Analysis of the discrepancies identified during medication reconciliation on patient admission in cardiology units: a descriptive study

ABSTRACT Objectives: this observational study aimed to describe the discrepancies identified during medication reconciliation on patient admission to cardiology units in a large hospital. Methods: the medication history of patients was collected within 48 hours after admission, and intentional and unintentional discrepancies were classified as omission, duplication, dose, frequency, timing, and route of drug administration. Results: most of the patients evaluated were women (58.0%) with a mean age of 59 years, and 75.5% of the patients had a Charlson comorbidity index score between 1 and 3. Of the 117 discrepancies found, 50.4% were unintentional. Of these, 61.0% involved omission, 18.6% involved dosage, 18.6% involved timing, and 1.7% involved the route of drug administration. Conclusion: this study revealed a high prevalence of discrepancies, most of which were related to omissions, and 50% were unintentional. These results reveal the number of drugs that are not reincorporated into the treatment of patients, which can have important clinical consequences.

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Medication Reconciliation during Admission at University Hospital

Global Journal of Health Science ◽

10.5539/gjhs.v13n1p1 ◽

2020 ◽

Vol 13 (1) ◽

pp. 1

Author(s):

Tatiane Contin ◽

Liliane Bernardes Campos ◽

Mônica Cristina Toffoli-Kadri ◽

Vanessa T. Gubert de Matos

Keyword(s):

Prescription Drugs ◽

Medication Reconciliation ◽

Treatment Interruption ◽

Cross Sectional Study ◽

University Hospital ◽

Medication History ◽

Cross Sectional ◽

Mato Grosso ◽

Home Based ◽

History Of

INTRODUCTION: Medication reconciliation is the process of comparing the most accurate list of all medications that a patient is taking with the list of prescription drugs within the healthcare system while considering the patient’s allergies and history of side effects. OBJECTIVES: To reconcile medication upon the patients’ admission to a university hospital in the municipality of Campo Grande, Mato Grosso do Sul, Brazil. METHOD: A prospective, cross-sectional study was conducted between June 2018 and May 2019 at the medical clinic unit of an university hospital. Discrepancies observed between the prescription and the best possible medication history were classified as intentional discrepancy; undocumented intentional; and unintentional. RESULTS: A total of 1,134 discrepancies were found between home-based drugs and those prescribed upon admission to the MCU. Among the discrepancies, 815 (72%) were intentional, 89 (8%) were undocumented intentional, and 230 (20%) were unintentional. The number of consultation sources and the number of medicines in use at home showed significant correlation with the occurrence of unintentional discrepancies (p = 0.039 and p = 0.008, respectively). A total of 318 pharmaceutical interventions were performed, 230 related to unintended discrepancies. Of these, 138 (60%) interventions were not accepted. CONCLUSION: The study verified the high frequency of drug omission, conferring treatment interruption and the need for pharmaceutical assistance of polymedicated patients.

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Medication reconciliation in admission hospitalization: retrospective study

Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde ◽

10.30968/rbfhss.2020.112.0397 ◽

2020 ◽

Vol 11 (2) ◽

pp. 397

Author(s):

JULIANA DORNELES ◽

Calize O. SANTOS ◽

Lucélia H. LIMA ◽

Carine R. BLATT

Keyword(s):

Patient Safety ◽

Retrospective Study ◽

Hospital Admission ◽

Medication Reconciliation ◽

Medication List ◽

Porto Alegre ◽

Medication History ◽

Large Hospital ◽

Anatomic Therapeutic Chemical ◽

The City

Objective: to quantify and describe the discrepancies found in medication reconciliation (MR) in patients at hospital admission. Methods: Retrospective study performed from September to November 2018, based on data from the MR of patients at hospital admission of a large hospital in the city of Porto Alegre / RS. MR was shared with nursing (collection of patient’s medication history) and pharmacy (comparison of medication list before and during hospitalization). The referred drugs were classify according to the Anatomic Therapeutic Chemical (ATC) classification in their first level and the discrepancies were classify according to intentionality (intentional and unintentional). Results: 81 patients submitted to MR, and 80% of them had some discrepancy. Of the 328 drugs evaluated, 44.8% presented discrepancies, totaling 147 discrepancies, being intentional (n= 97) and unintentional (n= 50). The omission of medication was the most frequent discrepancies (48.3%). After identify unintencional discrepancies 50% of drug were included in prescription. Cardiovascular drugs and digestive and metabolism drugs were the groups with the highest frequency of discrepancy. Conclusion: Since 80% of prescriptions on hospital admission had some discrepancy regarding the use of medication by patients before hospital admission, it is understood the importance of performing MR as a pharmaceutical service and with the objective of increasing patient safety regarding drug therapy.

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Clinical and anamnestic characteristics of patients with adenomyosis, accompanied by pelvic pain syndrome

GYNECOLOGY ◽

10.26442/20795696.2018.6.180132 ◽

2018 ◽

Vol 20 (6) ◽

pp. 77-80

Author(s):

M R Orazov ◽

V E Radzinsky ◽

M B Khamoshina ◽

A O Dukhin ◽

L R Toktar ◽

...

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain Syndrome ◽

Pain Syndrome ◽

Reproductive Age ◽

Pelvic Pain Syndrome ◽

Common Disease ◽

Contributing Factors ◽

High Prevalence ◽

Inflammatory Processes ◽

History Of

Pelvic pain syndrome associated with adenomyosis is a common disease in women of reproductive age. Frequency of detection in the population varies from 10 to 53%. The aim - to study the clinical and anamnestic risk factors of pelvic pain, with adenomiose. Materials and methods. The study included 120 (n=120) patients with diffuse adenomyosis with pain and painless form of the disease who underwent examination and treatment in the gynecological Department of the Central clinical hospital №6 of Russian Railways in Moscow. Each patient was provided with an individual card, which was encrypted 171 sign. The studied parameters reflected the passport and anthropometric data, information about education, social status, presence of occupational hazards, complaints, illness. Results. Burdened gynecological and somatic histories, manifested a low health index, a more pronounced hereditary a family history of neoplastic diseases are contributing factors, and high prevalence of postponed surgeries, chronic, long-term ongoing inflammatory processes of the pelvic organs to create a favorable background for the further progression of chronic pelvic pain syndrome in adenomiose.

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Prevalence of MDR organism (MDRO) carriage in children and their household members in Siem Reap Province, Cambodia

JAC-Antimicrobial Resistance ◽

10.1093/jacamr/dlaa097 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Shweta R Singh ◽

Bunsoth Mao ◽

Konstantin Evdokimov ◽

Pisey Tan ◽

Phana Leab ◽

...

Keyword(s):

Final Analysis ◽

Cross Sectional Study ◽

Cross Sectional ◽

Middle Income ◽

E Coli ◽

Middle Income Countries ◽

Siem Reap ◽

High Prevalence ◽

Significant Public Health ◽

History Of

Abstract Background The rising incidence of infections caused by MDR organisms (MDROs) poses a significant public health threat. However, little has been reported regarding community MDRO carriage in low- and middle-income countries. Methods We conducted a cross-sectional study in Siem Reap, Cambodia comparing hospital-associated households, in which an index child (age: 2–14 years) had been hospitalized for at least 48 h in the preceding 2–4 weeks, with matched community households on the same street, in which no other child had a recent history of hospitalization. Participants were interviewed using a survey questionnaire and tested for carriage of MRSA, ESBL-producing Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE) by culture followed by antibiotic susceptibility testing. We used logistic regression analysis to analyse associations between collected variables and MDRO carriage. Results Forty-two pairs of households including 376 participants with 376 nasal swabs and 290 stool specimens were included in final analysis. MRSA was isolated from 26 specimens (6.9%). ESBL-producing Escherichia coli was detected in 269 specimens (92.8%) whereas ESBL-producing Klebsiella pneumoniae was isolated from 128 specimens (44.1%), of which 123 (42.4%) were co-colonized with ESBL-producing E. coli. Six (2.1%) specimens tested positive for CPE (4 E. coli and 2 K. pneumoniae). The prevalence ratios for MRSA, ESBL-producing E. coli and ESBL-producing K. pneumoniae carriage did not differ significantly in hospital-associated households and hospitalized children compared with their counterparts. Conclusions The high prevalence of ESBL-E across both household types suggests that MDRO reservoirs are common in the community. Ongoing genomic analyses will help to understand the epidemiology and course of MDRO spread.

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Ultrasonographic Evaluation of the Shoulders and Its Associations with Shoulder Pain, Age, and Swim Training in Masters Swimmers

Medicina ◽

10.3390/medicina57010029 ◽

2020 ◽

Vol 57 (1) ◽

pp. 29

Author(s):

Yuta Suzuki ◽

Noriaki Maeda ◽

Junpei Sasadai ◽

Kazuki Kaneda ◽

Taizan Shirakawa ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Pain ◽

Structural Changes ◽

Partial Tear ◽

Increased Risk ◽

High Prevalence ◽

History Of ◽

Long Head ◽

Competitive Swimmers ◽

Rotator Cuff Tendinopathy

Background and objectives: The long head of the biceps (LHB) and rotator cuff tendinopathy is the major cause of shoulder pain in competitive swimmers. The risk of tendinopathy increases with aging; however, the structural changes of LHB and rotator cuff in populations of masters swimmers have not been well examined. The purpose of this study was to investigate the prevalence of ultrasonographic abnormalities of the shoulders in masters swimmers, and the association of pain, age, and swim training with structural changes in this population. Materials and Methods: A total of 60 subjects participated in this study, with 20 masters swimmers with shoulder pain, 20 asymptomatic masters swimmers, and 20 sex- and age-matched controls. All swimmers completed a self-reported questionnaire for shoulder pain, their history of competition, and training volume. Each subject underwent ultrasonographic examination of both shoulders for pathologic findings in the LHB tendon, rotator cuff (supraspinatus (SSP) and subscapularis (SSC)) tendons, and subacromial bursa (SAB) of both shoulders and had thickness measured. Results: The prevalence of tendinosis (LHB, 48.8%; SSP, 17.5%; SSC, 15.9%), partial tear (SSP, 35.0%), and calcification (SSC, 10.0%) were higher in swimmers than in controls. LHB and SSP tendinosis were associated with shoulder pain. Older age and later start of competition were associated with an increased risk of LHB tendinosis and SSC calcification. Earlier initiation of swimming and longer history of competition were associated with an increased risk of SSP and SSC tendinosis. The thicker SSP tendon significantly increased the risk of tendinosis and partial tear. Conclusions: A high prevalence of structural changes in the rotator cuff and biceps tendons in masters swimmers reflects the effect of shoulder symptoms, aging, and swim training.

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The ‘Natural History’ of Declined Outpatient Gastroenterology Referrals

Canadian Journal of Gastroenterology ◽

10.1155/2012/507174 ◽

2012 ◽

Vol 26 (11) ◽

pp. 785-790 ◽

Cited By ~ 1

Author(s):

Emelie M de Boer ◽

David Pincock ◽

Sander Veldhuyzen van Zanten

Keyword(s):

Natural History ◽

Occult Blood ◽

Total Sample ◽

Fecal Occult Blood ◽

X Rays ◽

University Of Alberta ◽

Fecal Occult ◽

Gastrointestinal Problems ◽

Clinical Consequences ◽

History Of

OBJECTIVE: To evaluate the ‘natural history’ of outpatients who were referred to the Division of Gastroenterology at the University of Alberta Hospital (Edmonton, Alberta) for gastrointestinal problems and were subsequently declined.METHODS: Patients were tracked for 12 months after they were referred and declined for the following indications: abdominal pain, rectal bleeding, fecal occult blood test-positive stools and iron deficiency. For each patient, data regarding consultations by other gastroenterologists or surgeons working in the region, clinically relevant diagnoses and the number of gastrointestinal-related x-rays performed were obtained.RESULTS: Of a total sample size of 230 patients, 110 (47.8%) were seen by another gastroenterologist or surgeon after decline. A significant diagnosis was made in 21 patients (9.1%), which had immediate clinical consequences in 29%. Forty per cent of patients underwent one or more gastointestinal-related x-rays before being declined, which increased to 55% after decline.CONCLUSION: Approximately 50% of declined patients were seen by other gastroenterologists or surgeons in the region. In 9.1% of these patients, a clinically important diagnosis was made, of which one-quarter had immediate medical consequences.

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First Environmental Investigation of Toxigenic Clostridium difficile at a Large Hospital in Bangladesh

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1015 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S406-S406

Author(s):

M Jahangir Alam ◽

Khurshida Begum ◽

Tasnuva Rashid ◽

Irtiza Hasan ◽

Jacob McPherson ◽

...

Keyword(s):

Developing Countries ◽

Clostridium Difficile ◽

Enrichment Culture ◽

Large Hospital ◽

Environmental Investigation ◽

Fluorescent Pcr ◽

High Prevalence ◽

Pcr Ribotyping ◽

Developed World ◽

Culture Positive

Abstract Background Toxigenic Clostridium difficile is the most common cause of infectious diarrhea in hospitalized patients in the developed world and an emerging pathogen in developing countries due to increased use of broad-spectrum antibiotics. Although likely ubiquitous worldwide, the prevalence of toxigenic C. difficile spores in the hospital environs of developing countries is poorly understood. The objectives of the study are to isolate and characterize C. difficile from the hospital environs of a large hospitals in Dhaka, Bangladesh. Methods As part of our environmental surveillance effort, we collected 330 shoe-bottom swab samples from hospital employees, patients, and visitors inside of a large hospital in Dhaka, Bangladesh. Samples were analyzed for C. difficile using anaerobic enrichment culture and molecular methods. Suspected colonies from cycloserine cefoxitin fructose agar (CCFA) plates were identified by PCR (tcdA, tcdB, cdtA, cdtB and tpi genes) and strain typed using fluorescent PCR ribotyping, and MLVA methods. Results A total 149 of 333 (44.7%) shoe-bottom swab samples were culture positive for C. difficile of which 19.8% samples were toxigenic (tcdA and tcdB) C. difficile. A total of 11 distinct ribotypes were identified from 58 toxigenic C. difficile isolates tested. Predominant ribotypes were F053-163 (24.1%), F017 (20.7%), F106 (19.0%), F014-020 (17.2%). Other ribotypes were R001, F005, F010, F018, F054, F216, and FP407. No R027 and R078 C. difficile isolated. A broad MLVA diversity has been seen among the tested strains. Conclusion We identified a high prevalence of toxigenic C. difficile with diverse ribotypes from hospital environmental shoe-bottom swabs in Bangladesh. This is the first hospital environmental report of C. difficile from Bangladesh. Disclosures All authors: No reported disclosures.

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Season of birth interacts with measures of inbreeding in multiplex schizophrenia pedigrees: evidence from genetic isolates in Daghestan

Open Medicine ◽

10.2478/s11536-006-0041-8 ◽

2006 ◽

Vol 1 (4) ◽

pp. 392-398

Author(s):

Kazima Bulayeva ◽

John McGrath

Keyword(s):

Genetic Diversity ◽

Family History ◽

Age Of Onset ◽

Population Genetic Study ◽

Season Of Birth ◽

High Genetic Diversity ◽

Low Genetic Diversity ◽

High Prevalence ◽

History Of ◽

Genetic Isolates

AbstractWhile the season-of-birth effect is one of the most consistent epidemiological features of schizophrenia, there is a lack of consistency with respect to the interaction between season of birth and family history of schizophrenia. Apart from family history, measures related to consanguinity can be used as proxy markers of genomic heterogeneity. Thus, these measures may provide an alternate, indirect index of genetic susceptibility. We had the opportunity to explore the interaction between season of birth and measure of consanguinity in well-described genetic isolates in Daghestan, some of which are known for their relatively high prevalence of schizophrenia. Our previous population-genetic study showed Daghestan has an extremely high genetic diversity between the ethnic populations and a low genetic diversity within them. The isolates selected for this study include some with more than 200 and some with less than 100 generations of demographical history since their founding. Based on pedigrees of multiply-affected families, we found that among individuals with schizophrenia, the measure of consanguinity was significantly higher in the parents of those born in winter/spring compared to those born in summer/autumn. Furthermore, compared to summer/autumn born, winter/spring born individuals with schizophrenia had an earlier age-of-onset, and more prominent auditory hallucinations. Our results suggest that the offspring of consanguineous marriages, and thus those with reduced allelic heterogeneity, may be more susceptible to the environmental factor(s) underpinning the season-of-the effect in schizophrenia.

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Incidence of diabetes in South Asian young adults compared to Pima Indians

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001988 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001988

Author(s):

K M Venkat Narayan ◽

Dimple Kondal ◽

Sayuko Kobes ◽

Lisa R Staimez ◽

Deepa Mohan ◽

...

Keyword(s):

Insulin Resistance ◽

Insulin Secretion ◽

South Asians ◽

Diabetes Incidence ◽

Pima Indians ◽

Men And Women ◽

High Prevalence ◽

History Of ◽

Indian Men ◽

Design And Methods

IntroductionSouth Asians (SA) and Pima Indians have high prevalence of diabetes but differ markedly in body size. We hypothesize that young SA will have higher diabetes incidence than Pima Indians at comparable body mass index (BMI) levels.Research design and methodsWe used prospective cohort data to estimate age-specific, sex, and BMI-specific diabetes incidence in SA aged 20–44 years living in India and Pakistan from the Center for Cardiometabolic Risk Reduction in South Asia Study (n=6676), and compared with Pima Indians, from Pima Indian Study (n=1852).ResultsAt baseline, SA were considerably less obese than Pima Indians (BMI (kg/m2): 24.4 vs 33.8; waist circumference (cm): 82.5 vs 107.0). Age-standardized diabetes incidence (cases/1000 person-years, 95% CI) was lower in SA than in Pima Indians (men: 14.2, 12.2–16.2 vs 37.3, 31.8–42.8; women: 14.8, 13.0–16.5 vs 46.1, 41.2–51.1). Risk of incident diabetes among 20–24-year-old Pima men and women was six times (relative risk (RR), 95% CI: 6.04, 3.30 to 12.0) and seven times (RR, 95% CI: 7.64, 3.73 to 18.2) higher as compared with SA men and women, respectively. In those with BMI <25 kg/m2, however, the risk of diabetes was over five times in SA men than in Pima Indian men. Among those with BMI ≥30 kg/m2, diabetes incidence in SA men was nearly as high as in Pima men. SA and Pima Indians had similar magnitude of association between age, sex, BMI, and insulin secretion with diabetes. The effect of family history was larger in SA, whereas that of insulin resistance was larger in Pima IndiansConclusionsIn the background of relatively low insulin resistance, higher diabetes incidence in SA is driven by poor insulin secretion in SA men. The findings call for research to improve insulin secretion in early natural history of diabetes.

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High prevalence of undiagnosed COPD among patients evaluated for suspected myocardial ischaemia

Open Heart ◽

10.1136/openhrt-2018-000848 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000848 ◽

Cited By ~ 1

Author(s):

Andreas Jönsson ◽

Artur Fedorowski ◽

Gunnar Engström ◽

Per Wollmer ◽

Viktor Hamrefors

Keyword(s):

Myocardial Ischaemia ◽

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Clinical Factors ◽

Obstructive Pulmonary Disease ◽

Presenting Symptoms ◽

High Prevalence ◽

History Of ◽

Artery Disease ◽

Global Initiative

ObjectiveChronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are leading causes of global morbidity and mortality. Despite the well-known comorbidity between COPD and CAD, the presence of COPD may be overlooked in patients undergoing coronary evaluation. We aimed to assess the prevalence of undiagnosed COPD among outpatients evaluated due to suspected myocardial ischemia.MethodsAmong 500 outpatients who were referred to myocardial perfusion imaging due to suspected stable myocardial ischaemia, 433 patients performed spirometry. Of these, a total of 400 subjects (age 66 years; 45% women) had no previous COPD diagnosis and were included in the current study. We compared the prevalence of previously undiagnosed COPD according to spirometry criteria from The Global Initiative for Chronic Obstructive Lung Disease (GOLD) or lower limit of normal (LLN) and reversible myocardial ischaemia according to symptoms and clinical factors.ResultsA total of 134 (GOLD criteria; 33.5 %) or 46 patients (LLN criteria; 11.5%) had previously undiagnosed COPD, whereas 55 patients (13.8 %) had reversible myocardial ischaemia. The presenting symptoms (chest discomfort, dyspnoea) did not differ between COPD, myocardial ischaemia and normal findings. Except for smoking, no clinical factors were consistently associated with previously undiagnosed COPD.ConclusionsAmong middle-aged outpatients evaluated due to suspected myocardial ischaemia, previously undiagnosed COPD is at least as common as reversible myocardial ischaemia and the presenting symptoms do not differentiate between these entities. Patients going through a coronary ischaemia evaluation should be additionally tested for COPD, especially if there is a positive history of smoking.

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