scholarly journals P16 CEASE: deprescribing on discharge from PICU

2020 ◽  
Vol 105 (9) ◽  
pp. e14.1-e14
Author(s):  
Charlotte Hayes ◽  
Teresa Brooks
Keyword(s):  
High Risk ◽  
Screening Tool ◽  
Improve Patient Safety ◽  
Inappropriate Medication ◽  
High Strength ◽  
Future Research ◽  
List Type ◽  
Definition Of ◽  
The Impact ◽  
Improve Patient

AimTo develop a screening tool for prescribers to aid desprescribing on discharge from paediatric intensive care (PICU). Deprescribing is defined as ‘the process of withdrawal of an inappropriate medication supervised by a healthcare professional with the goal of managing polypharmacy and improving outcomes’.1 On the subject of deprescribing in paediatrics there is currently a lack of published literature however it is thought that we will be able to rationalise medicine use by being able to identify and document their indications.2MethodAn audit was completed of twenty-five paediatric patients following discharge from PICU. Data was collected on which medicines were not appropriately stopped by PICU prescribers when patients were stepped down to the ward. These medicines were categorised by their indication and this information was used to create a deprescribing screening tool. Prescribers on PICU were educated on this new tool and a further audit is currently underway to assess the impact of this.ResultsTwenty-five children were discharged from PICU to wards within the hospital over a four week period. Of these all twenty-five had two medicines or more that should have been deprescribed or a plan documented for before stepping down. A total of 110 medicines could have been deprescribed (median 4 per patient, range 2–8). These medicines were categorised by their indication: sedation 38.2% (n=42), electrolytes 33.6% (n=37), additional charts 18.2% (n=20), gastro-protection 4.5% (n=5), antibiotics 2.7% (n=3), other 2.7% (n=3).We found that these medicines included high risk critical care only medicines that were unsafe to be administered on a ward such as high strength potassium infusions or inotropes, oral and IV sedative agents and antibiotics with no documented plan. Based on this information the following ‘CEASE’ screening tool was created:Charts - are additional charts still in use and appropriate?Electrolytes - have all PICU only electrolytes been stopped?Antibiotics - do all antibiotics have a documented plan?Sedation - has all sedation been stopped or if not is there a documented plan of when and how to stop?Enteral - if enteral feeds have started has all gastro-protection been stopped?A further audit is currently underway to assess the impact of the ‘CEASE’ tool.ConclusionThe audit has shown that a range of different medicines were inappropriately continued outside of PICU, this includes high risk medicines not suitable for use on the ward. The development of the ‘CEASE’ tool has been created to aid prescribers in the identification of medicines which should be deprescribed. This should help to provide better treatment, improve patient safety and promote antimicrobial stewardship.ReferencesReeve E, Gnjidic D, et al. A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol 2015;80:1254–68.Begum R, Tomlin S. Deprescribing in paediatrics. Eur J Hosp Pharm 2017;24:70.

scholarly journals Sustainability of Food Placement in Retailing during the COVID-19 Pandemic

2021 ◽  
Vol 13 (11) ◽  
pp. 5956
Author(s):  
Jelena Končar ◽  
Radenko Marić ◽  
Goran Vukmirović ◽  
Sonja Vučenović
Keyword(s):  
Supply Chain ◽  
Academic Research ◽  
Food Prices ◽  
Future Research ◽  
Retail Sector ◽  
Western Balkans ◽  
Skilled Workers ◽  
Empirical Survey ◽  
Definition Of ◽  
The Impact

This work aims to define the impact of different indicators on the sustainability of food placement in the retail sector, during periods of crisis and emergencies, such as the COVID-19 pandemic. An empirical survey conducted in the Western Balkans (WB) region showed that indicators such as developed infrastructure, consistency, and transparency of the supply chain, skilled workers, costs, food safety, food prices, energy consumption, and changes in consumer needs are statistically significant since they affect the sustainability of food placement in the retail sector. As food placement and the retail sector itself are inseparable from other participants in the food supply chain (FSC), an analysis was conducted at the level of all FSC sectors. The results showed some deviations viewed individually in the sectors of production, physical distribution, wholesale, and retail, and in selected Western Balkan countries. Based on the results obtained, the sustainability model of food placement in the retail sector has been defined. The model will serve as the basis for defining the set of measures and incentives that competent institutions and FSC management need to undertake, to minimize the impact of indicators that endanger sustainability. The originality of the study lies in the fact that it fills the research gap that exists in this subject matter in academic research and studies in the WB region. In addition, some indicators important for food placement have been precisely isolated, with the definition of the intensity of their impact, observed overall at the level of the entire FSC as well as by individual sectors. Guidelines and suggestions for future research are listed in the paper.

The Impact of the Privacy Rule on Cancer Research: Variations in Attitudes and Application of Regulatory Standards

2009 ◽  
Vol 27 (24) ◽  
pp. 4014-4020 ◽  
Author(s):  
Elizabeth Goss ◽  
Michael P. Link ◽  
Suanna S. Bruinooge ◽  
Theodore S. Lawrence ◽  
Joel E. Tepper ◽  
...  
Keyword(s):  
Cancer Research ◽  
Future Research ◽  
Research Committee ◽  
Data Repositories ◽  
Privacy Rule ◽  
Regulatory Standards ◽  
American Society ◽  
Definition Of ◽  
High Level ◽  
The Impact

Purpose The American Society of Clinical Oncology (ASCO) Cancer Research Committee designed a qualitative research project to assess the attitudes of cancer researchers and compliance officials regarding compliance with the US Privacy Rule and to identify potential strategies for eliminating perceived or real barriers to achieving compliance. Methods A team of three interviewers asked 27 individuals (13 investigators and 14 compliance officials) from 13 institutions to describe the anticipated approach of their institutions to Privacy Rule compliance in three hypothetical research studies. Results The interviews revealed that although researchers and compliance officials share the view that patients' cancer diagnoses should enjoy a high level of privacy protection, there are significant tensions between the two groups related to the proper standards for compliance necessary to protect patients. The disagreements are seen most clearly with regard to the appropriate definition of a “future research use” of protected health information in biospecimen and data repositories and the standards for a waiver of authorization for disclosure and use of such data. Conclusion ASCO believes that disagreements related to compliance and the resulting delays in certain projects and abandonment of others might be eased by additional institutional training programs and consultation on Privacy Rule issues during study design. ASCO also proposes the development of best practices documents to guide 1) creation of data repositories, 2) disclosure and use of data from such repositories, and 3) the design of survivorship and genetics studies.

scholarly journals Effects of long-term closed environment on human saliva microbiota and salivary cytokines

2020 ◽  
Author(s):  
Yinzhen Zhu ◽  
Zikai Hao ◽  
Yuming Fu ◽  
Jianlou Yang ◽  
Chen Dong ◽  
...  
Keyword(s):  
Human Saliva ◽  
Mucosal Barrier ◽  
Future Research ◽  
Controlled Environment ◽  
List Type ◽  
Tnf Α ◽  
Normal Environment ◽  
The Difference ◽  
Sharing Space ◽  
The Impact

AbstractCompared with the normal environment, the microbiota in controlled closed cabins such as space capsules, Lunar/Mars bases have changed. To ensure the health of crewmembers, it’s necessary to understand the effects of these changes on human symbiotic microorganisms and immunity. In this study, the experimental platform “Lunar Palace 1” with a similar closed and controlled environment was used to research the effects of changed microbial exposure on human saliva microbiota and salivary cytokines. This paper studied on four crewmembers who participated in the third phase of the “Lunar Palace 365” experiment, analyzing the dynamic changes of saliva microbiota and salivary cytokines, and further studying the correlation between salivary cytokines and highly abundant genera. According to our data, the crewmembers’ saliva microbiota and salivary cytokines fluctuated smoothly throughout the whole experiment. Although a part of microbes increased or decreased some times, they recovered quickly after leaving the controlled environment. The level of IL-6, IL-10 and TNF-α in crewmembers’ saliva decreased from normal environment to the controlled environment, showing reduced levels of oral inflammatory response in crewmembers. In addition, although there were significant individual differences in crewmembers’ saliva microbiota, sharing living space reduced the difference. Furthermore, the level of TNF-α showed a consistent positive correlation with the abundance of Actinomyces and Rothia in the controlled environment, indicating healthy individuals’ oral mucosal barrier may be sensitive to changes in saliva microbiota. According to the result, semi-sterile environments in controlled closed cabins didn’t cause persistent changes in human saliva microbiota and oral immunity. Besides, it provides a new idea for future research on the impact of the controlled environment on crewmembers health, and provides guidance for studying the effect of semi-sterile environments on human immunity based on saliva microbiota.Key pointsSaliva microbes kept stable for individual but got convergent when sharing space;The level of salivary cytokines reduced after entering the controlled environment;There were complex correlations between salivary cytokines and saliva microbes;The crewmembers adapt well to the controlled environment.

Advanced Joining Techniques in European Shipbuilding

2004 ◽  
Vol 20 (03) ◽  
pp. 200-210 ◽  
Author(s):  
Frank Roland ◽  
Luciano Manzon ◽  
Pentti Kujala ◽  
Markus Brede ◽  
Jan Weitzenbock
Keyword(s):  
Adhesive Bonding ◽  
High Strength ◽  
Industrial Applications ◽  
Future Research ◽  
Special Focus ◽  
Open Problems ◽  
Ongoing Research ◽  
Mechanical Joining ◽  
Laser Hybrid Welding ◽  
The Impact

Joining processes are an important key factor for the competitiveness of European shipbuilders. They not only represent a significant portion of the total man hour consumption in hull production and outfitting, but due to heat distortions they also have a significant impact on nonproductive work operations, such as straightening and fitting. Those operations can interfere with on-board outfitting and increase lead time and construction cost. In addition to their contribution to shipyard productivity, joining techniques have a significant impact on material properties and thus on product performance and quality. Those factors become increasingly important for complex structures using comparatively thin and high-strength materials. Considering the importance of efficient joining, European shipbuilders in the past decade have invested significant efforts to develop new joining techniques, such as laser welding, adhesive bonding, and mechanical joining. Based on research results, practical industrial applications have been developed recently. After reviewing the impact of joining processes on competitiveness, the article will summarize a number of past and ongoing research projects with special focus on design methods, process and equipment development, fatigue strength of joints, quality assurance, and approval. It will then present a number of recent applications of new joining techniques in European shipyards. Finally, open problems and future research needs will be briefly discussed. The article is based on a joint effort of leading European experts and will focus on laser and laser hybrid welding, adhesive bonding, and mechanical joining

Consumerism

2014 ◽  
pp. 1-17
Author(s):  
Ioanna Papasolomou
Keyword(s):  
Historical Development ◽  
Sustainable Consumption ◽  
Compulsive Buying ◽  
Future Research ◽  
Sustainable Marketing ◽  
Definition Of ◽  
Corporate Social ◽  
The Impact ◽  
The Relationship ◽  
Insight Into

This chapter reveals that the term ‘consumerism' encompasses a number of meanings which create confusion regarding the term. The discussion that follows, attempts to distinguish the different perspectives regarding the term by presenting its historical development and discussing the three definitions that have marked it. It explores the relationship between consumerism, marketing and corporate social responsibility (CSR). The growth of consumerism has led to the over-use of marketing which provided a flourishing ground for compulsive buying and consumption. There is evidence in the literature to suggest that in an era of increasing social problems and environmental challenges, there is a need for CSR and sustainable marketing. In fact, the second definition of consumerism is inextricably linked with CSR and societal marketing. The chapter is conceptual in nature and provides an in-depth review and discussion of some fundamental dimensions associated to consumerism based on the existent literature. The overarching aim is to provide an insight into the evolution and growth of consumerism based on the existent literature related to the topic. The discussion also focuses on exploring the relationship between marketing and consumerism shedding light onto compulsive buying, consumer attitudes and concerns on the micro consumerism issues, sustainable consumption and sustainable marketing. The chapter proceeds to raise some concerns related to the impact of the global economic crisis on consumerism by using as an example Cyprus based on the author's observations and thoughts. The chapter concludes with a list of suggestions to practitioners and directions for future research.

scholarly journals High-risk medications identified from the Danish Patient Safety Database and the challenge of dissemination

2018 ◽  
Vol 24 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Pia Knudsen ◽  
Lena Graversen ◽  
Torsten Larsen
Keyword(s):  
Patient Safety ◽  
High Risk ◽  
Improve Patient Safety ◽  
Healthcare Staff ◽  
Safety Database ◽  
Danish Patient ◽  
National Patient ◽  
Medication Incidents ◽  
Patient Safety Incidents ◽  
Improve Patient

Since 2004, patient safety incidents in Denmark have been reported to a national patient safety reporting system – the Danish Patient Safety Database. The goal of the system is to improve patient safety. In 2011, a decision was made to develop a national list of high-risk medications based on the medication incidents reported to the Danish Patient Safety Database. The high-risk medications are defined as medications that have been involved in medication errors and have caused harm to patients. The purpose is to identify medications that posed a particular and preventable risk for patients. It became clear through updates that there was a group of medications that caused severe harm to the patients more frequently than others. Based on the list, the Danish Patient Safety Authority in 2015 identified seven groups of medications that require special attention from healthcare staff: antidiabetic medications, anticoagulants, low-dose methotrexate, concentrated potassium, opioids, gentamicin and digoxin. Better handling of these seven types of medication could improve patient safety significantly. For many years, Danish Patient Safety Authority has distributed tables and booklets about these high-risk medications. In addition, ‘patient safety warnings’ are issued when it is considered necessary. In spite of this, many patient safety incidents involving these medications still occur. This points to the fact that disseminating knowledge from a government level all the way to frontline healthcare staff poses a challenge. On that background, Danish Patient Safety Authority is exploring new ways to disseminate knowledge to frontline healthcare staff about patient safety incidents.

A Systematic Review of Communication in Distributed Crews in High-Risk Environments

2018 ◽  
Vol 62 (1) ◽  
pp. 102-106
Author(s):  
Justine Rockwood ◽  
Dan Nathan-Roberts
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Team Performance ◽  
Task Complexity ◽  
Distributed Teams ◽  
Future Research ◽  
Team Members ◽  
Risk Environments ◽  
The Impact ◽  
High Risk Environments

Effective communication is critical to team performance but can be impacted by the distribution of team members. Distribution is increasingly found in high-risk environments where task complexity necessitates geographic and/or temporal separation of team members. Understanding the impact of distribution on communication is critical to ensuring effective team performance. We review the research examining communication in distributed teams in high-risk environments to provide an overview of the literature to date. Articles examining communication in distributed teams were analyzed in a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Themes relevant to the research question were extracted from the studies using thematic analysis. Five themes were identified: updating shared mental models, effects of transmission lags, content of communication, communication protocols, and technological advances. The five themes identify directions for future research.

Clinical “MUTATOME” Of Myelodysplastic Syndrome; Comparison To Primary Acute Myelogenous Leukemia

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 518-518 ◽  
Author(s):  
Hideki Makishima ◽  
Thomas LaFramboise ◽  
Bartlomiej P Przychodzen ◽  
Kenichi Yoshida ◽  
Matthew Ruffalo ◽  
...  
Keyword(s):  
High Risk ◽  
Lower Risk ◽  
Research Funding ◽  
Somatic Mutations ◽  
Low Risk ◽  
Myelogenous Leukemia ◽  
Clonal Architecture ◽  
Ras Family ◽  
Definition Of ◽  
The Impact

Abstract Chromosomal aberrations and somatic mutations constitute key elements of the pathogenesis of myelodysplastic syndromes (MDS), a clonal hematologic malignancy characterized by cytopenias, a dysplastic bone marrow and propensity to clonal evolution. Next generation sequencing (NGS) enables definition of somatic mutational patterns and clonal architecture as a discovery platform, and for clinical applications. We systematically applied NGS to 707 cases of MDS and MDS-related disorders. 205 cases (low-risk MDS: N=78, high-risk MDS: N=42, MDS/MPN: N=48 and sAML: N=37) were tested by whole exome sequencing (WES). For validation in an additional 502 patients (low-risk MDS: N=192, high-risk MDS: N=104, MDS/MPN: N=111 and sAML: N=95), targeted deep NGS was applied for 60 index genes which were most commonly affected in the cohort analyzed by WES. For NGS data analysis a statistical pipeline was developed to focus on: i) identification of the most relevant somatic mutations, and ii) minimization of false positive results. We studied serial samples from 21 exemplary informative patients. We also compared somatic mutational patterns to those seen in primary AML TCGA cohort (N=201). Given the size of the cohort, there was, for example, a 87% chance of seeing mutations at a frequency of 1% and a 98% of seeing those with a frequency of 2%. While focusing on the most common events, we observed 1117 somatic mutations in 199 genes. The 88 genes mutated mutated in >1% of cases with MDS carried 388 mutations in MDS+sAML (2.5/case), 128 in MDS/MPN (2.7/case) and 398 in pAML (2.0/case). The average number of mutations per case increased during progression (2.2 in lower-risk, 2.8 in higher-risk MDS, 3.4 in sAML). In MDS, the 30 most frequently affected genes were present at least once in 70% of patients. The 30 most frequently mutated genes in MDS/MPN were mutated in 82% of patients. Individual mutations were also sub-grouped according to their function. When we compared three MDS subcategories (lower-risk, higher-risk MDS and sAML) in a cross-sectional view, RTK family, RAS family, IDH family and cohesin family mutations were more frequently detected in the sAML group than in the MDS group. In contrast, the frequency of the DNMT family, TET2 and ASXL family gene mutations did not increase in frequency in the sAML cohort. In addition to better definition of mutational patterns of known genes, we have also defined new mutations, including in the RNA helicase family and the BRCC3pathway. Clonal architecture analysis indicates that mutations of TET2, DNMT3A, ASXL1, and U2AF1 most likely represent ancestral/originator events, while those of the IDH family, RTK family and cohesin family are typical secondary events. Establishment of mutational patterns may improve the precision of morphologically-based diagnosis. The comparison between MDS-related diseases (MDS+sAML) and pAML revealed a notably different mutational pattern suggestive of a distinct molecular derivation of these two disease groups. While RTK, IDH family and NPM1 mutations were more frequently observed in the pAML cohort, mutations of SF3B1 and SRSF2, were more common in MDS+sAML. With regard to the connections between individual mutation combinations, RTK mutations were strongly associated with DNMT, but not with RAS family mutations in the pAML cohort, while the mutual association between TET2 and PRC2 family, cohesin family and RUNX1were encountered in the MDS+sAML cohort. Individual mutations may have prognostic significance, including having an impact on survival, either within the entire cohort or within specific subgroups. In the combined MDS cohort, TP53 family mutations were associated with a poor prognosis (HR; 3.65, 95%CI; 1.90-7.01, P<.0001) by univariate analysis. Similar results were found for mutations in TCF4(HR; 7.98, 95%CI; 1.58-10.1, P<.0007). Such an individual approach does not allow for assessment of the impact of less common mutational events. In conclusion, our study continues to indicate the power of NGS in the molecular analysis of MDS. MDS and related disorders show a great deal of pathogenetic molecular overlap, consistent with their morphologic and clinical pictures, but also distinct molecular differences in mutational patterns. Some of the specific mutations are pathognomonic for specific subtypes while some may convey a prognostic rather than discriminatory value. Disclosures: Makishima: Scott Hamilton CARES grant: Research Funding; AA & MDS international foundation: Research Funding. Polprasert:MDS foundation: Research Funding.

scholarly journals THE IMPACT OF BARCODE MEDICATION ADMINISTRATION ON PATIENT SAFETY: A SYSTEMATIC REVIEW

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Seham Sahal Aloufi
Keyword(s):  
Systematic Review ◽  
Patient Safety ◽  
Medication Error ◽  
Medication Errors ◽  
Improve Patient Safety ◽  
Hospital Setting ◽  
Medication Administration ◽  
Bar Code ◽  
The Impact ◽  
Improve Patient

Patient safety is considered as an essential feature of healthcare system. Many trials have been conducted in order to find ways to improve patient safety, and many reports indicate that medication errors pose a threat to patient safety. Thus, some studies have investigated the impact of bar code medication administration (BCMA) system on medication error reduction during the medication administration procedure. This systematic review (SR) reports the impact of BCMA system on reducing medication errors to improve patient safety; it also compares traditional medication administration with the BCMA system. The review concentrates on the effectiveness of BCMA technology on medication administration errors, and on the accuracy of medication administration. This review also focused on different designs of quantitative studies, as they are more effective at investigating the impact of the intervention than qualitative studies. The findings from this systematic review show various results depending on the nature of the hospital setting. Most of the studies agree that the BCMA system enhances compliance with the 'five rights’' requirement (right drug, right patient, right dose, right time and right route) of medication administration. In addition, BCMA technology identified medication error types that could not be identified with the traditional approach which is applying the 'five rights' of medication administration. The findings of this systematic review also confirm the impact of BCMA system in reducing medication error, preventing adverse events and increasing the accuracy of the medication administration rate. However, BCMA technology did not consistently reduce the overall errors of medication administration. Keyword: Patient Safety, Impact, BCMA, eMAR

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