To evaluate the access to comprehensive diagnostics and novel antituberculosis medicines in European countries.
We investigated the access to genotypic and phenotypic Mycobacterium tuberculosis drug ...susceptibility testing and the availability of antituberculosis drugs and calculated the cost of drugs and treatment regimens at major tuberculosis treatment centres in countries of the WHO European region where rates of drug-resistant tuberculosis are the highest among all WHO regions. Results were stratified by middle-income and high-income countries.
Overall, 43 treatment centres from 43 countries participated in the study. For WHO group A drugs, the frequency of countries with the availability of phenotypic drug susceptibility testing was as follows: (a) 75% (30/40) for levofloxacin, (b) 82% (33/40) for moxifloxacin, (c) 48% (19/40) for bedaquiline, and (d) 72% (29/40) for linezolid. Overall, of the 43 countries, 36 (84%) and 24 (56%) countries had access to bedaquiline and delamanid, respectively, whereas only 6 (14%) countries had access to rifapentine. The treatment of patients with extensively drug-resistant tuberculosis with a regimen including a carbapenem was available only in 17 (40%) of the 43 countries. The median cost of regimens for drug-susceptible tuberculosis, multidrug-resistant/rifampicin-resistant tuberculosis (shorter regimen, including bedaquiline for 6 months), and extensively drug-resistant tuberculosis (including bedaquiline, delamanid, and a carbapenem) were €44 (minimum–maximum, €15–152), €764 (minimum–maximum, €542–15152), and €8709 (minimum–maximum, €7965–11759) in middle-income countries (n = 12) and €280 (minimum–maximum, €78–1084), €29765 (minimum–maximum, €11116–40584), and €217591 (minimum–maximum, €82827–320146) in high-income countries (n = 29), respectively.
In countries of the WHO European region, there is a widespread lack of drug susceptibility testing capacity to new and repurposed antituberculosis drugs, lack of access to essential medications in several countries, and a high cost for the treatment of drug-resistant tuberculosis.
Auswirkungen von elektronisch unterstützten Medikationssystemen auf Fachpersonen, sowie deren Einschätzung, Erwartungen und Haltung gegenüber neuen IT-Systemen im Medikationsprozess, sind neben ...technischen Funktionalitäten wichtige Faktoren, die hinsichtlich Akzeptanz und Implementationserfolg eine zentrale Rolle spielen. Bisher gibt es keine Daten aus Schweizer Universitätsspitälern, welche die Einschätzungen von Benutzer(innen) zu closed-loop Medikationsprozessen erhoben haben. Das Ziel der Studie war, diese Lücke zu schliessen.
Nach einer viermonatigen Testphase eines elektronisch unterstützten Richt- und Abgabesystems für Medikamente auf zwei gemischten chirurgisch-medizinischen Abteilungen eines Universitätsspitals, wurde eine Querschnittstudie mittels online Befragung von involvierten Pflegefachpersonen dazu durchgeführt (Rücklauf-Quote: 62.5%).
Das neue System wurde von den Benutzer(innen) mehrheitlich positiv bewertet (70%). Der Barcode-unterstützte Medikationsprozess wurde insbesondere für das Tagesrichten und die Bereitstellung von Parenteralia im klinischen Setting positiv bewertet. Die Benutzer-compliance bei Reservemedikationen sowie bei der Barcode-unterstützten Abgabe von Medikamenten am Patientenbett, wurde aufgrund teilweise ungenügender Systemperformance und knappen Zeitressourcen tief angegeben.
75% der Befragten gaben in der Studie an, offen bis begeistert für neue Technologien zu sein. Die Mehrheit der Befragten beurteilt das neue Medikationssystem für den klinischen Praxisalltag als insgesamt geeignet, sofern die technische Performance hoch ist.
New technologies, such as bar-code scanning systems, have played a significant role in enhancing medication processes over recent years. Despite the documented benefits, integration, acceptance, and user opinion continue to play an important role in the successful implementation of such systems. To date no studies have been carried out in Switzerland to assess the attitude or acceptance of nurses towards electronically supported medication systems after implementation. This study was conducted in order to close this gap.
Following a four-month test phase of a closed-loop medication system on two mixed medical-surgical units in a tertiary teaching hospital, a cross-sectional online survey was conducted among the participating registered nurses (response rate: 62.5%).
The new system was evaluated positively by the majority (70%) of users. Accordingly, the barcode-assisted medication process was proven to be especially beneficial to users during the 24-hour medication preparation process and during the preparation of infusions. However, user compliance decreased significantly during the administration of bedside medication and the preparation of additional single doses. This was mainly due to a lack of time and inadequate system performance.
In the study, 75% of participants reported that they were open to or even enthusiastic about using the new technologies and were supportive of their introduction into the medication process. Overall, the majority rated the new system as beneficial to daily clinical practice, provided the technical performance was high.
Abstract
Background
Medication errors are a common problem in hospitals and a major driver of adverse patient outcomes. Barcode verification technology is a promising strategy to help ensure safe ...medication preparation practices.
Objectives
The objectives of this study were (i) to assess the effects of a barcode-assisted medication preparation and administration system regarding the rate of medication preparation errors and (ii) to compare the time spent on medication preparation tasks by medical staff.
Methods
A quasi-experimental study with a pre–post design was conducted, from August 2017 to July 2018, in two mixed medical/surgical units of a tertiary teaching hospital. The primary aim was to assess the effects of a barcode-based electronically assisted medication preparation and administration system linked to the hospital’s electronic medication administration record regarding the rate of medication preparation errors and time-based staff performance. Data were collected using direct observation. Adjusted and unadjusted logistic models were used for error frequencies and linear regression models for time performance.
Results
5932 instances of medication selection and dosing during 79 medication preparation procedures were observed. The overall medication preparation error incidence decreased from 9.9% at baseline to 4.5% at post-intervention, corresponding to a relative risk reduction of 54.5% (P < 0.001). However, the adjusted effect by registered nurses (RNs) and nurses’ work experience of total medication preparation errors showed only borderline significance (odds ratio OR 0.64, P = 0.051). For adjusted error-specific analyses, significant error reductions were found in wrong medication errors (OR 0.38, P < 0.010) and wrong dosage errors (OR 0.12, P = 0.004). Wrong patient, wrong form and ambiguous dispenser errors did not occur at post-intervention. Errors of omission (OR 1.53, P = 0.17), additional doses (OR 0.63, P = 0.64) and wrong dispenser boxes (OR 0.51, P = 0.11) did not change significantly. The time necessary to prepare medications for a 24-h period also decreased significantly—from 30.2 min to 17.2 min (beta = −6.5, P = 0.047), while mean preparation time per individual medication dose fell from 24.3 s to 15.1 s (beta = −5.0, P = 0.002).
Conclusion
Use of the new barcode technology significantly reduced the rate of some medication preparation errors in our sample. Moreover, the time necessary for medication preparation, both per 24-h period and per single-medication dose, was significantly reduced.
BACKGROUNDNew technologies, such as bar-code scanning systems, have played a significant role in enhancing medication processes over recent years. Despite the documented benefits, integration, ...acceptance, and user opinion continue to play an important role in the successful implementation of such systems. To date no studies have been carried out in Switzerland to assess the attitude or acceptance of nurses towards electronically supported medication systems after implementation. This study was conducted in order to close this gap. METHODSFollowing a four-month test phase of a closed-loop medication system on two mixed medical-surgical units in a tertiary teaching hospital, a cross-sectional online survey was conducted among the participating registered nurses (response rate: 62.5%). RESULTSThe new system was evaluated positively by the majority (70%) of users. Accordingly, the barcode-assisted medication process was proven to be especially beneficial to users during the 24-hour medication preparation process and during the preparation of infusions. However, user compliance decreased significantly during the administration of bedside medication and the preparation of additional single doses. This was mainly due to a lack of time and inadequate system performance. CONCLUSIONIn the study, 75% of participants reported that they were open to or even enthusiastic about using the new technologies and were supportive of their introduction into the medication process. Overall, the majority rated the new system as beneficial to daily clinical practice, provided the technical performance was high.
Zusammenfassung. Hintergrund: Prospektive Observationsstudien, welche die Häufigkeit von Medikationsfehlern in Schweizer Spitälern durch direkte Beobachtung von Fachpersonen und Medikamentendosen ...erhoben haben, fehlten bislang. Eine wissenschaftliche Evaluation eines elektronisch unterstützten Richt- und Abgabeprozesses von Medikamenten in einem Universitätsspital liefert nun aktuelle Daten dazu. Ziel: Ziel der Studie war, die Häufigkeit von Richt- und Abgabefehlern von Medikamenten auf zwei Abteilungen eines Universitätsspitals, vor der Implementierung eines Systems zur elektronischen Unterstützung des Richt- und Abgabeprozesses zu erheben. Methode: Mittels Goldstandard, d. h. durch direkte Beobachtung von Fachpersonen und Medikamentendosen, wurden Richt- und Abgabefehler von Medikamenten während drei Monaten erhoben. Zudem wurde die Zeit, die für das Richten, Kontrollieren und Abgeben von Medikamenten benötigt wurde, gemessen. Ergebnisse: Während der Baseline-Messung wurden in den Prozessen Richten, Kontrollieren und Abgeben von Medikamenten insgesamt 14 571 Medikamentendosen beobachtet. Die Fehlerhäufigkeit beim Richten von Medikamenten lag je nach Abteilung und Fehlertyp zwischen 1 % und 7,6 %. Die Häufigkeit von Abgabefehlern lag, inklusive Zeitfehler, zwischen 21 % und 27 %, wobei Zeitfehler mit einem Anteil von durchschnittlich 84,1 % am häufigsten auftraten. Schlussfolgerungen: Die vorliegende Studie ist die erste Observationsstudie in einem Schweizer Universitätsspital, welche die Häufigkeit von Richt- und Abgabefehlern von Medikamenten systematisch erhoben hat. Sie bietet damit die Grundlage, Effekte von elektronisch unterstützen Medikationsprozessen wissenschaftlich nachzuweisen.
Background: Prospective observational studies from Swiss university hospitals, focusing on the frequency of medication preparation and medication administration errors using direct observation, are ...still missing. To close this gap, we have conducted a scientific evaluation of an electronically assisted medication preparation and administration process in a Swiss university hospital. Aim: The aim of this study was to measure the frequency of medication preparation and medication administration errors in two units in a Swiss university hospital before the implementation of an electronically assisted medication preparation and administration process. Method: To fulfil the study aims we used direct observation of medical staff during the medication process, the gold standard to detect medication errors. Furthermore, we measured the time that medical staff used in order to prepare and administer medications. Results: During the baseline measure, we observed a total of 14 571 medication doses. Errors in the medication preparation stage occurred between 1 % and 7.6 % depending on unit and type of error. Medication administration errors ranged between 21 % and 27 %. The most frequent administration errors were due to wrong administration time (84.1 %). Conclusions: This is the first study conducted in a Swiss university hospital using direct observation to detect medication preparation and medication administration errors. The current study offers important basic data to evaluate the effect of an electronically assisted medication preparation and administration process scientifically.
Treatment to restore sinus rhythm among patients with atrial fibrillation (AF) has limited long-term success rates. Gene expression profiling may provide new insights into AF pathophysiology.
To ...identify biomarkers and improve our understanding of AF pathophysiology by comparing whole blood gene expression before and after electrical cardioversion (ECV).
In 46 patients with persistent AF that underwent ECV, whole blood samples were collected 1-2 hours before and 4 to 6 weeks after successful cardioversion. The paired samples were sent for microarray and plasma biomarker comparison.
Of 13,942 genes tested, expression of SLC25A20 and PDK4 had the strongest associations with AF. Post-cardioversion, SLC25A20 and PDK4 expression decreased by 0.8 (CI 0.7-0.8, p = 2.0x10-6) and 0.7 (CI 0.6-0.8, p = 3.0x10-5) fold respectively. Median N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations decreased from 127.7 pg/mL to 44.9 pg/mL (p = 2.3x10-13) after cardioversion. AF discrimination models combining NT-proBNP and gene expression (NT-proBNP + SLC25A20 area under the curve = 0.88, NT-proBNP + PDK4 AUC = 0.86) had greater discriminative capacity as compared with NT-proBNP alone (AUC = 0.82). Moreover, a model including NT-proBNP, SLC25A20 and PDK4 significantly improved AF discrimination as compared with other models (AUC = 0.87, Net Reclassification Index >0.56, p<5.8x10-3). We validated the association between SLC25A20 and PDK4 with AF in an independent sample of 17 patients.
This study demonstrates that SLC25A20, PDK4, and NT-proBNP have incremental utility as biomarkers discriminating AF from sinus rhythm. Elevated SLC25A20 and PDK4 expression during AF indicates an important role for energy metabolism in AF.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Background The role of tachycardia-induced cardiomyopathy vs tachycardia-related short diastolic filling period and reduced atrial contraction in decline of left ventricular ejection ...fraction (LVEF) in atrial fibrillation (AF) is uncertain. We aimed to characterize left heart changes over time in patients with AF who undergo electrical cardioversion (ECV). Methods Consecutive AF patients who were to undergo ECV were enrolled. Patients with unstable or acute heart failure, severe valvular diseases, recent open-heart surgery, major disorders, or an unsuccessful ECV were excluded. Transthoracic echocardiography, including 3-dimensional left atrial and ventricular volume acquisitions, was performed 1-2 hours before and after ECV, and 4-6 weeks later. Results In 73 patients (77% male, 66 ± 11 years), ECV resulted in an immediate increase in LVEF (from 43 interquartile range (IQR), 33-50% to 48 IQR, 40-53%; P < 0.0001). Four to 6 weeks after ECV, ejection fraction increased further in patients who remained in sinus rhythm (SR) (n = 55) to 55 (IQR, 44-62)%; P < 0.001. In patients with AF relapse, LVEF returned to values comparable to pre-ECV (n = 18) (44 IQR, 32-51%; P = 0.03). The atrial emptying fraction did not significantly change immediately after ECV (n = 69; from 20 IQR, 13-25% to 20 IQR, 15-28%; P = 0.14). Only patients who remained in SR showed an increase in atrial emptying fraction after 4-6 weeks (n = 51; to 37 IQR, 26-48%; P < 0.0001 vs post-ECV). Conclusions Immediate improvement in LVEF after ECV explains approximately 50% of total LVEF increase over time. However, in SR, LVEF, and atrial function continuously increase over 4-6 weeks after ECV. This might be attributable to recovery of tachycardia-induced cardiomyopathy.
Left atrial (LA) enlargement is an important risk factor for incident stroke and a key determinant for the success of rhythm control strategies in patients with atrial fibrillation (AF). However, ...factors associated with LA volume in AF patients remain poorly understood.
Patients with paroxysmal or persistent AF were enrolled in this study. Real time 3-D echocardiography was performed in all participants and analyzed offline in a standardized manner. We performed stepwise backward linear regression analyses using a broad set of clinical parameters to determine independent correlates for 3-D LA volume.
We included 210 patients (70.9% male, mean age 61±11years). Paroxysmal and persistent AF were present in 95 (45%) and 115 (55%) patients, respectively. Overall, 115 (55%) had hypertension, 11 (5%) had diabetes, and 18 (9%) had ischemic heart disease. Mean indexed LA volume was 36±12ml/m2. In multivariable models, significant associations were found for female sex (β coefficient -10.51 (95% confidence interval (CI) -17.85;-3.16), p = 0.0053), undergoing cardioversion (β 11.95 (CI 5.15; 18.74), p = 0.0006), diabetes (β 14.23 (CI 2.36; 26.10), p = 0.019), body surface area (BSA) (β 34.21 (CI 19.30; 49.12), p<0.0001), glomerular filtration rate (β -0.21 (CI -0.36; -0.06), p = 0.0064) and plasma levels of NT-pro brain natriuretic peptide (NT-proBNP) (β 6.79 (CI 4.05; 9.52), p<0.0001), but not age (p = 0.59) or hypertension (p = 0.42). Our final model explained 52% of the LA volume variability.
In patients with AF, the most important correlates with LA volume are sex, BSA, diabetes, renal function and NT-proBNP, but not age or hypertension. These results may help to refine rhythm control strategies in AF patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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