Medication safety in community pharmacy: a qualitative study of the sociotechnical context

Background  

While much research has been conducted on medication safety, few of these studies have addressed primary care, despite the high volume of prescribing and dispensing of medicines that occurs in this setting. Those studies that have examined primary care dispensing emphasised the need to understand the role of sociotechnical factors (that is, the interactions between people, tasks, equipment and organisational structures) in promoting or preventing medication incidents. The aim of this study was to identify sociotechnical factors that community pharmacy staff encounter in practice, and suggest how these factors might impact on medication safety.     

A comparison of presenting characteristics of patients with intracapsular and extracapsular proximal femoral fractures.

The presenting characteristics of 1423 consecutive admissions with proximal femoral fractures were prospectively studied, to determine any differences that may exist between patients, dependent on the radiological site of the fracture. Patients with intracapsular fractures were of a lower average age, more mobile, less likely to use walking aids or live in residential accommodation, they also had a considerably shorter length of hospital stay than for those patients with extracapsular fractures. Comparison against previous series shows that the average age of hip fracture patients and the proportion of trochanteric fractures is increasing.     

Ethnicity, location, age, and fluoridation factors in baby bottle tooth decay and caries prevalence of Head Start children.

Baby bottle tooth decay (BBTD) is a term applied to a specific form of rampant decay associated with inappropriate bottle or breast feeding of infants and young children. Although the prevalence of BBTD has been studied in individual ethnic groups, comparison studies are rare. Head Start children have frequently served as study subjects for assessing the prevalence of BBTD. The purpose of this study was to compare BBTD and caries prevalence among Head Start children who are members of four ethnic groups in five southwestern States. Age, residence, and fluoridation status were also compared for the total sample and ethnic categories. The sampling process was a stratified random site selection; it was used to obtain data on 1,230 children. This number constituted 3 percent of the children enrolled in Head Start in Public Health Service Region VI (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas) where the study was conducted. The criterion for determining the presence of BBTD was based on the number of carious deciduous maxillary incisors observed. The severity of the condition was reported as two of four and three of four of the target teeth affected. Thus, two levels of severity are reported. BBTD was prevalent in approximately 24 percent and 15 percent of the total sample, depending on the severity criterion used. Native American children had a significantly higher (P less than 0.05) prevalence than Hispanic, white, and black subjects. Rural children had significantly higher (P less than 0.05) prevalence of BBTD than nonrural children for all ethnic groups except whites.(ABSTRACT TRUNCATED AT 250 WORDS)     

Asbestos exposure: A potential cause of retroperitoneal fibrosis

The etiology of retroperitoneal fibrosis is unknown in 70% of the cases. The aim of our study was to examine the possible association between occupational asbestos exposure and retroperitoneal fibrosis; only two cases have been reported in the literature. We gathered all the cases of retroperitoneal fibrosis diagnosed in the Tampere University Hospital between 1987 and 1995. We examined their hospital records to evaluate the possible etiology of the disease. We also sent a structured questionnaire to all living patients (10/13) to obtain information on their asbestos exposure. The chest radiographs of the patients were re-read to evaluate possible changes resulting from asbestos exposure. We found 13 cases of idiopathic retroperitoneal fibrosis. Seven patients (all male) had been exposed to asbestos in the past. The chest radiographs of the four most-exposed patients showed characteristic asbestos-related abnormalities, including bilateral pleural plaques, round atelectasis and small irregular lung opacities. In our study, we found that asbestos exposure and asbestos-induced changes in the lung and pleura were common among male retroperitoneal fibrosis patients. We suggest that occupational exposure to asbestos may be an important etiological factor for retroperitoneal fibrosis. Am. J. Ind. Med. 33:418–421, 1998. © 1998 Wiley-Liss, Inc.     

Excessive maternal weight gain patterns in adolescents

The objective of this study was to examine the correlates of excessive maternal weight gain among adolescent mothers in the United States. Data from the Centers for Disease Control & Prevention 2000 natality file were analyzed to examine weight gain among adolescents (≤19 years) compared with their older counterparts (≥20 years). Using the Institute of Medicine guidelines, we defined excessive weight gain as more than 40 pounds. Our study population was restricted to singleton births, delivered after 36 weeks of gestation, who did not live in California. Maternal weight gain distributions were tabulated by maternal age and other maternal characteristics. Demographic characteristics potentially associated with maternal weight gain were compared for adolescents and older mothers. We further evaluated the role of parity and maternal race on the relationship between excessive weight gain and maternal age. Odds ratios and 95% confidence intervals were estimated using logistic regression. Over 27% of adolescent mothers gained excessive weight during pregnancy, although approximately 18% of their older counterparts gained more than 40 pounds. The association between young maternal age and weight gain was stronger for primiparous women than multiparous women and stronger among non-Hispanic white and non-Hispanic black mothers than Hispanic mothers. Adolescents were more likely to gain excessive weight than their older counterparts in nearly all demographic categories, regardless of parity or race. Adolescents are at high risk of gaining an excessive amount of weight during pregnancy and should be monitored during pregnancy by dietetics professionals.     

Inoculation's efficacy with young adults' risky behaviors: can inoculation confer cross-protection over related but untreated issues?

This investigation examined the potential of inoculation to protect young adults' attitudes from pressures to engage in risky behaviors (unprotected sex and binge drinking) as well as inoculation's efficacy in conferring umbrella protection (cross-protection) over related, but experimentally untreated, attitudes. A three-phase experiment was conducted involving 120 participants. The results revealed that inoculation can protect the attitudes of young adults from counterattitudinal pressures to engage in unprotected sex (treated issue) and binge drinking (untreated issue). Practical applications of these findings are explored, including the use of inoculation when designing health messages and more thorough assessments of health campaigns designed to discourage risky behaviors.     

Case study. Respirator selection for clandestine methamphetamine laboratory investigation

First responders to illicit drug labs may not always have SCBA protection available. Air-purifying respirators using organic vapor cartridges with P-100 filters may not be sufficient. It would be better to use a NIOSH-approved CBRN respirator with its required multi-purpose cartridge system, which includes a P-100 filter. This would remove all the primary drug lab contaminants—organic vapors, acid gases, ammonia, phosphine, iodine, and airborne meth particulates. To assure the proper selection and use of a respirator, it is recommended that the contaminants present be identified and quantified and the OSHA 29 CFR 1910.134 respirator protection program requirements followed.     

Field and model investigations of external gamma dose rates along the Cumbrian coast, NW England.

A survey of the contribution to external dose from gamma rays originating from intertidal sediments in the vicinity of the British Nuclear Group Sellafield site showed that the major anthropogenic contributions were due to (137)Cs and (60)Co. At some sites, traces of other anthropogenic radionuclides were detected, namely (106)Ru, (125)Sb, and (154)Eu. The proportions of fine grained material (<63 microm) were used to improve model predictions of dose contribution due to external exposure to gamma rays, using the CUMBRIA77/DOSE77 model. Model dose predictions were compared to those directly measured in the field. Using the new proportions of fine grained material (1-17.5%) in conjunction with field gamma-ray spectra, model predictions were improved considerably for most sites. Exceptions were at Drigg Barn Scar and Whitehaven Coal Sands sites, which had their own unique characteristics. The highest (60)Co activity concentrations in this study were detected at Drigg Barn Scar. These relatively high activity concentrations of (60)Co were due to the presence of (60)Co in mussels and barnacles, hence upsetting the fine sediment relationships used in previous dose calculations. Whitehaven Coal Sands was unusual in that it contained higher levels of radionuclides than would be expected in sandy sediment. The mineralogy of these sediments was the controlling factor on (137)Cs binding, rather than the proportion of fine grained material. By adjusting the effective fine grained sediment proportions for calculations involving (60)Co and (137)Cs at Drigg Barn Scar and Whitehaven Coal Sands respectively, the CUMBRIA77/DOSE77 model predictions could be improved upon significantly for these sites. This work highlights the influence of particle size and sediment composition on external dose rate calculations, as well as the potential for external dose contributions from biota.     

The influence of erythrocyte folate and serum vitamin B12 status on birth weight

The extent to which maternal folate and vitamin B12 modulate infant birth weight is unclear. The present study investigated mothers in early gestation (mean 11.5 (sd 5.8) weeks) and neonates, at delivery. Erythrocyte (RBC) folate (mothers: n 683; neonates: n 614) and vitamin B12 (mothers: n 534; neonates: n 614) were measured. Data on smoking habits were available for 44 % of pregnancies (n 443). The relationship between vitamin levels and birth weight standardized for gender and gestational age was investigated, using linear regression and adjusting for possible confounding variables (maternal age, parity). Results are presented as standardized regression coefficients (b). Increasing maternal age was associated with elevated RBC folate (b 0.11 (95 % CI 0.08, 0.15), P<0.001; n 674) and smoking was associated with a decrease in maternal RBC folate (b -1.38 (95 % CI -1.92, -0.86), P=0.001; n 319). Neonatal RBC folate was predicted by maternal RBC folate (b 0.08 (95 % CI 0.04, 0.11), P=0.001; n 315) and maternal vitamin B12 (b 0.08 (95 % CI 0.01, 0.16), P=0.02; n 252). Smoking influenced maternal vitamin B12 status (b -0.88 (95 % CI -1.49, -0.27), P=0.005; n 231). Using univariate regression, smoking significantly influenced infant birth weight (b -2.15 (95 % CI -3.24, -1.04), P<0.001; n 437). However, the effect of smoking on birth weight was statistically non-significant when considered in a multivariate regression model, leaving maternal RBC folate as the only significant predictor of birth weight (b 0.25 (95 % CI 0.08, 0.42), P=0.005; n 145). These findings suggest that maternal folate status is an important determinant of infant birth weight. The combined effects of smoking and reduced RBC status on birth weight require further investigation.