Incorrect Frequency Research Articles

Prescribing Errors in an Ambulatory Care Setting: Mitigating Risks in Outpatient Medication Orders, Cross-Sectional Review

ABSTRACT Introduction Prescribing errors (PEs) are the most common type of medication error, which may occur by prescribing the wrong medication, improper dose, dosage, and/or even prescribing a drug to the wrong patient. The present study aims to compile PEs that were generated in an ambulatory care setting at a tertiary-care hospital in Saudi Arabia. Methods A retrospective cross-sectional review was conducted for all reported PEs in ambulatory care clinics for 3 years. The potential hazardous outcomes of these PEs were classified according to the medication error index. Results A total of 897 records containing 1199 PEs were retrieved. More than a third of prescribers had frequently committed PEs—ranging from 2 to 39 times. The most encountered errors were prescribing incorrect doses, medication duplication, incorrect dosing frequency, and inappropriate duration (34.5%, 14.1%, 11.6%, and 9.8%, respectively). The most frequent mistakes were when prescribing antibiotics (22.9%) and drugs for cardiovascular conditions (18.5%). Most errors were of mild to moderate severity, mostly type-B near-miss errors and did not reach patients. Only two prescription events (0.17%) had severe consequences that required intervention to avoid any subsequent harm or damage. Conclusion The current investigation has revealed a substantial percentage of PEs, mostly in internal medicine and cardiology departments. Although PEs are undoubtedly not easy to avoid, monitoring and recognizing these inaccuracies is pivotal to preventing potential harm and promoting patient safety.

2259 Assessing antibiotic usage on a geriatric ward

Abstract Introduction The World Health Organisation lists antibiotic resistance as one of the biggest threats to global health [1]. We contribute to this as clinicians, through errors such as delayed review of prescriptions or prescribing against local trust guidelines. Method We have carried out a quality improvement project to improve antibiotic prescriptions on a geriatric ward at Croydon University Hospital. We carried out a fortnightly cross-sectional analysis of the antibiotic prescriptions on a geriatric ward. This included looking at the antibiotic prescribed, indication, duration, route of administration and presence of a review date. These were then compared to trust guidelines. After the first 8-weeks, we delivered a departmental teaching session on antibiotic prescriptions. We then re-audited the prescriptions. Following this, we sent out weekly email reminders on locating trust guidelines and information on prescriptions. We then re-audited following this. Finally, we created an e-learning resource to deliver to the ward on antibiotic prescriptions. We are planning to deliver this to the ward and re-audit afterwards. Results Initially, up to 90.0% of prescriptions differed from trust guidelines. Common reasons for differences when compared included incorrect drug prescribed, incorrect frequency of dosing, or non-specific indications leading to difficulty comparing. Following all interventions, approximately 32% of prescriptions differed from trust guidelines. This showed sustained improvement across 2 complete PDSA cycles (plan, do, study, act). A 3rd PDSA cycle is ongoing at present and preliminary data has shown approximately 28% of prescriptions differed from trust guidelines. Conclusion This quality improvement project has successfully contributed to a reduction in prescription errors and safe prescribing. We will continue to provide information to our colleagues on antibiotic stewardship, to further encourage safe prescribing. [1]. Antibiotic resistance (2020) World Health Organisation. Available at: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance (Accessed: May 2023).

The quality of antimicrobial prescribing in skin and soft tissue management in Australian hospitals: an analysis of the National Antimicrobial Prescribing Survey data

Skin and soft tissue infections (SSTIs) are among the most common indications for antimicrobial prescribing in hospitals. Inappropriate antimicrobial use can lead to increased morbidity, unnecessary hospital re-admission and increased antimicrobial resistance. This study aimed to assess the quality of antimicrobial prescribing practices in SSTI management within Australian hospitals to provide guidance for future practice. A retrospective analysis was conducted with data from the National Antimicrobial Prescribing Survey (NAPS). SSTI prescribing data from Hospital NAPS (2013-2022) and surgical site infection data from Surgical NAPS (2016-2022) datasets were analysed. Variables assessed included guideline compliance, appropriateness as per the structured NAPS algorithm, and reasons for inappropriateness. From the Hospital NAPS dataset, 40,535 antimicrobial prescriptions for SSTIs were analysed. The most common indication was cellulitis (34.1%, N=13,822), and the most prescribed antimicrobial was flucloxacillin (18.8%, N=7,638). SSTI indications had a lower rate of guideline compliance but a higher rate of appropriateness compared with all other indications for antimicrobial prescriptions (guideline compliance 66.3%, N=21,035 vs 67.4%, N=156,285; appropriateness 75.6%, N=30,639 vs 72.7%, N=209,383). The most common reason for inappropriateness was incorrect dose or frequency (29.3%, N=2367). From the Surgical NAPS dataset, 5674 prescriptions for surgical site infections were analysed. Of these, 68.2% (N=3867) were deemed to be appropriate. The most common reason for inappropriateness was incorrect dose or frequency (27.7%, N=350). As SSTIs are a common indication for prescribing an antimicrobial in Australian hospitals, identifying effective antimicrobial stewardship strategies to optimize antimicrobial use for SSTI management is recommended to improve patient outcomes.

A Comprehensive Analysis of Medication Errors on Antimicrobials in a Tertiary Care Hospital of Northern India

Background: Medication errors, resulting from incomplete understanding, pose significant risks to patient safety. Antimicrobial medication error is a global concern further exacerbated by underreporting. This study aims to determine the prevalence of antimicrobial medication errors at a tertiary care medical facility. Methodology: A retrospective study was conducted over six months. Antimicrobial medication errors were analyzed and categorized as prescription, transcription, indenting, dispensing, and administration errors. A total of 208 antimicrobial medication errors were analyzed using the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) risk index. Results: Among 6,439 medication charts assessed, 558 (9%) medication errors were identified, with antimicrobial errors accounting for 208 (37.2%). Prescription errors were the most prevalent (61%), followed by transcription errors (16%) and administration errors (11%). Dispensing, indenting, and documentation errors occurred at rates of 8%, 2%, and 2%, respectively. The primary causes of errors were incorrect doses (47.2%) and frequencies (30%). Approximately 55.3% of antimicrobial medication errors were classified as Category C according to the NCCMERP risk assessment. Conclusion: Prescription errors represent the majority of antimicrobial medication errors, underscoring the need for enhanced vigilance among consultant physicians during prescription writing and drug schedule checks.

Simulation Analysis of Mode Hopping Impacts on OFDR Sensing Performance

This article examines the impacts of mode hopping on the sensing performance of optical frequency domain reflectometry (OFDR) and explores the potential for developing economical OFDR interrogators employing low-cost distributed feedback (DFB) lasers. By conducting numerical simulations, this study reveals that mode hopping has minimal effects on distance sensing measurements in free space due to the limited duration of beat interference signal at the incorrect frequency within the coherence length. Additionally, the simulations indicate that mode hopping only slightly affects the distributed strain sensing of OFDR, resulting in an error range of less than ±1µε when 100µε is applied to the sensing fiber. These findings highlight the potential of using low-cost DFB lasers with a 1-nm wavelength sweep range and a 1-MHz linewidth as tunable laser sources in OFDR while maintaining reliable and accurate sensing performance.

An Analytical Study of Impacts of Naad Yoga Therapy in Patients of Insomnia, Stress, Memory and Overall Brain Health

Chronic insomnia has been linked to a variety of contributing variables, including as psychological training, genetic predispositions, dysfunctional beliefs and attitudes, and cognitive and physiological arousal. The hyper-arousal theory of insomnia postulates that sleep disturbances are caused by an increase in physiological arousal based on the discovery of high physiological arousal, which may be connected to these people's active stress system. Sometimes, sleep issues including difficulties getting asleep, difficulty remaining asleep, or having poor-quality sleep are referred to as insomnia. Insomnia can be brought on by a variety of things, including the use of psychoactive drugs, caffeine, nicotine, amphetamines, and cocaine; hormonal changes, such as menstruation and menopause; stressful life events, like the birth of a child and bereavement; disruptions of the circadian rhythm, like shift work and jet lag; some neurological disorders; and medical conditions, such as hyperthyroidism and rheumatoid arthritis. Everything in the universe vibrates at a specific frequency, and when we are in a state of natural resonance, we are in perfect health. But if a bodily component begins to vibrate at the incorrect frequency, the energy becomes trapped, and illness appears. In order to release the repressed energy and return resonance to its natural level, chanting can therefore be employed to affect a therapy.

Integrating wind disturbances into forest planning: a stochastic programming approach

Forest disturbances challenge our ability to carefully plan for sustainable use of forest resources. As forest disturbances are stochastic, we cannot plan for the disturbance at any specific time or location. However, we can prepare for the possibility of a disturbance by integrating its potential intensity range and frequency when developing forest management plans. This study uses stochastic programming to integrate wind intensity (wind speed) and wind event frequency (number of occurrences) into the forest planning process on a small coastal Finnish forest landscape. We used a mechanistic model to quantify the critical wind speed for tree felling, with a Monte Carlo approach to include wind damage and salvage logging into forest management alternatives. We apply a stochastic programming model to explore two objectives: maximizing the expected forest net present value or maximizing the even-flow of income. To assess the effects of improper wind risk assumptions in planning, we compare the results when optimizing for correct versus incorrect wind intensity and frequency assumptions. When maximizing for net present value, the impacts of misidentifying wind intensity and frequency are minor, likely due to harvests planned immediately as trees reach maturity. For the case when maximizing even-flow of income, incorrectly identifying wind intensity and frequency severely impacts the ability to meet the required harvest targets and reduces the expected net present value. The specific utility of risk mitigation therefore depends on the planning problem. Overall, we show that incorporating wind disturbances into forest planning can inform forest owners about how they can manage wind risk based on their specific risk preferences.

Reducing medication errors in HIV-positive patients: Influence of a clinical pharmacist.

The roll-out of antiretroviral medicines has improved life expectancy in people living with HIV (PLHIV). This has resulted in more patients being hospitalised for non-communicable diseases, increasing risk for medication errors (MEs). Pharmacists, through medication reconciliation, may identify and reduce MEs in this population. To describe the importance of a pharmacist's involvement in identifying and quantifying types of MEs. A quantitative, prospective observational study was conducted over 14 weeks. A pharmacist reviewed HIV-positive, hospitalised patients' files, using a data collection instrument, to determine the prevalence of MEs in PLHIV. The study pharmacist recommended appropriate actions to the prescriber to resolve MEs and documented resolution of the MEs. The study population of n = 180 patient files were reviewed 453 times, identifying 466 MEs. Medication errors included incorrect medication reconciliation from history (19; 4.1%), prescription omission (17; 3.7%), duplication of therapy (10; 2.2%), missed doses (265; 57.1%), incorrect dosing (103; 22.2%), incorrect administration frequency (2; 0.4%), incorrect duration of therapy (15; 3.2%) and drug-drug interactions (18; 3.9%). More than half (58.2%) of the MEs were resolved in less than 24 h, with involvement of the pharmacist. This study demonstrates the magnitude of MEs experienced in hospitalised PLHIV and highlights the role clinical pharmacists play in identifying and resolving MEs to improve patient outcomes.

Medication administration errors among children admitted at a Regional Hospital in Northern Ghana

Background: Errors in medication administration have a number of detrimental effects, including delayed healing, drug resistance, morbidity, and even mortality, particularly in children. However, there are limited empirical data on the incidence of medication administration errors experienced by children admitted to healthcare facilities in Ghana. Methods: An analytic cross-sectional design was used to obtain prospective data from 399 sick children admitted to the Upper East Regional Hospital using a convenient sampling. Both descriptive and inferential statistical analyses such as Pearson chi-square tests and binary logistic regression, were also conducted. Results: The incidence of medication administration errors was 65.9 %. The intravenous route of medication was the most common route involved in medication administration errors (48.1 %). An incorrect frequency of drug administration (41.9 %) was the most common type of error. There were significant correlations between the occurrence of medication administration errors and hospital ward ((χ2=13.1, p < 0.001), patient’ age ((χ2 = 19.254, p < 0.001) and patient’ weight ((χ2 = 5.740, p < 0.05). Conclusion: The incidence of medication administration errors is very high among pediatric inpatients in healthcare facilities.

Medication reconciliation by community pharmacists: an essential contribution to ensure continuity of care with regard to medications at hospital discharge.

Background: Collaboration and communication between hospital and ambulatory care is crucial to ensure continuity of care with regard to medications. However, electronic platforms to facilitate seamless care are often deficient and/or insufficiently integrated. Different Belgian chronic care projects (i.e. regional projects with support of the National Institute for Health and Disability Insurance to enhance integrated care) have therefore decided to implement the ‘green envelope’ as a way to transfer the therapy plan of the patient at discharge to the community pharmacy. The green envelope also contains the prescriptions for the patient, as well as an information letter for the pharmacist, including a QR-code to an online platform where the characteristics of the medication reconciliation, as performed by the community pharmacist, can be registered. The aim of this study was to analyze the findings registered by the pharmacists, as to have a clear idea on their contribution to continuity of care with regard to medications.&#x0D; Methods: A descriptive analysis was performed on the data registered by the community pharmacist during / after medication reconciliation.&#x0D; Results: In total, 1807 online surveys were completed by community pharmacists. The mean duration of the patient encounter in the pharmacy, which in more than three quarter of the cases took place on the day of discharge or the day thereafter, was 12,8 minutes (SD 6,933). Over 63% of patients discharged from hospital were aged +75; 52.4% was female. In about 68% of cases, another person than the patient presented him/herself at the pharmacy.&#x0D; About 74% of the patients had not visited the GP before presenting at the pharmacy; only 24% of patients had a planned appointment with the GP.&#x0D; In about 19% of the cases, the pharmacist discovered at least one medication discrepancy. Most frequently it concerned omitted medication, i.e. medication that was taken by the patient before admission, and for which it was unclear for the patient and pharmacist whether it had been stopped intentionally or not.&#x0D; The pharmacist noted in about 11% of cases at least one drug-related problem, mostly related to the choice or use of the drug. With regard to the choice of drug, it mostly concerned a lack of re-substitution to the molecule used by the patient at home; problems related to the use of the drug mostly referred to incorrect dosing or frequency, or incorrect way of administration.&#x0D; In about 15% of cases, the pharmacist contacted another HCP, mostly the GP. On the level of the patient, the intervention mostly consisted of extensive counselling.&#x0D; The final therapy plan was in less than 60% shared with other HCPs. Problems with the platforms used, and lack of collaboration, were mentioned as the most important reasons for not sharing.&#x0D; Conclusion: Our results show that pharmacists discover a relatively high number of medication discrepancies and drug related problems while performing medication reconciliation at discharge. Their alertness, engagement to contact other HCPs and talk to the patients and their relatives undoubtedly contribute to a safe transfer of patients from the hospital to home.&#x0D;

Differgram: A convex optimization-based method for extracting optimal frequency band for fault diagnosis of rotating machinery

The extraction of fault resonance bands from a full frequency band has always stood as a classical and effective strategy for fault diagnosis in rotating machinery. Among the existing techniques for capturing fault frequency bands, methods such as fast kurtogram and its variants have been prevalent. However, these methods encounter two main limitations. Firstly, they are subject to the constraints of index performance, potentially leading to the identification of incorrect frequency bands. Secondly, they do not fully harness the potential of healthy signals, thus hindering accurate fault frequency band localization. While approaches like SKRgram and accugram endeavor to leverage healthy signals to highlight differences between healthy and faulty signals, SKRgram falls short in thoroughly exploring the significance of healthy signals. Accugram relies on classifier accuracy to pinpoint fault frequency bands, rendering it less robust and less interpretable. To capitalize more effectively on healthy signals' potential, this study proposed a novel approach called differgram based on the convex optimization model. By inputting both healthy and faulty signals into the differgram, optimal fault frequency bands can be extracted. By solving the constructed convex optimization model, the optimal difference frequency bands between healthy and faulty signals are automatically identified. The method is substantiated through mathematical proofs and physical explanations, enhancing its interpretability. Through simulations and experimental validation, the proposed diffetergram demonstrates its efficiency in the extraction of fault frequency bands. In comparison to fast kurtogram, SKRgram, and accugram, the differgram showcases heightened robustness and noise immunity.

Incorrect Feeding Practices, Dietary Diversity Determinants and Nutritional Status in Children Aged 6-23 Months: An Observational Study in Rural Angola.

More than a quarter of children who are affected by severe acute undernutrition reside in Sub-Saharan Africa. Incorrect feeding practices have a negative impact on a child's health in both the short and the long term, and the interval from conception to two years is the most critical for the development of undernutrition-related complications. These first 1000 days of life also represent an "opportunity window" for early interventions, hence, having a clear insight into dietary habits and the determinants of diet quality is fundamental to improving nutritional counseling practices. To investigate incorrect feeding practices, dietary diversity determinants and nutritional status in children aged 6-23 months. Prospective quali-quantitative observational study conducted at the Missionary Catholic Hospital of Chiulo (Angola) from March to April 2023. Of 250 children, global acute malnutrition affected 25.2% and was associated with starting complementary feeding at <4 months of age (p = 0.007) and not achieving the minimum meal frequency (p < 0.0001). Minimum dietary diversity was found in 11.2%, minimum meal frequency was experienced by 72.8%, and the minimum acceptable diet was found in 11.2% of participants. The minimum dietary diversity was reached only by households with access to food from five or more major food groups (p = 0.007) or the money to buy food from five or more major food groups (p = 0.008) and was higher in households where the householder had a higher educational level (p = 0.002). Regarding the determinants linked to family traditions and beliefs, the main religion-associated beliefs concerned the impurity of pork (n = 25) and fish (n = 8), while eggs (n = 19) and cow milk (n = 8) were the main food types that were deemed harmful for children. Although some factors (economic and religious) may be difficult to overcome, other factors linked to erroneous beliefs (dangerous foods) or incorrect feeding practices (early weaning and an incorrect frequency of meals) can be targeted, to improve the effectiveness of nutritional counseling practices.

Physical Insights on the Phonon Dispersion of TiS2

AbstractTitanium disulfide is a quasi‐2D transition‐metal dichalcogenide relevant for various potential applications. To exploit its technological capabilities, it is important to determine its fundamental properties including the lattice dynamics. The TiS2 phonon dispersion curves available to date do not reproduce properly the experimental data for several reasons: i) all available experimental data are not taken into consideration, thus poor theory‐experiment agreements have been obtained; ii) the (unknown) frequency of the infrared mode A2u is erroneously assumed; and iii) such incorrect assignment has propagated in the literature, particularly in phonon dispersion calculations. It is presented here a thorough density functional theory analysis to determine the phonon dispersion curves of TiS2, accounting for the frequencies of all experimental phonon data available to date. These include the frequencies of nine zone‐edge Raman active modes of Ag‐intercalated TiS2, in addition to infrared, Raman, and neutron scattering data. An incorrect frequency assignment of the A2u mode in the literature is thoroughly discussed. Moreover, results of attenuated total reflection terahertz spectroscopy applied to TiS2 are provided. A self‐intercalation paradigm is presented to give a rationale for the temperature dependence of the poorly understood Raman features observed in pristine TiS2 at frequencies above the A1g mode.

Suboptimal antimicrobial discharge prescriptions at a tertiary referral children's hospital.

To determine the rate of and factors associated with suboptimal discharge antimicrobial prescribing at a tertiary referral children's hospital. Retrospective cohort. Tertiary referral children's hospital. All enteral antimicrobial discharge prescriptions at Lucile Packard Children's Hospital Stanford from January 1st, 2021 through December 31st, 2021. All enteral discharge antimicrobials are routinely evaluated by our antimicrobial stewardship program within 48 hours of hospital discharge. Antimicrobials are determined to be optimal or suboptimal by an antimicrobial stewardship pharmacist after evaluating the prescribed choice of antimicrobial, dose, duration, dosing frequency, and formulation. The rate and factors associated with suboptimal antimicrobial discharge prescribing were evaluated. Of 2,593 antimicrobial prescriptions ordered at discharge, 19.7% were suboptimal. Suboptimal prescriptions were due to incorrect duration (72.2%), dose (31.0%), dose frequency (23.3%), drug choice (6.5%), or formulation (5.7%). In total, 87.2% of antimicrobials for perioperative prophylaxis and 13.5% of treatment antimicrobials were suboptimal. Antimicrobials with the highest rate of suboptimal prescriptions were amoxicillin-clavulanate (40.7%), clindamycin (36.6%), and cephalexin (36.6%). Suboptimal antimicrobial discharge prescriptions are common and present an opportunity for antimicrobial stewardship programs during hospital transition of care. Factors associated with suboptimal prescriptions differ by antimicrobial and prescribed indication, indicating that multiple stewardship interventions may be needed to improve prescribing.

Laryngology Outcomes Following Implantable Vagus Nerve Stimulation

Vagus nerve stimulation (VNS) devices have gained widespread acceptance for treatment of resistant epilepsy and depression. The increasing number of procedures has resulted in an increasing number of iatrogenic injuries to the vagus nerve, which can have a significant effect on vocalization and quality of life. To determine the relative frequency of laryngeal adverse effects reported to the US Food and Drug Administration (FDA) after VNS implantation and to analyze associated VNS device problems. This retrospective cross-sectional analysis queried the FDA Manufacturer and User Facility Device Experience database of adverse events in the US between 1996 and 2020. The primary outcome was the percent of adverse events reported to the FDA that included patients who received VNS with laryngeal adverse effects and the associated proportion of device problems after VNS surgery. A total of 12 725 iatrogenic vagus nerve issues were documented after VNS implantation, with apnea (n = 395; 3.1%) being the most common patient problem. Overall, 187 reports of laryngeal adverse effects associated with VNS devices were identified and represented the eighth most common iatrogenic vagus nerve problem reported to the FDA. Laryngeal adverse effects included 78 reports of voice alteration and 57 reports of paresis/paralysis. The VNS device problems frequently associated with laryngeal adverse effects were high impedance (n = 15, 8.02%), incorrect frequency delivery (n = 10, 5.35%), and battery problems (n = 11, 5.88%). The number of laryngeal adverse effect reports per year peaked in 2012 with 43 cases. This cross-sectional study found that although the literature demonstrates that vocal changes occur with nearly all VNS devices, the FDA receives adverse event reports of voice changes. Our results emphasize a potential need to improve patient counseling prior to VNS surgery to better set patient expectations regarding vocal changes and to prevent unnecessary patient concern. In addition, reports of vocal fold paresis/paralysis potentially suggest that patients may benefit from preoperative laryngeal assessment to differentiate preexisting vocal fold paralysis from that caused by VNS surgery.

Ophthalmic Antimicrobial Prescribing in Australian Healthcare Facilities.

The National Antimicrobial Prescribing Survey (NAPS) is a web-based, standardized tool, widely adopted in Australian healthcare facilities to assess the reasons for, the quantity of, and the quality of antimicrobial prescribing. It consists of multiple modules tailored towards the needs of a variety of healthcare facilities. Data regarding ophthalmological antimicrobial use from Hospital NAPS, Surgical NAPS, and Aged Care NAPS were analysed. In Hospital NAPS, the most common reasons for inappropriate prescribing were incorrect dose or frequency and incorrect duration. Prolonged duration was also common in Aged Care prescribing: about one quarter of all antimicrobials had been prescribed for greater than 6 months. All three modules found chloramphenicol to be the most prescribed antimicrobial with a high rate of inappropriate prescribing, usually for conjunctivitis.

A service evaluation of the accuracy of electronic prescriptions used to calculate nebulised medication adherence in adult with cystic fibrosis

Adherence to nebulised medications in people with cystic fibrosis (CF) is known to be suboptimal. CFHealthHub uses an electronic prescription (e-prescription) as a denominator and chipped nebuliser devices which capture the frequency of nebulised medications inhaled by the patient. This enables a calculation of nebulised medication adherence to be made. However, e-prescriptions may contain errors which can affect the adherence calculation. This service evaluation sought to review the accuracy of CFHealthHub e-prescriptions at a single adult CF centre, to understand the nature and causes of any inaccuracies and to evaluate the effect of prescription complexity on prescription accuracy. A total of thirty e-prescriptions from CFHealthHub were compared to ‘gold standard’ prescriptions. Inaccuracies and types of error in the e-prescriptions were recorded and analysis was conducted to understand the effect of prescription complexity on this. The two prescriptions were discussed with participants to determine the causes of inaccuracies. Inaccuracies were found in 43% (13/30) of e-prescriptions and were significantly associated with alternating medication regimens (p = 0.025). There were four error types found within the e-prescriptions: inaccurate medication list, incorrect medication duration, incorrect medication frequency and prescription duplication errors. Medication list errors were significantly associated with alternating medication regimens (p = 0.007). Causes of e-prescription inaccuracy were due to failure to update the prescription following a change, errors in prescription entry and inaccuracies caused by using two different nebuliser devices. CFHealthHub e-prescriptions contain inaccuracies and prescription complexity can increase the risk of prescription inaccuracy, although the small sample size limits the ability of the service evaluation to draw strong conclusions. Causes of e-prescription accuracy should be addressed by the local CF team.

Pharmaceutical care and evaluation of adherence to antiretroviral therapy in people living with HIV/AIDS

Highly Active Antiretroviral therapy (HAART) depends on optimal adherence to be effective. Pharmacotherapeutic follow-up can be used as a strategy for treatment fidelity. To provide pharmaceutical care for HAART patients, to assess adherence, to identify and resolve drug related problems (DRP). This is a prospective, interventional study aimed at people on HAART. Data was collected using the pharmacotherapeutic follow-up form and CEAT-VIH. There was a predominance of women (59%), older than 33 years (75%), mostly single (43%). Regarding adherence, 64% had insufficient adherence at the start of the study, while 36% had strict/adequate adherence. After the pharmacotherapeutic follow-up, 70% presented strict/adequate adherence. Regarding HAART, the relationship between adhesion versus time of HAART and adherence versus regimen used was significant, considering that less time of therapy and regimen containing protease inhibitors are predictors for insufficient adherence. Regarding the DRP identified (f=77), missed pills (32%), untreated disease, incorrect management frequency, and undue self-medication (12%) were the most frequent. Pharmaceutical interventions (f=137) were predominantly advising related to specific pharmacological treatment (32%), non-pharmacological measures (20%), and medication suspension (9%). Pharmaceutical care was shown to be animportant strategy, within the multi professional team, to improve adherence, besides identifying and resolving DRP.

POSB399 Systematic Identification of Pharmacological Inefficiencies By a Value-Based Patient Drug Safety Program

To describe the results of the systematic identification of pharmacological inefficiencies through a value-based patient drug safety program. Descriptive observational study, conducted between August 2020 - May 2021, in patients diagnosed with high-cost chronic pathologies. The pharmacists systematically identified and resolved the potential inefficiencies associated with drugs. A univariate analysis was performed, with summary measures of central tendency and relative and cumulative frequencies. R Core Team statistical package (2019) was used. Further, the potential savings of wasteful spending health was calculated. 13768 patients were evaluated with a mean age of 59 years (SD:4), 65.0% were women. In 1.9% of the patients evaluated, 16503 inefficiencies associated with inappropriate medication use were identified and intervened. 51.7% corresponded to therapeutic duplications, 12.9% unneeded medication, 10.3% drug interactions, 8.1% overdosage, 8.0% incorrect medication, 4.6% chronification of treatment, 1.4% incorrect use frequency, 1.1% underdosing, 1.1% prescribing cascade, 0.5% contraindications and, 0.3% dose adjustment due to renal or hepatic failure. The acceptance rate of pharmaceutical management was 18%. The potential savings from pharmacist interventions was 452002.44 USD (50222 USD an average month). The value-based patient drug safety program allows the systematic identification and management of pharmacological inefficiencies, generating impact on clinical and economic Results: However, articulation between pharmacist-physician-insurer health is required to improve the effectiveness of the pharmacist intervention.

Antibiotic resistance of Aeromonas spp. isolated from diseased walking catfish (Clarias sp.)

Abstract. Mulia DS, Isnansetyo A, Pratiwi R, Asmara W. 2021. Antibiotic resistance of Aeromonas spp. isolated from diseased walking catfish (Clarias sp.). Biodiversitas 22: 4839-4846. Aeromonas spp. is known to be pathogenic to freshwater fish, including catfish. Antibiotics are often used to overcome bacterial attacks. However, the indiscriminate use of antibiotics, especially at incorrect doses and frequencies, could result in the emergence of resistant bacteria. The presence of resistance genes is also suspected to trigger the resistance potential of Aeromonas sp. against antibiotics. The objective of this study is to characterize the resistance genes of Aeromonas spp. isolated from diseased walking catfish (Clarias sp.). Ten Aeromonas spp. were isolated from infected walking catfish cultivated in Java. The resistance genes assessed included tetA, strA-strB, and qnrA. The antibiotics tested consisted of ampicillin (AMP), erythromycin (ERY), oxytetracycline (OXT), kanamycin (KAN), enrofloxacin (ENRO), and chloramphenicol (CHL). Results showed that some Aeromonas spp. had at least one out of the three genes assessed (i.e., tetA and strA-strB) but none had the qnrA gene. Aeromonas spp. were sensitive to KAN, ENRO, and CHL but resistant to AMP, ERY, and OXT. Thus, KAN, ENRO, and CHL are effective antibiotics for treating fish infected with Aeromonas spp.