Leveraging Technology in Risk Evaluation and Mitigation Strategy Programs.

Description Medication safety is improved through REMS programs. Multidisciplinary teams and front-line staff are vital in setting up a REMS program and should be included in any discussions surrounding REMS programs. Certain components of the REMS requirements may be replaced with CDS screens. Utilizing technology can help advance patient safety and aid in regulatory compliance.

Vaccine wastage in Ghana, Mozambique, and Pakistan: An assessment of wastage rates for four vaccines and the context, causes, drivers, and knowledge, attitudes and practices for vaccine wastage.

Vaccine procurement costs comprise a significant share of immunization program costs in low- and middle-income countries, yet not all procured vaccines are administered. Vaccine wastage occurs due to vial breakage, excessive heat or freezing, expiration, or when not all doses in a multidose vial are used. Better estimates of vaccine wastage rates and their causes could support improved management of vaccine stocks and reduce procurement costs. This study examined aspects of wastage for four vaccines at service delivery points in Ghana (n = 48), Mozambique (n = 36), and Pakistan (n = 46). We used prospective data from daily and monthly vaccine usage data entry forms, along with cross-sectional surveys, and in-depth interviews. The analysis found that estimated monthly proportional open-vial wastage rates for vaccines in single-dose vials (SDV) or in multi-dose vials (MDV) that can be kept refrigerated up to four weeks after opening ranged from 0.08 % to 3 %. For MDV where remaining doses are discarded within six hours after opening, the mean wastage rates ranged from 5 % to 33 %, with rates being highest for measles containing vaccine. Despite national-level guidance to open a vaccine vial even when only one child is present, vaccines in MDV that are discarded within six hours of opening are sometimes offered less frequently than vaccines in SDV or in MDV where remaining doses can be used for up to 4 weeks. This practice can lead to missed opportunities for vaccination. While closed-vial wastage at service delivery points (SDPs) was relatively rare, individual instances can result in large losses, suggesting that monitoring closed-vial wastage should not be neglected. Health workers reported insufficient knowledge of vaccine wastage tracking and reporting methods. Improving reporting forms would facilitate more accurate reporting of all causes of wastage, as would additional training and supportive supervision. Globally, decreasing doses per vial could reduce open-vial wastage.

Comparison of new-onset post-operative atrial fibrillation between patients receiving carvedilol and metoprolol after off-pump coronary artery bypass graft surgery.

OBJECTIVE: Post-operative atrial fibrillation (POAF) is a common complication of coronary artery bypass graft (CABG) surgery. Previous studies suggest carvedilol is more effective than metoprolol in preventing POAF in on-pump CABG. This study investigated if the same benefit would be seen in off-pump CABG. METHODS: This single-center, retrospective review compared rates of new-onset POAF between adult patients who received carvedilol and metoprolol after off-pump CABG surgery. Safety endpoints included hypotension, bradycardia, dyspnea, and the composite. Multivariate logistic regression was conducted to identify associations between demographics, potential confounders, and beta-blocker dose and POAF. Kaplan-Meier plots and Cox proportional-hazards models examined differences in time-to-event for POAF. RESULTS: 134 patients were included (34 carvedilol and 100 metoprolol). The mean age was 63 years, 70.9% were male, 85% had history of hypertension, 3.7% had history of heart failure with reduced ejection fraction, and 38.8% were taking beta blockers prior to admission. POAF developed in 2 patients (5.8%) in the carvedilol group and 24 patients (24.0%) in the metoprolol group (odds ratio 0.17 [95% CI 0.03-0.83], p = 0.023). Safety endpoints occurred in 10 carvedilol (29.4%) and 44 metoprolol (44.0%) patients (p = 0.134). Hypotension and dyspnea rates were similar between groups; bradycardia occurred more commonly among metoprolol-treated patients (p = 0.040). Time-to-event analyses revealed a hazard ratio = 0.22 (95% CI 0.05-0.93, p = 0.040) for carvedilol use. CONCLUSIONS: In this single-center, retrospective study of off-pump CABG patients, carvedilol was associated with reduced POAF risk and enhanced safety compared to metoprolol.

Systematic Review of Tools and Methods to Measure Appetite in Undernourished Children in the Context of Low- and Middle-Income Countries.

Child undernutrition has multifactorial causes, ranging from food insecurity to etiologies refractory to conventional nutritional approaches, such as infections, environmental enteric dysfunction, and other conditions that lead to systemic inflammation. Poor appetite may be an important symptom of these causes and may be a useful marker of an undernourished child's ability to recover. We conducted a systematic review to characterize the methods and tools to measure appetite among children <5 y old in low- and middle-income countries. A systematic search of 8 databases identified 23 eligible studies published since 1995. Thirteen described methods based on direct feeding observation or quantification of nutrient intake from caregiver report, 16 described tools that assessed caregiver perceptions of appetite, and 6 reported assessments in both categories. Four studies that gauged caregiver perceptions assessed multiple appetite domains, whereas 12 assessed 1 domain-often with a single question. Only 6 studies reported validation processes, the most common of which compared an observed test meal with daily energy intake. No studies reported the use of a method or tool that was validated in multiple cultural or linguistic contexts. Although dietary intake measures and observed feeding tests have shown validity in some contexts, they are resource intensive. Subjective caregiver questionnaires may offer a more efficient appetite evaluation method, but they have been evaluated less consistently. A rigorously developed and validated tool to rapidly assess child appetite is needed and could be best addressed by a questionnaire that leverages the multiple domains of appetite. The application of interventions that target causes of undernutrition that are not amenable to food-based interventions in clinical or research contexts could be facilitated by an efficient appetite screening tool to identify appetite-related causes of undernutrition and to monitor children's response to such interventions.

Put on a smiley face: textspeak and personality perceptions.

With the emergence of Web 2.0, there has been a dramatic surge in user-generated content. Although the Internet provides greater freedom in self-presentation, computer-mediated communication is characterized by a more relaxed attitude to grammar, spelling, and punctuation. The language of the Internet, or textspeak, may be suitable for casual interactions but inappropriate in professional contexts. Participant perceptions of an author's personality were tested in two distinct contexts (formal vs. informal) and the written information was manipulated under three levels of textspeak: none, low, and high. Participants judged the author as less conscientious and less open but more emotionally stable when textspeak was used. However, context had no impact. Personality perceptions of textspeak users differ to those who write in Standard English, and this is likely to extend to informal impression management contexts (e.g., online dating). These findings also have a number of implications, for example in terms of screening applicants via social media.