearance pathway, central volume of distribution, and intercompartmental distribution increased with body weight. Blood lymphocyte counts, a potential substrate for alemtuzumab, did not impact clearance. CONCLUSION: The current practice with uniform milligram/kilogram doses leads to highly variable exposures in children due to the non-linear relationship between body weight and alemtuzumab PK. This model may be used for individualized dosing of alemtuzumab

An automatic repositioning system to prevent pressure ulcers : a case series

The Danish automated Vendlet V5s repositioning system is intended to reduce pressure ulcer risk in patients and work-related musculoskeletal disorders (MSDs) in caregivers. In two Belgian nursing homes, 13 residents with mobility levels C, D and E experienced the repositioning system, operated by 35 caregivers, for 4 weeks. Data about skin condition, nursing time needed for repositioning and MSD symptoms were collected. The use of the repositioning system was not associated with the development of nor a reduction in skin problems; the study included residents who were vulnerable to or already had pressure ulcers. In addition, four pressure ulcers healed during the experiment. The research focused only on the automated repositioning system. Repositioning frequency and postures were determined by the standard nursing home protocol. Frequency depended on the support surface in use, and a limited number of patient criteria (mobility in bed, presence of bony prominences/pressure points and presence of non-blanchable erythema). In future studies, the Vendlet V5s system should be tested with a more individualised patient repositioning protocol, including more criteria such as fever and moisture. The automated system reduces nursing time so could potentially improve staff efficiency. Compared with manual repositioning, caregivers perceived fewer work-related MSD symptoms during repositioning when using the Vendlet V5s system. Controlled studies with larger samples are needed to verify these conclusions

Determinants of implementation of primary preventive interventions on patient handling in healthcare: a systematic review

Objective: This systematic review aims (1) to identify barriers and facilitators during implementation of primary preventive interventions on patient handling in healthcare, and (2) to assess their influence on the effectiveness of these interventions. Methods: PubMed and Web of Science were searched from January 1988 to July 2007. Study inclusion criteria included evaluation of a primary preventive intervention on patient handling, quantitative assessment of the effect of the intervention on physical load or musculoskeletal disorders or sick leave, and information on barriers or facilitators in the implementation of the intervention. 19 studies were included, comprising engineering (n= 10), personal (n= 6) and multiple interventions (n= 3). Barriers and facilitators were classified into individual and environmental categories of factors that hampered or enhanced the appropriate implementation of the intervention. Results: 16 individual and 45 environmental barriers and facilitators were identified. The most important environmental categories were "convenience and easy accessibility'' (56%), "supportive management climate'' (18%) and "patient-related factors'' (11%). An important individual category was motivation (63%). None of the studies quantified their impact on effectiveness nor on compliance and adherence to the intervention. Conclusion: Various factors may influence the appropriate implementation of primary preventive interventions, but their impact on the effectiveness of the interventions was not evaluated. Since barriers in implementation are often acknowledged as the cause of the ineffectiveness of patient handling devices, there is a clear need to quantify the influence of these barriers on the effectiveness of primary preventive interventions in healthcare

The influence of individual and organisational factors on nurses' behaviour to use lifting devices in healthcare

Among nurses, low back pain is a common musculoskeletal disorder. A significant proportion of back pain episodes can be attributed to events that occur during patient handling activities when nurses are exposed to heavy lifting, awkward back postures, and pushing and/or pulling. In the past years, many ergonomic interventions have been developed, like lifting devices, to reduce mechanical load related to patient handling activities in order to (partly) decrease the occurrence of low back pain. The efficacy of lifting devices designed to reduce mechanical load has been demonstrated in several laboratory studies. However, the timely and integrated implementation at the workplace remains difficult. Various intervention studies have indicated that individual behaviour of nurses is a key factor in successful implementation of lifting devices in healthcare. As examples, Evanoff et al. (2003) and Li et al. (2004) identified the lack of perceived need to use lifts as an important barrier in the effectiveness of lifting devices at the workplace. Nelson et al. (2006) showed that acceptance of patient handling equipment by the staff was a crucial facilitator in the implementation process of a multiple intervention aimed at patient handling in healthcare. A previous study in hospitals and nursing homes showed that individual behaviour of nurses, i.e. nurses’ motivation to use lifting devices, was strongly associated with lifting devices use. This study also pointed at the influence of organisationallevel measures on nurses’ behaviour, comprising both factors in each ward as well as at the managerial level of the healthcare institute. Thus, the appropriate implementation of ergonomic devices requires a careful process whereby individual behaviour is supported by organisational measures in order to enable and support the individual to adopt the required behaviour to prevent musculoskeletal complaints. A recent systematic review corroborated that upstream organisational strategies had a profound impact on musculoskeletal health

Individual and organisational determinants of use of ergonomic devices in healthcare

Objective This study aims to identify individual and organisational determinants associated with the use of ergonomic devices during patient handling activities. Methods This cross-sectional study was carried out in 19 nursing homes and 19 hospitals. The use of ergonomic devices was assessed through real-time observations in the workplace. Individual barriers to ergonomic device use were identified by structured interviews with nurses and organisational barriers were identified using questionnaires completed by supervisors and managers. Multivariate logistic analysis with generalised estimating equations for repeated measurement was used to estimate determinants of ergonomic device use. Results 247 nurses performed 670 patient handling activities that required the use of an ergonomic device. Ergonomic devices were used 68% of the times they were deemed necessary in nursing homes and 59% in hospitals. Determinants of lifting device use were nurses' motivation (OR 1.96), the presence of back complaints in the past 12 months (OR 1.77) and the inclusion in care protocols of strict guidance on the required use of ergonomic devices (OR 2.49). The organisational factors convenience and easily accessible, management support and supportive management climate were associated with these determinants. No associations were found with other ergonomic devices. Conclusions The use of lifting devices was higher in nursing homes than in hospitals. Individual and organisational factors seem to play a substantial role in the successful implementation of lifting devices in healthcare

Musculoskeletal disorders among rural Australian nursing students

Aim: To investigate the prevalence of musculoskeletal disorders (MSD) among rural Australian nursing students and compare the results with other international studies.\ud \ud Method and analysis: A self-reporting questionnaire adapted from previous research, was administered to 260 students from all three grades of a major nursing school in regional north Queensland, Australia.\ud \ud Results: A high proportion of students reported an MSD at some body site (80.0%), with low back pain being the most common condition (59.2%). This was followed by MSD of the neck (34.6%), knee (25.0%), shoulder (23.8%), feet (16.5%), wrist (12.7%) and legs (11.9%). MSD of the shoulder was slightly more common among males when compared to females (39.3% vs 22.0%, P = 0.0424). Previous paid employment as a nurse or nursing assistant was found to increase the risk of upper arm MSD by a factor of 10.8 (odds ratio 10.8, 95% confidence interval 1.9–205.8, P = 0.0276).\ud \ud Conclusion: Overall, this investigation suggests that MSD is more frequent among rural Australian nursing students, when compared to their counterparts around the world. Their high rate of MSD is also comparable to that reported by hospital nurses in other countries.\ud \ud What is already known and why the study was done: Although musculoskeletal disorders (MSD) are known to affect nursing students at reasonably high rates, few studies have been undertaken in rural Australia. Therefore, it was considered necessary to investigate MSD among a complete cross-section of rural Australian nursing students, using a questionnaire adapted from previous research. Findings were then compared with similar international studies.\ud \ud What this study adds to the published literature: A high proportion of students reported an MSD at some body site, with low back pain being the most common condition. Overall, this investigation suggests that MSD is more frequent among rural Australian nursing students, when compared to their counterparts around the world. Their high rate of MSD is also comparable to that reported by hospital nurses in other countries