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Journal of Clinical Nursing Sep 2023Medication administration errors (MAEs) cause preventable patient harm and cost billions of dollars from already-strained healthcare budgets. An emerging factor... (Review)
Review
BACKGROUND
Medication administration errors (MAEs) cause preventable patient harm and cost billions of dollars from already-strained healthcare budgets. An emerging factor contributing to these errors is nurse fatigue. Given medication administration is the most frequent clinical task nurses undertake; it is vital to understand how fatigue impacts MAEs.
OBJECTIVE
Examine the evidence on the effect of fatigue on MAEs and near misses by registered nurses working in hospital settings.
METHOD
Arksey and O'Malley's scoping review framework was used to guide this review and PAGER framework for data extraction and analysis. The PRISMA checklist was completed. Four electronic databases were searched: CINAHL, PubMed, Scopus and PsycINFO. Eligibility criteria included primary peer review papers published in English Language with no date/time limiters applied. The search was completed in August 2021 and focussed on articles that included: (a) registered nurses in hospital settings, (b) MAEs, (c) measures of sleep, hours of work, or fatigue.
RESULTS
Thirty-eight studies were included in the review. 82% of the studies identified fatigue to be a contributing factor in MAEs and near misses (NMs). Fatigue is associated with reduced cognitive performance and lack of attention and vigilance. It is associated with poor nursing performance and decreased patient safety. Components of shift work, such as disruption to the circadian rhythm and overtime work, were identified as contributing factors. However, there was marked heterogeneity in strategies for measuring fatigue within the included studies.
RELEVANCE TO CLINICAL PRACTICE
Fatigue is a multidimensional concept that has the capacity to impact nurses' performance when engaged in medication administration. Nurses are susceptible to fatigue due to work characteristics such as nightwork, overtime and the requirement to perform cognitively demanding tasks. The mixed results found within this review indicate that larger scale studies are needed with particular emphasis on the impact of overtime work. Policy around safe working hours need to be re-evaluated and fatigue management systems put in place to ensure delivery of safe and quality patient care.
Topics: Humans; Pharmaceutical Preparations; Patient Safety; Hospitals; Fatigue; Menthol; Nurses
PubMed: 36707921
DOI: 10.1111/jocn.16620 -
Drug Discovery Today Sep 2023Artificial intelligence (AI) refers to the ability of a computer to carry out tasks associated with human intelligence, including thinking, discovering, and learning... (Review)
Review
Artificial intelligence (AI) refers to the ability of a computer to carry out tasks associated with human intelligence, including thinking, discovering, and learning from prior experience. AI can be integrated to simplify the complexity of pharmaceutical regulatory affairs. AI tools can be applied to automate regulatory processes such as administrative work, dossier filling, data extraction, auditing, the implementation of regulations, and quality management. AI creates process links and reduces complexity, resulting in a more efficient management system. Human-AI interaction opens up new opportunities in regulatory affairs. This article explores the potential role of AI in pharmaceutical regulatory affairs.
Topics: Humans; Artificial Intelligence; Pharmaceutical Preparations
PubMed: 37442291
DOI: 10.1016/j.drudis.2023.103700 -
Journal of Neurology Jan 2024This review addresses current changes in the approach to treating patients with multiple sclerosis (MS). The widely practiced approach of utilizing agents with lower... (Review)
Review
This review addresses current changes in the approach to treating patients with multiple sclerosis (MS). The widely practiced approach of utilizing agents with lower treatment efficacy (LETA) at onset with subsequent escalation has been challenged by new data suggesting that MS patients derive greater benefit when therapy is initiated with high-efficacy treatment agents (HETA). Several recent studies compared treatment efficacy and safety of early administration of HETA versus LETA. The results of randomized, double blind, phase III studies with LETA as a control arm and population-based larger and longer studies using propensity scoring, marginal structural modeling and weighted cumulative exposure analysis support the benefit of early treatment with HETA. Patients initiating their treatment with HETA, regardless of prognostic factors and MRI burden at baseline, showed significantly lower annualized relapse rate (ARR) and reduced disability progression in follow-up periods of up to 10-15 years. Moreover, the safety profile of recently approved HETA ameliorates concerns about off-target effects associated with a number of earlier high-efficacy drugs. Patient perception has also changed with an increasing preference for medication profiles that both improve symptoms and prevent disease progression. Accumulating data from randomized studies and the results of large population-based studies demonstrating short-term and longer-term patient benefits support the view that HETA should be more widely used. The adoption of early treatment with HETA capitalizes on a window of opportunity for anti-inflammatory drugs to maximally impact disease pathology and heralds a sea change in clinical practice toward pro-active management and away from a philosophy routed in generating clinical benefit as a consequence of treatment failure.
Topics: Humans; Multiple Sclerosis; Pharmaceutical Preparations; Treatment Outcome; Multiple Sclerosis, Relapsing-Remitting; Randomized Controlled Trials as Topic
PubMed: 37851189
DOI: 10.1007/s00415-023-11969-8 -
Handbook of Clinical Neurology 2024In migraine, when patients have failed medication management or are unable to be treated with systemic medications, minimally invasive interventions can be options used... (Review)
Review
In migraine, when patients have failed medication management or are unable to be treated with systemic medications, minimally invasive interventions can be options used to provide pain relief. The type of intervention depends on the pain location, associated clinical features, clinical context, medical comorbidities, and response to prior injections. Interventions can vary from bedside peripheral nerve blocks to fluoroscopically guided interventions. Growing evidence is supporting the use of interventions in migraine, and judicious use can improve clinical outcomes.
Topics: Humans; Migraine Disorders; Pain Management; Pain
PubMed: 38307642
DOI: 10.1016/B978-0-12-823357-3.00002-1 -
Multiple Sclerosis and Related Disorders Nov 2023Hypogammaglobulinemia is characterized by reduced serum immunoglobulin levels. Secondary hypogammaglobulinemia is of considerable interest to the practicing physician... (Review)
Review
Hypogammaglobulinemia is characterized by reduced serum immunoglobulin levels. Secondary hypogammaglobulinemia is of considerable interest to the practicing physician because it is a potential complication of some medications and may predispose patients to serious infections. Patients with multiple sclerosis (MS) treated with B-cell-depleting anti-CD20 therapies are particularly at risk of developing hypogammaglobulinemia. Among these patients, hypogammaglobulinemia has been associated with an increased risk of infections. The mechanism by which hypogammaglobulinemia arises with anti-CD20 therapies (ocrelizumab, ofatumumab, ublituximab, rituximab) remains unclear and does not appear to be simply due to the reduction in circulating B-cell levels. Further, despite the association between anti-CD20 therapies, hypogammaglobulinemia, and infections, there is currently no generally accepted monitoring and treatment approach among clinicians treating patients with MS. Here, we review the literature and discuss possible mechanisms of secondary hypogammaglobulinemia in patients with MS, hypogammaglobulinemia results in MS anti-CD20 therapy clinical trials, the risk of infection for patients with hypogammaglobulinemia, and possible strategies for disease management. We also include a suggested best-practice approach to specifically address secondary hypogammaglobulinemia in patients with MS treated with anti-CD20 therapies.
Topics: Humans; Multiple Sclerosis; Antigens, CD20; Agammaglobulinemia; Rituximab; Disease Management
PubMed: 37783194
DOI: 10.1016/j.msard.2023.105009 -
Surgical Oncology Clinics of North... Jul 2024
Topics: Humans; Esophageal Neoplasms; Stomach Neoplasms; Disease Management
PubMed: 38789202
DOI: 10.1016/j.soc.2024.02.001 -
Surgical Oncology Clinics of North... Jul 2024
Topics: Humans; Esophageal Neoplasms; Stomach Neoplasms; Disease Management
PubMed: 38789203
DOI: 10.1016/j.soc.2024.01.002 -
Biomedicine & Pharmacotherapy =... Jan 2024In the 21st century, cardiovascular disease (CVD) has become one of the leading causes of death worldwide. The prevention and treatment of CVD remain pressing scientific... (Review)
Review
In the 21st century, cardiovascular disease (CVD) has become one of the leading causes of death worldwide. The prevention and treatment of CVD remain pressing scientific issues. Several recent studies have suggested that ferroptosis may play a key role in CVD. Most studies conducted thus far on ferroptosis and CVD have supported the link. Ferroptosis mediated by different signaling and metabolic pathways can lead to ischemic heart disease, myocarditis, heart failure, ischemia-reperfusion injury, and cardiomyopathy. Still, the specific mechanism of ferroptosis in CVD, the particular organ areas affected, and the stage of disease involved need to be further studied. Therefore, understanding the mechanisms regulating ferroptosis in CVD may improve disease management. Throughout this review, we summarized the mechanism of ferroptosis and its effect on the pathogenesis of CVD. We also predicted and discussed future research directions, aiming to provide new ideas and strategies for preventing and treating CVD.
Topics: Humans; Cardiovascular Diseases; Ferroptosis; Heart Failure; Myocardial Ischemia; Disease Management
PubMed: 38159373
DOI: 10.1016/j.biopha.2023.116057 -
Best Practice & Research. Clinical... Dec 2023The introduction of targeted biological agents in systemic lupus erythematosus (SLE) has created a momentum for improving overall disease management and patients'... (Review)
Review
The introduction of targeted biological agents in systemic lupus erythematosus (SLE) has created a momentum for improving overall disease management and patients' prognosis. To achieve this, a comprehensive strategy is required spanning the entire patient journey from diagnosis to prevention and management of late complications and comorbidities. In this review, we focus on four aspects that are closely linked to SLE prognosis, namely early disease recognition and treatment initiation, reduction of the cumulative glucocorticoid exposure, attainment of well-defined targets of remission and low disease activity, prevention of flares and, kidney-protective strategies with non-immune-directed agents. We review the recent literature related to these topics in conjunction with the existing treatment recommendations, highlighting areas of uncertainty and providing guidance towards facilitating the care of SLE patients.
Topics: Humans; Lupus Erythematosus, Systemic; Glucocorticoids; Prognosis; Remission Induction; Disease Management
PubMed: 37978040
DOI: 10.1016/j.berh.2023.101895 -
Internal Medicine Journal May 2024Gout is a common and treatable chronic disease of monosodium urate crystal deposition. It is experienced as extremely painful episodes of joint inflammation that impact...
Gout is a common and treatable chronic disease of monosodium urate crystal deposition. It is experienced as extremely painful episodes of joint inflammation that impact all aspects of the person's life. This Clinical Perspectives article provides an update on gout diagnosis, medications and strategies to improve the quality of gout care.
Topics: Humans; Disease Management; Gout; Gout Suppressants; Uric Acid
PubMed: 38654576
DOI: 10.1111/imj.16382