Adverse drug reaction management in hospital settings: review on practice variations, quality indicators and education focus

Purpose

Adverse drug reactions (ADRs) contribute significantly to healthcare burden. However, they are largely preventable through appropriate management processes. This narrative review aims to identify the quality indicators that should be considered for routine monitoring of processes within hospital ADR management systems. It also examines the potential reasons behind variation in ADR management practices amongst HCPs, and explores possible solutions, focusing on targeted education programmes, to improve both the quality and quantity indicators of ADR management processes.

Methods

A comprehensive literature review was conducted to explore relevant themes and topics concerning ADR management, quality indicators and educational interventions.

Results

Substantial variability exists in ADR management amongst healthcare professionals (HCPs) with regard to reporting rates, characteristics of ADRs reported, quality of assessment, completeness of reports and, most importantly, risk communication practices. These variable practices not only threaten patient safety but also undermine pharmacovigilance processes. To date, quality indicators to monitor ADR management practices within hospital settings remain ill-defined. Furthermore, evidence behind effective interventions, especially in the form of targeted education strategies, to improve the quality of ADR management remains limited.

Conclusions

The focus of ADR management in hospitals should be to promote patient safety through comprehensive assessment, risk communication and safe prescribing. There is a need to develop a system to define, measure and monitor the quality of ADR management. Educational strategies may help improve the quality of ADR management processes.

Locally advanced esophageal cancer: Evaluation of prognosis by assessment of the “yp” stage based on the neoadjuvant regimen received

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Background: Neoadjuvant treatment in the form of chemoradiotherapy (nCRT) or chemotherapy (nCT) for resectable oesophageal cancer is the standard of care and improves R0 resection rates and overall survival (OS). The recently reported Neo-AEGIS study demonstrated ongoing equipoise between neoadjuvant chemoradiotherapy and peri-operative chemotherapy for oesophageal adenocarcinoma. There is limited data evaluating the prognostic outcomes by evaluation of the pathological stage after resection (yp stage) based on the neoadjuvant regimen received. The aim of this study was to look at the survival outcomes of patients with oesophageal cancer who received neoadjuvant therapy and to analyze the prognostic significance of pathological stage at surgery (“yp” stage) compared to the clinical stage based on the neoadjuvant therapy received. Methods: This was a single- centre, retrospective study over a fifteen-year period between 2005 and 2019. Consecutive patients with oesophageal and GOJ cancers that underwent resection post neoadjuvant treatment were included. The unit policy was to treat adenocarcinoma of the oesophagus and GOJ with perioperative chemotherapy until 2015 after which it was switched to neoadjuvant chemoradiotherapy in the form of the CROSS protocol. Results: Neoadjuvant treatment with either neoadjuvant chemoradiotherapy (nCRT) or neoadjuvant chemotherapy (nCT) prior to surgical resection was undertaken in 137 patients with resectable oesophageal and GOJ cancers between the years 2005 and 2019. The median age was 65 and 79% of the cohort was male. The majority of tumours were located in the lower oesophagus or GOJ and 96 patients in the cohort were clinical stage 3. 126 patients had adenocarcinoma and 11 patients had squamous cell carcinoma. 72 patients received nCT, and 65 patients received the nCRT. The “yp” stage showed 26 patients achieved a complete pathological response (CPR) and 47 patients were down-staged. The clinical stage was not a predictor of overall survival (p = 0.65). On the other hand, the “yp” stage was a significant predictor of survival (p < 1×10-8). In patients who received nCRT, 18 achieved a complete pathological response compared to 8 patients who had received nCT. Patients who received nCRT showed improved survival compared to patients who received nCT (p = 0.043). Patients who achieved a CPR with neoadjuvant chemotherapy had an OS of 100% compared to OS of 80% in patients who received nCRT (p = NS). Neoadjuvant chemoradiotherapy was associated with less loco-regional recurrences and distant recurrences compared to neoadjuvant chemotherapy. Conclusions: The “yp” stages, as well as down-staging with neoadjuvant therapy are strong predictors of survival. A greater proportion of patients achieved down-staging and CPR following neoadjuvant chemoradiotherapy compared to neoadjuvant chemotherapy.

Aetiologies and factors associated with poor clinical outcomes in rhabdomyolysis: a retrospective cohort study in an Australian trauma centre

Rhabdomyolysis is a clinical syndrome with significant morbidity and mortality that occurs as a result of traumatic and non-traumatic aetiologies. Acute kidney injury, the need for dialysis, and death, can occur due to rhabdomyolysis. This study explores the aetiologies, clinical outcomes and associated factors for poor outcomes in a cohort of patients with rhabdomyolysis in a tertiary trauma centre in Australia.

Cost-analysis of opportunistic influenza vaccination in general medical inpatients

Influenza vaccination is an important preventative health measure in the elderly and those with medical comorbidities. It has been shown to reduce hospitalisations, cardiovascular and respiratory complications. A significant proportion of patients admitted to general medicine are eligible for opportunistic inpatient influenza vaccination. This study explores the cost-effectiveness of such a strategy in reducing subsequent healthcare utilisation costs.

Opportunities to improve influenza vaccination rates in general medical inpatients

Influenza vaccination is an important preventative health measure. A significant proportion of general medical inpatients meets indications for annual inactivated influenza vaccination (IIV), as recommended by the Australian National Immunisation Programme. This study explores opportunities to provide IIV to eligible general medical inpatients and associated barriers.

Identification and molecular characterisation of the complete genome of a Singapore isolate of hepatitis C virus: sequence comparison with other strains and phylogenetic analysis

The complete genomic sequence of a Singapore isolate of the hepatitis C virus (HCV) was obtained from serum of an individual chronically infected with HCV. Nine overlapping cDNA clones covering the entire viral genome was amplified by reverse-transcription-polymerase chain reaction (RT-PCR), This isolate (HCV-S1) comprised 9,609 nucleotides (nt), including 341 nt of the complete 5' untranslated region (5' UTR), a single open reading frame of 3,011 amino acids (aa) and 235 nt of the complete 3' UTR. Its genotype was identified as type lb from analyses of its sequences in the 5' UTR, NS3 and NS5B regions. When compared against nine reported HCV isolates, the overall aa homology of HCV-SI was closest with an Australian strain, HCV-A (94%) and a Japanese strain, HCV-JT (93.9%). Phylogenetic analysis revealed that it was most closely related to the Taiwan strain, HCV-TW and another Japanese strain, HCV-K1-R1.

Mutations that affect dimer formation and helicase activity of the hepatitis C virus helicase

Interaction between viral proteins is necessary for viral replication and viral particle assembly. We used the yeast two-hybrid assay to identify interactions among all the mature proteins of the hepatitis C virus. The interaction between NS3 and NS3 was one of the strongest viral protein-protein interactions detected. The minimal region required for this interaction was mapped to a specific subdomain of 174 amino acids in the N terminus of the helicase region. Random mutations in the minimal region were generated by PCR, and mutants that failed to interact with a wild-type minimal fragment were isolated using the yeast two-hybrid assay as a screen. Three of these mutations resulted in a reduction or a loss of interaction between helicases. Analytical gel filtration showed that in the presence of an oligonucleotide, wild-type helicases form dimers whereas the mutants remain mostly monomeric. All three mutants were partially or almost inactive when assayed for helicase activity in vitro. Mixing a mutant helicase (Y267S) with wild-type helicase did not dramatically affect helicase activity. These data indicate that dimerization of the helicase is important for helicase activity. The mutations that reduce self-association of the helicase may define the key residues involved in NS3-NS3 dimerization.