Impact of Adoption of a Comprehensive Electronic Health Record on Nursing Work and Caring Efficacy

Nurses in acute care settings are affected by the technologies they use, including electronic health records. This study investigated the impacts of adoption of a comprehensive electronic health record by measuring nursing locations and interventions in three units before and 12 months after adoption. Time-motion methodology with a handheld recording platform based on Omaha System standardized terminology was used to collect location and intervention data. In addition, investigators administered the Caring Efficacy Scale to better understand the effects of the electronic health record on nursing care efficacy. Several differences were noted after the electronic health record was adopted. Nurses spent significantly more time in patient rooms and less in other measured locations. They spent more time overall performing nursing interventions, with increased time in documentation and medication administration, but less time reporting and providing patient-family teaching. Both before and after electronic health record adoption, nurses spent most of their time in case management interventions (coordinating, planning, and communicating). Nurses showed a slight decrease in perceived caring efficacy after adoption. While initial findings demonstrated a trend toward increased time efficiency, questions remain regarding nurse satisfaction, patient satisfaction, quality and safety outcomes, and cost. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Corresponding author: Elizabeth Schenk, PhD, MHI, RN-BC, College of Nursing, Washington State University, 2407 Wylie Ave, Missoula, MT 59802 (Elizabeth.schenk@wsu.edu). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The Traditional Medicinal Plants Cuphea calophylla, Tibouchina kingii, and Pseudelephantopus spiralis Attenuate Inflammatory and Oxidative Mediators

Aerial parts of Cuphea calophylla, Tibouchina kingii, and Pseudelephantopus spiralis have been used in Colombian traditional medicine for inflammation. However, the underlying mechanisms that could explain the anti-inflammatory actions remain unknown. This study aimed to elucidate the anti-inflammatory and cytoprotective effects of hydroalcoholic extracts from C. calophylla (HECC), T. kingii (HETK), and P. spiralis (HEPS) in LPS-stimulated THP-1 macrophages. Reactive oxygen species (ROS), nitric oxide (NO), and malondialdehyde (MDA) were monitored as inflammatory and oxidative markers. The inhibition of lipoxygenase (LOX) and cyclooxygenase (COX) activities in a cell-free system were also investigated. Antioxidant activities were determined using standard in vitro methods. All extracts inhibited the NO, ROS, and MDA levels. HETK showed the highest ROS production inhibition and the highest antioxidant values, whereas HETK and HEPS significantly decreased the cytotoxicity mediated by LPS. The release of MDA was reduced significantly by all extracts. Moreover, the catalytic activity of LOX was inhibited by HECC and HETK. HECC was a more potent reducer of COX-2 activity. All extracts effectively suppressed COX-1 activity. In summary, these results suggest that HECC, HEPS, and HETK possess anti-inflammatory properties. Therefore, these plants could provide a valuable source of natural bioactive compounds for the treatment of inflammatory-related diseases.

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Loss of function mutations in VARS encoding cytoplasmic valyl-tRNA synthetase cause microcephaly, seizures, and progressive cerebral atrophy

Abstract

Progressive microcephaly and neurodegeneration are genetically heterogenous conditions, largely associated with genes that are essential for the survival of neurons. In this study, we interrogate the genetic etiology of two siblings from a non-consanguineous family with severe early onset of neurological manifestations. Whole exome sequencing identified novel compound heterozygous mutations in VARS that segregated with the proband: a missense (c.3192G>A; p.Met1064Ile) and a splice site mutation (c.1577-2A>G). The VARS gene encodes cytoplasmic valyl-tRNA synthetase (ValRS), an enzyme that is essential during eukaryotic translation. cDNA analysis on patient derived fibroblasts revealed that the splice site acceptor variant allele led to nonsense mediated decay, thus resulting in a null allele. Three-dimensional modeling of ValRS predicts that the missense mutation lies in a highly conserved region and could alter side chain packing, thus affecting tRNA binding or destabilizing the interface between the catalytic and tRNA binding domains. Further quantitation of the expression of VARS showed remarkably reduced levels of mRNA and protein in skin derived fibroblasts. Aminoacylation experiments on patient derived cells showed markedly reduced enzyme activity of ValRS suggesting the mutations to be loss of function. Bi-allelic mutations in cytoplasmic amino acyl tRNA synthetases are well-known for their role in neurodegenerative disorders, yet human disorders associated with VARS mutations have not yet been clinically well characterized. Our study describes the phenotype associated with recessive VARS mutations and further functional delineation of the pathogenicity of novel variants identified, which widens the clinical and genetic spectrum of patients with progressive microcephaly.

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Plantar Stress-Related Injuries in Male Basketball Players: Variations on Plantar Loads during Different Maximum-Effort Maneuvers

This study aims to compare the insole load of three maximum-effort cutting tasks in basketball. Sixteen male basketball players were recruited to participate in the study. The Pedar Mobile system was used to record the insole plantar load distribution during three cutting tasks (45° cutting, 90° cutting, and sideward cutting). The peak pressures (PP) and maximum force (MF) at the total foot and at each foot mask were used in data analysis. ANOVA with repeated measures was employed to investigate the differences in the measures among these cutting tasks. At the total foot, the highest MF value was showed when performing sideward cutting. At the heel, the highest PP and MF were found when performing 90° cutting. The PP and MF were lower when performing 90° cutting than when conducting 45° and sideward cuttings at the medial midfoot and the central forefoot. Furthermore, the MF value was lower when performing 45° cutting than when conducting sideward cutting at the medial midfoot and the central forefoot. These findings corroborate the fact that plantar loads differed during the three maximum-effort cutting maneuvers. Differences in the plantar loads for different cutting may be potential risks for overuse-related injuries to the lower extremities of basketball players.

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Aetiological Features of Elderly Patients with Newly Diagnosed Symptomatic Epilepsy in Western China

Aims. Recent epidemiological studies have indicated that the incidence of epilepsy peaks after 60 years old, and epilepsy has become increasingly prevalent in elderly populations. The aim of this study is to identify the aetiologic characteristics of epilepsy in the elderly. Methods. We retrospectively recruited elderly patients with newly diagnosed epilepsy identified in three epilepsy centres in western China; elderly patients were defined as individuals aged 60 years or older. Demographic characteristics, clinical epilepsy data, and the diagnosis and aetiology of epilepsy were recorded. Results. A total of 760 patients with newly diagnosed epilepsy were enrolled in our study. Of these patients, 25% had experienced one or more episodes of status epilepticus, and 62.4% were confirmed as symptomatic. Among the symptomatic cohort, stroke and traumatic brain injury (TBI) were the two most common causes of epilepsy, followed by cerebral tumour, dementia, hippocampal sclerosis (HS), and central nervous system (CNS) infection. When analysed by residence and age, ischaemic stroke was the most common cause of epilepsy in urban patients, whereas traumatic brain injury was the leading cause of epilepsy in rural patients. Conclusion. More than three-fifths of newly diagnosed epilepsy cases in elderly patients were confirmed as symptomatic, and stroke and traumatic brain injury were the primary aetiologies in elderly epileptic patients.

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Stability of milrinone in continuous ambulatory delivery devices [Note]

Purpose

The stability of milrinone in continuous ambulatory delivery devices (CADDs) stored at 4, 25, and 35 °C was evaluated.

Method

Six CADDs (3 devices containing milrinone plus 0.9% sodium chloride injection and 3 devices containing milrinone plus 5% dextrose injection) were prepared. Devices were kept at 4 °C for 168 hours, followed by 24 hours at 25 °C and an additional 24 hours at 35 °C. Samples (n = 3) were withdrawn aseptically at 0, 24, 48, 72, 96, 120, 144, and 168 hours from the CADDs stored at 4 °C and at 0, 6, and 24 hours from the CADDs stored at 25 and 35 °C. The milrinone concentration of each aliquot was analyzed using a stability-indicating high performance liquid chromatographic method within 15–30 minutes of preparation. The samples were also evaluated for changes in pH, changes in color, and particulate content. Six control samples (3 containing 0.9% sodium chloride injection and 3 containing 5% dextrose injection) were prepared and similarly analyzed.

Results

Milrinone admixtures retained more than 99% of their initial concentration for 168 hours at 4 °C and for 24 hours when stored at 25 and 35 °C. No evidence of particle formation, color change, or pH change was observed throughout the study period.

Conclusion

Milrinone 600 μg/mL prepared in either 0.9% sodium chloride injection or 5% dextrose injection in CADDs was stable for 168 hours when stored at 4 °C and for 24 hours when stored at 25 and 35 °C.

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New drugs and dosage forms [News]

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