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Background Retrospective auditing identified the need to implement a client centered tool to measure occupational performance and re engagement in activities after burn injury. The Canadian Occupational Performance Measure (COPM) was chosen as it has a broad focus on occupational performance across the lifespan. However, given the time constraints that acute care clinicians work within in a tertiary teaching hospital, a feasibility study was warranted to identify the time to complete the COPM and any potential barriers which may arise in order to evaluate the appropriateness of using this tool. Methods This project was a prospective cohort study. All patients presenting to the ward and the Specialist Burns Outpatient Clinic were consecutively enrolled in this study. Information was collected regarding administration of the COPM including administration time, number of interruptions and reasons for non-completion of the outcome measure e.g. wound dressing procedures, surgery, scheduling conflicts. A survey method was used to explore the perceptions of Occupational Therapy clinicians regarding use of the COPM in clinical practice. Results Over the course of the study period 70 COPM’s were administered. The average time for administration across both settings was 9 min. Individually the average time taken for administration of the COPM with inpatients was 11.21 min, in the outpatient setting 7.85 min. The Survey Monkey questionnaire was emailed to 58 occupational therapy clinicians working at the facility associated with the study. The response rate was 41.4% (24). Discussion Patient reported outcome measures are central to patient centred care which is a core element of health care provision. Results from this study found that the COPM took approximately 9 min to administer, which is suitable within the time constraints of an acute tertiary environment and would be feasible in our setting. Fifty one percent of the participants identified return to work as the activity of daily living most impacted by their burn injury. As burn injuries impact all domains of daily life the use of patient reported outcome measures to direct goal orientated care is imperative. Conclusion This study found that the time to administer the COPM is feasible within the acute tertiary setting. Perceived barriers identified can be overcome with increased knowledge of client centred practice and the importance of goal directed care. The use of patient reported outcome measures in clinical practice empowers consumers to identify what goals they would like to achieve.

Inom nätverkstekniken och datakommunikationen råder idag en tro på tekniken nätverkscache som kan spara data för att senare kunna hämta hem det snabbare. Tekniken har genom åren visat att den effektivt kan skicka den önskade data till sina klienter. Det finns flera cache-tjänster som använder tekniken för Windows-uppdateringar. Bland dessa finns Windows Server Update Services (WSUS) och LanCache. På uppdrag från företaget TNS Gaming AB jämförs dessa tjänster med varandra under examensarbetet. Nätverkscache är ett intressant forskningsområde för framtida kommunikationssystem och nätverk tack vare sina fördelar. Likaså är uppgiften om att jämföra cache-tjänsterna WSUS och LanCache intressant i och med det öppnar upp insikt om vilken tjänst är bättre för företaget eller andra intressenter. Både forskningsområdet och uppgiften är viktiga och intressanta när användare vill effektivisera användningen av internetanslutningen och bespara nätverksresurser. Därmed kan tekniken minska nedladdningstiden. Till det här arbetet besvaras frågor om vilken nätverksprestanda, resursanvändning och administrationstid respektive cache-tjänst har, och vilken cache-tjänst som lämpar sig bättre för företagets behov. I arbetet genomförs experiment, som omfattar tre huvudmättningar, och följs av en enfallstudie. Syftet med arbetet är att med hjälp av experimentets mätningar få en jämförelse mellan WSUS och LanCache. Resultatet av arbetet utgör sedan ett underlag för det framtida lösningsvalet. Resultaten består av två delar. Den första visar att båda cache-tjänsterna bidrar till kortare nedladdningstider. Den andra är att LanCache är bättre än WSUS när det gäller nätverksprestanda och resursanvändning, samt mindre administrationstid jämfört med WSUS. Givet resultat dras slutsatsen att LanCache är cache-tjänsten som är mest lämpad i det här fallet. In the field of network technology and data communication, there is a current belief in the technology of network caching, which can store data to later retrieve it more quickly. Over the years, this technology has proven its ability to efficiently deliver the desired data to its clients. There are several caching services that utilize this technology for Windows updates, among them are Windows Server Update Services (WSUS) and LanCache. On behalf of the company TNS Gaming AB, these services are compared to each other in this thesis. Network caching is an interesting area of research for future communication systems and networks due to its benefits. Likewise, the task of comparing the cache services WSUS and LanCache is interesting as it provides insights into which service is better suited for the company or other stakeholders. Both the research area and the task are important and intriguing when users seek to streamline the use of their internet connection and conserve network resources. Thus, the technology can reduce download times. For this work, questions about the network performance, resource usage, and administration time of each cache service are answered, as well as which cache service that is better suited to the company's needs. The work involves conducting experiments, including three main measurements, followed by a single case study. The purpose of the work is to compare WSUS and LanCache using the measurements from the experiment. The outcome of the work then forms a basis for future solution choice. The results consist of two parts. The first shows that both cache services contribute to shorter download times. The second is that LanCache outperforms WSUS in terms of network performance and resource usage, and also requires less administration time than WSUS. Given the results, the conclusion is drawn that LanCache is the most suitable caching service in this case.

The bachelor thesis focuses on the issue of epidural analgesia as one of the most effective methods of labour pain control. The main aim of the bachelor thesis is to evaluate whether epidural analgesia is administered more frequently in primiparas or multiparas, and what is the frequency of epidural analgesia administration depending on the time of day at the Gynaecology and Obstetrics Clinic of the 1st Faculty of Medicine of Charles University in Prague. The thesis contains theoretical and practical part. The theoretical part is devoted to the definition of physiological labour, description of labour times, labour pain and epidural analgesia, which includes anatomy of the spinal canal, indications, contraindications, drugs and technique of application. The practical part is the research part. It was carried out using analytical data collection from medical records and Medea hospital information system. The retrospective analysis was performed at the Gynaecology and Obstetrics Clinic of the 1st Medical Faculty of Charles University and the General University Hospital in Prague. Keywords: epidural analgesia, time of administration, time of day, parity, primipara, multipara, effect, delivery, pain control

Medication errors are a serious problem that can be a threat to health and patient safety and can lead to mistrust of the health system and the work of professionals. Medication administration errors occur at any stage of patient care and can be related to a variety of influencing factors [1]. This literature review identifies the main medication administration errors, which are grouped into medication administration and incorrect documentation of administered medication groups. Along with medication administration errors, the main reasons why nurses make errors in medication administration are identified. The study focuses on medication administration errors and their determinants in nurses' work. The aim of the literature review was to analyze medication errors and their determinants in nurses' work. Methods: an exploratory review was conducted to analyze medication administration errors and their determinants in nurses' work. The methodology considered five main stages that contributed to a focused analysis of the selected studies. Results of the literature review. It was found that medication errors are influenced by the work environment, which is full of extraneous sounds, other members of the medical team, and conversations unrelated to the administration of medicines. The human factor is also a factor in medication administration errors related to the medication, its dose, or the wrong administration time. Medication administration errors are inevitable, no matter how advanced the patient's care and nursing techniques.

Purpose: The aim of this study was to investigate the tolerability of postoperative early intravesical chemotherapy session after transurethral resection of the bladder tumor (TUR-B) according to the different anesthesia types. Methods: The study was conducted between February 2017 and June 2020. Patients who were given intravesical mitomycin (MMC) 40 mg after TUR-B were included. Patients’ risk categories (low, medium, and high) were determined according to the European Association of Urology (EAU) risk stratification system based on the tumor number, size (Results: A total of 232 consecutive patients who received intravesical MMC were included. Sociodemographic characteristics of group S (n = 113) and group G (n = 119) were similar (p < 0.05). There were no significant differences in tumor size, number of tumors, concomitant CIS, and T stage in both groups (p > 0.05). High-grade tumors were higher in group S (23.9 vs. 11%; p = 0.008). Requirement of analgesic (53.9 vs. 91.5%; p = 0.00) and termination of therapy p = 0.00) and p = 0.00) were significantly lower in group S. The mean instillation time (108.05 ± 19.40 vs. 85.67 ± 24.66 min; p = 0.00) was found significantly higher for group S. In group G, mean VAS1–4 scores were significantly higher than in group S (p < 0.05). Linear correlation analyses showed that the VAS score is correlated with the instillation time (p < 0.05). The rates of minor (I–III) (7 vs. 8%; p = 0.706) and major (IV–V) (0.9 vs. 1.6%; p = 0.590) complications were similar in both groups. Conclusion: The patients’ tolerability of intravesical MMC treatment can be improved by spinal anesthesia. It provides longer instillation time and less pain during intravesical chemotherapy.

Medication shortage is a problem that affects patients, providers, and institutions of all sizes and scope across the United States. The objective of this quality improvement project was to promote the appropriate use of multi-dose vials (MDVs) by anesthesia providers at an independent plastic surgery office. Multi-dose vials can be used to decrease waste and potentially cost, thus increasing access to necessary medications for the patients at this practice. A focus group was used to obtain an understanding of barriers to the use of MDVs at this practice. A focused E-learning module on safe use based on established guidelines was then created, and a simplified flow sheet was implemented and placed in medication preparation areas as a cognitive aid. The education and flow sheet focused on identification and preparation of the medication area, proper identification of MDVs versus single-use vials, hand hygiene, proper beyond-use labeling, septum cleaning, use of a new sterile syringe and needle, and administration time frames. Provider feedback included high levels of satisfaction with the E-learning module. Our comparison of the use of ketamine from MDVs during the pre- and postimplementation phases showed a 14% increase in the number of doses used per vial. This finding suggests that were similar practices implemented at a larger site with MDVs of medications other than ketamine, resources could be impacted to manage shortages and increase access to medications.

Background/objectives Systematic screening can improve detection of delirium, but lack of time is often cited as why such screening is not performed. We investigated the time required to implement four screening protocols that use the Ultra-Brief two-item screener for delirium (UB-2) and the 3-Minute Diagnostic Interview for Confusion Assessment Method (CAM)-defined Delirium (3D-CAM), with and without a skip pattern that can further shorten the assessment. Our objective was to compare the sensitivity, specificity, and time required to complete four protocols: (1) full 3D-CAM on all patients, (2) 3D-CAM with skip on all patients, (3) UB-2, followed by the full 3D-CAM in "positives," and (4) UB-2, followed by the 3D-CAM with skip in "positives." Design Comparative efficiency simulation study using secondary data. Setting Two studies (3D-CAM and Researching Efficient Approaches to Delirium Identification (READI)) conducted at a large academic medical center (3D-CAM and READI) and a small community hospital (READI only). Participants General medicine inpatients, aged 70 years and older (3D-CAM, n = 201; READI, n = 330). Measurements We used 3D-CAM data to simulate the items administered under each protocol and READI data to calculate median administration time per item. We calculated sensitivity, specificity, and total administration time for each of the four protocols. Results The 3D-CAM and READI samples had similar characteristics, and all four protocols had similar simulated sensitivity and specificity. Mean administration times were 3 minutes 13 seconds for 3D-CAM, 2 minutes 19 seconds for 3D-CAM with skip, 1 minute 52 seconds for UB-2 + 3D-CAM in positives, and 1 minute 14 seconds for UB-2 + 3D-CAM with skip in positives, which was 1 minute 59 seconds faster than the 3D-CAM (P Conclusion The UB-CAM, consisting of the UB-2, followed in positives by the 3D-CAM with skip pattern, is a time-efficient delirium screening protocol that holds promise for increasing systematic screening for delirium in hospitalized older adults.

Administration of stable iodine has been considered a best measure to protect the thyroid from internal irradiation by radioiodine intake, and its efficacy on thyroid protection has been quantitatively evaluated in several simulation studies on the basis of simple iodine biokinetic models (i.e., three-compartment model). However, the new iodine biokinetic model adopted by the International Commission on Radiological Protection interprets and expresses the thyroid blocking phenomenon differently. Therefore, in this study, the new model was analyzed in terms of thyroid blocking and implemented to reassess the protective effects and to produce dosimetric data. The biokinetic model calculation was performed using computation modules developed by authors, and the results were compared with those of experimental data and prior simulation studies. The new model predicted protective effects that were generally consistent with those of experimental data, except for those in the range of stable iodine administration −72 h before radioiodine exposure. Additionally, the dosimetric data calculated in this study demonstrates a critical limitation of the three-compartment model in predicting bioassay functions, and indicated that dose assessment 1 d after exposure would result in a similar dose estimate irrespective of the administration time of stable iodine.

Venetoclax is a cytochrome P450, family 3, subfamily A (CYP3A) substrate and was shown to inhibit P-gp efflux transporters in vitro. To quantify the impact of CYP3A inhibition by ritonavir on venetoclax disposition and P-gp inhibition by venetoclax on digoxin pharmacokinetics, two semimechanistic drug-drug interaction (DDI) models of venetoclax were developed using clinical data from healthy volunteers who received subtherapeutic doses of venetoclax with ritonavir 50-100 mg or digoxin 0.5 mg. These models were then used to assess the magnitude of interaction at therapeutic venetoclax doses and to explore various clinical dosing strategies that maintain venetoclax and digoxin concentrations within their respective therapeutic windows. Simulations demonstrated that venetoclax dose reductions of at least 75% are needed when venetoclax is coadministered with ritonavir and administering digoxin at least 2 hours before venetoclax would minimize DDI. Semimechanistic modeling leveraging clinical data is a plausible approach to predict DDI and propose dose adjustments, and administration time of interacting drugs.

Objective We investigated the influence of the time to take hypnotics and daytime activity on patient satisfaction with sleeping pills.Methods Ninety-six cancer patients who were currently taking benzodiazepine or z-drug as hypnotics were grouped into satisfied and dissatisfied groups. The subjects’ symptoms, time to take sleeping pills, bedtime, sleep onset time, wake up time, and time in bed within 24 hours (TIB/d) were obtained.Results The satisfied group had significantly late sleeping pill ingestion time (p=0.04); significantly early wake up time (p=0.01); and significantly shorter sleep latency, TIB/d, duration from the administration of pills to sleep onset, and duration from the administration of pills to wake up time (PTW). Logistic regression analysis revealed that the significant predictors of patient satisfaction to hypnotics were less severity of insomnia [odds ratio (OR)=0.91] and the time variables, including late sleeping pill administration time (OR=1.53) and early wake up time (OR=0.57). Among the duration variables, short PTW (OR=0.30) and short TIB/d (OR=0.64) were significantly related with the satisfaction to hypnotics.Conclusion Reducing the duration from the administration of hypnotics to wake up time and TIB/d can influence the satisfaction to sleeping pills.

Switching from the healthy stage to the uncontrolled development of tumors relies on complicated mechanisms and the activation of antagonistic immune responses, that can ultimately favor the tumor growth. We introduce here a mathematical model intended to describe the interactions between the immune system and tumors. The model is based on partial differential equations, describing the displacement of immune cells subjected to both diffusion and chemotactic mechanisms, the strength of which is driven by the development of the tumors. The model takes into account the dual nature of the immune response, with the activation of both antitumor and protumor mechanisms. The competition between these antagonistic effects leads to either equilibrium or escape phases, which reproduces features of tumor development observed in experimental and clinical settings. Next, we consider on numerical grounds the efficacy of treatments: the numerical study brings out interesting hints on immunotherapy strategies, concerning the role of the administered dose, the role of the administration time and the interest in combining treatments acting on different aspects of the immune response. Such mathematical model can shed light on the conditions where the tumor can be maintained in a viable state and also provide useful hints for personalized, efficient, therapeutic strategies, boosting the antitumor immune response, and reducing the protumor actions., Le passage du stade sain à la croissance incontrôlée des tumeurs repose sur des mécanismes compliqués et l'activation de réponses immunitaires antagonistes, qui peuvent à terme favoriser la croissance tumorale. Nous introduisons ici un modèle mathématique destiné à décrire les interactions entre le système immunitaire et les tumeurs. Le modèle est basé sur des équations aux dérivées partielles, décrivant le déplacement de cellules immunitaires soumises à la fois à des mécanismes de diffusion et de chimiotactisme, dont la force est déterminée par le développement des tumeurs. Le modèle prend en compte la double nature de la réponse immunitaire, avec l'activation des mécanismes antitumoraux et protumoraux. La compétition entre ces effets antagonistes conduit soit à des phases d'équilibre, soit à des phases d'échappement, qui reproduisent les caractéristiques du développement tumoral observé dans des contextes expérimentaux et cliniques. Ensuite, nous considérons sur des bases numériques l'efficacité des traitements : l'étude numérique apporte des pistes intéressantes sur les stratégies d'immunothérapie, concernant le rôle de la dose administrée, le rôle du temps d'administration et l'intérêt de combiner des traitements agissant sur différents aspects du système immunitaire. Un tel modèle mathématique peut faire la lumière sur les conditions dans lesquelles la tumeur peut être maintenue dans un état viable et également fournir des pistes utiles pour des stratégies thérapeutiques personnalisées et efficaces, renforçant la réponse immunitaire antitumorale et réduisant les actions protumorales.

Introduction: Frailty scales are used very rarely by general practitioners as they are time consuming and are not well-adapted to current needs. Thus, we have designed with general practitioners a new scale for the early and rapid detection of frailty syndrome, called the simplified Zulfiqar Frailty Scale (sZFS). Patients and methods: This scale was tested in two general medicine practices in Normandy (France) for a total of six months and compared to the GFST tool “The Gerontopole Frailty Screening Tool”. Only patients who were over 65 years old with an ADL ≥ 4/6 were included. Results: 107 were patients included in the general medicine practice, with an average age of 74 years. The sZFS questionnaire has a shorter administration time than the GFST questionnaire (p < 0.001). Its sensitivity is of 93%, and its specificity is 58%. Its positive predictive value is 57%, and its negative predictive value is 93%. The area under the curve of the sZFS scale is 0.83 [0.76; 0.91] (IC95%). Conclusion: Our frailty screening scale is simple, relevant, and quick.

Background: Quantitative evaluation of antibiotic spectrum is an important, underutilized metric in measuring antibiotic use (AU) and may assist antimicrobial stewards in identifying targets and strategy for intervention. We evaluated the spectrum of initial antibiotic choices by hospital location, day of the week, and time of day to determine whether these factors may be associated with broad-spectrum antibiotic choices. Methods: We identified all admissions with antibiotic exposure in medical and surgical wards and critical care units in a tertiary academic medical center between July 1, 2014, and July 1, 2019. The antibiotic spectrum index (ASI), proposed by Gerber et al, is a numeric score based on the number of pathogens covered by a particular agent. We defined ASI for initial antibiotic choice as follows: ASI for each unique antibiotic administered within 24 hours of the first antibiotic administration was summed and assigned to the administration time of the first dose. We categorized time into 4 distinct categories: weekday days (Monday–Friday, 7 a.m.–7 p.m.), weekday nights, weekend days, and weekend nights. Weekend time began 7 p.m. Friday and ended 7 a.m. Monday. We constructed heatmaps stratified by hospital location. Mann-Whitney U tests were applied to evaluate differences in the distributions of ASI using weekday days as a reference. Results: Data included 90,455 unique antibiotic admissions with initial antibiotic starts in medical and surgical wards and critical care units. Patterns of ASI for initial antibiotic choice varied between unit locations and time (Figs. 1 and 2). Mean and median ASIs for initial antibiotic choices were higher for medical ward and medical ICUs than for surgical wards and surgical ICUs. Initial antibiotic choices had higher ASIs during overnight hours for all units except the surgical ICU. Notable differences in ASIs were identified between weekday and weekend prescribing for surgical units, whereas medical units demonstrated less extreme differences. Conclusion: We observed a “weekend effect” across hospital units; the most extreme occurred in surgical wards. This observation may be due to differences in patient volume and rounding patterns. For example, hospitalist and critical care units have 7-day schedules, whereas surgical wards are highly influenced by operating room schedules. Antimicrobial stewardship teams may use these data to identify strategies targeting the most opportune time and place to intervene on the spectrum of initial antibiotic choice.Funding: NoneDisclosures: None

Background The morning blood pressure surge (MBPS) is related to an exaggerated risk of cardiovascular diseases and mortality. With increasing attention on circadian change in blood pressure and extensive use of ambulatory blood pressure monitoring (ABPM), chronotherapy that administration of medication according to biological rhythm, is reported to improve cardiovascular outcomes. The aim of this study is to evaluate the influence of chronotherapy of antihypertensive drugs upon MBPS in hypertensive patients. Methods A search strategy was applied in Ovid MEDLINE, EMBASE, Cochrane (Wiley) CENTRAL Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the Chinese Biomedical literature database. No language and date restrictions. Randomized controlled trials (RCT) assessing the efficacy of evening and morning administration of the same medications in adult patients with primary hypertension were included. Results A total of ten trials, comprising 1724 participants with a mean age of 61 and 51% female, were included in this study. Combined analysis observed significant reduction of MBPS (− 5.30 mmHg, 95% CI − 8.80 to − 1.80), night-time SBP (− 2.29 mmHg, 95% CI − 4.43 to − 0.15), night-time DBP (− 1.63 mmHg, 95 %CI − 3.23 to − 0.04) and increase in night blood pressure dipping (3.23%, 95% CI 5.37 to 1.10) in evening dosage compared with traditional morning dosage of blood pressure-lowering drugs. No significant difference was found in the incidence of overall adverse effects (RR 0.65, 95% CI 0.30 to 1.41) and withdrawal due to adverse effects (RR 0.95, 95% CI 0.53 to 1.71). Conclusions Our study suggested that evening administration of antihypertensive medications exerted better blood pressure-lowering effect on MBPS compared with conventional morning dosage. Safety assessment also indicated that the evening regimen did not increase the risk of adverse events. However, endpoint studies need to be carried out to confirm the significance and feasibility of this treatment regimen in clinical practice.

Sport-related concussion (SRC) is an important public health concern with up to 3.8 million SRCs occurring each year. As the incidence and rate of SRC increases, reliable and valid tools for diagnosis and management are needed. The King-Devick (K-D) test assesses a patient's visual function based on reading a series of numbers as well as counting both time to completion and errors. Its rapid administration time and simplicity make the K-D test a potentially useful SRC diagnostic tool, though limitations exist in baseline testing and what constitutes an abnormal score. Additionally, the K-D tests should never be used in isolation to diagnose a concussion, but rather as one test in conjunction with additional clinical measures, as part of an individualized approach to each patient. The current review examines the clinical utility of the K-D test.

Purpose The primary objective of this study was to evaluate the time of day patients administer antihypertensive medications. Secondary objectives were to evaluate medication adherence rates between morning and bedtime dosing and possible barriers to bedtime administration. Methods A single-center, cross-sectional study using a mixed-methods model containing a retrospective chart review and telephone survey was administered to hypertensive patients at a multidisciplinary, private practice clinic. Patients above the age of 18 with a diagnosis of hypertension were eligible for inclusion. The primary endpoint was the number of patients administering one or more antihypertensive medications at bedtime. Secondary endpoints were medication adherence and potential barriers of adherence to bedtime dosing. Results A total of 139 responses were collected. Most patients (75.5%) administered all antihypertensive medications in the morning, with only 24.5% of patients administering at least one antihypertensive medication at bedtime. Adherence was higher for medications administered in the morning compared to medications administered at bedtime, 87.8% and 79.4%, respectively. Limitations to this study include the single-center design and potential for patient recall and reporting bias when using self-reported data. Conclusion Results of this study suggest that the prevalence of bedtime administration of antihypertensive medications is low. Although self-reported adherence rates were higher with morning dosing compared to bedtime dosing, adherence rates for bedtime dosing were still promising. Future studies should be conducted to expand on existing morbidity and mortality evidence as well as prevalence of and adherence to bedtime dosing of antihypertensive medications.

Objective: Ischemic strokes cause significant morbidity and mortality. Treatment with tissue plasminogen activator (tPA) is an important step to achieve reperfusion and minimize neuronal loss for those patients that qualify. Multiple studies have shown that there is a direct correlation between the timeliness of tPA administration after infarction has begun and improved health outcomes. Hospital process related barriers to tPA administration increase the time from the onset of stroke to treatment, leading to worse outcomes. Patients and methods: This retrospective review from a single stroke center looked at stroke patients across three years (July 2014–May 2017) and examined the temporal delay to treatment that potentially stemmed from the fact that tPA was given after transfer from the radiology suite (post-CT scan) back to the emergency department. This order of events is commonplace in stroke centers across the US. Results: Our results indicate there is a significant 26 minute delay with the commonly used protocol where tPA is given, not in the CT scanner, but rather after the scan when patients return to the emergency room. Conclusion: Our results imply that a change in the protocol (direct administration of tPA in the radiology suite) could improve health outcomes by decreasing the delay in tPA administration. Keywords: Stroke, tPA, Barriers to treatment, Vascular neurology, Quality improvement, Vascular neurosurgery

Psychotic experiences are prevalent across a wide variety of psychiatric, neurological, and medical conditions. Yet current assessments are often designed for one disorder, or are limited in their examination of phenomenological features; this has hindered transdiagnostic research. This article describes an examination of the validity and reliability of the English version of a new assessment, the Questionnaire for Psychotic Experiences (QPE). This study aimed to use the QPE to examine hallucinations and delusions across a number of different conditions, and to ensure that the QPE had acceptable psychometric properties. An International Consortium on Hallucination Research working group, along with consumer groups, developed the 50-item QPE to assess the presence, severity, and phenomenology of hallucinations and delusions. Participants in the study who reported psychotic experiences included those with schizophrenia, schizoaffective disorder, bipolar affective disorder, and major depressive disorder, and those without a need for care (ie, nonclinical participants). There were 173 participants in total. Convergent and discriminant validity were assessed. Reliability was examined in terms of stability, equivalence, and internal consistency. The data confirmed that the QPE had good psychometric properties and could be put forward as an accepted measure of the transdiagnostic evaluation of psychotic experiences. Further validation is recommended with neurological and medical populations. Given its validity and reliability, comprehensive evaluation of psychotic phenomena, and relatively quick administration time, we propose that the QPE is a valuable instrument for both clinical and research settings. publishedVersion

ENHANZE® drug delivery technology is based on the proprietary recombinant human hyaluronidase PH20 enzyme (rHuPH20; Halozyme Therapeutics, Inc.) that facilitates the subcutaneous (SC) delivery of co-administered therapeutics. rHuPH20 works by degrading the glycosaminoglycan hyaluronan (HA), which plays a role in resistance to bulk fluid flow in the SC space, limiting large volume SC drug delivery, dispersion, and absorption. Co-administration of rHuPH20 with partner therapies can overcome administration time and volume barriers associated with existing SC therapeutic formulations, and has been shown to reduce the burden on patients and healthcare providers compared with intravenous formulations. rHuPH20 (as HYLENEX® recombinant) is currently FDA-approved for subcutaneous fluid administration for achieving hydration, to increase the dispersion and absorption of other injected drugs, and in subcutaneous urography for improving resorption of radiopaque agents. rHuPH20 is also co-formulated with two anticancer therapies, trastuzumab (i.e. Herceptin® SC) and rituximab (i.e. RITUXAN HYCELA®/RITUXAN® SC/MabThera® SC) and dosed sequentially with human immunoglobin to treat primary immunodeficiency (i.e. HyQvia®/HYQVIA®). This article reviews pharmaceutical properties of rHuPH20, its current applications with approved therapeutics, and the potential for future developments.

Medication errors are frequent and should be focus in the prevention of medication-related harm under a broad and systemic approach. In this context, the aim of the present study was to characterize the profile of dispensing errors in a public hospital in Belo Horizonte (MG), and to evaluate the association of its occurrence with the the dispensing system. For this purpose, a cross-sectional study was carried out at the pharmacy of the hospitalization unit. The frequency, type of error, and drug involved in the error (type of drug and whether it was a high-alert medication - HAM) were determined by dispensing system (profile I - single pack dispensed every 24 hours; profile II - single pack dispensed every 12 hours, profile III – individual packaging according to the administration time dispensed every 12 hours). The difference in the proportion of errors between the profiles was determined (Pearson’s chi-square test; statistical significance = 5%). A total of 726 prescriptions were analyzed, and in 109 of them (15%) 138 dispensing errors were found; 26 of these errors (n = 19%) involved a HAM. The most common error was ‘dose omission’ (n = 55; 40%). The drugs most involved in errors were metamizole (n = 26; 19%), metoclopramide (n = 14; 10%) and heparin (n = 10; 7%). The dispensing profile III presented a higher proportion of prescriptions with errors (n = 42; 16%). Regarding the dispensed items (n = 9,730), 3% of them presented an error (n = 268). Profile II was highlighted, with the highest proportion of items with errors (n = 114, 4%), which was superior to the other dispensing profiles (p

Exposure to childhood adversity can result in negative behavioral and physical health outcomes due to potential long-term embedding into regulatory biological processes. Screening for exposure to adversity is a critical first step in identifying children at risk for developing a toxic stress response. We searched PubMed, PsycArticles, and CINAHL for studies published between January 1, 2012, and December 31, 2016, as well as other sources, to identify potential tools for measuring cumulative adversity in children and adolescents. We identified 32 tools and examined them for adversity categories, target population, administration time, administration qualifications and method, and reliability and validity. We also created a list of recommended tools that would be feasible for use by pediatric practitioners in most types of practice. This review provides a starting point for mobilizing screening in pediatric settings, highlighting the challenges with existing tools, and potential issues in the development and evaluation of future tools.

Background There is no clinical tool that assesses multiple components of postural control potentially impacted by sport-related concussion (SRC). Objective To develop and assess the feasibility and construct validity of the Functional Assessment of Balance in Concussion (FAB-C) battery. Study Design Cross-sectional study. Methods Tests for inclusion in the FAB-C battery were identified through a search of the literature. The feasibility and construct validity of the battery was assessed with a convenience sample of active individuals (13–24 years) with and without a SRC. Feasibility outcomes included battery completion (yes/no), number of adverse events, time to administer (minutes) and cost of the battery (Canadian Dollars). Construct validity was assessed by examining correlations between tests included in the battery, and describing differences [mean (standard deviation), median (range) or proportion] in outcomes between uninjured participants and participants with SRC. Results Seven tests were included in the FAB-C battery. All 40 uninjured participants [12 female; median age 17 years] completed the FAB-C assessment compared to 86% of seven participants with SRC [1 female; median age 17]. No participants demonstrated adverse effects. The median administration time of the battery was 49 minutes (range 44-60). The cost of the battery was low (~$100 Canadian Dollars). Limited correlations (r Conclusion Although promising, the FAB-C battery requires further evaluation before adoption for widespread clinical use. Level of Evidence Level 3b

Increasing fatness and avoiding puberty are desirable in gilts intended for high-quality dry-cured ham production. A total of 48 Duroc x (Landrace x Large White) females of 26.5 ± 3.70 kg body weight (BW) were used to evaluate the impact of immunocastration and to find the optimum application time of the second dose for immunocastration on growth, sex hormones, reproductive tract development, and carcass, meat, and fat quality. Gilts were allocated to four experimental treatments (n = 12): control (entire gilts, EG) and immunocastrated gilts (IG), providing the second dose at 12, 9, or 7 weeks before slaughter (with approximately 60, 75, or 90 kg BW, respectively). Mean slaughter BW was 125 kg. Immunocastrated gilts had lighter reproductive tracts and greater fat thickness than EG. Fat from IG was more saturated and less polyunsaturated than that from EG. Numerically, gilts immunocastrated 9 and 12 weeks before slaughter presented higher fatness than those immunocastrated 7 weeks before slaughter. In conclusion, immunocastration is a good strategy to improve the fatness of gilts destined to dry-cured ham elaboration, with the optimum time for the second dose application seemingly between 9 and 12 weeks before slaughter.

To investigate the effects of microparticles on the immune system, a device was designed for an optimal culture environment. Macrophages phagocytose microparticles and produce inflammatory cytokines. In a culture environment in which macrophages phagocytose microparticles mixed in a culture medium, it remains unclear whether the macrophages can physically access all the microparticles present in the culture medium. In the culturing of fine particles, such as microparticles, it is necessary to devise methods that can realize a close biological contact between the macrophages and the microparticles. To enable macrophages to appropriately phagocytose microparticles, a microchamber with a glenoid hole for cell culturing was designed and manufactured. To clarify the effects of the size, administration amount, and administration time of the microparticles on the production of inflammatory cytokines, a system that can continuously deliver and collect the culture medium was introduced. The results obtained using these systems helped clarify the aforementioned effects. Our study confirms the possibility of employing a system that can optimally adjust the biological contact between macrophages and microparticles in a culture environment.

Background Intravenous epinephrine has been a key treatment in cardiopulmonary arrest since the early 1960s. The ideal timing for the first dose of epinephrinee is uncertain. We aimed to investigate the association of immediate epinephrine administration (within 1-min of recognition of cardiac arrest) with return of spontaneous circulation (ROSC) up to 24-h. Methods This was a multicenter retrospective analysis of patients who underwent cardiopulmonary resuscitation. We included the following patients: 1) ≥18 years-old, 2) non-shockable rhythms, 3) received intravenous epinephrine during cardiopulmonary resuscitation, 4) witnessed in-hospital arrest and 5) first resuscitation attempt (for patients requiring more than one resuscitation attempt). We excluded patients who suffered from traumatic arrest, were pregnant, had shockable rhythms, arrested in the operating room, with Do-Not-Resuscitate (DNR) order, and patient aged 17 years-old or less. Results A total of 360 patients were included in the analysis. Median age was 62 years old and median epinephrine administration time was two minutes. We found that immediate epinephrine administration (within 1-min) is associated with higher rates of ROSC up to 24-h (OR = 1.25, 95% CI; [1.01–1.56]), compared with early epinephrine (≥2-min) administration. After adjusting for confounding covariates, earlier administration of epinephrine predicted higher rates of ROSC sustained for up to 24-h (OR 1.33 95%CI [1.13–1.55]). Conclusions Immediate administration of epinephrine in conjunction with high-quality CPR is associated with higher rates of ROSC.

The Achievement Emotions Questionnaire (AEQ) is a well-established instrument for measuring achievement emotions in educational research and beyond. Its popularity rests on the coverage of the component structure of various achievement emotions across different academic settings. However, this broad conceptual scope requires the administration of 6 to 12 items per scale (Mdn = 10), which limits the applicability of the AEQ in empirical studies that necessitate brief administration times. We therefore developed the AEQ-S, a short version of the AEQ, with only 4 items per scale that nevertheless maintain the conceptual scope of the instrument. We validated the AEQ-S based on a reanalysis of Pekrun, Goetz, Frenzel, Barchfeld, and Perry's (2011) dataset (N = 389 university students) and by administering them to a new and independent validation sample (N = 471 university students). Despite their brevity, the AEQ-S scales achieved satisfactory reliability and correlated substantially with the original AEQ scales. Moreover, structural relationships and intercorrelations between the scales and their relations with external measures of antecedents and outcomes of achievement emotions were highly similar for the AEQ-S and AEQ scales. These findings suggest that the AEQ-S is a suitable substitute for the AEQ when administration time is limited.

Identify factors influencing service delivery changes during COVID-19 and examine barriers and provider satisfaction with teleneuropsychology (teleNP). Licensed clinical neuropsychologists within the United States recruited via neuropsychology-specific listservs (July–August 2020) to complete an online survey. A total of 261 individuals completed the survey. Most (76%) reported delivering in-person testing in some capacity at the time of our survey. Relatively more private practitioners identified concerns with privacy/confidentiality (45.2% vs. 17.9%; χ2(2) = 6.99, p < 0.05), legal issues (47.6% vs. 17.9%; χ2(2) = 8.06, p < 0.05), and an undesirable precedent for legal/forensic cases (59.5% vs. 15.4%; χ2(2) = 17.54, p < 0.001) compared to hospital or other medical (non-VA) practitioners. Multiple resources informed teleNP protocols, such as organization guidelines (87.6%), literature review (75.9%), webinars (72.4%), and consultation (68%). Several factors influenced test selection, including availability of normative data (70.1%), test familiarity (66.4%), administration time (63.5%), and evidence base (60.6%). Reported barriers to continuing teleNP after COVID-19 included need for improved teleNP norms (85.9%), domain coverage (84.7%), improved patient access to technology (74.1%) and further validation studies (84.1%). TeleNP may not be feasible in all settings and/or referrals. Respondents employed multiple resources in aggregating teleNP protocols and considered several factors when selecting tests. Results highlight the complex and varied decision-making processes utilized by respondents to adapt to service delivery changes. Considering the many benefits of teleNP, future research addressing some of the potentially modifiable factors (e.g., technology access, attitudes regarding teleNP) and significant development needs for teleNP itself (i.e., improved teleNP norms, further validation studies, etc.) is warranted.

Purpose Due to the multifaceted chemotherapy workflow within the hospital, many patients often experience delays in receiving their treatment. This study aims to evaluate the causes for chemotherapy administration delays and implement new methods to reduce delays from order release to chemotherapy administration on an inpatient oncology unit at a community-focused academic medical center. Methods In this prospective quality improvement study, we developed a process map to track baseline time stamps and utilized performance improvement tools to identify causes for chemotherapy delays. Based on recognized areas for improvement, the Plan-Do-Study-Act (PDSA) model was used to implement one cycle of interventions. Chemotherapy orders were collected, and benchmark time stamps were documented from the electronic medical record. Results The primary outcome for the number of chemotherapy delays, based on compliance rate, was reduced from 63/100 (63.0%) to 48/100 (48.0%), a 15% reduction (p = 0.046). Our primary outcome of chemotherapy delays, based on our institutional benchmark of Conclusions This study allowed our institution to evaluate our current practice and reformulate the chemotherapy administration process. With the continuing education on the chemotherapy administration process and additional PDSA cycle interventions, it will help standardize our process and ultimately continue to reduce chemotherapy delays.

Backgroud: To evaluate the optimal administration time of butorphanol in suppressing sufentanil-induced cough(SIC) during the induction of general anesthesia.Methods:180 patients were randomly divided into 4 equally sized groups: at 5min, 2min and 0min before anesthesia induction, all patients were sequentially injected the drug labeled A/B/C (butorphanol 1mg or normal saline), GI received intravenously drug A/B/C (All were normal saline),GII received intravenously drug A/B/C (A was butorphanol, B and C were saline), GIII received intravenously drug A/B/C (B is butorphanol, A and C were saline), GIV received intravenously drug A/B/C (C is butorphanol，A and B were saline). ALL Patients were then administrated with sufentanil 0.4 µg/kg in 5s after drug C. The incidence and severity of SIC was recorded within 2 minutes after sufentanil injection. MAP, HR, and SpO2 were recorded at T0 (before the administration of any drug),Ta, Tb, Tc (before the injection of drug A/B/C), T1( 2minutes after sufentanil injection) and T2 (1 minutes after endotracheal intubation). Results: The incidences of cough in GII, GIII, and IV were lower than that in GI (0.09, 0.01, and 0 vs 42.2%, PPP2 of GII was significantly lower than GI, GIII and GIV (P2 of GII was significantly lower than GI (PP2 of GIII were significantly lower than GIV (PConclusion: Intravenous butorphanol 1 mg could effectively suppress SIC before sufentanil injection. Without waiting time before administering the sufentanil may be feasible in clinical practice, it has the same suppressive effection and has no influence on BP, HR, SpO2 and the total amount of sufentanil. Trial registration: Chinese Clinical Trial Registry with registration number ChiCTR1900024394. Registered 9 July 2019.

Barcode medication administration (BCMA) is advocated as a technology that reduces medication errors relating to incorrect patient identity, drug or dose. Little is known, however, about the impact it has on nursing workflow. Our aim was to investigate the impact of BCMA on nursing activity and workflow. A comparative study was conducted on two similar surgical wards within an acute UK hospital. We observed nurses during drug rounds on a non-BCMA ward and a BCMA ward. Data were collected on drug round duration, timeliness of medication administration, patient identification, medication verification and general workflow patterns. BCMA appears not to alter drug round duration, although it may reduce the administration time per dose. Workflow was more streamlined, with less use of the medicines room. The rate of patient identification increased from 74% (of 47) patients to 100% (of 43), with 95% of 255 scannable medication doses verified using the system. This study suggests that BCMA does not affect drug round duration, further research is required to determine the impact it has on timeliness of medication administration. There was reduced variability in the medication administration workflow of nurses, along with an increased patient identification rate and high medication scan rate, representing potential benefits to patient safety.

Structured diagnostic interviews involve significant respondent burden and clinician administration time. This study examined whether we can maintain diagnostic accuracy using fewer posttraumatic stress disorder (PTSD) assessment questions. Our study included 1,265 U.S. veterans of the Afghanistan and Iraq conflicts who were assessed for PTSD using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (SCID-5). We used random forests to assess the importance of each diagnostic item in predicting a SCID-5 PTSD diagnosis. We used variable importance to rank each item and removed the lowest ranking items while maintaining ≥90% accuracy (i.e., efficiency), sensitivity, and other metrics. We eliminated six diagnostic items among the overall sample, four items among male veterans, and six items among female veterans. Our findings demonstrate that we may shorten the SCID-5 PTSD module while maintaining excellent diagnostic performance. These findings have implications for potentially reducing patient and provider burden of PTSD diagnostic assessment.