An Analysis of Incident Reports Related to Electronic Medication Management: How They Change Over Time.

OBJECTIVE: Electronic medication management (EMM) systems have been shown to introduce new patient safety risks that were not possible, or unlikely to occur, with the use of paper charts. Our aim was to examine the factors that contribute to EMM-related incidents and how these incidents change over time with ongoing EMM use. METHODS: Incidents reported at 3 hospitals between January 1, 2010, and December 31, 2019, were extracted using a keyword search and then screened to identify EMM-related reports. Data contained in EMM-related incident reports were then classified as unsafe acts made by users and the latent conditions contributing to each incident. RESULTS: In our sample, 444 incident reports were determined to be EMM related. Commission errors were the most frequent unsafe act reported by users (n = 298), whereas workarounds were reported in only 13 reports. User latent conditions (n = 207) were described in the highest number of incident reports, followed by conditions related to the organization (n = 200) and EMM design (n = 184). Over time, user unfamiliarity with the system remained a key contributor to reported incidents. Although fewer articles to electronic transfer errors were reported over time, incident reports related to the transfer of information between different computerized systems increased as hospitals adopted more clinical information systems. CONCLUSIONS: Electronic medication management-related incidents continue to occur years after EMM implementation and are driven by design, user, and organizational conditions. Although factors contribute to reported incidents in varying degrees over time, some factors are persistent and highlight the importance of continuously improving the EMM system and its use.

Stakeholder perspectives of system-related errors: Types, contributing factors, and consequences.

BACKGROUND: Despite growing evidence of the benefits of electronic medication management systems (EMMS), research has also identified a range of new safety risks linked with their use. There is limited qualitative research focusing on system-related errors that result from use of EMMS. The aim of this study was to explore in-depth stakeholders' perceptions and experiences of system-related errors. METHODS: Semi-structured interviews were conducted with EMMS users and other relevant staff (e.g. supporting roles in EMMS) across a local health district in Sydney, Australia. Analysis was conducted iteratively using a general inductive approach, and then mapped to Reason's accident causation model, where codes were categorized as 1) unsafe acts (i.e. what error occurred), 2) latent conditions (i.e. what factors contributed to errors), and 3) consequences resulting from the error. RESULTS: Twenty-five participants were interviewed between September 2020 and May 2021. Participants most frequently described omission errors (e.g. failure to check for duplicate orders) as unsafe acts, although commission errors and workarounds were also reported. Poor EMMS design was reported to be a significant workplace factor contributing to system-related errors, however participants also described user factors, such as an overreliance on the system, and organizational factors, such as system downtime, as contributing to errors. Reported consequences of system-related errors included medication errors, but also impacts to the EMMS and on workers. CONCLUSIONS: EMMS design is a significant contributor to system-related errors, but this research showed that user and organizational factors are also at play. As these factors are not independent, minimizing system-related errors requires a multi-faceted approach, where mitigation strategies target not only the EMMS, but also the context in which the system has been implemented.

Multimodal high-intensity interval training increases muscle function and metabolic performance in females.

High-intensity interval training (HIIT) is a time-efficient method of improving aerobic and anaerobic power and capacity. In most individuals, however, HIIT using modalities such as cycling, running, and rowing does not typically result in increased muscle strength, power, or endurance. The purpose of this study is to compare the physiological outcomes of traditional HIIT using rowing (Row-HIIT) with a novel multimodal HIIT (MM-HIIT) circuit incorporating multiple modalities, including strength exercises, within an interval. Twenty-eight recreationally active women (age 24.7 ± 5.4 years) completed 6 weeks of either Row-HIIT or MM-HIIT and were tested on multiple fitness parameters. MM-HIIT and Row-HIIT resulted in similar improvements (p < 0.05 for post hoc pre- vs. post-training increases for each group) in maximal aerobic power (7% vs. 5%), anaerobic threshold (13% vs. 12%), respiratory compensation threshold (7% vs. 5%), anaerobic power (15% vs. 12%), and anaerobic capacity (18% vs. 14%). The MM-HIIT group had significant (p < 0.01 for all) increases in squat (39%), press (27%), and deadlift (18%) strength, broad jump distance (6%), and squat endurance (280%), whereas the Row-HIIT group had no increase in any muscle performance variable (p values 0.33-0.90). Post-training, 1-repetition maximum (1RM) squat (64.2 ± 13.6 vs. 45.8 ± 16.2 kg, p = 0.02), 1RM press (33.2 ± 3.8 vs. 26.0 ± 9.6 kg, p = 0.01), and squat endurance (23.9 ± 12.3 vs. 10.2 ± 5.6 reps, p < 0.01) were greater in the MM-HIIT group than in the Row-HIIT group. MM-HIIT resulted in similar aerobic and anaerobic adaptations but greater muscle performance increases than Row-HIIT in recreationally active women.

Differential response of lymphatic, venous and arterial endothelial cells to angiopoietin-1 and angiopoietin-2.

BACKGROUND: The lymphatic system complements the blood circulatory system in absorption and transport of nutrients, and in the maintenance of homeostasis. Angiopoietins 1 and 2 (Ang1 and Ang2) are regulators of both angiogenesis and lymphangiogenesis through the Tek/Tie-2 receptor tyrosine kinase. The response of endothelial cells to stimulation with either Ang1 or Ang2 is thought to be dependent upon the origin of the endothelial cells. In this study, we examined the effects of the angiopoietins on lymphatic, venous and arterial primary endothelial cells (bmLEC, bmVEC and bmAEC, respectively), which were isolated and cultured from bovine mesenteric vessels. RESULTS: BmLEC, bmVEC and bmAEC cell populations all express Tie-2 and were shown to express the appropriate cellular markers Prox-1, VEGFR3, and Neuropilin-1 that define the particular origin of each preparation. We showed that while bmLECs responded slightly more readily to angiopoietin-2 (Ang2) stimulation, bmVECs and bmAECs were more sensitive to Ang1 stimulation. Furthermore, exposure of bmLECs to Ang2 induced marginally higher levels of proliferation and survival than did exposure to Ang1. However, exposure to Ang1 resulted in higher levels of migration in bmLECs than did to Ang2. CONCLUSION: Our results suggest that although both Ang1 and Ang2 can activate the Tie-2 receptor in bmLECs, Ang1 and Ang2 may have distinct roles in mesenteric lymphatic endothelial cells.