A comprehensive study of prescribing, administering and drug handling medication errors in ten wards of a university hospital after implementation of electronic prescribing, clinical pharmacists or medication reconciliation.

Background and aim: Medication errors lead to preventable risks. Preventing strategies such as e-prescribing, clinical pharmacists and medication reconciliation have been implemented in recent years. However, information on long-term medication error rates in routine procedures is missing. Investigations: We aimed to identify predefined medication errors in ten wards of a university hospital where e-prescribing, clinical pharmacists and medication reconciliation have been partially implemented. Patient files were reviewed and routine processes were monitored for drug prescription errors (missing, unclear, outdated information), administration errors (wrong dispensed drugs) and drug handling errors (no light-, moisture-protection, wrong splitting, no separation of drugs, which ought to be taken by an empty stomach). Results: We analyzed 959 prescriptions with 933 solid peroral drugs for 182 patients (98 female, median age 66.5 years [Q25-Q75: 56-78 years]; the median number of drugs was 5 [Q25-Q75: 3-7]). The most frequent prescription error was a not specified drug form (91.1%). The most common administration error was a not adequately provided release dose formulation (72.7%). The lack of light protection for observed photosensitive drugs was the most frequent drug handling error (100%). We found a significantly higher amount of complete drug prescriptions with one of the implemented measurements e-prescribing, medication reconciliation and clinical pharmacists (Fisher's exact test two tailed, each p<0.001; CI 95%). Drug administration errors and drug handling errors were not significantly improved. Among the most frequently involved drug were drugs for acid-related disorders, immunosuppressant, and antineoplastic drugs. Conclusions: In the nearly 1,000 prescriptions and drugs analyzed, medication errors were still common. Various preventive strategies had been implemented in recent years, positively influencing the predefined errors rates.

[Pharmaceutical care in a visceral surgical ward]. / Pharmazeutische Betreuung einer viszeralchirurgischen Station.

BACKGROUND: Medication errors and subsequent drug-related problems (DRPs) result from lack of sufficient information during the prescribing step. The objectives of this study were to evaluate the contribution of having a pharmacist participate in clinical routine on a surgical unit by studying DRPs, and the classification of DRPs in the Pharmaceutical Care Network Europe (PCNE) system. MATERIALS AND METHODS: The pharmacotherapy of all patients of a visceral surgical ward was evaluated by a pharmacist in a prospective study design over a six-month period. The identified DRPs were classified using the PCNE system. RESULTS: In 29 131 prescription lines, 697 DRPs were registered. This corresponds to a mean intervention rate of 2.4 %. All DRPs were classified into the modified PCNE system with 910 causes and 1 148 interventions. The most frequent DRPs were "lack of home medication" (35.6 %), drug dosing problems (18.6 %), the inappropriate duplication of drugs of the same therapeutic group (6.7 %) and drug interactions (6.5 %). 78.6 % vs. 3.7 % of all registered DRPs were completely vs. near completely resolved by pharmacist. CONCLUSIONS: We consider the PCNE system with the four-level of classification to be a practical and easy-to-use tool in the daily hospital setting. Although we did not notice clinically relevant impairments of patient safety, a pharmacist may support the drug therapy and improve patient safety in clinics supporting the free choice of the drug therapy by the physician.

Selective induction of apoptosis in glioma tumour cells by a Gynostemma pentaphyllum extract.

At low concentration H(2)O(2) is an important signal molecule in proliferation of tumour cells. We report about a study investigating the effect of an ethanolic extract from Gynostemma pentaphyllum on proliferation of C6 glioma tumour cells and cellular H(2)O(2) concentration. The proliferation of these cells was maximal at about 1 muM extracellular H(2)O(2). HPLC-finger prints of the extract revealed a set of saponines as essential components. In C6 glioma cells the extract caused increase in super oxide dismutase (SOD) activity, in the amount of SOD protein, and in cellular H(2)O(2) concentration. It inhibited cell proliferation and induced activation of caspase 3 as indication of apoptosis. No effect of the extract was observed on the proliferation of astrocytes of a primary cell culture. From these findings we suggest that the ethanolic extract from Gynostemma pentaphyllum may selectively shift the H(2)O(2) concentration to toxic levels exclusively in tumour cells due to increased SOD activity. It may have a high potency in cancer therapy and cancer prophylaxis.

The Immunodeficiency Cancer Registry. A research resource.

The Immunodeficiency Cancer Registry (ICR) contains nearly 500 case records regarding patients with primary immunodeficiencies who have developed malignancies. There is a proportional excess of lymphomas (50.7%) among the ICR cases and more than one-half of these cases were diagnosed at less than 10 years of age. Information in the ICR database is accessible to investigators conducting research on the biology or epidemiology of cancers associated with immunodeficiency.

Hodgkin's disease in pediatric patients with naturally occurring immunodeficiency.

A case/control study of pediatric patients with Hodgkin's disease (HD) was undertaken to compare clinical characteristics in patients with known underlying immunodeficiency (20 Immunodeficiency Cancer Registry cases) and without known immunodeficiency (100 Late Effects Study Group cases). Immunodeficiency Cancer Registry cases demonstrated a younger mean age at diagnosis (p = 0.03), and a significantly higher rate of failure to achieve remission (p = 0.001) than did the Late Effects Study Group controls. Also, Immunodeficiency Cancer Registry cases showed a proportional excess of unfavorable histologies when compared with large published pediatric series. These discrepancies are consistent with a common etiology of HD relating to underlying immune defect in Immunodeficiency Cancer Registry HD patients as well as HD patients (or a select subgroup) without known immunodeficiency disorders.

Comparison of three techniques for the ex vivo elimination of T cells from human bone marrow.

The high incidence of graft-vs-host disease (GVHD) in allogeneic bone marrow transplantation (BMT) is a significant cause of morbidity and mortality, despite pharmacological prophylactic regimes. Laboratory technologies have been developed to eliminate the immunocompetent T-lymphocyte, the proposed effector cell in the GVHD reaction. In this study, three techniques for the ex vivo purging of T cells from human bone marrow (BM) were compared. BM treatment groups consisted of T-cell depletion by the monoclonal antibodies OKT3 and OKT11A plus complement (MoAb + C), soybean agglutination followed by sheep erythrocyte rosette depletion, or triple rosetting with neuraminidase-treated sheep erythrocytes. Mean final cell yields were 37.2 +/- 4.0%, 2.8 +/- 0.8%, and 2.5 +/- 1.3%, respectively, while final yields of BM progenitor cells, assayed in the double-layer soft-agar CFU-c assay, were 28.5 +/- 6.5%, 3.9 +/- 2.1%, and 10.5 +/- 3.8%, respectively. The three techniques were comparably efficient in elimination of mitogenic responses to irradiated allogeneic lymphoblastoid cells and cytotoxic lymphocyte responses of the BM. Immunofluorescence after T-cell depletion showed greater than 97.5% of all OKT3-positive cells to be eliminated by each technique. Despite the fact that all three techniques were effective in T-cell depletion, treatment with anti-T-cell MoAbs + C proved less labor-intensive and resulted in higher cell yields.