INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE最新文献

Background: Healthtech has become a nascent sector of the internet economy since the emergence of the COVID-19 pandemic in 2020. Telemedicine features are facilitated, such as teleconsultation, e-diagnosis, e-prescribing, and e-pharmacy. However, the intention to use digital health services in Indonesia is still underdeveloped though the sales of other risk-free e-commerce products are high enough.

Objective: This study aims to assess the human perception of perceived value and social influences regarding the intention to use digital health services.

Methods: Google Forms web link is employed to disseminate a set of 4-Point Likert scale questionnaires. In total, 364 complete responses are collected. A descriptive approach is employed to process the data using Microsoft Excel and SPSS software. Validity and reliability are quantified using the item total-correlation method and Cronbach's Alpha coefficient.

Results: Only 87 respondents (24%) ever used digital health services, of which Halodoc (92%) is the most preferred application, and teleconsultation became the most popular service to access. Out of four, the average score is 3.16 for perceived value and 2.86 for the social influence dimension.

Conclusion: Most respondents, not dependent on user experience, perceive more values obtained using digital health services, such as time and money savings, convenience, flexible order time, undiscovered identity, adventurous experience, and enjoyment. Another finding of this research proves that some social influences from family, friends, and mass media also bring effect to amplify the intention to use. A low level of trust is assumed to be the cause of a small number of users.

Background: Pharmacovigilance risk signals have proposed a relationship between the use of acid-suppressive medications and the development of certain autoimmune and immune-mediated inflammatory diseases.

Objective: A systematic review and a meta-analysis was performed.

Methods: We reviewed MEDLINE (Ovid) and Scopus for comparative observational studies between these diseases and previous exposure to proton-pump inhibitors (PPI), H2-receptor antagonists (H2RA), and antacids. The protocol was registered on the PROSPERO database (CRD42020192715).

Results: From 3,191 citations, 25 articles were eligible and covered 16 diseases. Microscopic colitis (MC) was studied the most (7 studies). In a random-effects meta-analysis, there was low certainty evidence (GRADE approach) of a non-significant relationship between exposure to any PPIs and MC (meta-OR 3.28, 95% CI 0.98-11.0, I2 98.2%, six studies, 4,436 PPI-exposed MC patients). Moderate certainty evidence pointed towards large odds of collagenous colitis after exposure to lansoprazole (meta-OR 14.5, 95% CI 9.37-22.3, I2 10.2%, three studies, 1,725 lansoprazole-exposed patients). After PPI exposure, the risk of rheumatoid arthritis was slightly increased based on low certainty evidence from two cohort studies totaling 475 diagnoses (meta-RR 1.62, 95% CI 1.12-2.34, I2 34.5%).

Conclusions: In patients with MC, it would be reasonable to carefully review the indication of PPI, especially in CC patients using lansoprazole.

Background: Renal transplant patients receive several drugs concomitantly.

Objective: Limited literature exists evaluating the drug use in this population that is at high risk for drug-induced acute kidney injury and complications due to under-or over-dosage of immunosuppressant drugs due to drug-drug interactions.

Methods: A retrospective observational study was carried out in 269 renal transplant patients in whom either oral or parenteral drugs were evaluated. World Health Organization (WHO) indicators of drug utilization such as the average number of drugs prescribed, daily defined dose, and proportion of drugs listed as WHO essential drugs were evaluated. Details on the drugs with nephrotoxic potential were obtained. Drug-drug interactions were assessed concerning the severity (major, moderate, and minor) as well as type (pharmacokinetic, pharmacodynamic, and toxicity).

Results: One-hundred and ninety-eight drugs were administered to the study participants. The median (range) total number of drugs received by the study participants was 23 (6-55). The proportion of drugs listed in the WHO essential drug database was 57.1 (16.7-100)%. Forty-six drugs with potential nephrotoxicity and seven drugs that were contra-indicated in patients with chronic renal disease/end-stage renal disease were administered to the study participants. The mean (SD) numbers of drug interactions observed amongst the study participants were 18.4 (10.1). Age (β: 0.2, 95% CI: 0.1, 0.3) and duration of renal transplantation (β: -0.3, 95% CI: -0.5, -0.1) were the significant predictors of drug burden. A total of 645 drug interactions were identified amongst the study participants (major - 240; moderate - 270; and minor - 135) of which the majority were pharmacokinetic followed by toxicity risk. Age was significantly associated with the risk of potential drug interaction (OR: 2.6, 95% CI: 1.8, 12.4; p = 0.001).

Conclusion: Drug treatment in renal transplant patients poses a significant burden in terms of nephrotoxicity potential and drug-drug interactions. A dedicated ambulatory clinical pharmacy service monitoring the drug use coupled with drug deprescribing strategies are the need of the hour in this population.

Background: Transdermal drug delivery has contributed positively to medical practice. However, prescriptions that do not meet minimum quality criteria and medication errors are common.

Objective: The objective was to determine how transdermal patches are being prescribed to a group of patients in Colombia, the compliance with established requirements of such prescriptions and the comparisons between correct and incorrect prescriptions.

Methods: This was a cross-sectional study of prescriptions for transdermal patches using data from a population-based drug dispensing database between December 1 and 31, 2019. Medical prescriptions were randomly reviewed, establishing whether the drugs were appropriately prescribed by the manufacturer's indications or national regulations. Descriptive and bivariate analysis was performed.

Results: A total of 415 prescriptions were reviewed; the prescription was provided to 412 patients with a median age of 76.9 years, and 63.3% were women. Rivastigmine was the most prescribed transdermal patch (57.8%). 66.3% of all prescriptions did not meet the minimum appropriate prescribing standards, especially those for rivastigmine (97.1%). The 7.0% of all prescriptions had posology errors, especially prescriptions for buprenorphine (43.8%). Older patients (84.4% vs 52.5%), from the Pacific region (34.4% vs 23.7%), with manual formulations (22.1% vs 0.8%), dementia (49.0% vs 6.8%), and in management with lipid-lowering drugs (41.8% vs 30.5%), presented incorrect transdermal patch formulations more frequently (p < 0.05).

Conclusion: The high proportion of inappropriately prescribed transdermal patches should draw the attention of those responsible for health care to improve the training of physicians and create prescription quality verification systems.

Background: Nurses, who are the last safeguard against and have the final opportunity to prevent medication errors (MEs), play a vital role in patient safety by managing medications.

Objective: This study described the characteristics of medical dispute cases, medication information, and stage and types of MEs in Korea.

Methods: We performed a descriptive analysis of 27 medical dispute cases related to MEs in nursing care in Korea.

Results: Around 77.7% of patients suffered serious harm or died due to MEs in this study. The types of medications included anxiolytics and analgesics, and 51.9% of them were high-alert medications. Among cases of administration errors, failure to patient assessment before and after administration was the most common error followed by administering the wrong dose.

Conclusion: Nurses should perform their duties to ensure safety and improve the quality of nursing care by monitoring patients after administering medications and should be prepared to take quick action to reduce harm.

Background: Dentists using dental amalgam are chronically exposed to low doses of elemental mercury. The complex toxico-kinetics of this systemic toxicant results in polymorphic and variable clinical phenotypes. In this context, adapted statistical methods are required to highlight potential adverse effects of occupational mercury exposure on dentists' health.

Objective: The present study aims to analyze the distribution of self-reported subjective symptoms, commonly associated with chronic mercury poisoning, according to occupational mercury exposure in a population of Moroccan liberal dentists.

Methods: In order to achieve the defined objectives, a three-step latent class regression was fitted. First a latent class analysis was performed to cluster the studied population according to their declared symptoms. Dentists were then classified in the defined latent classes based on their posterior probabilities. Finally, a logistic regression is fitted to identify predictors associated with the latent classes' membership.

Results: The final obtained model showed acceptable calibration and discrimination. Its interpretation revealed that the increase of the frequency of amalgam use was associated with significant higher odds of belonging to the high risk latent class.

Conclusions: The present study represents an initial step towards the development of diagnosis model that predict clinical profiles according to occupational mercury exposure.