Daily Patient Care Research Articles

Comparative analysis of pharmacists’ knowledge and perception on the utilization of precision medicine to reduce antimicrobial resistance in Lebanon and Greece

Pharmacogenomics and precision medicine are promising new tools in the fight against antimicrobial resistance by providing personalized treatment approaches based on an individual genetic makeup. Pharmacists, equipped with appropriate education and tools, can play a significant role in integrating pharmacogenomics and precision medicine into clinical practice and lead the rational use of pharmacogenomics in daily patient care. Improving patient outcomes in primary healthcare settings is the ultimate output. To date, there has been a lack of assessment and comparison of the knowledge and perceptions of pharmacists across different countries. A self-administered questionnaire was sent to 223 participants from Greece and Lebanon. Results showed that 96% and 68% of the pharmacists in both countries were familiar with the terminology of antimicrobial resistance and precision medicine. A deeper investigation showed gaps concerning the profound understanding of antimicrobial resistance from the one health perspective and the preventive measures. Knowledge of pharmacogenomics, its tests, and the value of precision medicine was low in both groups, with more pronounced deficiencies in the Lebanese group. Additionally, pharmacists didn’t perceive their current role in implementing pharmacogenomics and precision medicine in the combat against antimicrobial resistance, but they expressed openness to future involvement in this area. This research can serve as a foundational tool to establish or adjust policies to allocate resources and support both systems and people to enhance precision medicine implementation in low-to-middle-income countries. Furthermore, it highlights the importance of leveraging the experiences and knowledge of high-income countries to effectively address the challenge of antimicrobial resistance.

Examining the clinical role and educational preparation of heart failure nurses across Europe. A survey of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the Association of Cardiovascular Nursing and Allied Professions (ACNAP) of the ESC.

To describe the clinical practice and educational preparation of heart failure (HF) nurses across Europe and determine the key differences between countries. A survey tool was developed, in English, by the Heart Failure Association Patient Care committee of the European Society of Cardiology (ESC). It was translated into eight languages, before electronically disseminated by nurse ambassadors, presidents of HF national societies and through social media. A total of 837 nurses involved in the daily care of patients with HF from 15 countries completed the survey. Most nurses, 78% (n = 395) worked within a hospital outpatient setting, and 51% (n = 431) had access to a specialized HF multidisciplinary team. Nurses performed a range of activities including patient education to promote self-care, virtual and in-person symptom monitoring. A third had more than 5-year experience in cardiac care and 22% (n = 182) prescribed HF medications. There was a significant correlation between HF nurses that prescribed HF medications and access to a specialist multidisciplinary team (p = 0.04). A small number of nurses, mainly from Belgium, supported invasive monitoring (n = 68, 8%) with 14% (n = 120) of mostly Danish nurses supporting exercise programmes. The majority of nurses surveyed were committed to further academic professional development, with 41% (n = 343) having completed a HF course. The role of the HF nurse varies across Europe, however involvement in patient education, symptom monitoring and follow-up remain core to their practice. In specific activities including the prescribing of HF medications and involvement in invasive monitoring, practice has advanced with collaboration in the multidisciplinary team. Consequently, harmonization of education, training and career pathways are required to standardize HF care aligned with expert guidelines across Europe.

The United European Gastroenterology green paper-climate change and gastroenterology.

Climate change, described by the World Health Organization (WHO) in 2021 as 'the single biggest health threat facing humanity', causes extreme weather, disrupts food supplies, and increases the prevalence of diseases, thereby affecting human health, medical practice, and healthcare stability. Greener Gastroenterology is an important movement that has the potential to make a real difference in reducing the impact of the delivery of healthcare, on the environment. The WHO defines an environmentally sustainable health system as one which would improve, maintain or restore health while minimizing negative environmental impacts. Gastroenterologists encounter the impacts of climate change in daily patient care. Alterations in the gut microbiome and dietary habits, air pollution, heat waves, and the distribution of infectious diseases result in changed disease patterns affecting gastrointestinal and hepatic health, with particularly severe impacts on vulnerable groups such as children, adolescents, and the elderly. Additionally, women are disproportionally affected, since climate change can exacerbate gender inequalities. Paradoxically, while healthcare aims to improve health, the sector is responsible for 4.4% of global carbon emissions. Endoscopy is a significant waste producer in healthcare, being the third highest generator with 3.09kg of waste per day per bed, contributing to the carbon footprint of the GI sector. Solutions to the climate crisis can offer significant health co-benefits. Steps to reduce our carbon footprint include fostering a Planetary Health Diet and implementing measures for greener healthcare, such as telemedicine, digitalization, education, and research on sustainable healthcare practices. Adhering to the principles of 'reduce, reuse, recycle' is crucial. Reducing unnecessary procedures, which constitute a significant portion of endoscopies, can significantly decrease the carbon footprint and enhance sustainability. This position paper by the United European Gastroenterology aims to raise awareness and outline key principles that the GI workforce can adopt to tackle the climate crisis together.

Exploring Health Care Professionals' Perspectives on the Use of a Medication and Care Support System and Recommendations for Designing a Similar Tool for Family Caregivers: Interview Study Among Health Care Professionals.

With the aging population on the rise, the demand for effective health care solutions to address adverse drug events is becoming increasingly urgent. Telemedicine has emerged as a promising solution for strengthening health care delivery in home care settings and mitigating drug errors. Due to the indispensable role of family caregivers in daily patient care, integrating digital health tools has the potential to streamline medication management processes and enhance the overall quality of patient care. This study aims to explore health care professionals' perspectives on the use of a medication and care support system (MCSS) and collect recommendations for designing a similar tool for family caregivers. Fifteen interviews with health care professionals in a home care center were conducted. Thematic analysis was used, and 5 key themes highlighting the importance of using the MCSS tool to improve medication management in home care were identified. All participants emphasized the necessity of direct communication between health care professionals and family caregivers and stated that family caregivers need comprehensive information about medication administration, patient conditions, and symptoms. Furthermore, the health care professionals recommended features and functions customized for family caregivers. This study underscored the importance of clear communication between health care professionals and family caregivers and the provision of comprehensive instructions to promote safe medication practices. By equipping family caregivers with essential information via a tool similar to the MCSS, a proactive approach to preventing errors and improving outcomes is advocated.

Exploring Caregiver Burden in Alzheimer's Disease: The Predictive Role Of Psychological Distress

Background Alzheimer's Disease [AD], the most prevalent form of dementia, is on the rise in terms of its prevalence. Individuals affected by this condition typically require extensive care across all aspects of daily living. The mental well-being of caregivers for those with dementia stands as a significant public concern. Therefore, the current study aimed to investigate the association between the burden of caregiving and the psychological distress experienced by family caregivers of individuals with AD. Methods This cross-sectional study employed a census method and involved the participation of 150 caregivers of Alzheimer's patients in Shahroud, Iran. To assess the eligibility of family caregivers, the inclusion criteria comprised minimal literacy in reading and writing and at least six months of care for an individual with AD.. Exclusion criteria included being a formal caregiver or employed in healthcare, having mental disorders, or using neuroleptic drugs among family caregivers. Data collection tools consisted of the Zarit Care Burden Inventory [ZBI] and Lovibond's Depression, Anxiety, and Stress Scale [DASS-21]. Information was gathered online and through self-reporting, followed by analysis using descriptive statistics [frequency, percentage, mean, and standard deviation], as well as inferential statistical tests [multivariate linear regression]. Results In this study, the mean scores for caregiver burden, anxiety, stress, and depression were 28.09 ±13.01, 4.50 ±4.53, 8.12 ±4.98, and 4.69 ± 4.86, respectively. The study's findings revealed that with each additional hour spent on daily patient care, the burden score for caregivers increased by 0.327 units [p=0.025, β=0.327]. Furthermore, for every one-unit rise in stress [p<0.001, β=1.087] and depression scores [p=0.015, β=0.671], the burden score also increased by 1.087 and 0.671 units, respectively. Conclusion Caregivers of individuals with AD experienced notable levels of caregiving burden, particularly correlated with the duration of daily patient care and the manifestation of stress and depression symptoms. Hence, the study suggests the implementation of tailored interventions, such as psychoeducational programs, to provide vital support for these individuals.

The Effects of Adding Particles in Texture Modified Food on Tongue Strength and Swallowing Function in Patients with Oropharyngeal Dysphagia: A Proof of Concept Study.

The use of texture modified food (TMF) is widely spread in the daily care of patients with oropharyngeal dysphagia (OD). However, TMF have been shown to have a negative impact on the patients' quality of life. Adherence rates are low, increasing the risk of malnutrition and aspiration in an already vulnerable patient population. The aim of this exploratory study was to gain insight in the feasibility of adding particles to pureed food on tongue strength, swallowing safety and efficiency in patients with OD. Ten adult participants with OD swallowed three different boluses. Bolus 1 consisted of no particles (IDDSI level 4), small and bigger particles were added in bolus 2 and 3. Tongue strength during swallowing (Pswal) was measured using the Iowa Oral Performance Instrument (IOPI). Swallow safety (penetration and aspiration) and swallow efficiency (residu) were quantified during fiberoptic endoscopic evaluation of swallowing by means of the PAS scale and Pooling score. RM Anova and Friedman tests were performed for analyzing the impact of bolus on the outcome parameters. No significant effect of bolus type on Pswal was measured. Neither the PAS nor the Pooling score differed significantly between the three different boluses. Aspiration was never observed during swallowing any bolus with particles. This preliminary study shows that the addition of particles to pureed food had no impact on Pswal, swallowing efficiency or safety in patients with OD. This innovative project is the first step in research to explore the characteristics of TMF beyond bolus volume, viscosity and temperature.

A Novel Implantable Piezoresistive Microsensor for Intraocular Pressure Measurement.

Glaucoma is the world's second-leading irreversible eye disease causing blindness. Although the pathogenesis of glaucoma is not particularly well understood, high intraocular pressure (IOP) is widely recognized as a significant risk factor. In clinical practice, various devices have been used to measure IOP, but most of them cannot provide continuous measurements for a long time. To meet the needs of glaucoma patients who experience frequent fluctuations in the IOP and require constant monitoring, we fabricated an implantable piezoresistive IOP sensor based on microfluidic technology. The sensor has a sensitivity of 0.00257 Ω/mbar and demonstrates excellent linearity, stability, and repeatability. According to the calibration data, the average measurement error is ±0.5 mbar. We implanted it into the vitreous of a rabbit and successfully detected its IOP fluctuations. The sensor is simple in design, easy to fabricate, and can be used for long-term continuous IOP measurements. It presents a new approach for microfluidic-based IOP sensors and offers a novel method for the daily care of patients with glaucoma.

A pharmacist's guide to mitigating sleep dysfunction and promoting good sleep in the intensive care unit.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To review causes, risk factors, and consequences of sleep disruption in critically ill patients; evaluate the role of nonpharmacological and pharmacological therapies for management of sleep in the intensive care unit (ICU); and discuss the role of pharmacists in implementation of sleep bundles. Critically ill patients often have disrupted sleep and circadian rhythm alterations that cause anxiety, stress, and traumatic memories. This can be caused by factors such as critical illness, environmental factors, mechanical ventilation, and medications. Methods to evaluate sleep, including polysomnography and questionnaires, have limitations that should be considered. Multicomponent sleep bundles with a focus on nonpharmacological therapy aiming to reduce nocturnal noise, light, and unnecessary patient care may improve sleep disorders in critically ill patients. While pharmacological agents are often used to facilitate sleep in critically ill patients, evidence supporting their use is often of low quality, which limits use to patients who have sleep disruption refractory to nonpharmacological therapy. Dedicated interprofessional teams are needed for implementation of sleep bundles in the ICU. Extensive pharmacotherapeutic training and participation in daily patient care rounds make pharmacists vital members of the team who can help with all components of the bundle. This narrative review discusses evidence for elements of the multicomponent sleep bundle and provides guidance on how pharmacists can help with implementation of nonpharmacological therapies and management of neuroactive medications to facilitate sleep. Sleep bundles are necessary for patients in the ICU, and dedicated interprofessional teams that include pharmacists are vital for their successful creation and implementation.

An [illustrative] update on pediatric emergency medicine ultrasound: part 2 - abdominal and urogenital applications.

Emergency ultrasound, or point-of-care ultrasound (POCUS), has been established into daily patient care over the last decades. The use of abdominal and pelvic ultrasound in clinical practice has the potential to improve the efficiency and safety of pediatric emergency care. This article will provide a review of current applications of pediatric emergency abdominal and urogenital ultrasound, forming the second part of the series.

Licensed Practical Nurses' Perceptions of the Benefits of Information Systems in Social and Healthcare Services.

Licensed practical nurses (LPNs) are the second largest occupational group and the largest group in the social and healthcare sector in Finland, and they have an extensive working environment. Like other health and social care professionals, LPNs also use health information systems (HIS) and client information systems (CIS) in their daily work. The aim of this study was to describe LPNs' perceptions of the benefits of information systems in daily patient care. The information systems include the main HIS or CIS that the respondents mainly use in their work. The data comprised 3 866 LPNs' responses were collected via an online survey in 2022. Most of the LPNs work in social care using the Lifecare system. ESKO is used in public health care and was rated as the most popular system that LPNs use regarding the benefits of information systems. Highly experienced LPNs seem to rate the benefits of information systems higher than LPNs who have just started working.

An exploratory factor analysis of health professional perceptions of integrating spirituality in daily patient care

Introduction: Spirituality is very subjective, and it is commonly assumed as the modifiable factors that can affect the quality of life among elderly, where elderly is referred to the male or female with the age of above 60 years old. The main purpose of this study is to evaluate the perception of nurses toward spirituality in nursing care practice among the patients. Methods: An exploratory sequential design using qualitative study [N=24] by collecting data via face-to-face interview in Federal Territory of Kuala Lumpur. The spirituality tool was analysed using four categories: 1) Believe, 2) Faith, 3) Emotion and 4) Practice. Results: The reliability of the dimensions was all high as the Cronbach’s Alpha coefficients were above 0.90. Therefore, this spirituality measurement tool can be considered highly reliable. It was found, there was significant relationship between age, ethnicity, religion, versus the four-spiritual dimension. However, the results showed that there is no relationship between gender and spirituality dimension. Conclusion: In conclusion spirituality play large role throughout the individual and variances of cultural and closely context toward nursing. The spiritual care encompasses beliefs that significantly give meaning to the life of an individual, and then able to motivate individuals where may enhance the faith, hope, peace, and empowerment to an individual health. It was used to construct a profile of elderly in Malaysia, and it may be applied to profile elderly in other countries.

Caregivers' knowledge, attitudes and behaviour towards the daily oral care of bedridden patients in Chiang Rai, Thailand

Caregivers' knowledge, attitudes and behaviour towards the daily oral care of bedridden patients in Chiang Rai, Thailand

Palliative single-level selective dorsal rhizotomy for children with spastic cerebral palsy Gross Motor Function Classification System level IV and V: a case series and systematic review of the literature.

Single-level selective dorsal rhizotomy (SDR), typically indicated for ambulatory patients, is a controversial topic for severe spastic cerebral palsy (CP) with Gross Motor Function Classification System (GMFCS) level IV or V. The objective of this case series and systematic literature review was to outline the indication and outcome of palliative SDR for nonambulatory patients with CP and GMFCS level IV and V, focusing on improvement of spasticity and of patient and caregiver reported quality of life assessment. A retrospective case series of patients with CP and GMFCS level IV or V who underwent single-level SDR at the authors' institution is presented. Furthermore, two databases (PubMed and Embase) were searched and a systematic review with a search string based on the terms "selective dorsal rhizotomy," "cerebral palsy," and "outcome" was conducted. The primary outcome was the reduction of spasticity based on the modified Ashworth scale (MAS). Secondary outcomes were change on the Gross Motor Function Measure-66 (GMFM-66), evaluation of patient-reported outcome measures (PROMs), surgical morbidity, and mortality. Eleven consecutive children under the age of 25 years undergoing palliative single-level SDR were included. All patients showed a reduction in MAS score (mean 1.09 ± 0.66 points) and no surgical morbidity and mortality occurred. For the systematic review results from our case series, in addition to 4 reports, 274 total patients were included. Reduction of spasticity based on MAS score was noted in all studies (mean range 1.09-3.2 points). Furthermore, in 2 studies spasticity of the upper extremities showed a MAS score reduction as well (range 1.7-2.8 points). The GMFM-66 score improved in 72% of the patients, while bladder function improved in 78% of the patients. Based on the PROMs, 92% of the patients/caregivers were satisfied with the outcome and their quality of life after the procedure. Two wound infections (2.7%) and one CSF leak (1.3%) occurred, while no surgery-related deaths were described. This analysis showed an improvement in spasticity, daily care, and comfort for patients with CP and GMFCS levels IV and V. Larger cohorts analyzing the outcome of palliative single-level SDR, based on the MAS, GMFM-66, and PROMs, are still needed and should be the focus of future studies. Systematic review registration no.: CRD42024495762 (https://www.crd.york.ac.uk/prospero/).

Non-Enzymatic Glucose Sensors Composed of Polyaniline Nanofibers with High Electrochemical Performance.

The measurement of glucose concentration is a fundamental daily care for diabetes patients, and therefore, its detection with accuracy is of prime importance in the field of health care. In this study, the fabrication of an electrochemical sensor for glucose sensing was successfully designed. The electrode material was fabricated using polyaniline and systematically characterized using scanning electron microscopy, high-resolution transmission electron microscopy, X-ray diffraction, Fourier transform infrared spectroscopy, and UV-visible spectroscopy. The polyaniline nanofiber-modified electrode showed excellent detection ability for glucose with a linear range of 10 μM to 1 mM and a detection limit of 10.6 μM. The stability of the same electrode was tested for 7 days. The electrode shows high sensitivity for glucose detection in the presence of interferences. The polyaniline-modified electrode does not affect the presence of interferences and has a low detection limit. It is also cost-effective and does not require complex sample preparation steps. This makes it a potential tool for glucose detection in pharmacy and medical diagnostics.

Identifying ideal pharmacist‐to‐patient ratios for the successful provision of clinical pharmacy services

AbstractClinical pharmacists add significant value to the health care team and are associated with reduced hospital mortality, drug costs, length of stay, and adverse drug reactions. However, there remains a paucity of evaluative data regarding optimal clinical pharmacy practice models. Identifying optimal patient (or bed)‐to–clinical pharmacist ratios is one mechanism to assess the allocation of resources. The ACCP Task Force on Clinical Pharmacy Services was charged with developing a white paper to examine optimal ratios in different care settings, considering confounders and other factors that affect the interpretation of ratio data. The committee performed an extensive search of the pharmacy, medical, and nursing literature to identify existing data on provider‐to‐patient ratios. Recommendations on ratios are mainly from survey data or statements from various health care organizations. Many factors affect the capacity of clinical pharmacists to achieve patient care and non‐patient care responsibilities. Examples include general differences in baseline expectations; nonstandardized program performance metrics; variable hospital/practice setting types; variable patient acuity and complexity; competing priorities and other resources; industry‐wide rates of and variability in addressing burnout; inconsistent means for justifying numbers and historical corporate structures; and external endorsements and mandates. Although some areas of practice such as critical care pharmacy have more robust evidence for specific ratios, others such as pediatrics are far less clear. A clinical pharmacist ratio must be established as a starting point. This will allow for better allocation today and serve as a springboard for future determinations. Furthermore, clinical pharmacist ratios should be preserved to offer reliable patient care 365 days per year. As clinical pharmacist services shift from beneficial to essential, continuous daily patient care services must be the practice model moving forward.

Nurses' perspectives on shared decision-making in the daily care of hospitalized patients with dementia: An exploratory qualitative study.

Gain insight into the process of shared decision-making (SDM) in daily hospital care for patients with dementia from nurses' perspectives. Explorative qualitative design. In-depth digital interviews were conducted with 14 registered nurses between June and November 2022. A phenomenological approach was applied using Colaizzi's seven-step method. Five themes were identified in the data: (1) SDM in daily care: How shared decision-making is applied; (2) Nurses' perceptions and competence: How nurses perceive and manage SDM; (3) Nurses' roles and advocacy: The evolving roles of nurses and their advocacy efforts, (4) Recognition of dementia and its impact: How nurses recognize and manage dementia; and (5) Interventions to support SDM: Strategies and interventions to facilitate SDM. This study highlights the complexity of SDM in patients with dementia. It demonstrates the importance of the involvement of relatives, omission of patient goals in discussions and perceived deficiencies of nurses. The early identification of dementia, evaluation of nuanced capacity and targeted communication are essential. Further research and enhanced training are required to improve care in this context. Potential areas for further research on SDM in nurses involving patients with dementia include investigating the effects of integrating goal discussions into SDM training for nurses, overcoming barriers to SDM competence, and challenging the idea that SDM is solely the responsibility of physicians. These findings highlight the need for policies that encourage interdisciplinary collaboration, address misconceptions and recommend training programmes that focus on applying SDM to the daily care of patients with dementia, thereby improving the overall quality of patient care. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used for reporting. No patient or public contribution.

Cerebral Lactate Uptake After Half-Molar Sodium Lactate Therapy in Traumatic Brain Injury: A Brief Report.

Exogenous sodium lactate has many advantages after traumatic brain injury, including intracranial pressure control and alternative energetic supply. It remains unclear, however, whether half-molar sodium lactate (HSL) is effectively incorporated in brain metabolism, which we can verify using the arteriovenous difference in lactate (AVDlac). Hence we compared the AVDlac in patients with severe traumatic brain injury receiving an equiosmolar bolus of sodium lactate or mannitol for intracranial hypertension (IH) treatment. We included 23 patients: 14 received HSL for 25 IH episodes, and nine received mannitol for 19 episodes (total of 44 IH episodes). We observed that the median variation in AVDlac was positive in the group that received HSL (Δ +0.1 [IQR -0.08-0.2] mmol/L), which suggests a net lactate uptake by the brain. On the other hand, it was negative in the group that received mannitol (Δ -0.0 [IQR -0.1 to 0.0] mmol/L), indicating a net lactate export. Finally, there were more positive AVDlac values in the group that received HSL and more negative AVDlac values in the group that received mannitol (Fisher exact p = 0.04). Our study reports the first evidence of a positive AVDlac, which corresponds to a net lactate uptake by the brain, in patients who received HSL for severe TBI. Our results constitute a bedside confirmation of the integration of lactate into the brain metabolism and pave the way for a wider dissemination of sodium lactate in the daily clinical care of patients with traumatic brain injury.

Impact of internal medicine pharmacists on antimicrobial stewardship

AbstractIntroductionIncreased demands on infectious diseases (ID) pharmacists and providers may result in targeted antimicrobial stewardship (AMS) interventions. Internal medicine (IM) pharmacists frequently intervene on antimicrobials for their patients during general clinical care, although little is known regarding their overall impact on AMS.ObjectiveCharacterize AMS interventions made by IM pharmacists to identify areas of AMS that can be expanded to patients not covered by ID teams.MethodsThis was a prospective, dual‐center, cross‐sectional study where IM pharmacists, and their trainees were recruited to document routinely made AMS interventions that happened during daily patient care activities. These interventions were classified based on infection source, stewardship intervention type, whether recommendations were accepted or rejected by providers, and any barriers incurred during the implementation of interventions.ResultsFour IM pharmacists documented 386 interventions from February 2021 through May 2021. Physicians accepted pharmacist interventions 95.6% of the time. The most common interventions were for respiratory (n = 87, 22.5%), genitourinary (n = 80, 20.7%), and skin and skin structure infections (n = 65, 16.8%). The antimicrobials that IM pharmacists most frequently intervened on were vancomycin (n = 89, 23.1%) and ceftriaxone (n = 68, 17.6%). The most common interventions that were made were dose adjustment (n = 105, 27.2%), shortened duration of therapy (n = 86, 22.3%), and intravenous (IV) to oral (PO) conversions (n = 38, 9.8%). Of the 17 interventions not accepted, the most common barrier to implementation was physician concerns (n = 11, 52.4%), which were primarily associated with IV to PO recommendations (n = 7, 63.6%).ConclusionIM pharmacists participate in AMS for their patients and intervene frequently to adjust dosing for antimicrobials, shorten duration of therapy, and facilitate IV to PO conversions. IM pharmacists could serve as AMS extenders where additional AMS coverage is needed.

Highly Sensitive Wearable Sensor Based on (001)-Orientated TiO2 for Real-Time Electrochemical Detection of Dopamine, Tyrosine, and Paracetamol.

The concentration of dopamine (DA) and tyrosine (Tyr) reflects the condition of patients with Parkinson's disease, whereas moderate paracetamol (PA) can help relieve their pain. Therefore, real-time measurements of these bioanalytes have important clinical implications for patients with Parkinson's disease. However, previous sensors suffer from either limited sensitivity or complex fabrication and integration processes. This work introduces a simple and cost-effective method to prepare high-quality, flexible titanium dioxide (TiO2) thin films with highly reactive (001)-facets. The as-fabricated TiO2 film supported by a carbon cloth electrode (i.e., TiO2-CC) allows excellent electrochemical specificity and sensitivity to DA (1.390µAµM-1cm-2), Tyr (0.126µAµM-1cm-2), and PA (0.0841µAµM-1cm-2). More importantly, accurate DA concentration in varied pH conditions can be obtained by decoupling them within a single differential pulse voltammetry measurement without additional sensing units. The TiO2-CC electrochemical sensor can be integrated into a smart diaper to detect the trace amount of DA or an integrated skin-interfaced patch with microfluidic sampling and wireless transmission units for real-time detection of the sweat Try and PA concentration. The wearable sensor based on TiO2-CC prepared by facile manufacturing methods holds great potential in the daily health monitoring and care of patients with neurological disorders.

Care Bundle Approach for Oral Health Maintenance and Reduction of Ventilator-Associated Pneumonia.

Caring for patients in the intensive care unit (ICU) creates competing priorities of interventions for nurses and other health care providers. Oral care might be prioritized lower; however, its neglect may lead to sequelae such as extended time in the ICU, nosocomial diseases most notably ventilator-associated pneumonia (VAP), or oral problems. Safe patient care depends on effective and efficient oral care. The aim of this study was to lower the incidence of VAP and maintain oral health through implementing an "oral care bundle" for mechanically ventilated (MV) patients. Using a quasi-experimental design, we divided 82 adult MV patients in the ICUs of a university-based hospital in Egypt into a control group (n=41) that received the standard of care and a bundle group (n=41) that received an "oral care bundle." The results of the study reported a significantly lower incidence of VAP in the intervention group (P =.015). It can be concluded that there is a significant relationship between receiving an oral care bundle and improved oral health and a reduction in the VAP rate among MV patients. This highlights the need to incorporate the oral care bundle in the daily nursing care for MV patients.