Humoral response to John Cunningham virus during pregnancy in multiple sclerosis

ConclusionsJCV-Ab levels remain unaltered during MS pregnancy, while the total IgG concentration is reduced/diluted due to increasing plasma volumes during the course of pregnancy. This may imply a biologically significant alteration in the immune response to JCV during MS pregnancy.</p

Cysteamine inhibits lysosomal oxidation of low density lipoprotein in human macrophages and reduces atherosclerosis in mice

Background and aims: We have shown previously that low density lipoprotein (LDL) aggregated by vortexing is internalised by macrophages and oxidised by iron in lysosomes to form the advanced lipid/protein oxidation product ceroid. We have now used sphingomyelinase-aggregated LDL, a more pathophysiological form of aggregated LDL, to study lysosomal oxidation of LDL and its inhibition by antioxidants, including cysteamine (2-aminoethanethiol) which concentrates in lysosomes by several orders of magnitude. We have also investigated the effect of cysteamine on atherosclerosis in mice. Methods: LDL was incubated with sphingomyelinase, which increased its average particle diameter from 26 to 170 nm, and was then incubated for up to 7 days with human monocyte-derived macrophages. LDL receptor-deficient mice were fed a Western diet (19-22 per group) and some given cysteamine in their drinking water at a dose equivalent to that used in cystinosis patients. The extent of atherosclerosis in the aortic root and the rest of the aorta was measured. Results: Confocal microscopy revealed lipid accumulation in lysosomes in the cultured macrophages. Large amounts of ceroid were produced, which colocalised with the lysosomal marker LAMP2. The antioxidants cysteamine, butylated hydroxytoluene, amifostine and its active metabolite WR-1065, inhibited the production of ceroid. Cysteamine at concentrations well below those expected to be present in lysosomes inhibited the oxidation of LDL by iron ions at lysosomal pH (pH 4.5) for prolonged periods. Finally, we showed that the extent of atherosclerotic lesions in the aortic root and arch of mice was significantly reduced by cysteamine. Conclusions: These results support our hypothesis that lysosomal oxidation of LDL is important in atherosclerosis and hence antioxidant drugs that concentrate in lysosomes might provide a novel therapy for this disease

Top-down lipidomics of low density lipoprotein reveal altered lipid profiles in advanced chronic kidney disease

This study compared the molecular lipidomic profi le of LDL in patients with nondiabetic advanced renal disease and no evidence of CVD to that of age-matched controls, with the hypothesis that it would reveal proatherogenic lipid alterations. LDL was isolated from 10 normocholesterolemic patients with stage 4/5 renal disease and 10 controls, and lipids were analyzed by accurate mass LC/MS. Top-down lipidomics analysis and manual examination of the data identifi ed 352 lipid species, and automated comparative analysis demonstrated alterations in lipid profi le in disease. The total lipid and cholesterol content was unchanged, but levels of triacylglycerides and N -acyltaurines were signifi cantly increased, while phosphatidylcholines, plasmenyl ethanolamines, sulfatides, ceramides, and cholesterol sulfate were signifi cantly decreased in chronic kidney disease (CKD) patients. Chemometric analysis of individual lipid species showed very good discrimination of control and disease sample despite the small cohorts and identifi ed individual unsaturated phospholipids and triglycerides mainly responsible for the discrimination. These fi ndings illustrate the point that although the clinical biochemistry parameters may not appear abnormal, there may be important underlying lipidomic changes that contribute to disease pathology. The lipidomic profi le of CKD LDL offers potential for new biomarkers and novel insights into lipid metabolism and cardiovascular risk in this disease. -Reis, A., A. Rudnitskaya, P. Chariyavilaskul, N. Dhaun, V. Melville, J. Goddard, D. J. Webb, A. R. Pitt, and C. M. Spickett. Topdown lipidomics of low density lipoprotein reveal altered lipid profi les in advanced chronic kidney disease. J. Lipid Res. 2015

Medication calculation skills of graduating nursing students within European context.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAim: The aim of this study is to evaluate the medication calculation skills of graduating nursing students in six European countries and analyse the associated factors. Background: Medication calculation skills are fundamental to medication safety, which is a substantial part of patient safety. Previous studies have raised concerns about the medication calculation skills of nurses and nursing students. Design: As part of a broader research project, this study applies a multinational cross-sectional survey design with three populations: graduating nursing students, nurse managers and patients. Methods: The students performed two calculations (tablet and fluid) testing medication calculation skills requiring different levels of conceptual understanding and arithmetic. The managers and patients answered one question about the students' medication kills. In total, 1,796 students, 538 managers and 1,327 patients participated the study. The data were analysed statistically. The STROBE guideline for cross-sectional studies was applied. Results: Almost all (99%) of the students performed the tablet calculation correctly, and the majority (71%) answered the fluid calculation correctly. Older age, a previous degree in health care and satisfaction with their current degree programme was positively associated with correct fluid calculations. The patients evaluated the students' medication skills higher than the nurse managers did and the evaluations were not systematically aligned with the calculation skills tested. Conclusions: Nursing students have the skills to perform simple medication calculations, but a significant number of students have difficulties with calculations involving multiple operations and a higher level of conceptual understanding. Due to the variation in students' medication calculation skills and the unalignment between the managers' and patients' evaluations and the calculation tests, further research is needed. Relevance to clinical practice: Graduating nursing students enter clinical field as qualified professionals, but there is still room for improvement in their medication calculation skills. This calls for attention in the fields of clinical nursing, education and research. Keywords: drug dosage calculations; graduating nursing students; medication calculation skills; nurse managers; patients.Academy of Finland European Commissio

Detecting patient safety errors by characterizing incidents reported by medical imaging staff

Abstract The objectives of the study were to characterize events related to patient safety reported by medical imaging personnel in Finland in 2007–2017, the number and quality of reported injuries, the risk assessment, and the planned improvement of operations. The information was collected from a healthcare patient safety incident register system. The data contained information on the nature of the patient safety errors, harms and near-misses in medical imaging, the factors that lead to the events, the consequences for the patient, the level of risks, and future measures. The number of patient safety incident reports included in the study was 7,287. Of the incident reports, 75% concerned injuries to patients and 25% were near-misses. The most common consequence of adverse events and near-misses were minor harm (37.2%) related to contrast agent, or no harm (27.9%) related to equipment malfunction. Supervisors estimated the risks as low (47.7%) e.g., data management, insignificant (35%) e.g., verbal communication or moderate (15.7%) e.g., the use of contrast agent. The most common suggestion for learning from the incident was discussing it with the staff (58.1%), improving operations (5.7%) and submitting it to a higher authority (5.4%). Improving patient safety requires timely, accurate and clear reporting of various patient safety incidents. Based on incident reports, supervisors can provide feedback to staff, develop plans to prevent accidents, and monitor the impact of measures taken. Information on the development of occupational safety should be disseminated to all healthcare professionals so that the same mistakes are not repeated

Medication-related adverse events in health care—what have we learned?:a narrative overview of the current knowledge

Abstract Purpose: Although medication-related adverse events (MRAEs) in health care are vastly studied, high heterogeneity in study results complicates the interpretations of the current situation. The main objective of this study was to form an up-to-date overview of the current knowledge of the prevalence, risk factors, and surveillance of MRAEs in health care. Methods: Electronic databases (PubMed, MEDLINE, Web of Science, and Scopus) were searched with applicable search terms to collect information on medication-related adverse events. In order to obtain an up-to-date view of MRAEs, only studies published after 2000 were accepted. Results: The prevalence rates of different MRAEs vary greatly between individual studies and meta-analyses. Study setting, patient population, and detection methods play an important role in determining detection rates, which should be regarded while interpreting the results. Medication-related adverse events are more common in elderly patients and patients with lowered liver or kidney function, polypharmacy, and a large number of additional comorbidities. However, the risk of MRAEs is also significantly increased by the use of high-risk medicines but also in certain care situations. Preventing MRAEs is important as it will decrease patient mortality and morbidity but also reduce costs and functional challenges related to them. Conclusions: Medication-related adverse events are highly common and have both immediate and long-term effects to patients and healthcare systems worldwide. Conclusive solutions for prevention of all medication-related harm are impossible to create. In the future, however, the development of efficient real-time detection methods can provide significant improvements for event prevention and forecasting

Näköisnimisten lääkkeiden kartoitus Oulun yliopistollisessa sairaalassa

Abstrakti Näköisnimiset (Look alike / Sound alike -lääkkeet, LASA-lääkkeet) ovat lääkevalmisteita, joilla on riski sekaantua keskenään samankaltaisen pakkauksen tai valmistenimen vuoksi. Lääkevalmisteisiin liittyvät sekaannukset voivat johtaa lääkehoidon epäonnistumiseen, sairaalahoitojaksojen pidentymiseen tai potilaan kuolemaan. Näin ne vaikuttavat sekä lääkitysturvallisuuteen että terveydenhuollon kustannuksiin. Yhdysvalloissa tehdyn arvion mukaan lääkityspoikkeamista 33 % aiheutuu lääkevalmisteiden pakkauksen ja 25 % lääkevalmisteiden nimen samankaltaisuudesta. Suomessa LASA-lääkkeisiin liittyvien virheiden voidaan arvioida olevan niin ikään ongelma monilääkittyjen potilaiden ja markkinoilla olevien lääkevalmisteiden määrän kasvaessa. Tässä tutkimuksessa kartoitettiin Oulun yliopistollisen sairaalan (OYS) lääkevalikoimassa olevia LASAlääkkeitä ja niistä aiheutuvaa riskiä vuonna 2015. Kartoituksessa käytiin läpi 31 yksikön lääkevalikoima mahdollisten LASA-lääkkeiden osalta. Henkilöstön tietoisuus LASA-lääkkeistä ja arvio niiden vaikutuksesta lääkehoidon toteutumiseen arvioitiin henkilöstöhaastattelujen perusteella. Haastatteluihin valittiin 62 lääkehoitoon osallistuvaa henkilöä (sairaanhoitajia, kätilöitä ja osastofarmaseutteja) eri yksiköistä. Yksiköissä havaittiin keskimäärin 31 LASA-lääkeparia per yksikkö. Henkilöstö tunnisti keskimäärin 7 LASA-lääkettä per yksikkö. Suurin osa sairaalan lääkevalikoimassa olevista LASA-lääkkeistä oli sellaisia, että ne voivat sekaantuessaan aiheuttaa lievän tai kohtalaisen haitan potilaalle. LASA-lääkkeiden joukossa oli kuitenkin myös valmisteita, jotka voivat pahimmillaan aiheuttaa potilaan kuoleman. Tulosten perusteella LASA-lääkkeiden voidaan todeta olevan erittäin yleisiä OYS:n yksiköissä. Suurin osa henkilöstöstä tunnistaa LASA-lääkkeitä omassa yksikössään. Henkilöstö kuitenkin havaitsi merkittävästi vähemmän LASA-lääkkeitä työyksikössään kuin ulkopuolinen havainnoija, mikä viittaa siihen, että LASA-lääkkeisiin liittyvän riskin laajuutta ei täysin tiedosteta. Koska LASA lääkkeisiin liittyvää sekaannusriskiä ei voida koskaan täysin pois sulkea terveydenhuollossa, tulisi erityistä huomiota kiinnittää henkilöstön koulutukseen ja riskilääkkeistä, mukaan lukien LASA-lääkkeistä, tiedottamiseen