Introduction of Unit-Dose Care in the 1,125 Bed Teaching Hospital: Practical Experience and Time Saving on Wards

Purpose

The shortage of nursing staff as well as the slow progress in the German health care system's digitalisation has gained much attention due to COVID-19. Patient-specific medication management using the unit-dose dispensing system (UDDS) has the potential for a lasting and positive influence on both digitalisation and the relief of nursing staff.

Methods

Nursing staff UDDS-acceptance was determined via a validated online survey. For the evaluation of stock keeping on the wards, the delivery quantities were determined for a comparative period before and after the introduction of the UDDS. The time required for on-ward medication-related processes on ward before and after the introduction of UDDS was recorded based on a survey form and the nursing relief in full-time equivalent (FTE) was calculated using the data obtained.

Results

We show that nurses appreciate the UDDS and confirm a significant reduction in drug stocks on the wards. The UDDS reduces the time needed to dispense medications from 4.52 ± 0.35 min to 1.67 ± 0.15 min/day/patient. In relation to the entire medication process, this corresponds to a reduction of 50% per day and per patient. Based on 40,000 patients/year and a supply of 1,125 beds with unit-dose blisters, 7.36 FTE nursing staff can be relieved per year. In contrast, 6.5 FTE in the hospital pharmacy are required for supplying the hospitals.

Conclusion

UDDS is well accepted by nurses, reduces stock levels on ward, and fulfils criteria as a nursing-relief measure.

We Ask and Listen: A Group-Wide Retrospective Survey on Satisfaction with Digital Medication Software

Purpose

Computerized physician order entry (CPOE) and clinical decision support systems (CDSS) are used internationally since the 1980s. These systems reduce costs, enhance drug therapy safety, and improve quality of care. A few years ago, there was a growing effort to digitize the healthcare sector in Germany. Implementing such systems like CPOE-CDSS requires training for effective adoption and, more important, acceptance by the users. Potential improvements for the software and implementation process can be derived from the users' perspective. The implementation process is globally relevant and applicable across professions due to the constant advancement of digitalization. The study assessed the implementation of medication software and overall satisfaction.

Methods

In an anonymous voluntary online survey, physicians and nursing staff were asked about their satisfaction with the new CPOE-CDSS. The survey comprised single-choice queries on a Likert scale, categorizing into general information, digital medication administration, drug safety, and software introduction. In addition multiple-choice questions are mentioned. Data analysis was performed using Microsoft Office Excel 2016 and GraphPad PRISM 9.5.0.

Results

Nurses and physicians' satisfaction with the new software increased with usage hours. The software's performance and loading times have clearly had a negative impact, which leads to a low satisfaction of only 20% among physicians and 17% among nurses. 53% of nurses find the program's training period unsuitable for their daily use, while 57% of physicians approve the training's scope for their professional group. Both professions agree that drug-related problems are easier to detect using CPOE-CDSS, with 76% of nurses and 75% of physicians agreeing. The study provides unbiased feedback on software implementation.

Conclusion

In conclusion, digitizing healthcare requires managing change, effective training, and addressing software functionality concerns to ensure improved medication safety and streamlined processes. Interfaces, performance optimization, and training remain crucial for software acceptance and effectiveness.

Enzymatically hydrolyzed low-density lipoprotein modulates inflammatory responses in endothelial cells

There is evidence that low-density lipoprotein (LDL) is modified by hydrolytic enzymes,and that the product (E-LDL) induces selective production of interleukin 8 (IL-8) in endothelial cells. Since nuclear factor-kappaB (NF-κB) is a major regulator of IL-8 transcription, we studied its activation in endothelial cells treated with E-LDL. Unexpectedly,the modified lipoprotein not only failed to activate NF-κB, but completely blocked its activation by tumour necrosis factor-alpha (TNF-α) in EA.hy926-cells, as assessed by electrophoretic mobility shift assays and immunofluorescence. Inhibition occurred upstream of NF-κB translocation, as inhibitor of NF-κB- (IκB)-phosphorylation was suppressed by E-LDL. In contrast to NF-κB,transcription factor activator protein-1 (AP-1) proved to be activated. Removal of free fatty acids present in E-LDL obliterated both activation of AP-1 and inhibition of NF-κB. Chromatin immunoprecipitation revealed that phosphorylated c-jun, but not NF-κBp65 bound to the natural IL-8 promoter. Production of endothelial IL-8 and simultaneous modulation of NF-κB in response to hydrolyzed LDL might serve to protect the vessel wall and promote silent removal of the insudated lipoprotein.

Notizen: Ungewöhnliche Umlagerung eines Phosphinliganden in der Koordinationssphäre von Palladium / Unusual Rearrangement of a Phosphine Ligand in the Coordination Sphere of Palladium

(η3-Allyl)(η5-cyclopentadienyl)palladium reacts with bis(diphenylphosphino)maleic anhydride to form a complex in which the C5H5 ligand is inserted into a P-C bond of the phosphine ligand. Reaction of this compound with iodine leads to a new type of phosphino ligand. The structure is studied by X-ray crystal structure analysis.

Ungewöhnliche Substitutionsreaktion von (σ-Allyl)manganpentacarbonyl mit 2.3-Bis(diphenylphosphino)-N-methylmaleinimid / Unusual Reaction of (σ-Allyl)manganesepentacarbonyl with Bis(diphenylphosphino)-N-methyl Maleic Anhydride

σ-C3H5 · Mn(CO)5 reacts with bis(diphenyl-phosphino)-N-methyl maleic anhydride to form a complex in which the C3H5-ligand migrates from the coordination sphere of Mn to the phosphine ligand. The high yield (70%) suggests that this reaction takes place within the coordination sphere of Mn. The product (X-ray analysis) shows unusual bonding properties.

Enzymatically hydrolyzed low-density lipoprotein modulates inflammatory responses in endothelial cells

There is evidence that low-density lipoprotein (LDL) is modified by hydrolytic enzymes, and that the product (E-LDL) induces selective production of interleukin 8 (IL-8) in endothelial cells. Since nuclear factor-kappaB (NF-kappaB) is a major regulator of IL-8 transcription, we studied its activation in endothelial cells treated with E-LDL. Unexpectedly, the modified lipoprotein not only failed to activate NF-kappaB, but completely blocked its activation by tumour necrosis factor-alpha (TNF-alpha) in EA.hy926-cells, as assessed by electrophoretic mobility shift assays and immunofluorescence. Inhibition occurred upstream of NF-kappaB translocation, as inhibitor of NF-kappaB- (IkappaB)-phosphorylation was suppressed by E-LDL. In contrast to NF-kappaB, transcription factor activator protein-1 (AP-1) proved to be activated. Removal of free fatty acids present in E-LDL obliterated both activation of AP-1 and inhibition of NF-kappaB. Chromatin immunoprecipitation revealed that phosphorylated c-jun, but not NF-kappaBp65 bound to the natural IL-8 promoter. Production of endothelial IL-8 and simultaneous modulation of NF-kappaB in response to hydrolyzed LDL might serve to protect the vessel wall and promote silent removal of the insudated lipoprotein.

Colloidal synthesis of pt nanoparticles: on the formation and stability of nanowires

Catalytic properties of Pt nanoparticles can significantly depend on the crystallite shape, which renders shape control an important aim in the chemical synthesis. Starting from a colloidal synthesis of quasispherical Pt nanocrystals capped with dodecylamine ligands, systematic variations of different synthesis parameters were performed in the present work in order to obtain Pt nanowires. Mechanistic investigations revealed that nanowires can form by aggregation of quasispherical particles. The process of wire formation was found to be influenced by parameters such as the concentration of the stabilizing ligands on the particle surface. Furthermore, the thermal stability of the obtained nanoparticles was examined. The nanowires were found to be stable up to approximately 140-160 degrees C. In this temperature range a structural transition to a more spherical crystallite shape occurred, which can be understood by thermodynamic considerations.

Enzymatically modified LDL induces cathepsin H in human monocytes: potential relevance in early atherogenesis

OBJECTIVE

Modification with proteases and cholesterylesterase transforms LDL to a moiety that resembles lipoproteins isolated from atherosclerotic lesions and possesses atherogenic properties. To identify changes in monocyte-derived foam cells laden with enzymatically modified LDL (E-LDL), we compared patterns of the most abundant transcripts in these cells after incubation with LDL or E-LDL.

METHODS AND RESULTS

Serial analyses of gene expression (SAGE) libraries were constructed from human monocytes after treatment with LDL or E-LDL. Several tags were differentially expressed in LDL-treated versus E-LDL-treated cells, whereby marked selective induction by E-LDL of cathepsin H was conspicuous. We show that cathepsin H is expressed in atherosclerotic lesions in colocalization with E-LDL. Furthermore, we demonstrate that LDL modified with cathepsin H and cholesterylesterase can confer onto LDL the capacity to induce macrophage foam cell formation and to induce cathepsin H.

CONCLUSIONS

Cathepsin H could contribute to the transformation of LDL to an atherogenic moiety; the process might involve a self-sustaining amplifying circle.

Enzymatically modified nonoxidized low-density lipoprotein induces interleukin-8 in human endothelial cells: role of free fatty acids

BACKGROUND

Treatment of low-density lipoprotein (LDL) with a protease and cholesterolesterase transforms the lipoprotein to an entity that resembles lipoprotein particles in atherosclerotic lesions, which have a high content of free cholesterol, reflecting extensive de-esterification in the intima. Because de-esterification would occur beneath the endothelium, we examined the effects of enzymatically modified LDL (E-LDL) on cultured endothelial cells.

METHODS AND RESULTS

Incubation of endothelial cells with E-LDL provoked selective accumulation of interleukin (IL)-8 mRNA and production of the cytokine. Chemical analyses and depletion experiments indicated that the effect was caused by the presence of free fatty acids in the altered lipoprotein. Reconstitution studies demonstrated that the oleic and linoleic acids associated with E-LDL are particularly effective IL-8 inducers. The effects of E-LDL on endothelial cells could be abrogated with albumin.

CONCLUSION

IL-8 is required for rolling monocytes to adhere firmly to the endothelium; thus, the findings reveal a link between subendothelial entrapment of LDL, cleavage of cholesterol esters, and monocyte recruitment into the lesion.

Resealing of large transmembrane pores produced by streptolysin O in nucleated cells is accompanied by NF-kappaB activation and downstream events

Streptolysin O (SLO), archetype of a cholesterol-binding bacterial cytolysin, forms large pores in the plasma membrane of mammalian cells. We have recently reported that when a limited number of pores are generated in a cell, they can be sealed in a Ca++-dependent process. Here, we show that resealing is followed by the release of IL-6 and IL-8 from keratinocytes and from endothelial cells, both relevant targets for SLO attack. Production of cytokines by these cells was preceded by activation of transcription factor nuclear factor kappaB, which thus emerges as a common denominator of stress responses to various pore-forming agents, including alpha-toxin of Staphylococcus aureus and complement. Furthermore, we show that activation and cytokine release in response to an agent that forms a pore in the plasma membrane do not depend on paracrine effects, because supernatants of cells perforated by SLO did not activate bystander cells. The study provides definitive evidence that a transient transmembrane pore suffices to trigger productive transcriptional activation in a target cell.

Syntheses of Ru-S clusters with kinetically labile ligands via the photolysis of [(cymene)3RuS2](PF6)2

Three ruthenium sulfide clusters with labile CH3CN ligands have been photochemically synthesized. Irradiation of [(cymene)3Ru3S2](PF6)2 ([1](PF6)2) in CH3CN gives [(cymene)2(CH3CN)3Ru3S2](PF6)2 ([2](PF6)2), which has been characterized by 1H NMR spectroscopy, ESI mass spectrometry, and chemical reactivity. Treatment of [2](PF6)2 with PPh3 gives [(cymene)2(CH3CN)2(PPh3)Ru3S2](PF6)2 ([3](PF6)2) and [(cymene)2(CH3CN)(PPh3)2Ru3S2](PF6)2 ([4](PF6)2), while treatment with 1,4,7-trithiacyclononane (9S3) gives [(cymene)2(9S3)Ru3S2](PF6)2 ([5](PF6)2). A crystallographic study demonstrated that the Ru3 core in [3](PF6)2, [4](PF6)2, and [5](PF6)2 is distorted with a pair of elongated Ru-Ru bonds. Cyclic voltammetry shows that [3](PF6)2 and [4](PF6)2 undergo two closely spaced reversible one-electron reductions whereas [5](PF6)2 undergoes one irreversible one-electron reduction and one reversible one-electron reduction. Prolonged irradiation of [1](PF6)2 in CH3CN causes decomposition, resulting in the pentanuclear cluster [(cymene)4Ru5S4](PF6)2 ([6](PF6)2).

Size-dependent optical spectroscopy of a homologous series of CdSe cluster molecules

The optical properties and electronic structure of a homologous series of CdSe cluster molecules covering a size range between 0.7 and 2 nm are investigated. CdSe cluster molecules with 4, 8 10, 17, and 32 Cd atoms, capped by selenophenol ligands, were crystallized from solution and their structures determined by single-crystal X-ray diffraction. The cluster molecules are composed of a combination of adamanthane and barylene-like cages, the building blocks of the zinc blende and the wurtzite structures of the bulk CdSe. The onset of the room temperature absorption and low-temperature photoluminescence excitation spectra exhibit a systematic blue shift with reduced cluster size manifesting the quantum confinement effect down to the molecular limit of the bulk semiconductor. Blue-green emission, shifted substantially to lower energy from the absorption onset, is observed only at low temperature and its position is nearly independent of cluster size. The wavelength dependence of both photoluminescence and photoluminescence excitation was measured. The emission is assigned to forbidden transitions involving the cluster-molecule surface-capping ligands. This assignment is supported by the emission decay which exhibits distributed kinetics with microsecond time scale. The temperature dependence of the emission intensity is quantitatively explained by multiphonon-induced nonradiative relaxation mediated by low-frequency vibrations of the selenophenol capping ligands. Upon irradiation, the emission of all cluster molecules is quenched. Warming up and recooling leads to recovery of the emission (partial or complete) for all but the cluster molecule with 10 Cd atoms. This temporary darkening is assigned to the photoinduced charging of the cluster-molecule surface ligands, resembling the reversible on-off blinking of the emission observed for larger CdSe nanocrystals.

Self-assembly and structure of interconverting multinuclear inorganic arrays: a

Coordination of the pentatopic ligand 3 with AgI leads to the simultaneous self-assembly of two polynuclear architectures: a [4 x 5] grid-type species 10 and a quadruple-helicate 11, which contain twenty and ten silver ions. respectively. Their structures have been established by X-ray diffraction analysis of the crystals obtained as a mixture on crystallisation. Complex 10 contains two [2 x 5]-AgI10 rectangular subgrids located on opposite sides of an array of parallel ligands of 3 that are twisted into a transoid N=C-C=N arrangement around the central C-C bond; it may thus be formulated as a grid of grids: [2 x (2 x 5)]. Complex 11 is an inorganic quadruple helicate that consists of two sets of two parallel ligands of 3 connected by an array of ten silver ions. Both compounds 10 and 11 are novel types of polynuclear complexes that are composed of two subunits. Their formation points to the possibility of generating specific arrays of metal ions by self-assembly, involving, in particular, a combination of subunits within the overall entity. They represent organised patterns of ion dots of special significance in view of their formal relationship to quantum dots.

Metallostars: high-nuclearity linearly developed nanostructures containing multiple cluster motifs

Metallostars are complexes in which a single branching site bears a number of metallated arms. Although they are related to metallodendrimers, they have the advantage of being capable of extending in an unlimited sense; in contrast to metallodendrimers, steric interactions decrease with increasing generation number. In this paper a series of polyalkyne stars with four and six arms, based upon a single tetrahedral carbon core and a benzene core, respectively, are reported and their reactions with [Co2(CO)8] to give metallostars that contain multiple [C2Co2(CO)6] motifs are described.

Recognition-directed supramolecular assemblies of metal complexes of terpyridine derived ligands with self-complementary hydrogen bonding sites

The synthesis and X-ray structures of three metal complexes with terpyridine-derived ligands that contain amino-pyrimidine and amino-pyrazine moieties are presented. They have been designed in view of directing their self-assembly into specific supramolecular arrays through molecular recognition interactions. The solid-state structures indeed reveal extensive hydrogen-bonded networks. The Co complex 4a with PF6- counterions builds a two-dimensional infinite interwoven grid through strong double hydrogen bonds (d(N-H-N) =2.918-3.018 A) between the amino groups and the N atoms of the rings, with all H-bonding sites saturated. Changing the anions to BF4- in 4b leads to a similar infinite but partially broken grid with a quarter of the H-bonding sites unsaturated (d(N-H-N)=2.984-3.206 A). In the case of the Zn complex 12 with triflate anions, half of the hydrogen bonds are formed. Only one of the two orthogonal ligands has hydrogen bonds (d(N-H-N) = 3.082, 3.096 A) to the neighbouring complexes and thus builds linear, supramolecular, polymeric chains. These structural differences are mainly attributed to crystal-packing effects caused by the different anions. The data presented here may also be regarded as a prototype for the generation of organised arrays through sequential self-assembly processes.

Adaptive self-assembly: environment-induced formation and reversible switching of polynuclear metallocyclophanes

Ligand 3 has been shown to self-assemble under coordination of copper(II) cations in a 1:1 ratio in acetonitrile to give equilibrating mixtures of a [2 x 2] grid-type tetranuclear structure 1 and a hexanuclear achitecture of hexagonal shape 2. The latter was confirmed by determination of the crystal structure which further indicated that 2 contained acetonitrile molecules and hydroxo groups bound to the copper(II) centers, which are therefore five-coordinate. The structures assigned to 1 and 2 were further supported by the spectral (mass, UV/Vis) data. The self-assembly process is strongly dependent on the conditions of the medium. An increase in concentration in acetronitrile increases the relative amount of hexamer 2, which appears to be the favored entity at the highest concentrations that can be reached before precipitation occurs. On the other hand, in nitromethane only the tetranuclear complex 1 was detected by mass spectrometry. Replacement of nitromethane by acetonitrile and vice versa indicated the reversible switching between a solution containing either 1 alone or an equilibrium mixture of 1 and 2, respectively. In conclusion, the system described presents several remarkable features: 1) self-assembly with substrate binding, 2) dynamic combinatorial structure generation, and 3) environment-induced structural switching amounting in effect to a process of adaptive self-assembly.

Multiple expression of molecular information: enforced generation of different supramolecular inorganic architectures by processing of the same ligand information through specific coordination algorithms

The multisubunit ligand 2 combines two complexation substructures known to undergo, with specific metal ions, distinct self-assembly processes to form a double-helical and a grid-type structure, respectively. The binding information contained in this molecular strand may be expected to generate, in a strictly predetermined and univocal fashion, two different, well-defined output inorganic architectures depending on the set of metal ions, that is, on the coordination algorithm used. Indeed, as predicted, the self-assembly of 2 with eight CuII and four CuI yields the intertwined structure D1. It results from a crossover of the two assembly subprograms and has been fully characterized by crystal structure determination. On the other hand, when the instructions of strand 2 are read out with a set of eight CuI and four MII (M = Fe, Co, Ni, Cu) ions, the architectures C1-C4, resulting from a linear combination of the two subprograms, are obtained, as indicated by the available physico-chemical and spectral data. Redox interconversion of D1 and C4 has been achieved. These results indicate that the same molecular information may yield different output structures depending on how it is processed, that is, depending on the interactional (coordination) algorithm used to read it. They have wide implications for the design and implementation of programmed chemical systems, pointing towards multiprocessing capacity, in a one code/ several outputs scheme, of potential significance for molecular computation processes and possibly even with respect to information processing in biology.

Synthesis, structures and theoretical investigation of

The silylated derivative of thiophosphoric acid (S)P(SSiMe3)3 is used as a convenient starting compound for the synthesis of multinuclear Cu and Au cluster complexes. (S)P(SSiMe3)3 reacts with CuCI/PPh3 and [AuCClPPh3] to give the following compounds: [Cu4(P2S6)(PPh3)4] (1), [Cu6(P2S6)Cl2-(PPh3)6] (2) and [Au4(P2S6)(PPh3)4](3). According to X-ray structure determination, these compounds contain P2S6(4-) ions, in which S atoms act as ligands for Cu+ and Au+ ions. Although 1 and 3 have the same stoichiometry, bonding of the metal ions to the P2S6 skeleton displays small but remarkable differences. Au is twofold coordinated, whereas Cu shows a threefold coordination. Ab initio calculations have been carried out to rationalise these structural differences. The theoretical treatment of the corresponding Ag compound indicates the latter to be less stable.

[In]

Near C(3) symmetry is displayed by the 19-atom In-P polyhedron that forms the central structural unit in the title compound (see structure), which was synthesized by reaction of InCl(3) with PEt(3) and PhP(SiMe(3))(2). In addition to In-P bonds, the cage has In-In and P-P bonds. Six terminal chloro ligands and three PEt(3) ligands surround the cluster core which itself encloses a central chloride anion.

Self-assembly of a heteroduplex helicate from two different ligand strands and Cu(II) cations

Cu(II) ions have been reacted with a 1/1 mixture of two linear ligands, one containing three 2,2'- bipyridine groups and the other three 2,2':6',2"-terpyridine groups. Absorption spectroscopy and fast atom bombardment mass spectrometry indicate the formation of a trinuclear complex containing one ligand of each kind. Determination of the crystal structure of this compound has confirmed that it is indeed a linear trinuclear complex in which two different ligands are wrapped in a helical fashion around the pentacoordinated metal ions. The central coordination geometry is trigonal bipyramidal; the two lateral Cu(II) ions are in a square pyramidal environment. Thus, a heteroduplex helicate is formed by the self-assembly of two different ligand strands and three specific metal ions induced by the coordination number and geometry of the latter. The self-assembly process may be considered to result from the reading of the steric and binding information present in the two ligands by Cu(II) ions through a pentacoordination algorithm. The same ligands have been shown earlier to yield homoduplex helicates from ions of tetrahedral and octahedral coordination geometry and strands of bidentate bipyridines and tridentate terpyridines, respectively. These two types of artificial double helical species may be related on one hand to the natural homoduplex nucleic acids and on the other hand to the DNA:RNA heteroduplex.