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Drugs & Aging Jun 2024Listing tools have been developed to improve medications in older patients, including the Fit fOR The Aged (FORTA) list, a clinically validated, positive-negative list...
BACKGROUND
Listing tools have been developed to improve medications in older patients, including the Fit fOR The Aged (FORTA) list, a clinically validated, positive-negative list of medication appropriateness. Here, we aim to validate MyFORTA, an automated tool for individualized application of the FORTA list.
METHODS
331 participants of a multi-center cohort study (AgeCoDe) for whom the FORTA score (sum of overtreatment and undertreatment errors) had been determined manually (gold standard [GS]) were reassessed using the automated MyFORTA (MF) tool. This tool determines the score from ATC and ICD codes combined with clinical parameters.
RESULTS
The FORTA scores were 9.01 ± 2.91 (mean ± SD, MF) versus 6.02 ± 2.52 (GS) (p < 0.00001). Removing undertreatment errors for calcium/vitamin D (controversial guidelines) and influenza/pneumococcal vaccinations (no robust information in the database), the difference decreased: 7.5 ± 2.7 (MF) versus 5.98 ± 2.55 (GS) (p < 0.00001). The remaining difference was driven by, for example, missing nitro spray in coronary heart disease/acute coronary syndrome as the related information was rarely found in the database, but notoriously detected by MF. Three hundred and forty errors from those 100 patients with the largest score deviation accounted for 68% of excess errors by MF.
CONCLUSION
MF was more sensitive to detect medication errors than GS, all frequent errors only detected by MF were plausible, and almost no adaptations of the MF algorithm seem indicated. This automated tool to check medication appropriateness according to the FORTA list is now validated and represents the first clinically directed algorithm in this context. It should ease the application of FORTA and help to implement the proven beneficial effects of FORTA on clinical endpoints.
Topics: Humans; Aged; Male; Female; Aged, 80 and over; Potentially Inappropriate Medication List; Cohort Studies; Inappropriate Prescribing
PubMed: 38848020
DOI: 10.1007/s40266-024-01120-1 -
Contemporary Clinical Trials... Jun 2024Enteral nutrition (EN) is preferred when oral feeding is not possible. The use of the Nasogastric Tube (NGT) ensures rapid and low-risk nutrient administration. However,...
BACKGROUND
Enteral nutrition (EN) is preferred when oral feeding is not possible. The use of the Nasogastric Tube (NGT) ensures rapid and low-risk nutrient administration. However, confirming the placement through chest radiography, besides delaying the initiation of nutritional therapy, exposes patients to radiation. The pH test of gastric aspirate provides a quicker check for NGT placement, but its reliability is compromised by challenges related to aspirating gastric secretions.
STUDY OBJECTIVE
The main objective of this study is to assess the high-performance placement of NGTs for nutritional purposes, optimizing the evaluation of correct insertion through pH testing using an electronic pH meter. Additionally, the study aims to evaluate patient tolerance to the intervention.
MATERIALS AND METHODS
This single-center RCT will include 150 EN candidate patients divided into three groups. Each group will use distinct NGTs, evaluating placement through pH testing and chest radiography for safety. Tolerance, complications related to NGT placement, and costs will be assessed, with data collected anonymously through a secure electronic database.
ETHICAL CONSIDERATIONS
authorization no. 3624, Territorial Ethical Committee Lombardy 5, October 20, 2023.
IMPLICATIONS AND PERSPECTIVES
This protocol introduces innovative technologies, such as advanced NGTs and an electronic pH meter, aiming to optimize enteral nutrition management. This RCT focuses on replacing X-rays as the primary method for verifying NGT placement, thereby reducing costs, time, and patient exposure to radiation. Data analysis may provide insights into managing patients on pH-altering medication. Implementing innovative technologies has the potential to reduce errors and improve economic efficiency and process sustainability.
PubMed: 38845620
DOI: 10.1016/j.conctc.2024.101312 -
BMC Nursing Jun 2024When any aspect of patient care is overlooked or delayed, it is known as Missed Nursing Care (MNC), leading to adverse events such as medication errors, infections,...
BACKGROUND
When any aspect of patient care is overlooked or delayed, it is known as Missed Nursing Care (MNC), leading to adverse events such as medication errors, infections, increased mortality rates, and poor prognosis. Moral competence is crucial for clinical nurses as it guarantees high-quality patient care in nursing practice. Thus, this study aimed to investigate the correlation between moral competencies and MNC among nurses.
METHODS
This study was conducted with a descriptive-correlational design. The participants in the study were nurses who were currently enrolled at Shahid Beheshti University of Medical Sciences. In order to recruit nurses for the study, a convenience sampling method was implemented. The study tools were completed by a total of two hundred nurses. Research tools included a demographic questionnaire, the Moral Competence of Clinical Nurses Questionnaire, and the Kalisch and Williams Missed Nursing Care (MISSCARE) survey.
ETHICAL CONSIDERATION
This study was approved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences.
RESULTS
The mean scores of moral competencies and MNC were 151.83 ± 12.60 and 42.71 ± 9.38, respectively. In other words, descriptive statistics showed that the moral competence score was more than 75%, and the MNC score was less than 50%. Also, there was a significant negative correlation between the total scores of moral competencies and MNC (r = -0.38, p < 0.001), indicating that more moral competence was correlated with lower levels of MNC.
CONCLUSION
The study revealed a negative correlation between nurses' moral competence and MNC, suggesting that enhancing moral competence could reduce MNC. To reduce MNC occurrences, hospitals, and organizations should prioritize moral competency, according to our research.
PubMed: 38844989
DOI: 10.1186/s12912-024-02058-w -
BMC Public Health Jun 2024To explore the risk factors for maternal near-miss (MNM) using the WHO near-miss approach.
OBJECTIVE
To explore the risk factors for maternal near-miss (MNM) using the WHO near-miss approach.
METHODS
Data were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012-2022. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (aORs) were used to identify risk factors for MNM.
RESULTS
Our study included 780,359 women with 731,185 live births, a total of 2461 (0.32%) MNMs, 777,846 (99.68%) non-MNMs, and 52 (0.006%) maternal deaths were identified. The MNM ratio was 3.37‰ (95%CI: 3.23-3.50). Coagulation/hematological dysfunction was the most common cause of MNM (75.66%). Results of multivariate logistic regression analysis showed risk factors for MNM: maternal age > = 30 years old (aOR > 1, P < 0.05), unmarried women (aOR = 2.21, 95%CI: 1.71-2.85), number of pregnancies > = 2 (aOR > 1, P < 0.05), nulliparity (aOR = 1.51, 95%CI: 1.32-1.72) or parity > = 3 (aOR = 1.95, 95%CI: 1.50-2.55), prenatal examinations < 5 times (aOR = 1.13, 95%CI: 1.01-1.27), and number of cesarean sections was 1 (aOR = 1.83, 95%CI: 1.64-2.04) or > = 2 (aOR = 2.48, 95%CI: 1.99-3.09).
CONCLUSION
The MNM ratio was relatively low in Hunan Province. Advanced maternal age, unmarried status, a high number of pregnancies, nulliparity or high parity, a low number of prenatal examinations, and cesarean sections were risk factors for MNM. Our study is essential for improving the quality of maternal health care and preventing MNM.
Topics: Humans; Female; China; Risk Factors; Pregnancy; Adult; Near Miss, Healthcare; Young Adult; Pregnancy Complications; Logistic Models; Maternal Mortality
PubMed: 38844895
DOI: 10.1186/s12889-024-18970-4 -
PloS One 2024The pharmacist plays an essential role in identifying and managing drug-related problems. The aim of this research was to assess the costs avoided by clinical pharmacist...
BACKGROUND
The pharmacist plays an essential role in identifying and managing drug-related problems. The aim of this research was to assess the costs avoided by clinical pharmacist interventions to resolve drug-related problems.
RESEARCH DESIGN AND METHODS
Clinical pharmacists identified drug-related problems and interventions to address them in consecutive outpatients visiting internal medicine clinics at major teaching and public hospitals in Jordan from September 2012 to December 2013. The costs avoided by each intervention to address drug-related problems were collected from the literature. The collected data were used to calculate the overall cost saved and avoided by the interventions implemented to address the identified drug-related problems, adopting a Jordanian healthcare system perspective.
RESULTS
A total of 2747 patients were enrolled in the study. Diagnostic interventions, such as the need for additional diagnostic testing, were employed in 95.07% of the 13935 intervention to address the drug-related problem "Miscellaneous" which was the most frequent drug-related problems. Other common drug-related problems categories included inappropriate knowledge (n = 6972), inappropriate adherence (4447), efficacy-related drug-related problem (3395) and unnecessary drug therapy (1082). The total cost avoided over the research period was JOD 1418720 per month and total cost saved over the study period was JOD 17250.204. Drug-related problems were associated the number of prescription medications (odds ratio = 1.105; 95% confidence interval = 1.069-1.142), prescribed gastrointestinal drugs (3.485; 2.86-4.247), prescribed antimicrobials (3.326; 1.084-10.205), and prescribed musculoskeletal drugs (1.385; 1.011-1.852).
CONCLUSIONS
The study revealed that pharmacists have provided cognitive input to rationalize and optimize the medication use and prevent errors, that led to the reported projected avoided and saved expenditures via various interventions to address drug-related problems. This highlights the added economic impact to the clinical impact of drug-related problems on patients and the healthcare system. The high prevalence and cost of drug-related problems offer strong rationale for pharmacists to provide more vigilant intervention to improve patient outcomes while maintaining cost effectiveness.
Topics: Humans; Jordan; Pharmacists; Male; Female; Middle Aged; Drug-Related Side Effects and Adverse Reactions; Ambulatory Care Facilities; Aged; Adult; Cost Savings
PubMed: 38843244
DOI: 10.1371/journal.pone.0302287 -
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 -
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 -
Sultan Qaboos University Medical Journal May 2024
Topics: Humans; Polypharmacy; Inappropriate Prescribing; Medication Therapy Management
PubMed: 38828254
DOI: 10.18295/squmj.3.2024.014 -
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