Interprofessional education focused on medication safety: a systematic review.

Safe medication use necessitates interprofessional working, with calls to enhance interprofessional education (IPE) focusing on medication safety (MS) in healthcare professional (HCP) curricula. Little is known about the design, delivery or evaluation of such activities. This systematic literature review describes MS-focused IPE activities in pre-qualification HCP programmes. MedLine, EMBASE, CINAHL and ERIC were searched, relevant studies identified and data extracted. The McGill Mixed Methods Appraisal Tool was employed. The 3P (presage-process-product) theory structured deductive analysis. Thirty-one studies were included, reporting on 30 activities, mostly undertaken in North America or United Kingdom. Presage/Design: Most reported activities involved pharmacy, nursing, medical or physician assistant students learning with one or more other HCP group. Few studies matched student groups' skills or experiences. Few studies reported theoretical underpinnings. Process/Delivery: Multiple pedagogical approaches were employed, mostly social construction, and low- and high-fidelity simulation-based learning. Few studies reported learning outcomes or summative assessment, more reported formative assessment. Product/evaluation: Outcomes measured were learners' opinions, satisfaction or attitudes toward interprofessional working and findings were generally positive. Few studies reported on student development or outcomes specific to medication safety. Lack of integration of qualitative/quantitative components of mixed methods studies and limited outcome measurements' validity or reliability weakened study quality. MS-focused IPE for pre-qualification HCPs is well received by students. Design of future activities could be enhanced by employing theory and ensuring matching of students' and groups' skills, professional identity and learner attributes to enhance learning in an interprofessional setting. Future delivery should embed MS-focused IPE into the standard curricula to optimize constructive alignment, learner engagement, quality and drive development. The required skillset in pre-qualification HCP programmes to facilitate future safe medication practice, together with the associated learning outcomes and assessment approaches, should be defined. The quality of scholarly studies examining these activities needs improvement.

Agreement between renal prescribing references and determination of prescribing appropriateness in hospitalized patients with chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) is a risk factor for adverse drug events. The clinical significance of discordance between renal prescribing references is unknown. AIM: We determined the prevalence of potentially inappropriate prescribing (PIP) in CKD, measured agreement between two prescribing references, and assessed potential for harm consequent to PIP. DESIGN: Single-centre observational study. METHODS: A random sample of hospitalized patients with CKD were grouped according to baseline CKD stage (3, 4, or 5). Prescriptions requiring caution in CKD were referenced against the Renal Drug Handbook (RDH) and British National Formulary (BNF) to identify PIP (non-compliance with recommendations). Inter-reference agreement was measured using percentage agreement and Kappa coefficient. Potential for harm consequent to PIP was assessed by physicians and pharmacists using a validated scale. One-year mortality was compared between patients with or without PIP during admission. RESULTS: Among 119 patients (median age 73 years, 50% male), 136 cases of PIP were identified in 78 (65.5%) patients. PIP prevalence, per patient, was 64.7% using the BNF and 28.6% using the RDH (fair agreement, Kappa 0.33, P < 0.001). The majority (63.2%) of PIP cases detected exclusively by the BNF carried minimal or no potential for harm. PIP was not significantly associated with one-year mortality (34.7% vs. 21.1%, P = 0.14). CONCLUSIONS: PIP was common in hospitalized patients with CKD. Substantial discordance between renal prescribing references was apparent. The development of universally-adopted, evidence-based, prescribing guidelines for CKD might optimize medications safety in this vulnerable group.

Reevaluation of Neptunium-Nitric Acid Radiation Chemistry by Multiscale Modeling.

Multiscale modeling has been used to quantitatively reevaluate the radiation chemistry of neptunium in a range of aerated nitric acid solutions (0.1-6.0 mol dm-3). Exact calculation of initial radiolytic yields accounting for changes in radiation track chemistry was found to be crucial for reproducing experimental data. The γ irradiation induces changes in the Np(VI)/Np(V) oxidation-state distribution, predominantly driven by reactions involving HNO2, H2O2, NO2•, and NO3• from the radiolysis of aqueous nitric acid. Oxidation of Np(V) by NO3• (k = 8.1 × 108 dm3 mol-1 s-1) provides the initial increase in Np(VI) concentration, while also delaying net reduction of Np(VI) by consuming HNO2. Reduction of Np(VI) is dominated by thermal reactions with HNO2 (k = 0.7-73 dm3 mol-1 s-1) and H2O2 (k = 1.9 dm3 mol-1 s-1). A steady state is eventually established once the concentration of Np(V) is sufficiently high to be oxidized by NO2• (k = 2.4 × 102-3.1 × 104 dm3 mol-1 s-1). An additional thermal oxidation reaction between Np(V) and HNO3 (k = 2.0 × 103 dm3 mol-1 s-1) is required for nitric acid concentrations >4.0 mol dm-3. For 0.1 mol dm-3 HNO3, the rate of Np(VI) reduction is in excess of that which can be accounted for by radiolytic product mass balance, suggesting the existence of a catalytic-acid-dependent reduction process.

Relative accuracy and availability of an Irish National Database of dispensed medication as a source of medication history information: observational study and retrospective record analysis.

WHAT IS KNOWN AND OBJECTIVE: The medication reconciliation process begins by identifying which medicines a patient used before presentation to hospital. This is time-consuming, labour intensive and may involve interruption of clinicians. We sought to identify the availability and accuracy of data held in a national dispensing database, relative to other sources of medication history information. METHODS: For patients admitted to two acute hospitals in Ireland, a Gold Standard Pre-Admission Medication List (GSPAML) was identified and corroborated with the patient or carer. The GSPAML was compared for accuracy and availability to PAMLs from other sources, including the Health Service Executive Primary Care Reimbursement Scheme (HSE-PCRS) dispensing database. RESULTS: Some 1111 medication were assessed for 97 patients, who were median age 74 years (range 18-92 years), median four co-morbidities (range 1-9), used median 10 medications (range 3-25) and half (52%) were male. The HSE-PCRS PAML was the most accurate source compared to lists provided by the general practitioner, community pharmacist or cited in previous hospital documentation: the list agreed for 74% of the medications the patients actually used, representing complete agreement for all medications in 17% of patients. It was equally contemporaneous to other sources, but was less reliable for male than female patients, those using increasing numbers of medications and those using one or more item that was not reimbursable by the HSE. WHAT IS NEW AND CONCLUSION: The HSE-PCRS database is a relatively accurate, available and contemporaneous source of medication history information and could support acute hospital medication reconciliation.

Survey of medication documentation at hospital discharge: implications for patient safety and continuity of care.

BACKGROUND: Medication discrepancies at the time of hospital discharge are common and can result in error, patient/carer inconvenience or patient harm. Providing accurate medication information to the next care provider is necessary to prevent adverse events. AIMS: To investigate the quality and consistency of medication details generated for such transfer from an Irish teaching hospital. METHODS: This was an observational study of 139 cardiology patients admitted over a 3 month period during which a pharmacist prospectively recorded details of medication inconsistencies. RESULTS: A discrepancy in medication documentation at discharge occurred in 10.8% of medication orders, affecting 65.5% of patients. While patient harm was assessed, it was only felt necessary to contact three (2%) patients. The most common inconsistency was drug omission (20.9%). CONCLUSIONS: Inaccuracy of medication information at hospital discharge is common and compromises quality of care.

Dynamics of viral and proviral loads of feline immunodeficiency virus within the feline central nervous system during the acute phase following intravenous infection.

Animal models of human immunodeficiency virus 1, such as feline immunodeficiency virus (FIV), provide the opportunities to dissect the mechanisms of early interactions of the virus with the central nervous system (CNS). The aims of the present study were to evaluate viral loads within CNS, cerebrospinal fluid (CSF), ocular fluid, and the plasma of cats in the first 23 weeks after intravenous inoculation with FIV(GL8). Proviral loads were also determined within peripheral blood mononuclear cells (PBMCs) and brain tissue. In this acute phase of infection, virus entered the brain in the majority of animals. Virus distribution was initially in a random fashion, with more diffuse brain involvement as infection progressed. Virus in the CSF was predictive of brain parenchymal infection. While the peak of virus production in blood coincided with proliferation within brain, more sustained production appeared to continue in brain tissue. In contrast, proviral loads in the brain decreased to undetectable levels in the presence of a strengthening PBMC load. A final observation in this study was that there was no direct correlation between viral loads in regions of brain or ocular tissue and the presence of histopathology.

Fibrinogen is an important determinant of the metastatic potential of circulating tumor cells.

Detailed studies of tumor cell-associated procoagulants and fibrinolytic factors have implied that local thrombin generation and fibrin deposition and dissolution may be important in tumor growth and dissemination. To directly determine whether fibrin(ogen) or plasmin(ogen) are determinants of the metastatic potential of circulating tumor cells, this study examined the impact of genetic deficits in each of these key hemostatic factors on the hematogenous pulmonary metastasis of 2 established murine tumors, Lewis lung carcinoma and the B16-BL6 melanoma. In both tumor models, fibrinogen deficiency strongly diminished, but did not prevent, the development of lung metastasis. The quantitative reduction in metastasis in fibrinogen-deficient mice was not due to any appreciable difference in tumor stroma formation or tumor growth. Rather, tumor cell fate studies indicated an important role for fibrin(ogen) in sustained adhesion and survival of tumor cells within the lung. The specific thrombin inhibitor, hirudin, further diminished the metastatic potential of circulating tumor cells in fibrinogen-deficient mice, although the inhibitor had no apparent effect on tumor cell proliferation in vitro. The absence of plasminogen and plasmin-mediated fibrinolysis had no significant impact on hematogenous metastasis. The authors concluded that fibrin(ogen) is a critical determinant of the metastatic potential of circulating tumor cells. Furthermore, thrombin appears to facilitate tumor dissemination through at least one fibrin(ogen)-independent mechanism. These findings suggest that therapeutic strategies focusing on multiple distinct hemostatic factors might be beneficial in the containment of tumor metastasis.

The reification of normalcy.

Many researchers who investigate the putative effects of violent television on normal children claim there is a lifetime sociopathic effect on many of the children who watch. There may be. But there is a prevailing assumption that because television can produce sociopathic effects in a laboratory, that it does outside the laboratory. In addition, uncritical assumptions of psychological normalcy among most viewers are so prevalent among researchers in this field that any pathological lifetime effect may be exaggerated. The incidence of psychopathology, especially among nonrandom subject samples obtained from public schools, may be higher than investigators suspect, which could lead to overestimates of pernicious effects by television on children. Because pathological children are more vulnerable to commercial television's putative sociopathic effects than are normal children, they may bias study results toward sociopathic attitudes and behaviors, thus misleading researchers into believing that television has a greater sociopathic effect on normal populations than it actually has. Those psychopathologies are reviewed and prospective remedies are suggested for helping those children cope with the possible sociopathic effects of violently oriented television.

Emotionally disturbed children's reactions to violent media segments.

This study examined the reaction of children with a diagnosed disruptive behavior disorder (DBD) to violent movie scenes. Children without one of these disorders were tested as well. DBD children ranged in age from 8 to 12 years and were outpatients at The University of Kansas Medical Center's Department of Child Psychiatry. These children were diagnosed by a child psychiatrist as meeting Diagnostic and Statistical Manual of Mental Disorders (4th edition) (American Psychiatric Association 1994) (DSM-IV) diagnostic criteria for having at least one of three emotional disorders: attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). Results showed that the disordered children differed from the nondisordered children on several dimensions. This suggests that DBD children process the anti-social messages in violent movies differently from children without a psychiatric disorder. An unabated diet of antisocial media could have harmful effects on children with a psychiatric illness.

A survey of disease in five commercial flocks of meat breeder chickens.

Causes of sickness and death in approximately 30,000 chickens in 5 meat breeder flocks were investigated between May 1979 and April 1980. Approximately 23% of disease was due to neoplasms; 81% of these were Marek's disease despite vaccination against this infection. Other frequent diagnoses included cellulitis (15%), respiratory disease (14%), lesions of the reproductive tract (11%) and tenosynovitis/arthritis (9%). Antibodies to Mycoplasma gallisepticium, avian adenovirus, infectious bursal disease virus and reticuloendotheliosis virus were present in all flocks. Antibody to Newcastle disease virus (NDV) was found in 2 flocks but titres were not considered protective against a virulent NDV challenge. Antibody to egg drop syndrome 1976 virus was found in 2 flocks comprised of the same breed of bird.

Experimental infection of chickens with an Australian strain of reticuloendotheliosis virus 3. persistent infection and transmission by the adult hen.

Vertical transmission of reticuloendotheliosis virus (REV) infection was demonstrated in embryonated eggs from an adult hen with persistent REV viraemia but no serum antibody. Pooling of infected embryos from this hen with those from antibody-positive hens appeared to inhibit the infectivity of congenitally-transmitted REV. REV was detected in vaginal swabs from this hen on 11 occasions over a period of 26 weeks of adult life and infectious REV was shed from the eye, mouth and in the droppings. Direct contact between the hen and other adult hens and roosters resulted in the transmission of REV infection, with or without genital contact. These newly-established REV infections were not persistent. Transmission did not occur between the infected hen and others separated by a wire mesh barrier.

A transmissible chicken tumour associated with reticuloendotheliosis virus infection.

Histiocytic lymphosarcomas of the intestine, liver, spleen and sciatic nerve were found at necropsy in a 36-week-old laying hen that was culled from a flock of 1800 birds because of emaciation. Type C particles were observed in ultrathin sections of liver and spleen. The serum of the hen contained reticuloendotheliosis virus (REV) antigen, and antibody against REV, but lacked antibodies reactive with Marek's disease virus or subgroups A and B of Rous sarcoma virus. The tumour was transmitted to chickens using a suspension of the initial tumours. These experimental tumours were then transmitted to further chickens, using cultured spleen cells, viable spleen cells that had been stored frozen, and disrupted spleen cells. The tumours, which developed after incubation periods as short as 2 weeks, were histologically similar to those in the original hen. A few chickens also developed feather abnormalities. The chickens with experimentally transmitted tumours developed antibody against REV and REV antigen was demonstrated in cultured cells from these chickens. The chickens failed to develop antibody against Rous sarcoma virus and only 1 of 29 developed antibody against Marek's disease virus.

Experimental infection of chickens with an Australian strain of reticuloendotheliosis virus. 2. Serological responses and pathogenesis.

Fifteen SPF chickens were inoculated with an Australian strain of reticuloendotheliosis virus (REV) at 1 day of age and five uninoculated chickens were readily infected by horizontal spread from this group. Antibody detectable by the immunofluorescent antibody (IFA) test developed 3 to 6 weeks after infection, and usually persisted for 20-35 weeks, with maximum titres (40-1280) at 8 to 13 weeks. Agar gel precipitin (AGP) reactions developed more slowly and were variable in duration, the highest proportion of positive reactions being detectable 8 to 13 weeks after infection and persisting for 8 to 30 weeks. Infectious REV was readily detected in the plasma and serum of inoculated chickens 6 weeks after infection and a non-infectious REV antigenaemia usually persisted for at least a further 7 weeks, in the presence or absence of antibody. Development of a detectable REV viraemia was strongly associated with poor body development and premature mortality among the inoculated chickens. In two inoculated chickens which failed to develop detectable serological reactions, a REV viraemia occurred which persisted throughout life. At autopsy, REV was re-isolated from the kidneys of most of the inoculated chickens and from the reproductive and intestinal systems of two birds 22 and 56 weeks after infection.

Infection studies on a reticuloendotheliosis virus contaminant of a commercial Marek's disease vaccine.

Reticuloendotheliosis virus (REV) was isolated in cell cultures from commercial Marek's disease (herpesvirus of turkeys) vaccine and re-isolated from the organs of vaccinated chickens. Runting and feathering abnormalities were produced when 1-day-old specific pathogen free chickens were inoculated with REV. Histopathological lesions in infected chickens were hypoplasia of the thymus, bursa and spleen, and inflammation of the proventriculus, kidneys and liver. Serological responses to REV were detected by the indirect immunoflorescence test in chickens directly inoculated with contaminated vaccine, and spread of REV infection to in-contact chickens was demonstrated by histopathological and serological investigations.