A systematic review of the nature of dispensing errors in hospital pharmacies

Background: Dispensing errors are common in hospital pharmacies. Investigating dispensing errors is important for identifying the factors involved and developing strategies to reduce their occurrence. Objectives: To review published studies exploring the incidence and types of dispensing errors in hospital pharmacies and factors contributing to these errors. Methods: Electronic databases including PubMed, Scopus, Ovid, and Web of Science were searched for articles published between January 2000 and January 2015. Inclusion criteria were: studies published in English, and studies investigating type, incidence and factors contributing to dispensing errors in hospital pharmacies. One researcher searched for all relevant published articles, screened all titles and abstracts, and obtained complete articles. A second researcher assessed the titles, abstracts, and complete articles to verify the reliability of the selected articles. Key findings: Fifteen studies met the inclusion criteria all of which were conducted in just four countries. Reviewing incident reports and direct observation were the main methods used to investigate dispensing errors. Dispensing error rates varied between countries (0.015%–33.5%) depending on the dispensing system, research method, and classification of dispensing error types. The most frequent dispensing errors reported were dispensing the wrong medicine, dispensing the wrong drug strength, and dispensing the wrong dosage form. The most common factors associated with dispensing errors were: high workload, low staffing, mix-up of look-alike/sound-alike drugs, lack of knowledge/experience, distractions/interruptions, and communication problems within the dispensary team. Conclusion: Studies relating to dispensing errors in hospital pharmacies are few in number and have been conducted in just four countries. The majority of these studies focused on the investigation of dispensing error types with no mention of contributing factors or strategies for reducing dispensing errors. Others studies are thus needed to investigate dispensing errors in hospital pharmacies, and a combined approach is recommended to investigate contributing factors associated with dispensing errors and explore strategies for reducing these errors.Peer reviewe

Polifonia, uso ironico del linguaggio e ‘poetica della relazione’ nella poesia di Benjamin Zephaniah

This article deals with Benjamin Zephaniah’s poetry and it focuses on its polyphonic quality, its ironic language, and its similarity to Édouard Glissant’s ‘Poetics of Relation’. One of the most striking feature of the black British poet is his irony, which functions as an effective revolutionary act as it subtly reveals hypocrisies and prejudices. Benjamin Zephaniah’s subversive use of language is aimed at opening the boundaries of the literary canon and of the very idea of Britishness, in the same way as postcolonial authors do. Being himself a ‘product’ of cultural hybridisation, Benjamin Zephaniah creates a syncretic network of intermingled voices and personae, a sort of polyphony in Bakhtinian terms. Therefore, his poetics bears resemblance to Édouard Glissant’s idea of ‘creolisation’, according to which every identity is in fact a mixture, which is ‘happily’ and inevitably changing through a relationship with the Other

An evaluation of the types and contributing factors of dispensing errors in hospital pharmacy

Peer reviewe

Harmful algae and their potential impacts on the coastal ecosystem: growth and toxin production dynamics

The main goal of the present thesis was to study some harmful algal species which cause blooms in Italian coastal waters, leading to consequences for human health, coastal ecosystem, fishery and tourism. In particular, in the first part of this thesis the toxicity of Adriatic strains of the raphidophyte Fibrocapsa japonica was investigated. Despite several hypotheses have been proposed for the toxic mechanism of the raphidophytes, especially for the species Chattonella antiqua and C. marina, which have been studied more extensively, just a few studies on the toxic effects of these species for different organisms were reported. Moreover, a careful reading of the literature evidenced as any ichthyotoxic events reported worldwide can be linked to F. japonica blooms. Although recently several studies were performed on F. japonica strains from the USA, Japan, Australia, New Zealand, the Netherlands, Germany, and France in order to characterize their growth and toxicity features, the work reported in this thesis results one of the first investigation on the toxic effects of F. japonica for different organisms, such as bacteria, crustaceans and fish. Mortality effects, together with haemolysis of fish erythrocytes, probably due to the relatively high amount of PUFAs produced by this species, were observed. Mortality for fish, however, was reported only at a high cell density and after a long exposition period (9-10 days); moreover a significant increase of H2O2 obtained in the tanks where sea basses were exposed to F. japonica was also relevant. This result may justify the absence of ichthyotoxic events in the Italian coasts, despite F. japonica blooms detected in these areas were characterized by high cell densities. This work reports also a first complete characterization of the fatty acids produced and extracellularly released by the Adriatic F. japonica, and results were also compared with the fatty acid profile of other strains. The absence of known brevetoxins in F. japonica algal extracts was also highlighted, leading to the hypothesis that the toxicity of F. japonica may be due to a synergic effect of PUFAs and ROS. Another microalgae that was studied in this thesis is the benthic dinoflagellate Ostreopsis cf. ovata. This species was investigated with the aim to investigate the effect of environmental parameters on its growth and toxicity. O. cf. ovata, in fact, shows different blooming periods along the Italian coasts and even the reported toxic effects are variable. The results of this work confirmed the high variability in the growth dynamic and toxin content of several Italian strains which were isolated in recent years along the Adriatic and Tyrrhenian Seas. Moreover, the effects of temperature and salinity on the behaviour of the different isolates are in good agreement with the results obtained from field surveys, which evidence as the environmental parameters are important factors modulating O. cf. ovata proliferation. Another relevant result that was highlighted is the anomaly in the production of palytoxin-like compounds reported by one of the studied isolate, in particular the one isolated in 2008 in Ancona (Adriatic Sea). Only this strain reported the absence of two (ovatoxin-b and –c) of the five ovatoxins so far known in the toxin profile and a different relative abundance of the other toxins. The last aspect that was studied in this thesis regards the toxin biosythesis. In fact, toxins produced (palytoxin-like compounds) or supposed to be produced (brevetoxin-like compounds) by O. cf. ovata and F. japonica, respectively, are polyketides, which are highly oxygenated compounds synthesized by complex enzymes known as polyketide synthase (PKS) enzymes. These enzymes are multi-domain complexes that structurally and functionally resemble the fatty acid synthases (FASs). This work reports the first study of PKS proteins in the dinoflagellates O. cf. ovata, C. monotis and in the raphidophyte F. japonica. For the first time some PKSs were identified in these species, confirming the presence of PKS proteins predicted by the in silico translation of the transcripts found in K. brevis also in other species. The identification of O. cf. ovata PKSs and the localization of the palytoxin-like compounds produced by this dinoflagellate in a similar location (chloroplast) as that observed for other dinoflagellate and cyanobacterial toxins provides some indication that these proteins may be involved in polyketide biosynthesis. However, their potential function as fatty acid synthases cannot be ruled out, as plant fatty acid synthesis also occurs within chloroplasts. This last hypothesis is also supported by the fact that in all the investigated species, and in particular in F. japonica, PKS proteins were present. Therefore, these results provide an important contribution to the study of the polyketides and of the involvement of PKS proteins in the toxin biosynthesis

Novel psychoactive substances (NPS) – knowledge and experiences of drug users from Hungary, Poland, the UK and the USA

Submitted 19 September 2019; Accepted 29 November 2019; Proof received 29 November 2019; Published 18 February 2020. Note: No DOI allocated.Dopamine D 3 receptor partial agonists represent a new generation of atypical antipsychotics. Cariprazine, which has received centralized market authorization from the European Medicines Agency in 2017 for the treatment of adult patients with schizophrenia (including those with predominant negative symptoms of schizophrenia) differs from the other two partial agonist antipsychotics aripiprazole and brexpiprazole due to its unique features. Cariprazine is a dopamine D 3 preferring D 3/D2 partial agonist with very similar dopamine receptor sub-type selectivity as dopamine. It has proven efficacy in the treatment of positive and negative symptoms of schizophrenia, as well as for relapse prevention. Further phase-3 clinical studies proved the efficacy of cariprazine in the acute treatment of manic or mixed episodes associated with bipolar I disorder, as well as in bipolar depression. For the adjunctive treatment of major depressive disorder, phase 3 studies are in progress.Peer reviewedFinal Published versio

Investigating the prevalence and causes of prescribing errors in general practice : the PRACtICe Study

Report prepared by the University of Nottingham, University of Reading and University of Hertfordshir

Spring composition of the macroalgal vegetation of a small offshore island in the north-western Mediterranean (Gallinara Island, Ligurian Sea)

Gallinara Island, a small island located 1.5 km off the shore of Liguria (Italy, north-western Mediterranean Sea) was included in a list of proposed Marine Protected Areas (MPA) in the early 90s. Since then, its benthic assemblages have been studied in detail and the main macrophytic communities have been mapped. A detailed assessment of its benthic macroalgal flora, however, has never been made. Gallinara was visited in the course of 5 consecutive years and its macroalgal flora was studied based on collections made by snorkelling and SCUBA diving. Overall, 141 macroalgal taxa were collected and identified (23 Chlorophyta, 94 Rhodophyta, 24 Ochrophyta); 91 of them represent new records for the island. One of the most notable new records is the non-indigenous red alga Womersleyella setacea, previously unreported from the island and widely distributed, particularly on the south-eastern shore. Observations made in the course of the surveys confirm the rarefaction of some large-sized brown algae (particularly Sargassum vulgare) but indicate also that others previously reported as rare (Cystoseira compressa, Dictyopteris polypodioides) are still common on the island

Human factors in clinical handover: development and testing of a ‘handover performance tool' for doctors' shift handovers

Objective To develop and test a handover performance tool (HPT) able to help clinicians to systematically assess the quality and safety of shift handovers. Design The study used a mixed methods approach. In the development phase of the tool, a review of the literature and a Delphi process were conducted to sample five generic non-technical skills: communication, teamwork, leadership, situation awareness and task management. Validity and reliability of the HPT were evaluated through direct observation and during simulated handover video sessions. Setting This study was conducted in the Paediatrics, Obstetrics and Gynaecology wards of a UK district hospital. Participants Thirty human factor experts participated in the development phase; 62 doctors from various disciplines were asked to validate the tool. Main Outcome Measures Item development, HPT validity and reliability. Results The tool developed consisted of 25 items. Communication, teamwork and situation awareness explained, respectively, 55.5, 47.2 and 39.6% of the variance in doctors rating of quality. Internal consistency and inter-rater reliability of the HPT were good (Cronbach's alpha = 0.77 and intra-class correlation = 0.817). Conclusions Communication determined the majority of handover quality. Teamwork and situation awareness also provided an independent contribution to the overall quality rating. The HPT has demonstrated good validity and reliability providing evidence that it can be easily used by raters with different backgrounds and in several clinical settings. The HPT could be utilized to assess doctors' handover quality systematically, as well as teaching tool in medical schools or in continuing professional development programmes for self-reflective practic

Production of polyhydroxybutyrate by the cyanobacterium cf. Anabaena sp

Polyhydroxybutyrate (PHB) production by the cyanobacterium cf. Anabaena sp. was here studied by varying the medium composition and the carbon source used to induce mixotrophic growth conditions. The highest PHB productivity (0.06 gPHB gbiomass−1 d−1) was observed when cultivating cf. Anabaena sp. in phosphorus-free medium and in the presence of sodium acetate (5.0 g L−1 concentration), after an incubation period of 7 days. A content of 40% of PHB on biomass, a dry weight of 0.1 g L−1, and a photosynthetic efficiency equal to the control were obtained. The cyanobacterium was then grown on a larger scale (10 L) to evaluate the characteristics of the produced PHB in relation to the main composition of the biomass (the content of proteins, polysaccharides, and lipids): after an incubation period of 7 days, a content of 6% of lipids (52% of which as unsaturated fatty acids with 18 carbon atoms), 12% of polysaccharides, 28% of proteins, and 46% of PHB was reached. The extracted PHB had a molecular weight of 3 MDa and a PDI of 1.7. These promising results demonstrated that cf. Anabaena sp. can be included among the Cyanobacteria species able to produce polyhydroxyalkanoates (PHAs) either in photoautotrophic or mixotrophic conditions, especially when it is grown under phosphorus-free conditions