Interrupted time-series analysis of regulations to reduce paracetamol (acetaminophen) poisoning. (57/194)

BACKGROUND: Paracetamol (acetaminophen) poisoning is the leading cause of acute liver failure in Great Britain and the United States. Successful interventions to reduced harm from paracetamol poisoning are needed. To achieve this, the government of the United Kingdom introduced legislation in 1998 limiting the pack size of paracetamol sold in shops. Several studies have reported recent decreases in fatal poisonings involving paracetamol. We use interrupted time-series analysis to evaluate whether the recent fall in the number of paracetamol deaths is different to trends in fatal poisoning involving aspirin, paracetamol compounds, antidepressants, or nondrug poisoning suicide. METHODS AND FINDINGS: We calculated directly age-standardised mortality rates for paracetamol poisoning in England and Wales from 1993 to 2004. We used an ordinary least-squares regression model divided into pre- and postintervention segments at 1999. The model included a term for autocorrelation within the time series. We tested for changes in the level and slope between the pre- and postintervention segments. To assess whether observed changes in the time series were unique to paracetamol, we compared against poisoning deaths involving compound paracetamol (not covered by the regulations), aspirin, antidepressants, and nonpoisoning suicide deaths. We did this comparison by calculating a ratio of each comparison series with paracetamol and applying a segmented regression model to the ratios. No change in the ratio level or slope indicated no difference compared to the control series. There were about 2,200 deaths involving paracetamol. The age-standardised mortality rate rose from 8.1 per million in 1993 to 8.8 per million in 1997, subsequently falling to about 5.3 per million in 2004. After the regulations were introduced, deaths dropped by 2.69 per million (p = 0.003). Trends in the age-standardised mortality rate for paracetamol compounds, aspirin, and antidepressants were broadly similar to paracetamol, increasing until 1997 and then declining. Nondrug poisoning suicide also declined during the study period, but was highest in 1993. The segmented regression models showed that the age-standardised mortality rate for compound paracetamol dropped less after the regulations (p = 0.012) but declined more rapidly afterward (p = 0.031). However, age-standardised rates for aspirin and antidepressants fell in a similar way to paracetamol after the regulations. Nondrug poisoning suicide declined at a similar rate to paracetamol after the regulations were introduced. CONCLUSIONS: Introduction of regulations to limit availability of paracetamol coincided with a decrease in paracetamol-poisoning mortality. However, fatal poisoning involving aspirin, antidepressants, and to a lesser degree, paracetamol compounds, also showed similar trends. This raises the question whether the decline in paracetamol deaths was due to the regulations or was part of a wider trend in decreasing drug-poisoning mortality. We found little evidence to support the hypothesis that the 1998 regulations limiting pack size resulted in a greater reduction in poisoning deaths involving paracetamol than occurred for other drugs or nondrug poisoning suicide.  (+info)

Adherence to warfarin assessed by electronic pill caps, clinician assessment, and patient reports: results from the IN-RANGE study. (58/194)

BACKGROUND: Patient adherence to warfarin may influence anticoagulation control; yet, adherence among warfarin users has not been rigorously studied. OBJECTIVE: Our goal was to quantify warfarin adherence over time and to compare electronic medication event monitoring systems (MEMS) cap measurements with both self-report and clinician assessment of patient adherence. DESIGN: We performed a prospective cohort study of warfarin users at 3 Pennsylvania-based anticoagulation clinics and assessed pill-taking behaviors using MEMS caps, patient reports, and clinician assessments. RESULTS: Among 145 participants, the mean percent of days of nonadherence by MEMS was 21.8% (standard deviation+/-21.1%). Participants were about 6 times more likely to take too few pills than to take extra pills (18.8 vs. 3.3%). Adherence changed over time, initially worsening over the first 6 months of monitoring, which was followed by improvement beyond 6 months. Although clinicians were statistically better than chance at correctly labeling a participant's adherence (odds ratio = 2.05, p = 0.015), their estimates often did not correlate with MEMS-cap data; clinicians judged participants to be "adherent" at 82.8% of visits that were categorized as moderately nonadherent using MEMS-cap data (>or=20% nonadherence days). Similarly, at visits when participants were moderately nonadherent by MEMS, they self-reported perfect adherence 77.9% of the time. CONCLUSIONS: These results suggest that patients may benefit from adherence counseling even when they claim to be taking their warfarin or the clinician feels they are doing so, particularly several months into their course of therapy.  (+info)

Preventing medication errors in community pharmacy: root-cause analysis of transcription errors. (59/194)

BACKGROUND: Medication errors can have serious consequences for patients, and medication safety is essential to pharmaceutical care. Insight is needed into the vulnerability of the working process at community pharmacies to identify what causes error incidents, so that the system can be improved to enhance patient safety. METHODS: 40 randomly selected Danish community pharmacies collected data on medication errors. Cases that reached patients were analysed, and the most serious cases were selected for root-cause analyses by an interdisciplinary analysis team. RESULTS: 401 cases had reached patients and a substantial number of them had possible clinical significance. Most of these errors were made in the transcription stage, and the most serious were errors in strength and dosage. The analysis team identified four root causes: handwritten prescriptions; "traps" such as similarities in packaging or names, or strength and dosage stated in misleading ways; lack of effective control of prescription label and medicine; and lack of concentration caused by interruptions. CONCLUSION: A substantial number of the medication errors identified at pharmacies that reach patients have possible clinical significance. Root-cause analysis shows potential for identifying the underlying causes of the incidents and for providing a basis for action to improve patient safety.  (+info)

Lead pig for use with screw cap vials. (60/194)

A lead pig specifically designed for use with solid screw cap vials is described. METHODS: The salient features of this design include a compressible polyethylene sleeve, which is housed in the lower section of the pig, and a partially recessed O-ring, which is housed in the upper section of the pig. These features permit both the vial and the cap to be secured independently without the risk of overtightening. Fingertip radiation exposure associated with repetitively opening and closing a screw cap vial containing a sample of (18)F was monitored by use of a fingertip dosimeter. RESULTS: The cumulative fingertip radiation exposure resulting from opening and closing a screw cap vial containing 200 MBq of (18)F-FDG 3 times was 307 muSv without the aid of this lead pig, as compared with 6 muSv when using this device. CONCLUSION: Use of this lead pig with screw cap vials can significantly reduce fingertip radiation exposure and decrease the likelihood of accidental radioactive contamination of research personnel.  (+info)

Compliance assessed by the Medication Event Monitoring System. (61/194)

The accurate assessment of patient compliance is especially crucial in evaluating the efficacy of a new treatment. Because of the problems associated with parenteral desferrioxamine, the development of a safe, effective, and convenient iron chelator is of high priority. The high morbidity and mortality associated with iron overload requires careful evaluation of the ability of any new agent to promote long term effective iron chelation. Patients' compliance with an orally available chelating agent, 1,2,-dimethyl-3-hydroxypyrid-4-one (L1), that has been demonstrated to induce in vivo iron excretion equivalent to that of desferrioxamine during supervised short term administration, was examined. Compliance was assessed in seven patients by patient interview, by daily diaries reviewed monthly with each patient, and with the use of the Medication Event Monitoring System (MEMS) standard pill bottles with microprocessors in the cap that record the timing and frequency of bottle openings. L1 was dispensed in MEMS containers to the patients, who, unaware of their significance, recorded compliance using a daily diary. Overall compliance rate (% of prescribed doses taken) measured by MEMS was 88.7 +/- 6.8%. When 'doubling of doses' was accounted for, significantly poorer compliance with L1 was noted by MEMS (91.7 +/- 7.4%) than by patients' diaries (95.7 +/- 5.2%). There was no significant difference in patient compliance recorded between the first and last 30 day period of drug administration. MEMS can eliminate the confounding variable of erratic patient compliance in the evaluation of a new drug's efficacy. As MEMS cannot distinguish a missed dose from one doubled at the next bottle opening, the use of patient diaries is a useful adjunct to the accurate assessment of compliance and should be combined with the use of MEMS.  (+info)

Bacterially-derived nanocells for tumor-targeted delivery of chemotherapeutics and cell cycle inhibitors. (62/194)

Chemotherapeutic drug therapy in cancer is seriously hampered by severe toxicity primarily due to indiscriminate drug distribution and consequent collateral damage to normal cells. Molecularly targeted drugs such as cell cycle inhibitors are being developed to achieve a higher degree of tumor cell specificity and reduce toxic side effects. Unfortunately, relative to the cytotoxics, many of the molecularly targeted drugs are less potent and the target protein is expressed only at certain stages of the cell cycle thus necessitating regimens like continuous infusion therapy to arrest a significant number of tumor cells in a heterogeneous tumor mass. Here we discuss targeted drug delivery nanovectors and a recently reported bacterially-derived 400 nm sized minicell that can be packaged with therapeutically significant concentrations of chemotherapeutic drugs, targeted to tumor cell surface receptors and effect intracellular drug delivery with highly significant anti-tumor effects in vivo. We also report that molecularly targeted drugs can also be packaged in minicells and targeted to tumor cells with highly significant tumor growth-inhibition and regression in mouse xenografts despite administration of minute amounts of drug. This targeted intracellular drug delivery may overcome many of the hurdles associated with the delivery of cytotoxic and molecularly targeted drugs.  (+info)

Electronic pillboxes (MEMS) to assess the relationship between medication adherence and blood pressure control in primary care. (63/194)

OBJECTIVE: To investigate the relationship between blood pressure and medication adherence using electronic pillboxes (MEMS). SETTING: Five general practices in Bristol, UK. SUBJECTS: A total of 239 individuals with a clinical diagnosis of hypertension and being prescribed at least one blood pressure-lowering medication. Participants were asked to use the electronic pillbox as their drug bottle for at least one month. MAIN OUTCOME MEASURES: "Timing adherence" (correct inter-dose intervals) as measured through MEMS and systolic (SBP) and diastolic (DBP) office blood pressure. RESULTS: Mean (+/-SD) timing adherence was 88% (+/-17),>80% in 175 (73%), and less than 50% in 11 (5%) participants. Adherence was monitored for a mean of 33 (+/-6) days. Mean (+/-SD) SBP was 147.9+/-19.1 mmHg and DBP 82.3+/-10.1 mmHg. There was no evidence to suggest that timing adherence was associated with SBP or DBP (overall correlation coefficients -0.01 and -0.02 respectively). According to current guidelines, about one in four of all participants had controlled SBP (only 6% of diabetic patients). DBP was under control in 66% of the individuals. CONCLUSIONS: No relationship between adherence and blood pressure in patients with hypertension recruited from primary care was found. Average timing adherence measured by electronic monitors was high (88%) and blood pressure was controlled in a minority of patients. Our findings suggest that in terms of poor blood pressure control pharmacological non-response to or insufficient intensity of blood pressure-lowering medication might be more important than poor adherence to antihypertensive drug therapy.  (+info)

Awareness about vaccine vial monitor at pulse polio booths. (64/194)

All members present on booth, working on National Immunization Day during January and February, 2007 were interviewed by using predesigned and pretested questionnaires to assess their awareness regarding type of OPV and VVM in urban areas of Valsad district. Correct identification of trivalent OPV was highest (54.8%) among health staff members working at booths, but for monovalent OPV it was poor (38.7%). More than half (51.6%) of staff members interviewed had not heard of VVM. Awareness was very poor for VVM among those who have heard regarding its function, how to read VVM and when OPV should be discarded.  (+info)