Risk Of Harm Research Articles

Work-related injuries and illnesses among kitchen workers at two major students’ hostels

BackgroundKitchen workers face a disproportionately high risk of injuries and illnesses. Yet, despite the ubiquity of kitchen-related injuries, there has been a relative lack of comprehensive research on this topic, particularly in developing countries. Ain Shams University, as a prestigious educational institution with its diverse kitchen staff, provides an ideal setting for studying the challenges faced in professional kitchens. This study aims to measure the prevalence of work-related injuries and illnesses among kitchen workers of two major students’ hostels at Ain Shams University in Cairo and to explore their risk factors.MethodsA cross-sectional analytical study involving kitchen staff from two hostels that house students at the university was carried out in 2021. The study involved all kitchen staff in the dorms for students (n = 128). Data was collected using a structured interview questionnaire.ResultsThe findings showed a significant prevalence of work-related illnesses (81.3%) and injuries (77.3%) among restaurant employees. Age, education, and job type all had a statistically significant relationship with the frequency of work-related injuries over the previous year. Additionally, there was a statistically significant relationship between age, job type, and the frequency of diseases among kitchen workers (p ≤ 0.05).ConclusionCooks and other food service employees are more susceptible to occupational diseases and injuries in the workplace. Restaurants and the university hostel authorities should implement preventative measures and policies to lower the risk of harm among these employees by offering occupational health and safety services such as training and education programs, personal protective equipment, and regular health examinations.

Facile fabrication of chitosan/bone/bamboo biochar beads for simultaneous removal of co-existing Cr(VI) and bisphenol a from water

Heavy metal Cr(VI) and organic BPA have posed harmful risks to human health, aquatic organisms and the ecosystem. In this work, Chitosan/bone/bamboo biochar beads (CS-AMCM) were synthesized by co-pyrolysis and in situ precipitation method. These microbeads featured a particle size of approximately 1 ± 0.2 mm and were rich in oxygen/nitrogen functional groups. CS-AMCM was characterized using XRD, Zeta potential, FTIR, etc. Experiments showed that adsorption processes of CS-AMCM on Cr(VI) and BPA fitted well to Langmuir model, with theoretical maximum capacities of 343.61 mg/g and 140.30 mg/g, respectively. Pore filling, electrostatic attraction, redox, complexation and ion exchange were the main mechanisms for Cr(VI), whereas for BPA, the intermolecular force (hydrogen bond) and pore filling were involved. CS-AMCM with adsorbed Cr(VI) demonstrated effective activation in producing ·OH and ·O2 from H2O2, which degraded BPA and Cr(VI) with the removal rates of 99.2% and 98.2%, respectively. CS-AMCM offers the advantages of low-cost, large adsorption capacity, high catalytic degradation efficiency, and favorable recycling in treating Cr(VI) and BPA mixed wastewater, which shows great potential in treating heavy metal and organic matter mixed pollution wastewater.

Catheter ablation compared to medical therapy for ventricular tachycardia in sarcoidosis: nationwide outcomes and hospital readmissions

BackgroundCatheter ablation (CA) for ventricular tachycardia (VT) can be a useful treatment strategy, however, few studies have compared CA to medical therapy (MT) in the sarcoidosis population. ObjectiveTo assess in-hospital outcomes and unplanned readmissions following CA for VT compared to MT in patients with sarcoidosis. MethodsData was obtained from the Nationwide Readmissions Database between 2010 and 2019 to identify patients with sarcoidosis admitted for VT either undergoing CA or MT during elective and non-elective admission. Primary endpoints were a composite endpoint of inpatient mortality, cardiogenic shock, cardiac arrest and 30-day hospital readmissions. Procedural complications at index admission and causes of readmission were also identified. ResultsAmong 1581 patients, 1217 with sarcoidosis and VT underwent MT compared to 168 with CA during non-elective admission. 63 patients admitted electively underwent CA compared with 129 managed medically. There was no difference in the composite outcome for patients undergoing catheter ablation or medical therapy during both non-elective (9.0 % vs 12.0 %, p = 0.312) and elective admission (3.2 % vs. 7.8 %, p = 0.343). The most common cause of readmission were ventricular arrhythmias (VA) in both groups, however, those undergoing elective CA were less likely to be readmitted for VA compared to non-elective CA. The most common complication in the CA group was cardiac tamponade (4.8 %). ConclusionVT ablation is associated with similar rates of 30-day readmission compared to MT and does not confer increased risk of harm with respect to inpatient mortality, cardiogenic shock or cardiac arrest. Further research is warranted to determine if a subgroup of sarcoidosis patients admitted with VT are better served with an initial conservative management strategy followed by VT ablation.

O-182 To err is human, also for those working in ART

Abstract Medically assisted reproduction (MAR) centers combine clinical and technical expertise with a very high complexity. Over the years, MAR centers have undergone increased intricacy due to incorporating laboratory techniques, such as cryopreservation of oocytes and embryos and micromanipulation, embryo culture, and pre-implantation genetic testing. Not only the technicality of the MAR laboratory profession is challenging, but the complexity of each phase has increased over the years; the patient population undergoing treatment has expanded, where not only the intended parents’ gametes are involved but also the utilization of gametes from egg and sperm donors, as well as including a gestational carrier receiving the embryo. These complexities have led to the implementation of rigorous control measures to mitigate the risk of errors. Nevertheless, a zero-risk fertility clinic is an illusion, given the many necessary interventions and manipulations in each treatment cycle. Errors in fertility practice involving gametes or embryos can be devastating to patients and clinical personnel, often raising psychological, legal, ethical, economic, and practical concerns. The most critical cases of risk of harm in MAR procedures involve misidentifying a patient, gamete, or embryo, called ‘mix-up,’ which could lead to dramatic consequences. Although the frequency is low, mix-up cases have been described worldwide. Other adverse events derive from preventable human actions, e.g., overlooking an embryo when carrying out assessments, dropping a dish, incorrect labeling, improper pipetting technique, unusually poor thawing, and inadvertent discard of the sample. Human error cannot be eradicated. In the old view, human error was perceived as the root cause of problems, with individuals being viewed as variables requiring control. Conversely, contemporary perspectives consider human error a symptom of deeper systemic issues. As suggested by the Institute of Medicine in 2000, which published the report “To Err Is Human,” the core of the problem lies not with the fallibility of healthcare personnel but the flawed systems within which they operate. Preventing errors is possible by incorporating safety into system processes and hospital structures. Latent errors are errors that arise due to system inefficiencies. In the context of MAR, these latent conditions can, amongst others, be work-related pressure, high workload, lack of communication between team members, distraction, a suboptimal setup of the lab, a lack of clarity in the procedures, and insufficient time for thorough communication. In the famous Reason’s Swiss cheese theory of error, these latent conditions are weaknesses (or gaps/ holes) in the system’s defense layers. When all the holes from each layer (i.e., policy, planning, design, communication) align, they will permit an error to cause harm. Understanding the theory of human errors and building safety into various layers of care processes in MAR are effective ways of reducing errors rather than blaming sentinel individuals. Errors within MAR centers can be prevented by designing the healthcare system at all levels to make it safer, making it hard for people to do the wrong thing and easy for people to do the right thing.

Trends in drug overdose deaths among adults 65 years of age and older in Canada (2000–2022)

BackgroundAlthough young adults and middle-aged adults have borne the brunt of the drug overdose crisis in Canada, older adults are also at an increased risk of harms. We examined trends in drug overdose deaths and opioid overdose deaths among adults 65 years of age and older. MethodsAge-standardized rates of drug overdose deaths in Canada (2000–2022) and of opioid overdose deaths in Ontario (2003–2021) were computed. Drug overdose deaths were based on vital statistics registries, while opioid overdose deaths were based on toxicologic testing. Trends were characterized using joinpoint regression. ResultsDrug overdose deaths among adults 65 years of age and older in Canada rose from 4.3 to 9.9 deaths per million in the entire population between 2000 and 2022 (Average Annual Percentage Change [AAPC; 95 % CI]: 3.1 % [2.6 %-3.6 %]). Increases were observed in males (AAPC [95 % CI]: 4.0 % [3.1 %-4.9 %]), females (2.1 % [1.0 %-3.2 %]) and unintentional deaths (6.0 % [1.0 %-11.3 %]) after stratification by sex and manner of death. Opioid overdose deaths among adults 65 years of age and older in Ontario increased from 1.5 to 5.2 deaths per million in the entire population between 2003 and 2021 (AAPC [95 % CI]: 7.5 % [4.5 %-10.5 %]). ConclusionsDrug overdose deaths more than doubled in Canada and opioid overdose deaths more than tripled in Ontario among adults 65 years of age and older during the past two decades. These findings indicate a need for education of patients, prioritization of harm reduction interventions, screening, intervention and treatment and adherence to prescribing guidelines.

‘The health care system is more like a business’—medical overuse from the patients’ perspective in Germany: a qualitative study

ObjectivesMedical overuse exposes patients to unnecessary risks of harm. It is an open question whether and how patients perceive the concept of medical overuse, its causes and negative consequences.DesignA qualitative...

Omentum pregnancy resulting in severe hemoperitoneum: Lessons learned from a review of the literature along with a case report.

Abdominal pregnancies are a rare form of ectopic pregnancy with omentum pregnancies being even rarer. Ectopic pregnancy should be diagnosed and terminated early to prevent the risk of harm to the mother. This case report describes a rare case of omentum pregnancy with severe hemoperitoneum. The patient had not visited a doctor until she failed to menstruate for 3 months, by which point she had developed severe hypogastralgia. The patient was diagnosed with a ruptured ectopic pregnancy after ultrasonography. The omentum pregnancy was complicated by severe hemoperitoneum, which was confirmed by emergency laparotomy. The patient was treated successfully with fetal extraction and partial omentectomy. Ultrasound examination in early pregnancy is essential to detect and treat ectopic pregnancies as early as possible, as surgery is usually required for abdominal pregnancies. Prompt treatment of ectopic pregnancies is critical, as an omentum pregnancy is dangerous and may result in severe intraperitoneal bleeding.

Identifying Vulnerabilities to NSAID Adverse Events in the U.S. Population: An Analysis of Preexisting Conditions and Sex.

Purpose: In 2005, the Food and Drug Administration (FDA) issued a decision memorandum regarding nonsteroidal anti-inflammatory drugs (NSAIDs). The memorandum recommended the withdrawal of certain NSAIDs due to potential cardiovascular adverse effects. It highlighted the issue of cardiovascular risk associated with NSAIDs as a class. The NSAID medication guide includes a wide range of adverse drug reactions (ADRs), such as increased blood pressure, liver failure, allergic reactions, heart attack, and intestinal bleeding. Although both sexes have an increased risk of ADRs with NSAID use, females have a greater risk than males due to differences in pharmacodynamics and higher medication concentrations (mg/kg). In particular, females with high blood pressure, coronary heart, kidney, and liver disease are at an additional risk of harm from NSAID ADRs. This study quantifies sex-specific differences and other factors associated with prescription NSAID use. Method: The data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES), a complex survey conducted by the Centers for Disease Control and Prevention (CDC) in two-year cycles. A survey-weighted logistic regression model was utilized to investigate potential sex differences with prescription NSAIDs in the context of other factors, including kidney disease, hypertension, liver disease, insurance status, coronary heart disease, and age, within the 2011-2018 NHANES survey data. Results: Females reported a slightly higher percentage of high blood pressure and kidney disease than males, while males reported a slightly higher percentage of coronary heart and liver disease than females. Last, the model indicated that females were 58% more likely to have used a prescription NSAID than males. Conclusion: The results confirm that women and people with medical conditions, who would potentially suffer greater harm from NSAID ADRs, are more likely to use a prescription NSAID than individuals without these conditions.

Опасность и риск: смысл и толкование терминов

The article provides an analysis of the use of «Hazard» and «Risk» terms and associated phrases in legal and regulatory-technical documents and safety practices; their possible interpretations are identified. Most often, such problems arise during the classification of productions and facilities in accordance with their level of hazard, when various documents and articles use such terms as hazard degree, risk degree, risk level, etc. When using the «Risk» term as a connotation of the «Hazard» term, the probabilistic nature of potential undesirable events is considered; at the same time, the notion «Hazard» rather refers to the sources of hazard and possible consequences of undesirable events. Possible representations of risk as a fundamentally dualistic parameter for a single indicator in order to rank hazardous facilities in accordance with their hazard degree, which caused the use of terms such as hazard degree, hazard level, hazard class, risk index, risk level, etc., have been discussed. This is achieved by using different ranking methods, risk matrices, and risk graphs. Therefore, the «Risk» notion requires additional definitions (for example, «explosion risk index»). Often, the «Risk» term in phrases means probability; however, a certain undesirable event (explosion risk, risk of injuries to personnel, risk of harm to the legitimate interests of citizens) is specified.

A narrative review of risk mitigation strategies in the management of opioids for chronic pain and palliative care in older adults: interprofessional collaboration with the pharmacist.

The prevalence of chronic non-cancer pain (CNCP) in older adults is high. Opioids carry significant risk for harm in older adults. Yet, many older adults are established on long-term opioid therapy for the treatment of CNCP despite limited documented efficacy. Many of the non-opioid options to treat pain present challenges in this population. Since challenges with tapering patients off of opioids exist, older adults may remain established on long-term opioid therapy for CNCP. While opioid use is less scrutinized for older adults receiving palliative care, significant safety concerns exist. Therefore, efforts to mitigate risks for older adults receiving long-term opioids for CNCP and for palliative care are essential. Pharmacists as members of the interprofessional team are equipped to improve safety among older adults on chronic opioid therapy. Among patients receiving palliative care, collaboration with palliative care specialists is also key. The purpose of this narrative review is to describe risk mitigation strategies for opioid use among older adults with CNCP and those receiving palliative care. Data were identified by searching PubMed (January 1, 1990 to February 21, 2024) using the following search terms: older adults, opioids, chronic pain, palliative care, and pharmacist. The search was repeated using terms geriatric, elderly, opiates, narcotics, and controlled substances. Non-English articles and observational studies with fewer than 100 patients were excluded. Major North American and European guidelines were reviewed. Additional literature was obtained through review of relevant references of identified articles. A variety of risk mitigation strategies to improve safety for older adults using opioids exist. They include risk assessment, tapering opioids, reducing high-risk concomitant medications, utilizing non-opioid therapies, screening for and treatment of opioid use disorder (OUD), toxicology testing, co-prescribing naloxone, utilizing controlled substance agreements, reviewing prescription drug monitoring program data, prescriber and patient education, and collaboration with pharmacists and palliative care specialists. There are many opioid risk mitigation strategies for older adults. Collaboration with pharmacists and palliative care specialists can be an effective means for implementing strategies to optimize opioid safety for older adults with CNCP and those receiving palliative care.

User-Centered Education for Patients/Caregivers about Urinary Tract Infections, Asymptomatic Bacteriuria, and Antibiotics

Background: Older adults (aged ≥65) are at high risk of harm from overdiagnosis and overtreatment of urinary tract infections (UTIs) with antibiotics. Involving patients/caregivers in their antibiotic treatment decisions has potential to improve prescribing. To engage effectively, patients/caregivers must have sufficient knowledge about UTIs, asymptomatic bacteriuria (ASB: bacteria in the urine without signs of UTI), and antibiotics and opportunities to share their concerns and treatment preferences with healthcare staff. Patient education is one of the core elements of antibiotic stewardship recommended by the Centers for Disease Control and Prevention but, there are few resources for patients/caregivers about UTIs and antibiotics, leaving a knowledge gap as to what effective patient/caregiver antibiotic education for UTIs looks like. We sought to better understand the perspectives of patients/caregivers at high-risk of antibiotic overuse for UTIs and create an educational leaflet on UTIs, antibiotics, and ASB. Method: Between 11/2022 and 03/2023, we conducted virtual semi-structured interviews with patients ≥65yrs who had experienced UTI and caregivers about their needs, experiences, and preferences for educational support. Interviews lasted ~1 hour. Audio recordings were transcribed verbatim. NVivo software managed the data, which we analyzed using thematic analysis. Results: We conducted 9 interviews (5 patients, 4 caregivers). Interviewees expressed desire to be involved in their treatment decisions and learn more about antibiotics and alternative strategies (themes shown in Figure 1). Reported reasons for limited involvement in decisions included lacking the knowledge and confidence to ask questions, emotional factors (e.g., embarrassment/stress), deference to healthcare staff, and time constraints. Healthcare staff behaviors were described both as barriers (e.g., assertive treatment decisions) and facilitators (e.g., effective communication) of patient/caregiver engagement. Interviewees were eager for printed and digital educational support that could provide tailored content to help improve their knowledge and prepare for future conversations with healthcare staff. From this feedback we developed an educational leaflet (Figure 2). Conclusions: Involving patients/caregivers in antibiotic treatment decisions represents an opportunity to intervene before patients experience antibiotic overuse. Our findings offer important insights on patient/caregiver’ educational needs and preferences as well as perceived barriers to engaging in antibiotic treatment decisions for UTI. We used these insights to inform the development of educational materials about UTIs, ASB, and antibiotics for patients/caregivers and plan to test their use through multiple mediums with tailoring for unique patient needs, experiences, and backgrounds.

EUROPEAN APPROACHES AND REGULATORY MECHANISMS OF ECOLOGICAL AND HYGIENIC MONITORING FROM THE PERSPECTIVE OF POTENTIAL HARMONIZATION AND IMPLEMENTATION INTO DOMESTIC LEGISLATION

Background. The usage of pesticides against pests is also accompanied by potential negative effects on non-target organisms. The risk of harm to biodiversity is quite significant. Implementation of ecological and hygienic monitoring strategies, which is quite effectively applied in the countries of the European Union, will allow to reduce potential threats, financial costs and unforeseen consequences for beneficial insects, birds, aquatic organisms, etc. Aim: analysis of European approaches and regulatory mechanisms of ecological and hygienic monitoring from the standpoint of potential harmonization and implementation in Ukrainian legislation field. Materials and methods. Data from the literature and regulatory documents of the European Union in the field of environmental assessment and ecological and hygienic monitoring were used for the analysis. An array of literary sources was analyzed, which included the most relevant, up-to-date articles over the past 5 years and valid regulatory documents that have the greatest potential for implementation into the national regulatory framework. Results. In the EU and the US, a strict risk assessment process is in place to obtain permission to use pesticides, taking into account the potential impact on non-target organisms. Risk assessment of the use of chemical plant protection on the ecosystem and monitoring of the condition of non-target kinds of objects in the territories of intensive agricultural management is carried out at the stage of pre-registration tests. State regulatory agencies primarily require data on average lethal doses and concentrations for some bird kinds (Colinus virginianus, Anas platrynchos, Perdix perdix, Coturnix japonica). However, there are studies that describe the effects on smaller songbirds that are more sensitive to acute poisoning, therefore, to consider the established standards only for large birds is rather imperfect and needs to be refined in Ukrainian practice in the future. The European rules of environmental risk assessment (ERA) have undergone significant changes in recent decades, which have caused many scientists to worry about insufficient plant protection, slow implementation of scientific developments, simplification of environmental relevance and priority. Also, in many normative documents on pesticides, a political trail is traced, which is sometimes difficult to define and measure. Conclusion. The adoption and implementation of new laws in the field of chemical plant protection in the EU countries are the basis for improving the legislation of Ukraine in this field and ensuring state regulation in the handling of pesticides and agrochemicals.

Study on temperature field beneath tunnel ceiling induced by transverse symmetrical double fires

During a tunnel fire incident, a substantial volume of high-temperature smoke gathers and disperses beneath the tunnel ceiling, posing significant risks of casualties and structural harm. A comprehensive comprehension of the temperature distribution of smoke beneath the ceiling is pivotal for the fire-resistant design and formulation of rescue plans for tunnel structures. This paper initially employs the FTP theory to analyze the fire scene resulting from fire spread under vehicle congestion. Subsequently, A set of numerical simulations is performed, and a prediction model of the temperature field for transverse symmetrical double fires is established according to the simulation results. Finally, an air entrainment model for transverse symmetrical double fires is proposed. The air entrainment amount under different fire spacing is obtained by theoretical derivation. Combined with the relationship between air entrainment amount, flame height, and maximum temperature, the variation of temperature field under the ceiling with fire spacing is explained from the mechanism. The results show that: the maximum temperature beneath tunnel ceiling increases with the increase of the fire power, decreases and then increases with the increase of the fire spacing and the variation has symmetry; The temperature attenuation along transverse and longitudinal directions under the ceiling following the exponential attenuation model, and the temperature attenuation rate is positively correlated with the maximum temperature. The transverse temperature attenuation is smaller than that of the longitudinal temperature under the same conditions; There is an internal relationship between the air entrainment, flame height and temperature field of the transverse double fires. The variation law of the temperature field beneath the ceiling depends on the degree of air entrainment limitation. Based on mirror model, this paper indicates that when the fire spacing is within a certain range, the combustion of the double fires can be effectively represented as near-wall fire.

A ‘design justice’ approach to developing digital tools for addressing gender-based violence: exploring the possibilities and limits of feminist chatbots

ABSTRACT Digital tools, such as safety apps, reporting portals, and chatbots, are increasingly being used by victim-survivors of gender-based violence to report unlawful activity and access specialized support and information. Despite their limitations, these interventions offer a range of potential benefits, such as enhancing decisional certainty, promoting safety behaviors, and fostering positive psychological outcomes. In this paper, we introduce an innovative ‘design justice’ approach to the development of digital tools for addressing gender-based violence. Drawing on our experience of building a feminist chatbot focused on image-based sexual abuse, we argue that the integration of feminist principles throughout the design, content, and evaluation stages is crucial for mitigating the risk of harm and promoting positive outcomes. Our theory-informed and practice-led approach can help to guide the development of other digital tools for addressing gender-based violence. Nonetheless, more scholarly research is needed to investigate the use, efficacy, and impacts of such interventions, at the core of which should be interdisciplinary collaboration between subject matter experts, victim-survivors, technical specialists, and other key stakeholders.

Transfusion-Associated Circulatory Overload (TACO): Strategies to Mitigate the Risk of Harm

Transfusion-Associated Circulatory Overload (TACO): Strategies to Mitigate the Risk of Harm

Enhancing bacterial inhibition in beetroot beverages: The potent combination of sappan heartwood extracts via accelerated solvent extraction and pulsed electric field methods

This study aimed to investigate the potential of sappan heartwood extract as an inhibitor of foodborne pathogenic bacteria in beetroot juice. The extract was obtained using an accelerated solvent extraction process (using an ethanol/water solvent mixture (3:1 w/w) at 120 °C and 1500 psi for 5 min), yielding 10.04 g per 73.6 g of dried sappan heartwood powder, with a percentage yield of 13.64 and 2.69 % brazilin. The extract was combined with pulsed electric fields (PEF) at different strengths and tested against Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), Bacillus cereus (B. cereus), and Salmonella typhimurium (S. typhimurium). Results showed that the combination of sappan heartwood extract and PEF at 15 kV/cm and concentrations of 3.91, 5.86, and 11.73 mg/mL effectively reduced the total plate count and coliform bacteria count, and completely eliminated B. cereus and S. typhimurium during 7 days of storage at 4 °C. Furthermore, this combination was found to be more efficient in bacterial elimination compared to thermal pasteurization and potassium sorbate addition. These findings suggest that sappan heartwood extract can be used as a natural antimicrobial agent in food products, especially in beetroot juice, where regulatory standards restrict the addition of preservatives. Using sappan heartwood extract in combination with PEF is highly effective in killing foodborne pathogens, reducing the risk of consumer harm and ensuring food safety.

Social Workers’ Perceptions of the Nature of Child Neglect: A Systematic Literature Review

Abstract Neglect is the most common form of child maltreatment in the UK and the USA. This article reviews research about how child neglect is perceived by social workers. We conducted a systematic review and identified fifty relevant studies, using a range of methodologies, published since the 1989 Children Act. The themes were identified iteratively and synthesised using a narrative method. The review found that despite evidence that neglect is associated with several adverse outcomes, neglect is a lower priority for social work intervention compared to other forms of maltreatment. This is particularly true for emotional neglect and neglect of older children. The review found that social workers conceptualise poverty and neglect as being distinctly different and try to address poverty through practical, non-punitive interventions. However, assessments could better recognise how deprivation exacerbates other risk factors for neglect. The review found a lack of knowledge about perceptions of neglect in adolescents and children with a disability and about the threshold for intervention when neglect is cumulative. Practice may be improved by better recognising and addressing the societal context to neglect allegations and the risk of long-term harm. Achieving this may have resource and training implications.

Frailty, multimorbidity and polypharmacy: exploratory analyses of the effects of empagliflozin from the EMPA-KIDNEY trial.

Sodium-glucose co-transporter-2 (SGLT2) inhibitors are recommended treatment for adults with chronic kidney disease (CKD), but uncertainty exists regarding their use in patients with frailty and/or multimorbidity, among whom polypharmacy is common. We derived a multivariable logistic regression model to predict hospitalization (reflecting frailty) and assessed empagliflozin's risk-benefit profile in a post-hoc analysis of the double-blind, placebo-controlled EMPA-KIDNEY trial. The EMPA-KIDNEY trial randomized 6609 patients with CKD (estimated glomerular filtration rate [eGFR] ≥20<45 mL/min/1.73m2, or ≥45<90 mL/min/1.73m2 with urinary albumin-to-creatinine ratio ≥200 mg/g) to receive either empagliflozin 10 mg daily or matching placebo and followed for two years (median). Additional characteristics analysed in subgroups were multimorbidity, polypharmacy and health-related quality of life (HRQoL) at baseline. Cox regression analyses were performed with subgroups defined by approximate thirds of each variable. The strongest predictors of hospitalization were N-terminal prohormone of brain natriuretic peptide, poor mobility and diabetes; then eGFR and other comorbidities. Empagliflozin was generally well-tolerated independent of predicted risk of hospitalization. In relative terms, allocation to empagliflozin reduced the risk of the primary outcome of kidney disease progression or cardiovascular death by 28% (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.64-0.82); and all-cause hospitalization by 14% (HR 0.86, 95% CI 0.78-0.95); with broadly consistent effects across subgroups of predicted risk of hospitalization, multimorbidity, polypharmacy or HRQoL. In absolute terms, the estimated benefits of empagliflozin were greater in those at highest predicted risk of hospitalization (reflecting frailty) and outweighed potential serious harms. These findings support the use of SGLT2 inhibitors in CKD, irrespective of frailty, multimorbidity or polypharmacy.

Relationship between medication safety‐related processes and medication use in residential aged care facilities

AbstractObjectiveTo explore the association between the implementation of medication safety‐related processes measured with the Medication Safety Self‐Assessment for Long‐Term Care (MSSA‐LTC) tool and medication use in residential aged care facilities (RACFs).MethodsA descriptive cross‐sectional study was conducted in Australian RACFs. Data on facility characteristics, aggregated medication use at the facility level for selected medications commonly associated with a high risk of harm and the MSSA‐LTC were completed by clinical pharmacists providing clinical pharmacy services. The Spearman's correlation test was used to evaluate the association between the MSSA‐LTC score and medication use. A scatter plot between the MSSA‐LTC score and medication use data was generated, and a linear trend line was plotted using the least squares method.ResultsData were collected from 31 RACFs servicing 2986 residents. Most medication safety‐related processes were implemented in Australian RACFs. A higher facility MSSA‐LTC score was associated with a lower proportion of residents with polypharmacy (r = −.48, p = .01) and one or more benzodiazepines (r = −.41, p = .03). In addition, a negative linear trend was observed between the MSSA‐LTC score and the average number of medications per resident, the proportion of residents with one or more anticonvulsants and the proportion of residents using one or more opioid analgesics.ConclusionsThis study indicates that implementing medication safety‐related processes may improve medication use in RACFs.

The Dependence of Online Gambling Businesses on High-Spending Customers: Quantification and Implications.

Online gambling has grown to be a significant industry but it faces regulatory threats because of perception that it is heavily dependent on a small segment of its customers who gamble heavily and at a level carrying elevated risk of harm. Employing a large multi-operator data set from Britain, which records individual transactions by some 140,000 individuals observed over one year, we are enabled to provide more precise estimates of the degree of concentration of revenue, compared with previous studies. High dependence on a relatively small number of customers is shown though there is variation from product to product in how small the group of account-holders of potential concern is. We conclude with a discussion of prospects for the industry in light of heightened awareness of gambling harm and resulting restrictions on online gambling spending introduced or proposed by governments or regulators in several jurisdictions.