Patients prefer clinical handover at the bedside; Nurses do not: Evidence from a Discrete Choice Experiment

Background: Shift-to-shift bedside handover is advocated as a patient-centred approach, yet its enactment is challenging. Objectives: To describe and compare the preferences of both patients and nurses in the implementation of bedside handover in a Swedish University Hospital. Design: A discrete choice experiment (DCE) survey. Settings: University setting, four medical wards in two hospitals. Participants: Adult medical patients (n = 218) and registered nurses (n = 101) Methods: The survey was administered by an electronic tablet-assisted face-to-face survey. Respondents made repeated choices between two hypothetical bedside handover alternatives and a third alternative of ‘handover away from the bedside’. Handover alternatives were described according to six attributes: invitation to participate, number of nurses present at the handover, family member, carer or trusted friend (of the patient) allowed to be present, level of (patient) involvement, what information related to your (patient) care is discussed. Choice data were analyzed using a mixed logit model. Results: A total of 1308 (patients) and 909 (nurses) choice observations were included in the preference models. Patients showed a strong preference for handover at the bedside compared to nurses. Nurses generally preferred handover away from the bedside. Patients perceived their level of involvement in handover as highly important, being able to speak, hear what was said being the most important characteristic, closely followed by being invited to participate and asked questions as well as being heard. Nurses considered patients being invited to participate most important, followed by level of involvement. Different options for handing over sensitive information were not perceived of importance by patients or nurses. There was substantial variation at the individual level across both patients and nurses for where and how handover is delivered. Conclusions: In this study, patients strongly preferred handover at the bedside, while the nurses considered patients to be invited to participate to be the most important preference but generally preferred handover to take place away from the bedside, all else equal. When implementing bedside handover in a Swedish context this must be considered, although participation is a prerequisite for bedside handover. Differences between patients and nurses’ preferences could jeopardize future introduction of bedside handover in Swedish health care, and might explain why bedside handover is still not very common in hospital wards

How theories of complexity and resilience affect interprofessional simulation-based education: a qualitative analysis of facilitators' perspectives

Background Quality of care and patient safety rely on the ability of interprofessional teams to collaborate effectively. This can be trained through interprofessional simulation-based education (IPSE). Patient safety also relies on the ability to adapt to the complexity of such situations, an ability termed resilience. Since these needs are not explicitly addressed in IPSE, the aim of this study was to explore how central concepts from complexity-theory and resilience affect IPSE, from facilitators’ perspective, when applied in debriefings. Methods A set of central concepts in complexity-theory and resilience were introduced to facilitators on an IPSE course for nursing and medical students. In five iterations of focus groups interviews the facilitators discussed their application of these concepts by reviewing video recordings of their own debriefings. Video recordings of the interviews were subjected to coding and thematic analysis. Results Three themes were identified. The first, Concepts of complexity and resilience are relevant for IPSE, points to the applicability of these concepts and to the fact that students often need to deviate from prescribed guidelines/algorithms in order to solve cases. The second theme, Exploring complexity, shows how uncertainty could be used as a cue to explore complexity. Further, that individual performance needs to account for the context of actions and how this may lead to certain outcomes. Moreover, it was suggested that several ways to approach a challenge can contribute to important insight in the conditions for teamwork. The third theme, Unpacking how solutions are achieved, turns to needs for handling the aforementioned complexity. It illustrates the importance of addressing self-criticism by highlighting how students were often able to overcome challenges and find solutions. Finally, this theme highlights how pre-defined guidelines and algorithms still work as important resources to help students in transforming perceived messiness into clarity. Conclusions This study suggests that IPSE provides the possibility to explore complexity and highlight resilience so that such capability can be trained and improved. Further studies are needed to develop more concrete ways of using IPSE to account for complexity and developing resilience capacity and to evaluate to what extent IPSE can provide such an effect.publishedVersio

Inflammatory bowel disease professionals’ attitudes to and experiences of complementary and alternative medicine

BACKGROUND: Complementary and alternative medicine (CAM) use in patients with IBD is on the increase. Patients report they use CAM when their condition is unresponsive to conventional medication or when they suffer from side-effects, negative stress and disease-related concerns. CAM use may improve patients’ well-being but it can also lead to side-effects and interactions with conventional medications. Research on attitudes to and experiences of CAM among healthcare professionals working with IBD patients is not well studied. Studies in this area could lead to enhanced awareness of and improved communication about CAM between care staff and IBD patients. The aim of this study was to explore IBD professionals’ attitudes to and experience of CAM. METHODS: Sixteen physicians and nurses, 26–70 years old, who had worked with IBD patients for 1–42 years, were recruited. Semi-structured qualitative interviews were conducted. Qualitative content analysis was performed. RESULTS: Participants stated patients used CAM to improve their well-being generally and there conditions specifically. Participants had a positive attitude towards CAM and respected their patients’ decision to use it, but reported a lack of CAM knowledge. They required education about CAM to be able to meet patients’ needs and provide adequate information. The result of this study indicates that there is a need for CAM education to be implemented in nursing and medical school. CONCLUSIONS: All participants had experience of IBD patients who had used CAM in an attempt to achieve improvement and well-being. Attitudes to CAM were mainly positive, although a problematic aspect was lack of knowledge and evidence in relation to CAM. Implementing CAM education in nursing and medical school will allow healthcare professionals to gain an understanding of therapies widely used by patients with IBD. In clinical practice, using a standard questionnaire regarding CAM use allow healthcare professionals to better understand their patients’ wishes and current CAM use

Identification of Stage-Specific Breast Markers using Quantitative Proteomics

YesMatched healthy and diseased tissues from breast cancer patients were analyzed by quantitative proteomics. By comparing proteomic profiles of fibroadenoma (benign tumors, three patients), DCIS (noninvasive cancer, three patients), and invasive ductal carcinoma (four patients), we identified protein alterations that correlated with breast cancer progression. Three 8-plex iTRAQ experiments generated an average of 826 protein identifications, of which 402 were common. After excluding those originating from blood, 59 proteins were significantly changed in tumor compared with normal tissues, with the majority associated with invasive carcinomas. Bioinformatics analysis identified relationships between proteins in this subset including roles in redox regulation, lipid transport, protein folding, and proteasomal degradation, with a substantial number increased in expression due to Myc oncogene activation. Three target proteins, cofilin-1 and p23 (increased in invasive carcinoma) and membrane copper amine oxidase 3 (decreased in invasive carcinoma), were subjected to further validation. All three were observed in phenotype-specific breast cancer cell lines, normal (nontransformed) breast cell lines, and primary breast epithelial cells by Western blotting, but only cofilin-1 and p23 were detected by multiple reaction monitoring mass spectrometry analysis. All three proteins were detected by both analytical approaches in matched tissue biopsies emulating the response observed with proteomics analysis. Tissue microarray analysis (361 patients) indicated cofilin-1 staining positively correlating with tumor grade and p23 staining with ER positive status; both therefore merit further investigation as potential biomarkers.Cyprus Research Promotion Foundation, Yorkshire Cancer Researc

Patient preferences for participation in patient care and safety activities in hospitals

BackgroundActive patient participation is a patient safety priority for health care. Yet, patients and their preferences are less understood. The aim of the study was to explore hospitalised patients&rsquo; preferences on participation in their care and safety activities in Sweden.MethodsExploratory qualitative study. Data were collected over a four-month period in 2013 and 2014. Semi-structured interviews were conducted with 20 patients who were admitted to one of four medical wards at a university hospital in Sweden. Data were analysed using thematic analysis.ResultsNine men and eleven women, whose median age was 72 years (range 22&ndash;89), were included in the study. Five themes emerged with the thematic analysis: endorsing participation; understanding enables participation; enacting patient safety by participation; impediments to participation; and the significance of participation. This study demonstrated that patients wanted to be active participants in their care and safety activities by having a voice and being a part of the decision-making process, sharing information and possessing knowledge about their conditions. These factors were all enablers for patient participation. However, a number of barriers hampered participation, such as power imbalances, lack of patient acuity and patient uncertainty. Patients&rsquo; participation in care and patient safety activities seemed to determine whether patients were feeling safe or ignored.ConclusionThis study contributes to the existing literature with fundamental evidence of patients&rsquo; willingness to participate in care and safety activities. Promoting patient participation begins by understanding the patients&rsquo; unique preferences and needs for care, establishing a good relationship and paying attention to each patient&rsquo;s ability to participate despite their illness.<br /

Mmf1p, a novel yeast mitochondrial protein conserved throughout evolution and involved in maintenance of the mitochondrial genome

A novel protein family (p14.5, or YERO57c/YJGFc) highly conserved throughout evolution has recently been identified. The biological role of these proteins is not yet well characterized. Two members of the p14.5 family are present in the yeast Saccharomyces cerevisiae. In this study, we have characterized some of the biological functions of the two yeast proteins. Mmf1p is a mitochondrial matrix factor, and homologous Mmf1p factor (Hmf1p) copurifies with the soluble cytoplasmic fraction. Δmmf1 cells lose mitochondrial DNA (mtDNA) and have a decreased growth rate, while Δhmf1 cells do not display any visible phenotype. Furthermore, we demonstrate by genetic analysis that Mmf1p does not play a direct role in replication and segregation of the mtDNA. rho(+) Δmmf1 haploid cells can be obtained when tetrads are directly dissected on medium containing a nonfermentable carbon source. Our data also indicate that Mmf1p and Hmf1p have similar biological functions in different subcellular compartments. Hmf1p, when fused with the Mmf1p leader peptide, is transported into mitochondria and is able to functionally replace Mmf1p. Moreover, we show that homologous mammalian proteins are functionally related to Mmf1p. Human p14.5 localizes in yeast mitochondria and rescues the Δmmf1-associated phenotypes. In addition, fractionation of rat liver mitochondria showed that rat p14.5, like Mmf1p, is a soluble protein of the matrix. Our study identifies a biological function for Mmf1p and furthermore indicates that this function is conserved between members of the p14.5 family

The effects of thiopurine therapy on health-related quality of life in Inflammatory Bowel Disease patients

<p>Abstract</p> <p>Background</p> <p>The effect of thiopurine immunomodulators on health-related quality of life (HRQoL) in patients with inflammatory bowel disease (IBD) has been controversial. The aims were to evaluate the HRQoL in patients with IBD treated with thiopurines and assess the short- and long-term impacts of the treatment on HRQoL.</p> <p>Methods</p> <p>Ninety-two consecutive patients who started treatment with thiopurines were prospectively included. Evaluation of HRQoL was performed at months 0, 6, and 12 using two questionnaires, the Short-Form Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ).</p> <p>Results</p> <p>Baseline score of IBDQ was 4,6, range (2,31-6,84), with an impairment of the five dimensions of HRQoL compared with inactive patients. Results obtained in 8 dimensions of SF-36 showed worse HRQoL than Spanish general population. At 6 months patients had a significant improvement in overall IBDQ score -5,8 (1,58 -6,97)- and also in all IBDQ dimensions. All the 8 dimensions of SF-36 obtained a significant improvement. At twelve months score of IBDQ was 6,1, range (2,7-6,98), with improvement in all dimensions compared with baseline and 6 months. SF-36 showed a similar significant improvement in all subscales.</p> <p>Conclusions</p> <p>Thiopurine immunomodulators alone or with other treatments have a positive and long lasting impact on HRQoL of IBD patients.</p

Crystal structure of an Hsp90-nucleotide-p23/Sba1 closed chaperone complex

Hsp90 (heat shock protein of 90 kDa) is a ubiquitous molecular chaperone responsible for the assembly and regulation of many eukaryotic signalling systems and is an emerging target for rational chemotherapy of many cancers. Although the structures of isolated domains of Hsp90 have been determined, the arrangement and ATP-dependent dynamics of these in the full Hsp90 dimer have been elusive and contentious. Here we present the crystal structure of full-length yeast Hsp90 in complex with an ATP analogue and the co-chaperone p23/Sba1. The structure reveals the complex architecture of the ‘closed’ state of the Hsp90 chaperone, the extensive interactions between domains and between protein chains, the detailed conformational changes in the amino-terminal domain that accompany ATP binding, and the structural basis for stabilization of the closed state by p23/Sba1. Contrary to expectations, the closed Hsp90 would not enclose its client proteins but provides a bipartite binding surface whose formation and disruption are coupled to the chaperone ATPase cycle

Småskalig återvinning av toluen inom API-tillverkning

In response to the imperative for increased sustainability in pharmaceutical manufacturing, this project investigates solvent recycling to reduce environmental impact and promote circular economy practices. AstraZeneca, a global pharmaceutical leader, aims to enhance its sustainability efforts by exploring toluene recycling in the manufacturing of esomeprazole at Site API in Snäckviken, Sweden. The objective of the project was to identify the optimal separation and recovery system for toluene, focusing on achieving a minimum recovery rate of 90,0% and purifying waste streams to a purity of at least 99,5% by weight. Compliance with cGMP standards and mitigation of cross-contamination risks are also essential considerations. Using literature studies and simulations conducted on Aspen software, liquid-liquid extraction combined with distillation emerged as the most suitable technique. This approach achieved a toluene recovery rate of 98,3% with a purity of 99,5%, alongside a methanol recovery rate of 97,8% at 99,1% purity. Annually, this translates to savings of 630 tons of toluene and 344 tons of methanol. The results of the simulations validate the effectiveness of the proposed recycling system, which utilizes two extractors and two distillation columns to meet project objectives while addressing critical operational and environmental concerns. However, pilot-plant testing and experimental validation are recommended before scaling this process to industrial implementation, ensuring robustness and reliability in real-world applications. This project underscores a viable pathway for pharmaceutical companies to reduce carbon emissions and reliance on petroleum-based solvents, fostering sustainable and economically feasible manufacturing practices.I svar på behovet av ökad hållbarhet inom läkemedelstillverkning undersöker detta projekt återvinning av lösningsmedel som ett sätt att minska miljöpåverkan och främja cirkulär ekonomi. AstraZeneca, en global ledare inom läkemedelsindustrin, strävar efter att förbättra sin hållbarhet genom att utforska återvinning av toluen vid produktionen av esomeprazol på Site API i Snäckviken, Sverige. Projektets mål är att identifiera det optimala separation- och återvinningssystemet för toluen, med fokus på att uppnå en återvinningsgrad på minst 90,0% och rena avfallsströmmarna till en renhet av minst 99,5 vikt-%. Efterlevnad av cGMP-standarder och hantering av risker för korskontaminering är också centrala överväganden. Genom litteraturstudier och simuleringar utförda i Aspen-programvara framstod extraktion kombinerat med destillation som den mest lämpliga tekniken. Detta system uppnådde en återvinningsgrad för toluen på 98,3% med en renhet på 99,5%, samt en återvinningsgrad för metanol på 97,8% med en renhet på 99,1%. Årligen motsvarar detta besparingar på 630 ton toluen och 344 ton metanol. Simuleringsresultaten bekräftar effektiviteten i det föreslagna återvinningssystemet, som använder två extraktorer och två destillationskolonner för att uppnå projektets mål samtidigt som det hanterar kritiska operativa och miljömässiga frågor. Dock rekommenderas systemet att simuleras i pilotskala tillsammans med experimentell validering innan denna process skalas upp till industriell implementering, för att säkerställa robusthet och tillförlitlighet i verkliga tillämpningar. Detta projekt visar på en hållbar väg för läkemedelsföretag att minska koldioxidutsläpp och beroendet av petroleum-baserade lösningsmedel, främjande av tekniskt och ekonomiskt hållbara tillverkningsprocesser