scholarly journals Contributing factors that influence medication errors in the prehospital paramedic environment: a mixed-method systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e034094
Author(s):  
Dennis Walker ◽  
Clint Moloney ◽  
Brendan SueSee ◽  
Renee Sharples
Keyword(s):  
Systematic Review ◽  
Medication Errors ◽  
Medication Safety ◽  
Data Extraction ◽  
Prehospital Care ◽  
Integrated Approach ◽  
Care Providers ◽  
Contributing Factors ◽  
Multiple Sources ◽  
Qualitative Synthesis

IntroductionThere is limited reliable research available on medication errors in relation to paramedic practice, with most evidence-based medication safety guidelines based on research in nursing, operating theatre and pharmacy settings. While similarities exist, evidence suggests that the prehospital environment is distinctly different in many aspects. The prevention of errors requires attention to factors from the organisational and regulatory level down to specific tasks and patient characteristics. The evidence available suggests errors may occur in up to 12.76% of medication administrations in some prehospital settings. With multiple sources stating that the errors are under-reported, this represents significant potential for patient harm. This review will seek to identify the factors influencing the occurrence of medication errors by paramedics in the prehospital environment.Methods and analysisThe review will include qualitative and quantitative studies involving interventions or phenomena regarding medication errors or medication safety relating to paramedics (including emergency medical technicians and other prehospital care providers) within the prehospital environment. A search will be conducted using MEDLINE (Ovid), EBSCOhost Megafile Search, the International Committee of Medical Journal Editors trial registry, Google Scholar and the OpenGrey database to identify studies meeting this inclusion criteria, with initial searches commencing 30 September 2019. Studies selected will undergo assessment of methodological quality, with data to be extracted from all studies irrespective of quality. Each stage of study selection, appraisal and data extraction will be conducted by two reviewers, with a third reviewer deciding any unresolved conflicts. The review will follow a convergent integrated approach, conducting a single qualitative synthesis of qualitative and ‘qualitised’ quantitative data.Ethics and disseminationNo ethical approval was required for this review. Findings from this systematic review will be disseminated via publications, reports and conference presentations.

scholarly journals Misuse of medication in adult substance misuse services: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047283
Author(s):  
Rosalind Gittins ◽  
Louise Missen ◽  
Ian Maidment
Keyword(s):  
Systematic Review ◽  
Substance Misuse ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Opioid Analgesics ◽  
Physical And Mental Health ◽  
Qualitative Synthesis ◽  
Treatment Services ◽  
The Impact

IntroductionThere is a growing concern about the misuse of over the counter (OTC) and prescription only medication (POM) because of the impact on physical and mental health, drug interactions, overdoses and drug-related deaths. These medicines include opioid analgesics, anxiolytics such as pregabalin and diazepam and antidepressants. This protocol outlines how a systematic review will be undertaken (during June 2021), which aims to examine the literature on the pattern of OTC and POM misuse among adults who are accessing substance misuse treatment services. It will include the types of medication being taken, prevalence and demographic characteristics of people who access treatment services.Methods and analysisAn electronic search will be conducted on the Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases as well as grey literature. Two independent reviewers will conduct the initial title and abstract screenings, using predetermined criteria for inclusion and exclusion. If selected for inclusion, full-text data extraction will be conducted using a pilot-tested data extraction form. A third reviewer will resolve disagreements if consensus cannot be reached. Quality and risk of bias assessment will be conducted for all included studies. A qualitative synthesis and summary of the data will be provided. If possible, a meta-analysis with heterogeneity calculation will be conducted; otherwise, Synthesis Without Meta-analysis will be undertaken for quantitative data. The reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationEthical approval is not required. Findings will be peer reviewed, published and shared verbally, electronically and in print, with interested clinicians and policymakers.PROSPERO registration numberCRD42020135216.

scholarly journals Clinical effectiveness of drugs in hospitalized patients with COVID-19 infection: a systematic review and meta-analysis.

2020 ◽  
Author(s):  
Roberto Ariel Abeldano Zuniga ◽  
Silvia Coca ◽  
Giuliana Abeldano ◽  
Ruth Ana Maria Gonzalez Villoria
Keyword(s):  
Systematic Review ◽  
Clinical Improvement ◽  
Low Income ◽  
Randomized Clinical Trials ◽  
Data Extraction ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Hospitalized Patients ◽  
Low Income Countries ◽  
Qualitative Synthesis

Objective. The aim was to assess the clinical effectiveness of drugs used in hospitalized patients with COVID-19 infection. Method. We conducted a systematic review of randomized clinical trials assessing treatment with remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, dexamethasone, and convalescent plasma, for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, duration of ventilation, duration of oxygen support, duration of hospitalization), virological clearance, and severe adverse events. Results. A total of 48 studies were retrieved from the databases. Ten articles were finally included in the data extraction and qualitative synthesis of results. The meta-analysis suggests a benefit of dexamethasone versus standard care in the reduction of risk of mortality at day 28; and the clinical improvement at days 14 and 28 in patients treated with remdesivir. Conclusions. Dexamethasone would have a better result in hospitalized patients, especially in low-resources settings. Significance of results. The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries; since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline in countries with scarce resources. Keywords: Drugs; Antivirals; Clinical improvement; Mortality; COVID-19; SARS-CoV2.

scholarly journals Medication Safety: Reducing Anesthesia Medication Errors and Adverse Drug Events in Dentistry Part 2

2020 ◽  
Vol 67 (1) ◽  
pp. 48-59
Author(s):  
Daniel S. Sarasin ◽  
Jason W. Brady ◽  
Roy L. Stevens
Keyword(s):  
General Anesthesia ◽  
Medication Errors ◽  
Medication Safety ◽  
Adverse Drug Events ◽  
Contributing Factors ◽  
Full Spectrum ◽  
Dental Profession ◽  
Novel Method ◽  
Dental Providers ◽  
Preventive Methods

For decades, the dental profession has provided the full spectrum of anesthesia services ranging from local anesthesia to general anesthesia in the office-based ambulatory environment to alleviate pain and anxiety. However, despite a reported record of safety, complications occasionally occur. Two common contributing factors to general anesthesia and sedation complications are medication errors and adverse drug events. The prevention and early detection of these complications should be of paramount importance to all dental providers who administer or otherwise use anesthesia services. Unfortunately, there is a lack of literature currently available regarding medication errors and adverse drug events involving anesthesia for dentistry. As a result, the profession is forced to look to the medical literature regarding these issues not only to assess the likely severity of the problem but also to develop preventive methods specific for general anesthesia and sedation as practiced within dentistry. Part 1 of this 2-part article illuminated the problems of medication errors and adverse drug events, primarily as documented within medicine. Part 2 will focus on how these complications affect dentistry, discuss several of the methods that medical anesthesia has implemented to manage such problems that may have utility in dentistry, and introduce a novel method for addressing these issues within dentistry known as the Dental Anesthesia Medication Safety Paradigm (DAMSP).

scholarly journals The effect of electronic audits and feedback in primary care and factors that contribute to their effectiveness: a systematic review

2020 ◽  
Vol 32 (10) ◽  
pp. 708-720
Author(s):  
Steve Van Den Bulck ◽  
David Spitaels ◽  
Bert Vaes ◽  
Geert Goderis ◽  
Rosella Hermens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Cognitive Load ◽  
Medication Safety ◽  
Data Extraction ◽  
Cochrane Review ◽  
High Quality ◽  
Electronic Feedback ◽  
High Quality Evidence ◽  
Quality Evidence

Abstract Purpose The aim of this systematic review was (i) to assess whether electronic audit and feedback (A&F) is effective in primary care and (ii) to evaluate important features concerning content and delivery of the feedback in primary care, including the use of benchmarks, the frequency of feedback, the cognitive load of feedback and the evidence-based aspects of the feedback. Data sources The MEDLINE, Embase, CINAHL and CENTRAL databases were searched for articles published since 2010 by replicating the search strategy used in the last Cochrane review on A&F. Study selection Two independent reviewers assessed the records for their eligibility, performed the data extraction and evaluated the risk of bias. Our search resulted in 8744 records, including the 140 randomized controlled trials (RCTs) from the last Cochrane Review. The full texts of 431 articles were assessed to determine their eligibility. Finally, 29 articles were included. Data extraction Two independent reviewers extracted standard data, data on the effectiveness and outcomes of the interventions, data on the kind of electronic feedback (static versus interactive) and data on the aforementioned feedback features. Results of data synthesis Twenty-two studies (76%) showed that electronic A&F was effective. All interventions targeting medication safety, preventive medicine, cholesterol management and depression showed an effect. Approximately 70% of the included studies used benchmarks and high-quality evidence in the content of the feedback. In almost half of the studies, the cognitive load of feedback was not reported. Due to high heterogeneity in the results, no meta-analysis was performed. Conclusion This systematic review included 29 articles examining electronic A&F interventions in primary care, and 76% of the interventions were effective. Our findings suggest electronic A&F is effective in primary care for different conditions such as medication safety and preventive medicine. Some of the benefits of electronic A&F include its scalability and the potential to be cost effective. The use of benchmarks as comparators and feedback based on high-quality evidence are widely used and important features of electronic feedback in primary care. However, other important features such as the cognitive load of feedback and the frequency of feedback provision are poorly described in the design of many electronic A&F intervention, indicating that a better description or implementation of these features is needed. Developing a framework or methodology for automated A&F interventions in primary care could be useful for future research.

scholarly journals Clinical Procedures for the Prevention of Preeclampsia in Pregnant Women: A Systematic Review

2020 ◽  
Vol 42 (10) ◽  
pp. 659-668
Author(s):  
Nádya Santos Moura ◽  
Maria Luziene Sousa Gomes ◽  
Ivana Rios Rodrigues ◽  
Daniel Lorber Rolnik ◽  
Fabrício Silva Costa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Guideline Development ◽  
Data Extraction ◽  
Qualitative Synthesis ◽  
Manual Search ◽  
The Individual ◽  
Selection Of ◽  
Mcmaster University

Abstract Objective To identify the most effective procedures recommended for the prevention of preeclampsia. Data Sources A systematic review was performed in the following databases: Pubmed/MEDLINE, CINAHL, Web of Science, Cochrane and LILACS via the Virtual Health Library (VHL). A manual search was also performed to find additional references. The risk of bias, the quality of the evidence, and the classification of the strength of the recommendations were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Selection of Studies In the initial search in the databases, the total number of articles retrieved was 351, and 2 were retrieved through the manual search; after duplicate articles were removed, 333 citations remained. After a thorough review of the titles and abstracts, 315 references were excluded. Accordingly, 18 articles were maintained for selection of the complete text (phase 2). This process led to the exclusion of 6 studies. In total, 12 articles were selected for data extraction and qualitative synthesis. Data Collection The articles selected for the study were analyzed, and we inserted the synthesis of the evidence in the online software GRADEpro Guideline Development Tool (GDT) (McMaster University and Evidence Prime Inc. All right reserved. McMaster University, Hamilton, Ontário, Canada); thus, it was possible to develop a table of evidence, with the quality of the evidence and the classification of the strength of the recommendations. Data Synthesis In total, seven studies recommended the individual use of aspirin, or aspirin combined with calcium, heparin or dipyridamole. The use of calcium alone or in combination with phytonutrients was also highlighted. All of the studies were with women at a high risk of developing preeclampsia. Conclusion According to the studies evaluated, the administration of aspirin is still the best procedure to be used in the clinical practice to prevent preeclampsia.

scholarly journals Protocol for a systematic review and qualitative synthesis of information quality frameworks in eHealth

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e024722 ◽  
Author(s):  
Kayode Philip Fadahunsi ◽  
James Tosin Akinlua ◽  
Siobhan O’Connor ◽  
Petra A Wark ◽  
Joseph Gallagher ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Safety ◽  
Global Health ◽  
Information Quality ◽  
Health Management ◽  
Data Extraction ◽  
Primary Data ◽  
Academic Journal ◽  
Qualitative Synthesis ◽  
Eligibility Criteria

IntroductionElectronic health (eHealth) applications have become a very large repository of health information which informs critical decisions relating to the diagnosis, treatment and prognosis of patients. Poor information quality (IQ) within eHealth may compromise patient safety. Evaluation of IQ in eHealth is therefore necessary to promote patient safety. An IQ framework specifies what aspects of information to assess and how to conduct the assessment. This systematic review aims to identify dimensions within existing IQ frameworks in eHealth and develop a new IQ framework for the assessment of eHealth.Method and analysisWe will search Embase, Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature, Maternity and Infant Care, PsycINFO (American Psychological Association), Global Health, Scopus, ProQuest Dissertations and Theses Global, Health Management Information Consortium and reference lists of relevant publications for articles published in English until November 2018. Studies will be selected by two independent reviewers based on prespecified eligibility criteria. Two reviewers will independently extract data in each eligible study using a prepiloted Microsoft Excel data extraction form. Thematic synthesis will be employed to define IQ dimensions and develop a new IQ framework for eHealth.Ethics and disseminationEthical approval is not required for this systematic review as primary data will not be collected. The result of the review will be disseminated through publication in an academic journal and scientific conferences.PROSPERO registration numberCRD42018097142.

scholarly journals Nursing students’ experiences with faculty incivility in the clinical education context: a qualitative systematic review and meta-synthesis

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024383 ◽  
Author(s):  
Zheng Zhu ◽  
Weijie Xing ◽  
Lucylynn Lizarondo ◽  
Mengdi Guo ◽  
Yan Hu
Keyword(s):  
Systematic Review ◽  
Nursing Students ◽  
Clinical Education ◽  
Data Extraction ◽  
Included Study ◽  
Qualitative Studies ◽  
Contributing Factors ◽  
Open Communication ◽  
Eligibility Criteria ◽  
Deep Blue

ObjectiveThe aim of this study is to synthesise evidence for the experiences and perceptions of incivility during clinical education of nursing students.DesignWe used a meta-aggregation approach to conduct a systematic review of qualitative studies.Data sourcesPublished and unpublished papers from 1990 until 13 January 2018 were searched using electronic databases, including CINAHL, PubMed (MEDLINE), ProQuest Central, ProQuest Education Journals, ProQuest XML-Dissertations and Theses, Web of Science, Embase, EBSCO Discovery Service and PsycINFO. The search for unpublished studies included the Open Grey collection, conference proceedings and the Deep Blue Library.Eligibility criteriaWe included qualitative studies that focused on nursing students' perceptions and experiences of incivility from faculty during their clinical education.Data extraction and synthesisTwo reviewers independently appraised the methodological quality and extracted relevant data from each included study. Meta-aggregation was used to synthesise the data.ResultsA total of 3397 studies was returned from the search strategies. Eighteen studies fulfilled the inclusion criteria and were included in the meta-synthesis. Six synthesised findings were identified, covering features of incivility, manifestations of incivility, contributing factors, impacts on students, coping strategies and suggestions.ConclusionsThe results showed experiences of incivility during clinical education. However, the confidence was low for all synthesised findings. We suggest that nursing students should try to cope positively with incivility. Nurse managers and clinical preceptors should be aware of the prevalence and impact of incivility and implement policies and strategies to reduce incivility towards nursing students. Hospitals and universities should have an immediate response person or system to help nursing students confronting incivility and create an open communication environment.

Associations between anger and chronic primary pain: a systematic review and meta-analysis

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Tomonori Adachi ◽  
Keiko Yamada ◽  
Haruo Fujino ◽  
Kiyoka Enomoto ◽  
Masahiko Shibata
Keyword(s):  
Systematic Review ◽  
Methodological Quality ◽  
Negative Emotion ◽  
Data Extraction ◽  
Meta Analysis ◽  
Perceived Injustice ◽  
Qualitative Synthesis ◽  
Action Tendency ◽  
Comprehensive Search ◽  
Meta Analyses

Abstract Objectives Anger is a negative emotion characterized by antagonism toward someone or something, is rooted in an appraisal or attribution of wrongdoing, and is accompanied by an action tendency to undo the wrongdoing. Anger is prevalent in individuals with chronic pain, especially those with chronic primary pain. The associations between anger and pain-related outcomes (e.g., pain intensity, disability) have been examined in previous studies. However, to our knowledge, no systematic review or meta-analysis has summarized the findings of anger-pain associations through a focus on chronic primary pain. Hence, we sought to summarize the findings on the associations of anger-related variables with pain and disability in individuals with chronic primary pain. Methods All studies reporting at least one association between anger-related variables and the two pain-related outcomes in individuals with chronic primary pain were eligible. We searched electronic databases using keywords relevant to anger and chronic primary pain. Multiple reviewers independently screened for study eligibility, data extraction, and methodological quality assessment. Results Thirty-eight studies were included in this systematic review, of which 20 provided data for meta-analyses (2,682 participants with chronic primary pain). Of the included studies, 68.4% had a medium methodological quality. Evidence showed mixed results in the qualitative synthesis. Most anger-related variables had significant positive pooled correlations with small to moderate effect sizes for pain and disability. Conclusions Through a comprehensive search, we identified several key anger-related variables associated with pain-related outcomes. In particular, associations with perceived injustice were substantial.

Analysis of medication errors during anaesthesia in the first 4000 incidents reported to webAIRS

2021 ◽  
pp. 0310057X2110275
Author(s):  
Jee Young Kim ◽  
Matthew R Moore ◽  
Martin D Culwick ◽  
Jacqueline A Hannam ◽  
Craig S Webster ◽  
...  
Keyword(s):  
Medication Error ◽  
Medication Errors ◽  
Safety Culture ◽  
Medication Safety ◽  
Reporting System ◽  
Current Evidence ◽  
Contributing Factors ◽  
Incident Reporting System ◽  
Wrong Side ◽  
Inappropriate Choice

Medication error is a well-recognised cause of harm to patients undergoing anaesthesia. From the first 4000 reports in the webAIRS anaesthetic incident reporting system, we identified 462 reports of medication errors. These reports were reviewed iteratively by several reviewers paying particular attention to their narratives. The commonest error category was incorrect dose (29.4%), followed by substitution (28.1%), incorrect route (7.6%), omission (6.5%), inappropriate choice (5.8%), repetition (5.4%), insertion (4.1%), wrong timing (3.5%), wrong patient (1.5%), wrong side (1.5%) and others (6.5%). Most (58.9%) of the errors resulted in at least some harm (20.8% mild, 31.0% moderate and 7.1% severe). Contributing factors to the medication errors included the presence of look-alike medications, storage of medications in the incorrect compartment, inadequate labelling of medications, pressure of time, anaesthetist fatigue, unfamiliarity with the medication, distraction, involvement of multiple people and poor communication. These data add to current evidence suggesting a persistent and concerning failure effectively to address medication safety in anaesthesia. The wide variation in the nature of the errors and contributing factors underline the need for increased systematic and multifaceted efforts underpinned by a strengthening of the current focus on safety culture to improve medication safety in anaesthesia. This will require the concerted and committed engagement of all concerned, from practitioners at the clinical workface, to those who fund and manage healthcare.

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