Drug, Healthcare and Patient Safety最新文献

Background: Globally, healthcare systems are currently facing a significant challenge in terms of antibiotic resistance. Healthcare professionals actively participate in the process of prescribing, dispensing and administering antibiotics.

Objective: We examined the knowledge, attitudes and practices regarding antibiotic use and antibiotic resistance among healthcare professionals working in a tertiary hospital located in Monrovia, Liberia.

Methods: A hospital-based cross-sectional survey was carried out from January to June, 2023 involving 61 healthcare workers at the ELWA Hospital, Liberia. A purposive sample of healthcare workers across diverse professional roles was surveyed using a structured questionnaire on antibiotic use and resistance. Data were analyzed in SPSS v25 using descriptive statistics to summarize participant characteristics and inferential tests to explore variable associations.

Results: Participants ages ranged from 20 to 60 years (mean = 40.7 ± 5) and nurses constituted the majority professional group (59%). Most respondents (68.9%) disagreed that antibiotics are effective against viral infections (OR = 0.45; p = 0.020). However, 36.1% believed antibiotics could be stopped when symptoms resolve and 24.6% believed leftover antibiotics could be reused (OR = 0.33; p = 0.002). Majority, 72.1% and 70.5%, reported never using antibiotics for body pain or headaches, respectively (OR = 3.67; p = 0.001 and OR = 4.78; p < 0.001). Despite this, 39.3% admitted to sometimes or always storing leftover antibiotics and 39.3% agreed or strongly agreed that stopping antibiotics early is safe (OR = 0.36; p = 0.016).

Conclusion: The study identified persistent gaps in healthcare workers' knowledge, attitudes, and practices regarding antibiotic use and resistance, despite encouraging awareness in some areas. Misconceptions such as premature discontinuation and reuse of leftover antibiotics were common. Findings underscore the need for targeted education and strengthened stewardship programs in Liberia's healthcare settings.

Background: Polypharmacy has emerged as a major global public health concern. To mitigate its adverse effects, deprescribing has been introduced and integrated into clinical practice. This study aims to analyze the current research landscape and identify emerging trends in deprescribing from a bibliometric perspective.

Methods: Relevant studies on deprescribing published prior to December 2024 were retrieved from the Web of Science Core Collection database. Bibliometric analysis and visualization of co-authorship, citation, co-citation, co-occurrence, and burst detection were performed using VOSviewer, CiteSpace, and Bibliometrix.

Results: A total of 1809 publications were identified, with a marked increase over the past decade. The field is dominated by contributions from developed countries, notably the United States, Australia, and Canada. Studies primarily focus on chronic conditions, such as psychiatric disorders, cardiometabolic diseases, and chronic pain, and the medications used to treat them. Influential publications highlighted barriers and facilitators of deprescribing, deprescribing tools, and deprescribing interventions and their associated outcomes. Burst detection analysis pointed to increasing attention on pharmaceutical care and implementation science.

Conclusion: This study presents the first comprehensive bibliometric overview of deprescribing. The findings demonstrate that the field has grown rapidly but remains dominated by developed countries and a limited set of chronic diseases. The integration of implementation science frameworks emerges as a promising approach to enhance the design and evaluation of deprescribing interventions. Future studies should broaden their scope to include a wider range of diseases and medications, and encourage greater participation from developing countries.

Background: Prescription medication sharing (PMS) poses significant health risks, including side effects, delayed care, and worsening of illness. Despite these risks, evidence explaining why people share or avoid sharing prescription medicines remains scarce. To address this gap, the present study explored the perceived facilitators and barriers to PMS among the public in the Kingdom of Saudi Arabia (KSA) using a qualitative approach.

Methods: A qualitative study using face-to-face, semi-structured interviews was conducted in the Eastern Province with 60 participants, selected through a convenience sampling strategy. Eligibility criteria included the ability to communicate in Arabic or English, age ≥18 years, and taking a prescribed medication. Interviews continued until data saturation was achieved. Audio recordings were transcribed verbatim and analysed thematically using QSR NVivo 10 software.

Results: The study included 60 participants. Most participants were female, younger adults, and university educated. Thematic analysis identified two main themes: facilitators and barriers of PMS. Facilitators included saving time and cost, limited access to medicines or healthcare services, availability of leftover medicines, socio-cultural factors, and prior experience or knowledge about an illness and its treatment. Barriers included unsafe or ineffective treatment, awareness of public health risks, risk of dependence, and risk of non-adherence among lenders. These themes reflected a complex interaction of individual, cultural, and system-level influences. While some drivers aligned with international findings, others were more specific to the Saudi context, such as over-prescribing by doctors, brand preferences, misuse of insurance, medicine accumulation, strong family ties, cultural expectations of generosity, stigma-related communication gaps, and personal illness experiences.

Conclusion: This study provides the first qualitative insight into PMS in Saudi Arabia, highlighting how cultural norms, family dynamics, and healthcare system factors shape this behavior. The findings underscore the need for culturally informed policies and public health strategies to reduce risks and promote safe medication practices. Pharmacist-led counselling and community-based campaigns focused on safe medication use and proper disposal can further support safer medication practices and reduce the risks associated with PMS.

Background: Medication-related problems are especially frequent among home-care patients, who are predominantly older, multimorbid, polymedicated and interact with multiple professionals, necessitating timely, complete and accurate drug information communication.

Aim: To pilot a standardised approach to interprofessional home-care medication management focusing on deprescribing.

Methods: Home-care patients, cared for in their own homes by one professional nursing agency in the city of Bern, Switzerland, aged ≥64 and taking ≥4 prescribed medications were assessed for medication-related risk with the interprofessional, 10-item doMESTIC RISK tool. Community pharmacists performed structured medication reviews for at-risk patients, communicating with primary care physicians via standardised form.

Results: Nurses initiated 106 risk analyses (as defined in the process) in consenting patients, with 76 (72%) completed by pharmacists; 30 analyses could not be completed due to missing information. Out of 76 patients with a completed risk assessment, 26 patients did not need a medication review; one score was missing. The 49 patients qualifying for a medication review were on average 84.0 ± 7.7 years old and took a mean of 11.2 ± 4.5 prescribed medications regularly and 2.8 ± 3.5 prescribed as-needed medications. Pharmacists identified a median of two problems per patient, suggesting 64 potential interventions. Forty-three priority interventions for 18 patients were communicated to physicians, mostly dose reduction (27%) and therapy cessation (23%). Despite providing comprehensive information in the requests, physicians only reacted to 50% of pharmacists' recommendations (9/18 patients), accepting 57% of pharmacists suggestions in nine patients, predominantly deprescribing (nine medications).

Conclusion: While pharmacists identified medication improvements through structured medication reviews, limited access to clinical information and insufficient communication between health care professionals were key barriers. Strengthening interprofessional collaboration and structured communication through shared platforms allowing clinical data exchange is essential to optimizing medication management in home-care. Clarification of the roles of the team members must be improved.

Background: Paediatric pelvic X-rays are essential for diagnosing injuries and developmental abnormalities but pose radiation risks to sensitive children. Dose Reference Levels (DRLs) play a critical role in optimising radiographic procedures, ensuring both safety and high-quality imaging.

Objective: This research aimed to establish a National Dose Reference Level (NDRL) for digital paediatric pelvic X-rays in Jordan to optimise radiation doses, improve diagnostic accuracy, and minimise risks.

Methods: A Multicenter retrospective analysis was performed on paediatric Anterior-Posterior (AP) digital pelvic X-rays from various 12 Jordanian healthcare institutions. Parameters including Kilovoltage peak (kVp), milli Ampere second (mAs), and Focal to Skin Distance (FSD) were collected. Entrance Surface Dose (ESD) was indirectly calculated following international guidelines.

Results: The study analysed 1,674 paediatric pelvic X-rays, finding a mean ESD of 0.69 milli-Gray (mGy). The 75th percentile ESD, or (DRL), was 0.612 mGy overall, with age-specific DRLs of 0.265 mGy (0 to <1 year), 0.382 mGy (1 to <5 years), 0.704 mGy (5 to <10 years), and 0.995 mGy (10 to ≤15 years).

Conclusion: The study revealed age-dependent variations and notable disparities in radiation doses among various healthcare institutions in Jordan. Establishing the NDRL of 0.612 mGy provides a benchmark for dose optimisation and aligns Jordan's practices with international standards. The findings can guide national radiation protection policies and clinical guidelines, enhance paediatric imaging practices, and minimise unnecessary radiation exposure.

Purpose: E-labeling, which refers to delivering medicine package leaflets electronically, has been introduced in several countries as an alternative to printed leaflets. However, little is known about whether e-labeling improves the readability and usability of medicine information from the patient's perspective. This study aimed to evaluate the readability and usability of e-labeling compared to traditional paper leaflets in South Korea.

Methods: We conducted a mixed-methods user testing involving 77 adult participants recruited via convenience sampling. Participants were assigned to evaluate either a paper leaflet or e-labeling for a prescription antihypertensive or a non-prescription NSAID. Participants evaluated the printed leaflets or the corresponding PDF files by accessing them with their own mobile phones. Quantitative measures included traceability (accuracy in finding information), tracking speed (time taken to find information), and comprehension (whether the content was well understood). Semi-structured interviews were conducted to explore user experiences, perceived barriers, and preferences for e-labeling adoption.

Results: Across both drug types, e-labeling showed lower performance compared to paper leaflets. For the antihypertensive, traceability declined by 4.7%, tracking speed by 0.08 points, and comprehension by 3.3%. For the NSAID, these declines were 7.0%, 0.19 points, and 5.7%, respectively. Qualitative findings revealed mixed perceptions to e-labeling, with some valuing search functions and adjustable text size, while others highlighted difficulties navigating content and reduced accessibility. Participants emphasized the need for improved formatting, intuitive structure, and better utilization of digital features.

Conclusion: The current e-labeling format may not sufficiently meet patients' needs for medicine information. To support successful implementation, e-labeling should be redesigned with a focus on patient-centered principles, ensuring equitable access, and being tested in real-world settings. Education and awareness campaigns on how to use e-labeling would provide practical guidance and encourage acceptance among patients. These findings provide patient-centered evidence to inform improvements in e-labeling policies and design.

Background: Patient safety culture involves shared values, perceptions, and attitudes regarding safety within healthcare organizations, aiming to minimize preventable harm to patients. This concept has gained prominence worldwide, especially in Africa, where recent efforts focus on patient safety as a fundamental component of healthcare delivery. Despite progress, research into patient safety culture and its influencing factors remains limited in low-resource settings.

Objective: This study assessed the knowledge and attitudes of healthcare professionals toward patient safety at a tertiary hospital.

Methods: A cross-sectional study was conducted involving healthcare workers at the hospital. Data was collected using a structured self-administered questionnaire, capturing socio-demographic information, patient safety knowledge, and attitudes. Statistical analysis was performed using IBM SPSS Statistics 27, employing descriptive statistics and Pearson's chi-square test to evaluate differences between socio-demographic factors and patient safety attitudes.

Results: Among 300 respondents, 59% were male, and 65% were aged 21-30 years. Nurses accounted for 41% of participants. The majority (86%) reported sufficient patient safety knowledge, with 82% supporting patient safety inclusion in undergraduate education, furthermore 44.8% exhibited positive attitudes. Age and professional experience were significantly associated with positive patient safety attitudes (P = 0.012 and P = 0.003, respectively). Most respondents (74.7%) reported encountering medical errors, primarily technical errors, indicating a need for targeted training interventions.

Conclusion: Despite adequate self-reported knowledge, positive attitudes toward patient safety were limited-particularly among younger and less experienced professionals. These findings indicate that improving patient safety in Somali healthcare settings requires not only educational initiatives but also system-level interventions, including leadership support, non-punitive error reporting, and strategies that empower frontline staff. Future research should explore how these factors influence long-term safety culture development.

Background: Traumatic brain injury is a pressing public health issue worldwide that leads to profound disability and mortality. Medical guidelines recommend sedation and analgesia, with dexmedetomidine emerging as a promising option, given its unique pharmacological properties. However, the effect of dexmedetomidine in reducing the length of hospital stay in patients with traumatic brain injury remains unclear. This systematic review aimed to assess the effect of dexmedetomidine administration on traumatic brain injury management based on severity, with a specific focus on hospital and intensive care unit length of stay.

Methods: A systematic search following the PRISMA guidelines identified relevant studies from various databases. Eligible studies involving adult patients with traumatic brain injury and dexmedetomidine interventions were selected and assessed for the risk of bias. The extracted data included the study characteristics, intervention details, and outcome measures.

Results: Eight studies, three of which were randomized controlled trials, met the inclusion criteria. Dexmedetomidine has shown potential benefits in mitigating traumatic brain injury length of stay, particularly in patients with severe traumatic brain injury. However, the findings on hospital length of stay varied, preventing a definitive conclusion regarding the effectiveness of dexmedetomidine in reducing length of stay. Heterogeneity among the studies was the main factor in the reported variable results.

Conclusion: Dexmedetomidine has a promising role in traumatic brain injury management with evidence suggesting reduced intensive care unit length of stay with dexmedetomidine administration. A comprehensive understanding of dexmedetomidine dosing strategies and their long-term effects is crucial to optimize patient outcomes. A multifaceted approach to traumatic brain injury management will help enhance the therapeutic utility of dexmedetomidine and improve the care and outcomes of traumatic brain injury patients worldwide.

Background: Parental perceptions and concerns about vaccine safety and 'adverse effects following immunisation' (AEFI) are the reasons for vaccine hesitancy. This study aimed to understand how these vaccine-related concerns have become significant determinants of vaccine decision-making among non-vaccinating parents in the Alappuzha district of Kerala, India. The healthcare providers' views in this regard are also reported.

Methods: This is a qualitative study. In-depth interviews were conducted with informants from 110 households having non-immunised/partly-immunised children. In addition, 18 healthcare providers were interviewed. Thematic analysis using the reflective thematic method was carried out.

Results: Parents reported incidences of minor events of AEFI and are hesitant to continue vaccination in circumstances when children need medical treatment. AEFI incidents within the family have seriously hampered the trust in vaccines. Parents have concerns about multiple vaccinations and have misconceptions about the content of vaccines. Other concerns that lead to hesitancy are vaccine-related infertility, polio infection after polio vaccination and autism due to vaccination. Healthcare providers reported that there were no serious incidents that needed hospitalisation. Health workers opined that informing parents about AEFIs and preparing them is better.

Conclusion: The study reported that AEFIs are a barrier to vaccine acceptance. It warrants the need to build trust in vaccines and the vaccination process. Transparent communication with the beneficiaries is crucial. AEFI monitoring and reporting should be an essential component of efforts to minimise vaccination hesitancy.

Background: The 4th World Patient Safety Day (WPSD) 2024 commemoration in Uganda, themed "Improving Diagnosis for Patient Safety", highlighted critical challenges and opportunities in reducing diagnostic errors within healthcare systems. This review synthesizes key insights from the event, focusing on factors contributing to diagnostic inaccuracies, systemic gaps, and actionable strategies for improvement.

Methods: Using a qualitative synthesis approach guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ), we analyzed data from a hybrid webinar (210 participants) and a four-day medical camp (600+ patients served). Thematic analysis identified four key areas: (i) factors influencing diagnostic errors, (ii) the role of laboratory and imaging services in diagnosis error prevention, (iii) existing health system interventions, and (iv) patient empowerment in the diagnostic process.

Results: Diagnostic errors in Uganda stem from cognitive biases, systemic inefficiencies (eg, understaffing, inadequate equipment), and financial barriers in private healthcare. Strengthening laboratory capacity, digitizing health records, and enhancing provider-patient communication emerged as pivotal solutions. The Ministry of Health's initiatives such as laboratory accreditation, the 5S quality improvement framework, and patient feedback mechanisms demonstrate progress but require scaling.

Recommendations: We propose a multi-level approach: (1) national policies for error reporting and patient safety frameworks, (2) expanded supportive supervision and digitization (eg, EHRs with decision support), (3) stricter regulation of private healthcare, and (4) community engagement to improve health literacy and early care-seeking.

Conclusion: Reducing diagnostic errors demands systemic reforms, technological integration, and collaborative stakeholder engagement. Uganda's WPSD 2024 insights offer a model for similar low-resource settings to enhance diagnostic accuracy and patient safety.