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Rayamajhi S, Machin A, Breen C, Gebreheat G, Paterson R. Quality and impact of pharmacology digital simulation education on pre-registration healthcare students: A systematic literature review. NURSE EDUCATION TODAY 2024; 140:106295. [PMID: 38959780 DOI: 10.1016/j.nedt.2024.106295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/04/2024] [Accepted: 06/23/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE This review aimed to assess the quality and nature of the literature related to digital simulation-based pharmacology education. Specifically, we sought to understand the influence of simulations on the knowledge, satisfaction, and confidence of pre-registration nurses and other healthcare students participating in such educational programs. DESIGN Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. This study was registered in the Prospective Register of Systematic Reviews (PROSPERO, reg no: CRD42023437570). DATA SOURCES PubMed, MEDLINE, APA PsycInfo, ProQuest, Web of Science, ScienceDirect, and CINHAL databases were searched. REVIEW METHODS The review focused on the quantitative findings from the studies published from 2016 to 2023. Only the studies that assessed the impact of digital simulation-based pharmacology education on pre-registration healthcare students' knowledge, satisfaction, and confidence were selected for review. Data were synthesized using a narrative approach. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included articles. This was followed by a narrative synthesis to consolidate the themes. RESULT Out of 1587 articles,16 met the inclusion criteria. A wide variety of digital technologies have been utilised, such as virtual simulation, computer simulation (2D/3D), mixed reality, and augmented reality, with the majority using virtual simulation. All studies implemented single-user simulations. The themes emerging from the narrative synthesis suggest that a digital simulation-based pharmacology course is an effective tool for enhancing students' knowledge, confidence, and satisfaction in learning pharmacological concepts. Furthermore, simulation-based teaching with a blended approach was found to be beneficial. However, the integration of the polypharmacy concept and the intra and interprofessional approach to teaching and learning was not evident in these studies. CONCLUSION This systematic literature review provides evidence of the potential of digital simulation-based education in pharmacology teaching among healthcare pre-registration students. In future studies, the integration of polypharmacy content with an intra and interprofessional teaching-learning approach is recommended.
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Lyu H, Wang LY, Wang RX, Sheng H, Xia JM, Cheng JY. Clinical Predictors of Medication Compliance in Patients With Acute Herpetic Neuralgia. Pain Manag Nurs 2024:S1524-9042(24)00214-5. [PMID: 39153959 DOI: 10.1016/j.pmn.2024.07.002] [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: 09/03/2023] [Revised: 06/05/2024] [Accepted: 07/09/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE Pain is one of the most common and harmful symptoms experienced by individuals with acute herpetic neuralgia (AHN). In this population, studies to determine the causes that affect patients taking medications compliance are rare. This study aimed to construct a predictive model for medication compliance of patients with AHN and to verify its performance. DESIGN AND METHODS In this prospective study of 398 patients with AHN who were discharged from a tertiary hospital with medications from July 2020 to October 2022, we used logistic regression analysis to explore the predictive factors of medication compliance of patients with AHN and to construct a nomogram. The area under the curve was used to evaluate the predictive effect of the model. RESULTS A predictive model of drug compliance of patients with AHN was constructed based on the following four factors: disease duration, pain severity before treatment, medication beliefs, and comorbidity of chronic diseases. The area under the curve of the model was 0.766 (95% confidence interval [0.713, 0.819]), with a maximum Youden's index of 0.431, sensitivity of 0.776, and specificity of 0.655. A linear calibration curve was found with a slope close to 1. CONCLUSIONS The prediction model constructed in this study had good predictive performance and provided a reference for early clinical screening of independent factors that affected the medication compliance of patients with AHN.
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Affiliation(s)
- Hui Lyu
- Department of Pain, First Hospital of Jiaxing, Jiaxing, China.
| | - Ling-Yan Wang
- Department of Intensive Care Unit, First Hospital of Jiaxing, Jiaxing, China.
| | - Rui-Xia Wang
- Department of Nursing, Zhejiang Chinese Medical University, Hangzhou, China.
| | - Han Sheng
- Department of Nursing, First Hospital of Jiaxing, Jiaxing, China.
| | - Jian-Mei Xia
- Department of Pain, First Hospital of Jiaxing, Jiaxing, China.
| | - Jun-Ya Cheng
- Department of Nursing, First Hospital of Jiaxing, Jiaxing, China.
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Pereira F, Meyer-Massetti C, Del Río Carral M, von Gunten A, Wernli B, Verloo H. Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study. BMJ Open 2023; 13:e072738. [PMID: 37730411 PMCID: PMC10514617 DOI: 10.1136/bmjopen-2023-072738] [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] [Received: 02/14/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs). DESIGN Explanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously. SETTING Hospital and community healthcare in the French-speaking part of Switzerland. PARTICIPANTS The quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge. RESULTS Quantitative results from older adults' profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices. CONCLUSION By linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders' perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.
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Affiliation(s)
- Filipa Pereira
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Clinical of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - María Del Río Carral
- Institute of Psychology, Research Center for the Psychology of Health, Aging and Sports Examination (PHASE), University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Boris Wernli
- Swiss Centre of Expertise in the Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Shahrami B, Sefidani Forough A, Najmeddin F, Hadidi E, Toomaj S, Javadi MR, Gholami K, Sadeghi K. Identification of drug-related problems followed by clinical pharmacist interventions in an outpatient pharmacotherapy clinic. J Clin Pharm Ther 2022; 47:964-972. [PMID: 35218217 DOI: 10.1111/jcpt.13628] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Pharmacotherapy is an essential strategy for the treatment of many medical conditions especially chronic disease and often involves multiple medications being used simultaneously. Increasing the use of medications may pose some challenges to safe and effective drug therapy and if not identified and prevented by the pharmacists eventually can lead to drug-related problems (DRPs). The present study aimed to examine the incidence of DRPs in Iranian patients and to evaluate patients' adherence to the clinical pharmacist interventions as well as the physicians' acceptance of these recommendations. METHODS This study was conducted in a university-affiliated outpatient pharmacotherapy clinic over a 22-month period. Patients aged 18 years and older with at least one chronic disease receiving at least four medications were included in the study. The patients were interviewed by a clinical pharmacist for comprehensive medication review. DRPs were identified using the DOCUMENT classification system. Recommendations were provided by the clinical pharmacist including interventions involving patient and/or physician to resolve DRPs. The patients were followed up after 2 weeks to evaluate their compliance and physician acceptance of clinical pharmacist recommendations. RESULTS AND DISCUSSION Two hundred patients were included in this study. Overall, 875 DRPs were identified with an average of 4.37 per patient. The most prevalent DRPs were related to patient education or information (22.8%), undertreated indications (17.4%) and patient compliance (17.2%). The most common drugs associated with DRPs were alimentary and metabolism (22.2% of DRPs) followed by the cardiovascular system (19.2%) and nervous system (9.6%) medications. The DRP incidence correlated with gender only and was higher in females (p = 0.019). The clinical pharmacist provided 912 interventions with an average of 4.56 and 1.04 interventions per patient and per DRPs respectively. Patient education (41.3%), medication initiation or discontinuation (24.5%), and non-pharmacological interventions (12.9%) were the most common clinical pharmacist interventions. Out of 912 interventions, 665 were followed up, out of which 427 were patient dependent and 228 involved physicians. The patient's compliance with clinical pharmacist recommendations was 81.2%. The physician acceptance rate of the recommendations was 44.1%. WHAT IS NEW AND CONCLUSION The study shows that especially designed services such as pharmacotherapy clinics running by clinical pharmacists are necessary to detect and resolve DRPs in an effective way. The high compliance rate of the patients indicates patients' confidence in the clinical pharmacist services provided in the pharmacotherapy clinic. The low acceptance rate of the physicians highlights the need to improve interprofessional collaboration between clinical pharmacists and physicians in an outpatient setting.
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Affiliation(s)
- Bita Shahrami
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Sefidani Forough
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Farhad Najmeddin
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Hadidi
- 13-Aban Pharmacotherapy Clinic, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Toomaj
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Javadi
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Kheirollah Gholami
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Sadeghi
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Ng TM, Hing WC, Koh TY, Chang WT, Chang GSW, Heng JW, Abuaman IB, Sia BY, Saw YC, Chan D, Tan CH, Fan WS, Franky F, Tan PC, Tan CWY, Sng JHL, Yap CW, Gnanamani SUD, Tan DSY. Merits of a harmonised system to classify drug-related problems in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:572-577. [PMID: 34342338 DOI: 10.47102/annals-acadmedsg.202176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Tat Ming Ng
- Division of Pharmacy, Tan Tock Seng Hospital, Singapore
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Paliwal Y, Jones RM, Moczygemba LR, Gendron TL, Nadpara PA, Parab P, Slattum PW. Over-the-counter medication use in residents of senior living communities: A survey study. J Am Pharm Assoc (2003) 2021; 61:736-744. [PMID: 34140254 DOI: 10.1016/j.japh.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Self-medication with over-the-counter (OTC) products is common among older adults. Although OTC self-medication is a convenient way to manage some health issues, older persons may be at higher risk of experiencing medication-related problems. This study examines the prevalence, practices, and preferences associated with OTC medication use in older adult residents of senior living communities. OBJECTIVES The study aimed to examine the characteristics of OTC medication users and to quantify the prevalence, attitudes, perceptions, preferences, and practices regarding OTC medication use and decision-making in 2 senior living communities in central Virginia. METHODS The study used survey methodology. A 51-item semistructured questionnaire was designed by the research team of geriatrics specialists, and mixed-methods and evaluation researchers. The questionnaire was administered in-person to participants (N = 88). Descriptive analyses were conducted using SAS 9.4. Characteristics of those using OTC medications as directed by a health professional were compared with those of whom were self-medicating with OTC medications. RESULTS Most of the sample were women (55%), black (61%) and had less than or equal to a high school education (55%). Analgesics were the most (76%) prevalent OTC therapeutic category used, and aspirin was the most (65%) prevalent OTC medication. A greater (82%) proportion of respondents reported self-recommended OTC medication use (self-medication with OTC medications) rather than physician recommended use (18%). A high (41%) prevalence of inappropriate use of OTC medications was observed in this sample of older adults. Most (80%) considered OTC medications safe and effective. The pharmacy was the most (93%) commonly reported purchase location to buy an OTC medication. Physicians were the most (90%) commonly reported information source for OTC medications. CONCLUSION Considering the high percentage of self-reported self-medication, inappropriate use, and experiences of adverse effects, steps should be taken to develop consumer education and relationships with pharmacists to encourage the responsible use of OTC medications in this population.
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Abdellatif A, Bouaud J, Lafuente-Lafuente C, Belmin J, Séroussi B. Computerized Decision Support Systems for Nursing Homes: A Scoping Review. J Am Med Dir Assoc 2021; 22:984-994. [PMID: 33639117 DOI: 10.1016/j.jamda.2021.01.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To summarize the research literature describing the outcomes of computerized decision support systems (CDSSs) implemented in nursing homes (NHs). DESIGN Scoping review. METHODS Search of relevant articles published in the English language between January 1, 2000, and February 29, 2020, in the Medline database. The quality of the selected studies was assessed according to PRISMA guidelines and the Mixed Method Appraisal Tool. RESULTS From 1828 articles retrieved, 24 studies were selected for review, among which only 6 were randomized controlled trials. Although clinical outcomes are seldom studied, some studies show that CDSSs have the potential to decrease pressure ulcer incidence and malnutrition prevalence. Improvement of process outcomes such as increased compliance with practice guidelines, better documentation of nursing assessment, improved teamwork and communication, and cost saving, also are reported. CONCLUSIONS AND IMPLICATIONS Overall, the use of CDSSs in NHs may be effective to improve patient clinical outcomes and health care delivery; however, most of the retrieved studies were observational studies, which significantly weakens the evidence. High-quality studies are needed to investigate CDSS effects and limitations in NHs.
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Affiliation(s)
- Abir Abdellatif
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, LIMICS, UMR S_1142, Paris, France; APHP, Hôpital Charles-Foix, Ivry-sur-Seine, France; Teranga Software, Paris, France
| | - Jacques Bouaud
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, LIMICS, UMR S_1142, Paris, France; AP-HP, Direction de la Recherche Clinique et de l'Innovation, Paris, France
| | - Carmelo Lafuente-Lafuente
- APHP, Hôpital Charles-Foix, Ivry-sur-Seine, France; Faculté de Médecine, Sorbonne Université, Paris, France
| | - Joël Belmin
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, LIMICS, UMR S_1142, Paris, France; APHP, Hôpital Charles-Foix, Ivry-sur-Seine, France; Faculté de Médecine, Sorbonne Université, Paris, France.
| | - Brigitte Séroussi
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, LIMICS, UMR S_1142, Paris, France; APHP, Hôpital Tenon, Paris, France
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Hailu BY, Berhe DF, Gudina EK, Gidey K, Getachew M. Drug related problems in admitted geriatric patients: the impact of clinical pharmacist interventions. BMC Geriatr 2020; 20:13. [PMID: 31931723 PMCID: PMC6958579 DOI: 10.1186/s12877-020-1413-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/03/2020] [Indexed: 01/09/2023] Open
Abstract
Background Geriatric patients are at high risk of Drug Related Problems (DRPs) due to multi- morbidity associated polypharmacy, age related physiologic changes, pharmacokinetic and pharmacodynamics alterations. These patients often excluded from premarketing trials that can further increase the occurrence of DRPs. This study aimed to identify drug related problems and determinants in geriatric patients admitted to medical and surgical wards, and to evaluate the impact of clinical pharmacist interventions for treatment optimization. Methods A prospective interventional study was conducted among geriatric patients admitted to medical and surgical wards of Jimma University Medical Center from April to July 2017. Clinical pharmacists reviewed patients drug therapy, identified drug related problems and provided interventions. Data were analyzed by using SPSS statistical software version 20.0. Descriptive statistics were performed to determine the proportion of drug related problems. Logistic regression analyses were performed to identify the determinants of drug related problems. Results A total of 200 geriatric patients were included in the study. The mean age of the participants was 67.3 years (SD7.3). About 82% of the patients had at least one drug related problems. A total of 380 drug related problems were identified and 670 interventions were provided. For the clinical pharmacist interventions, the prescriber acceptance rate was 91.7%. Significant determinants for drug related problems were polypharmacy (adjusted odds ratio [AOR] = 4.350, 95% C.I: 1.212–9.260, p = 0.020) and number of comorbidities (AOR = 1.588, 95% C.I: 1.029–2.450, p = 0.037). Conclusions Drug related problems were substantially high among geriatric inpatients. Patients with polypharmacy and co-morbidities had a much higher chance of developing DRPs. Hence, special attention is needed to prevent the occurrence of DRPs in these patients. Moreover, clinical pharmacists’ intervention was found to reduce DRPs in geriatric inpatients. The prescriber acceptance rate of clinical pharmacists’ intervention was also substantially high.
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Affiliation(s)
- Berhane Yohannes Hailu
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Derebew Fikadu Berhe
- Department of Pharmacology and Toxicology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mestawet Getachew
- Department of clinical pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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Paliwal Y, Gendron TL, Jones RM, Moczygemba L, Nadpara PA, Slattum PW. A qualitative study to understand over-the-counter medication use and decision-making among residents of senior-living communities. Res Social Adm Pharm 2018; 15:730-737. [PMID: 30253975 DOI: 10.1016/j.sapharm.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION OTC medications are generally considered safe and convenient to use without requiring a prescription. However, the safety of an OTC medication and the final health outcome depends in part upon consumers' perceptions, beliefs, and their decision-making about OTC medication use. This study uses a qualitative approach to explore the knowledge, beliefs, and practices associated with OTC medication use and decision-making in adults aged 65 years and older. METHODS A set of focus groups (N = 10) were conducted in a sample of independently living older adult residents of senior apartment buildings (N = 80) using purposeful sampling. All focus groups were recorded, transcribed verbatim, and analyzed qualitatively. RESULTS Most participants considered OTC medications safe and effective to use if following the drug label instructions appropriately. Brand name products were perceived as equally or more effective compared to generic products by participants. Two approaches to OTC treatment decision-making were observed: 1) a decision to treat their symptoms by themselves (self-recommended) or 2) a decision to ask and/or follow their physician's recommendation (physician-recommended). Each of these treatment approaches may lead to the other depending on the person's financial and healthcare resources, the severity of the symptoms, experiences with the medication, and relationship with the physician. Maximum and fast relief was mentioned as the most important attribute in the final OTC purchase decision, followed by the lower cost, and easy to swallow dosage forms. Aspirin and ibuprofen were the two most frequently reported OTC medications associated with adverse effects and inappropriate use. CONCLUSIONS Older adults, in general, feel positive about OTC medications and are satisfied with using them. Considering the self-reported malpractices and side effects associated with OTC medications, older adults should be encouraged to make safe and responsible decisions about self-medication.
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Affiliation(s)
- Yoshita Paliwal
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, 410 N 12th Street, P.O. Box 980533, Richmond, VA, 23298-0533, USA.
| | - Tracey L Gendron
- Department of Gerontology, School of Allied Health Professions, Virginia Commonwealth University, Richmond, Virginia, 730 East Broad Street, Box 980228, Richmond, VA, 23298-0228, USA.
| | - Resa M Jones
- Department Chair and Associate Professor, Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, 1301 Cecil B. Moore Ave, Ritter Annex Room 917, Philadelphia, PA, 19122, USA.
| | - Leticia Moczygemba
- Health Outcomes & Pharmacy Practice, University of Texas College of Pharmacy, Division of Health Outcomes and Pharmacy Practice, University of Texas, Austin, Texas, 2409 University Avenue, STOP A1930, Austin, TX, 78712-1117, USA.
| | - Pramit A Nadpara
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, 410 N 12th Street, P.O. Box 980533, Richmond, VA, 23298-0533, USA.
| | - Patricia W Slattum
- Geriatric Pharmacotherapy Program, Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, 410 N 12th Street, P.O. Box 980533, Richmond, VA, 23298-0533, USA.
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Toffoletto MC, Oliveira EMD, Andolhe R, Barbosa RL, Padilha KG. COMPARAÇÃO ENTRE GRAVIDADE DO PACIENTE E CARGA DE TRABALHO DE ENFERMAGEM ANTES E APÓS A OCORRÊNCIA DE EVENTOS ADVERSOS EM IDOSOS EM CUIDADOS CRÍTICOS. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720180003780016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: comparar a gravidade do paciente e a carga de trabalho de enfermagem antes e após a ocorrência de evento adverso moderado e grave em idosos internados em unidades de terapia intensiva. Método: estudo comparativo, realizado em nove unidades de terapia intensiva de um Hospital Universitário de São Paulo. Os eventos foram coletados dos prontuários dos pacientes e classificados em moderados e graves segundo a Organização Mundial de Saúde. A análise da gravidade foi realizada segundo o Symplified Acute Phsiologic Score II e a carga de trabalho segundo o Nursing Activities Score, 24 horas antes e depois do evento moderado e grave. O teste t, com significância de 5%, foi utilizado para a comparação das médias da gravidade clínica e da carga de trabalho, antes e após o evento. Resultados: a amostra foi composta por 315 idosos, sendo que 94 (29,8%) sofreram eventos moderados e graves nas unidades. Dos 94 eventos, predominou o tipo processo clínico e procedimento (40,0%). A instalação e manutenção de artefatos terapêuticos e cateteres foram as intervenções prevalentes que resultaram em danos fisiopatológicos (66,0%), de grau moderado (76,5%). A média de pontuação da carga de trabalho (75,19%) diminuiu 24 horas após a ocorrência do evento (71,97%, p=0,008) e, a gravidade, representada pela probabilidade de morte, aumentou de 22,0% para 29,0% depois do evento (p=0,045). Conclusão: no contexto da segurança do paciente, a identificação das alterações nas condições clínicas e na carga de trabalho de enfermagem em idosos que sofrem eventos subsidiam a prevenção dessas ocorrências.
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Yang CY, Lo YS, Chen RJ, Liu CT. A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation. JMIR Med Inform 2018; 6:e6. [PMID: 29351893 PMCID: PMC5797291 DOI: 10.2196/medinform.9064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/23/2017] [Accepted: 12/23/2017] [Indexed: 11/21/2022] Open
Abstract
Background A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients’ integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients’ medication records prescribed by different health care facilities across Taiwan. Objective This study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters. Methods A CDS engine was developed that can download patients’ up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians’ responses to handling the alerts for each encounter. Results The CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When prescribing using the CDS engine, the median encounter time was 4.3 (IQR 2.3-7.3) min, longer than that without using the CDS engine (median 3.6, IQR 2.0-6.3 min). From the physicians’ responses, we found that 42.06% (1908/4536) of the potential duplicate medications were recognized by the physicians and the medication orders were canceled. Conclusions The CDS engine could easily extend functions for detection of adverse drug reactions when more and more electronic health record systems are adopted. Moreover, the CDS engine can retrieve more updated and completed medication histories in the PharmaCloud, so it can have better performance for detection of duplicate medications. Although our CDS engine approach could enhance medication safety, it would make for a longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDS engine. The successful key component of a CDS engine is the completeness of the patient’s medication history, thus further research to assess the factors in increasing the PharmaCloud consent rate is required.
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Affiliation(s)
- Cheng-Yi Yang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Medical Informatics, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Yu-Sheng Lo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Ray-Jade Chen
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Taipei Medical University Hospital, Taipei, Taiwan
| | - Chien-Tsai Liu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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12
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P Tafti A, Badger J, LaRose E, Shirzadi E, Mahnke A, Mayer J, Ye Z, Page D, Peissig P. Adverse Drug Event Discovery Using Biomedical Literature: A Big Data Neural Network Adventure. JMIR Med Inform 2017; 5:e51. [PMID: 29222076 PMCID: PMC5741828 DOI: 10.2196/medinform.9170] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The study of adverse drug events (ADEs) is a tenured topic in medical literature. In recent years, increasing numbers of scientific articles and health-related social media posts have been generated and shared daily, albeit with very limited use for ADE study and with little known about the content with respect to ADEs. OBJECTIVE The aim of this study was to develop a big data analytics strategy that mines the content of scientific articles and health-related Web-based social media to detect and identify ADEs. METHODS We analyzed the following two data sources: (1) biomedical articles and (2) health-related social media blog posts. We developed an intelligent and scalable text mining solution on big data infrastructures composed of Apache Spark, natural language processing, and machine learning. This was combined with an Elasticsearch No-SQL distributed database to explore and visualize ADEs. RESULTS The accuracy, precision, recall, and area under receiver operating characteristic of the system were 92.7%, 93.6%, 93.0%, and 0.905, respectively, and showed better results in comparison with traditional approaches in the literature. This work not only detected and classified ADE sentences from big data biomedical literature but also scientifically visualized ADE interactions. CONCLUSIONS To the best of our knowledge, this work is the first to investigate a big data machine learning strategy for ADE discovery on massive datasets downloaded from PubMed Central and social media. This contribution illustrates possible capacities in big data biomedical text analysis using advanced computational methods with real-time update from new data published on a daily basis.
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Affiliation(s)
- Ahmad P Tafti
- Biomedical Informatics Research Center, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Jonathan Badger
- Biomedical Informatics Research Center, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Eric LaRose
- Biomedical Informatics Research Center, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Ehsan Shirzadi
- Institute of Electrical and Electronics Engineers, Dublin, Ireland
| | - Andrea Mahnke
- Biomedical Informatics Research Center, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - John Mayer
- Biomedical Informatics Research Center, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Zhan Ye
- Biomedical Informatics Research Center, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - David Page
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, United States
| | - Peggy Peissig
- Biomedical Informatics Research Center, Marshfield Clinic Research Institute, Marshfield, WI, United States
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13
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Rhalimi F, Rhalimi M, Rauss A. Pharmacist's Comprehensive Geriatric Assessment: Introduction and Evaluation at Elderly Patient Admission. Drugs Real World Outcomes 2017; 4:43-51. [PMID: 27933555 PMCID: PMC5332309 DOI: 10.1007/s40801-016-0098-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The role of the clinical pharmacist within the healthcare system remains unclear. OBJECTIVE Our objective was to describe a pharmacist's comprehensive geriatric assessment (pCGA) at admission of elderly patients and to assess its relevance in terms of medication compliance and pharmacist interventions (PIs). METHODS We conducted a prospective interventional study over 29 months in a 34-bed medical/rehabilitation geriatric ward in a French geriatric hospital. At admission, patients received pharmaceutical care through a consistent three-step process: (1) pharmacists met with the patient to undertake cognitive screening and assess their medication adherence (using the Girerd score) and medication history; (2) medication reconciliation was conducted at admission to detect intentional and unintentional discrepancies in treatment; and (3) clinical medication review was carried out throughout the patient's stay. The pharmacist conveyed proposed interventions to optimise treatment to the physician through the electronic health record. The number and type of PIs and their rate of implementation were recorded. RESULTS In total, 539 patients aged >65 years were included; their mean age was 84 years. Cognitive screening showed that 45% of patients were confused at admission. Medication adherence assessment indicated that 50.2% had adherence problems. Medication reconciliation at admission detected discrepancies in 48%, with a mean of 1.09 unintended discrepancies per patient. Patients were taking an average of 7 ± 3 drugs. In total, 828 PIs were reported to physicians; 520 were accepted and implemented (62.8% acceptance rate). CONCLUSION This approach helps to avoid medication errors and enables the suggestion of relevant PIs, which were implemented by physicians in two-thirds of cases.
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Affiliation(s)
- Faiza Rhalimi
- Centre Hospitalier Bertinot Juël, 34 bis Rue Pierre Budin, 60240 Chaumont en Vexin, France
| | - Mounir Rhalimi
- Centre Hospitalier Bertinot Juël, 34 bis Rue Pierre Budin, 60240 Chaumont en Vexin, France
- INSERM U1088, University of Picardie Jules Verne, Amiens, France
| | - Alain Rauss
- ARCOSA Limeil-Brévannes, Val-de-Marne, Paris, France
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14
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Impact of Simulation-Enhanced Pharmacology Education in Prelicensure Nursing Education. Nurse Educ 2017; 42:S32-S37. [DOI: 10.1097/nne.0000000000000409] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Narayan SW, Nishtala PS. Decade-long temporal trends in the utilization of preventive medicines by centenarians. J Clin Pharm Ther 2016; 42:165-169. [DOI: 10.1111/jcpt.12487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/13/2016] [Indexed: 11/27/2022]
Affiliation(s)
- S. W. Narayan
- School of Pharmacy; University of Otago; Dunedin New Zealand
| | - P. S. Nishtala
- School of Pharmacy; University of Otago; Dunedin New Zealand
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16
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Elliott RA, Woodward MC. Thirty years of Geriatric Therapeutics. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2016. [DOI: 10.1002/jppr.1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rohan A. Elliott
- Austin Health; Heidelberg Australia
- Centre for Medicine Use and Safety; Monash University; Parkville Australia
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