Medication Errors in Pediatrics: Proposals to Improve the Quality and Safety of Care Through Clinical Risk Management

Medication errors represent one of the most common causes of adverse events in pediatrics and are widely reported in the literature. Despite the awareness that children are at increased risk for medication errors, little is known about the real incidence of the phenomenon. Most studies have focused on prescription, although medication errors also include transcription, dispensing, dosage, administration, and certification errors. Known risk factors for therapeutic errors include parenteral infusions, oral fluid administration, and tablet splitting, as well as the off-label use of drugs with dosages taken from adult literature. Emergency Departments and Intensive Care Units constitute the care areas mainly affected by the phenomenon in the hospital setting. The present paper aims to identify the risk profiles in pediatric therapy to outline adequate preventive strategies. Precisely, through the analysis of the available evidence, solutions such as standardization of recommended doses for children, electronic prescribing, targeted training of healthcare professionals, and implementation of reporting systems will be indicated for the prevention of medication errors.

A Critical Review of Herbo-Mineral Formulations in Jwara Chikitsa

Fever is a generalized body reaction to a variety of infectious and non-infectious causes. Fever was referred to as jwara by ancient Ayurvedic seers, and it was thought to be the most serious ofall diseases. Fever is described as a separate illness, a symptom, and a complication of many ailments in Ayurveda classics. Jwara is the first and most serious of all diseases, so it needs special attention. In this article, we will attempt to compile and evaluate Rasa yogas in jwara chikithsa from various Ayurvedic classics. Rasendra Sara Sangraha, Bhaishjya Rathnavali, Rasa Ratna Samucchaya, Rasa Tharangini and other works are reviewed in detail. In Rasasastra classics, these formulations are indicated separately for navajwara chikitsa, nirama jwara chikitsa, jeerna jwara chikitsa, vishama jwara chikitsa, and sannipatha jwara chikitsa. This article includes 112 formulations from various sources that have been classified based on their indications. There are certain peculiarities in the ingredients based on jwara avasthas that can be discovered by studying these formulations. The majority of these formulations are herbo-mineral compounds that come in tablet form, making dosage, administration, and palatability more convenient. A few of these formulations are commercially available for common clinical practise. Antipyretic use is excessive in everyday life in the present pandemic situation. The aim of this study is to raise awareness of these particular formulations in the health-care system so that they can be applied to community needs. Key words: fever, jwara, navajwara, vishama jwara, nirama jwara, sannipatha jwara, herbo mineral formulations, rasa yogas.

Does UK licensed NSAID administration reduce signs of postoperative pain in calves castrated without local anaesthesia?

PICO question In calves undergoing castration without local or general anaesthesia, do non-steroidal anti-inflammatory drugs (NSAIDs) licensed for use in cattle in the UK administered either before, during or after the procedure reduce signs of postoperative pain? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Twenty studies were critically appraised. All were controlled trials, of which 17 were randomised. Only NSAIDs licensed for use in cattle in the UK were included in the search strategy and in appraised papers Strength of evidence Moderate Outcomes reported Five studies reported an improvement in both physiological and behavioural indicators of postcastration pain following NSAID administration and a further eight reported improvements in either physiological or behavioural parameters. Seven studies found no improvements in pain indicators Conclusion There is moderate evidence to suggest that NSAID administration before, during or after castration is able to reduce the signs of postoperative pain in calves castrated without anaesthesia. The degree to which pain is reduced is variable and depends upon factors including but not limited to castration method, specific NSAID given, dosage, administration and calf age

Enhancing Clinical Translation of Cancer Using Nanoinformatics

Application of drugs in high doses has been required due to the limitations of no specificity, short circulation half-lives, as well as low bioavailability and solubility. Higher toxicity is the result of high dosage administration of drug molecules that increase the side effects of the drugs. Recently, nanomedicine, that is the utilization of nanotechnology in healthcare with clinical applications, has made many advancements in the areas of cancer diagnosis and therapy. To overcome the challenge of patient-specificity as well as time- and dose-dependency of drug administration, artificial intelligence (AI) can be significantly beneficial for optimization of nanomedicine and combinatorial nanotherapy. AI has become a tool for researchers to manage complicated and big data, ranging from achieving complementary results to routine statistical analyses. AI enhances the prediction precision of treatment impact in cancer patients and specify estimation outcomes. Application of AI in nanotechnology leads to a new field of study, i.e., nanoinformatics. Besides, AI can be coupled with nanorobots, as an emerging technology, to develop targeted drug delivery systems. Furthermore, by the advancements in the nanomedicine field, AI-based combination therapy can facilitate the understanding of diagnosis and therapy of the cancer patients. The main objectives of this review are to discuss the current developments, possibilities, and future visions in naoinformatics, for providing more effective treatment for cancer patients.

Interactions Between Ketamine and Magnesium for the Treatment of Pain: Current State of the Art

Background: Over the past three decades, NMDA-receptor antagonists have been shown to be efficient drugs for treating pain and particularly pain that is resistant to conventional analgesics. Emphasis will be on the old-new drugs, ketamine and magnesium and their combination as a novel approach for treating chronic pain. Methods: The MEDLINE database was searched via PubMed for articles which were published up to March 1, 2020 with the key words ‘ketamine’, ‘magnesium’ and ‘pain’ (in the title/abstract). Results: Studies in animals, as well as humans have shown that interactions of ketamine and magnesium can be additive, antagonistic and synergistic. These discrepancies might be due to differences in magnesium and ketamine dosage, administration times and the chronological order of drugs administration. Different kinds of pain can also be the source of divergent results. Conclusion: This review explains why studies performed with a combination of ketamine and magnesium have given inconsistent results. Because of the lack of efficacy of drugs available for pain, ketamine and magnesium in combination provide a novel therapeutic approach that needs to be standardized with a suitable dosing regimen, including the chronological order of drug administration.

Engineering non-covalently assembled protein nanoparticles for long-acting gouty arthritis therapy

As an incurable metabolic disease, gouty arthritis (GA) requires long-term treatment with frequent dosage administration several times per day. In comparison to non-specific small organic medications, interleukin-1β (IL-1β) blocking therapies,...

Automatic Anaesthesia Regularization System

Nowadays, in surgeries, the anaesthesia is delivered manually. During this process, there is a chance to commit minute mistakes which may lead to lethal complications. During anaesthesia drug injection, the doctors should concentrate on the drug dosage, amount of drug, response of vital body parameters. The vital body parameters include temperature, blood pressure, heart rate. The incorrect dosage administration may cause lethal effects. To avoid this, the anaesthetist administers few millilitres of anaesthesia in a regular intervals of time to the patient. Thus ,a microcontroller based automatic anaesthesia regularization system is developed. So that the adequate amount of drug is injected in optimum level, which ensures the patient safety. The drug is delivered depending on the sensors output.

Mitigative efficacy of the clinical dosage administration of granulocyte colony-stimulating factor and romiplostim in mice with severe acute radiation syndrome

Background: It has been reported that the high-dosage administration of domestically approved pharmaceutical drugs, especially granulocyte colony-stimulating factor (G-CSF) and romiplostim (RP), is a rapid and appropriate medical treatment for preventing severe acute radiation syndrome (ARS) of victims exposed to lethal total-body irradiation (TBI). However, it remains unclear whether or not the clinical dosage administration of these drugs can ameliorate TBI-induced ARS and related high mortality in order to find various drug treatment options and less toxic optimum protocol depending on the situation surrounding the radiological accidents.Methods: We assessed the clinical dosage administration in combination with G-CSF and RP as intraperitoneal injection in C57BL/6J mice exposed to more than 7-Gy lethal dose of X-ray TBI for the survival study evaluated by the log-rank test. Bone marrow and splenic cells were collected on the 21st day, when 1 week have passed from last administration, to detect the level of cell apoptosis, intracellular reactive oxygen species (ROS), and nuclear factor erythroid 2-related factor 2 (Nrf2)-related anti-oxidative gene expressions, and enzyme-linked immune sorbent assay using sera was performed for cell senescence and inflammation status analyzed with one-way ANOVA and Tukey-Kramer or Bonferroni/Dunn multiple comparison tests.Results: The combined once-daily administration of 10 μg/kg G-CSF for 4 times and 10 μg/kg RP once a week for 3 times improve the 30-day survival rate of lethal TBI mice compared with untreated TBI mice, accompanied by a gradual increase in the body weight and hematopoietic cell numbers. The radio-mitigative effect is probably attributed to the scavenging of ROS and the reduction in cell apoptosis. These changes were associated with the upregulation of Nrf2 and its downstream anti-oxidative targets in TBI mice. Furthermore, this combination modulated TBI-induced cell senescence and inflammation markers. Conclusions: This study suggested that the clinical dosage administration in combination with G-CSF and RP may also have radio-mitigative effects on mice exposed to lethal TBI and may be a potent therapeutic agent for mitigating radiation-induced severe ARS.

Mitigative Efficacy of the Clinical Dosage Administration of Granulocyte Colony-stimulating Factor and Romiplostim in Mice With Severe Acute Radiation Syndrome

Background:It has been reported that the high-dosage administration of domestically approved pharmaceutical drugs, especially granulocyte colony-stimulating factor (G-CSF) and romiplostim (RP), is a rapid and appropriate medical treatment for preventing severe acute radiation syndrome (ARS) of victims exposed to lethal total-body irradiation (TBI). However, it remains unclear whether or not the clinical dosage administration of these drugs can ameliorate TBI-induced ARS and related high mortality in order to find various drug treatment options and less toxic optimum protocol depending on the situation surrounding the radiological accidents.Methods:We assessed the clinical dosageadministration in combination with G-CSF and RP as intraperitoneal injection in C57BL/6J mice exposed to more than 7-Gy lethal dose of X-ray TBI for the survival studyevaluated by the log-rank test. Bone marrow and splenic cellswere collected on the 21st day, when1 week have passed from last administration, to detect the level of cell apoptosis, intracellular reactive oxygen species (ROS), and nuclear factor erythroid 2-related factor 2 (Nrf2)-related anti-oxidative gene expressions, and enzyme-linked immune sorbent assayusing serawas performed for cell senescence and inflammationstatusanalyzed with one-way ANOVA and Tukey-Kramer or Bonferroni/Dunn multiple comparison tests.Results: The combined once-daily administration of 10 μg/kg G-CSF for 4 times and 10 μg/kgRP once a week for 3 times improve the 30-day survival rate of lethal TBI mice compared with untreated TBI mice, accompanied by a gradual increase in the body weight and hematopoietic cell numbers. The radio-mitigative effect is probably attributed to the scavenging of ROS and the reduction in cell apoptosis. These changes were associated with the upregulation of Nrf2 and its downstream anti-oxidative targets in TBI mice. Furthermore, this combination modulated TBI-induced cell senescence and inflammation markers. Conclusions:This study suggested that the clinical dosage administration in combination with G-CSF and RP may also have radio-mitigative effects on mice exposed to lethal TBI and may be a potent therapeutic agent for mitigating radiation-induced severe ARS.