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Acta Informatica Medica : AIM : Journal... Mar 2022Computerized Provider Order Entry (CPOE) systems developed based on clinical guidelines are believed to greatly reduce chemotherapy medication prescription errors. (Review)
Review
BACKGROUND
Computerized Provider Order Entry (CPOE) systems developed based on clinical guidelines are believed to greatly reduce chemotherapy medication prescription errors.
OBJECTIVE
The present study reviewed the effects of guideline-based CPOEs on the chemotherapy order process.
METHODS
PubMed, Scopus, Embase, Web of Science, and IEEE Xplore databases published up to 1 June 2020 were systematically searched for studies investigating the effect of guideline-based CPOEs on the chemotherapy order process. Moreover, the bibliography of relevant retrieved publications was also checked.
RESULTS
Nineteen articles from the five databases met the eligibility criteria and were reviewed. Eleven out of 19 (58%) articles investigated the effect of CPOEs on medication errors, and other studies examined other aspects of CPOE efficacy, including time required for chemotherapy prescriptions; Safety, policy compliance and communication between health care providers; physicians prescribing behavior; quality and safety of treatment; workflow; direct patient care time; and adherence to guidelines. In addition, 15 out of 19 mentioned the use of specific clinical guidelines.
CONCLUSION
Evidence indicates CPOEs can positively affect the quality of healthcare service delivery for cancer patients, but there is still a dearth of clinical outcome evaluation data about the effects of these systems on patients undergoing chemotherapy. Moreover, there is limited information about guideline compliance errors, which highlights the needs for further research in this area.
PubMed: 35800912
DOI: 10.5455/aim.2022.30.61-68 -
International Journal of Clinical... Aug 2022People living with diabetes often experience multiple morbidity and polypharmacy, increasing their risk of potentially inappropriate prescribing. Inappropriate... (Review)
Review
BACKGROUND
People living with diabetes often experience multiple morbidity and polypharmacy, increasing their risk of potentially inappropriate prescribing. Inappropriate prescribing is associated with poorer health outcomes.
AIM
The aim of this scoping review was to explore and map studies conducted on potentially inappropriate prescribing among adults living with diabetes and to identify gaps regarding identification and assessment of potentially inappropriate prescribing in this group.
METHOD
Studies that reported any type of potentially inappropriate prescribing were included. Studies conducted on people aged < 18 years or with a diagnosis of gestational diabetes or prediabetes were excluded. No restrictions to language, study design, publication status, geographic area, or clinical setting were applied in selecting the studies. Articles were systematically searched from 11 databases.
RESULTS
Of the 190 included studies, the majority (63.7%) were conducted in high-income countries. None of the studies used an explicit tool specifically designed to identify potentially inappropriate prescribing among people with diabetes. The most frequently studied potentially inappropriate prescribing in high-income countries was contraindication while in low- and middle-income countries prescribing omission was the most common. Software and websites were mostly used for identifying drug-drug interactions. The specific events and conditions that were considered as inappropriate were inconsistent across studies.
CONCLUSION
Contraindications, prescribing omissions and dosing problems were the most commonly studied types of potentially inappropriate prescribing. Prescribers should carefully consider the individual prescribing recommendations of medications. Future studies focusing on the development of explicit tools to identify potentially inappropriate prescribing for adults living with diabetes are needed.
Topics: Adult; Databases, Factual; Diabetes Mellitus; Drug Interactions; Humans; Inappropriate Prescribing; Polypharmacy; Potentially Inappropriate Medication List
PubMed: 35776376
DOI: 10.1007/s11096-022-01414-7 -
The Journal of Antimicrobial... Aug 2022Primary care accounts for 80%-90% of antimicrobial prescriptions, making this setting an important focus for antimicrobial stewardship (AMS) interventions.
BACKGROUND
Primary care accounts for 80%-90% of antimicrobial prescriptions, making this setting an important focus for antimicrobial stewardship (AMS) interventions.
OBJECTIVES
To collate the findings and critically appraise the qualities of economic evaluation studies of AMS or related interventions aimed at reducing inappropriate antimicrobial prescribing in primary care.
METHODS
A systematic review of economic evaluations of interventions aimed at reducing inappropriate antimicrobial prescribing in primary care was performed. Published literature were retrieved through a search of Medline, Embase, EconLit and Web of Science databases for the period 2010 to 2020. The quality of the studies was assessed using the Consensus on Health Economic Criteria checklist and Good Practice Guidelines for Decision-Analytic Modelling in Health Technology Assessment.
RESULTS
Of the 2722 records identified, 12 studies were included in the review (8 trial-based and 4 modelled evaluations). The most common AMS interventions were communication skills training for health professionals and C-reactive protein point-of-care testing (CRP-POCT). Types of economic evaluations included in the review were cost-effectiveness (7 studies), cost-utility (1), cost-benefit (2), cost-effectiveness and cost-utility (1) and cost analysis (1). While six of the studies found AMS interventions to be cost-effective, the other six reported them as not cost-effective or inconclusive. The quality of the studies ranged from good to low.
CONCLUSIONS
There were significant variations in cost-effectiveness of AMS interventions across studies and depending on the inclusion of cost components such as the cost of antimicrobial resistance. However, communication skills training and CRP-POCT were frequently cost-effective or cost-beneficial for reducing inappropriate antimicrobial prescribing.
Topics: Anti-Bacterial Agents; Anti-Infective Agents; Antimicrobial Stewardship; Cost-Benefit Analysis; Humans; Inappropriate Prescribing; Primary Health Care
PubMed: 35724206
DOI: 10.1093/jac/dkac185 -
International Journal of Environmental... May 2022Potentially inappropriate prescribing (PIP) is associated with an increased risk of adverse drug reactions, recognized as a determinant of adherence and increased... (Review)
Review
Potentially inappropriate prescribing (PIP) is associated with an increased risk of adverse drug reactions, recognized as a determinant of adherence and increased healthcare costs. The study's aim was to explore and compare the results of interventions to reduce PIP and its impact on avoidable healthcare costs. A systematic literature review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement guidelines. PubMed and Embase were queried until February 2021. Inclusion criteria followed the PICO model: older patients receiving PIP; Interventions aimed at health professionals, structures, and patients; no/any intervention as a comparator; postintervention costs variations as outcomes. The search strategy produced 274 potentially relevant publications, of which 18 articles met inclusion criteria. Two subgroups were analyzed according to the study design: observational studies assessing PIP frequency and related-avoidable costs ( = 10) and trials, including specific intervention and related outcomes in terms of postintervention effectiveness and avoided costs ( = 8). PIP prevalence ranged from 21 to 79%. Few educational interventions carried out to reduce PIP prevalence and avoidable costs resulted in a slowly improving prescribing practice but not cost effective. Implementing cost-effective strategies for reducing PIP and clinical and economic implications is fundamental to reducing health systems' PIP burden.
Topics: Aged; Cost-Benefit Analysis; Drug-Related Side Effects and Adverse Reactions; Health Care Costs; Humans; Inappropriate Prescribing; Prevalence
PubMed: 35682331
DOI: 10.3390/ijerph19116724 -
Journal of the American Board of Family... 2022To review the literature on medication safety in primary care in the electronic health record era. (Review)
Review
PURPOSE
To review the literature on medication safety in primary care in the electronic health record era.
METHODS
Included studies measured rates and outcomes of medication safety in patients whose prescriptions were written in primary care clinics with electronic prescribing. Four investigators independently reviewed titles and analyzed abstracts with dual-reviewer review for eligibility, characteristics, and risk of bias.
RESULTS
Of 1464 articles identified, 56 met the inclusion criteria. Forty-three studies were noninterventional and 13 included an intervention. The majority of the studies (30) used their own definition of error. The most common outcomes were potentially inappropriate prescribing/medications (PIPs), adverse drug events (ADEs), and potential prescribing omissions (PPOs). Most of the studies only included high-risk subpopulations (39), usually older adults taking > 4 medications. The rate of PIPs varied widely (0.19% to 98.2%). The rate of ADEs was lower (0.47% to 14.7%). There was poor correlation of PIP and PPO with documented ADEs leading to physical harm.
CONCLUSIONS
This literature is limited by its inconsistent and highly variable outcomes. The majority of medication safety studies in primary care were in high-risk populations and measured potential harms rather than actual harms. Applying algorithms to primary care medication lists significantly overestimates rate of actual harms.
Topics: Aged; Ambulatory Care Facilities; Drug-Related Side Effects and Adverse Reactions; Humans; Inappropriate Prescribing; Potentially Inappropriate Medication List; Primary Health Care
PubMed: 35641040
DOI: 10.3122/jabfm.2022.03.210334 -
Frontiers in Pharmacology 2022Attention deficit hyperactivity disorder (ADHD) is commonly a neurodevelopmental behavioural disorder in children and adolescents. Mainly characterized by symptoms like...
Attention deficit hyperactivity disorder (ADHD) is commonly a neurodevelopmental behavioural disorder in children and adolescents. Mainly characterized by symptoms like lack of attention, hyperactivity, and impulsiveness, it can impact the overall mental development of the one affected. Several factors, both genetic and non-genetic, can be responsible for this disorder. Although several traditional treatment methods involve medication and other counselling techniques, they also come with different side effects. Hence, the choice is now shifting to alternative treatment techniques. Herbal treatments are considered one of the most popular complementary and alternative medicine (CAM) administered. However, issues related to the safety and efficacy of herbal remedies for the treatment of ADHD need to be investigated further. This study aims to find out the recent advancement in evidence-based use of herbal remedies for ADHD by a comprehensive and systematic review that depicts the results of the published works on herbal therapy for the disorder. The electronic databases and the references retrieved from the included studies present related randomized controlled trials (RCTs) and open-label studies. Seven RCTs involving children and adolescents diagnosed with ADHD met the inclusion criteria. There is a fair indication of the efficacy and safety of Melissa officinalis L., Bacopa monnieri (L.) Wettst., Matricaria chamomilla L., and Valeriana officinalis L. from the studies evaluated in this systematic review for the treatment of various symptoms of ADHD. Limited evidence was found for Ginkgo biloba L. and pine bark extract. However, various other preparations from other plants did not show significant efficacy. There is inadequate proof to strongly support and recommend the administration of herbal medicines for ADHD, but more research is needed in the relevant field to popularize the alternative treatment approach.
PubMed: 35592415
DOI: 10.3389/fphar.2022.827411 -
BMJ Global Health Apr 2022Maternal near miss (MNM) is a useful means to examine quality of obstetric care. Since the introduction of the WHO MNM criteria in 2011, it has been tested and... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Maternal near miss (MNM) is a useful means to examine quality of obstetric care. Since the introduction of the WHO MNM criteria in 2011, it has been tested and validated, and is being used globally. We sought to systematically review all available studies using the WHO MNM criteria to develop global and regional estimates of MNM frequency and examine its application across settings.
METHODS
We conducted a systematic review by implementing a comprehensive literature search from 2011 to 2018 in six databases with no language restrictions. The predefined data collection tool included sections on study characteristics, frequency of near-miss cases and study quality. Meta-analysis was performed by regional groupings. Reported adaptations, modifications and remarks about application were extracted.
RESULTS
7292 articles were screened by title and abstract, and 264 articles were retrieved for full text review for the meta-analysis. An additional 230 articles were screened for experiences with application of the WHO MNM criteria. Sixty studies with near-miss data from 56 countries were included in the meta-analysis. The pooled global near-miss estimate was 1.4% (95% CI 0.4% to 2.5%) with regional variation in MNM frequency. Of the 20 studies that made adaptations to the criteria, 19 were from low-resource settings where lab-based criteria were adapted due to resource limitations.
CONCLUSIONS
The WHO MNM criteria have enabled the comparison of global and sub-national estimates of MNM frequency. There has been good uptake in low-resource countries but contextual adaptations are necessary.
Topics: Family; Female; Humans; Maternal Mortality; Near Miss, Healthcare; Pregnancy; Pregnancy Complications; World Health Organization
PubMed: 35387768
DOI: 10.1136/bmjgh-2021-007077 -
The Journal of Allergy and Clinical... Jul 2022Inhaled medications are central to treating asthma and chronic obstructive pulmonary disease (COPD), yet critical inhaler technique errors are made by up to 90% of...
Is Inhaler Technique Adequately Assessed and Reported in Clinical Trials of Asthma and Chronic Obstructive Pulmonary Disease Therapy? A Systematic Review and Suggested Best Practice Checklist.
BACKGROUND
Inhaled medications are central to treating asthma and chronic obstructive pulmonary disease (COPD), yet critical inhaler technique errors are made by up to 90% of patients. In the clinical research setting, recruitment of subjects with poor inhaler technique may give a false impression of both the benefits and the necessity of add-on treatments such as biologic therapies.
OBJECTIVE
To assess the frequency with which inhaler technique is assessed and reliably optimized before and during patient enrollment into randomized controlled trials (RCTs) addressing the efficacy of topical therapy, and the escalation of therapy for asthma and COPD.
METHODS
Systematic searches were conducted of PubMed and Embase for RCTs published in the past 10 years involving patients with a diagnosis of asthma or COPD undergoing escalation of baseline inhaled therapy (stepping up, changing, adding, switching, increasing, etc) or the introduction of biologic agents.
RESULTS
Searches highlighted 1,014 studies, 118 of which were eligible after the removal of duplicates as well as screening and full text review. Of these, only 14 (11.9%) included accessible information in the methods section or referred to such information in online supplements or protocols concerning assessment of participants' inhaler technique. We therefore developed the proposed Best Practice Inhaler Technique Assessment and Reporting Checklist.
CONCLUSIONS
Our study identifies a concerning lack of checking and correcting inhaler technique, or at least reporting that this was undertaken, before enrollment in asthma and COPD RCTs, which may affect the conclusions drawn. Mandating the use of a standardized checklist in RCT protocols and ensuring all published RCTs report checking and correcting inhaler technique before enrollment are important next steps.
Topics: Administration, Inhalation; Asthma; Checklist; Humans; Nebulizers and Vaporizers; Pulmonary Disease, Chronic Obstructive
PubMed: 35364340
DOI: 10.1016/j.jaip.2022.03.013 -
Pain Research & Management 2022The dose of intrathecal morphine is important because of its narrow therapeutic range. Due to a compounding error, pharmacy-compounded, ready-to-use syringes contained... (Review)
Review
BACKGROUND
The dose of intrathecal morphine is important because of its narrow therapeutic range. Due to a compounding error, pharmacy-compounded, ready-to-use syringes contained 1 mg ml morphine instead of the intended 50 mcg ml. Six patients consequently received this twenty-fold dose. This study aims to describe the serious adverse events in these six patients and a systematic review is added to describe the characteristics of serious adverse events after intrathecal morphine.
METHODS
A retrospective case series described all six patients that received the erroneous morphine intrathecally for analgesia after laparoscopic segmental colonic resections. The patients' charts were reviewed for the occurrence, timing, duration and management of adverse events, the vital signs at the night after surgery, and length of hospital stay. A systematic review investigated characteristics of serious adverse events after intrathecal morphine in a perioperative setting.
RESULTS
Four patients had a serious adverse event, which was respiratory depression combined with somnolence ( = 3) and hypotension ( = 1). The review yielded 63 cases with serious adverse events, predominantly somnolence and/or respiratory depression. The onset occurred between 2 and 24 hours after injection. The severity of symptoms varied and life-threatening respiratory depression only occurred after a dose >900 mcg or when potentiating medication was used. Naloxone did not affect analgesia. No prolonged sequalae occurred.
CONCLUSION
This study reveals that respiratory depression and somnolence are the predominant serious adverse events after intrathecal morphine in a perioperative setting and demonstrated a large variation in the presentation of symptoms.
Topics: Analgesia; Humans; Injections, Spinal; Morphine; Naloxone; Retrospective Studies
PubMed: 35311036
DOI: 10.1155/2022/4567192 -
Frontiers in Public Health 2022Polypharmacy and inappropriate prescribing are overlooked issues in Bulgaria. We aimed at collecting and analyzing global literature on the most prevalent risk factors... (Meta-Analysis)
Meta-Analysis
Impact of Polypharmacy, Drug-Related Problems, and Potentially Inappropriate Medications in Geriatric Patients and Its Implications for Bulgaria-Narrative Review and Meta-Analysis.
OBJECTIVE
Polypharmacy and inappropriate prescribing are overlooked issues in Bulgaria. We aimed at collecting and analyzing global literature on the most prevalent risk factors and investigating what they could reveal about current practice.
MATERIALS AND METHODS
A systematic narrative review and meta-analysis was conducted on the topic, investigating the prevalence of polypharmacy, odds of potentially inappropriate medications (PIMs) due to polypharmacy, and the likelihood of developing a drug-related problem (DRP) due to PIMs. The results were then related to current demographic statistics to estimate the potential impact on Bulgarian elderly patients.
RESULTS
The prevalence of polypharmacy was estimated at 41% in elderly populations. The odds of a potentially inappropriate medication being prescribed were 2.095, with an expected 30.84% of those leading to a DRP. These numbers indicated that the expected Bulgarian elderly with polypharmacy should be 709,676 with 212,903 cases of DRPs.
CONCLUSION
Global polypharmacy rates seem to be on the rise, with an expected increase in DRPs.
Topics: Aged; Bulgaria; Humans; Inappropriate Prescribing; Polypharmacy; Potentially Inappropriate Medication List; Prevalence
PubMed: 35309221
DOI: 10.3389/fpubh.2022.743138