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Erdfelder F, Ebach F, Zoller R, Walterscheid V, Weiss C, Kappler J, Görtzen-Patin J, Schmitt J, Freudenthal NJ, Müller A, Ksellmann A, Grigutsch D, Külshammer M, Füssel M, Zenker S. Implementation of 2D Barcode Medication Labels and Smart Pumps in Pediatric Acute Care: Lessons Learned. Appl Clin Inform 2023; 14:503-512. [PMID: 37075805 PMCID: PMC10322227 DOI: 10.1055/a-2077-2457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/19/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND In pediatric intensive care, prescription, administration, and interpretation of drug doses are weight dependent. The use of standardized concentrations simplifies the preparation of drugs and increases safety. For safe administration as well as easy interpretation of intravenous drug dosing regimens with standardized concentrations, the display of weight-related dose rates on the infusion device is of pivotal significance. OBJECTIVES We report on challenges in the implementation of a new information technology-supported medication workflow. The workflow was introduced on eight beds in the pediatric heart surgery intensive care unit as well as in the pediatric anesthesia at the University of Bonn Medical Center. The proposed workflow utilizes medication labels generated from prescription data from the electronic health record. The generated labels include a two-dimensional barcode to transfer data to the infusion devices. METHODS Clinical and technical processes were agilely developed. The reliability of the system under real-life conditions was monitored. User satisfaction and potential for improvement were assessed. In addition, a structured survey among the nursing staff was performed. The questionnaire addressed usability as well as the end-users' perception of the effects on patient safety. RESULTS The workflow has been applied 44,111 times during the pilot phase. A total of 114 known failures in the technical infrastructure were observed. The survey showed good ratings for usability and safety (median "school grade" 2 or B for patient safety, intelligibility, patient identification, and handling). The medical management of the involved acute care facilities rated the process as clearly beneficial regarding patient safety, suggesting a rollout to all pediatric intensive care areas. CONCLUSION A medical information technology-supported medication workflow can increase user satisfaction and patient safety as perceived by the clinical end-users in pediatric acute care. The successful implementation benefits from an interdisciplinary team, active investigation of possible associated risks, and technical redundancy.
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Affiliation(s)
- Felix Erdfelder
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Mathematical Physiology (AMP) Lab, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Fabian Ebach
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Richard Zoller
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
| | - Verena Walterscheid
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Claudia Weiss
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Jochen Kappler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Jan Görtzen-Patin
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
- Department of Internal Medicine I - Gastroenterology and Hepatology, Nephrology, Infectious Diseases, Endocrinology and Diabetology, University Hospital Bonn, Bonn, Germany
| | - Joachim Schmitt
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Noa J. Freudenthal
- Pediatric Cardiac Surgery at the German Pediatric Heart Centre in Bonn, University Hospital Bonn, Bonn, Germany
| | - A. Müller
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Anne Ksellmann
- Pediatric Cardiac Surgery at the German Pediatric Heart Centre in Bonn, University Hospital Bonn, Bonn, Germany
| | - Daniel Grigutsch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Manuel Külshammer
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Maike Füssel
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Sven Zenker
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Mathematical Physiology (AMP) Lab, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
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Matz B, Kupfer B, Kallies R, Külshammer M, Flötenmeyer M, Kreil TR, Eis-Hübinger AM. Secondary structure of DNA released from purified capsids of human parvovirus B19 under moderate denaturing conditions. J Gen Virol 2019; 100:812-827. [PMID: 30924765 DOI: 10.1099/jgv.0.001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Parvovirus B19 (B19V) possesses a linear single-stranded DNA genome of either positive or negative polarity. Due to intramolecular sequence homologies, either strand may theoretically be folded in several alternative ways. Viral DNA, when extracted from virions by several procedures, presents as linear single-stranded and/or linear double-stranded molecules, except when one particular commercial kit is used. This protocol yields DNA with an aberrant electrophoretic mobility in addition to linear double-stranded molecules, but never any single-stranded molecules. This peculiar kind of DNA was found in all plasma or serum samples tested and so we decided to analyse its secondary structure. In line with our results for one- and two-dimensional electrophoresis, mobility shift assays, DNA preparation by an in-house extraction method with moderate denaturing conditions, density gradient ultracentrifugation, DNA digestion experiments and competition hybridization assays, we conclude that (i) the unique internal portions of this distinctive single-stranded molecules are folded into tight tangles and (ii) the two terminal redundant regions are associated with each other, yielding non-covalently closed pseudo-circular molecules stabilized by a short (18 nucleotides) intramolecular stem, whereas the extreme 3'- and 5'-ends are folded back on themselves, forming a structure resembling a twin hairpin. The question arises as to whether this fairly unstable structure represents the encapsidated genome structure. The answer to this question remains quite relevant in terms of comprehending the initiation and end of B19V genome replication.
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Affiliation(s)
- Bertfried Matz
- 1Institute of Virology, University of Bonn Medical Centre, Germany
| | - Bernd Kupfer
- 1Institute of Virology, University of Bonn Medical Centre, Germany
| | - René Kallies
- 1Institute of Virology, University of Bonn Medical Centre, Germany.,2Helmholtz Centre for Environmental Research, Leipzig, Germany
| | | | - Matthias Flötenmeyer
- 3Max-Planck-Institute for Developmental Biology, Tübingen, Germany.,4Centre for Microscopy and Microanalysis, University of Queensland, St Lucia/Brisbane, Australia
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Schildgen O, Gräper S, Blümel J, Külshammer M, Matz B. Temperature-sensitive origin-binding protein as a tool for investigations of herpes simplex virus activities in vivo. J Gen Virol 2018; 100:105-117. [PMID: 30520714 DOI: 10.1099/jgv.0.001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
While it is fairly clear that herpes simplex virus (HSV) DNA replication requires at least seven virus-encoded proteins in concert with various host cell factors, the mode of this process in infected cells is still poorly understood. Using HSV-1 mutants bearing temperature-sensitive (ts) lesions in the UL9 gene, we previously found that the origin-binding protein (OBP), a product of the UL9 gene, is only needed in the first 6 hours post-infection. As this finding was just a simple support for the hypothesis of a biphasic replication mode, we became convinced through these earlier studies that the mutants tsR and tsS might represent suitable tools for more accurate investigations in vivo. However, prior to engaging in highly sophisticated research projects, knowledge of the biochemical features of the mutated versions of OBP appeared to be essential. The results of our present study demonstrate that (i) tsR is most appropriate for cell biological studies, where only immediate early and early HSV gene products are being expressed without the concomital viral DNA replication, and (ii) tsS is a prime candidate for the analysis of HSV DNA replication processes because of its reversibly thermosensitive OBP-ATPase, which allows one to switch on the initiation of DNA synthesis precisely.
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Affiliation(s)
- Oliver Schildgen
- †Present address: Kliniken der Stadt Köln gGmbH, Krankenhaus Merheim, Klinikum der Privaten Universität Witten/Herdecke, Institut für Pathologie, Ostmerheimer Strasse 200, D-51109 Köln, Germany.,Institute of Virology, University of Bonn, Bonn, Germany
| | - Sascha Gräper
- Institute of Virology, University of Bonn, Bonn, Germany.,‡Present address: Sanofi-Aventis, Industriepark Hoechst, Bldg. D681, D-65926 Frankfurt am Main, Germany
| | - Johannes Blümel
- Institute of Virology, University of Bonn, Bonn, Germany.,§Present address: Paul-Ehrlich-Institu, Paul-Ehrlich-Strasse 51-59, D-63225 Langen, Germany
| | | | - Bertfried Matz
- Institute of Virology, University of Bonn, Bonn, Germany
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Külshammer M, Winke U, Frank M, Skali-Lami U, Steudel H, Schilling G, Drexler JF, Eis-Hübinger AM, Matz B. Poor immunity status against poliomyelitis in medical students: a semi-anonymous study. Med Microbiol Immunol 2012; 202:63-5. [PMID: 22692773 PMCID: PMC3562434 DOI: 10.1007/s00430-012-0237-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 03/27/2012] [Indexed: 11/27/2022]
Abstract
In spite of almost complete eradication, poliomyelitis continues to be a global threat even in non-endemic countries due to the ever-increasing international travel activities. Health care workers are at a special risk in acquiring pathogens from travelers returning from endemic countries. Polio vaccines are fairly well accepted throughout the German population. Yet, laboratory controls for successful immunization are carried out only sporadically in the general population, and not even the medical staff are routinely tested for polio immunity. The present study was initiated in order to assess the immunity status of young people at the very beginning of their career in clinical medicine. Within their first clinical semester, all students are supposed to undergo an obligatory health check in our Occupational Medicine Unit. A blood sample is taken and sent under a personal code to our diagnostic laboratories for virus serology, and for cryoconservation of residual serum, if available. Within the periods 2004–2006 and 2008–2010, we analyzed sera from 424 and 427 individuals, respectively, for anti-polio types 1, 2, 3 antibodies by a microneutralization assay. In the latest study period, there was a slight increase in the rate of fully protected persons: 63.9 % triple-seropositivity versus 57.1 % in the period 2004–2006. By the end of the second clinical semester, students with low or negative antibody levels (1:<10) were informed, and a (booster) vaccination was recommended.
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Affiliation(s)
- Manuel Külshammer
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
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