Bag Changes Research Articles

Adherence to Evidence-Based Guidelines and ImplicationsWhen Designing Electronic Documentation for Urinary Catheters.

The aim of this study was to investigate the point prevalence and the rate of adherence to evidence-based guidelines for patients who had indwelling urinary catheters in three Australian acute care hospitals. A cross-sectional observational design was used. A multisite cross-sectional observational design was utilised in three acute hospitals across Australia. Data were collected from each site in a single day directly from observation of the patient, the bedside notes and medical records. The data collected included observations of clinical care and scrutiny of the documentation of the insertion details and catheter care using best practice guidelines. Of the 1730 patients audited, 47% were female. The mean point prevalence of catheters insitu across three sites was 12.9%. Correct documentation compliance was reported to be, on average, 40%. Documentation was significantly better when a template was available to guide information recorded: this was regardless of whether it was hard copy or electronic. Overall, clinical care compliance with best practices was 77%. Of note for improvement was the fixing of the urinary catheter to the thigh in highly dependent patients. It was identified that there is a need for improvement across all three sites: specifically regarding securement of the urinary catheter to the patient's thigh within the ICU. In addition, it was identified that there is a need for documentation of the urine bag change in ward areas. Documentation may be improved by incorporating templates into healthcare documentation systems in the future. Further work is needed to ensure nurses are aware of the adverse effects of urinary catheters and thus, the need to adhere to best practice guidelines. There has been no patient or public contribution. We have adhered to the STROBE guidelines for reporting.

Abstract B081: Caring for the Caregivers: Characteristics and challenges faced by caregivers of Latino Californians with rectal cancer

Abstract Background/Purpose: Caregivers often face physical, psychological, and financial burdens when caring for people with cancer. Caregivers of Hispanic/Latino (HL) patients with cancer are often informal caregivers, such as families and friends, reflecting the traditional cultural value of familismo. While many studies acknowledge the impact of cultural differences on caregiving and caregiver burden, our understanding of the specific barriers HL patients with rectal cancer and their caregivers encounter is limited. The aim of this study was to explore the unique challenges, experiences, and perspectives of individuals caring for HL patients with rectal cancer in ways that could inform future interventions. Methods/Study population: We conducted semi-structured interviews of Bay Area and San Joaquin Valley HL patients with past or current rectal cancer in English and/or Spanish based on participant preference. We partnered with Visión y Compromiso, a promotores and community health worker organization, and developed a community advisory board to help refine our interview guide and interpret our results. We encouraged patients to identify and include someone who helped care for them during their treatment, but intentionally did not define caregiver in any other way. Over six months, we interviewed a total of 17 patients and eight caregivers and used reflexive thematic analysis to identify themes from their shared experiences using interview transcripts in NVivo 14. Results: Sixteen of seventeen interviews identified family members including spouses, sons, brothers, and friends as primary caregivers. Identified themes include (1) roles informal caregivers undertake for transportation, daily activities, and healthcare management; (2) limitations in utilizing social workers as a resource due to a knowledge gap and language barriers; (3) personal financial burden from supporting patients and navigating through available resources, and (4) psychosocial impacts resulting from role overload as an advocate, a translator, and a caregiver. Conclusion: In supporting cancer patients, caregivers wear many hats. While many caregivers share similar burdens, informal caregivers experience added emotional stress from unexpectedly assuming new responsibilities. Specific to rectal cancer care, caregivers are often tasked with aiding in ostomy bag changes and navigating the multidisciplinary treatment teams. Furthermore, HL patients and their caregivers face unique challenges due to language barriers, such as the burden of translation and delivering news. Understanding the caregiver burden among HL patients with rectal cancer is crucial in enhancing cancer treatment and care, creating culturally relevant resources, and reducing cancer outcome disparities faced by HL communities. Citation Format: Min Young Kim, Julian P. Howland, Eleanor Brown, Lucas K. Carpenter, Patricia Castañeda, Maria Gonzalez, Miriam T. Hernandez, Zaria N. Cosby, Kristen M. Davis-Lopez, Ysabel Duron, Gladys M. Rodriguez, Sandra S. Zaky, Arden M. Morris, Aaron J. Dawes. Caring for the Caregivers: Characteristics and challenges faced by caregivers of Latino Californians with rectal cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B081.

Impact of continuous-infusion meropenem degradation and infusion bag changes on bacterial killing of Pseudomonas aeruginosa based on model-informed translation

BackgroundContinuous infusion of meropenem has been proposed to increase target attainment in critically ill patients, although stability might limit its practical use. This study investigated the impact of meropenem degradation and infusion bag changes on the concentration-time profiles and bacterial growth and killing of P. aeruginosa given different continuous-infusion solutions. MethodsA semi-mechanistic pharmacokinetic-pharmacodynamic (PK-PD) model quantifying meropenem concentrations (CMEM) and bacterial counts of a resistant P. aeruginosa strain (ARU552, MIC = 16 mg/L) over 24 h was used to translate in vitro antibiotic effects to patients with severe infections. Concentration-dependent drug degradation of saline infusion solutions was considered using an additional compartment in the population PK model. CMEM, fT>MIC (time that concentrations exceed the MIC) and total bacterial load (BTOT) after 24 h were simulated for different scenarios (n = 144), considering low- and high-dose regimens (3000/6000 mg/day±loading dose), clinically relevant infusion solutions (20/40/50 mg/mL), different intervals of infusion bag changes (every 8/24 h, q8/24 h), and varied renal function (creatinine clearance 40/80/120 mL/min) and MIC values (8/16 mg/L). ResultsHighest deviations between changing infusion bags q8h and q24h were observed for 50 mg/mL solutions and scenarios with CMEM_24h close to the MIC, with differences (Δ) in CMEM_24h up to 4.9 mg/L, ΔfT>MIC≤65.7%, and ΔBTOT_24h≤1.1 log10 CFU/mL, thus affecting conclusions on whether bacteriostasis was reached. ConclusionsIn summary, this study indicated that for continuous infusion of meropenem, eight-hourly infusion bag changes improved PK/PD target attainment and might be beneficial particularly for high meropenem concentrations of saline infusion solutions and for plasma concentrations in close proximity to the MIC.

Roe Deer, Lithuania’s Smallest and Most Abundant Cervid

A review of 113 scientific and other publications on the smallest and most abundant deer in Lithuania, the roe deer (Capreolus capreolus), is presented, along with an analysis based on compound annual population growth rates of population numbers, hunting bags, and roadkill. This review covers the species’ history in the country from the last glaciation onwards, the changes in numbers from 1934 to 2023, hunting bag changes from 1965 to 2022, roadkill numbers from 2002 to 2022, data on roe deer reproduction, habitat selection, genetic diversity, pathogens, and damage to forest stands. It also provides an overview of species management and selection for trophies. Despite the exponential increase in roe deer numbers since 1990 and the dominance of this species in roadkill, even on urban roads, the number and density of animals and the damage they cause to forest stands are relatively low compared to other European countries. Within the observed period, drops in numbers were related to harsh winters in 1969/1970 and 1995/1996. Poaching, especially coinciding with weakened enforcement during the period of political–economic transition in the early 1990s, has also had a negative impact on population numbers, as have recent increases in the number of large predators. Population growth over the recent period does not correlate with hunting mortality, which has remained stable at an average of 16.9% since 2002.

The seven colors of Türkiye: investigation of the effectiveness of respect for cultural differences education program for preschool teachers

ABSTRACT This research aims to increase the cultural sensitivity of preschool children and their teachers living in different regions of Türkiye through education in respect to differences. It employed an experimental design with pre-test post-test control group including 26 teachers along with 261 children aged 48–72 months. The study was conducted in three stages. In the first stage, the preparatory step, teachers were given six-hour training regarding respect for cultural differences. After the teacher training, they received 84 h of mentoring support for six weeks during the design process of the Seven Colors of Türkiye: Respect for Differences Activities. Teachers from seven regions of Türkiye created activity bags in accordance with the established activity plans. All bags from the regions were implemented after a 7-week bag change procedure. According to the research, both teachers and students strengthened their cultural awareness and students’ respect for differences developed.

Young people's priorities for the self-management of distress after stoma surgery due to inflammatory bowel disease: A consensus study using online nominal group technique.

The aim of this study was to gain consensus among young people with a stoma due to inflammatory bowel disease (IBD) on the priorities for the content of an intervention for the self-management of stoma-related distress. The current identification and management of distress in young people with a stoma is often suboptimal in clinical settings and there is a need for improved support resources. Two consensus group meetings were carried out via online video conferencing, using nominal group technique. Participants generated, rated on a Likert scale and discussed, topics for inclusion in a future self-management intervention. Nineteen young people, aged 19-33, with a stoma due to IBD took part in one of two group meetings. Participants were located across England, Scotland, and Northern Ireland. Twenty-nine topics were generated by participants, seven of which reached consensus of ≥80%, that is, a mean of ≥5.6 on a 7-point Likert scale. These were: receiving advice from young people with lived experience of stoma surgery; advice on/addressing concerns about romantic relationships, sex and intimacy; information about fertility and pregnancy related to stoma surgery; stoma 'hacks', for example, useful everyday tips regarding clothing, making bag changes easier and so forth; reflecting on and recognising own emotional response to surgery; tips on managing the stoma during the night; and processing trauma related to the illness and surgery journey. Findings extend previous research on young people's experiences of stoma surgery, by generating consensus on young people's priorities for managing distress related to surgery and living with a stoma. These priorities include topics not previously reported in the literature, including the need for information about fertility and pregnancy. Findings will inform the development of a self-management resource for young people with an IBD stoma and have relevance for the clinical management of stoma-related distress in this population. Three patient contributors are co-authors on this paper, having contributed to the study design, interpretation of results and writing of the manuscript. The study's Patient and Public Involvement and Engagement advisory group also had an integral role in the study. They met with the research team for four 2-h virtual meetings, giving input on the aims and purpose of the study, recruitment methods, and interpretation of findings. The group also advised on the age range for participants. The views of young people with a stoma are the central component of the study reported in this paper, which aims to gain consensus among young people with an IBD stoma on their priorities for the content of a resource to self-manage distress related to stoma surgery.

Infrared spectroscopy as a tool to study the vibrational, mechanical, and structural changes in commercial plastic bags: Physical principles

This paper investigates the application of Fourier-transform infrared (FT-IR) spectroscopy by analyzing a commercially available plastic bag as an example. The study investigates the vibrational modes, mechanical properties, and structural changes of a bare sample during a tensile test. By measuring the absorption bands and their intensities, valuable information about the chemical composition and the concentration of certain components in the plastic bag is obtained. The behavior of vibrational modes in one, two, and three-dimensional systems is studied, with a focus on their representation in the IR spectrum. The concept of the dipolar electric moment and phenomena such as overtone bands and Fermi resonance are also explained. The X-ray patterns of the bag show talc and polyethylene crystalline phases. Scanning electron microscopy (SEM) determines the thickness of the sample. Tensile tests are performed to investigate the mechanical behavior of the plastic bags. This study demonstrates the informative and educational capabilities of FT-IR spectroscopy in studying the vibrational, mechanical, and structural properties of materials, with an emphasis on the correct application of this technique. The study highlights the importance of considering the effects of thickness and absorption coefficient and applying the Beer-Lambert law to understand the changes in vibrational modes during tensile testing. The results contribute to a deeper understanding of the structural behavior of plastic bags and demonstrate the effectiveness of FT-IR spectroscopy in characterizing such materials.

P09 Lancashire and South Cumbria Critical Care Network Vancomycin Project

Abstract Background This project was a collaborative piece of work across a critical care network that included specialist advice from colleagues including aseptic/technically trained pharmacists and microbiology to optimize care for critical care patients in Lancashire and South Cumbria. We used several members of our workforce including pharmacists, nursing staff, microbiologists, rotational doctors and consultants to work towards a harmonized guideline. Methods During our initial meeting, we identified that different centres were using different glycopeptides and administering them differently: East Lancashire Hospitals (ELHT)—continuous vancomycin infusion; Blackpool Cardiac and Blackpool General—continuous vancomycin infusion, with no formal guideline in place but adopted from ELHT; Lancashire Teaching Hospitals—intermittent vancomycin infusions; and University Hospitals Morecambe Bay—teicoplanin is glycopeptide of choice. Our consultant microbiologist discussed the use of glycopeptides and what infections they are used for in critical care. The pharmacokinetics of vancomycin and the benefit of using a continuous infusion was also discussed. We decided to undertake a clinical audit of our vancomycin guidelines at ELHT to ensure that we had an evidence base to implement our guideline and provide assurance to the working group. We agreed to reconvene the working group after this audit was completed and after the concerns of colleagues had been addressed. Results and conclusions We presented the results of our audit and highlighted the opportunities harmonizing this guideline would provide. We discussed various scenarios such as stepping up from a ward protocol to a continuous infusion and the different methods of calculating creatinine clearance and if this would influence the first 24 h of the infusion. One comment was concerning the administration of vancomycin and the number of times nurses will be changing bags for patients requiring higher doses, i.e. the majority of patients would usually be on 3 g/day or more depending on concentrations. This would mean changing the bag more than twice a day; as much as there is a therapeutic benefit to continuous vancomycin infusions, considering the max. concentration for peripheral and central lines allows for larger volumes, it would be beneficial (except in fluid restricted cases) to have a slightly larger volume to reduce the number of bag changes and plastic consumption. We considered this comment and discussed it with our aseptic services lead pharmacist. We attended a meeting of the ICS Aseptics Working Party across Lancashire and South Cumbria. WE discussed the proposed guideline and requested that aseptic units across Lancashire and South Cumbria developed worksheets to manufacture 5 g in 600 mL or 10 g in 1.2 L for central use to stop breaking the line when changing a bag and reducing plastic consumption. We also met with critical care practice educators across the network to discuss how we can promote this guideline and ensure nursing staff and prescribers are aware of how to prescribe and administer continuous vancomycin infusions. One of our units noted that they have had a few incidents with incorrect concentrations of vancomycin being made up for patients. We developed an e-learning package to educate our workforce.

Study of Microbial changes in tea bags prepared from mango and guava leaves during storage

The study was undertaken to study the microbial changes in 60 days of storage in tea bags. Tea drinking is an ancient custom with strong cultural roots in many nations. Furthermore, tea consumption has increased globally in recent years. Because germs and mold thrive in humid conditions, improper storage of herbal tea poses a significant health risk to customers. Mango leaves have traditionally been consumed, and using them to make tea has become a popular trend to help cure diabetes and blood vessel issues related to diabetes. The plant's leaves are rich in flavonoids, phenols, terpenoids, tannins, and resins. They also exhibit biocidal, antimicrobial, antidiarrhea, hepatoprotective, antimicrobial, and antioxidant activity against periodontal infections, as well as the ability to treat gastric ulcer disease. During various storage periods, the moisture level of the tea bags from the best treatment (T3) ranged between 6.63 and 7.2 percent, the total plate count ranged from 0.9×10^2 cfu/gram to 1.41×10^2 cfu/gram and yeast and mold count range from 0.54×10^2 cfu/gram to 1.02×10^2 cfu/gram during the first 60 days of storage. Longer storage times do, however, also increase the overall plate count and yeast mold count. It was discovered during the storage analysis that the shelf-life was just roughly 60 days.

Brain age gap, dementia risk factors and cognition in middle age

AbstractBackgroundBrain Age Gap (BAG) represents the difference between an individual’s predicted age, derived from machine learning models trained on neuroimaging data, and their chronological age. BAG has been associated with dementia and cognition in old age. Less is known relating BAG to dementia risk‐factors or cognitive performance in middle‐age.MethodCognitively healthy, middle‐aged (40‐59 years) subjects from PREVENT‐Dementia had an array of neuropsychological, neuroimaging and genetic assessments. Brain Ages were predicted from T1‐weighted 3T MRI scans. Cognition was assessed using COGNITO. Multiple linear robust regression models tested hypotheses that: (i) BAG is positively associated with dementia risk‐factors; (ii) increased BAG is associated with worse cognition; (iii) longitudinal BAG change is positively associated with longitudinal cognitive deterioration. A range of machine learning algorithms with nested cross‐validation was used to assess whether BAG and cognition could predict each other.Result552 middle‐aged participants (median age 52.8 years) had all baseline assessments; 68 had amyloid PET data and 138 had longitudinal data. Median BAG was ‐2.0 years with a range from ‐21.2 to 18.4 years (Figure 1). BAG in middle‐age was associated with hypertension (p = 0.007) and alcohol intake (p = 0.008) but not APOE4 carrier status (p = 0.14) or amyloid centiloids (p = 0.53). BAG was not associated with cognitive performance either cross‐sectionally (p = 0.74) or longitudinally (p = 0.30), and there was no added predictive value between BAG and cognition. More education was associated with better cognition (p = 4.7×10−11) but not with BAG (p = 0.32).ConclusionEven in midlife, substantial inter‐individual heterogeneity exists in the extent to which brains have aged. BAG in middle‐age is associated with modifiable dementia risk‐factors, suggesting that lifestyle risk‐factor modification needs to start at, or before, midlife to optimise brain health. BAG in middle‐age was not associated with risk‐factors for Alzheimer’s disease (APOE4, amyloid deposition) or cognitive performance, despite there being a plausible and expected association between more education and better cognitive performance. These results are important for understanding brain‐age in middle‐aged populations who might be the target of future dementia‐preventing therapies.

Evaluating Blinatumomab Treatment Adoption in Varied Resource Settings Using the RE-AIM Framework

Background Blinatumomab is a targeted immunotherapy for B-ALL. Widespread adoption of this evidence-based intervention in varied resource settings has been limited due to cost, commercial access, and barriers including institutional capacity and medication complexity. We used implementation science frameworks to facilitate and study the translation of blinatumomab into hospitals in lower-resource settings in partnership with a drug-donation program. After 2 years of collaboration, we applied the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework to assess implementation processes and effectiveness outcomes in 2 pilot centers. Methods As a component of a larger hybrid effectiveness-implementation type 2 study, we applied RE-AIM methodology retrospectively to examine data for one hospital in India and one in Pakistan. Quantitative and qualitative data were abstracted from meeting notes, readiness assessments, a 54-question implementation survey based on validated measures, and clinical team observations. Local physicians overseeing the patient treatment with blinatumomab collected de-identified clinical data from routine care from 20 patients. Infusion and 6-month follow-up data were available for 18 and 16 patients, respectively. Patient characteristics were summarized using descriptive statistics. Clinical data were analyzed in aggregate to report real-world effectiveness, and other data were integrated to report on the five RE-AIM domains. Results Overall reach was determined by comparing proportion of annual patient requests, predicted number of eligible patients, and characteristics of patients who received blinatumomab. Reach varied by site from 48%-110%. Participants were representative with a median age of 8 years (IQR 6.23) and 55% were female. MRD-positive disease was the primary indication for receiving blinatumomab (60%, n=12). Regarding effectiveness, 73.3% of patients achieved remission after cycle 1, and 9 patients (60%) proceeded to hematopoietic stem cell transplant after receiving blinatumomab. At six months, 81.3% of patients were alive, 1 had died, and 2 were lost to follow-up. Adoption at the staff level was measured based on engagement of provider roles in training and feedback as measured by completion of a multidisciplinary implementation survey. While nursing was engaged in training at both sites, there was a notable lack of nursing-specific input to the implementation survey, identifying a key opportunity to improve engagement strategies. Early-indicator implementation outcomes were assessed by local multidisciplinary teams demonstrated high feasibility (aggregate mean 4.64/5, SD 0.35), acceptability (aggregate mean 4.71/5, SD 0.39), and appropriateness (aggregate mean 4.86/5, SD 0.24) of blinatumomab at their institution. Site-specific modifications to improve implementation included: modifications to the bag change schedule due to the lack of availability of medical supplies (bag sizes, pump cassette), and nursing ratios were temporarily reduced to provide closer monitoring for patients receiving blinatumomab. Thematic analysis revealed that maintenance is supported by the perceived relative advantage of blinatumomab vs. traditional chemotherapy, with physicians appreciating the opportunity for improved quality of life for patients and noting that also “the treating teams and the parents are happy,” highlighting a potentially positive impact on the physician and family wellbeing. One challenge for program maintenance is the cost of associated medical supplies such as medication infusion tubing and filters and the need for prolonged hospitalization due to barriers related to transportation and the availability of outpatient and emergency services. This will inform future strategies, such as implementation mapping, to determine how to address these site and resource-specific barriers. Conclusion Successful implementation and collaboration with local multidisciplinary teams is a critical predecessor to establishing effectiveness and improving future global access to complex, novel therapies such as blinatumomab. Systematic application of established implementation measures, such as RE-AIM, can improve reporting of rich implementation data and inform strategies to improve the long-term adoption and maintenance of these effective therapies in the real world.

The Relationship of Bag Load to Changes Vertebra Curves in Students (Study on Students Age 9-12 Years at SDIT Al Ikhlas, Magetan)

In children aged 9-12, reduced bone density, length of schooling, duration of daily bag use and bag weight exceeding the recommended weight of 10-15% of body weight can affect changes in the vertebral curve either into kyphosis, lordosis or scoliosis. The purpose of this study was to determine the relationship between bag load and changes in the vertebral curve as measured by the plumb line and scoliometer. The load of the bag is seen from 2 things, namely the weight of the bag and the duration of use of the bag. The research method used a cross sectional study with a sample of 207 school children aged 9-12 years using 2 analytical tests. The results of the Kendall's tau-b analysis test showed p-value = 0.773 and 0.262 (>0.005) which showed that there was no relationship between the weight and duration of bag use and changes in the vertebral curve. The results of the Spearman Rho test analysis showed p-value = 0.448 and 0.407 (> 0.005) which showed no relationship between weight and duration of bag use with the degree of change in the vertebral curve (Angle of Trunk Rotation/ATR).

Go with the flow: An experimental analysis with tubing alternative with irrigation

AbstractBackground and AimsLiterature regarding alternative tubing for fluid delivery in irrigation and debridement procedures is lacking. The purpose of this study was to compare three different apparatuses with varying quantities of irrigation fluid to assess efficiency of administration and evaluate overall time for fluid administration.MethodsThis model was designed to compare available methods of gravity irrigation used in practice. Fluid flow time was measured for three types of tubing: single‐lumen cystoscopy tubing, Y‐type double‐lumen cystoscopy tubing, and nonconductive suction tubing. Irrigation times were assessed for varying volumes of 3, 6, and 9 L to investigate the relationship between bag changes and irrigation time. Bag changes were not conducted for the 3 L trial, but were for 6 and 9 L trials. Dimensions of cystoscopy tubing consisted of 4.95 mm internal diameter and 2.1 m length in both single‐lumen and Y‐type double‐lumen apparatus. Nonconduction suction tubing dimensions were 6.0 mm internal diameter and standard 3.7 m in length.ResultsThe mean flow time for suction tubing was significantly faster than the cystoscopy tubing for the 3 and 9 L trials (p < 0.001). At 6 L, flow time for the suction tubing and the double lumen cystoscopy tubing were similar, 264 versus 260 s, respectively. At 9 L, the mean flow time for the suction tubing was 80 s faster (410 vs. 491 s) compared with single‐lumen cystoscopy and was nearly 30 s faster compared with Y‐type cystoscopy tubing.ConclusionThe results of this study provide insight into a faster, widely available, and cost‐efficient alternative to commonly used cystoscopy tubing.

Purple urine bag syndrome: An unusual presentation of urinary tract infection

Introduction: Purple urine bag syndrome is a rare clinical entity characterized by purple discoloration of the urinary catheter and urinary drainage bag in chronically catheterized patients. Though it can be alarming to patients and clinicians, it is considered benign but can indicate an underlying urinary tract infection. Case Series: The first case was a 68-year-old woman with multiple comorbidities who was admitted to the orthopedic ward with a close fracture of the neck of the right femur. She was bedridden and had an indwelling urethral catheter. Her urine bag was noticed to stain purplish 22 days after bladder catheterization. Urine culture showed a heavy mixed growth. A change of urinary catheter and drainage bag led to a resolution of the condition. The second case was a 58-year-old male who was admitted on account of decompensated liver cirrhosis from chronic hepatitis C virus infection. He also had quadriparesis due to a traumatic cervical spine injury, urine retention, and constipation. On day 24 of his admission, his urine bag was stained with a purplish hue. A urine culture grew Klebsiella oxytoca. The urine bag remained clear and contained amber-colored urine after catheter changes and antibiotic treatment for cystitis. Conclusion: Purple urine bag syndrome can be alarming to the patient and caregiver who need to be reassured of its benign nature. Urine culture would identify any associated infection. Good catheter care, control of risk factors including constipation and antibiotic treatment for symptomatic urinary tract infection leads to the resolution of the discoloration.

단일소자 기반 집속 초음파의 집속점 위치 변경이 가능한 워터백 시스템 개발

Herein, the development of an applicator for coupling between the ultrasound transducer and human skin in a focused transcranial ultrasound (FUS) system is proposed. Generally, applicators that use a single element have the problem of a fixed-depth stimulating point because the focal point of ultrasound is around the transducer radius of curvature. This study proposes a method to increase the degree of freedom of selecting a stimulus depth, including in the coupling method, using a single-element transducer. This is achieved by developing a pump system, which connects to the water bag-based applicator to actively change the amount of water in the water bag and, thus, the position of the focal point. Herein, the water-bag-based applicator was developed and it was verified that there was no ultrasonic loss through sound field experiments. Additionally, a control system was developed to actively change the amount of water in the water bag when the desired stimulation depth is determined by deriving a relationship between the depth of the focal point of the transducer according to the volume change of the water bag. An average error of 0.26 mm was obtained from experiments. Lastly, a cooling system was developed to cool the water bag, and it was observed that water at 70 °C could be cooled to 40.3° C in 10 min.

Monitoring of peroxide in gamma irradiated PE/EVOH/PE multilayer film using methionine probe

Methionine oxidation is used as a proxy to model the gamma radiation induced changes in single-use bags. These changes can be the formation of acids, radicals and hydroperoxides due to the irradiation of the multilayer film the single use bag is made from. Biopharmaceutical multilayer polyethylene bags irradiated from 0 to 260 kGy and aged from 0 to 36 months were filled with a methionine solution to follow the oxidation of methionine. Methionine sulfoxide was measured using high performance liquid chromatography after 21 days of storage. The maximum methionine sulfoxide concentration detected after 21 days of storage was analyzed through a design of experiments. The results to the design of experiments were considered to obtain the desirability domain for the optimization of the conditions of use for the single-use bags, limiting the oxidation of methionine as well as the release of reactive species thereof.

Comparison of catheter-associated quality of life in external urinary diversion: nephrostomy vs. suprapubic catheter

EinleitungDie katheterbezogene Lebensqualität (LQ) bei Nephrostomieträgern wurde bisher noch nie systematisch untersucht. Dies sollte nun erstmalig vergleichend mit einer ebenfalls externen Urinableitung, dem suprapubischen Katheter, geschehen.MethodikDas die katheterbezogene LQ untersuchende Assessment nach Mary Wilde wurde bei Patienten mit perkutaner Nephrostomie (PCN) in lebenslanger Intention und minimaler Liegedauer von 3 Monaten vorgelegt.ErgebnisseEs zeigte sich insgesamt bei 66 Patienten (davon 42 mit unilateraler PCN) mit einem Punktwert von median 4,0 auf einer Skala von 0–5 eine nur moderat eingeschränkte katheterbezogene LQ. Diese wurde insgesamt und in allen Domänen schlechter als bei Patienten mit suprapubischem Katheter (SPK) bewertet, bei denen sich ein Score von 4,3 im Median fand. Signifikant waren die Unterschiede in den Einzelitems „Gefühl der Erniedrigung“, „Konflikte mit ärztlichem oder pflegerischem Personal“, „Angst vor schmerzhaften Katheterwechseln“, „Gefühl als kranke Person“, „Behinderungen in Aktivitäten des täglichen Lebens“ und „Besorgnis, nicht alles tun zu können, was ich mag“. Ebenso ergaben sich bei PCN-Trägern signifikant häufiger Angst vor Katheterlecks und Uringeruch. Die Anzahl der einliegenden PCN und die Grunderkrankung spielten für die Beurteilung der LQ keine Rolle.SchlussfolgerungErstmals wurde die katheterassoziierte LQ, die sich bei PCN-Trägern nur moderat eingeschränkt fand, mit einem validierten Assessment quantitativ eingeordnet. Die Angabe der Betroffenen, sich als „krank“ und in der Ausübung von Aktivitäten des täglichen Lebens „behindert“ zu fühlen und die Angst vor Urinleckagen und schmerzhaften Wechseln sollten Ansporn für eine sorgfältige Indikationsstellung und technisch korrekte Katheterwechsel sein.

Successful Outpatient Administration of Blinatumomab Infusion in Pediatric Patients with Acute Lymphoblastic Leukemia

Introduction:Acute lymphoblastic leukemia (ALL) is the most common type of pediatric cancer. Unfortunately, approximately 15% of children with high-risk B-cell ALL (B-ALL) relapse after frontline chemotherapy. Treatment of relapsed/refractory B-ALL is still challenging, and more effective novel therapies are urgently warranted. Blinatumomab, a first in class bispecific antibody therapeutic, has demonstrated superiority compared to standard chemotherapy in patients with B-ALL and has a manageable toxicity profile. Blinatumomab functions by binding to CD19 expressed on B-cells and CD3 expressed on T-cells, resulting in T-cell-mediated killing of CD19-positive cells common in B-cell malignancies.Despite remarkable efficacy and a manageable toxicity profile compared to standard-of-care chemotherapy, blinatumomab poses unique healthcare system challenges related to preparation, administration, toxicity monitoring, and medication error prevention. The drug's success in helping patients achieve complete remission relies on its continuous and uninterrupted administration. In order to ensure that it is delivered in the safest and most effective manner, education on its unique logistical and administration challenges is imperative.Objectives:The primary objective of this study is to describe and share the 6 years of institutional experience on the outpatient delivery of blinatumomab for the management of pediatric patients with B-ALL as per Children's Oncology Group protocols, as well as to retrospectively analyze the safety of this novel 28-day home-based therapy.Methods:A multidisciplinary team composed of physicians, nurses, and pharmacists was created to address administration challenges associated with blinatumomab infusions. Although blinatumomab requires a 28-day continuous infusion, it is not necessary for patients to remain hospitalized for the entire cycle. To ensure tolerability prior to discharge, patients are monitored closely during the first 3 days of Cycle 1 and 2 days of Cycle 2 for signs of cytokine release syndrome and neurological toxicities. Once discharged, they are seen every 96/72 hours for bag changes in either an outpatient hematology/oncology unit or by home health for those off study.Results:A total of 16 patients were treated with blinatumomab between May 2015 and June 2021; 10 were newly diagnosed and 6 were in first relapse. Of the 26 total infusions, 24 were successfully completed without significant adverse reactions. Two patients treated for relapsed disease had to discontinue therapy; one experienced neurotoxicity within 72 hours of blinatumomab infusion initiation and the other developed refractory disease and was switched to another protocol. No adverse events were observed in the home setting.Discussion:The team was successfully able to transform the original inpatient-only blinatumomab protocol to the outpatient setting. Retrospective analysis over 6 years demonstrates a clinically significant reduced rate of complications of blinatumomab administration in comparison to previous reports (Amicucci et al. 2021), which can be attributed to careful multidisciplinary team planning and delivery. This study confirms the feasibility of a home-based continuous blinatumomab infusion without adverse effects on safety. Additionally, this outpatient protocol leads to cost savings associated with reduced length of stay and an overall improved quality of life for pediatric patients able to receive therapy at home with their caregivers. DisclosuresNo relevant conflicts of interest to declare.

Purple urine bag syndrome: When the urine turns purple – An under diagnosed spot diagnosis

The Purple Urine Bag Syndrome (PUBS) is a rare condition in which the urine turns purple. It may occur in Urinary Tract Infections (UTIs) when bacteria metabolize dietary tryptophan to indole resulting in indigo (blue) and indirubin (red). This condition is mostly seen in elderly female patients with permanent urinary bladder catheterization. Patients, relatives and health professionals may be concerned about this discolouration, which is usually harmless. Medical management of PUBS involves frequent urinary bag change, antibiotic therapy and most importantly reassurance. We report an 89-years-old long-term catheterized female nursing home resident who was admitted to the emergency room because of a Community Acquired Pneumonia (CAP). After a few days of inpatient treatment her urine bag turned purple. Antibiotic therapy continued and the indwelling urinary catheter was changed resulting in clear urine. Keywords: Purple urine bag syndrome (PUBS); purple discolouration; urinary tract infection (UTI); long-term catheterization.

Monitoring of Peroxide in Gamma Irradiated EVA Multilayer Film Using Methionine Probe.

In this study, the oxidation of methionine is used as a proxy to model the gamma radiation-induced changes in single-use bags; these changes lead to the formation of acids, radicals, and hydroperoxides. The mechanisms of formation of these reactive species and of methionine oxidation are discussed. With the help of reaction kinetics, the optimal conditions for the use of these single-use bags minimizing the impact of radical chemistry are highlighted. Biopharmaceutical bags gamma irradiated from 0 kGy to 260 kGy and aged from 0 to 36 months were filled with a methionine solution to follow the oxidation of the methionine. The methionine sulfoxide was measured with HPLC after different storage times (0, 3, 10, 14, 17, and 21 days). Three main results were analyzed through a design of experiments: the oxidative induction time, the methionine sulfoxide formation rate, and the maximum methionine sulfoxide concentration detected. A key aspect of the study is that it highlights that methionine is oxidized not necessarily directly by hydro(gen) peroxide but throughperacid, and likely peracetic acid. The answers to the design of experiments were considered to obtain the desirability domain for the optimization of the conditions of use for the single-use bags limiting the oxidation of methionine as well as the release of reactive species thereof.