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BMJ Health & Care Informatics Aug 2020Electronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication...
Changes in medication administration error rates associated with the introduction of electronic medication systems in hospitals: a multisite controlled before and after study.
BACKGROUND
Electronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication administration errors (MAEs).
OBJECTIVE
To assess changes in MAE rates and types associated with EMS implementation.
METHODS
This was a controlled before and after study (three intervention and three control wards) at two adult teaching hospitals. Intervention wards used an EMS with no bar-coding. Independent, trained observers shadowed nurses and recorded medications administered and compliance with 10 safety procedures. Observational data were compared against medication charts to identify errors (eg, wrong dose). Potential error severity was classified on a 5-point scale, with those scoring ≥3 identified as serious. Changes in MAE rates preintervention and postintervention by study group, accounting for differences at baseline, were calculated.
RESULTS
7451 administrations were observed (4176 pre-EMS and 3275 post-EMS). At baseline, 30.2% of administrations contained ≥1 MAE, with wrong intravenous rate, timing, volume and dose the most frequent. Post-EMS, MAEs decreased on intervention wards relative to control wards by 4.2 errors per 100 administrations (95% CI 0.2 to 8.3; p=0.04). Wrong timing errors alone decreased by 3.4 per 100 administrations (95% CI 0.01 to 6.7; p<0.05). EMS use was associated with an absolute decline in potentially serious MAEs by 2.4% (95% CI 0.8 to 3.9; p=0.003), a 56% reduction in the proportion of potentially serious MAEs. At baseline, 74.1% of administrations were non-compliant with ≥1 of 10 procedures and this rate did not significantly improve post-EMS.
CONCLUSIONS
Implementation of EMS was associated with a modest, but significant, reduction in overall MAE rate, but halved the proportion of MAEs rated as potentially serious.
Topics: Drug Administration Schedule; Efficiency, Organizational; Hospitals, Teaching; Humans; Medication Errors; Medication Systems, Hospital; Pharmaceutical Preparations
PubMed: 32796084
DOI: 10.1136/bmjhci-2020-100170 -
Journal of Pharmaceutical Sciences Jan 2022The expeditious advancement in the organ on chip technology provided a phase change to the conventional in vitro tests used to evaluate absorption, distribution,... (Review)
Review
The expeditious advancement in the organ on chip technology provided a phase change to the conventional in vitro tests used to evaluate absorption, distribution, metabolism, excretion (ADME) studies and toxicity assessments. The demand for an accurate predictive model for assessing toxicity and reducing the potential risk factors became the prime area of any drug delivery process. Researchers around the globe are welcoming the incorporation of organ-on-a-chips for ADME and toxicity evaluation. Organ-on-a-chip (OOC) is an interdisciplinary technology that evolved as a contemporary in vitro model for the pharmacokinetics and pharmacodynamics (PK-PD) studies of a proposed drug candidate in the pre-clinical phases of drug development. The OOC provides a platform that mimics the physiological functions occurring in the human body. The precise flow control systems and the rapid sample processing makes OOC more advanced than the conventional two-dimensional (2D) culture systems. The integration of various organs as in the multi organs-on-a-chip provides more significant ideas about the time and dose dependant effects occurring in the body when a new drug molecule is administered as part of the pre-clinical times. This review outlines the comprehensive development in the organ-on-a-chip technology, various OOC models and its drug development applications, toxicity evaluation and efficacy studies.
Topics: Drug Development; Humans; Lab-On-A-Chip Devices; Pharmaceutical Preparations; Technology
PubMed: 34324944
DOI: 10.1016/j.xphs.2021.07.014 -
Pharmacological Research Jan 2017Chemotherapeutic drugs have multiple drawbacks, including severe side effects and suboptimal therapeutic efficacy. Nanomedicines assist in improving the biodistribution... (Review)
Review
Chemotherapeutic drugs have multiple drawbacks, including severe side effects and suboptimal therapeutic efficacy. Nanomedicines assist in improving the biodistribution and target accumulation of chemotherapeutic drugs, and are therefore able to enhance the balance between efficacy and toxicity. Multiple types of nanomedicines have been evaluated over the years, including liposomes, polymer-drug conjugates and polymeric micelles, which rely on strategies such as passive targeting, active targeting and triggered release for improved tumor-directed drug delivery. Based on the notion that tumors and metastases are highly heterogeneous, it is important to integrate imaging properties in nanomedicine formulations in order to enable non-invasive and quantitative assessment of targeting efficiency. By allowing for patient pre-selection, such next generation nanotheranostics are useful for facilitating clinical translation and personalizing nanomedicine treatments.
Topics: Animals; Antineoplastic Agents; Drug Delivery Systems; Humans; Nanomedicine; Nanoparticles; Neoplasms; Pharmaceutical Preparations; Theranostic Nanomedicine
PubMed: 27865762
DOI: 10.1016/j.phrs.2016.11.014 -
Current Hypertension Reports Sep 2020The purpose of this review is to provide an overview of psychiatric medications that impact blood pressure in adult patients either as a direct side effect or... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to provide an overview of psychiatric medications that impact blood pressure in adult patients either as a direct side effect or indirectly, via negative metabolic impact or interactions with other medications. In addition, pertinent interactions between psychiatric medications and antihypertensive agents will be discussed.
RECENT FINDINGS
Although the novel intranasal antidepressant, esketamine, has been shown to increase blood pressure shortly after dosing, treatment with antihypertensive medications is not typically required. In addition, no increase in serious adverse cardiac events was reported with this medication. The negative metabolic impact of antipsychotic medications has been shown to occur within the first month of treatment and necessitates early monitoring. When compared with the general population with cardiovascular disease, mortality risk in patients with severe and persistent psychiatric illness is higher, and death occurs 10 years earlier. There are several psychiatric treatments that increase blood pressure directly as well as indirectly, via negative metabolic impact and drug/diet interactions. Fortunately, there are no absolute contraindications for use of any psychiatric medication in patients with pre-existing hypertension. Given data which suggests that patients diagnosed with more severe psychiatric disorders are known to receive inadequate medical care for hypertensive illness and experience increased mortality risk from cardiovascular disease, it is important for all physicians to be aware of the increased risk in this population and for both thorough assessment and treatment to occur.
Topics: Adult; Antihypertensive Agents; Blood Pressure; Humans; Hypertension; Pharmaceutical Preparations
PubMed: 32893315
DOI: 10.1007/s11906-020-01096-4 -
The Journal of Maternal-fetal &... Dec 2023While medications for anxiety and depression are commonly used in the United States, it is unclear to what degree they are continued during pregnancy. We used a large...
While medications for anxiety and depression are commonly used in the United States, it is unclear to what degree they are continued during pregnancy. We used a large administrative database to determine whether psychiatric medications are continued during pregnancy and predictors of continued medication treatment. Of 2,672,656 women included in our analysis, 86,454 (3.1%) filled a pre-pregnancy prescription for an anxiolytic or antidepressant medication within 3 months of estimated conception. Of women who filled a pre-pregnancy prescription, 49.4%, 26.1%, and 20.1% filled subsequent prescriptions in the 1st, 2nd, and 3rd trimesters. Discontinuation rates ranged by pharmaceutical agent, from 16% for fluoxetine to 71% for alprazolam. White women and women over 25 were more likely to continue anxiolytic and antidepressant treatment during pregnancy. Because untreated and under-treated mental health conditions are linked to adverse maternal outcomes, high discontinuation rates may have important implications for maternal health.
Topics: Pregnancy; Female; Humans; United States; Depression; Anti-Anxiety Agents; Antidepressive Agents; Fluoxetine; Pharmaceutical Preparations; Pregnancy Complications
PubMed: 36710395
DOI: 10.1080/14767058.2023.2171288 -
Obesity Reviews : An Official Journal... May 2020Bariatric surgeries induce structural changes that can alter the absorption of drugs in patients already at risk of polypharmacy. This scoping review aimed to explore... (Review)
Review
Bariatric surgeries induce structural changes that can alter the absorption of drugs in patients already at risk of polypharmacy. This scoping review aimed to explore pharmacokinetic changes of orally administered drugs in patients post-bariatric surgery, and assess the quality and level of bias. Electronic databases were searched for articles relating to bariatric surgery and pharmacokinetics published between 1998 and 2019. Pre-post studies reporting on pharmacokinetic parameters were included, and the Newcastle-Ottawa Scale was used to assess risk-of-bias. A total of 21 studies were included in this review, and changes in absorption were reported in all included studies across 29 drugs. In 11 studies, this change was reported as statistically significant (p<.05), while six reported a nonsignificant change. More drugs exhibited a shorter Tmax and higher Cmax after surgery than otherwise, however changes in AUC were variable. Four studies were assessed as having fair quality while the remainder of the included studies were of good quality and low risk-of-bias. Bariatric surgery alters the absorption of drugs and several mechanisms are implicated to be responsible. Short and long-term monitoring is recommended in patients post-surgery for clinical changes in response to medications. Future research with a higher number of participants and greater control of variables, such as concurrent medications, malabsorptive disorders, and body composition should be considered.
Topics: Absorption, Physiological; Bariatric Surgery; Body Composition; Humans; Obesity; Pharmaceutical Preparations; Pharmacokinetics
PubMed: 32100411
DOI: 10.1111/obr.12988 -
Current Opinion in Structural Biology Jun 2020Allosteric drugs have become an indispensable toolbox of rapidly developing precision medicine, having already established reputation of advantages over traditional... (Review)
Review
Allosteric drugs have become an indispensable toolbox of rapidly developing precision medicine, having already established reputation of advantages over traditional medicines. Allosteric mechanisms are also widely involved in the action of SNPs and latent cancer drivers, and can be used in fine and specific tuning of biologics, providing a great potential in diagnostics and therapy. We discuss here major targets for prospected allosteric medicines, currently available allosteric compounds, and drug-candidates at different stages of research and (pre)clinical trials. We describe our computational model of the comprehensive allosteric control of protein activity, outlining the ways of implementing it in pharmacological applications. Finally, we formulate outstanding questions and discuss feasible directions in the work on allosteric drugs and mutations.
Topics: Allosteric Regulation; Allosteric Site; Drug Design; Drug Discovery; Humans; Pharmaceutical Preparations; Proteins
PubMed: 32062398
DOI: 10.1016/j.sbi.2020.01.010 -
Endocrine, Metabolic & Immune Disorders... 2020Chemistry as experimental science began in the seventeenth century, when it began moving away from being one of the alchemical doctrines and toward analyzing matter and...
BACKGROUND
Chemistry as experimental science began in the seventeenth century, when it began moving away from being one of the alchemical doctrines and toward analyzing matter and its transformations using scientific methods. Previously, the ancient Pre-Socratic philosophy through observation of nature was concerned with the laws that govern the natural world and the property of matter. Later, the Hellenistic Alexandrian culture took possession of the Hermetic doctrines of the Egyptians, mixing them with pre-Socratic thought and Gnosticism. At this historical moment, therefore, there was a fusion of the Greek philosophical patrimony and the Hellenistic and Alexandrian influences on medicine. The Hermetic gnosis evolved over time to become alchemy and then to usher in the birth of chemical science. Many doctors were wandering philosophers who dealt with cosmogony to understand the body and diseases and to discover new healing drugs for treatment, and thus they were the first chemist therapists.
METHODS
The influence of ancient physicians through the pre-Socratic philosophy for these prochemical theories and practice has been researched through ancient texts, so these texts have been referenced to determine the legacy of paleo-chemicals doctrines.
RESULTS
The study of various texts in particular from the Pre-Socratic age and the eminent physicians underline that, despite a different approach to the cosmogonic concepts of nature and the matter, the medicine of that age had an important influence on chemistry as an experimental science, especially concerning therapy with drugs.
CONCLUSION
The Pre-Socratic philosophers have influenced the medical practice and guided it toward the concept of the properties of matter for medical treatment and an understanding of the causes of diseases.
Topics: Alchemy; Chemistry; Egypt, Ancient; Greece, Ancient; History, Ancient; Humans; Pharmaceutical Preparations; Philosophy; Physicians
PubMed: 32384041
DOI: 10.2174/1871530320666200508115041 -
Nanomedicine (London, England) Feb 2017Pre-uptake metabolism within the GI tract is responsible for the poor oral bioavailability of numerous drugs. As nanocarriers function as a 'shield', protecting... (Review)
Review
Pre-uptake metabolism within the GI tract is responsible for the poor oral bioavailability of numerous drugs. As nanocarriers function as a 'shield', protecting incorporated drugs from enzymatic attack, there is an increasing interest in utilizing them as a tool for overcoming drug degradation. Degradation of carriers resulting in the release of incorporated drugs, mucus permeation, enzyme inhibitory properties and their toxicity are crucial factors that must be taken into account when designing proper nanocarriers. The use of polymer- and lipid-based nanocarriers as protective vehicles are discussed within this review. Lipid-based carriers and novel mucopenetrating particles seem to have a great potential in avoiding metabolizing enzymes. Accordingly, nanocarriers are promising tools for improving the bioavailability of drugs, being sensitive to a pre-uptake metabolism.
Topics: Administration, Oral; Biological Availability; Chemistry, Pharmaceutical; Drug Carriers; Drug Stability; Enzyme Activation; Gastrointestinal Tract; Humans; Intestinal Absorption; Lipids; Nanoparticles; Permeability; Pharmaceutical Preparations; Polymers; Solubility; Surface Properties
PubMed: 28093952
DOI: 10.2217/nnm-2016-0331 -
Journal of Separation Science Jan 2019Extraction of endogenous compounds and drugs and their corresponding metabolites from complex matrices, such as biofluids and solid tissues, requires adequate analytical... (Review)
Review
Extraction of endogenous compounds and drugs and their corresponding metabolites from complex matrices, such as biofluids and solid tissues, requires adequate analytical approach facilitating qualitative and quantitative analysis. To this end, solid-phase microextraction has been introduced as modern technology that is capable of efficient and high-throughput extraction of compounds due to its ability to amalgamate sampling, extraction, and pre-concentration steps, while requiring minimal use of organic solvents. The ability of solid-phase microextraction to enable analyses on small-volume biological samples and growing availability of biocompatible solid-phase microextraction coatings make it a highly useful technology for variety of applications. For example, solid-phase microextraction is particularly useful for identifying biomarkers in metabolomics studies, and it can be successfully applied in pharmaceutical and toxicological studies requiring the fast and sensitive determination of drug levels, especially those that are present at low levels in biological matrices such as plasma, urine, saliva, and hair. Moreover, solid-phase microextraction can be directly applied in in vivo studies because this extraction technique is non-exhaustive and its biocompatible probes offer minimal invasiveness to the analyzed system. In this article, we review recent progress in well-established solid-phase microextraction technique for in vitro and in vivo analyses of various metabolites and drugs in clinical, pharmaceutical, and toxicological applications.
Topics: Biomarkers; Biomedical Research; Metabolomics; Pharmaceutical Preparations; Solid Phase Microextraction
PubMed: 30289623
DOI: 10.1002/jssc.201800785