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Holbrook A, Perri D, Levine M, Mbuagbaw L, Jarmain S, Thabane L, Tarride JE, Dolovich L, Hyland S, Telford V, Silva J, Nieuwstraten C. Improving medication prescribing-related outcomes for vulnerable elderly in transitions on high-risk medications (IMPROVE-IT HRM): a pilot randomized trial protocol. Pilot Feasibility Stud 2024; 10:60. [PMID: 38600599 PMCID: PMC11005201 DOI: 10.1186/s40814-024-01484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Seniors with recurrent hospitalizations who are taking multiple medications including high-risk medications are at particular risk for serious adverse medication events. We will assess whether an expert Clinical Pharmacology and Toxicology (CPT) medication management intervention during hospitalization with follow-up post-discharge and communication with circle of care is feasible and can decrease drug therapy problems amongst this group. METHODS The design is a pragmatic pilot randomized trial with 1:1 patient-level concealed randomization with blinded outcome assessment and data analysis. Participants will be adults 65 years and older admitted to internal medicine services for more than 2 days, who have had at least one other hospitalization in the prior year, taking five or more chronic medications including at least one high-risk medication. The CPT intervention identifies medication targets; completes consult, including priorities for improving prescribing negotiated with the patient; starts the care plan; ensures a detailed discharge medication reconciliation and circle-of-care communication; and sees the patient at least twice after hospital discharge via virtual visits to consolidate the care plan in the community. Control group receives usual care. Primary outcomes are feasibility - recruitment, retention, costs, and clinical - number of drug therapy problems improved, with secondary outcomes examining coordination of transitions in care, quality of life, and healthcare utilization and costs. Follow-up is to 3-month posthospital discharge. DISCUSSION If results support feasibility of ramp-up and promising clinical outcomes, a follow-up definitive trial will be organized using a developing national platform and medication appropriateness network. Since the intervention allows a very scarce medical specialty expertise to be offered via virtual care, there is potential to improve the safety, outcomes, and cost of care widely. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT04077281.
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Affiliation(s)
- Anne Holbrook
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
- Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada.
| | - Dan Perri
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Digital Solutions, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Mitch Levine
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Biotatistics Unit, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Sarah Jarmain
- Medical and Academic Affairs, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Biotatistics Unit, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Center for Health Economic and Policy Analysis, McMaster University, Hamilton, ON, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sylvia Hyland
- Institute for Safe Medication Practices Canada, North York, ON, Canada
| | - Victoria Telford
- Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
| | - Jessyca Silva
- Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
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Lau EY, Cragg A, Small SS, Butcher K, Hohl CM. Characterizing and Comparing Adverse Drug Events Documented in 2 Spontaneous Reporting Systems in the Lower Mainland of British Columbia, Canada: Retrospective Observational Study. JMIR Hum Factors 2024; 11:e52495. [PMID: 38236629 PMCID: PMC10835584 DOI: 10.2196/52495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Robust adverse drug event (ADE) reporting systems are crucial to monitor and identify drug safety signals, but the quantity and type of ADEs captured may vary by system characteristics. OBJECTIVE We compared ADEs reported in 2 different reporting systems in the same jurisdictions, the Patient Safety and Learning System-Adverse Drug Reaction (PSLS-ADR) and ActionADE, to understand report variation. METHODS This retrospective observational study analyzed reports entered into PSLS-ADR and ActionADE systems between December 1, 2019, and December 31, 2022. We conducted a comprehensive analysis including all events from both reporting systems to examine coverage and usage and understand the types of events captured in both systems. We calculated descriptive statistics for reporting facility type, patient demographics, serious events, and most reported drugs. We conducted a subanalysis focused on adverse drug reactions to enable direct comparisons between systems in terms of the volume and events reported. We stratified results by reporting system. RESULTS We performed the comprehensive analysis on 3248 ADE reports, of which 12.4% (375/3035) were reported in PSLS-ADR and 87.6% (2660/3035) were reported in ActionADE. Distribution of all events and serious events varied slightly between the 2 systems. Iohexol, gadobutrol, and empagliflozin were the most common culprit drugs (173/375, 46.2%) in PSLS-ADR, while hydrochlorothiazide, apixaban, and ramipril (308/2660, 11.6%) were common in ActionADE. We included 2728 reports in the subanalysis of adverse drug reactions, of which 12.9% (353/2728) were reported in PSLS-ADR and 86.4% (2357/2728) were reported in ActionADE. ActionADE captured 4- to 6-fold more comparable events than PSLS-ADR over this study's period. CONCLUSIONS User-friendly and robust reporting systems are vital for pharmacovigilance and patient safety. This study highlights substantial differences in ADE data that were generated by different reporting systems. Understanding system factors that lead to varying reporting patterns can enhance ADE monitoring and should be taken into account when evaluating drug safety signals.
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Affiliation(s)
- Erica Y Lau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Centre, Vancouver, BC, Canada
| | - Amber Cragg
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Centre, Vancouver, BC, Canada
| | - Serena S Small
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Centre, Vancouver, BC, Canada
| | - Katherine Butcher
- Pharmaceutical Science, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
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Tassinari E, Rosellini M, Marchetti A, Mollica V, Massari F. What is the risk of hepatotoxicity induced by immune-checkpoint inhibitors and how can we avoid it? Expert Opin Drug Metab Toxicol 2024; 20:5-8. [PMID: 38299484 DOI: 10.1080/17425255.2024.2314059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/31/2024] [Indexed: 02/02/2024]
Affiliation(s)
- Elisa Tassinari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Matteo Rosellini
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Andrea Marchetti
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Veronica Mollica
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Ayre MJ, Lewis PJ, Phipps DL, Keers RN. unDerstandIng the cauSes of mediCation errOrs and adVerse drug evEnts for patients with mental illness in community caRe (DISCOVER): a qualitative study. Front Psychiatry 2023; 14:1241445. [PMID: 38144479 PMCID: PMC10746165 DOI: 10.3389/fpsyt.2023.1241445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Background It is estimated that 237 million medication errors occur in England each year with a significant number occurring in the community. Our understanding of the causes of preventable medication errors and adverse drug events (ADE) affecting patients with mental illness is limited in this setting. Better understanding of the factors that contribute to errors can support the development of theory-driven improvement interventions. Methods Remote qualitative semi-structured interviews with 26 community-based healthcare professionals in England and Wales were undertaken between June-November 2022. Recruitment was undertaken using purposive sampling via professional networks. Interviews were guided by the critical incident technique and analysed using the framework method. Any data that involved speculation was not included in the analysis. Independent analysis was carried out by the research team to extract themes guided by the London Protocol. Results A total of 43 medication errors and 12 preventable ADEs were discussed, with two ADEs having an unknown error origin. Prescribing errors were discussed most commonly (n = 24), followed by monitoring errors (n = 8). Six contributory factor themes were identified: the individual (staff); the work environment; the teams/interfaces; the organisation and management; the patient; and the task and technology. The individual (staff) factors were involved in just over 80% of all errors discussed. Participants reported a lack of knowledge regarding psychotropic medication and mental illnesses which accompanied diffusion of responsibility. There were difficulties with team communication, particularly across care interfaces, such as ambiguity/brevity of information being communicated and uncertainty concerning roles which created confusion amongst staff. Unique patient social/behavioural contributory factors were identified such as presenting with challenging behaviour and complex lifestyles, which caused difficulties attending appointments as well as affecting overall clinical management. Conclusion These findings highlight that the causes of errors are multifactorial with some unique to this patient group. Key areas to target for improvement include the education/training of healthcare professionals regarding neuropharmacology/mental illnesses and enhancing communication across care interfaces. Future research should explore patient perspectives regarding this topic to help develop a holistic picture. These findings can be used to guide future intervention research to ameliorate medication safety challenges for this patient group.
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Affiliation(s)
- Matthew J. Ayre
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Penny J. Lewis
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Denham L. Phipps
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
| | - Richard N. Keers
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
- Optimising Outcomes with Medicines (OptiMed) Research Unit, Pennine Care NHS Foundation Trust, Manchester, United Kingdom
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Ascenção R, Nogueira P, Sampaio F, Henriques A, Costa A. Adverse drug reactions in hospitals: population estimates for Portugal and the ICD-9-CM to ICD-10-CM crosswalk. BMC Health Serv Res 2023; 23:1222. [PMID: 37940971 PMCID: PMC10634004 DOI: 10.1186/s12913-023-10225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Adverse drug reactions (ADR), both preventable and non-preventable, are frequent and pose a significant burden. This study aimed to produce up-to-date estimates for ADR rates in hospitals, in Portugal, from 2010 to 2018. In addition, it explores possible pitfalls when crosswalking between ICD-9-CM and ICD-10-CM code sets for ADR identification. METHODS The Portuguese Hospital Morbidity Database was used to identify hospital episodes (outpatient or inpatient) with at least one ICD code of ADR. Since the study period spanned from 2010 to 2018, both ICD-9-CM and ICD-10-CM codes based on previously published studies were used to define episodes. This was an exploratory study, and descriptive statistics were used to provide ADR rates and summarise episode features for the full period (2010-2018) as well as for the ICD-9-CM (2010-2016) and ICD -10-CM (2017-2018) eras. RESULTS Between 2010 and 2018, ADR occurred in 162,985 hospital episodes, corresponding to 1.00% of the total number of episodes during the same period. Higher rates were seen in the oldest age groups. In the same period, the mean annual rate of episodes related to ADR was 174.2/100,000 population. The episode rate (per 100,000 population) was generally higher in males, except in young adults (aged '15-20', '25-30' and '30-35' years), although the overall frequency of ADR in hospital episodes was higher in females. CONCLUSIONS Despite the ICD-10-CM transition, administrative health data in Portugal remain a feasible source for producing up-to-date estimates on ADR in hospitals. There is a need for future research to identify target recipients for preventive interventions and improve medication safety practices in Portugal.
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Affiliation(s)
- Raquel Ascenção
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.
| | - Paulo Nogueira
- Escola Nacional de Saúde Pública - Universidade Nova de Lisboa, Lisboa, Portugal
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Adriana Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisboa, Portugal
| | - Andreia Costa
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Konstantinidis M, Le LW, Gao X. An Empirical Comparative Assessment of Inter-Rater Agreement of Binary Outcomes and Multiple Raters. Symmetry (Basel) 2022; 14:262. [DOI: 10.3390/sym14020262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Many methods under the umbrella of inter-rater agreement (IRA) have been proposed to evaluate how well two or more medical experts agree on a set of outcomes. The objective of this work was to assess key IRA statistics in the context of multiple raters with binary outcomes. Methods: We simulated the responses of several raters (2–5) with 20, 50, 300, and 500 observations. For each combination of raters and observations, we estimated the expected value and variance of four commonly used inter-rater agreement statistics (Fleiss’ Kappa, Light’s Kappa, Conger’s Kappa, and Gwet’s AC1). Results: In the case of equal outcome prevalence (symmetric), the estimated expected values of all four statistics were equal. In the asymmetric case, only the estimated expected values of the three Kappa statistics were equal. In the symmetric case, Fleiss’ Kappa yielded a higher estimated variance than the other three statistics. In the asymmetric case, Gwet’s AC1 yielded a lower estimated variance than the three Kappa statistics for each scenario. Conclusion: Since the population-level prevalence of a set of outcomes may not be known a priori, Gwet’s AC1 statistic should be favored over the three Kappa statistics. For meaningful direct comparisons between IRA measures, transformations between statistics should be conducted.
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Sauro KM, Soo A, de Grood C, Yang MMH, Wierstra B, Benoit L, Couillard P, Lamontagne F, Turgeon AF, Forster AJ, Fowler RA, Dodek PM, Bagshaw SM, Stelfox HT. Adverse Events After Transition From ICU to Hospital Ward: A Multicenter Cohort Study. Crit Care Med 2020; 48:946-53. [PMID: 32317594 DOI: 10.1097/CCM.0000000000004327] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To examine adverse events and associated factors and outcomes during transition from ICU to hospital ward (after ICU discharge). DESIGN Multicenter cohort study. SETTING Ten adult medical-surgical Canadian ICUs. PATIENTS Patients were those admitted to one of the 10 ICUs from July 2014 to January 2016. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two ICU physicians independently reviewed progress and consultation notes documented in the medical record within 7 days of patient's ICU discharge date to identify and classify adverse events. The adverse event data were linked to patient characteristics and ICU and ward physician surveys collected during the larger prospective cohort study. Analyses were conducted using multivariable logistic regression. Of the 451 patients included in the study, 84 (19%) experienced an adverse event, the majority (62%) within 3 days of transfer from ICU to hospital ward. Most adverse events resulted only in symptoms (77%) and 36% were judged to be preventable. Patients with adverse events were more likely to be readmitted to the ICU (odds ratio, 5.5; 95% CI, 2.4-13.0), have a longer hospital stay (mean difference, 16.1 d; 95% CI, 8.4-23.7) or die in hospital (odds ratio, 4.6; 95% CI, 1.8-11.8) than those without an adverse event. ICU and ward physician predictions at the time of ICU discharge had low sensitivity and specificity for predicting adverse events, ICU readmissions, and hospital death. CONCLUSIONS Adverse events are common after ICU discharge to hospital ward and are associated with ICU readmission, increased hospital length of stay and death and are not predicted by ICU or ward physicians.
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Lönnbro J, Holmqvist L, Persson E, Thysell P, Åberg ND, Wallerstedt SM. Inter-rater reliability of assessments regarding the quality of drug treatment, and drug-related hospital admissions. Br J Clin Pharmacol 2021; 87:3825-3834. [PMID: 33609324 DOI: 10.1111/bcp.14790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/04/2021] [Accepted: 02/13/2021] [Indexed: 12/30/2022] Open
Abstract
AIMS To investigate inter-rater agreement on the quality of drug treatment, and the relationship between the drug treatment and hospital admission. METHODS Three specialist physicians and two resident physicians determined, independently and in consensus, the quality of drug treatment from an overall medical perspective, and its association with admission, in 30 randomly selected patients (50% female, median age 72 years) admitted to Sahlgrenska University Hospital, Sweden, in April 2018. The inter-rater agreement was evaluated with Gwet's agreement coefficient (AC1 ). RESULTS In all, 200 (95%) out of 210 drugs at admission and 238 (97%) out of 245 drugs at discharge were assessed as reasonable drug treatment by all assessors. Conversely, none of the drugs at admission, and two at discharge, were assessed as unreasonable drug treatment by all assessors (AC1 : 0.88 and 0.94 [all], 0.86 and 0.95 [specialists], 0.92 and 0.92 [residents], respectively). The assessments regarding the association between the drug treatment and the hospital admission (not related or main/contributory reason) were consistent between the assessors for 16 out of 30 patients (AC1 : 0.67 [all], 0.74 [specialists], 0.54 [residents]). In none of the three cases where the hospital admission was considered possibly attributable to a prescribing error did the assessors make consistent assessments. CONCLUSIONS As the inter-rater agreement ranged between weak and almost perfect, the reliability of assessments of drug treatment quality, as well as adverse consequences, appears to be a methodological concern. To yield acceptably reliable results regarding both drug treatment aspects at issue, specialist physicians should be involved.
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Affiliation(s)
- Johan Lönnbro
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lina Holmqvist
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Persson
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Thysell
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - N David Åberg
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanna M Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,HTA Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
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Sauro K, Maini A, Machan M, Lorenzetti D, Chandarana S, Dort J. Are there opportunities to improve care as patients transition through the cancer care continuum? A scoping review protocol. BMJ Open 2021; 11:e043374. [PMID: 33495258 PMCID: PMC7839915 DOI: 10.1136/bmjopen-2020-043374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Transitions in Care (TiC) are vulnerable periods in care delivery associated with adverse events, increased cost and decreased patient satisfaction. Patients with cancer encounter many transitions during their care journey due to improved survival rates and the complexity of treatment. Collectively, improving TiC is particularly important among patients with cancer. The objective of this scoping review is to synthesise and map the existing literature regarding TiC among patients with cancer in order to explore opportunities to improve TiC among patients with cancer. METHODS AND ANALYSIS This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review Extension and the Joanna Briggs Institute methodology. The PubMed cancer filter and underlying search strategy will be tailored to each database (Embase, Cochrane, CINAHL and PsycINFO) and combined with search terms for TiC. Grey literature and references of included studies will be searched. The search will include studies published from database inception until 9 February 2020. Quantitative and qualitative studies will be included if they describe transitions between any type of healthcare provider or institution among patients with cancer. Descriptive statistics will summarise study characteristics and quantitative data of included studies. Qualitative data will be synthesised using thematic analysis. ETHICS AND DISSEMINATION Our objective is to synthesise and map the existing evidence; therefore, ethical approval is not required. Evidence gaps around TiC will inform a programme of research aimed to improve high-risk transitions among patients with cancer. The findings of this scoping review will be published in a peer-reviewed journal and widely presented at academic conferences. More importantly, decision makers and patients will be provided a summary of the findings, along with data from a companion study, to prioritise TiC in need of interventions to improve continuity of care for patients with cancer.
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Affiliation(s)
- Khara Sauro
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Arjun Maini
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Machan
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lorenzetti
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shamir Chandarana
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph Dort
- Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Kauppila M, Backman JT, Niemi M, Lapatto-Reiniluoto O. Incidence, preventability, and causality of adverse drug reactions at a university hospital emergency department. Eur J Clin Pharmacol 2021; 77:643-50. [PMID: 33188450 DOI: 10.1007/s00228-020-03043-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/09/2020] [Indexed: 01/24/2023]
Abstract
Purpose To investigate the characteristics of ADRs in patients admitting at the emergency room of a tertiary hospital. Methods We collected the patient records of 1600 emergency room visits of a university hospital in 2018. The patient files were studied retrospectively and all possible ADRs were identified and registered. Patient characteristics, drugs associated with ADRs, causality, severity, preventability, and the role of pharmacogenetics were assessed. Results There were 125 cases with ADRs, resulting in a 7.8% overall incidence among emergency visits. The incidence was greatest in visits among elderly patients, reaching 14% (men) to 19% (women) in the 80–89 years age group. The most common causative drugs were warfarin, acetylsalicylic acid (ASA), apixaban, and docetaxel, and the most common ADRs were bleedings and neutropenia and/or severe infections. Only two of the cases might have been prevented by pharmacogenetic testing, as advised in Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. Conclusion The same ATC classes, antithrombotics and cytostatics, were involved in ADRs causing university clinic hospitalizations as those identified previously in drug-related hospital fatalities. It seems difficult to prevent these events totally, as the treatments are vitally important and their risk-benefit-relationships have been considered thoroughly, and as pharmacogenetic testing could have been useful in only few cases. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-020-03043-3.
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Woo SA, Cragg A, Wickham ME, Villanyi D, Scheuermeyer F, Hau JP, Hohl CM. Preventable adverse drug events: Descriptive epidemiology. Br J Clin Pharmacol 2020; 86:291-302. [PMID: 31633827 PMCID: PMC7015751 DOI: 10.1111/bcp.14139] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022] Open
Abstract
AIM Our objective was to identify preventable adverse drug events and factors contributing to their development. METHODS We performed a retrospective chart review combining data from three prospective multicentre observational studies that assessed emergency department patients for adverse drug events. A clinical pharmacist and physician independently reviewed the charts, extracted data and rated the preventability of each adverse drug event. A third reviewer adjudicated all discordant or uncertain cases. We calculated the proportion of adverse drug events that were deemed preventable, performed multivariable logistic regression to explore the characteristics of patients with preventable events, and identified contributing factors. RESULTS We reviewed the records of 1 356 adverse drug events in 1 234 patients. Raters considered 869 (64.1%) of adverse drug events probably or definitely preventable. Patients with mental health diagnoses (OR 1.8; 95% CI 1.3-2.5) and diabetes (OR 1.7; 95% CI 1.2-2.4) were more likely to present with preventable events. The medications most commonly implicated in preventable events were warfarin (9.4%), hydrochlorothiazide (4.5%), furosemide (4.0%), insulin (3.9%) and acetylsalicylic acid (2.7%). Common contributing factors included inadequate patient instructions, monitoring and follow-up, and reassessments after medication changes had been made. CONCLUSIONS Our study suggests that patients with mental health conditions and diabetes require close monitoring. Efforts to address the identified contributing factors are needed.
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Affiliation(s)
| | - Amber Cragg
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Maeve E. Wickham
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Diane Villanyi
- Vancouver General HospitalVancouverBritish ColumbiaCanada
| | | | - Jeffrey P. Hau
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Corinne M. Hohl
- Vancouver General HospitalVancouverBritish ColumbiaCanada
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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Marra AR, Algwizani A, Alzunitan M, Brennan TMH, Edmond MB. Descriptive Epidemiology of Safety Events at an Academic Medical Center. Int J Environ Res Public Health 2020; 17:ijerph17010353. [PMID: 31947963 PMCID: PMC6982027 DOI: 10.3390/ijerph17010353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/26/2019] [Accepted: 01/02/2020] [Indexed: 11/16/2022]
Abstract
Background: Adverse safety events in healthcare are of great concern, and despite an increasing focus on the prevention of error and harm mitigation, the epidemiology of safety events remains incomplete. Methods: We performed an analysis of all reported safety events in an academic medical center using a voluntary incident reporting surveillance system for patient safety. Safety events were classified as: serious (reached the patient and resulted in moderate to severe harm or death); precursor (reached the patient and resulted in minimal or no detectable harm); and near miss (did not reach the patient). Results: During a three-year period, there were 31,817 events reported. Most of the safety events were precursor safety events (reached the patient and resulted in minimal harm or no detectable harm), corresponding to 77.3%. Near misses accounted for 10.8%, and unsafe conditions for 11.8%. The number of reported serious safety events was low, accounting for only 0.1% of all safety events. Conclusions: The reports analysis of these events should lead to a better understanding of risks in patient care and ways to mitigate it.
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Affiliation(s)
- Alexandre R. Marra
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
- Division of Medical Practice, Hospital Israelita Albert Einstein, 05652 São Paulo, Brazil
- Correspondence: ; Tel.: +1-319-353-7155; Fax: +1-319-353-7043
| | - Abdullah Algwizani
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
- Division of Infectious Diseases, Prince Mohammad Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia
| | - Mohammed Alzunitan
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
- Department of Infection Prevention and Control, King Abdulaziz Medical City, National Guard-Health Affairs, Riyadh 14611, Saudi Arabia
| | - Theresa M. H. Brennan
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
| | - Michael B. Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
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Hohl CM, Woo SA, Cragg A, Wickham ME, Ackerley C, Scheuermeyer F, Villanyi D. Repeat adverse drug events associated with outpatient medications: a descriptive analysis of 3 observational studies in British Columbia, Canada. CMAJ Open 2019; 7:E446-E453. [PMID: 31320328 PMCID: PMC6639095 DOI: 10.9778/cmajo.20180190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adverse drug events are an important cause of preventable emergency department visits and hospital admissions. We examined repeat adverse drug events associated with outpatient medications resulting in acute care utilization. METHODS This descriptive analysis combined data from 3 prospective multicentre observational studies, in which clinical pharmacists and physicians independently evaluated patients who visited the emergency department for adverse drug events in 3 hospitals in British Columbia. During these studies, an independent committee adjudicated all discordant and uncertain cases using a standardized algorithm. For the current study, we retrospectively reviewed the medical and research records of all patients 19 years of age and older who had been diagnosed with an adverse drug event during the primary studies to determine the proportion of repeat events. We used multivariable logistic regression to identify factors associated with repeat events; we adjusted for clustering at the hospital level for patient-level analyses and at the patient level for event-level analyses. RESULTS Among 12 977 patients, 1178 were diagnosed with 1296 adverse drug events at the point of care. Of these events, 32.5% (421 of 1296; 95% confidence interval [CI] 29.8%-35.1%) were repeat events, of which 75.3% (317 of 421; 95% CI 71.1%-79.5%) were deemed probably or definitely preventable as re-exposure to the culprit medication or repeat withdrawal of an indicated medication was inconsistent with best medical practice. Patients presenting with repeat events were more likely to have renal failure (odds ratio [OR] 2.01; 95% CI 1.32%-3.07%) or a mental health diagnosis (OR 1.39; 95% CI 1.02%-1.88%). INTERPRETATION A high proportion of adverse drug events were repeat events, most of which were deemed preventable. Interventions to ensure that care providers are aware of previously diagnosed adverse drug events when prescribing or dispensing need to be developed and evaluated and may reduce unintentional re-exposures to previously harmful medications.
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Affiliation(s)
- Corinne M Hohl
- Department of Emergency Medicine (Hohl, Cragg, Scheuermeyer), University of British Columbia; Emergency Department (Hohl), Vancouver General Hospital; Centre for Clinical Epidemiology and Evaluation (Hohl, Cragg, Wickham), Vancouver Coastal Health Research Institute; Pharmaceutical Sciences (Woo), Vancouver General Hospital; School of Population and Public Health (Wickham), University of British Columbia, Vancouver, BC; School of Communication (Ackerley), Simon Fraser University, Burnaby, BC; Division of Geriatrics (Villanyi), Department of Medicine, Vancouver General Hospital, Vancouver, BC
| | - Stephanie A Woo
- Department of Emergency Medicine (Hohl, Cragg, Scheuermeyer), University of British Columbia; Emergency Department (Hohl), Vancouver General Hospital; Centre for Clinical Epidemiology and Evaluation (Hohl, Cragg, Wickham), Vancouver Coastal Health Research Institute; Pharmaceutical Sciences (Woo), Vancouver General Hospital; School of Population and Public Health (Wickham), University of British Columbia, Vancouver, BC; School of Communication (Ackerley), Simon Fraser University, Burnaby, BC; Division of Geriatrics (Villanyi), Department of Medicine, Vancouver General Hospital, Vancouver, BC
| | - Amber Cragg
- Department of Emergency Medicine (Hohl, Cragg, Scheuermeyer), University of British Columbia; Emergency Department (Hohl), Vancouver General Hospital; Centre for Clinical Epidemiology and Evaluation (Hohl, Cragg, Wickham), Vancouver Coastal Health Research Institute; Pharmaceutical Sciences (Woo), Vancouver General Hospital; School of Population and Public Health (Wickham), University of British Columbia, Vancouver, BC; School of Communication (Ackerley), Simon Fraser University, Burnaby, BC; Division of Geriatrics (Villanyi), Department of Medicine, Vancouver General Hospital, Vancouver, BC
| | - Maeve E Wickham
- Department of Emergency Medicine (Hohl, Cragg, Scheuermeyer), University of British Columbia; Emergency Department (Hohl), Vancouver General Hospital; Centre for Clinical Epidemiology and Evaluation (Hohl, Cragg, Wickham), Vancouver Coastal Health Research Institute; Pharmaceutical Sciences (Woo), Vancouver General Hospital; School of Population and Public Health (Wickham), University of British Columbia, Vancouver, BC; School of Communication (Ackerley), Simon Fraser University, Burnaby, BC; Division of Geriatrics (Villanyi), Department of Medicine, Vancouver General Hospital, Vancouver, BC
| | - Christine Ackerley
- Department of Emergency Medicine (Hohl, Cragg, Scheuermeyer), University of British Columbia; Emergency Department (Hohl), Vancouver General Hospital; Centre for Clinical Epidemiology and Evaluation (Hohl, Cragg, Wickham), Vancouver Coastal Health Research Institute; Pharmaceutical Sciences (Woo), Vancouver General Hospital; School of Population and Public Health (Wickham), University of British Columbia, Vancouver, BC; School of Communication (Ackerley), Simon Fraser University, Burnaby, BC; Division of Geriatrics (Villanyi), Department of Medicine, Vancouver General Hospital, Vancouver, BC
| | - Frank Scheuermeyer
- Department of Emergency Medicine (Hohl, Cragg, Scheuermeyer), University of British Columbia; Emergency Department (Hohl), Vancouver General Hospital; Centre for Clinical Epidemiology and Evaluation (Hohl, Cragg, Wickham), Vancouver Coastal Health Research Institute; Pharmaceutical Sciences (Woo), Vancouver General Hospital; School of Population and Public Health (Wickham), University of British Columbia, Vancouver, BC; School of Communication (Ackerley), Simon Fraser University, Burnaby, BC; Division of Geriatrics (Villanyi), Department of Medicine, Vancouver General Hospital, Vancouver, BC
| | - Diane Villanyi
- Department of Emergency Medicine (Hohl, Cragg, Scheuermeyer), University of British Columbia; Emergency Department (Hohl), Vancouver General Hospital; Centre for Clinical Epidemiology and Evaluation (Hohl, Cragg, Wickham), Vancouver Coastal Health Research Institute; Pharmaceutical Sciences (Woo), Vancouver General Hospital; School of Population and Public Health (Wickham), University of British Columbia, Vancouver, BC; School of Communication (Ackerley), Simon Fraser University, Burnaby, BC; Division of Geriatrics (Villanyi), Department of Medicine, Vancouver General Hospital, Vancouver, BC
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Lo Giudice I, Mocciaro E, Giardina C, Barbieri MA, Cicala G, Gioffrè-Florio M, Carpinteri G, Di Grande A, Spina E, Arcoraci V, Cutroneo PM. Characterization and preventability of adverse drug events as cause of emergency department visits: a prospective 1-year observational study. BMC Pharmacol Toxicol 2019; 20:21. [PMID: 31029178 PMCID: PMC6486973 DOI: 10.1186/s40360-019-0297-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 04/05/2019] [Indexed: 12/25/2022] Open
Abstract
Background Adverse drug events (ADEs) are a significant cause of emergency department (ED) visits, with a major impact on healthcare resource utilization. A multicentre observational study, aimed to describe frequency, seriousness and preventability of ADEs reported in four EDs, was performed in Sicily (Italy) over a 1-year period. Methods Two trained monitors for each ED supported clinicians in identifying ADEs of patients admitted to EDs between June 1st, 2013 and May 31st, 2014 through a systematic interview of patients or their caregivers and with an additional record review. A research team analyzed each case of suspected ADE, to make a causality assessment applying the Naranjo algorithm and a preventability assessment using Schumock and Thornton criteria. Absolute and percentage frequencies with 95% confidence interval (CI) and medians with interquartile ranges (IQR) were estimated. Logistic regression models were used to evaluate independent predictors of serious and certainly preventable ADEs. Results Out of 16,963 ED visits, 575 (3.4%) were associated to ADEs, of which 15.1% resulted in hospitalization. ADEs were classified as probable in 45.9%, possible in 51.7% and definite in 2.4% of the cases. Moreover, ADEs were considered certainly preventable in 12.3%, probably preventable in 58.4%, and not preventable in 29.2% of the cases. Polytherapy influenced the risk to experience a serious, as well as a certainly preventable ADE. Whilst, older age resulted an independent predictor only of serious events. The most common implicated drug classes were antibiotics (34.4%) and anti-inflammatory drugs (22.6%). ADEs due to psycholeptics and antiepileptics resulted preventable in 62.7 and 54.5% of the cases, respectively. Allergic reactions (64%) were the most frequent cause of ADE-related ED visits, followed by neurological effects (10.2%) that resulted preventable in 1.9 and 37.3% of the cases, respectively. Conclusion ADEs are a frequent cause of ED visits. The commonly used antibiotics and anti-inflammatory drugs should be carefully managed, as they are widely involved in mild to severe ADEs. Polytherapy is associated with the occurrence of serious, as well as certainly preventable ADEs, while older age only with serious events. A greater sensitivity to drug monitoring programs among health professionals is needed.
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Affiliation(s)
- Ivan Lo Giudice
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Eleonora Mocciaro
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Claudia Giardina
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Maria Antonietta Barbieri
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Maria Gioffrè-Florio
- Department of Emergency Medicine, University Hospital G. Martino, Via Consolare Valeria, 98125, Messina, Italy
| | - Giuseppe Carpinteri
- Department of Emergency Medicine, University Hospital V. Emanuele, Via S. Sofia, 95123, Catania, Italy
| | - Aulo Di Grande
- Department of Emergency Medicine, General Hospital S. Elia, Via Luigi Russo, 93100, Caltanissetta, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.,Sicilian Regional Pharmacovigilance Center, Clinical Pharmacology Unit, University Hospital G. Martino, Via Consolare Valeria, 98125, Messina, Italy
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
| | - Paola Maria Cutroneo
- Sicilian Regional Pharmacovigilance Center, Clinical Pharmacology Unit, University Hospital G. Martino, Via Consolare Valeria, 98125, Messina, Italy
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