Estimation of External Dose Rates to Hotel Workers from bed linens Contaminated by 131I Patients

Iodine-131 is commonly used in medical diagnosis and therapy for patients with hyperthyroidism or differentiated thyroid cancer. Following treatment, patients may recuperate in a hotel room to avoid exposing family members. The main purpose of this study was to estimate external effective dose rate coefficients to a hotel worker who handles potentially contaminated bed linens due to secretions from I patients as sweat or urine. The external dose rate estimates were derived using Monte Carlo radiation transport code and the phantom with movable arms and legs to model a housekeeper standing in an upright position holding a pile of bed linens. Simulations further integrated the body burden of time-dependent biokinetic metabolism of I in the patient's body, differentiating between biokinetic excretion models of hyperthyroid vs. cancer patients. Organ absorbed dose rate and effective dose rate coefficients were calculated for three scenarios of bed linen contamination and estimated out to 5 d postadministration and compared to past I patient contamination measurements.

Categorization of adverse drug reactions in electronic health records

The purpose of this study was to evaluate the quality of adverse drug reaction (ADR) documentation in a state-wide electronic health record (EHR), and to assess the impact of the interface design on documentation accuracy and ability to provide decision support. Data were extracted from 43 011 unique records in a state-wide electronic health record in South Australia, Australia. Information obtained included ADR coding as allergy or intolerance, allergen name, reaction, and occupation of those entering data. Categorization into drug allergy or intolerance was assessed for accuracy. Reactions were entered predominantly by nurses (60.1%), also by doctors (31.0%) and pharmacists (6.1%). Of 27 314 reactions, 86.5% were coded as allergy and 13.5% as intolerance. The majority (78.2%) described reactions to drugs (as opposed to food, environmental or contact allergens), predominantly chosen from the drug database (96.4%). Many entries used free text for the reaction description (27.4%). Terms found in the predefined list under the allergy heading were more likely to be categorized as allergy, even when the mechanism was pharmacological intolerance. Only 45.1% (n = 1671/3705) of reactions consistent with intolerance (eg, "nausea," "diarrhea") were correctly categorized as such, although categorization by pharmacists was more accurate (P < .0001). These data suggest that ADR categorization as allergy or intolerance is influenced by the EHR design. The obligatory classification of ADRs into allergy or intolerance was not well understood and does not appear to have practical benefit.

Use of intravenous immunoglobulin therapy for myositis: an audit in South Australian patients

In South Australia, between 2000 and 2014, 57 patients with idiopathic inflammatory myositis (IIM) were treated with intravenous immunoglobulin (IVIg). We reviewed disease characteristics to determine predictors of response to therapy and IVIg dosing and duration to identify opportunities to rationalise IVIg use. Patients with dermatomyositis/polymyositis had a response rate of 77% and were more likely than inclusion body myositis to respond to therapy. Consideration should be given to the use of the lowest possible dose of IVIg and to the undertaking of trials of cessation of IVIg in patients with stable IIM.

Which aspects of health care are most valued by people living with HIV in high-income countries? A systematic review

BACKGROUND

Increasing numbers of people with HIV are living into older age and experiencing comorbidities. The development of new models of care to meet the needs of this population is now a priority. It is important that the views and preferences of patients inform the development of services in order to maintain high levels of patient satisfaction and engagement. The aim of this systematic review was to determine which aspects of healthcare are particularly valued by people living with HIV.

METHODS

We searched electronic databases and reference lists of relevant articles. The search strategy was developed to identify articles reporting on HIV positive patients' perceptions, evaluations or experiences of healthcare services and factors associated with satisfaction with care. Peer-reviewed papers and conference abstracts were included if the study reported on aspects of health care that were valued by people living with HIV, data were collected during the era of combination therapy (from 1996 onwards), and the paper was published in English. A thematic approach to data synthesis was used.

RESULTS

Twenty-three studies met the inclusion criteria. Studies used both qualitative and quantitative methods. Six studies specifically reported on relative importance to patients of different aspects of care. The valued aspects of care identified were grouped into seven themes. These highlighted the importance to patients of: a good health care professional-patient relationship, HIV specialist knowledge, continuity of care, ease of access to services, access to high quality information and support, effective co-ordination between HIV specialists and other healthcare professionals, and involvement in decisions about treatment and care. We were unable to determine the relative importance to patients of different aspects of care because of methodological differences between the studies.

CONCLUSIONS

This review identified several attributes of healthcare that are valued by people living with HIV, many of which would be relevant to any future reconfiguration of services to meet the needs of an ageing population. Further research is required to determine the relative importance to patients of different aspects of care.

ABO-incompatible heart transplantation: a perfusion strategy

Infants with fatal cardiac disease often die awaiting transplantation because of the shortage of donor hearts. The Hospital for Sick Children (HSC), Toronto, Canada, has researched and applied the concept of crossing the blood group compatibility barrier. Heart transplantation at HSC unrestricted by ABO compatibility greatly contributed to decreasing the mortality rate among infants on the waiting list from 58% to 10%.

From January 1996 to January 2002, 16 infants less than 14 months of age received ABO-incompatible heart transplants at our institution.

The cardiopulmonary bypass (CPB) circuit is primed with additional volume to replace the patient’s blood volume. Packed red blood cells (PRBC) used in priming must be ABO-compatible with the recipient. All plasma components and platelets must contain no anti-A or anti-B antibodies to donor or recipient. CPB is initiated and the patient’s venous blood is collected into a transfusion bag and sent to the blood bank. The total amount collected should be one and a half to two times the patient’s blood volume. The plasma is separated and discarded, returning only the PRBC, thus reducing the concentration of circulating antibodies to blood group antigens.

Our team has experienced an 87% survival rate with this technique. The success is believed to be associated with the recipients’ immunologic immaturity. Newborns do not produce isohemagglutinins, and serum anti-A and anti-B antibody titers usually remain low until 12-14 months of age. The complement system is not fully developed, therefore, the mediators of hyperacute rejection are absent during early infancy.

Heart transplantation unrestricted by the need for ABO compatibility would effectively expand the available donor pool and decrease waiting times.

Management of pediatric patients with isolated valvar aortic stenosis by balloon aortic valvuloplasty

Moderate to severe aortic stenosis in children requires an initial procedure to improve the stenosis and often additional procedures for recurrent stenosis or aortic insufficiency before adulthood. The purpose of this study was to evaluate children who underwent balloon valvuloplasty and were followed with a specific management plan. Twenty-two children with aortic stenosis underwent balloon valvuloplasty and were followed on a regular basis. Repeat valvuloplasty was performed if indicated. The initial gradient was reduced from 63 +/- 9 mmHg to 28 +/- 8 mmHg (P < 0.001). There were no deaths and only one major complication, which had no sequelae. Average follow-up was 61 +/- 23 months. Three patients required valve replacement 39-76 months after valvuloplasty for progressive insufficiency. Seven patients underwent successful repeat valvuloplasty. The overall probability of survival without surgical intervention was 75% at 100 months. Balloon valvuloplasty is an effective intermediate palliation for aortic stenosis and is an acceptable alternative to surgical valvotomy. Repeat valvuloplasty is successful without additional risk. In a subgroup of patients, aortic insufficiency is progressive and will require surgical intervention.

Stress responses of emergency services personnel to the Loma Prieta earthquake Interstate 880 freeway collapse and control traumatic incidents

A three-group quasi-experimental design contrasted the responses of rescue workers to the 1989 Loma Prieta earthquake Interstate 880 freeway collapse (n = 198) with responses to critical incident exposure of Bay Area Controls (n = 140) and San Diego Controls (n = 101). The three groups were strikingly similar with respect to demographics and years of emergency service. The I-880 group reported higher exposure, greater immediate threat appraisal, and more sick days. The three groups did not differ on current symptoms. For the sample as a whole EMT/Paramedics reported higher peritraumatic dissociation compared with Police. EMT/Paramedics and California road workers reported higher symptoms compared with Police and Fire personnel. Nine percent of the sample were characterized as having symptom levels typical of psychiatric outpatients. Compared with lower distress responders, those with greater distress reported greater exposure, greater peritraumatic emotional distress, greater peritraumatic dissociation, greater perceived threat, and less preparation for the critical incident.

Murine type-C virus group-specific antigens: interstrain immunochemical, biophysical, and amino acid sequence differences

The 30,000-molecular-weight internal protein, p30, was purified from seven strains of mouse type-C viruses. The individual p30's showed variation in isoelectric points and also intrastrain heterogeneity. The individual p30's could be distinguished by peptide map and quantitative complement fixation techniques with relatedness estimates of >95%. Amino terminal sequence analysis showed variability at position 4 for several p30's with complete homology otherwise through 24 residues. The intrastrain heterogeneity in p30 isoelectric points could not be explained by common contaminants, as shown by peptide mapping, and is more likely based on post-transcriptional modifications. These data provide a chemical basis for the recently described type-specific immunological properties of individual p30's.

Purification and immunological characterization of the major internal protein of the RD-114 virus

The major internal protein of the RD-114 virus that appeared in a human tumor cell line, RD, after passage through fetal cats was purified by isoelectric focusing and used to prepare antibody in guinea pigs. The protein has a molecular weight of 33,500 in sodium dodecyl sulfate-polyacrylamide gels, and an isoelectric point of 9.1. This contrasts with a molecular weight of 25,000 and an isoelectric point of 8.3 obtained previously for the major protein of cat C-type viruses. The RD-114 protein carries determinants common to all mammalian C-type viruses but not species-specific determinants of cat, mouse, rat, hamster, chicken, and Russell's viper C-type viruses. In addition, two other proteins found in cat virus preparations were not detected in the RD-114 virus. Antiserum to the RD-114 viral protein proved highly specific by complement fixation and gel diffusion assays, and, in addition to the above mentioned mammalian viruses, the antiserum did not react with concentrates of the Woolly monkey or Gibbon ape C-type viruses. These data support the conclusion that the RD-114 virus is a human virus activated by passage through fetal cats. Until additional isolates are made from human cells, the identity of the RD-114 virus as a human C-type tumor virus cannot be fully established; however, this would be highly probable if the species-specific group-specific antigen of RD-114 could be demonstrated in human tumor and/or embryonic tissues.