Drug, Healthcare and Patient Safety最新文献

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.

Purpose: To compare the impact of sodium-glucose cotransporter 2 inhibitor (SGLT2 inhibitor), glucagon-like peptide-1 receptor agonist (GLP-1 RA), with or without metformin, on out of pocket and total prescription expenditure and health-related quality of life (HRQoL) for patients with type 2 diabetes mellitus (T2DM).

Patients and methods: This observational study utilized 2017-2021 Medical Expenditure Panel Survey (MEPS) data from patients with T2DM (≥18 years) on SGLT2 inhibitor, GLP-1 RA, with or without metformin, from payer and self-perspective. HRQoL was assessed using physical (PCS) and mental component summary (MCS) scores based on Veterans Rand 12. This study estimated survey-weighed out-of-pocket (OOP) costs for prescription refills and total prescription expenditures. Propensity score matching was used to mitigate selection bias and health expenditures, and HRQoL were compared using the Mann-Whitney U-test. P-value thresholds were recalculated using Bonferroni adjustment (Total prescription expenditure or OOP, PCS, and MCS: p=0.017).

Results: Patients on GLP-1 RA alone had significantly higher OOP costs than those on SGLT2 inhibitor alone (median: $166.50 vs $81.00, p<0.01). No significant difference existed between the two treatments for total prescription expenditures (median: $9831.53vs. $9458.80, p=0.059), MCS (median:52.41 vs 53.48, p=0.40), or PCS (median: 45.22 vs 44.54, p=0.19). Patients on metformin with GLP-1 RA had higher OOP costs compared to those on SGLT2 inhibitor with metformin (median: $140.40 vs $107.33, p <0.01). There is a significant difference between the combination treatments for total prescription expenditure (median: $9453.96 vs $6711.47, p<0.01), MCS (median: 54.19 vs 54.30, p=0.70), or PCS (median: 45.69 vs 46.08, p=0.55).

Conclusion: Even though patients on GLP-1 RA have higher OOP costs, the difference in PCS or MCS scores between GLP-1 RA and SGLT2 inhibitor was not significant. Further investigation is needed to study the long-term impact on HRQoL and clinical outcomes.

Rhabdomyolysis is a pathophysiological process characterized by the destruction of muscle cells and the release of intracellular contents into the systemic circulation, which can lead to acute kidney injury (AKI) and failure. Causes are classified mainly as traumatic and non-traumatic, with statin-induced rhabdomyolysis being widely recognized. Other causes are seldomly reported, one being red yeast rice (RYR) or its active ingredient, monacolin K. We present a life-threatening case of fulminant rhabdomyolysis with severe hyperkalemia, accompanied by ECG changes, tetraparesis, impending compartment syndrome, and liver injury requiring intensive care treatment. Prompt renal replacement therapy was commenced, initially for the treatment of hyperkalemia and subsequently for myoglobin adsorption using the CytoSorb membrane. High doses of corticosteroids were administered as the trigger factor was initially unknown. The condition gradually improved, and the patient regained full functionality. The diagnosis of toxic rhabdomyolysis was confirmed only after the patient was discharged from the intensive care unit. An over-the-counter supplement containing red yeast rice (RYR) was identified as the sole possible triggering factor, with symptoms occurring two days after beginning the self-treatment.

Purpose: Vitamin B6 is a crucial water-soluble vitamin found in many foods and is involved in numerous physiological processes, including neurotransmitter synthesis and nervous system function. Although essential for overall health, both deficiency and excessive intake of vitamin B6 may lead to health complications, particularly peripheral neuropathy. This consensus statement aims to provide healthcare professionals with clear guidance on the safe and effective use of vitamin B6, focusing on its benefits, risks, recommended dosages, and treatment course.

Methods: This consensus statement was developed using a Delphi approach involving a panel of six experts from various medical specialties. This process includes a comprehensive literature review, two rounds of anonymous online surveys, and a virtual expert roundtable discussion. The GRADE approach was used to assess the quality of evidence for each recommendation.

Results: The expert panel reached consensus on five key statements. These key recommendations encompass the function of vitamin B6, complications due to vitamin B6 deficiency, dosage recommendations, adverse events, and monitoring guidance throughout the course of treatment. A washout period of 20-40 days for the complete clearance of vitamin B6 was calculated based on pharmacokinetic parameters. A clinical pathway for managing patients who might benefit from vitamin B6 treatment was proposed.

Conclusion: This consensus statement highlights the importance of recognizing the benefits and potential risks of vitamin B6. While the therapeutic dosage of vitamin B6 can be beneficial to treat deficiency, excessive intake can lead to adverse effects. This statement emphasizes the need for individualized patient care considering factors such as medical history, lifestyle, and potential drug interactions. Further research is needed to establish clearer dosage guidelines, understand the mechanisms of vitamin B6-induced neurological side effects, and optimize patient outcomes.

Background: The high prevalence of chronic diseases, workforce challenges, and growing polypharmacy adversely impact the quality use of medicines (QUM) and health outcomes in Saudi Arabia (SA). The SA Ministry of Health (MOH) has initiated several programs and policies to enhance QUM including a National Medication Safety Program, national clinical guidelines, and technology-based strategies.

Objective: To assess the published literature on the range, quality, and effectiveness of QUM methods in the SA health system.

Methods: Comprehensive search of electronic databases Scopus, Medline, and PubMed for papers reporting evaluation of QUM interventions or programs in SA.

Results: QUM programs involving medication reconciliation, interventions by hospital pharmacists, antibiotics stewardship, technology and staff training are the most commonly used programs reported in SA. Evaluations of several QUM interventions found a significant positive impact on health outcomes, prescribing patterns, chronic disease management, medication safety, and healthcare costs. Medication reconciliation programs reduced discrepancies by up to 20% in some studies. Hospital pharmacist interventions showed high acceptance rates (up to 92%) and improved medication safety. Antibiotic stewardship programs effectively reduced antimicrobial use and costs. Health information technology implementations like electronic health records (EHR), and computerized physician order entry (CPOE) showed mixed results but generally improved medication safety and efficiency. Staff training initiatives enhanced healthcare professionals' knowledge and skills in medication management.

Conclusion: While SA has national QUM policies and programs, and evidence that individual QUM interventions have significant positive local impact, more large-scale, multi-center studies are needed to provide a comprehensive view of QUM practices. More rigorous evaluations of existing programs and expansion of the range of QUM programs to align with international ones could further improve medication safety and patient outcomes in Saudi Arabia.