[Medication safety in the home care setting: error-prone process steps]. / Medikationssicherheit im Home-Care-Bereich: Identifikation von kritischen Prozessschritten.

So far, little is known about drug-related problems in the homecare setting. It is estimated that up to 30% of homecare patients experience a potential medication error, most frequently happening during preparation and administration of drugs. In order to identify error-prone process steps in a Swiss homecare organisation caring for 1854 patients per year, direct observation of the medication use process, including the analysis of 10% of all prescriptions, was executed. Three complimentary methods were combined for the assessment of qualitative aspects of the medication use process: the analysis of a critical incident reporting system, a survey among homecare nurses, and a failure, mode and effects analysis. The medication use process is complex, consisting of 20 individual steps. Patients are prescribed an average of 7.5 ± 3.5 drugs per day, including 1 to 9 doses not suitable for deblistering into weekly dispensing systems. Of 84 reported errors, 74% happened during drug preparation. Communication with physicians, patients interrupting drug preparation and not transmitted changes of the drug regimen were considered the most critical process steps.

[Marginal fit of dental restorations and the periodontium in Swiss army recruits]. / Restaurationsrandschlusse und Parodont bei Schweizer Rekruten.

The present study analyzed the relationship between periodontal health adjacent to filled and unfilled tooth sites in young men (recruits). The status of oral health of 419 Swiss army recruits, aged 19 to 20 years was assessed by determining Plaque Index (PI), Retention Index (RI) and Gingival Index (GI) as well as Pocket Probing Depth (PPD) and Probing Attachment Loss (PAL). In addition, the level of alveolar bone was measured using digitized bite-wing radiographs with an enlargement of 4.5x. Filling margins were assessed and the distance between the alveolar bone crest and the cemento-enamel junction (CEJ) measured to the nearest one tenth of a millimeter. These data were compared with the clinical parameters. A total of 8'050 sites were examined. 765 or 9.5 of the sites in the posterior area were filled. 119 of them showed filling overhangs larger than 0.2 mm. Thus, 1.5 % of the examined sites had a significant overhanging margin. All clinical parameters had greater values at filled than at unfilled sites. The differences were statistically not significant. Even the sites with margins overhanging more than 0.8 mm (n=14) did not show significantly different parameters compared to unfilled sites. The comparison with a similar study involving recruits 11 years earlier assessed that the recruits of 1996 had less and smaller filling overhangs. This, in turn, means that, in Switzerland restorative dentistry in young males has been markedly improved during the 1980's and 1990's.

Fractured prosthetic abutments in osseointegrated implants: a technical complication to cope with.

In the present report a repair set to retrieve fractured abutments remaining in the implants of the ITI Dental Implant System is presented. In 1 case in which such fractures occurred, the repair set was successfully applied. After removal of all particles of the fractured prosthetic abutments and recutting the threads, new abutments were used, and the original suprastructure could be reinserted. The causes for such technical failures are discussed considering the relatively sparse information in the literature on that topic.

Diagnostic characteristics of clinical and microbiological tests for monitoring periodontal and peri-implant mucosal tissue conditions during supportive periodontal therapy (SPT).

The aim of this study was to evaluate a clinical and a microbiological test for monitoring tissue condition during supportive periodontal therapy (SPT) and to compare their diagnostic characteristics at implant and tooth sites. Twelve female (age: 37-72 years) and 7 male patients (age: 26-83 years) were evaluated in this study on the basis of availability to follow a rigid SPT program. Patients had received a complete periodontal examination at 1 and 5 years after implant placement. This included standardized radiographs obtained at implants and matching control teeth. One implant site and one tooth site per patient were followed during the last 2 years of the SPT program. At each recall visit microbiological samples were analyzed according to DNA/RNA analysis identifying periodontal pathogens (IAI Pado Test 4.5, Institute for Applied Immunology, Zuchwil, Switzerland). Presence or absence of bleeding on probing at these sites was also noted using a standardized probing force of 0.25 N (Audio Probe, ESRO, Thalwil ZH, Switzerland). The percentage number of recall visits with positive bacteriological test results and positive BOP scores were calculated. Disease progression at the sites was defined if the annual increase in probing depth was > or = 0.5 mm/year (2.5 mm in 5 years) or if the annual decrease in CADIA values (Computer Assisted Densitometric Image Analysis) was more than -0.7 per year (-3.5 in 5 years). Changes below these values were considered as negative test results indicating stability of the sites. The diagnostic characteristics (sensitivity, specificity, positive and negative predictive values) of BOP and microbiological tests alone or in combination were then calculated using two-by-two tables. By application of increasing thresholds of BOP frequencies set for definition of positive test outcome (BOP > or = 10% > or = 20% > or = 25% > or = 50% > or = 75% > or = 90% or the combined BOP > or = 75%, but DNA positive > or = 10%, > or = 25% > or = 34% > or = 50% > or = 67% > or = 90%) receiver operator characteristics curves (ROC) were constructed for teeth and implants. The areas under the ROC curves were calculated and compared by means of chi-square tests. The results indicated statistically significant better diagnostic characteristics of both tests at implants compared to teeth. The inclusion of an additional microbiological test significantly enhanced the diagnostic characteristics of BOP alone at teeth as well as at implants.

New aspects on the chemotaxonomy of Phytolacca dodecandra with regard to the isolation of phytolaccagenin, phytolaccagenic acid and their glycosides.

In leaves, roots and calli of P. dodecandra we found two 28,30-dicarboxyolean-12-enes and their glycosides in addition to the hitherto known four 28-monocarboxyolean-12-enes on which the chemotaxonomy was based. Therefore, P. dodecandra can no longer be considered as chemotaxonomically different from the other Phytolacca species.

Dependence of the red blood cell calcium pump on the membrane potential.

(1) It is shown that the rate of calcium extrusion from intact human red cells is faster at a membrane potential of approximately +50 mV (inside) than at approximately -50 mV. (2) The positive potential applied was the chloride potential of KCl cells in a K-gluconate medium when the Ca2+ sensitive K+ channel was blocked by 0.3mM quinidine. The negative potential resulted from the high K+ permeability in Ca2+ loaded cells (the cells were loaded to a Ca2+ activity in the cell water of about 50 microM). (3) It is further demonstrated that the Ca2+ affinity of the pump ATPase is decreased both at the internal (high affinity) and external (low affinity) site by increasing the proton concentration. Acidification thus inhibits internally and stimulates externally. (4) An indirect effect of the membrane potential on the pump activity via the accompanying pH shifts on either side of the membrane could be ruled out by choosing Ca2+ concentrations which are fully activating at the internal Ca2+ binding site at pH 6.5 and not yet inhibitory at the external Ca2+ binding site at pH 8. (5) The result is compatible with the assumption that the human red cell Ca-pump is exchanging Ca2+ for protons, yet is electrogenic by virtue of a stoichiometry of 1H+:1Ca2+ for this exchange.

The site of action of La3+ in the reaction cycle of the human red cell membrane Ca2+-pump ATPase.

Lanthanum (La3+) inhibits the Ca-pump of the red cell by arresting the protein in a phosphorylated form (PI). Similar La3+ concentrations are required to increase the amount of PI and to stop PI-decay. In the presence of La3+ phosphorylation becomes insensitive to Mg2+. PI made in the presence of Mg2+ is not prevented from decaying by subsequent addition of La3+, whereas that made in the absence of Mg2+ is. Taken together, these findings seem to indicate that La3+ blocks the transition between a 1st and a 2nd form of PI.

Some properties of the purified (Ca2+ + Mg2+)-ATPase from human red cell membranes.

The (Ca2+ + Mg2+)-ATPase from red cell membranes, purified by means of a calmodulin-containing affinity column according to the method of Gietzen et al. (Gietzen, K., Tejcka, M. and Wolf, H.U. (1980) Biochem. J. 189, 81-88) with either phosphatidylcholine or phosphatidylserine as phospholipid is characterized. The phosphatidylcholine preparation can be activated by calmodulin, while the phosphatidylserine preparation is fully activated without calmodulin. The enzyme shows a biphasic ATP dependence with two Km values of 3.5 and 120 microM. The enzyme is phosphorylated by ATP in the presence of Ca2+ only.