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

Perceived causes of prescribing errors by physicians: A qualitative study

Purpose: To explore physicians’ perceived causes of prescribing errors in Saudi hospitals.Methods: This qualitative study was conducted in three tertiary hospitals in Riyadh, Saudi Arabia: two academic and one government military hospital. A total of 13 physicians from three hospitals participated in two focus groups. Discussions were audiotaped and transcribed verbatim. Transcripts were analysed using thematic content analysis and categorised into themes of error-producing conditions, latent conditions and both successful and unsuccessful defences, based on Reason’s Accident Causation Model.Results: Error-producing conditions included the prescriber, the work environment, the team, the task, the patient and the computer system. The most commonly cited category related to the prescriber’s skills and knowledge. The most important latent conditions reported were a shortage of clinical pharmacists followed by lack of computerised physician order entry. The major unsuccessful defences were appropriate references and internet facilities, which were often unavailable.Conclusion: Several causes of prescribing errors were identified. Lack of clinical pharmacists and lack of computerised prescribing systems are the key issues.Keywords: Prescribing errors, Qualitative study, Computerized prescribing system, Reason’s accident causation mode

Simvastatin Ameliorates Diabetic Cardiomyopathy by Attenuating Oxidative Stress and Inflammation in Rats

Simvastatin is a lipid-lowering agent used to treat hypercholesterolemia and to reduce the risk of heart disease. This study scrutinized the beneficial effects of simvastatin on experimental diabetic cardiomyopathy (DCM), pointing to the role of hyperglycemia-induced oxidative stress and inflammation. Diabetes was induced by intraperitoneal injection of streptozotocin and both control and diabetic rats received simvastatin for 90 days. Diabetic rats showed significant cardiac hypertrophy, body weight loss, hyperglycemia, and hyperlipidemia. Serum creatine kinase MB (CK-MB) and troponin I showed a significant increase in diabetic rats. Simvastatin significantly improved body weight, attenuated hyperglycemia and hyperlipidemia, and ameliorated CK-MB and troponin I. Simvastatin prevented histological alterations and deposition of collagen in the heart of diabetic animals. Lipid peroxidation and nitric oxide were increased in the heart of diabetic rats whereas antioxidant defenses were decreased. These alterations were significantly reversed by simvastatin. In addition, simvastatin decreased serum inflammatory mediators and expression of NF-κB in the diabetic heart. Cardiac caspase-3 was increased in the diabetic heart and decreased following treatment with simvastatin. In conclusion, our results suggest that simvastatin alleviates DCM by attenuating hyperglycemia /hyperlipidemia-induced oxidative stress, inflammation, and apoptosis

Antibacterial and Antibiofilm Activity of Mercaptophenol Functionalized-Gold Nanorods Against a Clinical Isolate of Methicillin-Resistant Staphylococcus aureus

Gold nanorods (AuNRs) were synthesized by the seed-mediated wet chemical method using a binary surfactant system. AuNRs were stabilized with polyethylene glycol, then functionalized with 4-mercaptophenol (4-MPH) ligand by surface ligand exchange. The surface-functionalized AuNRs (4-MPH-AuNRs) exhibited a typical UV–vis spectrum of AuNRs with a slightly shifted longitudinal peak. Furthermore, 4-MPH-AuNRs demonstrated a similar Fourier-Transformed Infrared spectrum to 4-MPH and a fading of the thiol band, which suggests a successful functionalization through thiol-gold binding. The antibacterial and antibiofilm activities of 4-MPH-AuNRs were evaluated against a clinical isolate of Methicillin-Resistant Staphylococcus aureus (MRSA). The results indicate that 4-MPH-AuNRs exhibit a bactericidal activity with a minimum inhibitory concentration (MIC) of ~ 6.25 μ g/mL against a planktonic suspension of MRSA. Furthermore, 4-MPH-AuNRs resulted in a 1.8–2.9 log-cycle reduction of MRSA biofilm viable count over a concentration range of 100–6.0 μ g/mL. The bacterial uptake of the surface-modified nanorods was investigated by inductively coupled plasma-optical emission spectroscopy (ICP-OES) and scanning electron microscopy (SEM) imaging; the results reveal that the nanorods were internalized into the bacterial cells after 6 h (h) of exposure. SEM imaging revealed a significant accumulation of the nanorods at the bacterial cell wall and a possible cellular internalization. Thus, 4-MPH-AuNRs can be considered a potential antibacterial agent, particularly against MRSA strain biofilms.Open Access funding provided by the Qatar National Library. Funding was provided by Al-Zaytoonah University of Jordan (2020-2019/12/28) and Qatar University (BRC-2021-ID-02, QUST-2-CHS-2021-2019)

Developmental Toxicity of Surface-Modified Gold Nanorods in the Zebrafish Model

Background: nanotechnology is one of the fastest-growing areas, and it is expected to have a substantial economic and social impact in the upcoming years. Gold particles (AuNPs) offer an opportunity for wide-ranging applications in diverse fields such as biomedicine, catalysis, and electronics, making them the focus of great attention and in parallel necessitating a thorough evaluation of their risk for humans and ecosystems. Accordingly, this study aims to evaluate the acute and developmental toxicity of surfacemodified gold nanorods (AuNRs), on zebrafish (Danio rerio) early life stages. Methods: in this study, zebrafish embryos were exposed to surface-modified AuNRs at concentrations ranging from 1 to 20 μg/mL. Lethality and developmental endpoints such as hatching, tail flicking, and developmental delays were assessed until 96 h post-fertilization (hpf). Results: we found that AuNR treatment decreases the survival rate in embryos in a dose-dependent manner. Our data showed that AuNRs caused mortality with a calculated LC50 of EC50,24hpf of AuNRs being 9.1 μg/mL, while a higher concentration of AuNRs was revealed to elicit developmental abnormalities. Moreover, exposure to high concentrations of the nanorods significantly decreased locomotion compared to untreated embryos and caused a decrease in all tested parameters for cardiac output and blood flow analyses, leading to significantly elevated expression levels of cardiac failure markers ANP/NPPA and BNP/NPPB. Conclusions: our results revealed that AuNR treatment at the EC50 induces apoptosis significantly through the P53, BAX/BCL-2, and CASPASE pathways as a suggested mechanism of action and toxicity modality.This research was funded by the Qatar University–internal grant, grant number QUCP-CHS-2022-483 for M.A. and financial funding of the Deanship of Scientific Research at the Al-Zaytoonah University of Jordan (2020-2019/12/28) for N.M

The effect of surface-modified gold nanorods on the early stage of embryonic development and angiogenesis: Insight into the molecular pathways

Gold nanorods have been implicated in several biomedical applications. Herein, the effect of two surface-modified gold nanorods on the early stages of embryogenesis and angiogenesis was investigated using avian embryos at three days and their chorioallantoic membrane (CAM) at five days of incubation. We found that gold nanorods (GNR) modified with PEGylated phospholipid moiety show a high mortality rate in embryos after four days of exposure compared to GNR modified with PEGylated cholesterol moiety. Meanwhile, our data revealed that surface modified-GNR significantly inhibit the formation of new blood vessels in the treated CAM model after 48 h of exposure. Moreover, we report that surface-modified GNR significantly deregulate the expression of several genes implicated in cell proliferation, invasion, apoptosis, cellular energy metabolism, and angiogenesis. On the other hand, our data point out that GNR treatments can modulate the expression patterns of JNK1/2/3, NF-KB/p38, and MAPK, which could be the main molecular pathways of the nanorods in our experimental models.This research was funded by the following Qatar University Grant: (QUCG-CMED-20/21-2) and the Deanship of Scientific Research at Al-Zaytoonah University of Jordan (2020–2019/12/28

Effects of feeding rate and formula fineness degree of ring die pellet mill on mechanical property, physical quality, energy requirements, and production cost of poultry diets

The effect of a machine feeding rate (FR; 1, 1.5 and 2 Mg/h) and/or three levels of selected fineness degree (FD; 3, 5 and 7 mm) on machine performance, pellet physical parameters, required energy and production cost of three main types of broilers diets were examined in this experiment. The examined broiler diets were formulated to meet the Ross 308 strain requirements. A complete factorial design (3×3×3) was used to identify the effects of studied factors on the pellet mill machine and pellet production. The obtained results indicated that the pellet mill productivity significantly (p˂0.001) improved through increased pellet mill feeding rate level. In addition, the machine pelleting efficiency was found to be significantly affected by all studied variables and their interactions. While the total power consumption of the machine showed no variations under the impact of the tested factors or with any of their combinations. Regarding the pellet physical quality indices, all broiler diets with all selected FD and lower FR had the maximum durability and bulk density levels. Furthermore, lower feeding rates were associated with higher hardness degrees. The lowest production costs were substantially correlated with high FR and intermediate FD (5 mm). Furthermore, production costs were determined to be reduced in finisher broiler diets under different feeding rates. Moreover, manufacturing costs of finisher broiler meals were observed to decrease in several feeding rates. Overall, these findings indicate the capabilities of producing high-quality pellets and reducing the needed production costs by optimizing feeding rates to 2 Mg/h and 2 mm fineness in broiler diets

Mass Spectrometry, Structural Analysis, and Anti-Inflammatory Properties of Photo-Cross-Linked Human Albumin Hydrogels

Albumin-based hydrogels offer unique benefits such as biodegradability and high binding affinity to various biomolecules, which make them suitable candidates for biomedical applications. Here, we report a non-immunogenic photocurable human serum-based (HSA) hydrogel synthesized by methacryloylation of human serum albumin by methacrylic anhydride (MAA). We used matrix-assisted laser desorption ionization-time-of-flight mass spectrometry, liquid chromatography-tandem mass spectrometry, as well as size exclusion chromatography to evaluate the extent of modification, hydrolytic and enzymatic degradation of methacrylated albumin macromer and its cross-linked hydrogels. The impacts of methacryloylation and cross-linking on alteration of inflammatory response and toxicity were evaluated in vitro using brain-derived HMC3 macrophages and Ex-Ovo chick chorioallantoic membrane assay. Results revealed that the lysines in HSA were the primary targets reacting with MAA, though modification of cysteine, threonine, serine, and tyrosine, with MAA was also confirmed. Both methacrylated HSA and its derived hydrogels were nontoxic and did not induce inflammatory pathways, while significantly reducing macrophage adhesion to the hydrogels; one of the key steps in the process of foreign body reaction to biomaterials. Cytokine and growth factor analysis showed that albumin-based hydrogels demonstrated anti-inflammatory response modulating cellular events in HMC3 macrophages. Ex-Ovo results also confirmed the biocompatibility of HSA macromer and hydrogels along with slight angiogenesis-modulating effects. Photocurable albumin hydrogels may be used as a non-immunogenic platform for various biomedical applications including passivation coatings

Wastewater-irrigated vegetables are a significant source of heavy metal contaminants : toxicity and health risks

Water contaminated with heavy metals constitutes an important threat. This threat is a real problem with a negative impact in some developing countries where untreated industrial effluents are used for irrigation. The present study examines heavy metals in wastewater-irrigated vegetables (apple gourd, spinach, cauliflower, sponge gourd, and coriander) water, and soil from Chenab Nagar, Chiniot, Pakistan. In particular, the metals quantified were cadmium (Cd), chromium (Cr), cobalt (Co), nickel (Ni), lead (Pb), and manganese (Mn). Among them, Cr and Co in crops irrigated -wastewater exceeded the levels recommended by the World Health Organization (WHO). In contrast, Ni, Cu, Pb, and Mn concentrations were in line with WHO standards. Compared with the limits established by the Food and Agriculture Organization of the United Nations (FAO), all the study vegetables presented higher (thus unsafe) concentrations of Cd (0.38 to 1.205 mg/Kg). There were also unsafe concentrations of Cr in coriander, sponge gourd, and cauliflower. Pb was found at an unsafe concentration (0.59 mg/Kg) in cauliflower. Conversely, Ni and Mn concentrations were below the maximum permissible limits by WHO, and FAO in all of the analyzed samples. The contamination load index (CLI) in soil, bioconcentration factor (BCF) in plants, daily intake of metals (DIM), and health risk index (HRI) have also been evaluated to estimate the potential risk to human health in that area. We have found an important risk of transitions of Pb, Cd, Cr, and Co from water/soil to the edible part of the plant. The highest HRI value associated with Cd (6.10–13.85) followed by Cr (1.25–7.67) for all vegetable samples presented them as high health risk metal contaminants. If the issue is not addressed, consumption of wastewater-irrigated vegetables will continue posing a health risk

Coronary Artery Bypass Grafting (CABG) versus Percutaneous Coronary Intervention (PCI) in treatment of left main coronary artery disease

BackgroundCoronary artery bypass graft surgery (CABG) has been widely used for left main coronary artery disease (LMCAD). Percutaneous coronary intervention (PCI) has become an option for this condition.AimsTo summarize the current evidence that compare between CABG vs. PCI in regards to ‎cardiac death, stroke, and myocardial infarction.‎Methods We searched randomized trials of treatment of LMCAD with PubMed, Google Scholar, and EBSCO.Results Five randomized studies were retrieved, which compared the efficacy between CABG vs. PCI in treatment of LMCAD.ConclusionPCI may be reasonable management of patients with LM stenosis involving distal bifurcation or with coexisting multivessel disease