Determining clinical pharmacy workload by patient disease classification in medical and surgical patients

Aim: To determine the time needed to provide clinical pharmacy services to individual patient episodes for medical and surgical patients and the effect of patient presentation and complexity on the clinical pharmacy workload. Method: During a 5-month period in 2006 at two general hospitals, pharmacists recorded a defined range of activities that they provided for patients, including the actual times required for these tasks. A customised database linked to the two hospitals\u27 patient administration systems stored the data according to the specific patient episode number. The influence of patient presentation and complexity on the clinical pharmacy activities provided was also examined. Results: The average time required by pharmacists to undertake a medication history interview and medication reconciliation was 9.6 (SD 4.9) minutes. Interventions required 5.7 (SD 4.6) minutes, clinical review of the medical record 5.5 (SD 4.0) minutes and medication order review 3.5 (SD 2.0) minutes. For all of these activities, the time required for medical patients was greater than for surgical patients and greater for \u27complicated\u27 patients. The average time required to perform all clinical pharmacy activities for 1071 completed patient episodes was 14.4 (SD 10.9) minutes and was greater for medical and \u27complicated\u27 patients. Conclusion: The time needed to provide clinical pharmacy services was affected by whether the patients were medical or surgical. The existence of comorbidities or complications affected these times. The times required to perform clinical pharmacy activities may not be consistent with recently proposed staff ratios for the provision of a basic clinical pharmacy service.<br /

New, efficient and robust, fiber-based quantum key distribution schemes

We present a new fiber based quantum key distribution (QKD) scheme which can be regarded as a modification of an idea proposed by Inoue, Waks and Yamamoto (IWY) [1]. The scheme described here uses a single phase modulator and two differential delay elements in series at the transmitter that form an interferometer when combined with a third differential delay element at the receiver. The protocol is characterized by a high efficiency, reduced exposure to an attack by an eavesdropper, and higher sensitivity to such an attack when compared to other QKD schemes. For example, the efficiency with which transmitted data contribute to the private key is 3/4 compared with 1/4 for BB84 [2]. Moreover, an eavesdropper can aquire a maximum of 1/3 of the key which leads to an error probability in the private key of 1/3. This can be compared to 1/2 and 1/4 for these same parameters in both BB84 and IWY. The combination of these considerations should lead to increased range and key distribution rate over present fiber-based QKD schemes.Comment: 4 pages, 5 figures, 1 equatio

Mutational analysis of feedback inhibition and catalytic sites of prephenate dehydratase from Corynebacterium glutamicum

Prephenate dehydratase is a key regulatory enzyme in the phenylalanine-specific pathway of Corynebacterium glutamicum. PCR-based random mutagenesis and functional complementation were used to screen for m-fluorophenylalanine (mFP)-resistant mutants. Comparison of the amino acid sequence of the mutant prephenate dehydratases indicated that Ser-99 plays a role in the feedback regulation of the enzyme. When Ser-99 of the wild-type enzyme was replaced by Met, the specific activity of the mutant enzyme was 30% lower than that of the wild-type. The Ser99Met mutant was active in the presence of 50 muM phenylalanine, whereas the wild-type enzyme was not. The functional roles of the eight conserved residues of prephenate dehydratase were investigated by site-directed mutagenesis. Glu64Asp substitution reduced enzyme activity by 15%, with a 4.5- and 1.7-fold increase in K-m and k(cat) values, respectively. Replacement of Thr-183 by either Ala or Tyr resulted in a complete loss of enzyme activity. Substitution of Arg-184 with Leu resulted in a 50% decrease of enzyme activity. The specific activity for Phe185Tyr was more than 96% lower than that of the wild-type, and the K-m value was 26-fold higher. Alterations in the conserved Asp-76, Glu-89, His-115, and Arg-236 residues did not cause a significant change in the K-m and k(cat) values. These results indicated that Glu-64, Thr-183, Arg-184, and Phe-185 residues might be involved in substrate binding and/or catalytic activity

Effect of a Video-Supported Nurse-Led Advance Care Planning for Older Adults with Frailty: A Randomized Controlled Trial

This chapter reports the results of a parallel, double-blinded randomized controlled trial to examine the effect of video-supported nurse-led advance care planning (ACP) as compared with a health education program plus an ACP promotion leaflet on end-of-life decision-making outcomes in older adults with frailty. Outcomes were assessed at 1 month and 6 months after the intervention via telephone. Between December 2018 and January 2020, 449 older adults were screened for eligibility. The trial was terminated early after 105 subjects had been assigned (intervention: 51; control: 54) because of the COVID-19 pandemic and the end of the funding period. No significant between-group difference was found in the retention rate at 1 (41.2% vs. 38.9%) and 6 months (35.3% vs. 44.4%). In the intention-to-treat analysis, the ACP group reported a higher but non-significant advance directive completion rate (5.9% vs. 1.9%) and a significantly higher mean score in quality of communication about end-of-life care at 1 month [estimated difference: 8.73 (1.16–16.30). There was no evidence of a difference in favorable outcomes of subjects receiving the video-supported, nurse-led ACP compared with those receiving active control. Results might have been confounded by high attrition, poor intervention completion, and reduced sample size due to the early termination of the study

Decreased fatty acid beta-oxidation in riboflavin-responsive, multiple acylcoenzyme A dehydrogenase-deficient patients is associated with an increase in uncoupling protein-3

Decreased fatty acid beta-oxidation in riboflavin-responsive, multiple acylcoenzyme A dehydrogenase-deficient patients is associated with an increase in uncoupling protein-3.Russell AP, Schrauwen P, Somm E, Gastaldi G, Hesselink MK, Schaart G, Kornips E, Lo SK, Bufano D, Giacobino JP, Muzzin P, Ceccon M, Angelini C, Vergani L.Department of Medical Biochemistry, University of Geneva Medical Center, 1206 Geneva, Switzerland. [email protected], multiple acylcoenzyme A dehydrogenase deficiency (RR-MAD), a lipid storage myopathy, is characterized by, among others, a decrease in fatty acid (FA) beta-oxidation capacity. Muscle uncoupling protein 3 (UCP3) is up-regulated under conditions that either increase the levels of circulating free FA and/or decrease FA beta-oxidation. Using a relatively large cohort of seven RR-MAD patients, we aimed to better characterize the metabolic disturbances of this disease and to explore the possibility that it might increase UCP3 expression. A battery of biochemical and molecular tests were performed, which demonstrated decreases in FA beta-oxidation and in the activities of respiratory chain complexes I and II. These metabolic alterations were associated with increases of 3.1- and 1.7-fold in UCP3 mRNA and protein expression, respectively. All parameters were restored to control values after riboflavin treatment. We postulate that the up-regulation of UCP3 in RR-MAD is due to the accumulation of muscle FA/acylCoA. RR-MAD is an optimal model to support the hypothesis that UCP3 is involved in the outward translocation of an excess of FA from the mitochondria and to show that, in humans, the effects of FA on UCP3 expression are direct and independent of fatty acid beta-oxidation.<br/

Normal-superconducting transition induced by high current densities in YBa2Cu3O7-d melt-textured samples and thin films: Similarities and differences

Current-voltage characteristics of top seeded melt-textured YBa2Cu3O7-d are presented. The samples were cut out of centimetric monoliths. Films characteristics were also measured on microbridges patterned on thin films grown by dc sputtering. For both types of samples, a quasi-discontinuity or quenching was observed for a current density J* several times the critical current density Jc. Though films and bulks much differ in their magnitude of both Jc and J*, a proposal is made as to a common intrinsic origin of the quenching phenomenon. The unique temperature dependence observed for the ratio J*/Jc, as well as the explanation of the pre-quenching regime in terms of a single dissipation model lend support to our proposal.Comment: 10 pages, 10 figures, submitted to Physical Review