No abstract

BackgroundMedication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors.MethodsProspective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects.ResultsTwenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care.ConclusionMedication administration errors are frequent. The identification of its determinants helps to undertake designed interventions.

ContextDrug administration in the hospital setting is the last barrier before a possible error reaches the patient.ObjectivesWe aimed to analyze the prevalence and nature of administration error rate detected by the observation method.Data SourcesEmbase, MEDLINE, Cochrane Library from 1966 to December 2011 and reference lists of included studies.Study SelectionObservational studies, cross-sectional studies, before-and-after studies, and randomized controlled trials that measured the rate of administration errors in inpatients were included.Data ExtractionTwo reviewers (senior pharmacists) independently identified studies for inclusion. One reviewer extracted the data; the second reviewer checked the data. The main outcome was the error rate calculated as being the number of errors without wrong time errors divided by the Total Opportunity for Errors (TOE, sum of the total number of doses ordered plus the unordered doses given), and multiplied by 100. For studies that reported it, clinical impact was reclassified into four categories from fatal to minor or no impact. Due to a large heterogeneity, results were expressed as median values (interquartile range, IQR), according to their study design.ResultsAmong 2088 studies, a total of 52 reported TOE. Most of the studies were cross-sectional studies (N=46). The median error rate without wrong time errors for the cross-sectional studies using TOE was 10.5% [IQR: 7.3%-21.7%]. No fatal error was observed and most errors were classified as minor in the 18 studies in which clinical impact was analyzed. We did not find any evidence of publication bias.ConclusionsAdministration errors are frequent among inpatients. The median error rate without wrong time errors for the cross-sectional studies using TOE was about 10%. A standardization of administration error rate using the same denominator (TOE), numerator and types of errors is essential for further publications.

No abstract

Background Patients with Fabry disease (FD) show left ventricular hypertrophy (LVH) mimicking hypertrophic cardiomyopathy (HCM) of sarcomeric origin and might benefit, if detected early, from specific enzyme replacement therapy. The prevalence of FD in patients with LVH of 13 mm or greater, screened using the leucocyte alpha-galactosidase A (a-gal A) activity test, a technique that is difficult to apply routinely, ranged from 0% to 6%. Objective To screen systematically for FD in patients with a diagnosis of HCM (LVH $15 mm) in primary cardiology practice, a validated, physician-friendly a-gal A assay was used on dried blood spots using a filter paper test. Design and patients A cohort of 392 adults (278 men) followed for HCM were screened for FD. A standard blood test was used for confirmation in nine men in whom the a-gal A result was 40% or less. Results Four men (1.5%; 1.8% of men $40 years vs 0% <40 years; all with a-gal A <30%), but no women, were diagnosed with FD. Index cases presented with diffuse but asymmetric LVH, with severe obstruction in one case and frequent high-grade atrioventricular conduction block necessitating a pacemaker in three cases. Family screening identified eight additional cases. Genotyping was performed successfully on DNA extracted from the filter papers. Conclusion In male patients diagnosed as having HCM, pure FD cardiac variants are not exceptional and can be specifically identified using a simple filter-paper test. The sensitivity of this test is low in female patients.

No abstract

The antibacterial activity of nitroxoline (NIT), an antibiotic used in the treatment of acute or recurrent urinary tract infections caused by Escherichia coli, is decreased in the presence of Mg 2؉ and Mn 2؉ but not Ca 2؉ . In order to elucidate the interaction between this drug and the divalent cations, spectrophotometric studies based on the natural absorption of the nitroxoline moiety were conducted. In the presence of the divalent metal ions, a shift in the NIT A 448 suggested the formation of drug-ion complexes, for which the stability followed the order Mn 2؉ > Mg 2؉ > Ca 2؉. A clear correlation was found between the chelating property and antibacterial activity of NIT; both were pH dependent. A convenient colorimetric method for the determination of NIT uptake by bacterial cells was also developed. Uptake was energy independent and showed biphasic kinetics: a rapid association with cells and then a slower increase in cell-associated NIT which reached a plateau. NIT uptake was reduced in the presence of magnesium. The implications of metal ion complexation and pH on the clinical efficacy of NIT are discussed.Nitroxoline (NIT), or 5-nitro-8-hydroxyquinoline, is an antibiotic which does not belong to any known antimicrobial class. This drug is used in France in the treatment of acute or recurrent urinary tract infections (UTIs) (14, 26) since it shows bacteriostatic activity against Escherichia coli strains frequently encountered in UTIs. On the other hand, the pharmacokinetics of NIT in plasma and urine are well established (4). NIT also possesses fungistatic activity (11) and bactericidal properties against Mycoplasma spp. (7).Recent studies have shown an inhibition of adherence of uropathogenic E. coli to uroepithelial cells (27) and urinary catheters (8) at sub-MICs of NIT. In order to explain this activity Bourlioux et al. (9) proposed that NIT promotes a disorganization of the bacterial outer membrane resulting from the chelation by NIT of the divalent ions Mg 2ϩ and Ca 2ϩ . The same investigators observed a decrease in the antibacterial activity of NIT on E. coli in the presence of some divalent metal ions (9). It is interesting to note that 8-hydroxyquinoline (oxine) and its derivatives have been reported to complex with metal ions (23, 37).To acquire further information on the mechanism of action of NIT and the behavior of the molecule toward the bacterial envelope, the interaction between NIT and some divalent metal ions was spectrophotometrically examined by using the absorption properties of the molecule in the visible region. In addition, microbiological investigations were carried out to determine the role of these ions and the pH in the antibacterial activity of NIT. The uptake of NIT by E. coli was also studied. MATERIALS AND METHODSBacterial strains and culture conditions. Three strains of E. coli were studied. Strains J96 and AL46 were isolated from patients with UTIs. J96 is a standard strain, frequently used in bacterial adherence assays, expressing type 1 and P fimbriae (24); the AL...

No abstract