Enhancing potential impact of hospital discharge interventions for patients with COPD: a qualitative systematic review.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are frequently readmitted to hospital resulting in avoidable healthcare costs. Many different interventions designed to reduce hospital readmissions are reported with limited evidence for effectiveness. Greater insight into how interventions could be better designed to improve patient outcomes has been recommended. AIM: To identify areas for optimisation within previously reported interventions provided to reduce COPD rehospitalisation to improve future intervention development. METHODS: A systematic review was conducted by searching Medline, Embase, CINAHL, PsycINFO, and CENTRAL in June 2022. Inclusion criteria were interventions provided to patients with COPD in the transition from hospital to home or community. Exclusion criteria were lack of empirical qualitative results, reviews, drug trials, and protocols. Study quality was assessed using the Critical Appraisal Skills Programme tool and results were synthesised thematically. RESULTS: A total of 2,962 studies were screened and nine studies included. Patients with COPD experience difficulties when transitioning from hospital to home. It is therefore important for interventions to facilitate a smooth transition process and give appropriate follow-up post-discharge. Additionally, interventions should be tailored for each patient, especially regarding information provided. CONCLUSION: Very few studies specifically consider processes underpinning COPD discharge intervention implementation. There is a need to recognise that the transition itself creates problems, which require addressing, before introducing any new intervention. Patients report a preference for interventions to be individually adapted-in particular the provision of patient information. Whilst many intervention aspects were well received, feasibility testing may have enhanced acceptability. Patient and public involvement may address many of these concerns and greater use of process evaluations should enable researchers to learn from each other's experiences. TRIAL REGISTRATION: The review was registered in PROSPERO with registration number CRD42022339523.

Pharmaceutical interventions on prescriptions in Norwegian community and hospital pharmacies.

Background Pharmacists in community and hospital pharmacies assess prescriptions to prevent prescription errors and adverse drug events. There are, however, few reports on prevalence of clinical important pharmaceutical interventions for patients located within primary care. Objective To study documented pharmaceutical interventions on prescriptions in Norwegian pharmacies for patients located in primary care. Setting Data were collected in 11 community pharmacies during a 3 months period in 2016, and the outpatient department of four hospital pharmacies in Norway during a 6 months period of 2018. Method Retrospective analysis of electronically documented pharmaceutical interventions on prescriptions for patients located in primary care. Main outcome measure The number and classification of pharmaceutical interventions in relation to the total number of prescriptions. Results An intervention was documented in 124,178 (45.1%) of the 275,339 prescriptions dispensed during the study period. Interventions of potential clinical importance were performed and documented in 0.8% (2262) of the prescriptions. Conclusion A substantial number of pharmaceutical interventions are performed on prescriptions in Norwegian pharmacies after introduction of electronic prescriptions. A potentially clinical important intervention is performed in one of every 125 prescriptions (0.8%). This result indicates that pharmacists at Norwegian pharmacies prevent more than 400,000 prescription errors of potential clinical importance each year.

Cytotoxic saponins and other natural products from flowering tops of Narthecium ossifragum L.

For more than four centuries, the intake of Narthecium ossifragum has been associated with poisoning in domesticated animals. Saponins occurring in flowering tops of the plant are considered to cause kidney damage in calves. At present, there are more than 30 papers on the saponins of N. ossifragum in the literature, although the structures of these compounds have hitherto not been determined. Here, we identify the saponins of N. ossifragum as sarsasapogenin, sarsasapogenin-3-O-ß-galactopyranoside, sarsasapogenin-3-O-(2'-O-ß-glucopyranosyl-ß-galactopyranoside) and sarsasapogenin-3-O-(2'-O-ß-glucopyranosyl-3'-O-α-arabinopyranosyl-ß-galactopyranoside). Moreover, six aromatic natural products were isolated and characterized from the methanolic extract from flowers of N. ossifragum. Five of these aromatic compounds, chrysoeriol 6-C-ß-arabinofuranoside-8-C-ß-glucopyranoside, chrysoeriol 6-C-ß-arabinopyranosyl-8-C-ß-glucopyranoside, chrysoeriol 6-C-ß-xylopyranosyl-8-C-ß-galactopyranoside, chrysoeriol 6-C-ß-galactopyranosyl-8-C-ß-glucopyranoside and chrysoeriol 6-C-ß-glucopyranosyl-8-C-ß-galactopyranoside are undescribed. All compounds were tested for cytotoxicity in mammalian cell lines derived from the heart, kidney, and haematological tissues. The saponins exhibited cytotoxicity in the micromolar range, with proportionally increasing cytotoxicity with increasing number of glycosyl substituents. The most potent compound was the main saponin sarsasapogenin-3-O-(2'-O-ß-glucopyranosyl-3'-O-α-arabinopyranosyl-ß-galactopyranoside), which produced cell death at concentrations below 3-4 µM in all three cell lines tested. This indicates that the saponins are the toxicants mainly responsible for kidney damage observed in cattle after ingestion of N. ossifragum. Our findings also pave the way for analysis of individual compounds isolated during the biopsies of intoxicated animals.

Toxic aromatic compounds from fruits of Narthecium ossifragum L.

The intake of Narthecium ossifragum, commonly known as bog asphodel, has been associated with toxic effects observed in sheep for centuries. Although the plant has been studied for five centuries little is known about its chemical constituents. Six previously undescribed natural products, naringenin(3 â†’ 6″)luteolin, naringenin(3 â†’ 6″)chrysoeriol, liovil 4-O-ß-glucopyranoside, 2,6-dimethoxy cinnamic acid, (E)-4-(3-hydroxy-2,2-dimethylchroman-6-yl)but-3-en-2-one and (E)-4-(4-(((E)-4-hydroxy-3-methylbut-2-en-1-yl)oxy)phenyl)but-3-en-2-one, have been identified from fruits of N. ossifragum for the first time. In addition, the rare natural product 4-hydroxy-3-(3-methylbut-2-enyl)benzaldehyde and the five known compounds 4-hydroxycinnamic acid, quercetin 3,3'-dimethyl ether, quercetin 3,7-dimethyl ether, chrysoeriol 7-O-ß-glucopyranoside and the di-C-glycosylflavone isoschaftoside were all characterized for the first time from the fruits of N. ossifragum. The discovery of sufficient amounts of 4-hydroxy-3-(3-methylbut-2-enyl)benzaldehyde in fresh plant material of N. ossifragum to allow complete structure elucidation by NMR and HRMS supports the possibility that fungi associated with N. ossifragum may be able to produce enough toxins to play a significant role in the pathogenicity of N. ossifragum. 4-Hydroxy-3-(3-methylbut-2-enyl)benzaldehyde showed mild toxicity towards normal rat kidney (NRK) and more profound activity towards MOLM13 acute myeloid leukemia cells (IC50 = 430 µM and 68 µM, respectively). Naringenin(3 â†’ 6″)luteolin had IC50 of 230 µM towards NRK cells, and 115 µM towards MOLM13 cells. Microscopic evaluation suggests that these two compounds induce cell death by different mechanisms.

Use of a generic protocol in documentation of prescription errors in Estonia, Norway and Sweden / Uso de un protocolo genérico en la documentación de los errores de prescripción en Estonia, Noruega y Suecia

Pharmacists have an important role in detecting, preventing, and solving prescription problems, which if left unresolved, may pose a risk of harming the patient. Objective: The objectives of this study were to evaluate the feasibility of a generic study instrument for documentation of prescription problems requiring contact with prescriber before dispensing. The study was organized: 1) by countries: Estonia, Norway and Sweden; 2) by type of prescriptions: handwritten prescriptions, printouts of prescriptions in the electronic medical record and electronically transmitted prescriptions to pharmacies; and 3) by recording method - self-completion by pharmacists and independent observers. Methods: Observational study with independent observers at community pharmacies in Estonia (n=4) and Sweden (n=7) and self-completed protocols in Norway (n=9). Results: Pharmacists’ in Estonia contacted the prescriber for 1.47% of the prescriptions, about 3 times as often as in Norway (0.45%) and Sweden (0.38%). Handwritten prescriptions dominated among the problem prescriptions in Estonia (73.2%), printouts of prescriptions in the electronic medical record (89.1%) in Norway and electronically transmitted prescriptions to pharmacies (55.9%) in Sweden. More administrative errors were identified on handwritten prescriptions and printouts of prescriptions in the electronic medical record in Estonia and in Norway compared with electronically transmitted prescriptions to pharmacies in Sweden (p<0.05 for prescription types and p<0.01 for countries). However, clinically important errors and delivery problems appeared equally often on the different types of prescriptions. In all three countries, only few cases of drug interactions and adverse drug reactions were identified. Conclusion: Despite the different patterns of prescription problems in three countries, the instrument was feasible and can be regarded appropriate to document and classify prescription problems necessitating contact with prescriber before dispensing, irrespective of the type of prescription or recording method (AU)

Los farmacéuticos juegan un papel importante en la detección, prevención y resolución de problemas de prescripción, que si no se resuelven pueden poner en riesgo de daño al paciente. Objetivo: Los objetivos de este estudio fueron evaluar la factibilidad de un instrumento de genérico de estudio para documentar los problemas de prescripción que requieren contactar al prescriptor antes de dispensar. El estudio se organizó: 1) por países: Estonia, Noruega y Suecia; 2) por tipo de recetas: recetas manuscritas, recetas impresas desde el historial electrónico del médico, y prescripción electrónica; y 3) por método de registro: auto-cumplimentación por los farmacéuticos o por observadores independientes. Métodos: Estudio observacional con observadores independientes en las farmacias comunitarias en Estonia (n=4) y Suecia (n=7) y protocolos autocumplimentados en Noruega (n=9). Resultados: Los farmacéuticos en Estonia contactaron a los prescriptores en el 1.47% de las recetas, unas 3 veces más frecuentemente que en Noruega (0.45%) y Suecia (0.38%).Las recetas manuscritas dominaron entre los problemas de prescripción en Estonia (73.2%), las impresiones de recetas desde el historial electrónico (89.1%) en Noruega, y las prescripciones electrónicamente transmitidas a las farmacias (55.9%) en Suecia. Se identificaron más errores administrativos en las recetas manuscritas y en las impresas desde el historial electrónico en Estonia y Noruega, comparadas con las electrónicamente transmitidas a la farmacia de Suecia (p<0.05 para los tipos de recetas y p<0.01 para los países). Sin embargo, los errores clínicamente importantes y los problemas de entrega aparecieron igualmente entre los diferentes tipos de recetas. En los tres países, se identificaron unos pocos casos de interacciones medicamentosas y de reacciones adversas. Conclusión: A pesar de los tres patrones diferentes de prescripción en los tres países, el instrumento fue factible y puede considerarse apropiado para documentar y clasificar los problemas de prescripción que necesitan contactar con el prescriptor antes de ser dispensados, independientemente del tipo de receta o del método de registro (AU)

Use of a generic protocol in documentation of prescription errors in Estonia, Norway and Sweden.

UNLABELLED: Pharmacists have an important role in detecting, preventing, and solving prescription problems, which if left unresolved, may pose a risk of harming the patient. OBJECTIVE: The objectives of this study were to evaluate the feasibility of a generic study instrument for documentation of prescription problems requiring contact with prescriber before dispensing. The study was organized: 1) by countries: Estonia, Norway and Sweden; 2) by type of prescriptions: handwritten prescriptions, printouts of prescriptions in the electronic medical record and electronically transmitted prescriptions to pharmacies; and 3) by recording method - self-completion by pharmacists and independent observers. METHODS: Observational study with independent observers at community pharmacies in Estonia (n=4) and Sweden (n=7) and self-completed protocols in Norway (n=9). RESULTS: Pharmacists''in Estonia contacted the prescriber for 1.47% of the prescriptions, about 3 times as often as in Norway (0.45%) and Sweden (0.38%). Handwritten prescriptions dominated among the problem prescriptions in Estonia (73.2%), printouts of prescriptions in the electronic medical record (89.1%) in Norway and electronically transmitted prescriptions to pharmacies (55.9%) in Sweden. More administrative errors were identified on handwritten prescriptions and printouts of prescriptions in the electronic medical record in Estonia and in Norway compared with electronically transmitted prescriptions to pharmacies in Sweden (p<0.05 for prescription types and p<0.01 for countries). However, clinically important errors and delivery problems appeared equally often on the different types of prescriptions. In all three countries, only few cases of drug interactions and adverse drug reactions were identified. CONCLUSIONS: Despite the different patterns of prescription problems in three countries, the instrument was feasible and can be regarded appropriate to document and classify prescription problems necessitating contact with prescriber before dispensing, irrespective of the type of prescription or recording method.

Safety and efficacy of herbal remedies in obstetrics-review and clinical implications.

OBJECTIVE: to review the literature on safety and efficacy of the most commonly used herbs to enable midwives to give evidence-based information to pregnant women. DESIGN: survey and review of the scientific literature. SETTING: the survey was performed at the antenatal clinic at Norfolk and Norwich University Hospital between 26 November 2007 and 15 February 2008. PARTICIPANTS: a total of 578 expectant mothers at least 20-weeks pregnant. MEASUREMENTS AND FINDINGS: 57.8% of the participants used one or more herbal remedies. The most commonly used herbal preparations during pregnancy were ginger, cranberry, raspberry leaf, chamomile, peppermint and echinacea. Altogether, 14 studies focusing on the safety and/or efficacy of these herbals in human pregnancy were identified. Ten studies of ginger, one of cranberry, two of raspberry leaf and one of echinacea were located. KEY CONCLUSIONS: there is limited documentation on the safety and efficacy of many herbs commonly used during pregnancy. IMPLICATIONS FOR PRACTICE: midwives are important caregivers for pregnant women and should strive to give evidence-based advice on herbal use in pregnancy. If 'traditional use' is the only available information, the pregnant woman should be made aware of this to enable her to make an informed decision about the eventual use.

Prescriptions from general practitioners and in hospital physicians requiring pharmacists' interventions.

PURPOSE: To study prescribing errors requiring pharmacists' interventions and to evaluate the potential clinical significance of the errors and omissions detected. METHODS: The pharmacists at ten community pharmacies and two out-patient hospital pharmacies recorded prescribing errors and corresponding interventions using a modified version of a previously developed registration scheme. Prescription errors with potential clinical significance were scored according to a modified version of Safety Assessment Code (SAC)-score RESULTS: During the study period 85,475 prescriptions were dispensed. A total of 2385 prescribing errors were detected on 2226 (2.6%) prescriptions. The proportion of prescriptions with errors and omissions was more than four times higher on prescriptions from hospital physicians (7.1%) than on prescriptions from general practitioners (1.5%). The information on the majority (62.2%) of the prescriptions with inaccuracies had to be clarified before the drug could be dispensed. About 1/4 of the errors and omissions were of potential importance for the drug therapy. An expert panel of physicians and pharmacists judged 85% of these errors and omissions to be clinically significant. Individual physicians and pharmacists judged the clinical importance of the detected prescribing errors somewhat differently. CONCLUSIONS: Pharmacists intervened on 2.6% of prescriptions, and the majority of the potentially clinically significant prescribing errors were judged as significant to the patient's drug therapy and safety.

Raspberry leaf--should it be recommended to pregnant women?

This review evaluates the safety and efficacy of raspberry leaf (Rubus idaeus) in pregnancy. The electronic databases PubMed, ISI Web of Science, AMED, EMBASE, Natural Medicines Comprehensive Database and Cochrane Library were searched. Altogether 12 original publications with focus on safety or efficacy during pregnancy, pharmacology and in vitro tests explaining mode of action or constituents in Rubus idaeus were reviewed. Limited documentation exists and part of it is 50 years old or older. Only the latest animal study indicates an increased risk for the unborn child; however, all the studies are small and cannot rule out negative effects on pregnancy outcome. The efficacy of raspberry leaf is not convincingly documented. The use of raspberry leaf in pregnancy is a traditional herbal therapy and is recommended by some midwives. Due to the lack of evidence for safety and efficacy such recommendations are questionable. Suggestions for future work are given.

Use of herbal preparations during pregnancy: focus group discussion among expectant mothers attending a hospital antenatal clinic in Norwich, UK.

BACKGROUND: The extent of herbal medicine use in pregnancy has been widely researched throughout the world but little research has been published about the motivations for this use. METHODS: Focus group discussion. Women who participated in a survey at an antenatal clinic were asked to participate in a focus group discussion to elaborate further on some of the results from the survey. Six women participated. RESULTS: The major themes identified were: the "underground" nature of taking herbal remedies, reliance on family and friends for information, perceived safety of herbal remedies whilst acknowledging the lack of trial evidence and a desire for the NHS to be more open minded. CONCLUSION: Herbal medicines are pharmacologically active and pregnant women frequently take these without informing their pregnancy care provider. If doctors want to obtain a full medical picture which includes herb use then non-judgemental responses to such behaviour is required.

The use and the user of herbal remedies during pregnancy.

BACKGROUND: The physiologic changes that occur during pregnancy can lead to a variety of conditions that can usually be self-treated. There are no licensed medicines for conditions such as morning sickness or insomnia in pregnancy, and evidence from Western countries suggests that patients often resort to using herbal medicines. Research on the health behaviors of pregnant women in the United Kingdom with respect to herbal remedies has not been undertaken. OBJECTIVE: The objective of this study is to describe the use and the user of herbal remedies during pregnancy and to study the sources of information about herbs used. DESIGN: The study design was a survey among expectant mothers more than 20 weeks pregnant presenting at an antenatal clinic. SETTING: The setting was an antenatal clinic and antenatal ultrasound department at Norfolk and Norwich University Hospital. One thousand and thirty-seven (1037) questionnaires were handed out between November 2007 and February 2008. RESULTS: Five hundred and seventy-eight (578) questionnaires were returned (55.7%). Three hundred and thirty-four (334) of the 578 respondents (57.8%) reported using herbal remedies during pregnancy with a mean of 1.2 remedies per woman (median: 1, range: 0-10). The most commonly used remedies were ginger, cranberry, and raspberry leaf. The most probable user had been pregnant before and had a university degree. "Family and friends" were the most frequently cited source of information about herbal remedies during pregnancy, and more than 75% of the users reportedly did not tell their doctor or midwife about the use. CONCLUSIONS: A large percentage of the women in the study used herbal remedies during pregnancy--many of them without informing their doctor or midwife. Doctors or midwives should ask pregnant women if they use herbal remedies during pregnancy. Health care personnel should be open to discuss the use of herbal remedies during pregnancy and be able to give balanced information as the use is so widespread.

Use of herbal drugs during early pregnancy in relation to maternal characteristics and pregnancy outcome.

PURPOSE: To study characteristics of women using herbal drugs and the possible impact of use in early pregnancy on pregnancy outcome. METHODS: Data on the use of herbal drugs during pregnancy were obtained from the Swedish Medical Birth Register during the period 1st July 1995 to end of 2004. Women who reported use of herbal drugs were compared to all women giving birth during the period. Outcome variables were prematurity, birth weight, Apgar score, number of infants in delivery and congenital malformations. RESULTS: Among the 860 215 women in the register, 787 (0.9%) reported use of herbal drugs during early pregnancy. The most frequently used herbal drugs were Floradix (iron-rich herbs), ginseng and valerian. Use of such drugs was independently associated with high maternal age, normal weight and 14-15 years of education. Risk factors for valerian differed from those for other herbal drugs, for example with respect to maternal smoking and country of birth. Concomitant drug use was common and the most frequently used drugs were multivitamins, folic acid, cardiovascular drugs (mainly antihypertensive drugs), non-steroid anti-inflammatory drugs (NSAIDs), analgesics and psycholeptics. None of the infant characteristics studied were influenced significantly by the mother's use of the examined herbal drugs during early pregnancy. CONCLUSIONS: The most commonly reported herbal drugs used during pregnancy were Floradix (iron-rich herbs), ginseng and valerian. No signs of unfavourable effect on pregnancy outcome were seen. The number of exposures, however, was low and therefore effects on rare outcomes (e.g. specific malformations) cannot be excluded.

[Prescription errors--dimension and measures]. / Forskrivningsfeil--omfang og oppklaring.

BACKGROUND: A prescription should contain sufficient information to dispense the right medicine with correct instructions for use. The information given on the prescription also forms the basis for reimbursement of drug expenses. Knowledge of prescription errors may improve the procedures of the prescribing physician and the pharmacy. MATERIAL AND METHOD: Prescriptions without information on the indication of the drug therapy were registered in ten Norwegian pharmacies during two days in the autumn of 2004. Other errors and omissions on prescriptions were registered in nine of the pharmacies during a five week period. RESULTS AND INTERPRETATION: A total of 1884 (39%) of the 4667 prescriptions included in the first part of the study contained no information on the indication. A total of 1696 other errors and omissions were registered on 1359 (2%) of the 69,315 prescriptions included in the second part of the study. The most common errors and omissions were incomplete instructions for use (26%), missing information about the patient (17%), and errors and omissions related to reimbursement of drug expenses. 294 (17%) of the errors were judged to have potential clinical significance if they had not been corrected. The most common intervention was to interview the patient or to contact the prescribing physician. The most common changes were to change or clarify drug and dose.

Immunologic quantitation of the carcinoma specific human carcinoma antigen in clinical samples.

BACKGROUND: Based on the cross-reactivity of the human carcinoma antigen, HCA, with epiglycanin, a mouse mammary carcinoma cell surface glycoprotein, HCA has been detected in the tissue and blood of patients with every type of epithelium-derived cancer tested. METHODS: Competitive binding assays utilized the following antiepiglycanin antibodies: a polyclonal rabbit antiserum (immunoglobulin [Ig] G and IgM) in a radioimmunoassay; mouse monoclonal antibodies (Ab-1, IgM) on immunoplates; anti-idiotypic (Ab-2) and anti-anti-idiotypic (Ab-3) monoclonal antibodies (both IgG) from spleen cells of C57BL mice immunized, respectively, with Ab-1 and Ab-2, and utilized on immunoplates. IgG and IgM antibodies were evaluated for their ability to detect HCA and to distinguish between the blood of patients with, or without, carcinomas. RESULTS: Assays with the rabbit antiserum distinguished plasmas of metastatic breast carcinoma patients from those of patients with benign breast disease with a sensitivity of approximately 93% (specificity 90%). Antiepiglycanin IgM monoclonal antibodies (i.e., AE3) showed high specificity and sensitivity (> 90%) with sera from advanced carcinoma patients when compared with normal sera. The IgG anti-anti-idiotypic (Ab-3) monoclonal antibodies (i.e., AF2), which bind the same epitope as Ab-1, appear to possess less nonspecific binding capacity, however, than the Ab-1 (IgM) antibodies. Anti-Ab-1 (i.e., C8F2) anti-idiotypic monoclonal antibodies, which bear an idiotope equivalent to the epitope present in epiglycanin and the HCA, demonstrated greater consistency as a standard calibrator and for coating wells than epiglycanin. CONCLUSIONS: The concentration of the HCA in the body fluids of patients with carcinomas may be accurately determined by competitive binding assays. It is suggested that the use of anti-idiotypic antibodies (IgG), rather than epiglycanin/HCA, and Ab-3 anti-anti-idiotypic antibodies (IgG), rather than Ab-1 (IgM), will improve the consistency, as well as the sensitivity and specificity, of the assay.