Utilising in situ simulation within translational simulation programmes to evaluate and improve multidisciplinary response to anaphylaxis in the paediatric emergency department.

OBJECTIVE: The prevalence of paediatric anaphylaxis is rising in Australia. Treatment requires timely administration of intramuscular (IM) adrenaline. Study goals included utilising in situ simulation (ISS) within a translational simulation (TS) programme as a diagnostic tool to identify the frequency and cause of IM adrenaline errors in a paediatric ED, and utilising ISS to evaluate multidisciplinary emergency team response to anaphylaxis. METHODS: A prospective observational study was conducted in the Royal Children's Hospital Melbourne ED utilising an ISS anaphylaxis scenario with a debrief pro forma within an established ISS/TS programme. RESULTS: Twenty-three anaphylaxis ISS were delivered over 16 months. One hundred and sixty-four multidisciplinary staff participated (mean of 8 per session). Median times (in minutes) for the total ISS were 12:33 (interquartile range [IQR] 9:06-15:19), consisting of the scenario 4:07 (IQR 3:33-4:44) and debriefing 9:00 (IQR 5-11). IM adrenaline was administered in all ISS within 5 min, median 2:57 (IQR 2:30-3:40). Adrenaline medication errors occurred in 30% ISS (7/23). Errors included three (13%) administrations and four (17%) potential or 'near misses' associated with a verbal order or medication preparation error. A weight-based medication cognitive aid was utilised in 56% (13/23) ISS but was not utilised in all three administration errors. CONCLUSIONS: ISS within TS programmes was successfully utilised as a diagnostic tool in identifying that medication errors were common during anaphylaxis management in the ED. Improving access to adrenaline in dosing boxes and promoting the utilisation of weight-based cognitive aids alongside ISS education will likely reduce errors and improve patient safety.

Efficacy and safety of front-line treatments for advanced Hodgkin lymphoma: a systematic literature review.

OBJECTIVE: To assess evidence on the safety and efficacy of ABVD (doxorubicin [Adriamycin®], bleomycin, vinblastine, and dacarbazine), BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), and A+AVD (brentuximab vedotin, with doxorubicin, vinblastine, and dacarbazine) for advanced-stage Hodgkin lymphoma (HL). METHODS: A systematic literature review (SLR) was conducted on 29 July 2016 (updated 26 July 2018) to identify randomized controlled trials (RCTs) and non-RCTs assessing the treatment of newly-diagnosed advanced-stage HL with ABVD and BEACOPP (and their variants), and A+AVD. RESULTS: The SLR identified 62 RCTs and 42 non-RCTs. Five-year overall survival rates for ABVD and BEACOPP were 60-97% and 84-99%, and 5-year progression-free survival rates were 58-81% and 83-96%, respectively. Both regimens were associated with tolerability issues and side effects. Discontinuation or dose reduction of bleomycin resulted in fewer adverse events, without significantly affecting efficacy. A head-to-head trial demonstrated improved efficacy for A+AVD vs ABVD, with an acceptable tolerability profile. No data from head-to-head trials comparing A+AVD with BEACOPP were available, and an indirect treatment comparison was not feasible. CONCLUSION: New therapies, such as A+AVD, maintain the efficacy observed with current treatments, and may provide a more tolerable treatment option for patients with advanced-stage HL.

Patient safety and interprofessional education: A report of key issues from two interprofessional workshops.

This article presents the outcomes of two workshops which explored historical and recent issues on patient safety that directly relate to leaders in the interprofessional field. The article considers the impact of flattened team-based structures where collaborative working constantly considers safe patient-centred high-quality care. These issues are mainly rooted in changes within a UK context, but the historical case studies present situations which could enlighten and enliven discussions of patient safety in an international context. The article was sparked by discussion of recurrent themes in healthcare that have undermined the abilities of medical practitioners to adequately manage hazard in clinical care settings throughout modern history. Examining the issues that confront healthcare practitioners and care workers in their dealings with patients and clients, such as the aged or the severely disabled, can reveal commonalities across global healthcare settings, in the past and present, that provide a useful tool in facilitating the goals of interprofessional education (IPE). The potential of IPE has links to both how professionals respond together to care situations and involve the general public in shared health understandings. The outcomes focus on how to ensure ministrations where optimal team-based collaborative care is recognised and constantly sought. We conclude that IPE has much to offer in this arena and more evidence of impact here is well worth pursuing.

Medication use and gender in Massachusetts: results of a household survey.

In this study, we investigate the extent to which women and men differ in patterns of medication use, based on quantitative and qualitative data from a household survey in Western Massachusetts. Using a broad definition of medications, 96% of the sample reported taking one or more medications in the month preceding the survey (86% if vitamins, supplements, and alternative medications are excluded). Twenty-one percent of respondents reported taking five or more medications, and women were significantly more likely to report taking five or more medications in the month preceding the survey. For both sexes, analgesics and vitamins were the most commonly used medications, but women were more likely to report having taken hormones, supplements, and antihistamines. The likelihood of medicating reported health conditions did not differ by sex, but the frequency of reporting health conditions was higher among women, and the difference was significant for body aches and psychosomatic conditions. Analyses of qualitative data indicate that female networks of relatives and friends are an important source of advice on medications for both men and women. Responses to open-ended questions suggest that women's discourse about the effect of medications differs from men's in terms of the range and detail of descriptions of symptoms and side effects.

Determinants of hot flashes and night sweats.

PRIMARY OBJECTIVE: The purpose of this study was to identify determinants of hot flashes and night sweats, two vasomotor symptoms associated with the hormonal changes of the menopause transition. METHODS: Participants were 293 women, aged 45 to 55, randomly selected from automated demographic and membership records of a health maintenance organization in the northeast USA. Letters were mailed to eligible women, followed by face-to-face interviews. RESULTS: Hot flashes during the month before interview were reported by 57% of the participants, although only 9% of the entire sample reported hot flashes to be "bothersome". Night sweats were reported by 36% of all participants, with 6% reporting night sweats to be "bothersome". Fifty-four percent of women reporting hot flashes also reported night sweats. In logistic regression analyses that controlled for menopause status and use of hormone therapy (HT), daily alcohol consumption significantly increased the risk of hot flashes, night sweats, and bothersome night sweats. Higher education and an excellent self-rating of health decreased the risk of night sweats, but not hot flashes. Smoking increased the risk of bothersome hot flashes, but not bothersome night sweats. CONCLUSIONS: In logistic regression analyses, alcohol consumption was a significant predictor of vasomotor symptoms. A slightly different set of variables were associated with hot flashes compared to night sweats.

The menopause in Spain: results of the DAMES (Decisions At MEnopause) study.

OBJECTIVE: To assess the symptomatology of menopause and the use of hormone therapy among women in Spain. METHODS: A survey conducted on a representative sample of 300 women aged 45-55 in Madrid. The instrument included closed- and open-ended questions about demographic and socio-economic information, health and reproductive history, symptoms in past month, use of health services, life style, and therapeutic decisions. RESULTS: Eighty-three percent of respondents report five or more symptoms. Joint pains, weight gain, mood changes and nervousness are the most frequently reported; just under half of respondents report hot flashes; 4/5 report emotional/mental symptoms. The frequencies of some symptoms vary with socio-economic status. Two-thirds of respondents have consulted physicians, and 10% are currently taking hormone therapy; the use of hormone therapy is lower among women from the lower strata. One-fifth of respondents use of nonconventional and alternative medications. Just under half of respondents find that menopause is difficult. CONCLUSION: Symptom reporting is relatively high, but general symptoms are more frequent than "core" menopausal symptoms. The use of hormone therapy is relatively low, but the use of alternative medicines is relatively high.

Therapeutic decisions for menopause: results of the DAMES project in central Massachusetts.

OBJECTIVE: To investigate the factors that influence therapeutic decisions at menopause, particularly those related to the burden of menopause symptoms, in a population of women living in Massachusetts, as part of the multisite DAMES (Decisions At Menopause Study). DESIGN: A survey using face-to-face interviews with a randomly selected sample of 293 women aged 45 to 55 who are members of the Fallon Community Health Plan in Central Massachusetts. The instrument combined closed- and open-ended questions and elicited information about a number of health topics, including the symptoms experienced by respondents over the preceding month and the decisions they made regarding therapies. RESULTS: Symptom reporting was found to be relatively high, with more than half of the sample reporting hot flashes, sleep disturbances, joint pains, and headaches in the month preceding the survey; one third to one half of the women reported palpitations, night sweats, fatigue, and numbness. The highest frequency of symptoms occurred during perimenopause. Nearly four fifths of the women consulted a healthcare provider, and one fifth used hormone therapy. More than half of the respondents said menopause is a difficult phase, and about half found decisionmaking about it to be difficult. CONCLUSIONS: This study documents a relatively heavy burden of symptoms in a relatively healthy population and provides an update on earlier studies in Massachusetts.

Gender and medication use: an exploratory, multi-site study.

OBJECTIVE: This comparative study in four countries was designed to explore differences in women's and men's patterns of medication use. METHODS: A total of 539 individuals, 303 women and 236 men, aged 15 years and older, were interviewed in Mexico, the Philippines, Uganda, and the US. Country-specific variables and codes adapted questions and answers to local contexts, and the instrument alternated between closed- and open-ended questions. RESULTS: In all sites, women reported using medications more frequently than men. Differences in reported use between women and men over the month preceding the survey were significant in Mexico and Uganda, but not in the two countries with the highest medication use, the Philippines and the USA. Gender differences are explained in part by differences in the frequencies with which major symptoms/conditions are reported, as women were generally more likely to report these conditions then men, but not more likely to treat symptoms or conditions with medications. This analysis also found gendered patterns of communication and information about health: women are central to the process of communication about health and therapies and they appear to draw on a richer repertoire of knowledge, perceptions and attitudes regarding medications. CONCLUSIONS: This study documents differences in patterns of medication use, with women reporting higher use than men overall. It also finds gendered patterns of use, manifested in information and perceptions surrounding medications.