Better performance of medical students on pharmacotherapy knowledge and skills tests is associated with practising with e-learning program P-scribe

Aims: Junior doctors write most hospital prescriptions, yet are more than twice as likely to make an error in their prescriptions compared to senior doctors. A possibility to enhance pharmacotherapy education is through the use of e-learning modules. The aim of this study was to determine whether P-scribe, as the chosen e-learning resource, helps students in passing their pharmacotherapy assessments. Methods: This retrospective study was undertaken in the Erasmus Medical Center, the Netherlands. All 270 medical students who started their master's curriculum in the academic session of 2017–2018 were included. Data were analysed to identify the frequency of student's use per e-learning module, total time students spent on e-learning modules and timing of the use of e-learning modules in relation to their assessments. The results of the assessments were analysed to identify possible correlations between the time students spent using P-scribe, their timing of use and their assessment results. Results: Students who passed their knowledge-based assessment first time had a mean practice time of five more hours than students who did not pass first time (P <.05, 95% CI: 3.4–6.6). These students practised on average six e-learning modules more (P <.05, 95% CI: 4.1–7.0) than students who failed their first attempt. Students who passed their skill-based prescription test first time, practised on average five more e-learning modules (P =.006, 95% CI: 1.4–8.3) than students who failed their first attempt. Conclusion: Students who passed their pharmacotherapy assessments first time spent more time, and practised more frequently, with e-learning modules

Prioritizing Emerging Zoonoses in The Netherlands

Background: To support the development of early warning and surveillance systems of emerging zoonoses, we present a general method to prioritize pathogens using a quantitative, stochastic multi-criteria model, parameterized for the Netherlands. Methodology/Principal Findings: A risk score was based on seven criteria, reflecting assessments of the epidemiology and impact of these pathogens on society. Criteria were weighed, based on the preferences of a panel of judges with a background in infectious disease control. Conclusions/Significance: Pathogens with the highest risk for the Netherlands included pathogens in the livestock reservoir with a high actual human disease burden (e.g. Campylobacter spp., Toxoplasma gondii, Coxiella burnetii) or a low current but higher historic burden (e.g. Mycobacterium bovis), rare zoonotic pathogens in domestic animals with severe disease manifestations in humans (e.g. BSE prion, Capnocytophaga canimorsus) as well as arthropod-borne and wildlife associated pathogens which may pose a severe risk in future (e.g. Japanese encephalitis virus and West-Nile virus). These agents are key targets for development of early warning and surveillance.Infrastructures, Systems and ServicesTechnology, Policy and Managemen

Design of a prospective cohort study to assess ethnic inequalities in patient safety in hospital care using mixed methods

<p>Abstract</p> <p>Background</p> <p>While US studies show a higher risk of adverse events (AEs) for ethnic minorities in hospital care, in Europe ethnic inequalities in patient safety have never been analysed. Based on existing literature and exploratory research, our research group developed a conceptual model and empirical study to increase our understanding of the role ethnicity plays in patient safety. Our study is designed to (1) assess the risk of AEs for hospitalised patients of non-Western ethnic origin in comparison to ethnic Dutch patients; (2) analyse what patient-related determinants affect the risk of AEs; (3) explore the mechanisms of patient-provider interactions that may increase the risk of AEs; and (4) explore possible strategies to prevent inequalities in patient safety.</p> <p>Methods</p> <p>We are conducting a prospective mixed methods cohort study in four Dutch hospitals, which began in 2010 and is running until 2013. 2000 patients (1000 ethnic Dutch and 1000 of non-Western ethnic origin, ranging in age from 45-75 years) are included. Survey data are collected to capture patients’ explanatory variables (e.g., Dutch language proficiency, health literacy, socio-economic status (SES)-indicators, and religion) during hospital admission. After discharge, a two-stage medical record review using a standardized instrument is conducted by experienced reviewers to determine the incidence of AEs. Data will be analysed using multilevel multivariable logistic regression. Qualitative interviews with providers and patients will provide insight into the mechanisms of AEs and potential prevention strategies.</p> <p>Conclusion</p> <p>This study uses a robust study plan to quantify the risk difference of AEs between ethnic minority and Dutch patients in hospital care. In addition we are developing an in-depth description of the mechanisms of excess risk for some groups compared to others, while identifying opportunities for more equitable distributions of patient safety for all.</p

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Key Learning Outcomes for Clinical Pharmacology and Therapeutics Education in Europe: A Modified Delphi Study.

Harmonizing clinical pharmacology and therapeutics (CPT) education in Europe is necessary to ensure that the prescribing competency of future doctors is of a uniform high standard. As there are currently no uniform requirements, our aim was to achieve consensus on key learning outcomes for undergraduate CPT education in Europe. We used a modified Delphi method consisting of three questionnaire rounds and a panel meeting. A total of 129 experts from 27 European countries were asked to rate 307 learning outcomes. In all, 92 experts (71%) completed all three questionnaire rounds, and 33 experts (26%) attended the meeting. 232 learning outcomes from the original list, 15 newly suggested and 5 rephrased outcomes were included. These 252 learning outcomes should be included in undergraduate CPT curricula to ensure that European graduates are able to prescribe safely and effectively. We provide a blueprint of a European core curriculum describing when and how the learning outcomes might be acquired

Ethnic inequalities in patient safety in Dutch hospital care

This thesis shows the first results of Dutch studies on the relation between ethnicity and patient safety. We used mixed methods to identify patient safety outcomes and patient safety risks in a cohort study in 4 urban hospitals among 763 Dutch patients and 576 ethnic minority patients. In a record review and questionnaire study, we found that ethnic minority patients were not at increased risk of adverse events while receiving care in Dutch hospitals. Healthcare providers seem to have responded effectively to specific patient care needs, but we do not know whether this occurred in an ad hoc or in a systematic way. In a qualitative study we found that relatives of hospitalized ethnic minority patients took upon themselves the role of the interpreter, the patient, and the care provider which can have both a positive or negative effect on patient safety. In a mixed methods study we found several situations in hospital care where a language barrier threatened patient safety, that a language barrier was often not documented in the patient record, and that professional interpreters were hardly consulted in daily hospital care. Are there ethnic inequalities in patient safety in Dutch hospital care? No, we did not find ethnic inequalities in patient safety outcomes (adverse events) in Dutch hospitals with ethnically diverse populations. However, we did find increased patient safety risks for ethnic minorities and thus patient safety of ethnic minorities deserves a place on the healthcare agenda

Differences in prescribing errors between electronic prescribing and traditional prescribing among medical students:A randomized pilot study

Aims: This randomized controlled pilot study aimed to assess the differences in the frequency, type and severity of prescribing errors made by medical students when assessed in an electronic (e-)prescribing system compared to a traditional prescribing method (e.g., typing out a prescription). Methods: Fourth year medical students in the period of 1 November to 31 July 2023, were asked to participate in this single-centre prospective, randomized, controlled intervention study. Participants performed a prescribing assessment in either an e-prescribing system (intervention group) or in a more traditional prescribing platform (control group). The prescriptions were checked for errors, graded and categorized. Differences in prescribing errors, error categories and severity were analysed. Results: Out of 334 students, 84 participated in the study. Nearly all participants (98.8%) made 1 or more prescribing errors, primarily involving inadequate information errors. In the intervention group, more participants made prescribing errors involving the prescribed amount (71.4 vs. 19.0%; P &lt;.01), but fewer involving administrative errors (2.4 vs. 19.0%; P =.03). Prescribing-method-specific errors were identified in 4.8 and 40.5% of the intervention and control group, respectively, with significant differences in overlapping errors as well. Conclusion: This pilot study shows the importance of training e-prescribing competencies in medical curricula, in addition to traditional prescribing methods. It identifies prescribing-method-specific prescribing errors and emphasizes the need for further research to define e-prescribing competencies. Additionally, the need for an accessible real-life-like e-prescribing environment tailored to educators and students is essential for effective learning and incorporation of e-prescribing into medical curricula.</p

Role of relatives of ethnic minority patients in patient safety in hospital care: a qualitative study

Relatives of ethnic minority patients often play an important role in the care process during hospitalisation. Our objective was to analyse the role of these relatives in relation to the safety of patients during hospital care. Four large urban hospitals with an ethnic diverse patient population. On hospital admission of ethnic minority patients, 20 cases were purposively sampled in which relatives were observed to play a role in the care process. We used documents (patient records) and added eight cases with qualitative interviews with healthcare providers, patients and/or their relatives to investigate the relation between the role of relatives and patient safety. An inductive approach followed by selective coding was used to analyse the data. Besides giving social support, family members took on themselves the role of the interpreter, the role of substitutes of the patient and the role of care provider. The taking over of these roles can have positive and negative effects on patient safety. When family members take over various roles during hospitalisation of a relative, this can lead to a safety risk and a safety protection for the patient involved. Although healthcare providers should not hand over their responsibilities to the relatives of patients, optimising collaboration with relatives who are willing to take part in the care process may improve patient safet