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Petranker R, Anderson T, Fewster EC, Aberman Y, Hazan M, Gaffrey M, Seli P. Keeping the promise: a critique of the current state of microdosing research. Front Psychiatry 2024; 15:1217102. [PMID: 38374976 PMCID: PMC10875010 DOI: 10.3389/fpsyt.2024.1217102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/05/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction The practice of taking small, sub-hallucinogenic doses of psychedelics, known as microdosing, has exploded in popularity over the last decade. Users claim benefits ranging from improved mood and enhanced creativity to an increased sense of meaning and connectedness in life. While research on microdosing is still lagging behind the shift in public opinion, several papers have been published in the last five years which attempted to assess the effects of microdosing. Methods This review paper aimed to critically analyze the research practices used in the recent wave of microdosing research: We reviewed 15 papers published before the closing date of this review in March 2022. Results Our review concludes that it is premature to draw any conclusions about the efficacy or safety of microdosing since the research quality cannot be considered confirmatory. Discussion We propose some potential causes for the current state of the literature and some suggestions for how these causes may be ameliorated.
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Affiliation(s)
- Rotem Petranker
- Department of Psychology, Neuroscience and Behaviour, Hamilton, ON, Canada
| | - Thomas Anderson
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | | | | | - Marik Hazan
- Independent Researcher, New York, NY, United States
| | - Michael Gaffrey
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Paul Seli
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
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Gatta L, Nyssen OP, Fiorini G, Saracino IM, Pavoni M, Romano M, Gravina AG, Granata L, Pellicano R, Gasbarrini A, Di Leo A, Losurdo G, Franceschi F, Nardone G, Rocco A, Dore MP, Farinati F, Ghisa M, Bellini M, Holton J, Puig I, Vaira D, Borghi C, Mégraud F, O'Morain C, Gisbert JP. Effectiveness of first and second-line empirical treatment in Italy: Results of the European registry on Helicobacter pylori management. United European Gastroenterol J 2022; 11:103-113. [PMID: 36565017 PMCID: PMC9892436 DOI: 10.1002/ueg2.12348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/13/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIMS The optimal management of naïve and not naïve Helicobacter pylori patients remains unclear. Therefore, it is essential to evaluate whether the actual clinical practice mirrors the indications suggested by the guidelines. This study aimed to assess the effectiveness and the safety of the empirical first- and second-line treatments prescribed to patients enroled at Italian centres participating in the European Registry on H. pylori Management (Hp-EuReg). METHODS The Hp-EuReg is an international multicentre prospective non-interventional registry starting in 2013 aiming to evaluate the management of H. pylori infection by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap. Variables assessed included demographics, previous eradication attempts, treatment regimen, effectiveness, and tolerance. RESULTS Overall, 3723 patients from 2013 to February 2021 were included: 2996 and 727 received an empirical first- and second-line treatment, respectively. According to the modified ITT analysis, among the first-line regimens, only the bismuth quadruple therapy with three-in-one-single capsule (BQT-TSC), the concomitant, and the sequential treatment - all lasting 10 days - achieved an eradication rate >90%. Among the second-line regimens, only the 10-day BQT-TSC reported an effectiveness >90%. High-dose PPI twice daily also significantly increased the effectiveness of some therapies. The BQT-TSC was the regimen with the highest incidence of adverse events. CONCLUSIONS Only quadruple therapies lasting at least 10 days achieved over 90% eradication rates among the empirical first- and second-line regimens. It remains unclear whether high-dose PPI twice daily can improve the efficacy of quadruple treatment.
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Affiliation(s)
- Luigi Gatta
- Gastroenterology UnitVersilia HospitalLido di CamaioreItaly
| | - Olga P. Nyssen
- Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria Princesa (IIS‐Princesa)Universidad Autónoma de Madrid (UAM)and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)MadridSpain
| | - Giulia Fiorini
- Department of Medical and Surgical SciencesIRCCS S. OrsolaUniversity of BolognaBolognaItaly
| | - Ilaria Maria Saracino
- Department of Medical and Surgical SciencesIRCCS S. OrsolaUniversity of BolognaBolognaItaly
| | - Matteo Pavoni
- Department of Medical and Surgical SciencesIRCCS S. OrsolaUniversity of BolognaBolognaItaly
| | - Marco Romano
- Università degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | | | - Lucia Granata
- Università degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | | | - Antonio Gasbarrini
- Medicina Interna, Fondazione Policlinico Universitario A. Gemelli IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
| | - Alfredo Di Leo
- Section of GastroenterologyDepartment of Emergency and Organ TransplantationUniversity “Aldo Moro” of BariBariItaly
| | - Giuseppe Losurdo
- Section of GastroenterologyDepartment of Emergency and Organ TransplantationUniversity “Aldo Moro” of BariBariItaly
| | - Francesco Franceschi
- Emergency MedicineFondazione Policlinico Universitario “A. Gemelli” IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
| | - Gerardo Nardone
- Gastroenterology UnitDepartment of Clinical Medicine and SurgeryUniversity Federico II of NaplesNaplesItaly
| | - Alba Rocco
- Gastroenterology UnitDepartment of Clinical Medicine and SurgeryUniversity Federico II of NaplesNaplesItaly
| | - Maria Pina Dore
- Department of Medical, Surgical and Experimental ScienceUniversity of SassariSassariItaly
| | - Fabio Farinati
- Gastroenterology UnitDepartment of Surgery, Oncology and GastroenterologyUniversity Hospital of PaduaPaduaItaly
| | - Matteo Ghisa
- Gastroenterology UnitDepartment of Surgery, Oncology and GastroenterologyUniversity Hospital of PaduaPaduaItaly
| | - Massimo Bellini
- Gastrointestinal UnitDepartment of Translational Sciences and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - John Holton
- Department Natural Sciences (Microbiology) University of MiddlesexLondon UK & Dartford & Gravesham NHS TrustDarent Valley HospitalDartfordKentUK
| | - Ignasi Puig
- Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic‐Universitat Central de Catalunya (UVicUCC)ManresaSpain
| | - Dino Vaira
- Department of Medical and Surgical SciencesIRCCS S. OrsolaUniversity of BolognaBolognaItaly
| | - Claudio Borghi
- Department of Medical and Surgical SciencesIRCCS S. OrsolaUniversity of BolognaBolognaItaly
| | | | | | - Javier P. Gisbert
- Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria Princesa (IIS‐Princesa)Universidad Autónoma de Madrid (UAM)and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)MadridSpain
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Safety and effectiveness of 4-week therapy with aceclofenac controlled release once a day. Sci Rep 2022; 12:16519. [PMID: 36192565 PMCID: PMC9530112 DOI: 10.1038/s41598-022-20633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Aceclofenac controlled-release (CR) is a once-a-day tablet with 200 mg of aceclofenac, and is bioequivalent to conventional aceclofenac. However, its safety in humans has not been well studied in Korea. Therefore, we aimed to evaluate the overall incidence and patterns of adverse events (AEs), the effectiveness of aceclofenac CR, and the differences in incidence rates of the AEs based on each patient’s baseline charateristics. This study was conducted on patients receiving aceclofenac CR in clinical practice at each investigational institution to treat musculoskeletal pain and inflammation. The subjects were administered one tablet of aceclofenac CR (200 mg once-a-day) and were observed for 4 weeks post-administration. Factors affecting the occurrence of AEs were evaluated, and the Visual Analogue Scale (VAS) was used to measure the pain intensity. Among 14,543 subjects, the incidence rate of AEs was 0.86%, and that of adverse drug reactions was 0.74%. No serious AEs and unexpected adverse drug reactions were monitored. The incidence rates of AEs were significantly higher in females, inpatient treatment, individuals with concurrent disorders, and those receiving concomitant medications, respectively (all P < 0.05). Four weeks post-using aceclofenac CR, the mean changes in VAS was significantly decreased compared to prior administration. The overall clinical efficacy rate was 91.63%. This study confirmed that no severe adverse reactions were observed for aceclofenac CR exceeding those previously reported for safety results of conventional formulation of this drug in routine clinical practice settings. The use of aceclofenac CR might not violate the previously reported information on the safety and effectiveness of aceclofenac.
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Otchi EH, Esena RK, Srofenyoh EK, Marfo K, Agbeno EK, Asah-Opoku K, Ken-Amoah S, Ameh EO, Beyuo T, Oduro F. Types and prevalence of adverse events among obstetric clients hospitalized in a secondary healthcare facility in Ghana. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519881524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The main objective of this study was to determine the types and prevalence of adverse events among obstetric clients hospitalized in a secondary health facility in Ghana. Design A retrospective study that reviewed medical records of obstetric clients on admission at the Obstetrics Unit of a secondary healthcare facility in Ghana. Setting Clinical environment. The study site is the third largest health facility in Ghana that provides maternity services and serves as the major referral facility for Greater Accra Region, the capital of Ghana. About 41% (4676) of its total antenatal cases (11,406) in 2015 were referrals from other facilities in Ghana. The medical records were reviewed retrospectively from 1 January to 31 December 2015. A four-stage review process was used: the first and second stages (by nurse/midwife reviewers) involved the identification and exclusion of records that had a length of stay less than 24 h and inadequate documentation; and were unlikely to include an adverse event. The third stage by obstetrician gynaecologist reviewers included a full review of all the positive trigger folders to determine the types, causes and degree of preventability of the adverse events. The fourth stage involved an independent obstetrician gynaecologist review of all records that had discrepancies. Details of the review process are presented in the figure. Participants Obstetric clients (i.e. pregnant women at any stage of gestation or less than 5 days after delivery who were attended to at the hospital). About a third (1402, 49.3%) met the inclusion criteria and were reviewed. Main outcome measures The main outcome measure for this study was the prevalence of adverse events among hospitalized obstetric clients. Results The prevalence of adverse events was 12% (168) out of 1402 records reviewed. The mean maternal age of the clients was 30.0 ± 5.8 years. Among these, the greatest proportion of adverse events was related to surgical interventions (66.3%) and the smallest were related to patient care (0.7%). Conclusions This study has provided the first documented prevalence (12.0%) and types of adverse events among hospitalized obstetric clients in a secondary health facility in Ghana. It provides a preliminary baseline for the burden of adverse events among the obstetric population in Ghana.
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Affiliation(s)
- Elom-Hilary Otchi
- Africa Institute of Healthcare Quality Safety & Accreditation (AfIHQSA), Accra, Ghana
- Department of Health Policy, Planning & Management, University of Ghana School of Public Health, Accra, Ghana
| | - Reuben K Esena
- Department of Health Policy, Planning & Management, University of Ghana School of Public Health, Accra, Ghana
| | | | | | - Evans Kofi Agbeno
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Kwaku Asah-Opoku
- Department of Obstetrics and Gynaecology, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Sebastian Ken-Amoah
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | - Titus Beyuo
- Department of Obstetrics and Gynaecology, University of Ghana School of Medicine and Dentistry, Accra, Ghana
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Convertino I, Salvadori S, Pecori A, Galiulo MT, Ferraro S, Parrilli M, Corona T, Turchetti G, Blandizzi C, Tuccori M. Potential Direct Costs of Adverse Drug Events and Possible Cost Savings Achievable by their Prevention in Tuscany, Italy: A Model-Based Analysis. Drug Saf 2018; 42:427-444. [PMID: 30276630 DOI: 10.1007/s40264-018-0737-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Adverse drug events (ADEs) may represent an important item of expenditure for healthcare systems and their prevention could be associated with a relevant cost saving. OBJECTIVE The objective of this study was to simulate the annual economic burden for ADEs in Tuscany (Italy) and the potential cost savings related to avoidable ADEs. METHODS A systematic review was performed, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statements, on observational studies published from 2006 to 2016 in MEDLINE and EMBASE, focusing on direct costs of ADEs in the inpatient setting from high-income countries. The mean probability of preventable ADEs was estimated over the included studies. The mean ADE cost was calculated by means of Monte Carlo simulation. We then extrapolated the spontaneous reports of ADEs in Tuscany, Italy in 2016 from the Italian National Pharmacovigilance Network (Rete Nazionale di Farmacovigilanza), and we assumed the same costs and preventability probability for these as obtained in the systematic review. Finally, we simulated the possible costs of ADEs and preventable ADEs in Tuscany. Three sensitivity analyses were also performed to test the robustness of the results. RESULTS Of 11,936 articles initially selected, 12 observational studies were included. The estimated mean [± standard deviation (SD)] ADE cost was €2471.46 (± €1214.13). The mean (± SD) probability of preventable ADEs was 45% (± 21). The Tuscan expenditure for ADEs was €3,406,280.63 per million inhabitants (95% confidence interval (CI) 1,732,910.44-5,079,664.61) and the potential cost saving was €1,532,760.25 per million inhabitants (95% CI 779,776.1-2,285,750.60). Sensitivity analyses confirmed the robustness of the results. CONCLUSIONS The present simulation showed that ADEs could have a relevant economic impact on the Tuscan healthcare system. In this setting, the prevention of ADEs would result in important cost savings. These results could be likely extended to other healthcare systems.
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Affiliation(s)
- Irma Convertino
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alessandro Pecori
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Maria Teresa Galiulo
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Ferraro
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Parrilli
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Tiberio Corona
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Giuseppe Turchetti
- Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Corrado Blandizzi
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Tuscan Regional Centre of Pharmacovigilance, Florence, Italy.,Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, via Roma 55, Pisa, 56126, Italy
| | - Marco Tuccori
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. .,Tuscan Regional Centre of Pharmacovigilance, Florence, Italy. .,Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, via Roma 55, Pisa, 56126, Italy.
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Mortality among patients due to adverse drug reactions that lead to hospitalization: a meta-analysis. Eur J Clin Pharmacol 2018; 74:819-832. [PMID: 29556685 DOI: 10.1007/s00228-018-2441-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study was to estimate the prevalence of mortality among patients due to adverse drug reactions that lead to hospitalisation (fatal ADRAd), to explore the heterogeneity in its estimation through subgroup analysis of study characteristics, and to identify system-organ classes involved and causative drugs for fatal ADRAd. METHODS We identified prospective ADRAd-related studies via screening of the PubMed and Google Scholar databases with appropriate key terms. We estimated the prevalence of fatal ADRAd using a double arcsine method and explored heterogeneity using the following study characteristics: age groups, wards, study region, ADR definitions, ADR identification methods, study duration and sample size. We examined patterns of fatal ADRAd and causative drugs. RESULTS Among 312 full-text articles assessed, 49 studies satisfied the selection criteria and were included in the analysis. The mean prevalence of fatal ADRAd was 0.20% (95% CI: 0.13-0.27%; I2 = 93%). The age groups and study wards were the important heterogeneity modifiers. The mean fatal ADRAd prevalence varied from 0.01% in paediatric patients to 0.44% in the elderly. Subgroup analysis showed a higher prevalence of fatal ADRAd in intensive care units, emergency departments, multispecialty wards and whole hospitals. Computer-based monitoring systems in combination with other methods detected higher mortality. Intracranial haemorrhage, renal failure and gastrointestinal bleeding accounted for more than 50% of fatal ADRAdcases. Warfarin, aspirin, renin-angiotensin system (RAS) inhibitors and digoxin accounted for 60% of fatal ADRAd. CONCLUSIONS ADRAd is an important cause of mortality. Strategies targeting the safer use of warfarin, aspirin, RAS inhibitors and digoxin could reduce the large number of fatal ADRAdcases.
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Mevik K, Griffin FA, Hansen TE, Deilkås ET, Vonen B. Does increasing the size of bi-weekly samples of records influence results when using the Global Trigger Tool? An observational study of retrospective record reviews of two different sample sizes. BMJ Open 2016; 6:e010700. [PMID: 27113238 PMCID: PMC4853999 DOI: 10.1136/bmjopen-2015-010700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the impact of increasing sample of records reviewed bi-weekly with the Global Trigger Tool method to identify adverse events in hospitalised patients. DESIGN Retrospective observational study. SETTING A Norwegian 524-bed general hospital trust. PARTICIPANTS 1920 medical records selected from 1 January to 31 December 2010. PRIMARY OUTCOMES Rate, type and severity of adverse events identified in two different samples sizes of records selected as 10 and 70 records, bi-weekly. RESULTS In the large sample, 1.45 (95% CI 1.07 to 1.97) times more adverse events per 1000 patient days (39.3 adverse events/1000 patient days) were identified than in the small sample (27.2 adverse events/1000 patient days). Hospital-acquired infections were the most common category of adverse events in both the samples, and the distributions of the other categories of adverse events did not differ significantly between the samples. The distribution of severity level of adverse events did not differ between the samples. CONCLUSIONS The findings suggest that while the distribution of categories and severity are not dependent on the sample size, the rate of adverse events is. Further studies are needed to conclude if the optimal sample size may need to be adjusted based on the hospital size in order to detect a more accurate rate of adverse events.
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Affiliation(s)
- Kjersti Mevik
- Regional Patient Safety Resource Center, Nordland Hospital Trust, Bodø, Norway
| | | | | | - Ellen T Deilkås
- Center for Health Service Research, Akershus University Hospital, Lørenskog, Norway
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van Minderhout HM, Joosse MV, Grootendorst DC, Schalij-Delfos NE. Adverse reactions following routine anticholinergic eye drops in a paediatric population: an observational cohort study. BMJ Open 2015; 5:e008798. [PMID: 26700273 PMCID: PMC4691733 DOI: 10.1136/bmjopen-2015-008798] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate the presence, nature and relationship to age, sex, ethnicity and body mass index (BMI) of adverse reactions following routine cycloplegic eye drops in children. DESIGN Prospective observational cohort study. SETTING Ophthalmology outpatient clinic Dutch metropolitan hospital; February, March and April 2009. PARTICIPANTS Children aged 3-14-year-old children receiving two drops of cyclopentolate 1% (C+C) or one drop of cyclopentolate 1% and one drop of tropicamide 1% (C+T). Patients were categorised by age (3-6, 7-10 and 11-14 years), sex, ethnicity and body mass index (BMI) (low, normal or high). OUTCOME MEASURES Rate and nature of adverse reactions reported at 45 min following treatment. Crude and adjusted ORs for reporting an adverse reaction using stepwise regression analysis with BMI, age, ethnicity and sex. RESULTS 912 of 915 eligible patients participated (99.7%). Adverse reactions were reported for C+C in 10.3% and in C+T in 4.8% (42/408 and 24/504, p=0.002), respectively. Central effects were present in 95% in C+C and in 92% in C+T. Compared to C+T, an increased risk was present in C+C (crude OR 2.3 (1.4 to 3.9), p=0.002). Forward adjustment showed BMI to be an influencing factor in treatment (OR 3.1 (1.7 to 5.6), p<0.001). In a multivariate model, a dose of cyclopentolate remained associated with adverse reactions. Analysis per BMI and regime and age category and regime, indicated associations with low BMI (OR C+C 21.4 (6.7 to 67.96), p<0.001, respectively, C+T 5.2 (2.1 to 12.8), p<0.001) and young age (OR C+C 8.1 (2.7 to 24.8), p<0.001). CONCLUSIONS Adverse reactions were common and almost exclusively involved the central nervous system. Both presence and severity were associated with repeated instillation of cyclopentolate 1%, low BMI and young age. In specific paediatric populations, a single dose of cyclopentolate must be considered. Vital function monitoring facilities are advisable. Adjustment of guidelines is recommended.
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Affiliation(s)
| | - Maurits V Joosse
- Department of Ophthalmology, Medical Centre Haaglanden, The Hague, The Netherlands
| | - Diana C Grootendorst
- Department of Research and Development, Landsteiner Institute, Medical Centre Haaglanden, The Hague, The Netherlands
| | - Nicoline E Schalij-Delfos
- Department of Ophthalmology, Pediatric Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
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[Patient safety: a topic of the future, the future of the topic]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:4-9. [PMID: 25487852 DOI: 10.1007/s00103-014-2082-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Almost 10 years ago, the German Coalition for Patient Safety (Aktionsbündnis Patientensicherheit) was founded as a cooperation covering most institutions of the German health care system. As in other countries facing the issue of patient safety, methods for the analysis of "never events" have been developed, instruments for the identification of the "unknown unknowns" have been established (e.g., CIRS), and the paradigm of individual blame has been replaced by organizational, team and management factors. After these first steps, further developments can only be achieved in so far as patient safety is understood as a system property, which leads to specific implications for the further evolution of the healthccare system. The "patient safety movement" has to participate in this discussion in order to avoid misuse of the patient safety concept as a defensive means, merely confined to overcome the adverse events of payment and structural incentives (e.g., diagnosis related groups in the inpatient sector). Because the dominant requirements for the future healthcare system consist of care for an elderly population with chronic and multiple diseases, the focus has to be shifted away from acute and surgical procedures and diseases, as given in the present quality assurance programs in Germany, to prevention and coordination of chronic care. Efforts to improve drug and medication safety of elderly people can be regarded as perfect examples, but other efforts are still missing. Second, the structural problems as the sector-associated optimization of care should be addressed, because typical safety issues are not limited to single sectors but represent problems of missing integration and suboptimal population care (e.g., MRSA). In the third line, the perspectives of society and institutions on safety (and quality of care) must urgently be enlarged to the perspectives of patients on the one hand and the benefit of treatments (e.g., overuse) on the other hand. All these issues are only to be implemented as far as the general societal attitude supportings further improvement of patient safety and is ready to regard it as a major aim for future developments. Cost arguments alone - costs of suboptimal safety can be estimated to around <euro> 1 billion in Germany per year - are considered as insufficient to guarantee further improvements because other issues in the healthcare system show similar magnitudes. As a consequence, ethical implications remain as major arguments for ongoing professional and public discussions.
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Rinner C, Sauter SK, Neuhofer LM, Edlinger D, Grossmann W, Wolzt M, Endel G, Gall W. Estimation of severe drug-drug interaction warnings by medical specialist groups for Austrian nationwide eMedication. Appl Clin Inform 2014; 5:603-11. [PMID: 25298801 DOI: 10.4338/aci-2014-04-ra-0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 05/21/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study is to estimate the amount of severe drug-drug interaction warnings per medical specialist group triggered by prescribed drugs of a patient before and after the introduction of a nationwide eMedication system in Austria planned for 2015. METHODS The estimations of interaction warnings are based on patients' prescriptions of a single health care professional per patient, as well as all patients' prescriptions from all visited health care professionals. We used a research database of the Main Association of Austrian Social Security Organizations that contains health claims data of the years 2006 and 2007. RESULTS The study cohort consists of about 1 million patients, with 26.4 million prescribed drugs from about 3,400 different health care professionals. The estimation of interaction warnings show a heterogeneous pattern of severe drug-drug-interaction warnings across medical specialist groups. CONCLUSION During an eMedication implementation it must be taken into consideration that different medical specialist groups require customized support.
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Affiliation(s)
- C Rinner
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna , Vienna, Austria
| | - S K Sauter
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna , Vienna, Austria
| | - L M Neuhofer
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna , Vienna, Austria
| | - D Edlinger
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna , Vienna, Austria
| | - W Grossmann
- Research Group Scientific Computing, University of Vienna , Vienna, Austria
| | - M Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
| | - G Endel
- Main Association of Austrian Social Security Organizations , Vienna, Austria
| | - W Gall
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna , Vienna, Austria
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Abstract
BACKGROUND Sunitinib, a multi-targeted receptor tyrosine kinase inhibitor, has demonstrated survival benefit in patients with metastatic renal cell carcinoma (mRCC); however, significant adverse events (AEs) have been associated with its use. The significant variation in the reported incidences of AEs has prompted this meta-analysis to quantify the risk and explore associated predictors. METHODS According to predefined selection criteria, a literature search identified 12 studies that were included in the analyses. RESULTS The meta-analysis included 5,658 patients; 66 % patients had prior systemic therapy whereas the remaining patients (34 %) received sunitinib in the first-line setting. For any grade toxicity, skin rash, fatigue, diarrhea, and mucositis were the most frequently encountered events (81, 52, 45, and 33 %, respectively). Anemia, neutropenia, or thrombocytopenia of any grade occurred in more than one-third of patients, although grades 3 or 4 were less common. Any grade raised by liver enzymes or serum creatinine occurred in 40 and 44 % of patients, respectively. Meta-regression analyses showed that study size was inversely related to the risk of experiencing fatigue, diarrhea, mucositis, anemia, and thrombocytopenia. In particular, the incidence of AEs was higher when sunitinib was used in pretreated versus naive patients; however, there was no significant difference between the two groups concerning the incidence of laboratory abnormalities. We addressed the limitations of reporting AEs in clinical studies. CONCLUSIONS The present meta-analysis quantified sunitinib-associated AEs. The derived estimates would be similar to that to be expected from the use of sunitinib in community practice in unselected patients with metastatic renal cell carcinoma (mRCC).
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de Feijter JM, de Grave WS, Muijtjens AM, Scherpbier AJJA, Koopmans RP. A comprehensive overview of medical error in hospitals using incident-reporting systems, patient complaints and chart review of inpatient deaths. PLoS One 2012; 7:e31125. [PMID: 22359567 PMCID: PMC3281055 DOI: 10.1371/journal.pone.0031125] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 01/02/2012] [Indexed: 11/29/2022] Open
Abstract
Background Incident reporting systems (IRS) are used to identify medical errors in order to learn from mistakes and improve patient safety in hospitals. However, IRS contain only a small fraction of occurring incidents. A more comprehensive overview of medical error in hospitals may be obtained by combining information from multiple sources. The WHO has developed the International Classification for Patient Safety (ICPS) in order to enable comparison of incident reports from different sources and institutions. Methods The aim of this paper was to provide a more comprehensive overview of medical error in hospitals using a combination of different information sources. Incident reports collected from IRS, patient complaints and retrospective chart review in an academic acute care hospital were classified using the ICPS. The main outcome measures were distribution of incidents over the thirteen categories of the ICPS classifier “Incident type”, described as odds ratios (OR) and proportional similarity indices (PSI). Results A total of 1012 incidents resulted in 1282 classified items. Large differences between data from IRS and patient complaints (PSI = 0.32) and from IRS and retrospective chart review (PSI = 0.31) were mainly attributable to behaviour (OR = 6.08), clinical administration (OR = 5.14), clinical process (OR = 6.73) and resources (OR = 2.06). Conclusions IRS do not capture all incidents in hospitals and should be combined with complementary information about diagnostic error and delayed treatment from patient complaints and retrospective chart review. Since incidents that are not recorded in IRS do not lead to remedial and preventive action in response to IRS reports, healthcare centres that have access to different incident detection methods should harness information from all sources to improve patient safety.
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Affiliation(s)
- Jeantine M de Feijter
- Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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