Medication Labels Research Articles

Nirsevimab: Expansion of Respiratory Syncytial Virus Prevention Options in Neonates, Infants, and At-Risk Young Children.

Review available data from clinical trials of nirsevimab for efficacy and safety in the setting of respiratory syncytial virus (RSV) prophylaxis in infants and children, while exploring nirsevimab's role in clinical practice and highlighting continuing questions. A literature search of PubMed was conducted utilizing the phrases "nirsevimab" and "medi8897." Additional references were identified through found references. Organizational guidelines, medication labeling, and regulatory organization presentations were utilized. Relevant clinical trials investigating nirsevimab in infants and children were included as well as other references on pharmacology, pharmacokinetics, and pharmacoeconomics. Nirsevimab, a once-a-season monoclonal antibody, demonstrated a 79.5% (95% CI, 65.9-87.7; P < 0.00001) lower incidence of RSV-associated medically attended lower respiratory tract infections (MA RSV-associated LRTI) and 77.3% (95% CI, 50.3-89.7; P = 0.0002) reduction in hospitalizations for RSV-associated MA-LRTI across 2 placebo-controlled studies. Nirsevimab demonstrated comparable safety to placebo with minor dermatologic reactions being the most common adverse event (0.9% vs 0.6%). Nirsevimab was approved by the US Food and Drug Administration, and recommended by the Advisory Committee on Immunization Practices and American Academy of Pediatrics for broad administration to infants entering their first RSV season and at risk patients during their second RSV season. Questions remain over efficacy in infants born < 29-week gestation and other economical considerations. Nirsevimab demonstrated clinical efficacy in reducing RSV-associated MA-LRTI and RSV-associated hospitalizations in infants and was well tolerated.

Store and cost of medicine in Libya house.

Background: The way we store our medications affects their effectiveness. When patients need to take their prescriptions outside the home, the health care provider should advise them on how to transport and store them safely. Objective: This study aimed to investigate or determine the storage conditions of medicines, usage habits, and cost of medications in households in Libya. Methods: This cross-sectional study included questionnaires conducted randomly in 100 Libyan homes. Householders were informed in advance of the survey, which took place from September to November 2023. Results: the final questionnaire included the following sections: there was demographic data on household storage of medicines in Libya, types of medications found in Libyan households, places for drugs were stored in Libyan households, factors related to medications in Libyan households, and cost of drugs found in Libyan households. Conclusion: the prevalence of household drug storage in 100-libya households was analgesics, antihypertension, and antiasthmatic. Most drugs kept at home were not appropriately labeled or stored in a safe place. This study highlights the urgent need for improved awareness and education regarding proper medication storage and labeling in Libyan households.

On-the-fly point annotation for fast medical video labeling.

In medical research, deep learning models rely on high-quality annotated data, a process often laborious and time-consuming. This is particularly true for detection tasks where bounding box annotations are required. The need to adjust two corners makes the process inherently frame-by-frame. Given the scarcity of experts' time, efficient annotation methods suitable for clinicians are needed. We propose an on-the-fly method for live video annotation to enhance the annotation efficiency. In this approach, a continuous single-point annotation is maintained by keeping the cursor on the object in a live video, mitigating the need for tedious pausing and repetitive navigation inherent in traditional annotation methods. This novel annotation paradigm inherits the point annotation's ability to generate pseudo-labels using a point-to-box teacher model. We empirically evaluate this approach by developing a dataset and comparing on-the-fly annotation time against traditional annotation method. Using our method, annotation speed was faster than the traditional annotation technique. We achieved a mean improvement of AP@50 over conventional method at equivalent annotation budgets on the developed dataset. Without bells and whistles, our approach offers a significant speed-up in annotation tasks. It can be easily implemented on any annotation platform to accelerate the integration of deep learning in video-based medical research.

Improving Efficiency in Hospital Pharmacy Services: An Integrated Strategy Using the OCTAGON-P Framework and Lean 5S Management Practices.

Background Hospital pharmacy departments have a critical role in the healthcare system, as they aim to provide excellent patient services while also ensuring cost-effectiveness. Lean methodologies are well-known for improving efficiency and quality in various industries, but their impact on healthcare, particularly in hospital pharmacy settings, has not been thoroughly investigated. Aim This quality improvement (QI) study aimed to assess the impact of implementing the sort, set in order, shine, standardize, and sustain (5S) methodology using the innovative orientation, coordination, training, awareness, governance, observation, normalization, and promotion (OCTAGON-P) framework on the operations of Mediclinic Parkview Hospital (MPAR) Pharmacy in Dubai, UAE. Methods The QI project spanned a period of six weeks, from December 18th, 2023, to January 28th, 2024. Throughout this period, a new novel OCTAGON-P framework's eight crucial elements were methodically integrated. Simultaneously, an extensive preparation processencompassing the five stages of the 5S methodwas carried out. Results The findings indicated a notable enhancement in organization, orderliness, cleanliness, medication storage, and workspace standardization. The significant improvement of 217% in terms of organization highlighted the effectiveness of resource arrangement. The orderliness of the workspace saw an increase of 800%, indicating a transformation in the systematic organization. Additionally, cleanliness improved by 138%, demonstrating a significant advancement in maintaining a spotless environment. The standardization of processes experienced a boost of 300%, reflecting a solidified approach to consistent operational methods. These refinements resulted in an overall improvement of 90% from the initial baseline of 20% on the 5S checklist scores. Efficiency gains were observed, with outpatient medication retrieval times reduced by 50%, inpatient times by 40%, emergency prescription serving by 16.7%, and pediatric prescription serving by 11%. The inpatient medication return process saw a 67% improvement. Patient counseling time increased by 23.3%, indicating a more patient-centered approach. Prescription verification and medication expiry checks increased by 50% and 200%, respectively, enhancing the quality of care. Inventory management efficiency improved by 36%, and medication label printing time decreased by 70% with the additional label printers. Installing extra medication label printers was done through the OCTAGON-P framework, specifically in the "orientation" and "coordination" phases. These two initial phases focused on leadership's 5S orientation, management support, and securing additional resources. Therefore, the OCTAGON-P framework provided a structured approach that promoted continuous improvement and sustained lean practices. Conclusion This research study presented the remarkable effectiveness of the OCTAGON-P framework in structurally implementing the 5S methodology into hospital pharmacy operations. The findings underscored the potential of lean 5S to enhance and optimize operational efficiency and overall quality within the critical environment of hospital pharmacy settings. Consequently, these improvements can conclusively result in the provision of superior and enhanced patient care, which is truly fundamental and central to the mission and objectives of any healthcare institution.

'Either something's wrong, or I'm a terrible parent': A systematic review of parent experiences of illness-related interpretations for unsettled babies.

To explore parents' experiences of unsettled babies and medical labels. Qualitative systematic review, thematic synthesis and development of a conceptual model. Systematic review and thematic synthesis of primary, qualitative research into parents' experiences of unsettled babies <12 months of age. 'Unsettled' was defined as perception of excessive crying with additional feature(s) such as vomiting, skin or stool problems. The Critical Appraisal Skills Programme (CASP) checklist was used to assess trustworthiness. Structured searches completed in CINAHL, Medline, Embase, PsychINFO and CochraneCT on 23 March 2022 and rerun on 14 April 2023. Ten eligible studies were included across eight countries contributing data from 103 mothers and 24 fathers. Two analytical themes and eight descriptive themes were developed. Firstly, parents expressed fearing judgement, feeling guilty and out of control as a result of babies' unsettled symptoms and seeking strategies to construct an 'Identity as a "Good Parent"'. This desire for positive parenting identity underpinned the second analytical theme 'Searching for an explanation' which included seeking external (medical) causes for babies' unsettled behaviours. Parents can become trapped in a cycle of 'searching for an explanation' for their baby's unsettled behaviours, experiencing considerable distress which is exacerbated by feelings of guilt and failure. Insight gained from this review could inform interventions to support parents, reducing inaccurate medicalization. Health visiting teams supporting parents with unsettled baby behaviour could focus on supporting a positive parenting identity by managing expectations, normalizing the continuum of infant behaviours, reducing feelings of guilt or uncertainty and helping parents regain a feeling of control. ENTREQ guidelines were adhered to in the reporting of this review. Parent input was crucial in the design phase; shaping the language used (e.g., 'unsettled babies') and in the analysis sense-checking findings.

Attention-guided jaw bone lesion diagnosis in panoramic radiography using minimal labeling effort

Developing a deep-learning-based diagnostic model demands extensive labor for medical image labeling. Attempts to reduce the labor often lead to incomplete or inaccurate labeling, limiting the diagnostic performance of models. This paper (i) constructs an attention-guiding framework that enhances the diagnostic performance of jaw bone pathology by utilizing attention information with partially labeled data; (ii) introduces an additional loss to minimize the discrepancy between network attention and its label; (iii) introduces a trapezoid augmentation method to maximize the utility of minimally labeled data. The dataset includes 716 panoramic radiograph data for jaw bone lesions and normal cases collected and labeled by two radiologists from January 2019 to February 2021. Experiments show that guiding network attention with even 5% of attention-labeled data can enhance the diagnostic accuracy for pathology from 92.41 to 96.57%. Furthermore, ablation studies reveal that the proposed augmentation methods outperform prior preprocessing and augmentation combinations, achieving an accuracy of 99.17%. The results affirm the capability of the proposed framework in fine-grained diagnosis using minimally labeled data, offering a practical solution to the challenges of medical image analysis.

A quantitative and qualitative analysis of a medication health literacy workshop for newly and recently arrived refugees

AbstractIntroductionRefugees entering the United States are often unfamiliar with the healthcare system and have different medication beliefs. Since 2016, pharmacy students and faculty have been conducting medication literacy workshops to improve knowledge of medications for newly arriving refugees.ObjectivesThe primary study objective was to measure the newly arriving refugees' medication knowledge after a one‐time educational workshop.MethodsThis was a retrospective quantitative and qualitative evaluation. Participants engaged in a student‐led 90‐min educational workshop utilizing interpreters, translated materials, and demonstrations. Topics included medical definitions, information on getting sick, medication use, and label reading. A translated, postworkshop evaluation included 22 questions grouped into the following categories: demographics (n = 4), medication use (n = 7), label reading (n = 6), access (n = 3), and cultural beliefs (n = 2). Three optional, free‐response questions regarding overall workshop feedback were included. Quantitative data was analyzed utilizing descriptive statistics. Thematic analysis was used to analyze qualitative data. Two independent coders reviewed each free‐response question and discussed any discrepancies for consensus. The study team developed key themes based on the codes.ResultsTwenty‐one workshops were conducted with 419 participants from 42 countries. Correct responses were highest for medication beliefs (84%), label reading (78%), access (74%), and medication use (73%). Prescription label reading ability was high (86%), while preventative medicine understanding was lower (34%). Three major learning themes developed, including (1) Cultural differences impact medication habits, (2) Knowing provider roles and how to access different services in healthcare settings was important, and (3) Understanding how to read a label was useful. Researchers found that demonstrations were helpful in participants' learning and that additional education on prevention and specific disease states would be useful.ConclusionNewly and recently arrived refugees were able to correctly identify basic medication health information through a medication literacy workshop. Additional classes exploring other topics, including preventative medicine and medications, should be considered.

Annual review of progress in research on chronic obstructive pulmonary disease(2022-2023)

Chronic obstructive pulmonary disease (COPD) is the most common chronic airway disease, with a high prevalence and high disease burden. Clinical questions have driven advances in clinical research that continue to deepen our understanding of COPD. At the same time, new perspectives, evidence, and strategies have emerged. Studies since 2022 have increased knowledge of the impact of risk factors, such as low-to-moderate income and ambient ozone, on the prevalence of COPD. The effect of preterm birth on obstructive lung function deficits and COPD in the sixth decade of life was investigated for the first time. Screening studies for COPD in developed and low- and middle-income countries suggest the importance of tailoring screening strategies to local conditions. Developments in artificial intelligence provide a general framework for using machine-learning-based methods and medical record-based labels to improve disease prediction. New perspectives on endotypes/phenotypes and prognostic assessment of COPD were provided by lifetime spirometry patterns of obstruction and limitation, sensitisation to recombinant Aspergillus fumigatus allergens, airway-occluding mucus plugs and exacerbation history in COPD group A and B patients. Clinical trials focusing on inflammatory mediators, comorbidity treatment, non-pharmacological treatments, and environmental interventions shed light on some crucial and long-debated issues. Further research is needed for individualised diagnosis and treatment of COPD.

Realistic Chest X‐Ray Image Synthesis via Generative Network with Stochastic Memristor Array for Machine Learning‐Based Medical Diagnosis

AbstractArtificial Intelligence (AI) technology has attracted tremendous interest in the medical community, from image analysis to lesion diagnosis. However, progress in medical AI is hampered by a lack of available medical image datasets and labor‐intensive labeling processes. Here, it is demonstrated that a large number of annotated, realistic chest X‐ray images can be generated using a state‐of‐the‐art generative adversarial network (GAN) that exploits noise produced by stochastic in‐memory computing of memristor crossbar arrays. Memristors based on polymer film with high thermal resistance can increase the stochasticity of the tunneling distance for randomly ruptured conductive filaments via excessive Joule heating, thus generating true random numbers required for creating naturally diverse images in GAN. Using StyleGAN2‐adaptive discriminator augmentation (ADA), high‐quality chest X‐ray images with and without pneumothorax are successfully augmented while maintaining a good Frechet inception distance score. The results provide a cost‐effective solution for preparing privacy‐sensitive medical images and labeling to develop innovative medical AI algorithms.

The development of the Belgian paediatric clinical trial network

ABSTRACT Paediatric clinical trials are critical to ensure that medications prescribed to children are safe and effective. However, evidence-based dosing and labelling of such medications remain limited, and most clinical trials in paediatrics fail. Factors for lack of trial completion include performance at site level (limited patient recruitment, limited site staff experience and lack of infrastructure), the sponsor team (limited paediatric specific expertise in design, uncertainties on robustness of biomarkers or outcome variables) as well as regulatory and administrative burdens. As a result of the growing demand for site support, the Belgian Paediatric Clinical Research Network (BPCRN) established in 2009 has been relaunched in 2018 to improve paediatric clinical trials, with the support of innovative-medicines-initiative 2 (IMI2) pan-European network conect4children (c4c) and the transatlantic network I-ACT for Children (US). This paper highlights the formation of the BPCRN and the practical insights it offers for advancing paediatric clinical trials through national networks. A national network can improve trial quality, safety and efficiency, provide clinical research expertise, identify suitable sites, and help with troubleshooting of common trial issues. The BPCRN’s centralized approach has advanced paediatric clinical trials by streamlining communication and standardizing trial conduct. Challenges and opportunities have arisen, including a relaunch in 2018, orphan medicine trials, and network sustainability. Collaboration between network activities, government support, site-level improvements, efficient communication, and interaction with industry are key to achieve lasting transformation in paediatric medicine research.

A cross-sectional study of appropriateness evaluation of anticoagulation therapy for inpatients with nonvalvular atrial fibrillation.

Background: Oral anticoagulants (OACs) are essential for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). However, the appropriateness of anticoagulation treatment in locally practice remains unclear. This study evaluated compliance with anticoagulation therapy concerning the guidelines and drug labels in patients with NVAF. Methods: Hospitalized patients diagnosed with NVAF between 1 November 2020, and 31 December 2021, were retrospectively enrolled. The appropriateness of anticoagulation regimens at discharge was evaluated based on a flowchart designed according to atrial fibrillation (AF) guidelines and medication labels. Furthermore, we explored factors potentially influencing the "no-use of OACs" using binary logistic regression and verified anticoagulation-related issues through a physician questionnaire. Results: A total of 536 patients were enrolled in this study, including 254 patients (47.4%) with inappropriate anticoagulation regimens. 112 patients (20.9%) were categorized as "underdosing-use of OACs," 134 (25%) who needed anticoagulation therapy were "no-use of OACs" and eight (1.5%) were "over-use of OACs." The results of a binary logistic regression analysis showed that paroxysmal AF (odds ratio [OR], 7.74; 95% confidence interval [CI], 4.57-13.10), increased blood creatinine levels (OR, 1.88; 95% CI, 1.11-3.16), hospitalized pacemaker implantation (OR, 6.76; 95% CI, 2.67-17.11), percutaneous coronary intervention (OR, 3.35; 95% CI, 1.44-7.80), and an increased HAS-BLED score (OR, 1.62; 95% CI, 1.11-2.35) were associated with "no-use of OACs" in patients with NVAF who had indications for anticoagulation therapy. Conclusion: For patients with NVAF with severe renal dysfunction and paroxysmal AF, anticoagulation therapy was inadequate. The underdosing-use of OACs in patients with NVAF was frequently observed. We recommend an anticoagulation management team to tailor anticoagulation regimens to suit each patient's needs.

QRxPERT: Automated Medicine Dispensing Machine with QR Code-Enabled Medication Counselling

QRxPERT aims to tackle chronic illnesses and medication non-compliance by integrating smart medication counseling and AI-enabled drug dispensers, with the help of a Smart Health Card. Patients can effortlessly scan QR codes on medication labels, unlocking a wealth of information instantly available at their fingertips. This includes vital details such as dosage instructions, potential side effects, and other pertinent information crucial for informed and effective self-management. QRxPERT’s AI-enabled drug Dispenser uses advanced machine learning and an RFID chip to accurately dispense medication, reducing human error and preventing medication non-compliance. This dispenser is designed to significantly reduce the margin of error in medication administration, ensuring that patients receive the precise dosage required. This not only enhances the efficacy of treatment but also serves as a robust preventative measure against medication non-compliance. The SMART HEALTH CARD also sends Reminder Messages to Mobile Phones, Regarding Tablets/Medication to take according to dose Interval given by DOCTORS. In conclusion, QRxPERT is a revolutionary healthcare innovation that integrates advanced technology to improve medication management and adherence, by offering smart medication counseling and AI-enabled drug dispensers.

The blind leading the blind: Co-production of medication safety solutions for people with sight impairment in community pharmacy

Abstract Introduction Around 237 million medication errors occur each year in England, with an estimated cost of £98 million1. We carried out a scoping review identified that people with sight impairments were a group at high risk of errors (under review). Aim To improve medication safety for people with sight impairments by developing an ‘App’ to help them manage medications. Methods We attended an initial in-person ‘Tea and Tech’ stakeholder group led by Henshaws Sight Loss charity in Manchester, UK and sought feedback from people with sight impairments about their experiences of medication. Ethical approval for this study was granted by The University of Manchester Research Ethics Committee (Ref: 2021-11098-18381). Co-design workshops – Due to the ongoing COVID-19 pandemic, we held two online workshops, minimising the need for travel and face to face meetings2. Workshops were promoted by RNIB amongst their ‘Community Connectors’. Community Pharmacists who were part of our NIHR Greater Manchester Patient Safety Translational Research Centre were also invited to participate to provide their perspective as healthcare professionals. Sessions were co-facilitated by patient safety researchers and researchers acting as notetakers. The first workshop (June 2021), focussed on the experiences of people with sight impairment around using medication, and potential solutions to these. The second workshop (July 2021), ranked these potential solutions, prioritising ideas for development. Results Those attending the Tea and Tech group warned against developing ‘another App’, highlighting problems caused by their sight impairment around installing and using ‘Apps’ generally. Co-design workshops were attended by six people with sight impairment and six community pharmacists. The difficulties reported included inability to distinguish between medications, to access dosing instructions (on medication labels) and safety information within product information leaflets. The solutions ranked as most important were 1) one to one consultations with pharmacists 2) improving medication packaging and 3) the need for pharmacist training. Discussions highlighted the lack of a system for pharmacists to reliably identify people with sight impairments. This led us to develop a pharmacy software system called Find Logo And Give Medication advice (FLAG-Me Vision) which identifies people with sight impairments using existing data within the electronic health record. An on-screen alert (shown as a logo) on the patient medication record, prompts pharmacy staff to offer a one-to-one consultation. Resources available on our website (www.flag-me.org) supports consultations and meets the remit for pharmacist training. Our prototype software created by Imago Student Software company at The University of Manchester, was tested using dummy NHS records and Hospital Run (open-source software). Discussion/Conclusion Market discovery and testing for FLAG-Me Vision has been undertaken via iCURe DISCOVER programme3. Feedback is that FLAG-Me Vision is well received by people with sight impairments and pharmacists alike. Future plans include piloting this software with pharmacy software suppliers within one community pharmacy chain in Greater Manchester.

Prevalence, associated factors and clinical implications of medication literacy linked to frailty in hemodialysis patients in China: a cross-sectional study

BackgroundMaintenance hemodialysis (MHD) patients have complex medication regimens that require a high level of skill to interpret medication information. However, there is currently a lack of research evaluating the ability to read and understand medication labels in Chinese MHD patients. In addition, the relationship between frailty and medication literacy among MHD patients remains unclear. Therefore, this study aims to assess the potential factors affecting medication literacy in MHD patients and to explore the relationship between frailty and medication literacy.MethodsThis cross-sectional study was conducted using convenience sampling in West China Hospital of Sichuan University, China. Using a general questionnaire, we collected demographic, clinical and laboratory data. Medication literacy was assessed by the Chinese Medication Literacy Scale, and frailty was assessed by the FRAIL Scale. Univariate analyses examined potential factors associated with medication literacy. An ordered logistic regression was used to analyze the relationships between medication literacy and these factors. Spearman’s correlation was used to assess the association between medication literacy and frailty.ResultsA total of 290 MHD patients were included in the analysis. Inadequate, marginal, and adequate medication literacy was found in 56 (19.3%), 153 (52.8%), and 81 (27.9%) patients, respectively. Ordered logistic regression revealed factors associated with inadequate medication literacy: age (OR = 0.281, 95% CI = 0.139–0.565, p < 0.001 for < 65 years); education (OR = 8.612, 95% CI = 3.524–21.046, p < 0.001 for ≤ primary school education; OR = 3.405, 95% CI = 1.683–6.887, p = 0.001 for junior high school education); presence of caregiver medication assistance (OR = 2.302, 95% CI = 1.173–4.516, p = 0.015); frailty (OR = 0.440, 95% CI = 0.216–0.893, p = 0.023 for frail patients); and high β2-microglobulin (β2-MG) (OR = 1.010, 95% CI = 1.002–1.019, p = 0.012). Spearman’s analysis showed that medication literacy was negatively correlated with frailty in MHD patients (R=-0.189, p = 0.001).ConclusionsMedication literacy levels in MHD patients needed improvement and were associated with certain patient characteristics, including age, education level, presence of caregiver support, β2-microglobulin levels, and risk of frailty. This study identified subgroups of MHD patients, such as those who were older, had lower education, had caregiver assistance, had high β2-microglobulin levels, or were frail, to have inadequate medication literacy. These findings underscore the need for routine screening and targeted interventions to improve medication literacy in this population.

Stochastic co-teaching for training neural networks with unknown levels of label noise

Label noise hampers supervised training of neural networks. However, data without label noise is often infeasible to attain, especially for medical tasks. Attaining high-quality medical labels would require a pool of experts and their consensus reading, which would be extremely costly. Several methods have been proposed to mitigate the adverse effects of label noise during training. State-of-the-art methods use multiple networks that exploit different decision boundaries to identify label noise. Among the best performing methods is co-teaching. However, co-teaching comes with the requirement of knowing label noise a priori. Hence, we propose a co-teaching method that does not require any prior knowledge about the level of label noise. We introduce stochasticity to select or reject training instances. We have extensively evaluated the method on synthetic experiments with extreme label noise levels and applied it to real-world medical problems of ECG classification and cardiac MRI segmentation. Results show that the approach is robust to its hyperparameter choice and applies to various classification tasks with unknown levels of label noise.

Therapy monitoring of psoriatic arthritis patients with and without skin involvement via objective evaluation of near infrared fluorescence optical imaging: A pilot study

Abstract In this work, we investigate the possibility of automatically and objectively evaluate an initialized therapy for psoriatic arthritis patients (therapy monitoring). Near infrared fluorescence optical imaging (NIR-FOI) is used to visualise the microcirculation in the hands, giving insights into possible inflammations (e.g. synovitis). Due to the time consuming and expansive data acquisition, we firstly investigate the feasibility of NIR-FOI in this scope of application using retrospective data. To increase the data quality and harmonize the heterogeneous patient population, certain inclusion criteria must be met, leaving only a limited amount of data sets for data analysis. A neural network was trained to segment the hands into areas of interest (e.g. joints and fingers) and an image registration pipeline was developed to compare identified regions of interest among different patient visits. It is shown that data from different visits are not directly comparable and thus, needs to be normalised. Due to the limited amount of meta data, only a simple normalisation can be performed. Even though with this normalisation the therapy monitoring cannot be carried out, the normalised data shows an increased agreement to a medical label in comparison to unnormalised data. Therefore, we conclude that further research can lead to a robust therapy monitoring algorithm.

Evaluation of intermittent antimicrobial infusion documentation practices in intensive care units: A cross-sectional study

ObjectiveTo observe nurse administration of carbapenem antibiotics, in the context of medication safety measures, in intensive care units. Research Methodology/DesignA quantitative study was conducted using observation principles. SettingThree adult private and public Intensive Care Units in the health district of a capital city in KwaZulu-Natal, South Africa. Main Outcome MeasuresNurse practices were observed for double-checking of the medication order, medication vial, and method of preparation and administration. Infusion bags were inspected for nurse labelling of medication and patient details. Patient medication treatment charts were inspected for nurse signature. ResultsCarbapenem infusion administrations (n = 223) to twenty patients were observed. Adherence to the scheduled time occurred in 34.9% administrations, 5.4% doses were not given, and an incorrect dose given on 1.4% administrations. One hundred and forty-four (64.6%) infusion bags were inspected during the administrations: there was no medication label affixed to 21.5% bags, and only 8.3% of bags were labelled with essential details; the patient’s name, drug, dose, date, time, signature of the nurse mixing and administering the dose, and signature of the secondary nurse. ConclusionThere was a lack of compliance with accepted medication risk mitigation measures. Sub-optimal double-checking resulted in the incorrect dose given, missed dose, and non-adherence to scheduled administration time. This has implications for the optimal administration of antimicrobial medications, raising concerns about the efficacy of treatment for critically ill patients. Implications for Clinical PracticeParenteral administration errors pose a challenge in acute care areas. Risk mitigation measures include double-checking of medications. If antimicrobial treatment is not administered at the prescribed dosing intervals, this may have implications for the efficacy of time-dependent broad-spectrum antibiotics such as carbapenems. Medication administration errors involving antimicrobial medications should therefore be considered as high-risk errors, with the potential to contribute towards antimicrobial resistance.

Understanding reasons and determinants of medication non-adherence in community-dwelling adults: a cross-sectional study comparing young and older age groups

BackgroundMedication non-adherence has become a striking problem among patients with chronic diseases worldwide. However, literature on prevalence, reasons and factors associated with medication non-adherence in Singapore general population is still lacking. This study aimed to (1) estimate the prevalence of intentional and unintentional medication non-adherence in young (aged 21–64 years) and older adults (aged ≥ 65 years), respectively; (2) identify and compare the main reasons for non-adherence; and (3) examine the association between potential factors and non-adherence in each group.MethodsThis study sampled 1,528 community-dwelling adults on medications (young adults:766, older adults: 762) from a cross-sectional population health survey conducted in the northern and central regions of Singapore in 2018/2019. Self-reported medication non-adherence and its reasons were collected using a modified questionnaire and compared between the two groups. Multiple logistic regressions were conducted to examine the association between potential factors (e.g., social-demographic factors, smoking and drinking status, presence of diabetes, hypertension, or dyslipidaemia, and presence of depressive symptoms) and medication non-adherence in each group.ResultsThe prevalence of non-adherence was 38.4% and 22.3% in young and older adults, respectively, with young adults reporting higher unintentional and intentional non-adherence rates than older adults. “Afraid of developing drug dependence” was the most common reason in both groups (young:74.8% vs. old:73.5%). Compared to young adults (3.7%), “Not understanding medication labels” was more prevalent in older adults (8.8%). Presence of depressive symptoms was associated with non-adherence in both young (odds ratio [95% confidence interval]: 3.00 [1.79, 5.05]) and older adults (4.16 [2.31, 7.51]). Being employed (2.92 [1.76, 4.84]) and taking ≥ 2 medications (1.42 [1.04, 1.95]) had positive association while personal income of SGD1,000–4,000 (0.53 [0.36, 0.77]) and current smoking (0.61 [0.39, 0.95]) had inverse association with non-compliance in young adults. Diagnosis of diabetes, hypertension, or dyslipidaemia (2.63 [1.25, 5.53]) was associated with higher odds of non-compliance in older adults.ConclusionsYoung adults had higher prevalence of medication non-adherence than older adults. The main reasons for non-adherence reported by young and older adults were generally comparable. Presence of depressive symptoms was a risk factor of medication non-adherence in both groups.

Accuracy of medication labels on community pharmacy-prepared dose administration aids: An observational study

BackgroundHospital prescribers often use the labels on multicompartment compliance aids or monitored dosage systems, known in Australia as dose administration aids (DAAs), as a trusted source of information about patients' medication regimens taken in the community. AimThe primary aim was to explore the prevalence and nature of labelling incidents on community pharmacy-prepared DAAs. MethodsA convenience sample of 100 adult patients admitted to a metropolitan teaching hospital who used a community pharmacy-prepared DAA at home was recruited. Patients were excluded if their DAAs were not brought to hospital. As part of usual care, a pharmacist took a best possible medication history (BPMH) using multiple information sources. This ‘gold standard’ BPMH was compared to the regimen listed on the DAA summary label and the DAA contents. The primary outcome was the percentage of patients whose DAA summary label(s) had one or more incidents for DAA packed medications. DAA label incident was defined as incorrect, missing or illegible/ambiguous medication name, strength, dose or dose-form when compared to the BPMH and DAA contents. Secondary outcomes were compliance with best-practice guidelines for labelling DAAs; and percentage of patients with a DAA packing error. ResultsThe 100 patients used 110 DAAs, packed by 75 community pharmacies. Four (4.0%) patients had no medication summary label on their DAAs. Of the 96 patients whose DAA(s) had a summary label, 82 (85.4%) had one or more summary label incidents. The most prevalent incidents were ‘illegible, ambiguous or missing medication details’, ‘truncated medication name’ and ‘omission of a medication’. The most prevalent guideline non-compliance was not including generic medication names (68% DAA-packed medications). Two DAA packing errors were identified. ConclusionA high prevalence of DAA labelling incidents was identified. Improved DAA labelling software functionality, more robust pharmacy procedures and pharmacy staff education are required.

Older adult patient preferences for the content and format of prescription medication labels – A best-worst scaling and discrete choice experiment study

BackgroundPatient preferences for the content and format of prescription medication labels (PMLs, i.e., sticker labels placed on medication bottles/packets at dispensing) have been extensively studied. However, accommodating all preferences on PMLs is impractical due to space limitations. Understanding how patients prioritise the content and format attributes of PMLs can inform improvements while working within PML space constraints. ObjectivesWe aimed to (1) identify a ranking of medication-related content attributes to be prioritised on PMLs using best-worst scaling (BWS), and (2) determine the relative importance of format attributes when incorporated onto PMLs using discrete choice experiment (DCE), from the perspective of older adult patients in Singapore. MethodsAttributes were informed by our prior qualitative study and PML best practice guidelines. For the BWS component, the assessed content attributes were indication, precautions, interaction or paired medicines, food instructions, side effects, expiry date, and missed dose action, all of which are currently not legally mandated on PMLs in Singapore. A BWS object case was used to rank the content attributes. For the DCE component, in a series of questions, participants were asked to choose between two PML options each time, that varied in the presentation of dosage-frequency instructions, font size, presentation of dosage, presentation of precautions, and font colour of precautions. A mixed logit model estimated the relative utilities of format attribute levels, enabling the calculation of importance scores of the format attributes. ResultsThe study recruited 280 participants (mean age: 68.8 ± 5.4 years). The three most-preferred content attributes were indication, precautions and interaction or paired medicines. The top three format preferences were tabular style presentation of dosage-frequency instructions, large font size and precautions in red colour. ConclusionsHealthcare institutions should consider improving their PMLs based on the leading content and format preferences voiced by older adult patients. The methodology adopted in the study can also be used for aligning the content and format of other patient education materials with patient preferences.