Background: Medication errors continue to be one of the most prevalent problems in healthcare related to patient safety, often resulting in injury or death, with higher incidences of error occurring with intravenous medications. The purpose of this study was to explore the use of deliberate practice (DP) with second-degree nursing students in developing and maintaining fundamental intravenous medication management practices required for safe practice. Method: This was a feasibility study using a two-arm, single-blind, randomized controlled trial design. Vygotsky’s Zone of Proximal Development model was used to explore the use of a DP teaching intervention to achieve competency in skills associated with safe IV medication management. A convenience sample of first-year, first-semester nursing students enrolled in an accelerated graduate program (N = 32) were invited to participate; 19 enrolled, and 12 completed the study. Students (n = 12) received three 30- minute one-on-one practice sessions at 2-week intervals with an expert nurse (the intervention group focused on IV skills and the control group on skills unrelated to IVs). Pre- and post-intervention instruments tested participants’ confidence with IV management and safety skills. The primary outcome was their ability to safely administer and monitor IV medications during a 20-minute videotaped medication administration scenario. Results: Low recruitment (19 of 32) and high attrition (37%) were observed. Participants completing the study (5 in the intervention group and 7 in the control group) reported that the time required to attend the sessions was not burdensome (91.7%); time allotted was adequate (100%); 100% reported positive experience; 91.7% found the DP sessions essential to learning. Change in confidence scores for IV skills were not significant (P = 0.210), but were higher in the intervention group (2.97–4.14 = 1.50 change) compared to the control group (2.71–3.77 = 1.04 change). Significant differences were found in overall medication administration skills between the control and intervention groups (t [-2.302], p = 0.044) in favor of the intervention group, particularly with medication preparation skills (p = 0.039). Overall raw scores were low in both groups; only 16–42 (26%–70%) of the total 60 steps required for safe practice were completed. Participants scored lowest in the evaluation phase, with all participants performing less than 50% of the 14 steps. Conclusion: Even though participant satisfaction was high, significant attrition occurred. Students reported the DP sessions to be beneficial and they felt more confident in performing skills, but three 30-minute sessions (90 minutes) were not adequate to develop, maintain, or refine all the IV-management skills associated with safe medication practices. Determining the length and duration of DP sessions as well as comparing the efficacy of DP sessions between individual and group sessions with varying doses and frequencies is needed to advance our understanding of using DP within nursing education.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第21456号 / 社医博第90号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 滝田 順子, 教授 小杉 眞司, 教授 三森 経世 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Background: Drug use is a public health problem associated with increased mortality, morbidity and lack of contact with healthcare. Stigmatization and discrimination surround drug use. Harm reduction aims to improve health without coercive measures to become drug-free in collaboration with people who inject drugs. Harm reduction is evidence-based, cost-effective and reduces the spread of infectious diseases. Needle exchanges provide information about drug-related risks and offer protection against this.  Aim: The aim was to describe experiences of harm reduction in needle exchanges in people who inject drugs.  Method: A qualitative literature study was carried out according to Polit and Beck's nine-step model. 11 articles were included and analyzed thematically according to the model of Braun and Clarke.  Results: The main finding is that people who inject drugs experience that needle exchanges offer knowledge and enable harm reduction. Needle exchanges are a place of health promotion for people who inject drugs.  Conclusion: How people who inject drugs experience the services and what makes them return is important knowledge for harm reduction to reach more people. Continued research is needed on how needle exchanges can reach more people who inject drugs. / Bakgrund: Drogbruk är ett folkhälsoproblem förenat med ökad dödlighet, sjuklighet och bristande kontakt med hälso- och sjukvård. Stigmatisering och diskriminering omgärdar drogbruk. Skadereduktion syftar till att förbättra hälsan utan tvingande åtgärder rörande drogfrihet. Skadereduktion är evidensbaserat, kostnadseffektivt och minskar spridningen av smittsamma sjukdomar. Sprututbyten ger information om drogrelaterade risker och erbjuder skydd mot dessa.  Syftet: Att beskriva erfarenheter av skadereduktion vid sprututbyten hos personer som injicerar droger. Metod: En kvalitativ litteraturstudie enligt Polit och Becks niostegsmodell. Elva artiklar inkluderades och analyserades tematiskt enligt modell av Braun och Clarke. Resultat: Huvudfynd är att personer som injicerar droger upplever att sprututbyten erbjuder kunskap och möjliggör skadereduktion. Sprututbyten är en plats för hälsopromotion för personer som injicerar droger.  Slutsats: Hur personer som injicerar droger upplever erbjuden skadereduktion vid sprututbyten och vad som får dem att återkomma är betydelsefull kunskap för att skadereduktion ska nå fler. Fortsatt forskning behövs om hur sprututbyten kan nå fler personer som injicerar droger.

Chronic kidney disease (CKD) is growing global public health problem affecting 1 in 10 adults in developed countries and recognised as an important risk factor for cardiovascular disease (CVD) development. CVD is the main cause of death among CKD patients. Endothelial injury and dysfunction are critical steps in atherosclerosis, a major CVD. Oxidative stress (increased level of reactive oxygen species, ROS) has been associated with CVD development. Intravenous (IV) iron preparations are widely used in the management of CKD mediated anaemia, and have been associated with increased oxidative stress and cellular dysfunction. This study examined the effect of pharmacologically-relevant concentrations of IV Venofer (iron sucrose) or IV Ferinject (Ferric carboxymaltose, FCM) on primary human umbilical vein endothelial cell (HUVEC) activation/damage and on intracellular ROS generation as well as studying the potential mechanisms responsible. Data from TUNEL assay and Annexin V-FITC/PI staining showed that, IV FCM had no effect, but IV iron sucrose increased HUVEC apoptosis at 24hr. IV iron sucrose inhibited cell proliferation and reduced cell viability. Both compounds induced EC activation through sustained activation of p38 MAPK and up-regulation of ICAM-1 and VCAM-1. Additionally, the compounds induced significant increase in total ROS and superoxide anion production, which was attenuated by the anti-oxidant N-acetylcysteine (NAC). P38 MAPK showed up-regulation of pro-apoptotic protein Bax and down-regulation of antiapoptotic Bcl-2 protein in HUVEC treated with IV iron sucrose and p38 inhibition reversed these effects. In summary, these results suggest that IV iron sucrose causes more severe EC injury than IV FCM. However, both IV iron preparations induced intracellular ROS and superoxide anion generation in HUVEC leading to EC activation/dysfunction, providing a potential explanation for vascular damage in CKD patients.

No description available.

Background: There are a number of different anesthetic techniques used in same-day surgery. The aim of the present study was to try to describe the postoperative clinical course and to identify factors that may be associated with the delay time from the surgical procedure was completed until discharge from hospital when intravenous anesthesia was used. Methods: A Quantitative Cross- sectional designed was used by using a self-designed questionnaire. Results: Total of 289 patients were enrolled in the study. The mean age was 40 years and 63% were women and 37% men. Of the 289 patients’ only one required unanticipated admission over night at the hospital. The median delay from completed surgery until discharge from hospital was 2 hours and 5 minutes and the maximum delay was 5 hours and 55 minutes. All patients received general anesthesia with an intravenous as maintenance anesthesia. Important risk factors for increasing postoperative delay were the severity of the postoperative pain and thereby the requirement of opioids in the postoperative phase Conclusion: Then undergoing daytime surgery the median delay from completed surgery until hospital discharge was about two hours. Problems with postoperative pain was associated with a prolonged delay. Thus, in order to shorten the delay to hospital discharge even further the pain-relieving treatment needs to be enhanced.

O presente trabalho visa desenvolver métodos que permitam determinar as concentrações de tetraciclina, por Cromatografia Líquida de Alta Eficiência, no plasma e líquido sinovial, além de analisar as concentrações correspondentes em leite de gado leiteiro em lactação submetidos aos tratamentos intravenoso e intravenoso regional. Desta forma, objetivando determinar a depuração da tetracic1ina no organismo dos animais tratados, a concentração do fármaco no sítio de ação e a quantidade residual em leite, as amostras biológicas foram colhidas e quantificadas em diferentes tempos pré e pós-administração do fármaco. Os métodos analíticos validados apresentaram linearidade, limite de detecção, quantificação, exatidão, precisão e recuperação adequados à quantificação do antibiótico nas matrizes biológicas estudadas. As amostras de leite de animais tratados com o medicamento por via intravenosa regional, não apresentaram resíduos após 120h da administração do fármaco. O mesmo ocorreu plasma e líquido sinovial após 48 h. Através da administração via intravenosa do medicamento foram observados resíduos no leite em todos os tempos avaliados, ao passo que no plasma e líquido sinovial, a presença do princípio ativo não foi detectada após 72 horas pós-tratamento. / The purpose of the present work is to develop methods which allow the determination of tetracycline by High Pressure Liquid Chromatography in serum, synovial fluid, as well as analyze the corresponding milk concentrations in milk cows subjected to intravenous and regional intravenous treatment. Therefore, aiming to determine the clearance of tetracycline in the body of the treated animals, the concentration of the active principle in the action site and the residual quantity in milk, biological matrices were collected at different times. The validated analytical methods depicted suitable linearity, detection and quantification limits, accuracy, precision and recovery, allowing the quantification of the antibiotic in the studied biological matrices. In relation to the milk samples from animals treated with the drug by regional intravenous via, they did not present residues of tetracycline after 120 h post-administration. The values were also null for both serum and synovial fluid after 48 h. Through regional intravenous drug administration, milk residues were observed in all the evaluated times whereas for serum and synovial fluid, the presence of the active principle was not detected after 72h post-treatment.

HCV genotype 6 is restricted in its distribution in South East Asia and it has been circulating for a long period of time. Phylogenetic and phylodynamic analysis on epidemic history of HCV focusing genotype 6 in South East Asia was explored, taking references from the pattern delineated in Liuzhou. Our results show that the date of most recent common ancestor (MRCA) of the whole HCV genotype 6 was estimated to be 100 years ago or more. There was an obvious increase of effective number of HCV genotype 6 infections in the part 20 years. Epidemic history of Subtype 6a and 6e/6d also showed the similar time course as that of the genotype 6. Interestingly, there was an increase of effective number of infections around 15-20 years ago which was maintained in the following decade for subtype 6a as well as 6e/6d. This specific pattern was consistent with the history of needle sharing in South East Asia, where the number of IDUs increased in the 1980s. The epidemic then spread to Southern China as evident by the increasing trend in Liuzhou. There was an exponential growth around 5 years ago involving subtype 6a predominantly, which might remain prevalent in Southern China in the coming decades. In conclusion, the study has shed new light on the transmission history of HCV, providing an explanation on the emergence of HCV genotype 6 in South East Asia. / HCV infection is an important public health problem associated with blood transfusion and needle-sharing in injection drug users (IDU) in Southern China. An understanding of the epidemiological pattern of the HCV infection, in conjunction with the transmission dynamics, would be beneficial for supporting effective prevention and control. This is accessed using a combination of molecular and public health approaches. / Through the Liuzhou Methadone Clinic, a total of 117 IDUs were recruited from Guangxi, Southern China. A majority of the IDUs (96%) were HCV antibody positive, of which 21% were HIV infected. Unlike HCV monoinfection, there was spatial heterogeneity in the distribution of HIV/HCV coinfection. The latter was also characterised by a higher prevalence of needle-sharing. Phylogenetic analysis of HCV revealed that genotype 6a was predominant in the study population. There were shorter genetic distances among the 6a samples compared to 3 other HCV genotypes/subtypes, 1a, 3a, and 3b. Our results suggested that HIV and HCV were both introduced at around the same time to the IDU populations in Southern China, followed by their differential spread as determined by the biologie characteristics of the virus and the intensity of behavioural risk. This pattern might be different from that in other South East Asian countries where HCV infections have probably predated HIV. / Tan, Yi. / Adviser: Kung Hsiang-fu. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3404. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 164-178). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1572. Adviser: Lu-Yu Hwang. Includes bibliographical references.

O presente trabalho visa desenvolver métodos que permitam determinar as concentrações de tetraciclina, por Cromatografia Líquida de Alta Eficiência, no plasma e líquido sinovial, além de analisar as concentrações correspondentes em leite de gado leiteiro em lactação submetidos aos tratamentos intravenoso e intravenoso regional. Desta forma, objetivando determinar a depuração da tetracic1ina no organismo dos animais tratados, a concentração do fármaco no sítio de ação e a quantidade residual em leite, as amostras biológicas foram colhidas e quantificadas em diferentes tempos pré e pós-administração do fármaco. Os métodos analíticos validados apresentaram linearidade, limite de detecção, quantificação, exatidão, precisão e recuperação adequados à quantificação do antibiótico nas matrizes biológicas estudadas. As amostras de leite de animais tratados com o medicamento por via intravenosa regional, não apresentaram resíduos após 120h da administração do fármaco. O mesmo ocorreu plasma e líquido sinovial após 48 h. Através da administração via intravenosa do medicamento foram observados resíduos no leite em todos os tempos avaliados, ao passo que no plasma e líquido sinovial, a presença do princípio ativo não foi detectada após 72 horas pós-tratamento. / The purpose of the present work is to develop methods which allow the determination of tetracycline by High Pressure Liquid Chromatography in serum, synovial fluid, as well as analyze the corresponding milk concentrations in milk cows subjected to intravenous and regional intravenous treatment. Therefore, aiming to determine the clearance of tetracycline in the body of the treated animals, the concentration of the active principle in the action site and the residual quantity in milk, biological matrices were collected at different times. The validated analytical methods depicted suitable linearity, detection and quantification limits, accuracy, precision and recovery, allowing the quantification of the antibiotic in the studied biological matrices. In relation to the milk samples from animals treated with the drug by regional intravenous via, they did not present residues of tetracycline after 120 h post-administration. The values were also null for both serum and synovial fluid after 48 h. Through regional intravenous drug administration, milk residues were observed in all the evaluated times whereas for serum and synovial fluid, the presence of the active principle was not detected after 72h post-treatment.