Patient safety begins with proper planning: a quantitative method to improve hospital design.

BACKGROUND: A quantitative methodology that enhances design of patient-safe healthcare facilities is presented. The prevailing paradigm of evaluating the design of healthcare facilities relies mainly on postconstruction criticism of design flaws; by then, design flaws may have already negatively affected patient safety. The methodology presented here utilises simulation-based testing in real-size replicas of proposed hospital designs. Other simulations to assess design solutions generated mainly qualitative data about user experience. To assess the methodology, we evaluated one patient safety variable in a proposed hospital patient room. METHOD: Fifty-two physicians who volunteered to participate were randomly assigned to examine a standardised patient in two hospital room settings using a replica of the proposed architectural plan; the two settings differed only by the placement of the alcohol-based hand-rub dispenser. The primary outcome was the hand hygiene compliance rate. RESULTS: When the dispenser was in clear view of the physicians as they observed the patient, 53.8% sanitised their hands. When the dispenser was not in their field of view (as in the original architectural plan), 11.5% sanitised their hands (p=0.0011). Based on these results, the final architectural plans were adjusted accordingly. CONCLUSION: The methodology is an effective and relatively inexpensive means to quantitatively evaluate proposed solutions, which can then be implemented to build patient-safe healthcare facilities. It enables actual users to proactively identify patient safety hazards before construction begins.

Frequency glides in the impulse responses of auditory-nerve fibers.

Previous reports of frequency modulations, or glides, in the impulse responses of the auditory periphery have been limited to analyses of basilar-membrane measurements and responses of auditory-nerve (AN) fibers with best frequencies (BFs) greater than 1.7 kHz. These glides increased in frequency as a function of time. In this study, the instantaneous frequency as a function of time was measured for impulse responses of AN fibers in the cat with a range of BFs (250-4500 Hz). Impulse responses were estimated from responses to wideband noise using the reverse-correlation technique. The impulse responses had increasing frequency glides for fibers with BFs greater than 1500 Hz, nearly constant frequency as a function of time of BFs between 750 and 1500 Hz, and decreasing frequency glides for BFs below 750 Hz. Over the levels tested, the glides for fibers at all BFs were nearly independent of stimulus level, consistent with previous reports of impulse responses of the basilar membrane and AN fibers. Implications of the different glide directions observed for different BFs are discussed, specifically in relation to models for the auditory periphery as well as for the derivation of impulse responses for the human auditory periphery based on psychophysical measurements.

[Chemical synthesis of a proteinase inhibitor (eglin C) gene without use of T4-DNA-ligase and its expression in E. coli]. / Khimicheskii sintez gena ingibitora proteinaz (églin C) bez ispol'zovaniia T4-DNK-ligazy i ego ékspressiia v E. coli.

A synthetic gene for a proteinase inhibitor (eglin C) that was obtained by direct amplification with oligonucleotides without using DNA ligase and polynucleotide kinase of T4 phage was cloned into expression vectors. A high yield of the polypeptide (110-130 mg/l) was attained in E. coli strains.

[The content of ceruloplasmin, fibronectin and selenium in the blood of patients with an acute myocardial infarct]. / Soderzhanie tseruloplazmina, fibronektina i selena v krovi bol'nykh ostrym infarktom miokarda.

The content of ceruloplasmin, fibronectin and selenium was evaluated in the blood plasma of acute myocardial infarction patients within the first three days after onset if the disease. Results showed a reduction of fibronectin during the first hours after onset of the disease. The content of ceruloplasmin was increased, selenium reduced during the entire period of examination indicating pronounced disturbances of lipid peroxidation in the acute period of myocardial infarction as well as potentiation of antioxidant processes.

[The effect of the combined use of hemosorption and plasmapheresis on the blood rheological and hemodynamic indices of hypertension patients]. / Vliianie sochetannogo primeneniia gemosorbtsii i plazmafereza na gemoreologicheskie i gemodinamicheskie pokazateli u bol'nykh gipertonicheskoi bolezn'iu.

Basing on the response obtained in 46 patients with stage II essential hypertension, the conclusion is made on a positive action of hemosorption plus plasmapheresis on blood rheology, hemodynamics, clinical course of hypertension. The response persisted for up to 6 months.

[Obtaining human recombinant (serine-17) beta-interferon by the method of oligonucleotide-directed mutagenesis and its expression in Escherichia coli]. / Poluchenie rekombinantnogo (serin-17) beta-interferona cheloveka metodom oligonukleotidnapravlennogo mutageneza i ego ékspresiia v Escherichia coli.

The gene of human mutant (serine-17) fibroblast interferon was isolated with the use of highly efficient oligonucleotide-directed mutagenesis. On the basis of the constructed expression plasmid pPR-IFN Ser17 a strain producing human mutant beta-interferon (VKPM V-4678) was developed. It was shown that the specific activity of the human mutant (serine-17) fibroblast interferon was 1 order of magnitude higher than that of the recombinant interferon which reaches the specific activity of natural fibroblast interferon.

[Use of uracil-repair selection for extensive DNA sequence deletions]. / Primenenie uratsil-reparatsionnoi selektsii pri deletirovanii protiazhennoi posledovatel'nosti DNK.

A procedure for extensive deletion mutagenesis of DNA using the uracil repair system is exemplified by reconstruction of the pBR322 replication regulatory region cloned into M13tg131. By means of an oligonucleotide primer the 116-nucleotide fragment was excised and four nucleotides were introduced to form a BglII restriction site. Use of the uracil repair selection provided a 30-fold increase in the deletion mutagenesis efficiency.

[Site-directed mutagenesis with the use of addressed fragmentation of single-stranded DNA for obtaining hybrids of homologous proteins]. / Sait-napravlennyi mutagenez s ispol'zovaniem adresovannogo fragmentirovaniia odnonitevoi DNK dlia polucheniia gibridov gomologichnykh belkov.

Site-directed multiple mutagenesis to obtain hybrids of homologous proteins was carried out by means of the oligonucleotide-targeting digestion of ss DNA. The procedure is more convenient, rapid and simple than the step-by-step approach. To demonstrate different approaches to targeting digestion of ss DNA, NcoI, HinfI, FokI endonucleases were used for DNA cleavage. A hydride of the human and porcine IFN-alpha-2-genes has been constructed.

[Site-directed mutagenesis in the uracil-repair system. Preparation of mutated forms of human alpha 2 interferon]. / Sait-napravlennyi mutagenez v uratsil-reparatsionnoi sisteme. Poluchenie mutantnykh form interferon alpha2 cheloveka.

The mutant forms of human IFN-alpha 2 gene are obtained by oligonucleotide-directed mutagenesis with the use of uracil-repair system. To intensify the process the procedure of the uracil-containing DNA template preparation is modified. It was determined that when mutagenesis is performed in the uracil-repair system the yield of the process depends on the mutant DNA-strand in vitro synthesis efficiency. It is shown that the stability of the 5'-end primer-template complex and the level of the endogenic primers elongation are the basis factors, that determine induction mutations.

[Study of the role of the insA open reading frame in the IS1 insertion element structure during transposition and resolution of the IS1 mediated cointegrates]. / Izuchenie roli ramki schityvaniia insA v strukture insertsionnogo élementa IS1 v protsessakh transpozitsii i razresheniia oposredovannykh IS1 kointegratov.

In order to elucidate the function of the IS1 insA gene derivatives of plasmid pUC19::Tn9' with insertions of synthetic oligonucleotides were obtained. The latter are equal or multiple of 9 b.p. in length and are located in the Pst1 site within each of the two IS1 copies of the Tn9' transposon. The insertions of the nine base oligonucleotides code for the neutral amino acids and do not shift the reading frame. One of the mutant transposon obtained - Tn9'/X was studied on the ability to form simple insertions and plasmid cointegrates. For this purpose the pUC19 derivatives carrying the wild type and mutant transposon were mobilized by conjugative plasmid pRP3.1. It was found that the damage of the insA gene does not influence the ability of transposon to form simple insertions and plasmid cointegrates in both recA - and rec+ cells of E. coli. However, the frequency of the cointegrate formation in the subsequent transposition of the mutant transposon from pRP3.1::Tn9'/X to pBR322 was by 10-20 times lower in comparison to the wild type transposon. Instable (dissociating) Tn9'/X-mediated plasmid cointegrates formed by interaction pUC19::Tn9'/X and pRP3.1 were obtained. It was shown that in the E. coli recA-cells such cointegrates dissociate, as a rule, "correctly", i.e. they segregate mainly plasmids of types pUC19::Tn9'/X and pUC19::IS1/X. The data obtained correspond with the notion that the gene insA product is not essential for transposition, but is, possibly, involved in the formation of the IS1-generated deletions.