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Research in Social & Administrative... Dec 2020Older adults with cancer often require multiple medications including cancer-specific treatments and supportive care medications (e.g. analgesics), as well as... (Review)
Review
BACKGROUND
Older adults with cancer often require multiple medications including cancer-specific treatments and supportive care medications (e.g. analgesics), as well as medications for pre-existing medical conditions. Increasing numbers of medications pose risks of potentially inappropriate prescribing, drug-drug interactions and drug-disease interactions. The burden of treatment (i.e. the workload of healthcare and its impact on patient functioning and well-being) may also negatively affect the way patients take their medications. Non-adherence to medication in patients with cancer is associated with treatment failure and increased healthcare costs. Therefore, it is crucial that medicines are optimised for older adults with cancer to enhance appropriate prescribing, reduce the complexity of treatment regimens and minimise the risk of non-adherence.
OBJECTIVE
To provide an overview of evaluations of interventions aimed at optimising medication prescribing and/or adherence in older adults with cancer.
METHODS
A systematic scoping review will be undertaken. Four databases will be searched from inception: PubMed, EMBASE, CINAHL and PsycINFO. In order to meet inclusion criteria, studies must evaluate an intervention seeking to improve medication prescribing and/or adherence in older adults (aged ≥65 years) with an active cancer diagnosis using a comparative evaluation (e.g. inclusion of a control group). Two reviewers will independently screen titles and abstracts for inclusion and extract data relating to study population, intervention characteristics, outcome assessments and key findings. Extracted data will be collated using tables, figures and accompanying descriptive summaries. The review will be reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.
PROJECT IMPACT
The scoping nature of this review will serve to provide an overview of the existing literature on interventions aimed at optimising medication prescribing and adherence in older adults with cancer. The review findings will help to identify research gaps and highlight areas to explore further in future research.
Topics: Aged; Delivery of Health Care; Drug Prescriptions; Humans; Inappropriate Prescribing; Medication Adherence; Neoplasms
PubMed: 32147463
DOI: 10.1016/j.sapharm.2020.02.021 -
BMJ Quality & Safety May 2014Medication administration errors are frequent and lead to patient harm. Interruptions during medication administration have been implicated as a potential contributory... (Review)
Review
BACKGROUND
Medication administration errors are frequent and lead to patient harm. Interruptions during medication administration have been implicated as a potential contributory factor.
OBJECTIVE
To assess evidence of the effectiveness of interventions aimed at reducing interruptions during medication administration on interruption and medication administration error rates.
METHODS
In September 2012 we searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Effective Practice and Organisation of Care Group reviews, Google and Google Scholar, and hand searched references of included articles. Intervention studies reporting quantitative data based on direct observations of at least one outcome (interruptions, or medication administration errors) were included.
RESULTS
Ten studies, eight from North America and two from Europe, met the inclusion criteria. Five measured significant changes in interruption rates pre and post interventions. Four found a significant reduction and one an increase. Three studies measured changes in medication administration error rates and showed reductions, but all implemented multiple interventions beyond those targeted at reducing interruptions. No study used a controlled design pre and post. Definitions for key outcome indicators were reported in only four studies. Only one study reported κ scores for inter-rater reliability and none of the multi-ward studies accounted for clustering in their analyses.
CONCLUSIONS
There is weak evidence of the effectiveness of interventions to significantly reduce interruption rates and very limited evidence of their effectiveness to reduce medication administration errors. Policy makers should proceed with great caution in implementing such interventions until controlled trials confirm their value. Research is also required to better understand the complex relationship between interruptions and error to support intervention design.
Topics: Drug Administration Routes; Humans; Medication Errors
PubMed: 23980188
DOI: 10.1136/bmjqs-2013-002118 -
Journal of Maxillofacial and Oral... Feb 2024Mucormycosis has emerged as one of the most fatal complications arising due to COVID-19, though it has to be mentioned that the disease is capable of causing serious... (Review)
Review
INTRODUCTION
Mucormycosis has emerged as one of the most fatal complications arising due to COVID-19, though it has to be mentioned that the disease is capable of causing serious illness even on its own.
OBJECTIVES
Through this investigation, we would review the threat that mucormycosis poses, in terms of its prevalence and degree of severity both in the pre- and post-COVID world.
MATERIALS AND METHODS
A comprehensive examination of the studies published in online databases turned up 207 papers, 103 of which had undergone in-depth analysis, using both inclusion and exclusion criteria, shortlisting 15 studies that were appropriate for reviewing.
RESULTS
The incidence of mucormycosis was linked to coronavirus in 7 of the 15 studies that were chosen. The remaining eight studies had sufferers of various systemic diseases, like HIV/AIDS and diabetes.
DISCUSSION
All the cases suffered diabetes mellitus. Regardless of the time period of the chosen article, corticosteroids and antifungal medications were administered to all patients. There were noticeable differences in terms of mortality, predisposing factors, and virulence between pre-COVID and post-COVID mucormycosis.
SUMMARY AND CONCLUSION
The prevalence of systemic conditions such as diabetes in cases of mucormycosis has remained the same even after the incidence of this pandemic, showing that the basic treatment modalities continue to remain the same irrespective of the damage that corona virus has caused to the sufferer, although mucormycosis arising due to COVID-19 differs from mucormycosis that was incident before the advent of the pandemic.
PubMed: 38312959
DOI: 10.1007/s12663-023-02028-w -
Journal of Racial and Ethnic Health... Aug 2023Pre-exposure prophylaxis (PrEP) provides a salient avenue to address the profound HIV-related health disparities that Black women in the United States face. This... (Review)
Review
OBJECTIVES
Pre-exposure prophylaxis (PrEP) provides a salient avenue to address the profound HIV-related health disparities that Black women in the United States face. This systematic review assessed the acceptability of PrEP within this population, and identified barriers and facilitators to its acceptability and uptake.
METHODS
We searched PubMed and Web of Science using 48 search input combinations; this produced 338 unique articles, 16 of which were included in the review.
RESULTS
We analyzed the results using the socio-ecological model (SEM). Findings indicate generally positive attitudes towards PrEP among Black women, although acceptance levels vary widely. Individual-level barriers included inadequate levels of PrEP awareness and knowledge, low HIV-risk perception, and concerns about adherence and side effects; interpersonal-level barriers were the influence of sexual and romantic partners and stigma from family; societal-level barriers included lack of PrEP marketing towards Black women, medical mistrust, cost, and structural violence. The main facilitators at the individual-level were PrEP education and information; at the interpersonal-level, distrust in sexual partners, healthcare provider encouragement, and social support; at the societal-level, PrEP accessibility, and affordability. No community-level barriers or facilitators were identified.
CONCLUSIONS
PrEP should be marketed directly to Black women in the US and campaigns should highlight this medication's effectiveness, accessibility, affordability, and safety. Medical mistrust must also be addressed to enable Black women to feel comfortable following their healthcare providers' advice regarding PrEP.
PubMed: 37531021
DOI: 10.1007/s40615-023-01729-9 -
BMJ Quality & Safety Apr 2018Pharmacists' completion of medication reconciliation in the community after hospital discharge is intended to reduce harm due to prescribed or omitted medication and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pharmacists' completion of medication reconciliation in the community after hospital discharge is intended to reduce harm due to prescribed or omitted medication and increase healthcare efficiency, but the effectiveness of this approach is not clear. We systematically review the literature to evaluate intervention effectiveness in terms of discrepancy identification and resolution, clinical relevance of resolved discrepancies and healthcare utilisation, including readmission rates, emergency department attendance and primary care workload.
METHODS
This is a systematic literature review and meta-analysis of extracted data. Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Allied and Complementary Medicine Database (AMED),Education Resources Information Center (ERIC), Scopus, NHS Evidence and the Cochrane databases were searched using a combination of medical subject heading terms and free-text search terms. Controlled studies evaluating pharmacist-led medication reconciliation in the community after hospital discharge were included. Study quality was appraised using the Critical Appraisal Skills Programme. Evidence was assessed through meta-analysis of readmission rates. Discrepancy identification rates, emergency department attendance and primary care workload were assessed narratively.
RESULTS
Fourteen studies were included, comprising five randomised controlled trials, six cohort studies and three pre-post intervention studies. Twelve studies had a moderate or high risk of bias. Increased identification and resolution of discrepancies was demonstrated in the four studies where this was evaluated. Reduction in clinically relevant discrepancies was reported in two studies. Meta-analysis did not demonstrate a significant reduction in readmission rate. There was no consistent evidence of reduction in emergency department attendance or primary care workload.
CONCLUSIONS
Pharmacists can identify and resolve discrepancies when completing medication reconciliation after hospital discharge, but patient outcome or care workload improvements were not consistently seen. Future research should examine the clinical relevance of discrepancies and potential benefits on reducing healthcare team workload.
Topics: Medication Reconciliation; Patient Discharge; Pharmacists; Professional Role
PubMed: 29248878
DOI: 10.1136/bmjqs-2017-007087 -
Antibiotics (Basel, Switzerland) Nov 2022The phenomenon of bacterial antimicrobial resistance (AMR) is a rapidly growing global problem. Overuse and misuse of antibiotics as well as self-prescription are among... (Review)
Review
The phenomenon of bacterial antimicrobial resistance (AMR) is a rapidly growing global problem. Overuse and misuse of antibiotics as well as self-prescription are among the most important causes contributing to the growth of antibiotic resistance in humans. This systematic review describes the phenomenon of antibiotics self-medication (ASM) in children. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist by searching PubMed, Scopus, and Web of Science until July 2022. Published English language studies containing information regarding parents knowledge, attitudes, and behaviors in self-administration of antibiotics in children were included. A total of 702 articles were identified, and 57 were selected. A higher prevalence of ASM among children was found in the Middle-East (34%), Africa (22%), Asia (20%) and South America (17%), while the lowest prevalence was found in Europe (8%). High distance from hospital, and low income, such as having more than one child, are related with an increased risk of ASM in children. Fever and cough can also promote the misuse of antibiotics by parents. A greater attention to the regulation of the sale of antimicrobial drugs can certainly limit the risk of self-medicating behavior.
PubMed: 36358240
DOI: 10.3390/antibiotics11111583 -
BMJ Open Jan 2020Infections remain a threat for solid organ and stem cell transplant recipients. Antimicrobial prophylaxis and pre-emptive therapy have improved survival of these...
OBJECTIVES
Infections remain a threat for solid organ and stem cell transplant recipients. Antimicrobial prophylaxis and pre-emptive therapy have improved survival of these patients; however, the failure rates of prophylaxis are not negligible. The aim of this systematic review is to explore the reasons behind failure of antimicrobial prophylaxis and pre-emptive therapy.
SETTING
This systematic review included prospective randomised controlled trials and prospective single-arm studies.
PARTICIPANTS
The studies included were on prophylaxis and pre-emptive therapy of opportunistic infections in transplant recipients. Studies were included from databases MEDLINE, CENTRAL and Embase published until October first 2018.
PRIMARY AND SECONDARY OUTCOME MEASURES
Primary outcome measures were breakthrough infections, adverse events leading to stopping of treatment, switching medication or dose reduction. Secondary outcome measures were acquired resistance to antimicrobials, antifungals or antivirals and death.
RESULTS
From 3317 identified records, 30 records from 24 studies with 2851 patients were included in the systematic review. Seventeen focused on prophylactic and pre-emptive treatment of cytomegalovirus and seven studies on invasive fungal infection. The main reasons for failure of prophylaxis and pre-emptive therapy were adverse events and breakthrough infections, which were described in 54% (13 studies) and 38% (9 studies) of the included studies, respectively. In 25%, six of the studies, a detailed description of patients who experienced failure of prophylaxis or pre-emptive therapy was unclear or lacking.
CONCLUSIONS
Our results show that although failure is reported in the studies, the level of detail prohibits a detailed analysis of failure of prophylaxis and pre-emptive therapy. Clearly reporting on patients with a negative outcome should be improved. We have provided guidance on how to detect failure early in a clinical setting in accordance to the results from this systematic review.
PROSPERO REGISTRATION NUMBER
CRD42017077606.
Topics: Adult; Antibiotic Prophylaxis; Clinical Trials as Topic; Cytomegalovirus Infections; Documentation; Drug Resistance, Microbial; Humans; Invasive Fungal Infections; Opportunistic Infections; Organ Transplantation; Randomized Controlled Trials as Topic; Stem Cell Transplantation; Transplant Recipients; Treatment Failure
PubMed: 31915177
DOI: 10.1136/bmjopen-2019-034940 -
Clinical Biochemistry Jul 2011Low thiopurine S-methyltransferase (TPMT) enzyme activity is associated with increased thiopurine drug toxicity, particularly myelotoxicity. Pre-analytic and analytic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Low thiopurine S-methyltransferase (TPMT) enzyme activity is associated with increased thiopurine drug toxicity, particularly myelotoxicity. Pre-analytic and analytic variables for TPMT genotype and phenotype (enzyme activity) testing were reviewed.
DESIGN AND METHODS
A systematic literature review was performed, and diagnostic laboratories were surveyed.
RESULTS
Thirty-five studies reported relevant data for pre-analytic variables (patient age, gender, race, hematocrit, co-morbidity, co-administered drugs and specimen stability) and thirty-three for analytic variables (accuracy, reproducibility). TPMT is stable in blood when stored for up to 7 days at room temperature, and 3 months at -30°C. Pre-analytic patient variables do not affect TPMT activity. Fifteen drugs studied to date exerted no clinically significant effects in vivo. Enzymatic assay is the preferred technique. Radiochemical and HPLC techniques had intra- and inter-assay coefficients of variation (CVs) below 10%.
CONCLUSION
TPMT is a stable enzyme, and its assay is not affected by age, gender, race or co-morbidity.
Topics: Aging; Azathioprine; Enzyme Stability; Health Care Surveys; Hematocrit; Humans; Mercaptopurine; Methyltransferases; Prescription Drugs; Purines; Sex Characteristics; Thioguanine
PubMed: 21402061
DOI: 10.1016/j.clinbiochem.2011.03.022 -
The Journal of Sexual Medicine Mar 2023Sexual function after hysterectomy can be a concern for patients, and research remains inconclusive about changes in sexual function associated with hysterectomy. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sexual function after hysterectomy can be a concern for patients, and research remains inconclusive about changes in sexual function associated with hysterectomy.
AIM
We meta-analyzed studies on change in sexual function from pre- to posthysterectomy and the role of total vs subtotal hysterectomy and concomitant bilateral salpingo-oophorectomy (BSO) in differences in such change.
METHODS
We searched PubMed, Embase, and Cochrane databases from inception to January 2022. Two reviewers screened and included studies if they were published in a peer-reviewed journal and reported on sexual function pre- and posthysterectomy for benign nonprolapse indication. Methodological quality was assessed with the STROBE checklist. We used random effects multilevel models to meta-analyze standardized mean differences in pre- to postoperative sexual function and the posthysterectomy Female Sexual Function Index mean across study groups in R (RStudio).
OUTCOMES
Outcomes included overall sexual function, dyspareunia, desire, arousal, lubrication, and orgasm.
RESULTS
Thirty-two articles were analyzed: 8 randomized controlled trials, 20 prospective studies, 2 retrospective studies, 1 cross-sectional study, and 1 secondary analysis, comprising a total of 4054 patients. Each study provided data for at least 1 outcome. Study quality was moderate, and effect sizes showed large between-study heterogeneity. Hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route, with patients tending to report potentially remaining sexual dysfunction posthysterectomy. Cervix removal was not significantly associated with differences in magnitude of change. Hysterectomy without BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy with BSO, which was not the case for desire, arousal or overall sexual function. However, these significant differences were not replicated within studies that directly compared cases with and without BSO.
CLINICAL IMPLICATIONS
Clinicians should address remaining sexual dysfunction posthysterectomy, and BSO should not be considered if not medically required.
STRENGTHS AND LIMITATIONS
We analyzed a comprehensive number of trials and studied clinically relevant factors that might relate to differences in change in sexual function. Conclusions need to be interpreted with caution since many studies showed moderate methodological quality and large effect size heterogeneity.
CONCLUSION
Subtotal and total hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route, with patients tending to report potentially remaining sexual dysfunction posthysterectomy. Hysterectomy without BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy with BSO. Future research on hysterectomy should analyze predictors of sexual function change trajectories, such as different indications.
Topics: Female; Humans; Retrospective Studies; Prospective Studies; Cross-Sectional Studies; Hysterectomy; Sexual Dysfunction, Physiological; Randomized Controlled Trials as Topic
PubMed: 36857309
DOI: 10.1093/jsxmed/qdac051 -
The Canadian Journal of Hospital... 2018Pharmacists have been involved in the care of transplant recipients for several decades, and a growing body of literature shows the beneficial effects of clinical... (Review)
Review
BACKGROUND
Pharmacists have been involved in the care of transplant recipients for several decades, and a growing body of literature shows the beneficial effects of clinical pharmacist care on important outcomes for these patients.
OBJECTIVES
The primary objective was to describe the roles and impacts of pharmacists in a solid organ transplant setting. The secondary objective was to describe and rate the pharmacists' interventions.
DATA SOURCES
Three databases-PubMed, Embase, and Evidence-Based Medicine Reviews-were searched from January 1, 1990, to June 16, 2015.
STUDY SELECTION AND DATA EXTRACTION
All studies addressing the roles of pharmacists and the impacts of clinical pharmacy services on the care of solid organ transplant recipients were considered. Only studies providing a statistical analysis were included. Design, setting, sample size, patient characteristics, pharmacists' interventions, study bias, and outcomes were extracted for analysis.
DATA SYNTHESIS
Four randomized controlled trials, 4 cohort studies, 3 pre-post studies, and 1 quasi-randomized controlled trial were included in the review, representing a total of 1837 patients. Of the 12 studies included, 8 specifically focused on renal transplant, and 1 each focused on liver, lung, abdominal organ, and general solid organ transplant. The pivotal pharmacist activities leading to the main patient outcomes were medication counselling ( = 8 studies), medication reconciliation ( = 5), and reviewing and optimizing drug therapy ( = 3). Improvements to medication adherence ( = 6 studies), morbidity ( = 4), costs ( = 2), and medication errors ( = 2) were reported.
CONCLUSION
Currently available evidence suggests that pharmacists can improve patient outcomes in the solid organ transplant setting. Adherence, morbidity, costs, and medication errors were identified as the main outcomes that were improved by pharmaceutical interventions. Transplant programs need to invest more in this resource.
PubMed: 30401999
DOI: No ID Found