What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.Objective To investigate the epidemiology of medication errors and error-related adverse events in adults in primary care, ambulatory care and patients’ homes. Design Systematic review. Data source Six international databases were searched for publications between 1 January 2006 and 31 December 2015. Data extraction and analysis Two researchers independently extracted data from eligible studies and assessed the quality of these using established instruments. Synthesis of data was informed by an appreciation of the medicines’ management process and the conceptual framework from the International Classification for Patient Safety. Results 60 studies met the inclusion criteria, of which 53 studies focused on medication errors, 3 on error-related adverse events and 4 on risk factors only. The prevalence of prescribing errors was reported in 46 studies: prevalence estimates ranged widely from 2% to 94%. Inappropriate prescribing was the most common type of error reported. Only one study reported the prevalence of monitoring errors, finding that incomplete therapeutic/safety laboratory-test monitoring occurred in 73% of patients. The incidence of preventable adverse drug events (ADEs) was estimated as 15/1000 person-years, the prevalence of drug–drug interaction-related adverse drug reactions as 7% and the prevalence of preventable ADE as 0.4%. A number of patient, healthcare professional and medication-related risk factors were identified, including the number of medications used by the patient, increased patient age, the number of comorbidities, use of anticoagulants, cases where more than one physician was involved in patients’ care and care being provided by family physicians/general practitioners. Conclusion A very wide variation in the medication error and error-related adverse events rates is reported in the studies, this reflecting heterogeneity in the populations studied, study designs employed and outcomes evaluated. This review has identified important limitations and discrepancies in the methodologies used and gaps in the literature on the epidemiology and outcomes of medication errors in community settings.Peer reviewe

Shear strength properties of clean and clay infilled rock joints: an analysis of the impast of moisture content under CNL conditions

Rock joints are a type of fracture or discontinuity that have little or no movement that is parallel to the plane of fracture caused by forces acting perpendicular to the fractured walls, where the opening of the break is parallel to the face of least resistance. These are common phenomena in geology around the world and range from small scale to tectonic fault lines. The first part of this project focused on the effect of clean rock joints on the shear strength of the joint at normal loads of 100, 300, 500 and 700 kPa. Rock joints leave an opportunity for infill to occur in the form of soil, water, or mineral precipitates. The second part of this project focuses on the effects of sodium bentonite clay infill with moisture contents of 0%, 10% and 16% and normal stresses of 100, 300, 500 and 700 kPa on the shear strength properties of rock joints. As shear strength is a controlling factor for slope stability, it is important to continue research into this area in order to optimise future engineering project outcomes. There are two main loading conditions for the direct shear testing of rock joints; Constant Normal Loading (CNL) and Constant Normal Stiffness (CNS). As CNL and CNS conditions are representative of different real-world applications it is critical to understand the scope and context of each investigation. This project was conducted under the CNL boundary condition as it predominately focuses on the impact of moisture content on the shear strength of rock joints under unsaturated conditions. These conditions are more likely to occur in shallow rock formations due to the infill and moisture fluctuations that are caused by water infiltration and precipitation

Towards a Rational Design of an Asymptomatic Clinical Herpes Vaccine: The Old, the New, and the Unknown

The best hope of controlling the herpes simplex virus type 1 and type 2 (HSV-1 and HSV-2) pandemic is the development of an effective vaccine. However, in spite of several clinical trials, starting as early as 1920s, no vaccine has been proven sufficiently safe and efficient to warrant commercial development. In recent years, great strides in cellular and molecular immunology have stimulated creative efforts in controlling herpes infection and disease. However, before moving towards new vaccine strategy, it is necessary to answer two fundamental questions: (i) why past herpes vaccines have failed? (ii) Why the majority of HSV seropositive individuals (i.e., asymptomatic individuals) are naturally “protected” exhibiting few or no recurrent clinical disease, while other HSV seropositive individuals (i.e., symptomatic individuals) have frequent ocular, orofacial, and/or genital herpes clinical episodes? We recently discovered several discrete sets of HSV-1 symptomatic and asymptomatic epitopes recognized by CD4+ and CD8+ T cells from seropositive symptomatic versus asymptomatic individuals. These asymptomatic epitopes will provide a solid foundation for the development of novel herpes epitope-based vaccine strategy. Here we provide a brief overview of past clinical vaccine trials, outline current progress towards developing a new generation “asymptomatic” clinical herpes vaccines, and discuss future mucosal “asymptomatic” prime-boost vaccines that could optimize local protective immunity

The prevalence of blinding trachoma in northern states of Sudan.

BACKGROUND: Despite historical evidence of blinding trachoma, there have been no widespread contemporary surveys of trachoma prevalence in the northern states of Sudan. We aimed to conduct district-level surveys in this vast region in order to map the extent of the problem and estimate the need for trachoma control interventions to eliminate blinding trachoma. METHODS AND FINDINGS: Separate, population based cross-sectional surveys were conducted in 88 localities (districts) in 12 northern states of Sudan between 2006 and 2010. Two-stage cluster random sampling with probability proportional to size was used to select the sample. Trachoma grading was done using the WHO simplified grading system. Key prevalence indicators were trachomatous inflammation-follicular (TF) in children aged 1-9 years and trachomatous trichiasis (TT) in adults aged 15 years and above. The sample comprised 1,260 clusters from which 25,624 households were surveyed. A total of 106,697 participants (81.6% response rate) were examined for trachoma signs. TF prevalence was above 10% in three districts and between 5% and 9% in 11 districts. TT prevalence among adults was above 1% in 20 districts (which included the three districts with TF prevalence >10%). The overall number of people with TT in the population was estimated to be 31,072 (lower and upper bounds = 26,125-36,955). CONCLUSION: Trachoma mapping is complete in the northern states of Sudan except for the Darfur States. The survey findings will facilitate programme planning and inform deployment of resources for elimination of trachoma from the northern states of Sudan by 2015, in accordance with the Sudan Federal Ministry of Health (FMOH) objectives

The Effect of Andrographolide on the Metabolism of Carbamazepine in Rats

Objective: To determine if andrographolide (AND) impacts the pharmacokinetics of carbamazepine (CBZ). Background: CBZ is an anticonvulsant medication that is metabolized in the liver by cytochrome P450 (CYP) enzymes. AND is an over-the-counter medication that is common in Eastern cultures to treat inflammation and is a CYP enzyme inhibitor. Because CBZ is metabolized in the liver by these specific CYP enzymes, coadministration of andrographolide and CBZ could result in a herb-drug interaction. Methods: Sprague-Dawley rats (N=12) aged between 3 months and 6 months (250-350 g) will be split into control (N=6) and treatment (N=6) groups. The treatment group will receive an AND injection (dissolved in dimethyl sulfoxide to 10 mg/mL) intraperitoneally for seven consecutive days. On the eighth day, another AND injection will be administered intraperitoneally as well as an injection of CBZ (CBZ powder prepared into a 20 mg/mL emulsion) administered via intravenous route. Plasma samples will be collected every 20 minutes for 4 hours and stored at -20℃. Analysis: HPLC analysis will yield a time vs. plasma concentration graph that will allow us to calculate the rate of elimination (K). The mean K value will be determined for both the control and treatment group. The mean K value of 6 rats in the treatment group will be compared to the mean value of K of the 6 rats in the control group. These will be analyzed using SPSS and utilizing an unpaired t test, with a p\u3c0.05 deemed statistically significant

Herb-Drug Interaction of Andrographolide on the Pharmacokinetics of Carbamazepine in Rats

Objective: To determine if andrographolide (AND) impacts the pharmacokinetics of carbamazepine (CBZ). Background: CBZ is an anticonvulsant medication that is metabolized in the liver by cytochrome P450 (CYP) enzymes. AND is an over-the-counter medication that is common in Eastern cultures to treat inflammation and is a CYP enzyme inhibitor. Because CBZ is metabolized in the liver by these specific CYP enzymes, coadministration of andrographolide and CBZ could result in a herb-drug interaction. Methods: Sprague-Dawley rats (N=12) aged between 3 months and 6 months (250-350 g) will be split into control (N=6) and treatment (N=6) groups. The treatment group will receive an AND injection (dissolved in dimethyl sulfoxide to 10 mg/mL) intraperitoneally for seven consecutive days. On the eighth day, another AND injection will be administered intraperitoneally as well as an injection of CBZ (CBZ powder prepared into a 20 mg/mL emulsion) administered via intravenous route. Plasma samples will be collected every 20 minutes for 4 hours and stored at -20℃. Analysis: HPLC analysis will yield a time vs. plasma concentration graph that will allow us to calculate the rate of elimination (K). The mean K value will be determined for both the control and treatment group. The mean K value of 6 rats in the treatment group will be compared to the mean value of K of the 6 rats in the control group. These will be analyzed using SPSS and utilizing an unpaired t test, with a

Perceptions of women, their husbands and healthcare providers about anemia in rural Pakistan: Findings from a qualitative exploratory study

Background: In Pakistan, there is a dearth of literature on the perceptions of anemia among women of reproductive age (WRA). This study was undertaken to explore the perceptions of women, their husbands, and healthcare providers about anemia, its possible causes, and how anemia impacts maternal and child health in Thatta, Pakistan.Methods: A qualitative study was conducted in Thatta, Pakistan from September to December 2018. Using a pre-tested semi-structured interview (SSI), we collected data to understand their definitions of anemia through ten focus group discussions (FGDs) with women and their partners and ten primary informant interviews (KIIs) with healthcare providers. We identified six major themes: (I) Knowledge and awareness of anemia, (II) Causes and consequences of Anemia, (III) Dietary practices, (IV) Knowledge and practices regarding the use of iron-folic acid supplements, (V) Factors influencing prevention and control of anemia and (VI) Women\u27s health behavior. We analyzed the data through thematic analysis using NVivo 10 software.Results: Most community members were not aware of the term anemia but described anemia as a condition characterized by \u27blood deficiency\u27 in the body. All study participants perceived anemia as an important health problem tending to cause adverse outcomes among WRA and their children. Study participants perceived gutka (chewable tobacco) consumption as an important cause of anemia. Healthcare providers identified short inter-pregnancy intervals, lack of family planning, poor health-seeking behavior, and consumption of unhealthy food as causes of anemia in the district. Consumption of unhealthy food might not be related to related to a poorer knowledge of iron-deficient foods, but economic constraints. This was further endorsed by the healthcare providers who mentioned that most women were too poor to afford iron-rich foods. All men and women were generally well versed with the sources of good nutrition to be consumed by WRA to prevent anemia.Conclusion: The findings suggest that the government should plan to develop strategies for poverty-stricken and vulnerable rural women and plan health awareness programs to improve dietary practices, compliance with supplements, and health-seeking behavior among women of reproductive age. There is a need to develop effective counseling strategies and context-specific health education sessions to improve the health-seeking behavior of women and men in the Thatta district of Pakistan. Besides, there is need to address social determinants of health such as poverty that pushes women of poorer socioeconomic strata to eat less nutritious foods and have more anaemia. Therefore, a comprehensive and robust strategic plan need to be adopted by government that focuses not only on the awareness programs, but also aim to reduce inequities that lead to pregnant women eat iron-poor foods, which, in turn, forces them to become anemic

Pregnancy Outcomes among Women with an Unintended Pregnancy: Findings from a Prospective Registry in Rural Pakistan

Background: Unintended pregnancies are an important public health issue in both developed and developing countries. An unintended pregnancy may affect maternal health seeking behavior during the antenatal and postpartum periods, which can adversely affect perinatal outcomes. Aim: The specific aim of our study was to measure antepartum, intrapartum, and postpartum pregnancy outcomes among women with unintended pregnancies in a rural Pakistani population.Methods: Using a prospective maternal and newborn health registry in Thatta Pakistan, we evaluated temporal associations between unintended pregnancy and several dimensions of health seeking behavior including: antenatal care, preference for private versus government facility for antenatal care, and use of tetanus toxoid (TT) vaccine during the current pregnancy. We performed logistic regressions to analyze the data.Results: In a multivariable model, we found that women who claimed their pregnancies as unintended were 1.27 times more likely to not utilize any facility for antenatal care as compared to women with intended pregnancies [OR = 1.27; 95% CI (1.11 - 1.46)]. Likewise, women with unintended pregnancies were 1.23 times more likely to not receive tetanus toxoid vaccine during the antenatal period [OR = 1.23; 95% CI (1.06 - 1.41)] and were 1.20 times more likely to utilize a government facility compared to private facilities for the antenatal care as compared to their counterparts with intended pregnancies [OR = 1.20; 95% CI (1.04 - 1.38)].Conclusions: Women with unintended pregnancies were less likely to seek antenatal care and preferred government facilities when they did enroll; these facilities are known for providing subsidized but suboptimal care. Our results show that women who decide to carry unintended pregnancies should be considered a high-risk group that requires focused counseling on adherence to antenatal care and delivery planning. Prevention of unintended and unplanned pregnancies in rural areas through provision of family planning services should be encouraged

Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: prospective longitudinal qualitative study

Objectives To examine the care experiences of South Asian Sikh and Muslim patients in Scotland with life limiting illness and their families and to understand the reasons for any difficulties with access to services and how these might be overcome