Medication Warnings Research Articles

의료기관 종사자들의 전자의무기록 인증제 시행 목적에 대한 인식

This study was conducted to examine the perceptions of employees at tertiary and general hospitals, which have passed the certification of Electronic Medical Record (EMR) systems, regarding the objectives of the EMR certification program. The study was conducted from the perspectives of the public, medical institutions, and the industry. Data collection spanned from August 1 to October 31, 2022, involving responses from 1,187 employees across 11 or more accredited hospitals. The analysis included descriptive statistics, mean analysis, regression analysis, and Scheffé's analysis to understand the perceptions from the three different perspectives. The results revealed that from the public's perspective, the highest recognition was for “enhanced information security in medical information leading to the prevention of personal data breaches and security incidents” (t=-3.827, p<.01). From the perspective of medical institutions, the highest but not statistically significant recognition was for “improved clinical decision support such as medication warnings and effective history management of medical information, enabling safer and higher quality medical services” (f=-1.612). From the industrial perspective, there was high recognition for “the capability to meet market quality demands due to national recognition of EMR system quality standards” (f=-3.154, p<.01). Linear regression analysis was conducted to identify factors influencing the recognition of the objectives of the EMR certification system. The results showed that the model explained 27.4% of the variance for the public perspective, 26.9% for the medical institution perspective, and 28.6% for the industrial perspective, with all models being significant (P<.05). Following the implementation of the EMR certification system, medical institution employees positively perceived it from the perspectives of the public, medical institutions, and the industry. Future efforts should focus on enhancing system functionality awareness among employees, improving quality, and government and medical institutions should work together to enhance user interoperability of the system.

The Effect of Retroconversion Metabolism of N-oxide Metabolites by Intestinal Microflora on Piperaquine Elimination in Mice, as well as in Humans Predicted Using a PBPK Model.

Piperaquine (PQ) and its pharmacologically active metabolite PQ N-oxide (PM1) can be metabolically interconverted via hepatic cytochrome P450 and FMO enzymes. The reductive metabolism of PM1 and its further N-oxidation metabolite (PM2) by intestinal microflora was evaluated, and its role in PQ elimination was also investigated. The hepatic and microbial reduction metabolism of PM1 and PM2 was studied in vitro. The reaction phenotyping experiments were performed using correlation analysis, selective chemical inhibition, and human recombinant CYP/FMO enzymes. The role of microbial reduction metabolism in PQ elimination was evaluated in mice pretreated with antibiotics. The effect of the reduction of metabolism on PQ exposures in humans was predicted using a physiologically-based pharmacokinetic (PBPK) model. Both hepatic P450/FMOs enzymes and microbial nitroreductases (NTRs) contributed to the reduction metabolism of two PQ N-oxide metabolites. In vitro physiologic and enzyme kinetic studies of both N-oxides showed a comparable intrinsic clearance by the liver and intestinal microflora. Pretreatment with antibiotics did not lead to a significant (P > 0.05) change in PQ pharmacokinetics in mice after an oral dose. The predicted pharmacokinetic profiles of PQ in humans did not show an effect of metabolic recycling. Microbial NTRs and hepatic P450/FMO enzymes contributed to the reduction metabolism of PQ N-oxide metabolites. The reduction in metabolism by intestinal microflora did not affect PQ clearance, and the medical warning in patients with NTRs-related disease (e.g., hyperlipidemia) will not be clinically meaningful.

A Network Architecture and Routing Protocol for the MEDIcal WARNing System

The MEDIcal WARNing (MEDIWARN) system continuously and automatically monitors the vital parameters of pre-intensive care hospitalized patients and, thanks to an intelligent processing system, provides the medical teams with a better understanding of their patients’ clinical condition, thus enabling a prompt reaction to any change. Since the hospital units generally lack a wired infrastructure, a wireless network is required to collect sensor data in a server for processing purposes. This work presents the MEDIWARN communication system, addressing both the network architecture and a simple, lightweight and configurable routing protocol that fits the system requirements, such as the ability to offer path redundancy and mobility support without significantly increasing the network workload and latency. The novel protocol, called the MultiPath Routing Protocol for MEDIWARN (MP-RPM), was therefore designed as a solution to support low-latency reliable transmissions on a dynamic network while limiting the network overhead due to the control messages. The paper describes the MEDIWARN communication system and addresses the experimental performance evaluation of an implementation in a real use-case scenario. Moreover, the work discusses a simulative assessment of the MEDIWARN communication system performance obtained using different routing protocols. In particular, the timeliness and reliability results obtained by the MP-RPM routing protocol are compared with those obtained by two widely adopted routing protocols, i.e., the Ad-hoc On-demand Distance Vector (AODV) and the Destination-Sequenced Distance-Vector Routing (DSDV).

Of Cosmetic Value Only: Make-Up and Terrible Old Ladies in Victorian Literature

By looking at the figure of the painted older woman in nineteenth-century novels, this article examines how changing attitudes to cosmetics punished ageing women who clung to the make-up of their youth. As a warning against such continued practices, Catherine Gore’s ageing Lady Ormington demonstrates how devotion to make-up cannot hold back the signs of ageing. In a similar manner, Dickens’s Mrs Skewton shows how Georgian make-up, her ageing features, and her corrupt personality are equally contaminative. Finally, Percy Fitzgerald’s ‘Terrible Old Lady’ shows how heavy make-up is a literary motif that better delineates the ravages of female ageing than biological change alone. I conclude that in nineteenth-century novels, cosmetics do not function as a worrying disguise or serve as a medical warning, but rather act to depict the ageing woman as extraneous, purposeless, and aesthetically irrelevant.

Medications and risk of motor vehicle collision responsibility in British Columbia, Canada: a population-based case-control study

Many medications impair driving skills yet their influence on collision risk remains uncertain. We aimed to systematically investigate the risk of collision responsibility associated with common classes of prescription medications. In this population-based case-control study we analysed linked driving and health records in British Columbia, Canada from Jan 1, 1997, to Dec 31, 2016. The study cohort included all drivers involved in an incident collision (defined as first collision after 3 collision-free years) that resulted in a police report. We scored police collision reports and classified drivers as responsible for the collision (cases) or not responsible (controls); drivers with indeterminate scores were excluded. We used logistic regression to determine odds of collision responsibility in drivers with current prescriptions for medications of interest versus drivers without prescriptions. To explore whether risk of collision responsibility was related to medication effect or driver factors, we compared risk in current medication users versus past users. To study whether drivers developed tolerance to medication effects, we compared risk in new (first 30 days of a prescription) versus established users. During the study period, 4 906 925 drivers had their driving licence linked to health records; of these drivers, 747 662 unique drivers were involved in 837 919 incident collisions between Jan 1, 2000, and Dec 31, 2016. 382 685 drivers responsible for the collision (cases) and 332 259 drivers not responsible (controls) were included in the final analysis; 122 975 drivers with indeterminate responsibility were excluded. We found increased risk of collision responsibility in drivers prescribed sedating antipsychotics (adjusted odds ratio [aOR] 1·35 [98·75% CI 1·25-1·46]), long-acting benzodiazepines (aOR 1·30 [1·22-1·38]), short-acting benzodiazepines (aOR 1·25 [1·20-1·31]), and high-potency opioids (aOR 1·24 [1·17-1·30]). Among medications used for medical indications, the highest risk was seen in drivers prescribed neurological medications: cholinergic drugs (aOR 1·83 [1·39-2·40]), anticholinergic agents for Parkinson's disease (aOR 1·45 [1·08-1·96]), dopaminergic agents (aOR 1·20 [1·04-1·38]), and anticonvulsants (aOR 1·20 [1·14-1·26]). People currently taking benzodiazepines, non-sedating antidepressants, high-potency opioids, and anticonvulsants had increased risk compared with past users, and we did not find increased risk in new compared with established users of these drugs. Drivers prescribed benzodiazepines or high-potency opioids are at increased risk of being responsible for collisions and this risk does not decrease over time. Several other classes of medications are associated with increased risk, but this association might be independent of medication effect. These findings can guide medication warnings and prescription choices and inform public education campaigns targeting impaired driving. Canadian Institutes of Health Research.

Singular and short-term anesthesia exposure in the developing brain induces persistent neuronal changes consistent with chronic neurodegenerative disease

The potential adverse impact of inhalational anesthetics on the developing brain was highlighted by the addition of a medication warning by the U.S. Food and Drug Administration for their use in the pediatric population. To investigate mechanisms by which early life anesthesia exposure could induce long-term neuronal dysfunction, we exposed rats to 1 minimum alveolar concentration sevoflurane at 7 days of life. The animals were raised normally until adulthood (P300) prior to sacrifice and analysis of cortical tissue structure (TEM), mitochondrial quality control and biogenesis pathways (Western blot, ELISA, ADP/ATP content), and markers of oxidative stress, proteotoxicity and inflammation (Western blot, ELISA). We found that early life anesthesia exposure led to adverse changes in mitochondrial quality maintenance pathways, autophagy and mitochondrial biogenesis. Although there was an escalation of oxidative stress markers and an increase in the nuclear localization of stress-related transcription factors, cellular redox compensatory responses were blunted, and oxidative phosphorylation was reduced. We found upregulation of mitochondrial stress and proteotoxicity markers, but a significant reduction of mitochondrial unfolded protein response end-effectors, contributing to an increase in inflammation. Contrary to acute exposure, we did not find an increase in apoptosis. Our findings suggest that a limited, early exposure to anesthesia may produce lasting cellular dysfunction through the induction of a sustained energy deficient state, resulting in persistent neuroinflammation and altered proteostasis/toxicity, mimicking aspects of chronic neurodegenerative diseases.

Food allergy history and reaction to propofol administration in a large pediatric population.

Anaphylaxis to propofol is rare; however, providers face a clinical quandary as medication warnings still exist regarding propofol administration to egg-, soy-, and peanut-allergic patients. The primary aim evaluated the rate of allergic reactions during propofol-containing anesthesia in patients listed allergic to egg, soy, or peanut compared with nonallergic patients who received propofol. The secondary aim evaluated the relationship between food allergy history and allergy testing data. A retrospective chart review conducted between May 2012 and October 2018 identified pediatric patients listed allergic to egg, soy, and/or peanut, who received propofol. Allergy testing and results are presented. Evidence of allergic reaction to propofol during anesthesia was evaluated, and compared with a large nonallergic cohort who received propofol. Of the 232392 anesthetics administered, 177360 (76%) included propofol and 11308 (6%) involved a patient listed allergic to at least 1 index food. A large number of patients had no food allergy testing (n=6153) or negative testing (n=2198). Of the 3435 patients listed egg-allergic, 976 tested positive; 750 tested negative; and 1709 had no testing. Of the 2011 patients listed soy-allergic, 322 tested positive; 585 tested negative; and 1104 had no testing. Additionally, 5862 patients were listed peanut-allergic; 1659 tested positive; 863 tested negative and 3340 had no testing. One record of proven propofol anaphylaxis occurred; it was in a patient without a history of food allergies. There were 6 other cases of suspected allergy to propofol. One had a peanut and tree nut allergy and was lost to follow-up; one had no testing available, while 4 patients had positive propofol allergy testing and positive allergy tests to other medications. The rate of proven propofol anaphylaxis during anesthesia in the nonallergic cohort was 0.06/10000, and the rate in egg- and soy-allergic patients was 0/5446. One patient with a listed peanut allergy had a possible reaction to propofol. In the listed food-allergic cohort, the majority had no allergy testing or negative testing. We found no evidence of a relationship between food allergy history and perioperative propofol reaction. We suggest multiply allergic and atopic patients may have a similar likelihood of propofol reaction as with other medications.

Development and initial implementation of electronic clinical decision supports for recognition and management of hospital-acquired acute kidney injury

BackgroundAcute kidney injury (AKI) is common in hospitalized patients and is associated with poor patient outcomes and high costs of care. The implementation of clinical decision support tools within electronic medical record (EMR) could improve AKI care and outcomes. While clinical decision support tools have the potential to enhance recognition and management of AKI, there is limited description in the literature of how these tools were developed and whether they meet end-user expectations.MethodsWe developed and evaluated the content, acceptability, and usability of electronic clinical decision support tools for AKI care. Multi-component tools were developed within a hospital EMR (Sunrise Clinical Manager™, Allscripts Healthcare Solutions Inc.) currently deployed in Calgary, Alberta, and included: AKI stage alerts, AKI adverse medication warnings, AKI clinical summary dashboard, and an AKI order set. The clinical decision support was developed for use by multiple healthcare providers at the time and point of care on general medical and surgical units. Functional and usability testing for the alerts and clinical summary dashboard was conducted via in-person evaluation sessions, interviews, and surveys of care providers. Formal user acceptance testing with clinical end-users, including physicians and nursing staff, was conducted to evaluate the AKI order set.ResultsConsiderations for appropriate deployment of both non-disruptive and interruptive functions was important to gain acceptability by clinicians. Functional testing and usability surveys for the alerts and clinical summary dashboard indicated that the tools were operating as desired and 74% (17/23) of surveyed healthcare providers reported that these tools were easy to use and could be learned quickly. Over three-quarters of providers (18/23) reported that they would utilize the tools in their practice. Three-quarters of the participants (13/17) in user acceptance testing agreed that recommendations within the order set were useful. Overall, 88% (15/17) believed that the order set would improve the care and management of AKI patients.ConclusionsDevelopment and testing of EMR-based decision support tools for AKI with clinicians led to high acceptance by clinical end-users. Subsequent implementation within clinical environments will require end-user education and engagement in system-level initiatives to use the tools to improve care.

Fall prevention implementation strategies in use at 60 United States hospitals: a descriptive study

BackgroundTo guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls...

Assessment of handwritten prescriptions from Saudi Arabia according to international guidelines.

Objective:Prescription dispensing services are not digitalized in the majority of governmental hospitals and private clinics in Saudi Arabia, which makes them prone to error. We aimed to evaluate handwritten prescriptions in a region in Saudi Arabia for consistency and accuracy according to international guidelines.Methods:A sample of handwritten prescriptions (dated 2016 or 2017) from selected pharmacies in the Al-Qassim region (n = 556) were evaluated for missing information on items related to prescriber, patient, and medication according to the World Health Organization and Food and Drug Administration guidelines.Results:We found that the prescriber’s name and contact information were missing in two-thirds of the prescriptions (66%). Patients’ addresses were always missing (100%). No prescription contained medication warnings; a majority lacked information on mode of administration (68%) and methods to avoid refilling (66%).Conclusion:Saudi Arabia should take a multipronged approach, including digitalization of prescription dispensing services, in both public and private health care facilities in order to reduce prescription errors.

The Aesthetics of Mental Illness in Defoe’s Crusoe Trilogy

Abstract This essay studies Robinson Crusoe’s ‘chronical Distemper’ of wanderlust in the context of early eighteenth-century concepts of mental illness, which often hinge on unruly passions and, even more specifically, an overactive imagination. Defoe describes Crusoe’s insatiable urge to ramble as a type of insanity that is rooted in fancy, not reason, yet simultaneously indicates that the expression of this impulse differentiates his character and generates magnificent gains. Although at odds with religious and medical warnings about the dangers of excessive passion, then, Defoe suggests that Crusoe’s ‘unconquerable’ wanderlust is a beneficial kind of madness that counteracts idleness and cements his distinctly English, merchant capitalist identity. More largely, the Crusoe trilogy as a whole contributes to early novelistic discourse by aligning mental illness, self-analysis, and the production of narrative, thereby stitching together evolving concepts of the human mind and literary form.

MON-148 Medication Adherence Mobile Apps And Diabetes Self Management Education/Support Guidelines

Background: Medication adherence is a problem in the management of chronic diseases like Diabetes. As there are 325,000 mobile health apps in 2017, "medication adherence" mobile apps are now a subtype of this sector in the ehealth marketplace. More and more patients are using such apps to self manage their medication and disease management. Purpose: To evaluate free, medication compliance mobile apps in terms of the Diabetes Self Management Education/Support Guidelines Methods: We used Google Play Store to find the free medication adherence apps, ranging from 1 million to 50,000 downloads, for 2018. Android apps downloads are documented by Google Play whereas iPhone apps downloads are not available to the public. Inclusion criteria: apps that emphasized medication compliance. Exclusion criteria: apps with malfunctioning websites on a daily basis. Result: Ranked by most downloads to least number of downloads: 1) Pill Reminder and Medication Tracker by Medisafe (1 million downloads (DL)); 2)CareZone (1 million DL); 3) Medication Reminder & Pill Tracker (500,000 DL); 4)Dosecast (100,000 DL); 5) Med Help Pill Reminder (100,000 DL); 6) Alarm and pill reminder (100,000 DL); 7) Mango Health (100,000 DL); 8) Medicine time! (100,000 DL); 9) Mr. Pillster (100,000 DL) ;10) Medica (50,000 DL). 100% of the 10 apps have reminders and missed medication warnings. Other features included in the apps: rewards 1/10 ; HIPAA compliance 1/10; BP 6/10; FBS 6/10; HbA1c 2/10 ; weight 6/10; height 3/10; exercise 2/10; carb 2/10; 4/10 mood; 0/10 stress mgmt; BMI 1/10, lipids 1/10. Conclusion: Medication adherence apps are available to patients with smartphones. However, most of the current medication adherence apps do not track the important health parameters for diabetes management, according to the DSME/S guidelines such as FBS, HbA1C, weight loss, exercise, carb intake, stress management and BMI. We, as physicians, can use our knowledge to guide our diabetic patients in their judicious use of mobile health medication adherence apps.

Users' Interpretation of Pictograms and Pictures for Conveying Instructions and Warnings on Pharmaceutical Labels.

Pharmaceutical pictograms are figures that provide a visual representation of medication instructions and warnings. Pictograms were created in order to lower the continuously rising problem of poor medication adherence due to patients misunderstanding what is being instructed on medication labels. Research on pictograms show that their use could increase patients' comprehension of medication instructions, but the comprehension rates are still low. Researchers have argued that in order to improve the effectiveness of pictograms, they must be more concrete, simple, meaningful, and familiar. Pictures have these properties. Thus, the goal of this study was to examine if the use of pictures (i.e., real images) provide a better representation of what is being instructed to users on medication labels than pictograms. We hypothesized that real images would lead to a better understanding of the instructions and warnings for taking medication, and in turn, users would have higher comprehension levels. Participants completed an online survey evaluating the meaning of either pictograms or pictures. Both quantitative and qualitative data analyses were conducted on free responses to the questions and on users' ratings of the "goodness" of the stimuli. The results showed that participants were moderately accurate (74%) in their interpretation of pictograms, and the use of pictures did not improve their comprehension.

Depression screening for prescribed medications with mental health risk: Considerations for clinical decision support, workflow redesign, and health information exchange arrangements.

Depression screening should be increased when prevailing knowledge underscoring medication-associated mental health risk is highest. Depression screening in primary care practices when medications with mental health risk were prescribed was estimated while considering the absence and presence of clinical decision support systems. A cross-sectional, descriptive study using the National Ambulatory Medical Care Survey (NAMCS) data from 2008 to 2010 was conducted. Primary care physician visits were classified based on whether a medication prescribed had a contraindication, severe warning, moderate warning, adverse event only, or no documented mental health risk. Adjusted odds of depression screening for each risk warning level were estimated while controlling for important sociodemographic factors and presence of computerized systems for medication warnings and guideline recommendations. Depression screening at primary care practice visits when medications were prescribed was 2.1% and increased to 2.8% or higher when medications had a moderate or severe mental health risk warning ormedication-disease contraindication. Depression screening was increased at visits when at least one medication was prescribed that had a contraindication (AOR=6.31, P<0.001), severe warning (AOR=2.04, P=0.003), or moderate warning (AOR=2.50, P=0.012) for mental health risk, but not for mental health adverse event only warnings alone (AOR=1.54, P=0.074). Depression screening is increased when medications were prescribed with a documented mental health risk. Presence of clinical decision support systems may help discern between minor and major medication-associated mental health risks. Appropriately, positioned warning systems with targeted content, workflow redesign, and health information exchange may improve depression screening in at-risk patients.

Physicians' use of computerized clinical decision supports to improve medication management in the elderly - the Seniors Medication Alert and Review Technology intervention.

BackgroundElderly people (aged 65 years or more) are at increased risk of polypharmacy (five or more medications), inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS) within an electronic medical record (EMR) could improve medication safety.MethodsParticipatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers’ Criteria for medication management and the Cockcroft–Gault formula for estimating glomerular filtration rates (GFR). The “Seniors Medication Alert and Review Technologies” (SMART) intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages) and active (order-entry alerts) prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed.ResultsAnalysis of subjective data revealed that most clinicians agreed that CDS appeared at appropriate times during patient care. Although managing alerts incurred a modest time burden, most also agreed that workflow was not disrupted. Prevalent concerns related to clinician accountability and potential liability. Approximately 36% of eligible encounters triggered at least one SMART alert, with GFR alert, and most frequent medication warnings were with hypnotics and anticholinergics. Approximately 25% of alerts were overridden and ~15% elicited an evidence check.ConclusionWhile most SMART alerts validated clinician choices, they were received as valuable reminders for evidence-informed care and education. Data from this study may aid other attempts to implement Beers’ Criteria in ambulatory care EMRs.

Implementation of Medical Early Warning System in Rehabilitation: A Tool to Reduce Unplanned Transfers

Implementation of Medical Early Warning System in Rehabilitation: A Tool to Reduce Unplanned Transfers

Factors associated with medication warning acceptance for hospitalized adults

Computerized provider order entry (CPOE) systems can warn clinicians ordering medications about potential allergic or adverse reactions, duplicate therapy, and interactions with other medications. Clinicians frequently override these warnings. Understanding the factors associated with warning acceptance should guide revisions to these systems. Increase understanding of the factors associated with medication warning acceptance. Retrospective study of all single-medication warnings generated in a CPOE system from October 2009 through April 2010. Academic medical center. All adult non-intensive care unit patients hospitalized during the study period. A total of 40,391 medication orders generated a single-medication warning during the 7-month study period. Of these warnings, 47% were duplicate warnings, 47% interaction warnings, 6% allergy warnings, 0.1% adverse reaction warnings, and 9.8% were repeated for the same patient, medication, and provider. Only 4% of warnings were accepted. In multivariate analysis, warning acceptance was positively associated with male patient gender, admission to a service other than internal medicine, caregiver status other than resident, parenteral medications, lower numbers of warnings, and allergy or adverse reaction warning types. Older patient age, longer length of stay, inclusion on the Institute for Safe Medication Practice's List of High Alert Medications, and interaction warning type were all negatively associated with warning acceptance. Medication warnings are rarely accepted. Acceptance is more likely when the warning is infrequently encountered, and least likely when it is potentially most important. Warning systems should be redesigned to increase their effectiveness for the sickest patients, the least experienced physicians, and the medications with the greatest potential to cause harm.

Abstract A79: Empowering Latino cancer patients on the reality of cancer pain and debunking cultural myths via an interactive pain education program

Abstract Introduction: Limited educational programs on pain management are available for Spanish speaking cancer patients. One way of addressing Latinos cancer pain needs and barriers was to conduct a needs assessment. Thus taking a patient centered approach by involving Latino patients/families to enhance their care, expand their voice and address needs. The purpose of the Spanish interactive pain education program was to provide patients and families with tools and resources to assist them in communicating their pain to the healthcare team and debunking the cultural myths of cancer pain during and after treatment. Methods: Needs assessments (n=132) were mailed to all new Spanish speaking patients over a 90 day period, 57 were completed. Data identified the need to educate patients/families on cancer pain management and greater need for Spanish educational programs versus support. Thus, an interactive pain management education program was developed. Cultural factors were considered in designing and delivering the education intervention such as the significance of family or “familismo” which is considered one of the most culturally specific values for Latinos. Three Spanish pain classes were conducted by an Advanced Practice Nurse and a Health Educator. Five interactive components were embedded into the program to ensure patients understanding and learning. Education was provided on how to interpret and use two pain scales (Faces versus ten point scale), creating a pain diary, medication list, and how to read medication bottles and warnings, including complementary and alternative options for pain management. A Bingo game was used as a way for patients to demonstrate the skills and knowledge gained during the class, and for educators to re-address objectives or provide clarification. Data was collected at the end of each class to evaluate effectiveness and knowledge gained. Patients received a one week follow-up phone call to see if they applied any of the skills gained during the class. Findings: The pilot program further identified a distorted perception of pain when undergoing cancer treatment: (1) pain was not manageable (2) part of the treatment process (3) a way that the body is getting rid of cancer. Others refused medication for fear of addiction. When asked how they dealt with pain, the majority mentioned that they preferred to receive support or comfort in their families or talk with other cancer patients in similar situations. Some patients shared that they did not communicate their pain issues to their healthcare team, for fear of treatment delay. Patients stated that the class provided them with tools and resources to take more of an active role in their care and managing their pain. Conclusion: After attending class patients are able to take more of an active role in their care. Attendees are able to communicate their pain to their health care team by using descriptive words and/or using the pain scale to rate their pain or describe it. Patients have incorporated non-drug intervention strategies to help them cope with pain (music, meditation, attending educational classes). Citation Format: Gloria Juarez, Lina Mayorga. Empowering Latino cancer patients on the reality of cancer pain and debunking cultural myths via an interactive pain education program. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A79. doi:10.1158/1538-7755.DISP13-A79

Perceptions of prescription warning labels within an underserved population

To understand how underserved populations attend to prescription warning label (PWL) instructions, examine the importance of PWL instructions to participants and describe the challenges associated with interpreting the information on PWLs. Adults from an underserved population (racial and ethnic minorities, individuals with low income, older adults) who had a history of prescription medication use and were able to understand English took part in semi-structured interviews. Participants were presented with eight different prescription bottles with an attached PWL. Participants were asked, "If this prescription was yours, what information would you need to know about the medicine?" The number of participants who attended to the warning labels was noted. Other questions assessed the importance of PWLs, the challenges with understanding PWLs, and ways a pharmacist could help participant understanding of the PWL. There were 103 participants. The mean age was 50.25 years (SD=18.05). Majority attended to the PWL. Participants not currently taking medications and who had limited health literacy were likely to overlook the warning labels. Majority rated the warning instructions to be extremely important (n=86, 83.5 %), wanted the pharmacist to help them understand PWLs by counseling them on the information on the label (n=63, 61.2%), and thought the graphics made the label information easy to understand. PWLs are an important method of communicating medication information, as long as they are easily comprehensible to patients. In addition to placing PWLs on prescription bottles, health care providers need to counsel underserved populations on medication warnings, especially individuals with limited health literacy who are not currently using a prescription medication.

Consumer Perceptions of Medication Warnings About Driving: A Comparison of French and Australian Labels

Objective: Little research has examined user perceptions of medication warnings about driving. Consumer perceptions of the Australian national approach to medication warnings about driving are examined. The Australian approach to warning presentation is compared with an alternative approach used in France. Visual characteristics of the warnings and overall warning readability are investigated. Risk perceptions and behavioral intentions associated with the warnings are also examined. Method: Surveys were conducted with 358 public hospital outpatients in Queensland, Australia. Extending this investigation is a supplementary comparison study of French hospital outpatients (n = 75). Results: The results suggest that the Australian warning approach of using a combination of visual characteristics is important for consumers but that the use of a pictogram could enhance effects. Significantly higher levels of risk perception were found among the sample for the French highest severity label compared to the analogous mandatory Australian warning, with a similar trend evident in the French study results. The results also indicated that the French label was associated with more cautious behavioral intentions. Conclusion: The results are potentially important for the Australian approach to medication warnings about driving impairment. The research contributes practical findings that can be used to enhance the effectiveness of warnings and develop countermeasures in this area. Hospital pharmacy patients should include persons with the highest level of likelihood of knowledge and awareness of medication warning labeling. Even in this context it appears that a review of the Australian warning system would be useful particularly in the context of increasing evidence relating to associated driving risks. Reviewing text size and readability of messages including the addition of pictograms, as well as clarifying the importance of potential risk in a general community context, is recommended for consideration and further research.