Reduced prevalence of drug-related problems in psychiatric inpatients after implementation of a pharmacist-supported computerized physician order entry system - a retrospective cohort study

IntroductionIn 2021, a computerized physician order entry (CPOE) system with an integrated clinical decision support system (CDSS) was implemented at a tertiary care center for the treatment of mental health conditions in Lübeck, Germany. To date, no study has been reported on the types and prevalence of drug-related problems (DRPs) before and after CPOE implementation in a psychiatric inpatient setting. The aim of this retrospective before-and-after cohort study was to investigate whether the implementation of a CPOE system with CDSS accompanied by the introduction of regular medication plausibility checks by a pharmacist led to a decrease of DRPs during hospitalization and unsolved DRPs at discharge in psychiatric inpatients.MethodsMedication charts and electronic patient records of 54 patients before (cohort I) and 65 patients after (cohort II) CPOE implementation were reviewed retrospectively by a clinical pharmacist. All identified DRPs were collected and classified based on ‘The PCNE Classification V9.1’, the German database DokuPIK, and the ‘NCC MERP Taxonomy of Medication Errors’.Results325 DRPs were identified in 54 patients with a mean of 6 DRPs per patient and 151.9 DRPs per 1000 patient days in cohort I. In cohort II, 214 DRPs were identified in 65 patients with a mean of 3.3 DRPs per patient and 81.3 DRPs per 1000 patient days. The odds of having a DRP were significantly lower in cohort II (OR=0.545, 95% CI 0.412-0.721, p<0.001). The most frequent DRP in cohort I was an erroneous prescription (n=113, 34.8%), which was significantly reduced in cohort II (n=12, 5.6%, p<0.001). During the retrospective in-depth review, more DRPs were identified than during the daily plausibility analyses. At hospital discharge, patients had significantly less unsolved DRPs in cohort II than in cohort I.DiscussionThe implementation of a CPOE system with an integrated CDSS reduced the overall prevalence of DRPs, especially of prescription errors, and led to a smaller rate of unsolved DRPs in psychiatric inpatients at hospital discharge. Not all DRPs were found by plausibility analyses based on the medication charts. A more interactive and interdisciplinary patient-oriented approach might result in the resolution of more DRPs

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Compatibility of chitosan in polymer blends by chemical modification of bio-based polyesters

For some applications of bioplastics like food packaging or medical devices, applying additives can be necessary to avoid microbial activity and hinder biofilm or fouling formation. A currently promising additive is chitosan (CS), the deacetylated form of the biogenic scaffolding material chitin. Due to its hydrophilicity, chitosan is not compatible with most of the thermoplastic bio-based polymers like poly(lactic acid) (PLA) or polyhydroxyalkanoates (PHA). In this work, compatibilization between chitosan and two selected bio-based polyesters, PLA and poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), was enhanced by grafting maleic anhydride (MAH) and glycidyl methacrylate (GMA), respectively, onto polymer chains using peroxide. The success of grafting was confirmed via titration methods. The effects of grafting agent and peroxide concentrations on grafting reaction and the physical and thermal properties of the functionalized polyesters were investigated. Compounding of the functionalized polyesters with different weight portions of chitosan was accomplished in a discontinuous internal mixer by in-situ functionalization, followed by blending with chitosan. The titration method, scanning electron microscopy, DSC, FTIR and mechanical characterization of the composites showed good interfacial adhesion and suggest the formation of covalent bonds between functional groups of the polyesters and chitosan, especially for the samples functionalized with GMA. The molecular weights (Mw) of the samples showed a change in the molecular weight related to the thermal degradation of the sample. The Mw of the samples grafted with MAH are lower than those functionalized with GMA. Furthermore, integration of chitosan into non-functionalized PLA polymer matrix showed a nucleating effect, while for PHBV, the increase of crystallinity with the content of chitosan was only observed for grafted PHBV

DataSheet_1_Reduced prevalence of drug-related problems in psychiatric inpatients after implementation of a pharmacist-supported computerized physician order entry system - a retrospective cohort study.pdf

IntroductionIn 2021, a computerized physician order entry (CPOE) system with an integrated clinical decision support system (CDSS) was implemented at a tertiary care center for the treatment of mental health conditions in Lübeck, Germany. To date, no study has been reported on the types and prevalence of drug-related problems (DRPs) before and after CPOE implementation in a psychiatric inpatient setting. The aim of this retrospective before-and-after cohort study was to investigate whether the implementation of a CPOE system with CDSS accompanied by the introduction of regular medication plausibility checks by a pharmacist led to a decrease of DRPs during hospitalization and unsolved DRPs at discharge in psychiatric inpatients.MethodsMedication charts and electronic patient records of 54 patients before (cohort I) and 65 patients after (cohort II) CPOE implementation were reviewed retrospectively by a clinical pharmacist. All identified DRPs were collected and classified based on ‘The PCNE Classification V9.1’, the German database DokuPIK, and the ‘NCC MERP Taxonomy of Medication Errors’.Results325 DRPs were identified in 54 patients with a mean of 6 DRPs per patient and 151.9 DRPs per 1000 patient days in cohort I. In cohort II, 214 DRPs were identified in 65 patients with a mean of 3.3 DRPs per patient and 81.3 DRPs per 1000 patient days. The odds of having a DRP were significantly lower in cohort II (OR=0.545, 95% CI 0.412-0.721, pDiscussionThe implementation of a CPOE system with an integrated CDSS reduced the overall prevalence of DRPs, especially of prescription errors, and led to a smaller rate of unsolved DRPs in psychiatric inpatients at hospital discharge. Not all DRPs were found by plausibility analyses based on the medication charts. A more interactive and interdisciplinary patient-oriented approach might result in the resolution of more DRPs.</p

Acceptation sociale et développement des territoires

Der Begriff der sozialen Akzeptanz, der in den Humanwissenschaften bisher wenig formalisiert wurde, ist dennoch allgegenwärtig in der Territorialentwicklungsplanung. Verträglichkeitsprüfungen, partizipative Politik, die Suche nach einer guten territorialen Governance und nach sozialer Nachhaltigkeit in den öffentlichen Entscheidungen versuchen alle durch engere Mitwirkung der Beteiligten bei der territorialen Umgestaltung den Widerstand der Zivilgesellschaft bei (Groß) Projekten zu reduzieren. Allerdings können diese Instrumente nicht auf technische oder institutionelle Maßnahmen reduziert werden die automatisch eine bessere Akzeptanz der Projekte garantieren. Viele subjektive Komponenten bedingen die Aufnahme von sozialen Innovationen und den Wandel der Mentalitäten die sie zur Folge haben. Dieses Buch soll daher die Akzeptanzkriterien von Territorialentwicklungsprojekten beleuchten. Mit einem deutsch-französischen Vergleich einer Reihe von analytischen Methoden die die Autoren mehr oder weniger zeitgleich angewendet haben wird versucht die visuellen Dimension der Projekte, den Machtbeziehungen oder der Repräsentationen von spezifisch Praktiken von Territorien zu beleuchten. Diese Sichtbarmachung kann Forschern und Praktikern helfen die Spannungen und sozialen Konflikte bei Plaungsprozessen besser zu verstehen.The notion of social acceptance, though weakly conceptualized in the field of social sciences is, however, omnipresent in spatial planning policies. Impact assessments, participative policies, the search for good local and regional governance practices as well as social sustainability in public decision-making are all approaches that implicitly aim at reducing civil society dissent against development projects therefore, at improving social acceptance through closer involvement in the processes of spatial change. Notwithstanding, these mechanisms should not be understood as limited only to technical and institutional measures that would automatically ensure better adherence to projects. Many subjective components rule the social approval of innovations, and the resulting attitudes towards them. This work, therefore, seeks to explore the acceptability criteria of spatial development projects. Using a stimulating Franco-German comparative approach, the authors develop a wide range of analytical methods that question, in particular, the visual dimension of projects, the inter-personal relationships for power-sharing and the representations and practices of space, all levers which may help researchers and territorial experts better understand tensions and social conflicts.La notion d’acceptation sociale, qui reste peu formalisée par la recherche en sciences humaines, est pourtant omniprésente dans les politiques de développement des territoires. Les études d’impact, les politiques participatives, la quête d’une bonne gouvernance territoriale ou d’une durabilité sociale dans la décision publique sont des démarches qui visent toutes, implicitement, à réduire les contestations de la part de la société civile face aux projets de développement, donc à améliorer l’acceptation sociale par une association plus étroite aux processus de transformation du territoire. Cependant, ces dispositifs ne sauraient se réduire à des mesures d’ordre technique et institutionnel qui garantiraient automatiquement une meilleure adhésion aux projets. De nombreuses composantes subjectives régissent la réception sociale des innovations ainsi que les attitudes qui en résultent. Cet ouvrage vise donc à mettre en lumière les critères d’acceptabilité des projets de développement territorial. Dans une approche comparative franco-allemande stimulante, les auteurs développent toute une série de méthodes d’analyse qui interrogent, notamment, la dimension visuelle des projets, les rapports interpersonnels de pouvoir ou encore les représentations et pratiques du territoire, autant de leviers dont l’identification peut aider les chercheurs comme les praticiens du territoire à mieux comprendre les tensions et conflits sociaux

Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe) : an analysis of paediatric survey data from 56 countries

Background Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions. Methods 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications. Findings Of the 23 572 patients included from 56 countries, 18305 were children (77.7%) and 5267 were neonates (22.3%). Access antibiotic use in children ranged from 7.8% (China) to 61.2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77.3%) and lowest in Finland (23.0%). In neonates, Access antibiotic use was highest in Singapore (100.0%) and lowest in China (24.2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries. Interpretation There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd