Lehmanrosen1496

Objective To test the compatibility of intravenous (IV) lactated Ringer's injection (LR) with 94 injectable (IV) drugs during simulated Y-site administration. Methods Ninety-four IV drugs were investigated for compatibility with LR (Baxter). Each sample was prepared in duplicate and performed at room temperature. Two observers performed visual evaluation independently immediately upon mixing and then 15 minutes, 1 hour, 2 hours, 3 hours, and 4 hours after admixture. Another observer performed a particle counting test on 1 of the 2 duplicates of each admixture that did not immediately show incompatibility and then after 4 hours by a light obscuration particle count test. Results Of the 94 tested drugs, 86 were found to be compatible with LR. A total of 8 drugs were found to be physically incompatible. Of these incompatible drugs, 7 were directly identified visually and 1 was confirmed by the light obscuration particle count test. Conclusion Lactated Ringer's injection was physically compatible for 4 hours with 86 tested drugs during simulated Y-site administration. Eight drugs, ciprofloxacin, cyclosporine, diazepam, ketamine, lorazepam, nitroglycerin, phenytoin, and propofol, were found to be incompatible and should not be administered with LR.BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR) testing can rapidly detect MRSA colonization via nasopharyngeal swab. With a high negative predictive value for MRSA pneumonia, this test may help minimize the duration of anti-MRSA therapy and associated adverse drug events. Objective This study aimed to evaluate the impact of a pharmacist-initiated MRSA nasal PCR protocol on pneumonia therapy. Methods This retrospective, quasi-experimental study evaluated adult patients with pneumonia before and after the implementation of a pharmacist-initiated MRSA nasal PCR protocol. The primary outcome of this study was to compare duration of anti-MRSA therapy between the Pre-PCR group and PCR group. Secondary comparisons included duration of antipseudomonal therapy, time from intravenous (IV) to oral interchange, and clinical outcomes. Results In total, 210 patients (Pre-PCR n = 138, PCR n = 72) were included. The MRSA nasal PCR result was negative for 63 patients (87.5%), and 56 (88.9%) vancomycin orders were discontinued within 24 hours of the negative result. The mean duration of vancomycin therapy was significantly shorter in the PCR group (2.5 vs 1.4 days, P less then .001) as well as duration of IV therapy (5 vs 3.9 days, P = .003). There was no difference between groups in duration of antipseudomonal therapy (P = .425), acute kidney injury (AKI; P = .332), 30-day readmission (P = .137), or 30-day mortality (P = .179). Conclusion and Relevance A pharmacist-driven MRSA nasal PCR protocol significantly decreased the duration of anti-MRSA therapy and IV antibiotics in patients with pneumonia. These findings add to the relatively small body of literature supporting pharmacist-initiated rapid diagnostic testing and follow-up.Purpose Dilute intravenous (IV) admixtures of dexamethasone sodium phosphate (DSP) are becoming increasingly used in antiemetic regimens to prevent chemotherapy-induced nausea and vomiting (CINV). Based on its chemical structure and previous studies, DSP is known to be susceptible to hydrolysis and oxidation under certain conditions. There are limited data to directly support the selection of IV diluents, storage conditions, and beyond-use dates for the dilute IV solutions of DSP used in the antiemetic regimens. This study was designed to investigate these parameters. Methods A stability-indicating high-performance liquid chromatography (HPLC) method was first developed for the analysis of DSP. Commercially available 100 mg/10 mL DSP injection vials were used to prepare the IV admixtures of DSP in 0.9% sodium chloride injection or 5% dextrose injection. The final DSP concentrations were 0.08 or 0.4 mg/mL, which bracketed the range commonly used in antiemetic regimens. These admixtures were packaged in 50-mL pin PVC bags. These admixtures are also chemically and physically stable when stored at room temperature or under refrigeration for up to 14 days.Background Antimicrobial therapy for asymptomatic bacteriuria (ASB) is often unnecessary and is a common reason for inappropriate antimicrobial use in hospitalized patients. Unnecessary ASB treatment leads to collateral damage such as resistance, and Clostridium difficile infections. This study evaluated the impact of interdisciplinary antimicrobial stewardship interventions on antimicrobial utilization in ASB. Methods This was a quasi-experimental institutional review board (IRB)-approved study evaluating the impact of antimicrobial stewardship on antibiotic utilization for ASB in a pilot medical-surgical unit. The control phase was from August-October 2017 and the postintervention phase was from December-March 2018. In the control phase, electronic medical records of patients with positive urine cultures were retrospectively reviewed. Patients were classified as either having ASB or urinary tract infection (UTI) based on the absence or presence of UTI symptoms documented in the medical record. The interventicrobial therapy for the treatment of ASB. With increasing antimicrobial resistance, healthcare institutions should evaluate the role of these interdisciplinary interventions to reduce unnecessary treatment for ASB.Introduction Readmission scoring systems are used to predict 30-day hospital readmission. selleck inhibitor These prediction tools do not considerlack of patient medication knowledge or adherence which can worsen disease outcomes or increase risk of readmissions. Objective To determine if medication knowledge and adherence, as assessed by validated questionnaires, are associated with an increased rate of 30-day readmission. Methods Adult medical inpatients were randomly selected for a prospective, single center study that was conducted from January to August 2017. Patients were asked the 4-question Morisky Green Levine Scale (MGLS) and the 4-question Medication Knowledge Score (MKS). Validated readmission score; MKS; and MGLS, as well as baseline information and readmission status within 30 days after the index admission were recorded. Mean or median scores were compared for patients readmitted within 30 days with those not readmitted using descriptive and univariate inferential statistics. Results Data from 119 patients showed a mean age of 63 years (SD = 16). There was no difference in baseline information age, sex, or number of scheduled home medications between those readmitted within 30 days and those not readmitted. Patients readmitted within 30 days had a statistically higher readmission score compared to patients not readmitted (66.4 vs 57.1, P = .017). There was no difference in median MKS or mean MGLS between patients readmitted within 30 days and those not readmitted (MKS 4.0 vs 3.0, P = .753; MGLS 1 vs 1.3, P = .162). Conclusions In this prospective study, neither the MKS nor the MGLS scores were associated with 30-day hospital readmission.Are higher levels of work-family enrichment a consequence or manifestation of certain personality traits and individuals' psychological functioning? Using random intercept cross-lagged panel models, this study examined the hypothesized stability of work-to-family enrichment (WFE) and family-to-work enrichment (FWE) over two 10-year intervals, the extent to which the within-person changes of WFE and FWE are associated with personality traits and psychological well-being (PWB), and possible gender differences. In this 20-year, longitudinal data analysis of employed adults (N=535), results indicated the robust nature of the stability of WFE/FWE. Our results suggest that personality traits were not associated with within-person change for either WFE or FWE, but PWB was associated with within-person change. Theoretically and conceptually, our findings provide strong evidence that work-family enrichment is not simply an "optimistic worldview" created by personality and well-being. The within-person results lend strong evidence that interventions that improve psychological well-being will also enhance work-family enrichment.We present elemental abundance data of C, N, O, Na, Mg, Al, Ca, and Cr in Genesis silicon targets. For Na, Mg, Al, and Ca, data from three different SW regimes are also presented. Data were obtained by backside depth profiling using Secondary Ion Mass Spectrometry. The accuracy of these measurements exceeds those obtained by in-situ observations; therefore the Genesis data provide new insights into elemental fractionation between Sun and solar wind, including differences between solar wind regimes. We integrate previously published noble gas and hydrogen elemental abundances from Genesis targets, as well as preliminary values for K and Fe. The abundances of the solar wind elements measured display the well-known fractionation pattern that correlates with each elements' First Ionization Potential (FIP). When normalized either to spectroscopic photospheric solar abundances or to those derived from CI-chondritic meteorites, the fractionation factors of low-FIP elements (K, Na, Al, Ca, Cr, Mg, Fe) are essentially identical within uncertainties, but the data are equally consistent with an increasing fractionation with decreasing FIP. The elements with higher FIPs between ~11 and ~16 eV (C, N, O, H, Ar, Kr, Xe) display a relatively well-defined trend of increasing fractionation with decreasing FIP, if normalized to modern 3D photospheric model abundances. Among the three Genesis regimes, the Fast SW displays the least elemental fractionation for almost all elements (including the noble gases) but differences are modest for low-FIP elements the precisely measured Fast-Slow SW variations are less than 3%.Aerobic glycolysis in cancer cells, also known as the 'Warburg effect', is driven by hyperactivity of lactate dehydrogenase A (LDHA). LDHA is thought to be a substrate-regulated enzyme, but it is unclear whether a dedicated intracellular protein also regulates its activity. Here, we identify the human tumor suppressor folliculin (FLCN) as a binding partner and uncompetitive inhibitor of LDHA. A flexible loop within the amino terminus of FLCN controls movement of the LDHA active-site loop, tightly regulating its enzyme activity and, consequently, metabolic homeostasis in normal cells. Cancer cells that experience the Warburg effect show FLCN dissociation from LDHA. Treatment of these cells with a decapeptide derived from the FLCN loop region causes cell death. Our data suggest that the glycolytic shift of cancer cells is the result of FLCN inactivation or dissociation from LDHA. Together, FLCN-mediated inhibition of LDHA provides a new paradigm for the regulation of glycolysis.CRISPR-CasΦ, a small RNA-guided enzyme found uniquely in bacteriophages, achieves programmable DNA cutting as well as genome editing. To investigate how the hypercompact enzyme recognizes and cleaves double-stranded DNA, we determined cryo-EM structures of CasΦ (Cas12j) in pre- and post-DNA-binding states. The structures reveal a streamlined protein architecture that tightly encircles the CRISPR RNA and DNA target to capture, unwind and cleave DNA. Comparison of the pre- and post-DNA-binding states reveals how the protein rearranges for DNA cleavage upon target recognition. On the basis of these structures, we created and tested mutant forms of CasΦ that cut DNA up to 20-fold faster relative to wild type, showing how this system may be naturally attenuated to improve the fidelity of DNA interference. The structural and mechanistic insights into how CasΦ binds and cleaves DNA should allow for protein engineering for both in vitro diagnostics and genome editing.