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Alternative Therapies in Health and... Jun 2024This meta-analysis aims to investigate the effects of prenatal prophylactic antibiotics on the diversity of intestinal flora in premature infants, with a focus on...
OBJECTIVE
This meta-analysis aims to investigate the effects of prenatal prophylactic antibiotics on the diversity of intestinal flora in premature infants, with a focus on elucidating the rationale behind this investigation and the potential impact of altered intestinal flora on the health of preterm infants, such as increased susceptibility to infections, impaired nutrient absorption, and compromised immune function.
METHODS
Relevant literature consistent with the effects of prenatal prophylactic antibiotics on intestinal flora diversity in preterm infants was systematically searched and screened from both domestic and foreign databases, including Wanfang Medical Center, CNKNET, VIpp, and PubMed. Meta-analysis was performed using RevMan 5.2 software. Inclusion criteria for the study were: (1) comparison of prophylactic antibiotic use versus non-use, (2) no restrictions on subjects' characteristics, (3) follow-up loss < 20%, (4) institutional approval, (5) publication within the time frame from January 2017 to December 2022, (6) minimal missing data or suppliable by author contact, and (7) no major errors in sequencing or detection. Outcome measures included intestinal flora composition, phylum flora content, abundance index, and Shannon index, comparing antibiotic-treated and non-treated groups. RevMan 5.2 software was used for statistical analysis. Counting data was expressed as risk ratio (RR), and weighted mean difference (WMD) or standard mean difference (SMD) was selected as analysis statistics.
RESULTS
The study encompassed five Chinese literature sources, with one deemed low quality and four high quality. No significant publication bias was observed. Among the included studies, a significant reduction in the intestinal flora abundance index ACE was noted in the treated group compared to the non-treated group (RR: -8.10, 95% CI: -8.81 to -7.40, P < .00001). ACE estimates species richness in a microbial community by considering both abundant and rare species. Higher ACE values indicate greater diversity. Similarly, the Shannon diversity index was lower in the medication group compared to the non-medication group (RR: 0.73, 95% CI: 0.64 to 0.82, P < .00001). Shannon Diversity Index measures species diversity and evenness within a community. Higher values indicate higher diversity, considering both the number of species and their relative abundance. Analysis of Firmicutes content revealed a higher level in the treated group (RR: -6.44, 95% CI: -7.26 to -5.63, P < .00001). Additionally, lower Proteus (RR: 10.96, 95% CI: 9.47 to 12.45, P < .00001) and Klebsiella (RR: 15.96, 95% CI: 15.31 to 16.62, P < .00001) content was observed in the treated group. Conversely, Enterococcus content was higher in the treated group (RR: 2.18, 95% CI: 1.84 to 2.52, P < .00001), along with a higher proportion of Enterococcus (RR: 0.45, 95% CI: 0.27 to 0.76, P = .003). These findings collectively suggest that prophylactic antibiotic use in preterm infants significantly alters the composition of intestinal flora.
CONCLUSION
Our findings suggest that prophylactic antibiotic use in preterm infants leads to a notable reduction in intestinal flora diversity, potentially impacting their health outcomes. Decreased microbial diversity has been linked to gastrointestinal issues, infections, and weakened immune function. These results highlight the importance of cautious antibiotic use in this vulnerable population and the need for further research to better understand and mitigate the potential health implications.
PubMed: 38836722
DOI: No ID Found -
Military Medicine Jun 2024During high-fidelity simulations in the Critical Care Air Transport (CCAT) Advanced course, we identified a high frequency of insulin medication errors and sought...
INTRODUCTION
During high-fidelity simulations in the Critical Care Air Transport (CCAT) Advanced course, we identified a high frequency of insulin medication errors and sought strategies to reduce them using a human factors approach.
MATERIALS AND METHODS
Of 169 eligible CCAT simulations, 22 were randomly selected for retrospective audio-video review to establish a baseline frequency of insulin medication errors. Using the Human Factors Analysis Classification System, dosing errors, defined as a physician ordering an inappropriate dose, were categorized as decision-based; administration errors, defined as a clinician preparing and administering a dose different than ordered, were categorized as skill-based. Next, 3 a priori interventions were developed to decrease the frequency of insulin medication errors, and these were grouped into 2 study arms. Arm 1 included a didactic session reviewing a sliding-scale insulin (SSI) dosing protocol and a hands-on exercise requiring all CCAT teams to practice preparing 10 units of insulin including a 2-person check. Arm 2 contained arm 1 interventions and added an SSI cognitive aid available to students during simulation. Frequency and type of insulin medication errors were collected for both arms with 93 simulations for arm 1 (January-August 2021) and 139 for arm 2 (August 2021-July 2022). The frequency of decision-based and skill-based errors was compared across control and intervention arms.
RESULTS
Baseline insulin medication error rates were as follows: decision-based error occurred in 6/22 (27.3%) simulations and skill-based error occurred in 6/22 (27.3%). Five of the 6 skill-based errors resulted in administration of a 10-fold higher dose than ordered. The post-intervention decision-based error rates were 9/93 (9.7%) and 23/139 (2.2%), respectively, for arms 1 and 2. Compared to baseline error rates, both arm 1 (P = .04) and arm 2 (P < .001) had a significantly lower rate of decision-based errors. Additionally, arm 2 had a significantly lower decision-based error rate compared to arm 1 (P = .015). For skill-based preparation errors, 1/93 (1.1%) occurred in arm 1 and 4/139 (2.9%) occurred in arm 2. Compared to baseline, this represents a significant decrease in skill-based error in both arm 1 (P < .001) and arm 2 (P < .001). There were no significant differences in skill-based error between arms 1 and 2.
CONCLUSIONS
This study demonstrates the value of descriptive error analysis during high-fidelity simulation using audio-video review and effective risk mitigation using training and cognitive aids to reduce medication errors in CCAT. As demonstrated by post-intervention observations, a human factors approach successfully reduced decision-based error by using didactic training and cognitive aids and reduced skill-based error using hands-on training. We recommend the development of a Clinical Practice Guideline including an SSI protocol, guidelines for a 2-person check, and a cognitive aid for implementation with deployed CCAT teams. Furthermore, hands-on training for insulin preparation and administration should be incorporated into home station sustainment training to reduced medication errors in the operational environment.
PubMed: 38836595
DOI: 10.1093/milmed/usae286 -
European Journal of Hospital Pharmacy :... Jun 2024Patients in intensive care units (ICUs) are potentially more vulnerable to medication errors than patients admitted to general wards. However, little is known about...
OBJECTIVES
Patients in intensive care units (ICUs) are potentially more vulnerable to medication errors than patients admitted to general wards. However, little is known about medication safety strategies used in European ICUs. Our objectives were to explore the strategies being used and being planned within European ICUs, to identify areas of variation, and to inform recommendations to improve medication safety in this patient group.
METHODS
We distributed an online survey, in seven European languages, via professional networks and social media. The survey explored a range of medication safety strategies and whether they were in use (and if so, whether fully or partially implemented) or being planned. Demographic information about respondents and their ICUs was also captured. A descriptive analysis was conducted, which included exploring geographical variation.
RESULTS
We obtained 587 valid responses from 32 different countries, with 317 (54%) completed by pharmacy staff. Medication safety practices most commonly implemented were patients' allergies being visible for all staff involved in their care (fully implemented in 382 (65%) of respondents' ICUs), standardised emergency medication stored in a fixed place (337, 57%), and use of standardised medication concentrations for commonly used intravenous infusions (330, 56%). Electronic prescribing systems were fully implemented in 310 (53%). A pharmacist was reported to be fully implemented in 181 (31%) of ICUs, of which there was 126 (70%) where there was a pharmacist review of all ordered medication five days per week. Critical care pharmacists were most common in Northern European ICUs (fully implemented to ICUs in 102, 50%) and electronic prescribing in Western Europe (108, 65%).
CONCLUSIONS
There is considerable variation in medication safety strategies used within European ICUs, both between and within geographical areas. Our findings may be helpful to ICU staff in identifying strategies that should be considered for implementation.
PubMed: 38834286
DOI: 10.1136/ejhpharm-2023-004018 -
AMA Journal of Ethics Jun 2024Overprescription of antibiotics in cases in which bacterial infection is clinically uncertain contributes to increased prevalence of multidrug-resistant bacteria....
Overprescription of antibiotics in cases in which bacterial infection is clinically uncertain contributes to increased prevalence of multidrug-resistant bacteria. Ethically, merits and drawbacks of stricter prescription practice oversight should be weighed against risks of untreatable bacterial infections to patients and communities. This article considers how to balance this set of ideas and values.
Topics: Humans; Anti-Bacterial Agents; Patient-Centered Care; Bacterial Infections; Drug Resistance, Multiple, Bacterial; Inappropriate Prescribing; Drug Resistance, Bacterial
PubMed: 38833425
DOI: 10.1001/amajethics.2024.494 -
Annals of Medicine Dec 2024Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs)...
INTRODUCTION
Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia.
METHODS
Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented.
RESULTS
The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2-3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8).
CONCLUSIONS
Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations.
Topics: Humans; Nursing Homes; Polypharmacy; Benzodiazepines; Inappropriate Prescribing; Male; Female; Aged, 80 and over; Aged; Croatia; Homes for the Aged; Prevalence; Psychotropic Drugs; Practice Patterns, Physicians'
PubMed: 38833339
DOI: 10.1080/07853890.2024.2357232 -
Clinical Journal of Oncology Nursing May 2024Managing antineoplastic orders, side effects, and symptoms is a primary role of oncology advanced practice providers (APPs). Antineoplastic management (ANM) is complex...
BACKGROUND
Managing antineoplastic orders, side effects, and symptoms is a primary role of oncology advanced practice providers (APPs). Antineoplastic management (ANM) is complex because of risk of medication errors, narrow therapeutic range of agents, frequent dose adjustments, and multiple drug regimens.
OBJECTIVES
This article describes an academic institution's review of current practice for ANM privileging and employing Plan-Do-Study-Act (PDSA) cycles to develop a revised process relevant to APP practice, addressing efficiency, accessibility, and cost-effectiveness.
METHODS
Using consecutive PDSA cycles, the team revised the didactic portion of the ANM privileging process and collaborated with nurses, pharmacists, and physicians for mentoring expertise.
FINDINGS
The revised process resulted in increased relevance of ANM didactic content while requiring 75% less time to complete. To date, all ANM-privileged APPs at the institution (N = 49) have completed the revised ANM privileging process, with a 100% pass rate on the competency assessment.
Topics: Humans; Antineoplastic Agents; Quality Improvement; Neoplasms; Female; Male; Advanced Practice Nursing; Medical Oncology; Oncology Nursing
PubMed: 38830244
DOI: 10.1188/24.CJON.263-271 -
Sultan Qaboos University Medical Journal May 2024
Topics: Humans; Polypharmacy; Inappropriate Prescribing; Medication Therapy Management
PubMed: 38828254
DOI: 10.18295/squmj.3.2024.014 -
European Journal of Clinical... Jun 2024To demonstrate the effective integration of pharmacometrics and pharmacovigilance in managing medication errors, highlighted by a case involving secukinumab in a patient...
PURPOSE
To demonstrate the effective integration of pharmacometrics and pharmacovigilance in managing medication errors, highlighted by a case involving secukinumab in a patient with hidradenitis suppurativa.
METHODS
We present the case of a 41-year-old male with progressive hidradenitis suppurativa, unresponsive to multiple antibiotic regimens and infliximab treatment. Due to a medication error, the patient received 300 mg of secukinumab daily for 4 days instead of weekly, totaling 1200 mg. The regional pharmacovigilance center assessed potential toxicity, and a pharmacometric analysis using a population pharmacokinetic model was performed to inform dosing adjustments.
RESULTS
Clinical data indicated that the received doses were within a non-toxic range. No adverse effects were observed. Pharmacometric simulations revealed a risk of underexposure due to the dosing error. Based on these simulations, it was recommended to restart monthly secukinumab injections on day 35 after the initial dose. Measured plasma concentrations before re-administration confirmed the model's accuracy.
CONCLUSION
This case highlights the crucial collaboration between clinical services, pharmacovigilance, and pharmacometrics in managing medication errors. Such interdisciplinary efforts ensure therapeutic efficacy and patient safety by maintaining appropriate drug exposure levels.
PubMed: 38822846
DOI: 10.1007/s00228-024-03705-6 -
BMC Health Services Research May 2024To explore the application effect of the direct reporting system of adverse nursing events and special continuous nursing quality improvement measures in the management...
OBJECTIVE
To explore the application effect of the direct reporting system of adverse nursing events and special continuous nursing quality improvement measures in the management of these adverse events.
METHODS
The implementation time of continuous nursing improvement based on the direct reporting system was the demarcation point. We retrospectively collected and analyzed nursing adverse event reports and hospitalization data from Xiangtan Central Hospital before implementation (2015-2018) and after implementation (2019-2022). The active reporting rate of adverse events, the composition of these events and the processing time were compared between the two groups.
RESULTS
The rate of active reporting of adverse events before the implementation was lower than that after the implementation (6.7% vs. 8.1%, X = 25.561, P < 0.001). After the implementation of the direct reporting system for nursing events and the continuous improvement of nursing quality, the reporting proportion of first-level and second-level events decreased significantly. Moreover, the reporting proportion of third-level events increased significantly. The proportion of falls and medication errors decreased, and the proportion of unplanned extubation, infusion xerostomia and improper operation increased. The processing time of the reported nursing adverse events was significantly reduced (31.87 ± 7.83 vs. 56.87 ± 8.21, t = 18.73, P < 0.001).
CONCLUSION
The direct reporting system of adverse nursing events and the continuous improvement measures for nursing quality can effectively improve the active reporting rate of adverse events, change their composition and reduce their processing time, as well as help create a safe psychological environment for both patients and nursing staff.
Topics: Humans; Retrospective Studies; Quality Improvement; Female; Male; Medical Errors; Nursing Staff, Hospital; China; Adult; Middle Aged
PubMed: 38822344
DOI: 10.1186/s12913-024-10913-4 -
BMJ Case Reports May 2024While typically thought of as an illicit substance, oxybate salts or gamma-hydroxybutyrate (GHB) has more recently been prescribed to treat narcolepsy by enhancing...
Accidental calcium, magnesium, potassium and sodium oxybates (Xywave) overdose: mistiming of a single night's narcolepsy medication leading to respiratory failure requiring mechanical ventilation.
While typically thought of as an illicit substance, oxybate salts or gamma-hydroxybutyrate (GHB) has more recently been prescribed to treat narcolepsy by enhancing night-time sleep resulting in decreased daytime drowsiness. This case involves a college-aged female with prescribed GHB for narcolepsy who took her second nightly dose too early. This resulted in mental depression, respiratory failure, intubation and mechanical ventilation. The patient was successfully extubated in the intensive care unit several hours later with no residual morbidity. We were unable to identify any prior reports of mixed-salt oxybate toxicity following mistimed drug administration. This case should serve as a warning to emergency physicians to be on the lookout for GHB as part of the differential diagnosis for patients with narcolepsy presenting with altered mental status. It should also serve as a warning to patients and prescribers that this medication can have outcomes that require immediate medical intervention.
Topics: Humans; Female; Narcolepsy; Sodium Oxybate; Respiratory Insufficiency; Drug Overdose; Respiration, Artificial; Magnesium; Potassium; Medication Errors
PubMed: 38821567
DOI: 10.1136/bcr-2024-260025