Reducing Medication Errors in the Acute Care In-Patient Setting: An Integrative Review

Promoting a culture of safety in healthcare organizations has become a necessary goal to ensure that patients are safe, well cared for, and satisfied with the services they receive. One of the areas recognized as a major safety concern across hospitals in the United States and abroad are medication errors, which continue to occur at a staggering rate. This integrative review seeks to serve two purposes to combat this pandemic problem. First, the project will attempt to determine if an appropriate intervention or strategic initiative exists that can reduce medications errors for adult patients on an acute care patient unit in an inpatient hospital setting. Second, will be to disseminate and implement the identified cluster of interventions at a healthcare organization in central Virginia, and follow the data trends to determine its effectiveness

Subcortical control of precision grip after human spinal cord injury.

The motor cortex and the corticospinal system contribute to the control of a precision grip between the thumb and index finger. The involvement of subcortical pathways during human precision grip remains unclear. Using noninvasive cortical and cervicomedullary stimulation, we examined motor evoked potentials (MEPs) and the activity in intracortical and subcortical pathways targeting an intrinsic hand muscle when grasping a small (6 mm) cylinder between the thumb and index finger and during index finger abduction in uninjured humans and in patients with subcortical damage due to incomplete cervical spinal cord injury (SCI). We demonstrate that cortical and cervicomedullary MEP size was reduced during precision grip compared with index finger abduction in uninjured humans, but was unchanged in SCI patients. Regardless of whether cortical and cervicomedullary stimulation was used, suppression of the MEP was only evident 1-3 ms after its onset. Long-term (∼5 years) use of the GABAb receptor agonist baclofen by SCI patients reduced MEP size during precision grip to similar levels as uninjured humans. Index finger sensory function correlated with MEP size during precision grip in SCI patients. Intracortical inhibition decreased during precision grip and spinal motoneuron excitability remained unchanged in all groups. Our results demonstrate that the control of precision grip in humans involves premotoneuronal subcortical mechanisms, likely disynaptic or polysynaptic spinal pathways that are lacking after SCI and restored by long-term use of baclofen. We propose that spinal GABAb-ergic interneuronal circuits, which are sensitive to baclofen, are part of the subcortical premotoneuronal network shaping corticospinal output during human precision grip

Peer-review in a world with rational scientists: Toward selection of the average

One of the virtues of peer review is that it provides a self-regulating selection mechanism for scientific work, papers and projects. Peer review as a selection mechanism is hard to evaluate in terms of its efficiency. Serious efforts to understand its strengths and weaknesses have not yet lead to clear answers. In theory peer review works if the involved parties (editors and referees) conform to a set of requirements, such as love for high quality science, objectiveness, and absence of biases, nepotism, friend and clique networks, selfishness, etc. If these requirements are violated, what is the effect on the selection of high quality work? We study this question with a simple agent based model. In particular we are interested in the effects of rational referees, who might not have any incentive to see high quality work other than their own published or promoted. We find that a small fraction of incorrect (selfish or rational) referees can drastically reduce the quality of the published (accepted) scientific standard. We quantify the fraction for which peer review will no longer select better than pure chance. Decline of quality of accepted scientific work is shown as a function of the fraction of rational and unqualified referees. We show how a simple quality-increasing policy of e.g. a journal can lead to a loss in overall scientific quality, and how mutual support-networks of authors and referees deteriorate the system.Comment: 5 pages 4 figure

Shared services in UK higher education: best practice and future possibilities

Shared services in UK higher education: best practice and future possibilitie

Dissociation between behavior and motor cortical excitability before and during ballistic wrist flexion and extension in young and old adults

PURPOSE: Aging is associated with slow reactive movement generation and poor termination. OBJECTIVE: We examined the hypothesis that the build-up of excitability in the primary motor cortex in the agonist muscle to generate ballistic wrist flexion and extension and in the antagonist to stop the movement, is lower and slower in old compared with young adults. METHODS: We measured the size of the motor potentials evoked (MEP) produced by transcranial magnetic stimulation (TMS), background integrated EMG (iEMG), and the MEP:iEMG ratio in healthy young (23 y, n = 14) and old adults' (73 y, n = 14) wrist flexors and extensors as they rapidly flexed or extended the wrist in response to an auditory cue. TMS was delivered at 80% of resting motor threshold randomly in 20 ms increments between 130 and 430 ms after the tone. RESULTS: Even though old compared to young adults executed the two wrist movements with ~23% longer movement duration and ~15% longer reaction time (both p < 0.05), the rise in MEP:iEMG ratio before the main similar in the two age groups. CONCLUSION: These data suggest that an adjustment of current models might be needed to better understand how and if age affects the build-up excitability accompanying movement generation and termination

Dopamine increases risky choice while D2 blockade shortens decision time

Dopamine is crucially involved in decision-making and overstimulation within dopaminergic pathways can lead to impulsive behaviour, including a desire to take risks and reduced deliberation before acting. These behavioural changes are side effects of treatment with dopaminergic drugs in Parkinson disease, but their likelihood of occurrence is difficult to predict and may be influenced by the individual’s baseline endogenous dopamine state, and indeed correlate with sensation-seeking personality traits. We here collected data on a standard gambling task in healthy volunteers given either placebo, 2.5 mg of the dopamine antagonist haloperidol or 100/25 mg of the dopamine precursor levodopa in a within-subject design. We found an increase in risky choices on levodopa. Choices were, however, made faster on haloperidol with no effect of levodopa on deliberation time. Shortened deliberation times on haloperidol occurred in low sensation-seekers only, suggesting a correlation between sensation-seeking personality trait and baseline dopamine levels. We hypothesise that levodopa increases risk-taking behaviour via overstimulation at both D1 and D2 receptor level, while a single low dose of haloperidol, as previously reported (Frank and O’Reilly 2006), may block D2 receptors pre- and post-synaptically and may paradoxically lead to higher striatal dopamine acting on remaining striatal D1 receptors, causing speedier decision without influencing risk tolerance. These effects could also fit with a recently proposed computational model of the basal ganglia (Moeller and Bogacz 2019; Moeller et al. 2021). Furthermore, our data suggest that the actual dopaminergic drug effect may be dependent on the individual’s baseline dopamine state, which may influence our therapeutic decision as clinicians in the future

Ropinirole, a dopamine agonist with high D3 affinity, reduces proactive inhibition: A double-blind, placebo-controlled study in healthy adults

Response inhibition describes the cognitive processes mediating the suppression of unwanted actions. A network involving the basal ganglia mediates two forms of response inhibition: reactive and proactive inhibition. Reactive inhibition serves to abruptly stop motor activity, whereas proactive inhibition is goal-orientated and results in slowing of motor activity in anticipation of stopping. Due to its impairment in several psychiatric disorders, the neurochemistry of response inhibition has become of recent interest. Dopamine has been posed as a candidate mediator of response inhibition due to its role in functioning of the basal ganglia and the observation that patients with Parkinson's disease on dopamine agonists develop impulse control disorders. Although the effects of dopamine on reactive inhibition have been studied, substantial literature on the role of dopamine on proactive inhibition is lacking. To fill this gap, we devised a double-blind, placebo-controlled study of 1 mg ropinirole (a dopamine agonist) on response inhibition in healthy volunteers. We found that whilst reactive inhibition was unchanged, proactive inhibition was impaired when participants were on ropinirole relative to when on placebo. To investigate how ropinirole mediated this effect on proactive inhibition, we used hierarchical drift-diffusion modelling. We found that ropinirole impaired the ability to raise the decision threshold when proactive inhibition was called upon. Our results provide novel evidence that an acute dose of ropinirole selectively reduces proactive inhibition in healthy participants. These results may help explain how ropinirole induces impulse control disorders in susceptible patients with Parkinson's disease

Ropinirole, a dopamine agonist with high D3 affinity, reduces proactive inhibition: A double-blind, placebo-controlled study in healthy adults

Response inhibition describes the cognitive processes mediating the suppression of unwanted actions. A network involving the basal ganglia mediates two forms of response inhibition: reactive and proactive inhibition. Reactive inhibition serves to abruptly stop motor activity, whereas proactive inhibition is goal-orientated and results in slowing of motor activity in anticipation of stopping. Due to its impairment in several psychiatric disorders, the neurochemistry of response inhibition has become of recent interest. Dopamine has been posed as a candidate mediator of response inhibition due to its role in functioning of the basal ganglia and the observation that patients with Parkinson's disease on dopamine agonists develop impulse control disorders. Although the effects of dopamine on reactive inhibition have been studied, substantial literature on the role of dopamine on proactive inhibition is lacking. To fill this gap, we devised a double-blind, placebo-controlled study of 1 mg ropinirole (a dopamine agonist) on response inhibition in healthy volunteers. We found that whilst reactive inhibition was unchanged, proactive inhibition was impaired when participants were on ropinirole relative to when on placebo. To investigate how ropinirole mediated this effect on proactive inhibition, we used hierarchical drift-diffusion modelling. We found that ropinirole impaired the ability to raise the decision threshold when proactive inhibition was called upon. Our results provide novel evidence that an acute dose of ropinirole selectively reduces proactive inhibition in healthy participants. These results may help explain how ropinirole induces impulse control disorders in susceptible patients with Parkinson's disease

Definition of a crowdsourcing innovation service for the european SMEs

Based on literature review and on the study of the most known and referred Crowdsourcing brokers, there's a clear trend to implement this model by large companies and mainly within the North American context. Our research team is focused in bringing this approach closer to the European culture, more specifically the cultural factors underlying the dynamics and motivation of communities available to solve the innovation challenges of Small and Medium Enterprises (SMEs), that we call Crowdsourcing Innovation. We believe that, due to the common lack of resources for innovation in these companies, a service capable of involving them in large networks filled with useful and reachable knowledge, and capable of supporting these companies through all the innovation process, is crucial to the future competitiveness of the European SMEs. Although our team is focusing on several aspects related to Crowdsourcing, my main research focuses the information services and supporting applications to create a web platform adapted to the key economical, organizational, legal and cultural differences that make current Crowdsourcing Innovation businesses less popular among European SMEs than in North America.- (undefined

Age-dependent association of white matter abnormality with cognition after TIA or minor stroke

ObjectiveTo investigate if the association between MRI-detectable white matter hyperintensity (WMH) and cognitive status reported in previous studies persists at older ages (&gt;80 years), when some white matter abnormality is almost universally reported in clinical practice.MethodsConsecutive eligible patients from a population-based cohort of all TIA/nondisabling stroke (Oxford Vascular Study) underwent multimodal MRI, including fluid-Attenuated inversion recovery and diffusion-weighted imaging, allowing automated measurement of WMH volume, mean diffusivity (MD), and fractional anisotropy (FA) in normal-Appearing white matter using FSL tools. These measures were related to cognitive status (Montreal Cognitive Assessment) at age 6480 vs &gt;80 years.ResultsOf 566 patients (mean [range] age 66.7 [20-102] years), 107 were aged &gt;80 years. WMH volumes and MD/FA were strongly associated with cognitive status in patients aged 6480 years (all p &lt; 0.001 for WMH, MD, and FA) but not in patients aged &gt;80 years (not significant for WMH, MD, and FA), with age interactions for WMH volume (pinteraction = 0.016) and MD (pinteraction = 0.037). Voxel-wise analyses also showed that lower Montreal Cognitive Assessment scores were associated with frontal WMH in patients 6480 years, but not &gt;80 years.ConclusionMRI markers of white matter damage are strongly related to cognition in patients with TIA/minor stroke at younger ages, but not at age &gt;80 years. Clinicians and patients should not overinterpret the significance of these abnormalities at older ages