Incorrect Interval Research Articles

Improving documentation of zoledronic acid interval in ambulatory oncology patients.

323 Background: Therapy plan orders for certain repetitive medications such as Zoledronic Acid do not always reflect the interval administered. This creates a patient safety risk as patients may get extra or fewer doses than required, a lack of clarity for pharmacy dispensing and nurses administering the medication and delays for patients while the orders are corrected. In a 3-month period, 30 safety reports of Zoledronic Acid therapy plan discrepancies were reported. Methods: Baseline data was determined using manual chart review of a sample of 50 patients, reviewing documentation of Zoledronic Acid interval in four fields in the chart. 58% of patients had an incorrect interval in therapy plan title and 12% of charts had discrepancies in other fields. In initiating this improvement project, we identified and engaged key stakeholders (nurses, providers, IT, patient safety and pharmacists) in DFCI oncology outpatient areas in a series of interactive meetings to share baseline data and use quality improvement tools (process mapping and impact-effort matrix) to identify solutions. In PDSA cycle 1, the options of Zoledronic Acid therapy plans were modified from having separate plans for each interval to a single therapy plan with options to select the interval. This was done with the goal of reducing the number of fields with the interval to reduce discrepancies in interval. In PDSA cycle 2, a team of pharmacists reviewed charts of patients who had an appointment with a provider and were on Zoledronic acid weekly, for 12 weeks. Charts with interval discrepancies were sent to the ordering provider for correction. This was done for two disease groups over a period of 6 months. Results: Post the completion of PDSA cycle 1, an analysis of 7165 dispenses showed that Zoledronic Acid therapy plans containing information apart from medication name in title decreased from 90% in 2019 to 0.4% in 2021. PDSA cycle 2 addressed discrepancies in another 126 patient charts, reducing the overall discrepancies from 12% to 7%. Conclusions: This project demonstrates multidisciplinary approach to identifying solutions to discrepancies around Zoledronic Acid intervals in patient charts has reduced this patient safety risk. The solutions implemented in PDSA cycle 1 was a system-based solution with a high impact. PDSA cycle 2 helped mitigate the safety risk further. Additional system-based solutions are essential in the long term to reduce documentation variability and improve quality and safety of care for patients receiving Zoledronic Acid.

Evaluation of the validity of large-scale serial sectioning TEM for three-dimensional reconstruction of rice mesophyll cells and chloroplasts.

Serial sectioning transmission electron microscopy (ssTEM) is a classical method of 3D reconstruction using serial sections obtained with an ultramicrotome. However, producing a long ribbon with homogeneity is difficult. Here, ultramicrotome movement was suspended after producing a ribbon of 15-30 serial sections (cutting intervals, 100nm), and then, the ribbon was mounted on an individual one-slot grid. However, as this ssTEM method may include influencing factors such as incorrect intervals of section thickness and distortion of sections, which is produced by cutting sections using a diamond knife and beam interaction under TEM observation, qualitative and quantitative data on rice mesophyll cells and chloroplasts were compared with those obtained from a focused ion beam scanning electron microscopy (FIB-SEM) (cutting intervals, 50nm). No structural distortion in 3D models was observed. In addition, no significant differences in the volume and surface area were observed between the two methods. The surface to volume ratio was significantly affected by the increase in section thickness, but not the difference of methodologies. Our method was useful for observing large volumes of plant cells and organelles, leading to the identification of various sizes and types of chloroplasts. The formation of a chloroplast pocket, which is a structure surrounding other intracellular compartments, was confirmed in rice leaves grown under moderate growth conditions using the ssTEM method. As only four out of 90 chloroplasts formed pocket structures, the formation was considered to be rare under the applied moderate growth conditions.

Indirect standardization for rare events and a dynamic standard population rate: An analysis and simulation of U.S. military suicide mortality rates.

Comparing suicide mortality rates between the U.S. military and U.S. general populations is common in lay and professional literature. Standardization is required for this comparison to account for differences in the population structure, but small event counts complicate the analysis. We demonstrated the performance of direct, indirect, and reverse-direct standardization using U.S. military and U.S. general population suicide mortality data from 2011 to 2018. We also used simulations of direct and indirect standardization in annual comparisons, and over time for the standardized mortality ratio in Poisson regression. Indirect standardization outperformed direct standardization for annual rate standardization. Direct standardization with combined subgroups can produce a biased estimate. Reverse-direct standardization was unbiased, but it generally yields incorrect interval estimates. Over 2011-2018, the U.S. military suicide mortality data were very consistent with the U.S. general population. Indirect standardization provides more flexibility in rate standardization with rare outcomes. For comparisons between the U.S. military and the U.S. general populations, it can provide valid point and interval estimates of standardized rates and ratios both within a single year and between years without combining categories to account for sparseness.

A Gyssens Evaluation On Antibiotics Usage On Inpatients With Urinary Tract Infection In Hospital X, Central Jakarta, on January 2017 – June 2019

Urinary tract infections are infections from the bladder to the renal parenchyma, and can affect all ages. Empirical therapy can reduce morbidity, but due to the use of antibiotics that are not appropriate will have an impact on resistance that will cause increase morbidity, mortality, and health costs. In the Southeast Asian region, high use of antibiotics were found almost more than 80% in various provinces in Indonesia. This study aims to assess the appropriatness use of antibiotics in hospitalized patients with UTIs in the District Hospital X in the period January 2017 - June 2019 using gyssens criteria. This is retrospective study. Research data sourced from medical records. Data was collected and assessed with Gyssens flow, then processed using Microsoft Excel. The results found 15 cases (46.88%) with the appropriate use (category 0), 3 cases (9.37%) incorrect interval (category IIB), 1 case (3.33%) incorrect dosage (category IIA ), 10 cases (31.25%) too short given (category IIIB), 3 cases (9.37%) too long given (category IIIA). Empirical therapy inpatients with diagnosis urinary tract infections atvDistrict Hospital X, 46.8% of antibiotics were used appropriately.

Cystinosis: Therapy adherence and metabolic monitoring in patients treated with immediate-release cysteamine

BackgroundCystinosis is a metabolic disease caused by intracellular accumulation of cystine within lysosomes. Development of symptoms can be delayed significantly by a life-long therapy with cysteamine, a drug that enters the lysosome and reacts with cystine thereby enabling its export from the organelle. MethodsDuring a period of 16 years, blood samples of 330 cystinosis patients were analyzed to investigate therapeutic adherence and metabolic control in patients treated with immediate-release cysteamine. The accepted therapeutic goal is to measure intracellular cystine levels in white blood cells every 3 months and to keep them below 0.5 nmol cystine/mg protein (= 1 nmol hemicystine/mg protein). Results42% of measurements were within the desired 3-month interval, 38% were done every 3–5 months, 11% every 6–8 months, 5% every 9–12 months and 4% after a 12-month interval only. 64.4% of the measurements were higher than the therapeutic target value. Median cystine levels increased with longer control intervals. ConclusionsThe majority of the cystinosis patients showed insufficient metabolic adjustment. Intracellular cystine levels were not done as often as recommended and were not within therapeutic range. Poor therapy adherence is likely to be caused by gastrointestinal side effects of immediate-release cysteamine. Incorrect intervals between drug intake and blood sampling could contribute to the results.

Evaluasi Penggunaan Antibiotik pada Pasien Tifoid Rawat Inap di Salah Satu Rumah Sakit Pemerintah Provinsi Bali dengan Metode Gyssens dan ATC/DDD

Typhoid is a global health problem especially in developing countries, one of which is in Indonesia. The incidence of antibiotic resistance in typhoid therapy can occur due to inappropriate use of antibiotics. This study aims to determine patterns of antibiotic use as well as the quality and quantity of antibiotic use in typhoid therapy in one of the provincial government hospitals in Bali. This study was an observational study conducted retrospectively which was analyzed using the Gyssens and ATC/DDD methods. The research data were taken from the medical records of patients in the January-December 2019 period that met the inclusion criteria. The results showed that of the 40 total antibiotics prescribing, ceftriaxone was the most widely used antibiotic for typhoid therapy. The quality of antibiotic use as much as 40% is stated rational (category 0), while the other 60% is irrational (categories I-VI) which includes the use of antibiotics with incorrect interval of administration (IIB; 5%), the use of antibiotics that is too long (IIIA; 40%), the use of antibiotics that are too short (IIIB; 5%), there are other antibiotics that are more effective (IVA; 5%), and there are other antibiotics that are less toxic/safer (IVB; 5%). The quantity of antibiotic use was stated more than WHO standards which includes the use of ceftriaxone at 83.80 DDD/100 patient days; levofloxacin at 27.47 DDD/100 patient days; and azithromycin at 3.52 DDD/100 patient days. The results of this study are expected to be a consideration for the hospital as a material for evaluation and improvement in order to improve the rationality of antibiotic use.

Iot Based Medication Monitoring System for Independently Living Patient

Medicines are synthesized to cure, cease, prevent diseases or help in the diagnosis of illnesses. Lots of aged people live unaccompanied; few of them are endure from disorder, making it difficult to take care by oneself. Delay of taking their tablets or even taking it at the incorrect interval may raise health consequences. The design of an IoT based medication system is established and it can be used by patients as well as caretakers in sequence to monitor and ensure that the correct amount of each medicine is being taken at the exact time. This provides audio communication to aware the user when a confirmed medicine is to be taken. Furthermore, a software application is used to send messages and email alerts to the patient and the caretaker.

Misuse of antibiotics reserved for hospital settings in outpatients: a prospective clinical audit in a university hospital in Southern France

Some antibiotics are reserved essentially for hospital settings owing to cost effectiveness and in order to fight the emerging antibiotic resistance crisis. In some cases, antibiotics reserved exclusively for use in hospitals may be prescribed in outpatients for serious infections or in the absence of a therapeutic alternative. A 30-day prospective audit of outpatient prescriptions of antibiotics reserved exclusively for use in hospitals was performed. The objective of this study was to evaluate the relevance of outpatient antibiotic prescriptions by measuring appropriateness according to guidelines. During the study period, 53 prescriptions were included, only 40% of which were appropriate. Among the 32 inappropriate prescriptions, 4 cases lacked microbial arguments, 1 case was not adequate for the infection type, 1 case involved an incorrect antibiotic dosage, 1 case involved an incorrect interval of dose administration, 3 cases had a therapeutic alternative and 22 cases were not recommended. Of the 53 prescriptions, 66% were started in hospital and 34% in outpatients. Only 25% of cases were prescribed with infectious diseases specialist (IDS) advice, 64% were based on microbiological documentation and 13% had a negative bacterial culture. Inappropriate prescriptions were usually observed in antibiotic lock therapy, skin infections, Clostridium difficile colitis, intra-abdominal infections and intravascular catheter-related infections. Outpatient prescriptions of antimicrobial drugs reserved exclusively for use in hospitals are frequently inappropriate. We recommend a real-time analysis algorithm with the involvement of an IDS for monitoring prescriptions to improve the quality of these prescriptions and possibly to prevent antibiotic resistance.

Priming of lowpass-filtered speech affects response bias, not sensitivity, in a bandwidth discrimination task

Priming is demonstrated when prior information about the content of a distorted, filtered, or masked auditory message improves its clarity. The current experiment attempted to quantify aspects of priming by determining its effects on performance and bias in a lowpass-filter-cutoff frequency discrimination task. Nonsense sentences recorded by a female talker were sharply lowpass filtered at a nominal cutoff frequency (F) of 0.5 or 0.75 kHz or at a higher cutoff frequency (F + ΔF). The listeners' task was to determine which interval of a two-interval-forced-choice trial contained the nonsense sentence filtered with F + ΔF. On priming trials, the interval 1 sentence was displayed on a computer screen prior to the auditory portion of the trial. The prime markedly affected bias, increasing the number of correct and incorrect interval 1 responses but did not affect overall discrimination performance substantially. These findings were supported through a second experiment that required listeners to make confidence judgments. The paradigm has the potential to help quantify the limits of speech perception when uncertainty about the auditory message is removed.

Parental understanding of dosing instructions for paracetamol and ibuprofen suspension

AimsThis study was undertaken to identify whether parents and carers of children undergoing day-case surgery are able to read and understand the dosing instructions supplied with general sales list (GSL)...

Counting on Inhibition and Rate-Dependent Excitation in the Auditory System

The intervals between acoustic elements are important in audition. Although neurons have been recorded that show interval tuning, the underlying mechanisms are unclear. The anuran auditory system is well suited for addressing this problem. One class of midbrain neurons in anurans responds selectively over a narrow range of pulse-repetition rates (PRRs) and only after several sound pulses have occurred with the "correct" timing. This "interval-counting" process can be reset by a single incorrect interval. Here we show, from whole-cell patch recordings of midbrain neurons in vivo, that these computations result from interplay between inhibition and rate-dependent excitation. An individual pulse or slowly repeated pulses elicited inhibition and subthreshold excitation. Excitation was markedly enhanced, however, when PRR was increased over a neuron-specific range. Spikes were produced when the enhanced excitation overcame the inhibition. Interval-number thresholds were positively correlated with the strength of inhibition and number of intervals required to augment the excitation. Accordingly, interval-number thresholds decreased when inhibition was attenuated by loading cells with cesium fluoride. The selectivity of these neurons for the interpulse interval, and therefore PRR, was related to the time course of excitatory events and the rate dependence of enhancement; for cells that were tuned to longer intervals, EPSPs were broader, and enhancement occurred at slower PRRs. The frequency tuning of the inhibition generally spanned that of the excitation, consistent with its role in temporal computation. These findings provide the first mechanistic understanding of interval selectivity and counting in the nervous system.

ORAL CONTRACEPTIVE NON-COMPLIANCE IN RURAL BANGLADESH

This paper examines incorrect use of oral contraceptives (OCs) in rural Bangladesh by using data from an OC compliance survey. Of the 1031 current users of OCs interviewed, about 13% took their pills out of sequence, while 17% left incorrect intervals between pill packs. Forty per cent of the women reported missing one active pill during the 6 months prior to the survey, and 74% of them took correct action with the missed pill. Of the women who missed two active pills (16%), only 9% took correct action. Multivariate analyses revealed that women's education and their husbands' support helped protect against taking incorrect action with a missed pill. The fieldworker's contact was found to protect against leaving an incorrect interval between pill packs. Women who had membership of non-government organizations were less likely to interrupt their pill use, and more likely to take their pill out of sequence. The present study underscores the need for providing women with more support in their pill use, and advocates that service providers should be the focal point of efforts. Husbands' support is essential to improve the pill-taking behaviour of Bangladeshi women.

68 Medication Errors in A Neonatal Unit

Background: The magnitude and consequences of medical errors are controversial issues; nevertheless, there is a consensus on the preventability of medication errors and their frequent occurrence. Aim: To determine the frequency of different types of error in medical prescriptions and to estimate its occurrence as a function of characteristics and circumstances of the prescriptions. Methods: Cross-sectional study of hand-written prescriptions for newborn infants admitted to a third level neonatal unit during a 5 months study period (july–november 2003). Data were extracted from all prescriptions written on 53 randomly sampled days. Outcome variables: different elements were assessed to describe the correction of a prescription (drug name, dose, units, administration route, interval, legibility); a prescription was considered correct when all its elements were present. Determinants: characteristics and circumstances of the prescriptions (type of drug, day of the week, night/day shift, training of the prescriber and clinical profile of the patient). Data analysis: Proportions and logistic regression adjusted odds ratio (95% confidence interval). Results: 4132 hand-written prescriptions were reviewed. 58.6% of the prescriptions fullfilled the correction criteria. 88% of incorrect prescriptions were intercepted. No adverse effect was related to a prescription error. Dose calculation was incorrect in 12.3% of the prescriptions. An incorrect abbreviation of the units was used in 8.4%; 4% did not stated dose interval and 2.8% stated an incorrect interval. At least one of the elements of the prescription was considered illegible or uncertain in 13.7%. The route of administration was not stated in 12.7%, and it was not correct in 0.7%. The drugs with the higher proportion of incorrect prescriptions were caffeine and erythropoietin. Prescriptions were more frequently correct for newborns admitted to intensive vs. intermediate care, 1.5 (1.3–1.7); birth weight over 2500 g, 1.9 (1.5–2.4); on week-ends vs. rest of the week, 1.3 (1.1–1.5); on afternoon/night vs. morning shifts, 1.8 (1.4–2.3); and when written by intraining vs. staff doctors, 1.5 (1.4–1.8). Conclusion: More than half of prescriptions written out by hand in a neonatal unit were not considered correct. A higher workload is not related with a higher number of incorrect prescriptions. Professional experience does not reduce, in general, the number of prescription errors. The occurrence of miscalculation of dose was higher for medication prescribed daily or routinely.

Linkage mapping in experimental crosses: the robustness of single-gene models.

The robustness of parametric linkage mapping against model misspecification is considered in experimental breeding designs, with a focus on localization of the gene. By examining the expected LOD across the genome, it is shown that single-gene models are quite robust, even for polygenic traits. However, when the marker map is of low resolution, linked polygenes can give rise to an apparent "ghost" gene, mapped to an incorrect interval. The results apply equally well to quantitative traits or qualitative (categorical) traits. The results are derived for backcross populations, with a discussion of extensions to intercross populations and relative-pair mapping in humans.