Entwicklung von Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ im Klinikum Mutterhaus

Ziel der vorliegenden Masterarbeit ist die Entwicklung von Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ im Klinikum Mutterhaus. Damit soll ein Instrument entwickelt werden, das patientenbezogene Dienstleistungen der Krankenhausapotheker an der intersektoralen Schnittstelle im Hinblick auf das Qualitätsziel Arzneimitteltherapiesicherheit messen und bewerten kann. Schwachstellen und Verbesserungspotentiale über den Verantwortungsbereich der Apotheke hinaus sollen identifiziert und in einen kontinuierlichen Verbesserungsprozess eingebracht werden können. Methodik: Zur Entwicklung der Qualitätsindikatoren wurde ein mehrstufiges Verfahren gewählt. Zunächst wurden die Qualitätsziele des Prozesses definiert und eine Prozessanalyse durchgeführt. Die Literaturrecherche auf nationaler und internationaler Ebene gab Anhaltspunkte zur Ableitung von Qualitätsindikatoren. Basierend auf der Prozessanalyse und der Literaturrecherche wurden Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ entwickelt. Anhand einer retrospektiven Datenerhebung wurden die entwickelten Qualitätsindikatoren auf ihre Aussagekraft und Eignung geprüft. Der Prozess wurde mit Hilfe der Qualitätsindikatoren gemessen und bewertet. Schlussfolgerung: Mit Hilfe von fünf Qualitätsindikatoren-Sets kann der Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ umfassend untersucht werden. Die entwickelten Qualitätsindikatoren sind geeignet, die pharmazeutische Dienstleistung im Hinblick auf das Qualitätsziel Arzneimitteltherapiesicherheit zu messen und zu bewerten. Sie ermöglichen die Evaluation des Prozesses und zukünftiger Verbesserungsmaßnahmen. Anhand der Qualitätsindikatoren wird zukünftig ein Monitoring der Dienstleistung möglich sein.Purpose: The aim of this thesis is the development of quality indicators for the process "recommendations of the pharmacy to continue patient’s medication" at Klinikum Mutterhaus. An instrument is to be developed that can measure and rate the patient-related services of the hospital pharmacist at the intersectoral interface in terms of quality target in medication safety. Weaknesses and potential improvements should be identified and incorporated into a continuous improvement process. Methods: A multistage process is selected for the development of the quality indicators. First, the quality objectives of the process are defined and a process analysis is performed. A literature review on national and international level shall provide evidence for the derivation of quality indicators. Based on the process analysis and the literature review the quality indicators for the "Recommendations of the pharmacy to continue patient`s medication” are developed. In a retrospective data collection, the developed quality indicators are tested for their validity and suitability. The process is finally measured by the quality indicators and evaluated. Conclusion: With the help of five quality indicator sets the process "recommendations of the pharmacy to continue patient’s medication" can be fully investigated. The developed quality indicators are suitable to measure and evaluate the process in terms of the quality target medication safety. So the evaluation of the process and future improvements are possible. On the basis of the quality indicators a monitoring of the process can be established in the future

CD4+ and πσT Cells are the main Producers of IL-22 and IL-17A in Lymphocytes from Mycobacterium bovis-infected Cattle

Gene transcription studies have identified dual roles for the cytokines IL-17A and IL-22 in bovine tuberculosis, where they show potential as both predictors of vaccine success and correlates of infection. To allow for a detailed investigation of the cell populations responsible for production of these cytokines, we have utilised a novel bovine IL-22 specific recombinant antibody for flow cytometry. Bovine tuberculin (PPDB) induced greater IL-22 and IL-17A production in Mycobacterium bovis (M. bovis)-infected cattle compared to non-infected controls, while PWM-induced cytokine levels were similar between the two groups. In M. bovis-infected animals, PPDB specific IL-22 and IL-17A responses were observed in both CD4+ T cell and γδ T cell populations. Although both cytokines were detected in both cell types, IL-22/IL-17A double producers were rare and confined mainly to the γδ T cell population. These results support previous gene transcription studies and extend the observation of increased IL-22 and IL-17A responses in M. bovis-infected animals to the level of protein production. We were also able to characterise the cell populations responsible for these disease-related cytokine responses. The data generated can be used to further our understanding of the immunopathology of bovine tuberculosis and to produce more sensitive and specific immune-diagnostic reagents

Herd mobility leads the way for sustainable pastoral development: the case of Borana rangelands, southern Ethiopia 1

Abstract Insights gained from experiences in pastoral developmen

Oral vaccination of cattle with heat inactivated Mycobacterium bovis does not compromise bovine TB diagnostic tests

AbstractIn this study we investigated whether oral uptake of a heat inactivated M. bovis wildlife vaccine by domestic cattle induced systemic immune responses that compromised the use of tuberculin or defined antigens in diagnostic tests for bovine TB. Positive skin test and blood-based IFN-γ release assay (IGRA) results were observed in all calves vaccinated via the parenteral route (i.e. intramuscular). In contrast, no positive responses to tuberculin or defined antigens were observed in either the skin test or IGRA test when performed in calves vaccinated via the oral route. In conclusion, our results suggest that the heat inactivated M. bovis vaccine could be used to vaccinate wildlife in a baited form in conjunction with the following in cattle: (i) continuation of existing tuberculin skin testing or novel skin test formats based on defined antigens; and (ii) the use of IGRA tests utilizing tuberculin or defined antigens

Protection associated with a TB vaccine is linked to increased frequency of Ag85A-specific CD4⁺ T cells but no increase in avidity for Ag85A

AbstractThere is a need to improve the efficacy of Bacille Calmette-Guérin (BCG) vaccination against tuberculosis in humans and cattle. Previously, we found boosting BCG-primed cows with recombinant human type 5 adenovirus expressing antigen 85A (Ad5-85A) increased protection against Mycobacterium bovis infection compared to BCG vaccination alone. The aim of this study was to decipher aspects of the immune response associated with this enhanced protection. We compared BCG-primed Ad5-85A-boosted cattle with BCG-vaccinated cattle. Polyclonal CD4+ T cell libraries were generated from pre-boost and post-boost peripheral blood mononuclear cells – using a method adapted from Geiger et al. (2009) – and screened for antigen 85A (Ag85A) specificity. Ag85A-specific CD4+ T cell lines were analysed for their avidity for Ag85A and their Ag85A epitope specificity was defined. Boosting BCG with Ad5-85A increased the frequencies of post-boost Ag85A-specific CD4+ T cells which correlated with protection (reduced pathology). Boosting Ag85A-specific CD4+ T cell responses did not increase their avidity. The epitope specificity was variable between animals and we found no clear evidence for a post-boost epitope spreading. In conclusion, the protection associated with boosting BCG with Ad5-85A is linked with increased frequencies of Ag85A-specific CD4+ T cells without increasing avidity or widening of the Ag85A-specific CD4+ T cell repertoire

No-meat eaters are less likely to be overweight or obese, but take dietary supplements more often: results from the Swiss National Nutrition survey menuCH

Objective: To describe and analyse the sociodemographic, anthropometric, behavioural and dietary characteristics of different types of Swiss (no-)meat eaters. Design: No-, low-, medium- and high-meat eaters were compared with respect to energy and total protein intake and sociodemographic, anthropometric and behavioural characteristics. Setting: National Nutrition Survey menuCH, the first representative survey in Switzerland. Participants: 2057 participants, aged 18-75 years old, who completed two 24-h dietary recalls (24-HDR) and a questionnaire on dietary habits, sociodemographic and lifestyle factors. Body weight and height were measured by trained interviewers. No-meat eaters were participants who reported meat avoidance in the questionnaire and did not report any meat consumption in the 24-HDR. Remaining study participants were assigned to the group of low-, medium- or high-meat eaters based on energy contributions of total meat intake to total energy intake (meat:energy ratio). Fifteen percentage of the participants were assigned to the low- and high-meat eating groups, and the remaining to the medium-meat eating group. Results: Overall, 4·4 % of the study participants did not consume meat. Compared with medium-meat eaters, no-meat eaters were more likely to be single and users of dietary supplements. Women and high-educated individuals were less likely to be high-meat eaters, whereas overweight and obese individuals were more likely to be high-meat eaters. Total energy intake was similar between the four different meat consumption groups, but no-meat eaters had lowest total protein intake. Conclusions: This study identified important differences in sociodemographic, anthropometric, behavioural and dietary factors between menuCH participants with different meat-eating habits

Hydrophobic Mycobacterial Antigens Elicit Polyfunctional T Cells in Mycobacterium bovis Immunized Cattle:Association With Protection Against Challenge?

Bovine tuberculosis (bTB), caused by Mycobacterium bovis, is a chronic disease of cattle with a detrimental impact on food quality and production. Research on bTB vaccines has predominantly been focused on proteinaceous antigens. However, mycobacteria have a thick and intricate lipid outer layer and lipids as well as lipopeptides are important for immune-evasion and virulence. In humans, lipid extracts of M. tuberculosis have been shown to elicit immune responses effective against M. tuberculosisin vitro. Chloroform-methanol extraction (CME) was applied to M. bovis BCG to obtain a hydrophobic antigen extract (CMEbcg) containing lipids and lipopeptides. CMEbcg stimulated IFN-γ+IL-2+ and IL-17A+IL-22+ polyfunctional T cells and elicited T cell responses with a Th1 and Th17 cytokine release profile in both M. bovis BCG vaccinated and M. bovis challenged calves. Lipopeptides were shown to be the immunodominant antigens in CMEbcg, stimulating CD4 T cells via MHC class II. CMEbcg expanded T cells killed CMEbcg loaded monocytes and the CMEbcg-specific CD3 T cell proliferative response following M. bovis BCG vaccination was the best predictor for reduced pathology following challenge with M. bovis. Although the high predictive value of CMEbcg-specific immune responses does not confirm a causal relationship with protection against M. bovis challenge, when taking into account the in vitro antimycobacterial phenotype of CMEbcg-specific T cells (e.g. Th1/Th17 cytokine profile), it is indicative that CMEbcg-specific immune responses could play a functional role in immunity against M. bovis. Based on these findings we conclude that lipopeptides of M. bovis are potential novel subunit vaccine candidates and that further studies into the functional characterization of lipopeptide-specific immune responses together with their role in protection against bovine tuberculosis are warranted

Temporal dynamics of intradermal cytokine response to tuberculin in Mycobacterium bovis BCG-vaccinated cattle using sampling microneedles

AbstractBovine tuberculosis (bTB) is a disease of livestock with severe and worldwide economic, animal welfare and zoonotic consequences. Application of test-and-slaughter-based control polices reliant on tuberculin skin testing has been the mainstay of bTB control in cattle. However, little is known about the temporal development of the bovine tuberculin skin test response at the dermal sites of antigen injection. To fill this knowledge gap, we applied minimally-invasive sampling microneedles (SMNs) for intradermal sampling of interstitial fluid at the tuberculin skin test sites in Mycobacterium bovis BCG-vaccinated calves and determined the temporal dynamics of a panel of 15 cytokines and chemokines in situ and in the peripheral blood. The results reveal an orchestrated and coordinated cytokine and local chemokine response, identified IL-1RA as a potential soluble biomarker of a positive tuberculin skin response, and confirmed the utility of IFN-γ and IP-10 for bTB detection in blood-based assays. Together, the results highlight the utility of SMNs to identify novel biomarkers and provide mechanistic insights on the intradermal cytokine and chemokine responses associated with the tuberculin skin test in BCG-sensitized cattle.</jats:p