In view of the environmental issues caused by antibiotics, this research studies competitive adsorption/desorption for tetracycline (TC) and sulfadiazine (SDZ) in agricultural soils. Competitive ...adsorption was studied in binary systems (adding equal concentrations of both antibiotics). In addition, it was compared with results from simple systems. In all cases, batch-type adsorption/desorption experiments were carried out. In the binary systems, for the highest antibiotic concentration added, adsorption percentages were always higher for TC (close to 100%) than for SDZ (10–90%). In these systems, TC desorption was lower than 5% for all soils, and generally <10% for SDZ. Comparing TC and SDZ adsorption for the different systems, SDZ was clearly affected by the presence of TC, with SDZ adsorption percentages being was much higher (with differences generally above 65%) in the binary than in the simple systems. On the contrary, comparing the results of TC adsorption in simple and binary systems, TC was not affected by the presence of SDZ, obtaining similar adsorption percentages in both systems. Kd and KF values (in the Linear and Freundlich models), were higher in the simple systems in the case of TC, which could be due to competition with SDZ, while for SDZ Kd and KF were higher in the binary systems, with a synergistic effect of TC favoring SDZ adsorption. Regarding desorption, it reached 100% for SDZ in some soils in simple systems, dropping to 10% in the presence of TC. TC desorption was <4%, not affected by SDZ. The results indicate that environmental risks would be higher for SDZ, showing differences when both antibiotics are present. This can be considered relevant as regards public health and environmental preservation, in view of direct toxicities and the promotion of resistance to antibiotics associated with the presence of these contaminants in the environment.
Antibiotic consumption at high levels in both human and veterinary populations pose a risk to their eventual entry into the food chain and/or water bodies, which will adversely affect the health of ...living organisms. In this work, three materials from forestry and agro-food industries (pine bark, oak ash and mussel shell) were investigated as regards their potential use as bio-adsorbents in the retention of the antibiotics amoxicillin (AMX), ciprofloxacin (CIP) and trimethoprim (TMP). Batch adsorption/desorption tests were conducted, adding increasing concentrations of the pharmaceuticals individually (from 25 to 600 μmol L−1), reaching maximum adsorption capacities of ≈ 12000 μmol kg−1 for the three antibiotics, with removal percentages of ≈ 100% for CIP, 98–99% adsorption for TMP onto pine bark, and 98–100% adsorption for AMX onto oak ash. The presence of high calcium contents and alkaline conditions in the ash favored the formation of cationic bridges with AMX, whereas the predominance of hydrogen bonds between pine bark and TMP and CIP functional groups explain the strong affinity and retention of these antibiotics. The Freundlich's model provided the best prediction for AMX adsorption onto oak ash and mussel shell (heterogeneous adsorption), whereas the Langmuir's model described well AMX adsorption onto pine bark, as well as CIP adsorption onto oak ash (homogeneous and monolayer adsorption), while all three models provided satisfactory results for TMP. In the present study, the results obtained were crucial in terms of valorization of these adsorbents and their subsequent use to improve the retention of antibiotics of emerging concern in soils, thereby preventing contamination of waters and preserving environment quality.
•Pine bark, oak ash and mussel shell can retain specific antibiotics.•Polarity, hydrophobicity, structure and speciation are key in adsorption.•Pine bark showed the best results for ciprofloxacin and trimethoprim adsorption.•Oak ash exhibited the highest retention for amoxicillin through cationic bridges.
The fate of antibiotics reaching soils is a matter of concern, given its potential repercussions on public health and the environment. In this work, the potential bio-reduction of the antibiotic ...amoxicillin (AMX), affected by sorption and desorption, is studied for 17 soils with clearly different characteristics. To carry out these studies, batch-type tests were performed, adding increasing concentrations of AMX (0, 2.5, 5, 10, 20, 30, 40, and 50 μmol L−1) to the soils. For the highest concentration added (50 μmol L−1), the adsorption values for forest soils ranged from 90.97 to 102.54 μmol kg−1 (74.21–82.41% of the amounts of antibiotic added), while the range was 69.96–94.87 μmol kg−1 (68.31–92.56%) for maize soils, and 52.72–85.40 μmol kg−1 (50.96–82.55%) for vineyard soils. When comparing the results for all soils, the highest adsorption corresponded to those more acidic and with high organic matter and non-crystalline minerals contents. The best adjustment to adsorption models corresponded to Freundlich's. AMX desorption was generally <10%; specifically, the maximum was 6.5% in forest soils, and 16.9% in agricultural soils. These results can be considered relevant since they cover agricultural and forest soils with a wide range of pH and organic matter contents, for an antibiotic that, reaching the environment as a contaminant, can pose a potential danger to human and environmental health.
•Amoxicillin was retained up to 82% in forest soils when added at 50 μmol/L.•Amoxicillin was retained up to 93% in maize soils when added at 50 μmol/L.•Amoxicillin was retained up to 83% in vineyard soils when added at 50 μmol/L.•High sorption in acidic soils with high C and non-crystalline minerals contents.•Desorption was generally lower than 10% of the amount previously sorbed.
Sewage sludge as agricultural amendment is the main route of human-medicine antibiotics to enter soils. When reaching environmental compartments, these compounds can cause significant risks to human ...and ecological health. Specifically, the antibiotic amoxicillin (AMX) is highly used in medicine, and the fact that more than 80% of the total ingested is excreted increases the chances of causing serious environmental and public health problems. As the use of low-cost bio-adsorbents could help to solve these issues, this research focuses on the retention of AMX onto four by-products of the forestry industry (eucalyptus leaf, pine bark, pine needles, and wood ash) and one from food industry (mussel shell). To carry out this study, batch-type tests were performed, where increasing concentrations of the antibiotic (0, 2.5, 5, 10, 20, 30, 40 and 50 μmol L−1) were added to samples of 0.5 g of each bio-adsorbent. Eucalyptus leaf, pine needle and wood ash showed adsorption scores higher than 80%, while it was up to 39% and 48% for pine bark and mussel shell, respectively. For pine bark, wood ash and mussel shell, adsorption data showed good adjustment to the Freundlich and Linear models, while pine needles and eucalyptus leaf did not fit to any model. There was not desorption when the maximum concentration of AMX (50 μmol L−1) was added. Overall, eucalyptus leaf, pine needles and wood ash can be considered good bio-adsorbents with high potential to retain AMX, which has significant implications regarding their eventual use to reduce risks of environmental pollution by this antibiotic.
•100% AMX was retained in pine needles, 90% in wood ash, when added at 50 μmol/L.•AMX retention up to 76% in eucalyptus leaves, 48% in mussel shell, 29% in pine bark.•No AMX desorption was detected when the highest dose of the antibiotic was added.
The use process for chimeric antigen receptor T (CAR-T) cell drugs is complex and has been associated with a number of potentially severe complications, which requires management by a ...multidisciplinary team. Pharmacists are a key element in the team and have roles and responsibilities. Our objective was to develop a structured and practical guide that supports hospital pharmacist responsibilities and defines specific activities in a CAR-T cell therapy program, specifically in Europe.
A literature review was performed, and the recommendations related to pharmacy practice in CAR-T therapy programs were analyzed. A multidisciplinary team was assembled, and meetings were held to address the key tasks in the CAR-T cells' management process and to create the guide, based on national and international recommendations and in expert's opinions.
The multidisciplinary team defined the following key tasks and issued recommendations to improve patient safety, treatment efficacy, and quality: patient selection and evaluation, CAR-T cell drug order to manufacturer, apheresis and material shipment, reception of CAR-T cell drug and storing, CAR-T cell drug prescription and pharmacy verification, CAR-T cell drug thawing and dispensing, CAR-T cell drug administration, patient education, pharmacovigilance and monitoring and outcomes' record and evaluation. In each task the pharmacist's role and how it can improve patient care are defined. A checklist was created to guarantee the compliance of standard operating procedures approved in the institution to manage CAR-T cell therapy and as a tool to collect required data for outcomes' record and evaluation.
This article provides a consensus set of safety recommendations regarding CAR-T therapy management in clinical practice, easily implementable by other institutions in the European setting. The guide identifies key steps where the involvement of hospital pharmacists would improve the safety and quality of the process and is a support guide to standardize hospital pharmacists' responsibilities within the multidisciplinary team.
Medication error prevalence Belén Jiménez Muñoz, Ana; Muiño Miguez, Antonio; Paz Rodriguez Pérez, María ...
International journal of health care quality assurance,
01/2010, Volume:
23, Issue:
3
Journal Article
Peer reviewed
Purpose - Healthcare risk epidemiology identifies medication error as the commonest cause of adverse effects on patients. Medication error can occur at any phase of the complex medication process so ...prevalence rates need to be estimated at each drug treatment phase: prescription, transcription and administration along with their clinical repercussions. This paper aims to investigate this issue.Design methodology approach - Medication errors were recorded on an ad hoc sheet and staff were observed handling medications. Recorded errors were later classified and their clinical repercussions determined by experts.Findings - In total 757 inpatients and 5,466 drug prescriptions were studied. The prescription error rate was 4.79 percent (95 percent CI 4.21-5.36). The most frequent error in this phase was failing to observe international prescribing standards. The highest error rate was found in transcription (14.61 percent, 95 percent CI 13.67-15.54). Almost 1,900 dose administrations were observed. There was a 9.32 percent error rate (95 percent CI 7.98-10.67). The commonest error in this phase was omission. Most were transcription errors, which were detected before harm was done.Research limitations implications - The dispensation phase is absent.Practical implications - Errors can be reduced if they are understood. Education and training based on the study's findings can reduce medication errors.Originality value - The paper highlights ways to reduce errors in the medication process.
Cardiorenal syndrome (CRS) involves joint dysfunction of the heart and kidney. Acute forms share biochemical alterations like hyperuricaemia (HU) with tumour lysis syndrome (TLS). The mainstay ...treatment of acute CRS with systemic overload is diuretics, but rasburicase is used in TLS to prevent and treat hyperuricaemia. An observational, retrospective study was performed to assess the effectiveness and safety of a single dose of rasburicase in hospitalized patients with cardiorenal syndrome, worsening renal function and uric acid levels above 9 mg/dL. Rasburicase improved diuresis and systemic congestion in the 35 patients included. A total of 86% of patients did not need to undergo RRT, and early withdrawal was possible in the remaining five. Creatinine (Cr) decreased after treatment with rasburicase from a peak of 3.6 ± 1.27 to 1.79 ± 0.83 mg/dL, and the estimated glomerular filtration rate (eGFR) improved from 17 ± 8 to 41 ± 20 mL/min/1.73 m
(
= 0.0001). The levels of N-terminal type B Brain Natriuretic Peptide (Nt-ProBNP) and C-reactive protein (CRP) were also significantly reduced. No relevant adverse events were detected. Our results show that early treatment with a dose of rasburicase in patients with CRS and severe HU is effective to improve renal function and systemic congestion, avoiding the need for sustained extrarenal clearance, regardless of comorbidities and ventricular function.
This research is concerned with the adsorption and desorption of Cu and As(V) on/from different soils and by-products. Both contaminants may reach soils by the spreading of manure/slurries, ...wastewater, sewage sludge, or pesticides, and also due to pollution caused by mining and industrial activities. Different crop soils were sampled in A Limia (AL) and Sarria (S) (Galicia, NW Spain). Three low-cost by-products were selected to evaluate their bio-adsorbent potential: pine bark, oak ash, and mussel shell. The adsorption/desorption studies were carried out by means of batch-type experiments, adding increasing and individual concentrations of Cu and As(V). The fit of the adsorption data to the Langmuir, Freundlich, and Temkin models was assessed, with good results in some cases, but with high estimation errors in others. Cu retention was higher in soils with high organic matter and/or pH, reaching almost 100%, while the desorption was less than 15%. The As(V) adsorption percentage clearly decreased for higher As doses, especially in S soils, from 60−100% to 10−40%. The As(V) desorption was closely related to soil acidity, being higher for soils with higher pH values (S soils), in which up to 66% of the As(V) previously adsorbed can be desorbed. The three by-products showed high Cu adsorption, especially oak ash, which adsorbed all the Cu added in a rather irreversible manner. Oak ash also adsorbed a high amount of As(V) (>80%) in a rather non-reversible way, while mussel shell adsorbed between 7 and 33% of the added As(V), and pine bark adsorbed less than 12%, with both by-products reaching 35% desorption. Based on the adsorption and desorption data, oak ash performed as an excellent adsorbent for both Cu and As(V), a fact favored by its high pH and the presence of non-crystalline minerals and different oxides and carbonates. Overall, the results of this research can be relevant when designing strategies to prevent Cu and As(V) pollution affecting soils, waterbodies, and plants, and therefore have repercussions on public health and the environment.
The aim of this study was to identify risk points in the different stages of the smart infusion pump implementation process to prioritize improvement measures.
Failure modes and effects analysis ...(FMEA) in the pediatric intensive care unit (PICU) of a General and Teaching Hospital. A multidisciplinary team was comprised of two intensive care pediatricians, two clinical pharmacists and the PICU nurse manager. FMEA was carried out before implementing CareFusion infusion smart pumps and eighteen months after to identify risk points during three different stages of the implementation process: creating a drug library; using the technology during clinical practice and analyzing the data stored using Guardrails® CQI v4.1 Event Reporter software.
Several actions for improvement were taken. These included carrying out periodical reviews of the drug library, developing support documents, and including a training profile in the system so that alarms set off by real programming errors could be distinguished from those caused by incorrect use of the system. Eighteen months after the implementation, these measures had helped to reduce the likelihood of each risk point occurring and increase the likelihood of their detection.
Carrying out an FMEA made it possible to detect risk points in the use of smart pumps, take action to improve the tool, and adapt it to the PICU. Providing user training and support tools and continuously monitoring results helped to improve the usefulness of the drug library, increased users' compliance with the drug library, and decreased the number of unnecessary alarms.
PDF
