Screening For Adverse Effects Research Articles

Knowledge of antipsychotic medication and their side effects among psychiatric nurses at a tertiary hospital in Lesotho

Factors that impede the physical health monitoring of patients with severe mental illness are multidimensional, and healthcare providers’ knowledge and expertise regarding antipsychotic medication and side effects remain key determinants of the frequency and quality of screening a patient shall be subjected to. This challenge transcends the monitoring of patients treated with antipsychotics, where scholars have determined a lack of knowledge about screening for adverse effects, resulting in poor clinical assessments among patients prescribed antipsychotics. This study aimed to describe nurses’ knowledge regarding antipsychotic medications and their side effects at the psychiatric hospital in Lesotho. To guide the research process, a quantitative, non-experimental, descriptive approach was employed with 40 nurses out of 44 nurses as respondents, who were selected using convenience sampling, and respondents rated their knowledge regarding the side effects of antipsychotic medication using a Likert scale on a structured research questionnaire. The data were collected using a self-administered questionnaire, analysed using SPSS (version 28), and displayed using tables, frequencies, standard deviations, and means. This study's female respondents comprised 30 (75.0%) and 10 (25.0%) males. The mean age was 39.05 (SD 8.9), with eight years of psychiatry experience. A total of 29 (72.0%) had sufficient antipsychotic knowledge (t = 36.38, df = 39, p < .000), 31 (78.3%) and had adequate knowledge of the side effects of antipsychotic drugs (t = 34.00375, df = 39, p < .000). In conclusion, this study reveals a positive trend in nursing knowledge about antipsychotic medications and associated side effects, highlighting the importance of ongoing professional development to maintain and enhance this expertise.

Abstract 10368: The Safety and Tolerability of Prolonged Inhalation of Hydrogen Gas in Air: A Phase I Clinical Trial

Introduction: Ischemia reperfusion injury (IRI) is central to many critical illnesses, including cardiac arrest, myocardial infarction, and stroke. Inhaled hydrogen gas (H2) has been shown to diminish IRI in a number of preclinical models, in part by the selective reduction of oxyradical species. Methods: Following FDA and IRB approval of this Investigator-Initiated Phase I IND study (NCT04046211), 8 healthy participants underwent hospitalized exposure to 2.4% H2 in medical air via high flow nasal cannula (15 LPM) for either 24 hours (n=2), 48 hours (n=2), or 72 hours (n=4). Screening for adverse effects included periodic nurse-adjudicated assessments using Common Terminology Criteria for Adverse Events (CTCAE, v5.0); regularly-spaced vital signs, pulmonary function testing, and mini-mental state exam (MMSE); EKG and serologic testing prior to versus following exposure. Data were compared over time using Wilcoxon matched-pairs signed rank test. All AE assignments were verified by two clinicians external to the study team and an external DSMB. Results: Eight adult participants (18-30 years; 50% female; 62% non-Caucasian) completed the study without early termination. No symptoms or clinically significant adverse events occurred in any patient. Compared with baseline measures, there were no significant changes over time in blood pressure, heart rate, oxygen saturation, or respiratory rate (A). There were no significant changes in PFTs (B), MMSE scores (C), EKG measurements (D) or serologic tests for hematologic (except for clinically-insignificant increases in hematocrit and platelet counts), renal, hepatic, pancreatic, or cardiac injury (E) associated with H2 inhalation. Conclusion: Inhalation of 2.4% H2 gas does not appear to cause clinically significant adverse effects in healthy adults. These data will be foundational to future interventional studies of inhaled H2 in injury states, including following cardiac arrest.

Wilson's Disease: An Update on the Diagnostic Workup and Management.

Wilson’s disease (WD) is a rare autosomal recessive disorder of hepatocellular copper deposition. The diagnostic approach to patients with WD may be challenging and is based on a complex set of clinical findings that derive from patient history, physical examination, as well as laboratory and imaging testing. No single examination can unequivocally confirm or exclude the disease. Timely identification of signs and symptoms using novel biomarkers and modern diagnostic tools may help to reduce treatment delays and improve patient prognosis. The proper way of approaching WD management includes, firstly, early diagnosis and prompt treatment introduction; secondly, careful and lifelong monitoring of patient compliance and strict adherence to the treatment; and, last but not least, screening for adverse effects and evaluation of treatment efficacy. Liver transplantation is performed in about 5% of WD patients who present with acute liver failure at first disease presentation or with signs of decompensation in the course of liver cirrhosis. Increasing awareness of this rare inherited disease among health professionals, emphasizing their training to consider early signs and symptoms of the illness, and strict monitoring are vital strategies for the patient safety and efficacy of WD therapy.

Measurement of catecholamines in rat and mini-pig plasma and urine by liquid chromatography-tandem mass spectrometry coupled with solid phase extraction.

A tandem mass spectrometry method combined with an ion-pair chromatographic separation after weak cation exchange solid phase sample extraction for epinephrine (E), norepinephrine (NE) and dopamine (DA) has been developed. Two surrogate matrixes for plasma and urine as well as stable isotope labeled internal standards were utilized for quantitation. The observed dynamic range of E, NE and DA was 0.025-100ng/ml for plasma, and 0.25-1000ng/ml for urine with a r(2) regression coefficient >0.99. Extraction recoveries were greater than 60% and the lower limit of quantitation was 25pg/ml for all three analytes in plasma. This method provided excellent sensitivity and selectivity for use with small sample volumes (≤25uL), enabling high-throughput pharmacodynamic animal model development and screening of adverse effects.

PERSYVE - Design and validation of a questionnaire about adverse effects of antihypertensive drugs.

The aim of this study was to design and validate a questionnaire to measure perceived symptoms associated with antihypertensive drugs (PERSYVE). THE PERSYVE DEVELOPMENT AND VALIDATION INCLUDED FOUR STAGES: 1) item development (bibliographic review and questionnaire elaboration); 2) face and content validation; 3) field testing (pre-test); and 4) test-retest validation, assessment of internal consistency (Cronbach's alpha) and reproducibility over time (intraclass correlation coefficient and Cohen's kappa coefficient). PERSYVE IS DIVIDED INTO SIX SECTIONS ACCORDING TO RESULTS OBTAINED FROM THE LITERATURE REVIEW: (1) drug adherence, (2) perceived symptoms and how they affect quality of life (five-point Likert scale), (3) communication with health professionals, (4) perception of symptoms as adverse reactions, (5) influence on therapy compliance, and (6) adoption of non-pharmacological methods for blood pressure control. Content and face validation of the questionnaire led to some vocabulary changes and the introduction of section 2.1. Field-testing (n=26) revealed high comprehensibility of the questions. The Cronbach's alpha, calculated for section 2 (five-point Likert scale) was 0.850. PERSYVE was reproducible (n=167): kappa values presented fair to substantial reproducibility and, in section 2, ICC values resulted in good to excellent reproducibility. Results showed that PERSYVE is a well-structured, objective, patient-friendly, valid and reliable questionnaire. PERSYVE can be a very useful instrument in hypertensive patients' monitoring and in the screening of adverse effects.

Improving adherence to safe prescription guidelines for Dapsone: harnessing an enhanced electronic medical records system and a team approach

Dapsone is a commonly prescribed medication in dermatological practice. Its use is associated with a broad spectrum of adverse effects. Careful selection and monitoring of patients on dapsone are paramount in the prevention and early recognition of adverse effects. We designed a risk-management program for dapsone at National Skin Centre, Singapore, enhancing an existing electronic medical records system and harnessing a team approach involving the nurses. This includes the performance of key laboratory tests before and after starting dapsone, ensuring adequate counseling before starting dapsone and screening for adverse effects using a questionnaire every visit. This system of dapsone prescription efficiently improved the adherence to safe prescription and monitoring guidelines. Average adherence rates for key safety parameters improved from 61.4% pre-implementation to 95.3% at six months and were sustained at 12 months at 91.3%. Percentage of follow-up cases in which all three key monitoring parameters were fulfilled increased from 9.5% to 79.6% (p=0.0001) after 12months. The percentage of new patients in which all four key monitoring parameters were met increased from 50% to 80%. It was not statistically significant possibly because of small patient numbers. This project has also translated into enhanced patient safety with dapsone dosages adjusted in 17 patients who experienced mild adverse effects. No severe adverse effects to dapsone were observed in the 12-month period. This example of risk management for dapsone may serve as a model for institutions looking at harnessing information technology and a team approach for safer prescription of high-alert medications.

Testing strategies in immunotoxicology

Developing a battery of immune function assays to screen potential immunotoxic compounds has been a major issue these past years. Improving this approach is possible using new probes and parameters that are now available from recent knowledge on how the immune system is working (apoptosis, RT-PCR for cytokine mRNA expression). Immunotoxic outcome generally results in serious adverse effects, thus it seems appropriate to evaluate this risk early in drug development. This is especially true in the context of the emerging combinatorial chemistry techniques and high throughput screening in pharmacology resulting in probably numerous molecules to test in toxicology. In this case, screening for adverse effects (genotoxicity, hepatotoxicity, immunotoxicity) that may compromise definitely the development of a molecule should be a help in the decision process since more than one molecule with equivalent pharmacological properties may be available.