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Kirkendall ES, Brady PW, Corathers SD, Ruddy RM, Fox C, Nelson H, Wetterneck TB, Rodgers I, Walsh KE. Safer Type 1 Diabetes Care at Home: SEIPS-based Process Mapping with Parents and Clinicians. Pediatr Qual Saf 2023; 8:e649. [PMID: 38571735 PMCID: PMC10990404 DOI: 10.1097/pq9.0000000000000649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/02/2023] [Indexed: 04/05/2024] Open
Abstract
Introduction The limited data indicate that pediatric medical errors in the outpatient setting, including at home, are common. This study is the first step of our Ambulatory Pediatric Patient Safety Learning Lab to address medication errors and treatment delays among children with T1D in the outpatient setting. We aimed to identify failures and potential solutions associated with medication errors and treatment delays among outpatient children with T1D. Methods A transdisciplinary team of parents, safety researchers, and clinicians used Systems Engineering Initiative for Patient Safety (SEIPS) based process mapping of data we collected through in-home medication review, observation of administration, chart reviews, parent surveys, and failure modes and effects analysis (FMEA). Results Eight (57%) of the 14 children who had home visits experienced 18 errors (31 per 100 medications). Four errors in two children resulted in harm, and 13 had the potential for harm. Two injuries occurred when parents failed to treat severe hypoglycemia and lethargy, and two were due to repeated failures to administer insulin at home properly. In SEIPS-based process maps, high-risk errors occurred during communication between the clinic and home or in management at home. Two FMEAs identified interventions to better communicate with families and support home care, especially during evolving illness. Conclusion Using SEIPS-based process maps informed by multimodal methods to identify medication errors and treatment delays, we found errors were common. Better support for managing acute illness at home and improved communication between the clinic and home are potentially high-yield interventions.
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Affiliation(s)
- Eric S. Kirkendall
- From the Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, N.C
- Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, N.C
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, N.C
| | - Patrick W. Brady
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center of Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sarah D. Corathers
- James M. Anderson Center of Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Richard M. Ruddy
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Catherine Fox
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Hailee Nelson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Tosha B. Wetterneck
- Department of Medicine, Division of General Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Isabelle Rodgers
- Division of General Pediatrics, Harvard Medical School, Boston, Mass
- Department of Pediatrics, Boston Children’s Hospital, Boston, Mass
| | - Kathleen E. Walsh
- Division of General Pediatrics, Harvard Medical School, Boston, Mass
- Department of Pediatrics, Boston Children’s Hospital, Boston, Mass
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2
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Boeder S, Matamoros D, Mansy C. Practical Guidance for Healthcare Providers on Collaborating with People with Type 2 Diabetes: Advancing Treatment and Initiating Injectable Therapy. Diabetes Ther 2023; 14:425-446. [PMID: 36520406 PMCID: PMC9943835 DOI: 10.1007/s13300-022-01330-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022] Open
Abstract
Type 2 diabetes (T2D) progresses over time, and to achieve and maintain adequate glucose control, many people eventually require injectable therapies such as insulin. However, there can be significant barriers to the initiation of these medications, both from people living with T2D and from healthcare practitioners (HCPs). Misconceptions and misinformation relating to the potential risks and benefits of injectable therapies are common and can contribute to negative perceptions regarding their use. Additionally, HCPs are often unaware of the emotional burden associated with T2D. In particular, diabetes distress is a key contributory factor that needs to be addressed to alleviate fears before diabetes education can be successful. The onus is often on the HCP to initiate effective, individualized communication with each patient and make that person feel an active and equal participant in the management of their T2D. Shared decision-making has been demonstrated to improve understanding of the pathophysiology and treatment options, to increase risk awareness, adherence, and persistence, and to improve self-management behaviors (e.g., exercise, self-care) and patient satisfaction. While therapeutic inertia can result from both patient and HCP, HCPs need to bear the responsibility for escalating therapy when necessary. A proactive approach by the HCP, combined with shared decision-making and a patient-centric approach, are important for optimal T2D management; therefore, an open and effective relationship between the HCP and the person living with T2D is essential. This article is written by a person with T2D, a nurse practitioner/Certified Diabetes Care and Education Specialist, and a clinical endocrinologist, with the goal of providing a holistic view of the management experience, exploring patient needs and expectations, recognizing and avoiding HCP and patient barriers, and providing practical advice to HCPs to empower patients who would benefit from injectable therapy.Infographic and video abstract available for this article.
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Affiliation(s)
- Schafer Boeder
- Division of Endocrinology and Metabolism, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla, CA, USA.
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3
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Sanjanwala D, Londhe V, Trivedi R, Bonde S, Sawarkar S, Kale V, Patravale V. Polysaccharide-based hydrogels for drug delivery and wound management: a review. Expert Opin Drug Deliv 2022; 19:1664-1695. [PMID: 36440488 DOI: 10.1080/17425247.2022.2152791] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Polysaccharide-based hydrogels (PBHs) offer several advantages over their synthetic counterparts. Their natural origin contributes to their nontoxicity, high biocompatibility, and in vivo biodegradability. Their properties can be tuned finely to obtain hydrogels with desired mechanical, structural, and chemical properties. AREAS COVERED Such versatile characteristics have potentiated the use of PBHs for the delivery of drugs, vaccines, protein and peptide therapeutics, genes, cells, probiotics, bacteriophages, and other therapeutic agents. Recent advances in hydrogel-based formulations such as nanogels, microgels, microneedles, hydrogel beads, nanocarrier-loaded hydrogels, and complexation hydrogels have enabled the precise delivery of a wide range of therapeutics. This review aims to give a holistic overview of hydrogels in the delivery of a variety of therapeutics through different routes. EXPERT OPINION PBHs have been used to enable the oral delivery of vaccines and other biologicals, thereby allowing self-administration of life-saving vaccines during public health emergencies. There is a lack of commercialized wound dressings for the treatment of chronic wounds. PBH-based wound dressings, especially those based on chitosan and loaded with actives and growth factors, have the potential to help in the long-term treatment of such wounds. Recent developments in the 3D printing of hydrogels can enable the quick and large-scale production of drug-loaded hydrogels.
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Affiliation(s)
- Dhruv Sanjanwala
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, Matunga (E), Mumbai, India
| | - Vaishali Londhe
- SVKM's NMIMS, Shobhaben Pratapbhai School of Pharmacy and Technology Management, Mumbai, India
| | - Rashmi Trivedi
- Smt. Kishoritai Bhoyar College of Pharmacy, Nagpur, India
| | - Smita Bonde
- SVKM's NMIMS, School of Pharmacy and Technology Management, Maharashtra, India
| | - Sujata Sawarkar
- Department of Pharmaceutics, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, University of Mumbai, Mumbai, India
| | - Vinita Kale
- Department of Pharmaceutics, Guru Nanak College of Pharmacy, Nagpur, India
| | - Vandana Patravale
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, Matunga (E), Mumbai, India
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Bosch-Frigola I, Coca-Villalba F, Pérez-Lacasta MJ, Carles-Lavila M. European national health plans and the monitoring of online searches for information on diabetes mellitus in different European healthcare systems. Front Public Health 2022; 10:1023404. [PMID: 36504997 PMCID: PMC9729732 DOI: 10.3389/fpubh.2022.1023404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022] Open
Abstract
Diabetes mellitus (DM) is a serious non-communicable disease (NCD) and relies on the patient being aware of their condition, proactive, and having adequate medical care. European countries healthcare models are aware of the impact of these variables. This study evaluates the impact of online health information seeking behavior (OHISB) during World Diabetes Mellitus Day (WDMD) in European countries from 2014 to 2019 by grouping countries according to the changes in citizens' search behavior, diabetes mellitus prevalence, the existence of National Health Plans (NHP), and their respective healthcare systems. We extracted data from Global Burden of Disease, Google Trends (GT), Public Health European Commission, European Coalition for Diabetes, and the Spanish Ministry of Health. First, we used the broken-line models to analyze significant changes in search trends (GT) in European Union member countries in the 30-day intervals before and after the WDMD (November 14) from 2014 to 2019. Then the results obtained were used in the second phase to group these countries by factor analysis of mixed data (FAMD) using the prevalence of DM, the existence of NHP, and health models in each country. The calculations were processed using R software (gtrendsR, segmented, Factoextra, and FactoMineR). We established changes in search trends before and after WDMD, highlighting unevenness among European countries. However, significant changes were mostly observed among countries with NHP. These changes in search trends, in addition to being significant, were reiterated over time and occurred especially in countries belonging to the Beveridge Model (Portugal, Spain, and Sweden) and with NHPs in place. Greater awareness of diabetes mellitus among the population and continuous improvements in NHP can improve the patients' quality of life, thus impacting in disease management and healthcare expenditure.
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Affiliation(s)
- Irene Bosch-Frigola
- Department of Economics, Rovira i Virgili University, Reus, Spain
- Facultad de Comunicación y Ciencias Sociales, Universidad San Jorge, Zaragoza, Spain
| | | | - María José Pérez-Lacasta
- Department of Economics, Rovira i Virgili University, Reus, Spain
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
- Research Center on Economics and Sustainability (ECO-SOS), Reus, Spain
| | - Misericòrdia Carles-Lavila
- Department of Economics, Rovira i Virgili University, Reus, Spain
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
- Research Center on Economics and Sustainability (ECO-SOS), Reus, Spain
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5
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Ortiz La Banca R, Rebustini F, Alvarenga WA, de Carvalho EC, Lopes M, Milaszewski K, Nascimento LC. Checklists for Assessing Skills of Children With Type 1 Diabetes on Insulin Injection Technique. J Diabetes Sci Technol 2022; 16:742-750. [PMID: 33423543 PMCID: PMC9294572 DOI: 10.1177/1932296820984771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND School-aged children often participate in type 1 diabetes (T1D) self-care tasks. Despite widespread discussion about the importance of developing self-care skills in childhood, few explain how the health care team should assess the skills of children with T1D when performing insulin injections. OBJECTIVE We sought to assess content validity evidence in two checklists regarding injection technique performed by children. METHODS Two checklists were designed based on a systematic review of the insulin injection technique. Experts in pediatric diabetes, health literacy, and diabetes education assessed the checklists regarding their clarity, objectivity, and relevance. Content validity was assessed using the content validity ratio (CVR). RESULTS Eleven providers (72% nurses or physicians, professional experience 19.4 ± 10.1 years, 45% of specialists in endocrinology, and 18% in pediatrics) participated in the assessment. Experts considered items containing the word homogeneity inappropriate. Items related to the needle insertion angle and the skin fold did not reach the CVR critical value. The final version of the checklist for syringe injection comprised 22 items with CVR = 0.91, and the checklist for pen injection comprised 18 items with CVR = 0.87. CONCLUSIONS The checklists presented clear, objective, and relevant content that assesses the skills of children with T1D for insulin injection. The checklists formally present the order of the technique and all the steps for insulin injection and allow a quantitative assessment of the operational skills of children. The developed instruments offer providers the possibility of continuous assessment of the progress of the pediatric clientele until they reach independence in diabetes self-care.
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Affiliation(s)
- Rebecca Ortiz La Banca
- Section on Clinical, Behavioral and
Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA,
USA
- Rebecca Ortiz La Banca, RN, MSN, PhD,
Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center,
Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA.
| | - Flávio Rebustini
- Department of Gerontology, College of
Arts, Science and Humanities, University of Sao Paulo, São Paulo, SP, Brazil
| | | | - Emilia C. de Carvalho
- Ribeirao Preto College of Nursing,
University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | - Mayara Lopes
- Paulista School of Nursing, Federal
University of Sao Paulo, São Paulo, SP, Brazil
| | - Kerry Milaszewski
- Section on Clinical, Behavioral and
Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA,
USA
| | - Lucila C. Nascimento
- Ribeirao Preto College of Nursing,
University of Sao Paulo, Ribeirão Preto, SP, Brazil
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6
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Veasey R, Ruf CA, Bogatirsky D, Westerbacka J, Friedrichs A, Abdel-Tawab M, Adler S, Mohanasundaram S. A review of reusable insulin pens and features of TouStar-a new reusable pen with a dedicated cartridge. Diabetol Metab Syndr 2021; 13:147. [PMID: 34924015 PMCID: PMC8684684 DOI: 10.1186/s13098-021-00763-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Since the introduction of the first reusable insulin pen, the advancement in the design of these pens is still ongoing to develop a safe, more efficacious, less painful, and easy to use insulin pen device. MAIN BODY Possible errors in insulin delivery can occur at any stage of insulin delivery such as during the prescription stage, dispensing stage, or at administration stage. Mismatch of the insulin pen and cartridge is not uncommon and is a potential risk for individuals with diabetes due to serious consequences associated with incorrect insulin usage. The similarities in insulin cartridges of different manufacturers with regard to color and product names could lead to mix-up of insulin pens and cartridges. These unmet needs have led to the ongoing search for developing insulin pens that can address these errors and provide more efficacious and safer choices for patients with diabetes. CONCLUSION This review provides an overview of currently available reusable pens in the market and highlights the features of TouStar®, a new reusable pen with a dedicated cartridge intended to mitigate the risk of mismatch of the cartridge.
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Affiliation(s)
| | | | | | | | | | | | - Steffen Adler
- Dr. Arnd Friedrichs Unternehmensberatung, Görlitz, Germany
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7
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Peer Teaching in an Interprofessional Education Activity Focused on Professional Skills Development. PHARMACY 2021; 9:pharmacy9020112. [PMID: 34208571 PMCID: PMC8293411 DOI: 10.3390/pharmacy9020112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to assess the impact of a peer-taught interprofessional education (IPE) activity on pharmacy and physician assistant (PA) student self-assessed confidence and attitudes related to professional skills. First-year pharmacy (n = 210) and PA (n = 45) students participated in a two-hour IPE activity. Forty-five teams consisting of one PA and at least four pharmacy students completed three peer-teaching stations focused on diabetes device education, pulmonary device teaching/case workup, and physical assessment skills. Students completed a pre- and post-activity confidence survey and a post-activity attitudes survey. For pharmacy students, highest confidence gains were noted on the items related to performing a physical exam. For PA students, largest gains were noted on the items related to insulin delivery systems. Eighty-three percent of students either agreed or strongly agreed with the statement “I learned things during this IPE activity that I will implement in clinical practice.” Seventy six percent of students felt that the physical assessment station was “beneficial or very beneficial” to their learning. A vast majority of students noted the IPE activity “somewhat or definitely” enhanced their communication with other health professionals and promoted a climate of mutual respect. In conclusion, peer teaching improved student attitudes and confidence.
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Benyettou F, Kaddour N, Prakasam T, Das G, Sharma SK, Thomas SA, Bekhti-Sari F, Whelan J, Alkhalifah MA, Khair M, Traboulsi H, Pasricha R, Jagannathan R, Mokhtari-Soulimane N, Gándara F, Trabolsi A. In vivo oral insulin delivery via covalent organic frameworks. Chem Sci 2021; 12:6037-6047. [PMID: 33995999 PMCID: PMC8098678 DOI: 10.1039/d0sc05328g] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
With diabetes being the 7th leading cause of death worldwide, overcoming issues limiting the oral administration of insulin is of global significance. The development of imine-linked-covalent organic framework (nCOF) nanoparticles for oral insulin delivery to overcome these delivery barriers is herein reported. A gastro-resistant nCOF was prepared from layered nanosheets with insulin loaded between the nanosheet layers. The insulin-loaded nCOF exhibited insulin protection in digestive fluids in vitro as well as glucose-responsive release, and this hyperglycemia-induced release was confirmed in vivo in diabetic rats without noticeable toxic effects. This is strong evidence that nCOF-based oral insulin delivery systems could replace traditional subcutaneous injections easing insulin therapy.
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Affiliation(s)
- Farah Benyettou
- New York University Abu Dhabi P.O. Box 129188 Abu Dhabi United Arab Emirates
| | - Nawel Kaddour
- Laboratory of Physiology Physiopathology and Biochemistry of Nutrition, Department of Biology, University of Tlemcen Algeria
| | | | - Gobinda Das
- New York University Abu Dhabi P.O. Box 129188 Abu Dhabi United Arab Emirates
| | - Sudhir Kumar Sharma
- New York University Abu Dhabi P.O. Box 129188 Abu Dhabi United Arab Emirates
| | - Sneha Ann Thomas
- New York University Abu Dhabi P.O. Box 129188 Abu Dhabi United Arab Emirates
| | - Fadia Bekhti-Sari
- Laboratory of Physiology Physiopathology and Biochemistry of Nutrition, Department of Biology, University of Tlemcen Algeria
| | - Jamie Whelan
- New York University Abu Dhabi P.O. Box 129188 Abu Dhabi United Arab Emirates
| | - Mohammed A Alkhalifah
- Department of Chemistry, College of Science, King Faisal University P.O. Box 400, Al-Ahsa 31982 Saudi Arabia
- School of Chemistry, University of Bristol Cantocks Close Bristol BS8 1TS UK
| | - Mostafa Khair
- New York University Abu Dhabi P.O. Box 129188 Abu Dhabi United Arab Emirates
| | - Hassan Traboulsi
- Department of Chemistry, College of Science, King Faisal University P.O. Box 400, Al-Ahsa 31982 Saudi Arabia
| | - Renu Pasricha
- New York University Abu Dhabi P.O. Box 129188 Abu Dhabi United Arab Emirates
| | - Ramesh Jagannathan
- New York University Abu Dhabi P.O. Box 129188 Abu Dhabi United Arab Emirates
| | - Nassima Mokhtari-Soulimane
- Laboratory of Physiology Physiopathology and Biochemistry of Nutrition, Department of Biology, University of Tlemcen Algeria
| | | | - Ali Trabolsi
- New York University Abu Dhabi P.O. Box 129188 Abu Dhabi United Arab Emirates
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9
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Zhao M, Hoti K, Wang H, Raghu A, Katabi D. Assessment of medication self-administration using artificial intelligence. Nat Med 2021; 27:727-735. [PMID: 33737750 DOI: 10.1038/s41591-021-01273-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/29/2021] [Indexed: 11/09/2022]
Abstract
Errors in medication self-administration (MSA) lead to poor treatment adherence, increased hospitalizations and higher healthcare costs. These errors are particularly common when medication delivery involves devices such as inhalers or insulin pens. We present a contactless and unobtrusive artificial intelligence (AI) framework that can detect and monitor MSA errors by analyzing the wireless signals in the patient's home, without the need for physical contact. The system was developed by observing self-administration conducted by volunteers and evaluated by comparing its prediction with human annotations. Findings from this study demonstrate that our approach can automatically detect when patients use their inhalers (area under the curve (AUC) = 0.992) or insulin pens (AUC = 0.967), and assess whether patients follow the appropriate steps for using these devices (AUC = 0.952). The work shows the potential of leveraging AI-based solutions to improve medication safety with minimal overhead for patients and health professionals.
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Affiliation(s)
- Mingmin Zhao
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Kreshnik Hoti
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Division of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo.
| | - Hao Wang
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Aniruddh Raghu
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dina Katabi
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
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10
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Efficient Clinical Counseling for Sickle Cell Disease. J Natl Med Assoc 2021; 113:382-387. [PMID: 33610309 DOI: 10.1016/j.jnma.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/22/2021] [Indexed: 11/22/2022]
Abstract
Sickle cell anemia (SCA) is a chronic illness that requires frequent health care visits for preventative management. Adherence to national guidelines such as the National Heart Lung and Blood Institute (NHLBI) Expert Panel Report on the Evidence-Based Management of Sickle Cell Disease can be challenging to both the clinician and the patient. Utilizing effective communication strategies with patients and their families can improve clinician/patient relationships, as well as adherence to national guidelines. Aims of this overview are to review challenges faced in outpatient subspecialty medicine and describe evidence-based techniques for more effective communication for patients with sickle cell anemia.
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12
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Schmidt SJ, Wurmbach VS, Lampert A, Bernard S, Haefeli WE, Seidling HM, Thürmann PA. Individual factors increasing complexity of drug treatment-a narrative review. Eur J Clin Pharmacol 2020; 76:745-754. [PMID: 32239242 PMCID: PMC7239823 DOI: 10.1007/s00228-019-02818-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 12/08/2019] [Indexed: 12/11/2022]
Abstract
Purpose Complexity of drug treatment is known to be a risk factor for administration errors and nonadherence promoting higher healthcare costs, hospital admissions and increased mortality. Number of drugs and dose frequency are parameters often used to assess complexity related to the medication regimen. However, factors resulting from complex processes of care or arising from patient characteristics are only sporadically analyzed. Hence, the objective of this review is to give a comprehensive overview of relevant, patient-centered factors influencing complexity of drug treatment. Methods A purposeful literature search was performed in MEDLINE to identify potential complexity factors relating to the prescribed drug (i.e. dosage forms or other product characteristics), the specific medication regimen (i.e. dosage schemes or additional instructions), specific patient characteristics and process characteristics. Factors were included if they were associated to administration errors, nonadherence and related adverse drug events detected in community dwelling adult patients. Results Ninety-one influencing factors were identified: fourteen in “dosage forms”, five in “product characteristics”, twelve in “dosage schemes”, nine in “additional instructions”, thirty-one in “patient characteristics” and twenty in “process characteristics”. Conclusions Although the findings are limited by the non-systematic search process and the heterogeneous results, the search shows the influence of many factors on the complexity of drug treatment. However, to evaluate their relevance for individual patients, prospective studies are necessary. Electronic supplementary material The online version of this article (10.1007/s00228-019-02818-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steffen J Schmidt
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Viktoria S Wurmbach
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anette Lampert
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Simone Bernard
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | | | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Petra A Thürmann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.,Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Heusnerstraße 40, 42283, Wuppertal, Germany
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13
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Perceptions of Insulin Pen Use and Technique in Black and Hispanic/Latino Patients with Type 2 Diabetes: a Qualitative Study. J Racial Ethn Health Disparities 2020; 7:949-957. [DOI: 10.1007/s40615-020-00718-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/09/2019] [Accepted: 02/02/2020] [Indexed: 01/09/2023]
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14
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Hirsch LJ, Strauss KW. The Injection Technique Factor: What You Don't Know or Teach Can Make a Difference. Clin Diabetes 2019; 37:227-233. [PMID: 31371853 PMCID: PMC6640874 DOI: 10.2337/cd18-0076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IN BRIEF To be consistently effective, insulin must be delivered into subcutaneous tissue. If insulin is delivered intramuscularly, its uptake and action become variably faster, leading to suboptimal, inconsistent glucose control. The best strategy to avoid intramuscular injection is to use the shortest needles available. Injection sites should be rotated systematically to prevent lipohypertrophy, which also substantially affects insulin uptake and action. New evidence-based insulin delivery recommendations are available, and awareness of them should lead to more effective use of insulin therapy, improved clinical outcomes, and considerable cost savings.
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Gomez-Peralta F, Abreu C, Gomez-Rodriguez S, Ruiz L. Insulclock: A Novel Insulin Delivery Optimization and Tracking System. Diabetes Technol Ther 2019; 21:209-214. [PMID: 30896261 DOI: 10.1089/dia.2018.0361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Achieving and maintaining controlled glycemic levels are challenging in people with insulin-treated diabetes mellitus, suboptimal insulin injections being the main obstacle to treatment success. METHODS This research article presents the main functionalities and performance tests on Insulclock®, an electronic device plugged into insulin pens and connected with a smartphone app to improve insulin management. Insulclock tracks the date, time of day, dose, type of insulin, temperature, and duration of insulin injections. Information is stored in the device memory and is available for analysis by patients and health care providers. Insulclock device also has a reminder system with visual and acoustic alerts to reduce insulin omissions and mistiming. RESULTS The main performance tests reveal that Insulclock can detect seven types of insulin pens with a 97% correct classification rate. Among 556 injections, most of the doses were accurately detected (deviation = 0), with relative errors ranging from 3% to 7% across different dosages. The duration of injections recorded by this device strongly correlated with that detected by an external chronometer (R2 = 0.99, root-mean-square deviation [RMSD] = 0.39). Moreover, the precision of the temperature sensor was evidenced by high correlation of temperatures detected by Insulclock and by an external thermometer (Pearson's R2 = 0.90, RMSD = 0.45). CONCLUSIONS Insulclock is a novel device capable of tracking dosing, timing, and missing insulin injections. The promising capabilities it offers for diabetes mellitus self-management may help health care providers, researchers, and insulin users avoid frequent errors in insulin administration.
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Affiliation(s)
| | - Cristina Abreu
- 1 Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia, Spain
| | | | - Luis Ruiz
- 2 Insulcloud S.L. (B87131454), Madrid, Spain
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