Postdischarge 24/7 Hotline Service for Neurology and Neurosurgery Patients and 1-Year Impact on Readmission Rates, Unplanned Emergency Department Visits, and Patient Satisfaction.

OBJECTIVE: Telephone triage is a system in which trained nurses use standardized protocols to evaluate symptoms over the phone and determine the appropriate course of action. MATERIALS AND METHODS: We implemented a protocol for systematic follow up phone calls and telephonic triage to families of neurology and neurosurgery patients after discharge, primarily to improve care transition and to assess its impact on the ratio of visits in the emergency department, readmissions, and overall satisfaction of patients and families. The intervention comprised the implementation of nurse led telephone triage and postdischarge follow up phone calls. After implementing hotline services in mind and brain service line, a retrospective cohort study was conducted to evaluate the impact of hotline services on patient readmissions, emergency department visits, and overall satisfaction rate. We collected data of readmission rate and emergency visits of discharge patients in three periods a prehotline period, immediate posthotline period, and late posthotline period to make comparison. Patients discharged home from the neurology and neurosurgery services from January 2017 to September 2019 were provided with hotline number to call in case of any issue or query. These patients also received postdischarge follow up calls from hotline nurses. We initiated the hotline in October 2017. RESULTS: On analysis, we found a 25% decline in readmission rate in the immediate period of hotline followed by a further decline to 37.2% in the late period as compared to the prehotline period. Among discharge patients visiting the emergency department, we found a decline of 18.5% in the immediate posthotline period which further declined to 77.7% in the later phase as compared to the prehotline period. CONCLUSION: A standardized telephone system and pathway can be an effective way to improve nurse-patient communication which can further improve health outcomes for many patients.

Screening Genotoxicity Chemistry with Microfluidic Electrochemiluminescent Arrays.

This review describes progress in the development of electrochemiluminescent (ECL) arrays aimed at sensing DNA damage to identify genotoxic chemistry related to reactive metabolites. Genotoxicity refers to chemical or photochemical processes that damage DNA with toxic consequences. Our arrays feature DNA/enzyme films that form reactive metabolites of test chemicals that can subsequently react with DNA, thus enabling prediction of genotoxic chemical reactions. These high-throughput ECL arrays incorporating representative cohorts of human metabolic enzymes provide a platform for determining chemical toxicity profiles of new drug and environmental chemical candidates. The arrays can be designed to identify enzymes and enzyme cascades that produce the reactive metabolites. We also describe ECL arrays that detect oxidative DNA damage caused by metabolite-mediated reactive oxygen species. These approaches provide valuable high-throughput tools to complement modern toxicity bioassays and provide a more complete toxicity prediction for drug and chemical product development.

Comparison of fast electron transfer kinetics at platinum, gold, glassy carbon and diamond electrodes using Fourier-transformed AC voltammetry and scanning electrochemical microscopy.

Heterogeneous electron transfer (ET) processes at electrode/electrolyte interfaces are of fundamental and applied importance and are extensively studied by a range of electrochemical techniques, all of which have various attributes but also limitations. The present study focuses on the one-electron oxidation of tetrathiafulvalene (TTF) and reduction of tetracyanoquinodimethane (TCNQ) in acetonitrile solution by two powerful electrochemical techniques: Fourier-transformed large amplitude alternating current voltammetry (FTACV); and scanning electrochemical microscopy (SECM), both of which are supported by detailed theoretical models. At conventional Pt, Au and glassy carbon (GC) electrode materials, the apparent (overall) charge transfer kinetic values determined by FTACV give standard ET rate constants, k, that are fast and close to the reversible limit. They are in good agreement with highly localised k measurements determined by SECM under conditions of high mass transport rates. In contrast, the impact of both the complex heterogeneous surface of polycrystalline boron doped diamond (pBDD) and degenerate p-type doping results in a range of k values across the electrode surface compared to the overall k measured for both processes studied. Moreover, the reduced availability of charge carriers at the electrode surface, at each energy state, compared to a metal, which decreases as the potential becomes more negative, results in lower k0 values at pBDD than Pt, Au and GC. The measurement technique also has an influence: SECM measurements are made at much higher local current density than FTACV, and for TCNQ/TCNQ˙-, which has the more negative formal potential, limited charge carrier availability results in k > k, with unusual apparent charge transfer coefficients and voltammetric waveshapes from SECM. These data thus highlight the importance of understanding the influence of the measurement technique and further demonstrate how ET kinetics at pBDD differ from conventional electrodes, in this case for processes in an organic solvent, which has received much less attention compared to aqueous systems for studies with pBDD.

Electrochemiluminescence Arrays for Studies of Metabolite-related Toxicity.

This article reviews recent progress from our laboratory in electrochemiluminescence (ECL) arrays designed for screening toxicity-related chemistry of chemical and drug candidates. Cytochrome P450s and metabolic bioconjugation enzymes convert lipophilic chemicals in our bodies by oxidation and bioconjugation that can lead to toxic metabolites. DNA can be used as an easily measurable toxicity-related endpoint, targeting DNA oxidation and addcut formation with metabolites. ECL using guanosines in the DNA strands as co-reactants have been used in high throughput arrays utilizing DNA-enzyme films fabricated layer-by-layer. This review describes approaches developed to provide new high throughput ECL arrays to aid in toxicity assessment for drug and chemical product development.

Determination of fast electrode kinetics facilitated by use of an internal reference.

The concept of using an internal reversible reference process as a calibration in the determination of fast electrode kinetics has been developed and applied with the technique of Fourier transformed large amplitude ac voltammetry to minimize the influence of errors arising from uncertainties in parameters such as electrode area (A), concentration (C), diffusion coefficient (D), and uncompensated resistance (Ru). Since kinetic parameters (electron transfer rate constant, k(0), and electron transfer coefficient, α) are irrelevant in the voltammetric characterization of a reversible reaction, parameters such as A, C, D, and Ru can be calibrated using the reversible process prior to quantification of the electrode kinetics associated with the fast quasi-reversible process. If required, new values of parameters derived from the calibration exercise can be used for the final determination of k(0) and α associated with the process of interest through theory-experimental comparison exercises. Reference to the reversible process is of greatest significance in diminishing the potentially large impact of systematic errors on the measurement of electrode kinetics near the reversible limit. Application of this method is demonstrated with respect to the oxidation of tetrathiafulvalene (TTF), where the TTF(0/•+) process is used as a reversible internal reference for the measurement of the quasi-reversible kinetics of the TTF(•+/2+) process. The more generalized concept is demonstrated by use of the Fc(0/+) (Fc = ferrocene) reversible process as an internal reference for measurement of the kinetics of the Cc(+/0) (Cc(+) = cobaltocenium) process. Via the internal reversible reference approach, a k(0) value of 0.55 cm s(-1) was obtained for the TTF(•+/2+) process at a glassy carbon electrode and 2.7 cm s(-1) for the Cc(+/0) one at a carbon fiber microelectrode in acetonitrile (0.1 M Bu4NPF6).

Large amplitude Fourier transformed ac voltammetry at a rotating disc electrode: a versatile technique for covering Levich and flow rate insensitive regimes in a single experiment.

The theory for large amplitude Fourier transformed ac voltammetry at a rotating disc electrode is described. Resolution of time domain data into dc and ac harmonic components reveals that the mass transport for the dc component is controlled by convective-diffusion, while the background free higher order harmonic components are flow rate insensitive and mainly governed by linear diffusion. Thus, remarkable versatility is available; Levich behaviour of the dc component limiting current provides diffusion coefficient values and access to higher harmonics allows fast electrode kinetics to be probed. Two series of experiments (dc and ac voltammetry) have been required to extract these parameters; here large amplitude ac voltammetry with RDE methodology is used to demonstrate that kinetics and diffusion coefficient information can be extracted from a single experiment. To demonstrate the power of this approach, theoretical and experimental comparisons of data obtained for the reversible [Ru(NH(3))(6)](3+/2+) and quasi-reversible [Fe(CN)(6)](3-/4-) electron transfer processes are presented over a wide range of electrode rotation rates and with different concentrations and electrode materials. Excellent agreement of experimental and simulated data is achieved, which allows parameters such as electron transfer rate, diffusion coefficient, uncompensated resistance and others to be determined using a strategically applied approach that takes into account the different levels of sensitivity of each parameter to the dc or the ac harmonic.