Case report of a medication error by look-alike packaging: a classic surrogate marker of an unsafe system

Background: The acronym LASA (look-alike sound-alike) denotes the problem of confusing similar- looking and/or sounding drugs accidentally. The most common causes of medication error jeopardizing patient safety are LASA as well as high workload. Case presentation: A critical incident report of medication errors of opioids for postoperative analgesia by lookalike packaging highlights the LASA aspects in everyday scenarios. A change to a generic brand of medication saved costs of up to 16% per annum. Consequently, confusion of medication incidents occurred due to the similar appearance of the newly introduced generic opioid. Due to consecutive underdosing no life-threatening situation arose out of this LASA based medication error. Conclusion: Current recommendations for the prevention of LASA are quite extensive; still, in a system with a lump sum payment per case not all of these security measures may be feasible. This issue remains to be approached on an individual basis, taking into consideration local set ups as well as financial issues

D7.4 Third evaluation report. Evaluation of PANACEA v3 and produced resources

D7.4 reports on the evaluation of the different components integrated in the PANACEA third cycle of development as well as the final validation of the platform itself. All validation and evaluation experiments follow the evaluation criteria already described in D7.1. The main goal of WP7 tasks was to test the (technical) functionalities and capabilities of the middleware that allows the integration of the various resource-creation components into an interoperable distributed environment (WP3) and to evaluate the quality of the components developed in WP5 and WP6. The content of this deliverable is thus complementary to D8.2 and D8.3 that tackle advantages and usability in industrial scenarios. It has to be noted that the PANACEA third cycle of development addressed many components that are still under research. The main goal for this evaluation cycle thus is to assess the methods experimented with and their potentials for becoming actual production tools to be exploited outside research labs. For most of the technologies, an attempt was made to re-interpret standard evaluation measures, usually in terms of accuracy, precision and recall, as measures related to a reduction of costs (time and human resources) in the current practices based on the manual production of resources. In order to do so, the different tools had to be tuned and adapted to maximize precision and for some tools the possibility to offer confidence measures that could allow a separation of the resources that still needed manual revision has been attempted. Furthermore, the extension to other languages in addition to English, also a PANACEA objective, has been evaluated. The main facts about the evaluation results are now summarized

D4.1. Technologies and tools for corpus creation, normalization and annotation

The objectives of the Corpus Acquisition and Annotation (CAA) subsystem are the acquisition and processing of monolingual and bilingual language resources (LRs) required in the PANACEA context. Therefore, the CAA subsystem includes: i) a Corpus Acquisition Component (CAC) for extracting monolingual and bilingual data from the web, ii) a component for cleanup and normalization (CNC) of these data and iii) a text processing component (TPC) which consists of NLP tools including modules for sentence splitting, POS tagging, lemmatization, parsing and named entity recognition

How to improve prescription of inhaled salbutamol by providing standardised feedback on administration: a controlled intervention pilot study with follow-up

Background: The effectiveness of inhaled salbutamol in routine care depends particularly on prescribed dosage and applied inhalation technique. To achieve maximum effectiveness and to prevent drug-related problems, prescription and administration need to work in concert. Methods: We performed a controlled intervention pilot study with 4 consecutive groups in a general paediatric unit and assessed problems in salbutamol prescribing and administration. Control group [i]: Routine care without additional support. First intervention group [ii]: We carried out a teaching session for nurses aimed at preventing problems in inhalation technique. Independently from this, a pharmacist counselled physicians on problems in salbutamol prescribing. Second intervention group [iii]: Additionally to the first intervention, physicians received standardised feedback on the inhalation technique. Follow-up group [iv]: Subsequently, without any delay after the second intervention group had been completed, sustainability of the measures was assessed. We performed the chi-square test to calculate the level of significance with p ≤ 0.05 to indicate a statistically significant difference for the primary outcome. As we performed multiple testing, an adjusted p ≤ 0.01 according to Bonferroni correction was considered as significant. Results: We included a total of 225 patients. By counselling the physicians, we reduced the number of patients with problems from 55% to 43% (control [i] vs. first intervention [ii], n.s.). With additional feedback to physicians, this number was further reduced to 25% ([i] vs. [iii], p < 0.001). In the follow-up [iv], the number rose again to 48% (p < 0.01 compared to feedback group). Conclusions: Teaching nurses, counselling physicians, and providing feedback on the quality of inhalation technique effectively reduced problems in salbutamol treatment. However, for success to be sustained, continuous support needs to be provided. Trial registration: German Clinical Trials register: DRKS00006792

Hospital and Community Pharmacists’ Perceptions of Which Competences Are Important for Their Practice

The objective of the PHAR-QA (Quality assurance in European pharmacy education and training) project was to investigate how competence-based learning could be applied to a healthcare, sectoral profession such as pharmacy. This is the first study on evaluation of competences from the pharmacists’ perspective using an improved Delphi method with a large number of respondents from all over Europe. This paper looks at the way in which hospital pharmacists rank the fundamental competences for pharmacy practice. European hospital pharmacists (n = 152) ranked 68 competences for pharmacy practice of two types (personal and patient care), arranged into 13 clusters. Results were compared to those obtained from community pharmacists (n = 258). Generally, hospital and community pharmacists rank competences in a similar way. Nevertheless, differences can be detected. The higher focus of hospital pharmacists on knowledge of the different areas of science as well as on laboratory tests reflects the idea of a hospital pharmacy specialisation. The difference is also visible in the field of drug production. This is a necessary competence in hospitals with requests for drugs for rare diseases, as well as paediatric and oncologic drugs. Hospital pharmacists give entrepreneurship a lower score, but cost-effectiveness a higher one than community pharmacists. This reflects the reality of pharmacy practice where community pharmacists have to act as entrepreneurs, and hospital pharmacists are managers staying within drug budgets. The results are discussed in the light of a “hospital pharmacy” specialisation.Peer reviewe

D3.8 Lexical-semantic analytics for NLP

UIDB/03213/2020 UIDP/03213/2020The present document illustrates the work carried out in task 3.3 (work package 3) of ELEXIS project focused on lexical-semantic analytics for Natural Language Processing (NLP). This task aims at computing analytics for lexical-semantic information such as words, senses and domains in the available resources, investigating their role in NLP applications. Specifically, this task concentrates on three research directions, namely i) sense clustering, in which grouping senses based on their semantic similarity improves the performance of NLP tasks such as Word Sense Disambiguation (WSD), ii) domain labeling of text, in which the lexicographic resources made available by the ELEXIS project for research purposes allow better performances to be achieved, and finally iii) analysing the diachronic distribution of senses, for which a software package is made available.publishersversionpublishe

A Hydrogenated amorphous silicon detector for Space Weather Applications

The characteristics of a hydrogenated amorphous silicon (a-Si:H) detector are presented here for monitoring in space solar flares and the evolution of large energetic proton events up to hundreds of MeV. The a-Si:H presents an excellent radiation hardness and finds application in harsh radiation environments for medical purposes, for particle beam characterization and in space weather science and applications. The critical flux detection threshold for solar X rays, soft gamma rays, electrons and protons is discussed in detail.Comment: 32 pages, 13 figures, submitted to Experimental Astronom

ROCK-ALS: Protocol for a Randomized, Placebo-Controlled, Double-Blind Phase IIa Trial of Safety, Tolerability and Efficacy of the Rho Kinase (ROCK) Inhibitor Fasudil in Amyotrophic Lateral Sclerosis

Objectives: Disease-modifying therapies for amyotrophic lateral sclerosis (ALS) are still not satisfactory. The Rho kinase (ROCK) inhibitor fasudil has demonstrated beneficial effects in cell culture and animal models of ALS. For many years, fasudil has been approved in Japan for the treatment of vasospasm in patients with subarachnoid hemorrhage with a favorable safety profile. Here we describe a clinical trial protocol to repurpose fasudil as a disease-modifying therapy for ALS patients.Methods: ROCK-ALS is a multicenter, double-blind, randomized, placebo-controlled phase IIa trial of fasudil in ALS patients (EudraCT: 2017-003676-31, NCT: 03792490). Safety and tolerability are the primary endpoints. Efficacy is a secondary endpoint and will be assessed by the change in ALSFRS-R, ALSAQ-5, slow vital capacity (SVC), ECAS, and the motor unit number index (MUNIX), as well as survival. Efficacy measures will be assessed before (baseline) and immediately after the infusion therapy as well as on days 90 and 180. Patients will receive a daily dose of either 30 or 60 mg fasudil, or placebo in two intravenous applications for a total of 20 days. Regular assessments of safety will be performed throughout the treatment period, and in the follow-up period until day 180. Additionally, we will collect biological fluids to assess target engagement and evaluate potential biomarkers for disease progression. A total of 120 patients with probable or definite ALS (revised El Escorial criteria) and within 6–18 months of the onset of weakness shall be included in 16 centers in Germany, Switzerland and France.Results and conclusions: The ROCK-ALS trial is a phase IIa trial to evaluate the ROCK-inhibitor fasudil in early-stage ALS-patients that started patient recruitment in 2019