Multicompartment compliance aids in the community: the prevalence of potentially inappropriate medications.

The aim of this study was to assess the prevalence of potentially inappropriate medications (PIMs) use in a population of community-based multicompartment compliance aid (MCA) users in north-east Scotland. The research recorded data for MCAs dispensed by 48 of the 50 community pharmacies in Aberdeen City, between 1st June to 31st October 2014, together with concurrently prescribed medications, patient demographics and Carstairs index of social deprivation. Drug-specific quality indicators for PIMs from the Swedish National Board of Health and Welfare were applied, and bivariate logistic regression analysis was used to investigate associations with demographic variables. The median age was 82 years (range 12-105 years, 59% female). A total of 1977 PIMs were identified, affecting 57.8% of patients. A quarter of patients were prescribed >10 medications and 43% had a prescription containing at least one clinically significant drug-drug interaction (DDI). Ten drug groups accounted for 76% of all DDIs. A significant increase in the risk for at least one PIM was associated with female sex (for all indicators of PIM use), age 10 medications [OR: 1.43, 95% CI: 1.16-1.78], prescription of a long-acting benzodiazepine [OR: 1.84, CI: 1.14-2.98]). The study concluded that MCA use is associated with a significant incidence of PIMs, particularly affecting those younger than 80 years and those living in deprived areas. Our findings indicate the need for a more aggressive multidisciplinary approach to the review of the medications prescribed to MCA users

Adequate Levels of Adherence with Controller Medication Is Associated with Increased Use of Rescue Medication in Asthmatic Children

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Health, educational and employment outcomes among children treated for a skin disorder : Scotland-wide retrospective record linkage cohort study of 766,244 children

Acknowledgments The authors would like to acknowledge the support of the electronic Data Research and Innovation Services (eDRIS) within Public Health Scotland for their involvement in obtaining approvals, provisioning, and linking data and the use of the secure analytical platform within the National Safe Haven. Funding: The study was sponsored by Health Data Research UK (www.hdruk.ac.uk) (grant reference number MR/S003800/1 awarded to Dr Michael Fleming) which is a joint investment led by the Medical Research Council, together with the National Institute for Health Research (England), the Chief Scientist Office (Scotland), Health and Care Research Wales, Health and Social Care Research and Development Division (Public Health Agency, Northern Ireland), the Engineering and Physical Sciences Research Council, the Economic and Social Research Council, the British Heart Foundation and Wellcome Trust. The sponsor and funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review or approval of the manuscript, or decision to submit the manuscript for publication.Peer reviewedPublisher PD

Complementary and Alternative Medicines Use during Pregnancy : A Systematic Review of Pregnant Women and Healthcare Professional Views and Experiences

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Prevalence and causes of prescribing errors: the prescribing outcomes for trainee doctors engaged in clinical training (PROTECT) study

Objectives Study objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing. Method A three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors' self-efficacy were established. Results 4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p&#60;0.001), surgical (p = &#60;0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p&#60;0.001), a greater number of prescribed medicines (p&#60;0.001) and the months December and June (p&#60;0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen. Conclusions Prescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.</p

Educational and health outcomes of children treated for type 1 diabetes: Scotland-wide record linkage study of 766,047 children

Objective: This study was conducted to determine the association between childhood type 1 diabetes and educational and health outcomes. Research Design and Methods: Record linkage of nine Scotland-wide databases (diabetes register, dispensed prescriptions, maternity records, hospital admissions, death certificates, annual pupil census, school absences/exclusions, school examinations, and unemployment) produced a cohort of 766,047 singleton children born in Scotland who attended Scottish schools between 2009 and 2013. We compared the health and education outcomes of schoolchildren receiving insulin with their peers, adjusting for potential confounders. Results: The 3,330 children (0.47%) treated for type 1 diabetes were more likely to be admitted to the hospital (adjusted hazard ratio [HR] 3.97, 95% CI 3.79–4.16), die (adjusted HR 3.84, 95% CI 1.98–7.43), be absent from school (adjusted incidence rate ratio [IRR] 1.34, 95% CI 1.30–1.39), and have learning difficulties (adjusted odds ratio [OR] 1.19, 95% CI 1.03–1.38). Among children with type 1 diabetes, higher mean HbA1c (particularly HbA1c in the highest quintile) was associated with greater absenteeism (adjusted IRR 1.75, 95% CI 1.56–1.96, P &lt; 0.001), increased school exclusion (adjusted IRR 2.82, 95% CI 1.14–6.98), poorer attainment (adjusted OR 3.52, 95% CI 1.72–7.18), and higher risk of unemployment (adjusted OR 2.01, 95% CI 1.05–3.85). Conclusions: Children with type 1 diabetes fare worse than their peers in respect of education and health outcomes, especially if they have higher mean HbA1c. Interventions are required to minimize school absence and ensure that it does not affect educational attainment

Herbal Medicinal Product Use During Pregnancy and the Postnatal Period: : A Systematic Review

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Educational and health outcomes of children and adolescents receiving antidepressant medication : Scotland-wide retrospective record linkage cohort study of 766 237 schoolchildren

Funding Health Data Research UK (grant reference number MR/S003800/1). Acknowledgements The study was sponsored by Health Data Research UK (www.hdruk.ac.uk), which is a joint investment led by the Medical Research Council, together with the National Institute for Health Research (England), the Chief Scientist Office (Scotland), Health and Care Research Wales, Health and Social Care Research and Development Division (Public Health Agency, Northern Ireland), the Engineering and Physical Sciences Research Council, the Economic and Social Research Council, the British Heart Foundation and Wellcome (grant reference number MR/S003800/1). The sponsor and funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication. This study formed part of a wider PhD thesis undertaken by the lead author within the University of Glasgow and was published in 2017. Certain sections of this paper appear in the thesis, which is accessible and downloadable from the following link: http://theses.gla.ac.uk/8594/1/2017flemingphd.pdf. Author Contributions J.P.P. had the original concept. All authors agreed the study design. D.C. and A.K. provided data and undertook record linkage. M.F. and D.F.M. undertook the statistical analyses. All authors interpreted the results. M.F. and J.P.P. drafted the manuscript and all other authors contributed revisions. All authors reviewed and approved the final version of the manuscript. M.F. is guarantor for the study. Approvals The authors applied for permission to access, link and analyse these data and undertook mandatory training in data protection, IT security and information governance. Therefore, the datasets generated and analysed during the study are not publicly available. The study was approved by the National Health Service Privacy Advisory Committee and covered by a data-processing agreement between Glasgow University and ISD, and a data-sharing agreement between Glasgow University and ScotXed. All data were linked by the Electronic Data Research and Innovation Service (eDRIS), part of NHS National Services Scotland. Ethics The NHS West of Scotland Research Ethics Service confirmed that formal NHS ethics approval was not required, since the study involved anonymized extracts of routinely collected data with an acceptably negligible risk of identification. Conflict of interest: None declaredPeer reviewedPublisher PD

Educational and health outcomes of children and adolescents receiving antiepileptic medication : Scotland-wide record linkage study of 766 244 schoolchildren

Acknowledgements The study was sponsored by Health Data Research UK (www.hdruk.ac.uk) which is a joint investment led by the Medical Research Council, together with the National Institute for Health Research (England), the Chief Scientist Office (Scotland), Health and Care Research Wales, Health and Social Care Research and Development Division (Public Health Agency, Northern Ireland), the Engineering and Physical Sciences Research Council, the Economic and Social Research Council, the British Heart Foundation and Wellcome. This study formed part of a wider PhD thesis undertaken by the lead author within the University of Glasgow, which was published in 2017. Therefore, certain sections of this paper appear in the thesis, which is accessible and downloadable from the following link: http://theses.gla.ac.uk/8594/1/2017flemingphd.pdf. Funding The study was sponsored by Health Data Research UK. The sponsor and funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review or approval of the manuscript, or decision to submit the manuscript for publication. Availability of data and materials The authors applied for permission to access, link and analyse these data and undertook mandatory training in data protection, IT security and information governance. Therefore, the datasets generated and analysed during the study are not publicly available.Peer reviewedPublisher PD

Views and experiences of decision-makers on organisational safety culture and medication errors

ACKNOWLEDGEMENTS The authors wish to acknowledge the contributions of all interviewees, as well as support departments at Hamad Medical Corporation, Doha, Qatar. This work was supported by NPRP grant NPRP 7‐388‐3‐095 from Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the authors.Peer reviewedPublisher PD