INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE最新文献

BackgroundMachine learning approaches for the prediction of antimicrobial resistance (AMR) are gaining attention but are yet to be commonly applied in practice.ObjectiveThis study aims to predict the AMR in surgical intensive care unit patients using logistic regression (LR) and artificial neural network (ANN) model.MethodsSurgical ICU patients with resistant infections, regardless of the microorganism, were considered cases. Those with susceptible or no infections were considered controls. A total of 104 variables for patient characteristics, disease-related and clinical parameters, and surgical, culture, and prescription details were tested for the prediction of AMR using two methods: LR and ANN. The dataset was divided into a training (n = 3179) and a test (n = 1363) set. The outcome was considered a binary outcome: resistant infection and sensitive infection. Model evaluation metrics were an area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Predictive analysis was performed by using R software.ResultsOut of 8010 ICU patients, 4542 patients underwent surgery. Out of these surgical ICU patients, 36.90% were cases and 63.09% were controls. Both models performed similarly concerning sensitivity (ANN 86.6%; LR 86%), while improvement was found with respect to accuracy (ANN 88.2%; LR 86%), specificity (ANN 91.2%; LR 86%), AUROC (ANN 94%; LR 93%), and NPV (ANN 82.8%; LR 91%).ConclusionsThe ANN model has more predicting performance than the LR model to predict AMR in surgical ICU patients. These prediction algorithms may assist clinical decisions to aid the prevention of AMR.

Background and ObjectiveThe rapid proliferation of mobile technology has intensified debates on the potential adverse effects of non-ionizing electromagnetic radiation (NIER) from mobile phones on various human organs and cells. This study aimed to evaluate the impact of mobile phone-emitted NIER on parotid gland function.MethodologyThis cross-sectional study included 104 student volunteers from the University campus, categorized based on their mobile phone usage and exposure duration. Saliva samples were collected from the dominant (test) and non-dominant (control) sides. Key metrics measured were salivary flow rate, pH, albumin, Ischemia-Modified Albumin (IMA), and the IMA/albumin ratio (IMAR). Data analysis was performed using one-way ANOVA and Fisher's LSD multiple comparisons, with p ≤ 0.05 considered statistically significant.ResultsThe salivary flow rate and pH were higher on both sides in all groups, correlating with increased mobile phone usage duration. Although albumin levels were lower on the dominant side, they increased with longer mobile phone use. Salivary IMA and IMAR were higher on the dominant side in subjects using mobile phones for ≤3 years compared to those using them for >3 years.Interpretation and ConclusionConsistent exposure to NIER and the heat generated by mobile phones adversely affects parotid gland function, as indicated by increased salivary flow rate, pH, and altered levels of albumin, IMA, and IMAR. Public health recommendations should encourage reducing long-duration conversations and using earphones to minimize NIER exposure. Further studies are needed to evaluate the long-term effects of NIER on parotid gland function.

BackgroundSevere finger infections requiring emergency department (ED) attention are common occurrences resulting from many common household items.ObjectiveThe purpose of this study was to identify U.S. trends and the nature of ED visits due to infected finger injuries using reports in the National Electronic Injury Surveillance System (NEISS).MethodsNEISS data from 2019 to 2023 were analyzed for cases of finger infections. The data were compared by sex, race, location of injury, and year of infection with the type of infection. Chi square analyses and logistic regression tests were conducted.ResultsThere were 1816 infections with a yearly incidence rate of 4.3/100,000. Males had 58.4% of finger infections needing an ED visit; those ages ≥36 years were more likely to have a finger infection (62.5%). The trend for the 5 years was not significant (p = 0.1048). Paronychias were the most common type of finger infection and manicure items were the most common cause of paronychias.ConclusionParonychias continue to be the most prevalent finger infection. Efforts are needed to improve awareness toward prevention and early intervention to reduce finger infection incidence.

BackgroundAnagen effluvium is described as abrupt hair loss during the anagen phase due to reduced follicular mitotic activity. Chemotherapeutic medicines, toxic metals, and sporadically bismuth, levodopa, colchicine, and cyclosporine are often implicated in etiology. Plica polonica is a rare disorder that develops when the scalp hair mats completely and abruptly, resulting in an extended stiff mass of hair that resembles dreadlocks.ObjectiveWe are describing this case because it is unusual to see plica polonica linked with azathioprine-induced pancytopenia in the literature and since the source of the condition was cuticular damage to the hair shaft as a result of the medication rather than carelessness or excessive bathing of the patient's hair.Case descriptionA 32-year-old female presented to the dermatology outpatient department with vitiligo over bilateral forearm and lips for 6 months. She was started on azathioprine 50 mg daily for the past 1 month, and then she complained of sudden onset of extensive hair loss on attempting to comb her hair associated with matting of rest of uncombable hairs, multiple oral ulcers, and mild grade fever for 15 days. The possibility of systemic lupus erythematosus and azathioprine-induced anagen effluvium and neutropenic ulcers was thought.ResultsWe started on injectable granulocyte colony-stimulating factor for 3 days, and antibiotics and antifungals for 1 week. Improvement in clinical (oral ulcers, fever) and hematological profiles were noted.ConclusionAlthough azathioprine is not often associated with the development of anagen effluvium, it is probable that the patient's abrupt pancytopenia caused damage to the hair shaft, which resulted in hair loss, and cuticular damage to the hair shaft, which led to the formation of Plica.

BackgroundPharmacovigilance is a global effort to protect patients and public health by detecting and responding to adverse drug reactions (ADRs). However, underreporting is a major obstacle in reporting ADRs. An effective reporting culture is one way to overcome the challenges in ADR reporting.ObjectivesThis study aimed to determine the factors affecting the patient safety culture related to adverse drug reaction reporting among healthcare professionals in a public hospital in Indonesia.MethodsThis observational cross-sectional study was conducted by Dr. R. Soedjono Selong Hospital, East Lombok, Indonesia. Data were collected using the Hospital Survey on Patient Safety Culture 2.0, conducted by the Agency for Healthcare Research and Quality, and a researcher-developed questionnaire.ResultsAmong the 238 healthcare professionals who responded, 60.9% had previously reported ADRs. Age, education, working period, knowledge, perception, facilities, policies, and environment were significantly associated with patient safety culture and ADR reporting. The working period and age emerged as the most influential factors in patient safety culture and ADR reporting, respectively.ConclusionAge, education, working period, knowledge, perception, facilities, policy, and environment significantly affected the patient safety culture and ADR reporting.

BackgroundThe use of rational and safe antibiotic therapies for pregnant women remains an important issue within the medical community.ObjectiveTo analyze the preferences in the choice of antimicrobial drugs (AMD) among obstetricians-gynecologists of Central Russia in treatment of infectious diseases in pregnancy.MethodsThis is anonymous survey of obstetrician and gynecology specialists conducted in Central Russia between September 1st, and November 30th, 2017. Study included five healthcare facilities (ambulatory and in-patient), located in regional center, city Belgorod. Questionnaire contained six open-ended questions to evaluate AMD preferences in treatment of Chlamydia trachomatis, Mycoplasma hominis or genitalium, Ureaplasma species, acute cystitis, pyelonephritis, and other conditions, such as placental insufficiency, fetal growth restriction. Descriptive statistics was used including absolute and relative frequencies, minimum and maximum values, mean, frequency of prescribing AMD, and their proportion in the total number prescribed.ResultsA total of 52 responses were included in final analysis. There was significant rate of 15.4% of prescribing pregnancy unsafe (fluoroquinolones, tetracyclines) or non-rational AMD or deviation from existing clinical protocols and guidelines.ConclusionsThere were large variations in provider's AMD preference between healthcare facilities.

BackgroundMany reports on the impact of vaccination on COVID-19 pandemic deaths were projections undertaken as the global emergency was unfolding. An increasing number of independent investigators have drawn attention to the subjective nature and inherent biases in mathematical models used for such forecasts that could undermine their accuracy when excess mortality was the metric of choice.ObjectiveCOVID-19 deaths were compared between the pre-vaccines and vaccination eras to observe how vaccination impacted COVID-19 death trajectory worldwide during the pandemic emergency.MethodsCOVID-19 cases, deaths and vaccination rates in World Health Organization (WHO) database till 07 June 2023, Case fatality rate per 1000 for the pre-vaccines period (CFR1), and that over vaccination era (CFR2) were compared for all WHO regions, while tests of correlation between the percentage change in COVID-19 deaths and variables of interest were examined.ResultsCOVID-19 deaths increased with vaccination coverage ranging from 43.3% (Africa) to 1275.0% (Western Pacific). The Western Pacific (1.5%) and Africa (3.8%) regions contributed least to the global cumulative COVID-19 deaths pre-vaccines, while the Americas (49.9%) and Europe (27.6%) had the highest counts. The Americas (39.8%) and Europe (34.1%) accounted for >70% of global COVID-19 deaths despite high vaccination, and the percentage increase in COVID-19 mortality and the percentage of person's ≥65 years were significantly correlated (0.48) in Africa.ConclusionCOVID-19 mortality increased in the vaccination era, especially in regions with higher vaccination coverage.

BackgroundStevens-Johnson syndrome (SJS), a rare and severe toxic epidermal necrolysis, is reported here for the first time at the University Hospital Center of Libreville (CHUL), suspected to be related to fluconazole administration.ObjectiveTo inform clinicians about the risks associated with fluconazole in immunocompromised patients and the related healthcare expenses.Case presentationThe patient is a 39-year-old immunocompromised woman who received a single dose 400 mg of fluconazole. Two weeks later, she developed a rash affecting approximately 10 % of her body surface, confirmed as SJS. During clinical examinations, no signs of infection, such as fever, dizziness, or chills, were present, suggesting a drug-induced SJS reaction.ResultsCausality assessment assigned an intrinsic score of I6 and extrinsic score of B2 according to the French method, and a probable temporal relationship was confirmed using the world Health Organization (WHO) method. The ALDEN scale identified fluconazole as the probable cause (score = 4). No additional risk factors were identified (SCORTEN = 0, predicted mortality: 3.2 %). Economically, the total direct medical cost of hospitalization amounted to 605,700 CFA francs, or 923.38 €.ConclusionImmunocompromised HIV-positive patients treated with 400 mg of fluconazole are likely to develop SJS and incur costs.

BackgroundPatients with atrial fibrillation often require anticoagulation therapy to prevent stroke and thromboembolism. However, anticoagulants can have serious side effects, such as bleeding, particularly when combined with antiplatelet therapy.ObjectiveThe aim of this study is to estimate the prevalence of major bleeding in patients receiving either dual or triple antithrombotic therapy.MethodThis study is a single-center retrospective chart review utilizing the hospital electronic health record. The prevalence and percentage of bleeding events were reported for each antithrombotic regimen.ResultsOf the 539 patients receiving oral anticoagulants, 202 were using oral anticoagulants in combination with either single or dual antiplatelet therapy. Out of 35 patients using triple antithrombotic therapy, four (11.4%) experienced major bleeding. Based on the analysis of 73 patients using anticoagulants in combined with clopidogrel, the results showed that one patient (1.3%) suffered bleeding. Among the 94 patients treated with anticoagulants plus aspirin, seven (7.4%) experienced major bleeding events.ConclusionThe combination of anticoagulants and antiplatelet agents is associated with an elevated bleeding risk. Patients receiving triple antithrombotic therapy experience high prevalence of bleeding. Nonetheless, the group receiving anticoagulant and clopidogrel alone exhibited low prevalence of bleeding risk.

BackgroundEnsuring the quality of pharmaceutical products is essential for effective healthcare delivery. Good storage practices (GSPs) play a crucial role in maintaining drug integrity and safety.ObjectivesThis study aimed to evaluate the adherence of Syrian drug import warehouses to GSP and identify key factors influencing compliance.MethodsA mixed-methods research design was employed, involving questionnaires and observations of drug import warehouses in Syria. Data were collected from June to August 2022. The first questionnaire assessed the reality of applying GSP, while the second explored perceived benefits and obstacles. The majority of respondents (>80%) had at least 6 years of working experience in the drug warehouse field.ResultsTwenty-three public and private warehouses participated out of the 26 warehouses that were the subject of our study (88%). The study found that in Syria, a significant difference has been detected between existing requirements in drug import warehouses and the needed requirements for the successful implementation of GSP (p = 0.000). Key constraints to GSP implementation included a lack of a quality-oriented culture among warehouse owners (100%) and inadequate equipment (87%). Regarding the benefits of GSP application, respondents identified ensuring the quality of sensitive products (100%) and reducing waste and damage (96%) as the most important.ConclusionsTo enhance GSP adherence, warehouses should prioritize staff training, adopt electronic data loggers, secure fuel for generators, obtain GSP certificates, and raise public awareness. Government agencies and international organizations should support these efforts and provide financial incentives.