Possible effect of blonanserin on gambling disorder: A clinical study protocol and a case report

BACKGROUNDGambling disorder is characterized by excessive and recurrent gambling and can have serious negative social consequences. Although several psychotherapeutic and pharmacological approaches have been used to treat gambling disorder, new treatment strategies are needed. Growing evidence suggests that dopamine D3 receptor plays a specific role in the brain reward system.AIMTo investigate if blonanserin, a dopamine D3 receptor antagonist, would be effective in reducing gambling impulses in patients with gambling disorder.METHODSWe developed a study protocol to measure the efficacy and safety of blonanserin as a potential drug for gambling disorder, in which up to 12 mg/d of blonanserin was prescribed for 8 wk.RESULTSA 37-year-old female patient with gambling disorder, intellectual disability, and other physical diseases participated in the pilot study. The case showed improvement of gambling symptoms without any psychotherapy. However, blonanserin was discontinued owing to excessive saliva production.CONCLUSIONThis case suggests that blonanserin is potentially an effective treatment for patients with gambling disorder who resist standard therapies, but it also carries a risk of adverse effects. Further studies are needed to confirm the findings.     

Medication errors during medical emergencies in a large, tertiary care, academic medical center

Purpose

Evaluate the rate, type and severity of medication errors occurring during Medical Emergency Team (MET) care at a large, tertiary-care, academic medical center.

Methods

A prospective, observational evaluation of 50 patients that required MET care was conducted. Data on medication use were collected using a direct-observation method whereby an observer documented drug information such as drug, dose, frequency, rate of administration and administration technique. Subsequently, a team of three clinicians assessed rate, type and severity of medication errors using definitions consistent with United States Pharmacopeia MEDMARX system. Severity was assessed on a scale of minor, moderate and severe.

Results

One hundred eighty six doses were observed for 36 different medications. A total of 296 errors were identified; of these 196 errors (66%) were inappropriate aseptic technique. Of the remaining 100 errors, 46% were prescribing errors, 28% administration technique errors, 14% mislabeling errors, 10% drug preparation errors and 2% improper dose prescribing. Examples included: (1) prescribing errors, (2) administering wrong doses, (3) mislabeling, and (4) wrong administration technique such as not flushing intravenous medication through intravenous access. The rate of medication administration errors was 1.6 errors/dose including aseptic technique and 0.5 errors/dose excluding aseptic technique. A notable portion (14%) of errors was considered at least moderate in severity.

Conclusions

One out of 2 doses was administered in error after errors of using inappropriate aseptic technique were excluded. There is a need for education and systematic changes to prevent medication errors during medical emergencies as an effort to avoid harm.     

住院精神病患者服药依从性的影响因素

目的分析住院精神病患者服药依从性的影响因素,从而提出干预措施。方法通过与病人、家属及其他病友交流以及对病人进行观察,对89例服药依从性差的住院患者进行分析。结果影响住院精神病患者服药依从性的原因很多,在89例被调查者中,对疾病无正确认识23例(占25.84%),害怕出现药物副反应17例(占19.10%),受幻觉妄想内容的影响15例(占16.85%),认为自己病好了没有必要再服药11例(占12.36%),对医护人员不信任7例(占7.86%),经济因素7例(占7.86%),家属对病人支持不良6例(占6.74%),企图积存药物自杀3例(占3.37%)。结论影响住院精神病患者服药依从性的原因,有病人个人的因素、医护人员的因素和其他因素(经济因素、家属的态度)等。     

The impact of computerized physician medication order entry in hospitalized patients--a systematic review

OBJECTIVE: To identify all published studies evaluating computerized physician order entry (CPOE) in the inpatient setting and uniformly classify these studies on outcome measure and study design. DATA SOURCES: All studies that evaluated the effect of CPOE on outcomes pertaining to the medication process in inpatients were electronically searched in MEDLINE (1966 to August 2006), EMBASE (1980 to August 2006) and the Cochrane library. In addition, the bibliographies of retrieved articles were manually searched. Articles were selected if one of their main objectives was CPOE evaluation in an inpatient setting. REVIEW METHOD: Identified titles and abstracts were independently screened by three reviewers to determine eligibility for further review. RESULTS: We found 67 articles, which included articles on CPOE evaluation on some outcome at the time of ordering. Most papers evaluated multiple outcome measures. The outcome measures were clustered in the following categories: adherence (n=22); alerts and appropriateness of alerts (n=7); safety (n=21); time (n=7); costs and (organizational) efficiency (n=23); and satisfaction, usage and usability (n=10). Most studies used a before-after design (n=35) followed by observational studies (n=24) and randomized controlled trials (n=8). CONCLUSION: The impact of CPOE systems was especially positive in the category adherence to guidelines, but also to some extent in alerts and appropriateness of alerts; costs and organizational efficiency; and satisfaction and usability. Although on average, there seems to be a positive effect of CPOE on safety, studies tended to be non-randomized and were focused on medication error rates, not powered to detect a difference in adverse drug event rates. Some recent studies suggested that errors, adverse drug events (ADEs) and even mortality increased after CPOE implementation. Only in the category time the impact has been shown to be negative, but this only refers to the physician's time, not the net time. Except for safety, on the whole spectrum of outcomes, results of RCT studies were in line with non-RCT study results.     

The association of benefit finding to psychosocial and health behavior adaptation among HIV+ men and women

Psychological and behavioral adaptation to HIV is integral to long-term survival. Although most research on coping with HIV has focused on factors associated with poor adaptation, recent research has expanded to include positive concomitants of adaptation, such as benefit finding. This study examined the occurrence of benefit finding among HIV+ men and women and evaluated the potential relevance of benefit finding to positive health behavior and psychosocial adaptation. HIV+ participants (N = 221) recruited during outpatient care completed self-report assessments of benefit finding, social support, depression, HAART adherence, substance use, and physical activity. In a series of multivariate analyses that controlled for demographic and health status variables, benefit finding was associated with lower depression scores, greater social support, and more physical activity, but showed no association to HAART adherence or substance use. The association of benefit finding to depression was partially mediated by differences in social support. Thus, benefit finding may improve psychological adjustment by motivating patients who experience stress-related growth to seek social support.     

How does patient-provider communication influence adherence to asthma medications?

ObjectiveTo assess hypothesized pathways through which patient-provider communication impacts asthma medication adherence.MethodsA national sample of 452 adults with asthma reported assessments of patient-provider communication, proximal outcomes (understanding of asthma self-management, patient-provider agreement, trust in the clinician, involvement in care, motivation), and adherence to asthma medications. Structural equation modeling was used to examine hypothesized pathways.ResultsSignificantly positive direct pathways were found between patient-provider communication and all proximal outcomes. Only positive indirect pathways, operating through trust and motivation, were found between patient-provider communication and medication adherence.ConclusionPatient-provider communication influences many desirable proximal outcomes, but only influences adherence through trust and motivation.Practice implicationsTo promote better adherence to asthma medication regimens and, ultimately positive asthma outcomes, healthcare providers can focus on implementing communication strategies that strengthen patients’ trust and increase patient motivation to use asthma medications.     

Relationship between beliefs about medicines and adherence in elderly patients with cardiovascular and respiratory diseases: A cross-sectional study in Romania

ObjectivesThe aim of this study was to explore elderly patients’ beliefs about medicines in general, and specific towards their treatment and the relationship between beliefs and adherence.MethodsA cross-sectional study was performed by administering a questionnaire developed to meet the study’s objectives. Elderly patients were recruited from three different settings.Results167 patients agreed to participate to our study, having a mean age of 73 years. Patients were aware of the necessity for treatment, but they also showed concern over the potential for the adverse outcomes. Only 15% of the patients were completely accepting their treatment having high necessity and low concerns, while 40% were ambivalent, having high necessity beliefs, but also high concerns, with 89% being adherent in this group. Overall, higher adherence was significantly correlated with higher necessity and with higher necessity-concern differential.ConclusionPatients beliefs have an impact on adherence, thus patients’ concerns and necessities should be addressed in order to improve adherence and treatment outcome.Practice implicationsHigher necessity positively influenced adherence to treatment, suggesting the fact that healthcare professionals could improve patients’ adherence by outlining and educating the patients on the necessity of the treatment, while also managing patients’ concerns.     

Preferences for pharmacist services to enhance medication management among people with diabetes in Indonesia: A discrete choice experiment

ObjectivesTo elicit patients’ preferences for pharmacist services that can enhance medication management among people with diabetes in Indonesia.MethodsA discrete choice experiment (DCE) among 833 respondents with diabetes in 57 community health centers (CHCs) and three hospitals in Surabaya, Indonesia. Consultation was the baseline service. Four attributes of consultation and two attributes of additional services were used in the DCE profiles based on literature and expert opinion. The DCE choice sets generated were partially balanced and partially without overlap. Random effect logistic regression was used in the analysis.ResultsRespondents preferred a shorter duration of consultation and flexible access to the pharmacist offering the consultation. A private consultation room and lower copayment (fee) for services were also preferred. Respondents with experience in getting medication information from pharmacists, preferred to make an appointment for the consultation. Total monthly income and experience with pharmacist services influenced preferences for copayments.ConclusionDifferences in patients’ preferences identified in the study provide information on pharmacist services that meet patients’ expectations and contribute to improve medication management among people with diabetes.Practice implicationThis study provides insight into evaluating and designing pharmacist services in accordance with the preferences of people with diabetes in Indonesia.     

Comparison of greater occipital nerve and greater occipital nerve + supraorbital nerve block effect in chronic medication overuse headache

Background /aimIn this study, we aimed to compare the efficacy of greater occipital nerve (GON) block alone and GON combined with supraorbital nerve (SON) block in the treatment of medication overuse headache (MOH).Material and methods82 patients were divided into two groups: 41 patients were administered bilateral GON block while the other 41 patients GON + SON block. Nerve blocks were administered every 10 days for a total of 5 sessions. After each administration and 20 days after the last injection, information on pre and post treatment numerical rating scale (NRS) score, number of painful days, analgesic intake, duration of pain were collected.ResultsThe decrease in headache evaluation parameters was similar in both groups after the block. The NRS scores in the GON and GON + SON groups before the treatment was (8.2 ±  0.7, 8.5  ± 0.7), the number of painful days in a month was (21.4 ±  6.9, 21.2 ± 4.6 days), the number of analgesics taken monthly was (45 ±  25.6, 47.5 ±  29.9), the duration of pain was (44.9 ±  24.6, 41.7 ±  22.8 h), respectively. On the 60th day of treatment, the NRS scores in the GON and GON + SON groups were found to be (6.8 ±  2.5, 4.8 ± 2.3), the number of painful days in a month was (4.2 ±  3.3, 2.2 ±  1.5), respectively. The number of monthly nalgesic consumption was (4.4 ±  3.8, 0.9 ±  1.2), and the duration of pain was (28.4 ±  19.3, 19.4  ± 16.1 h).ConclusionThis study showed significant reductions in headache parameters in both groups. However, NRS score, analgesic intake, number of painful days, and pain duration significantly better improved in the GON block added SON block group.     

Patients' satisfaction with information and experiences with counseling on cardiovascular medication received at the pharmacy

Objective

To assess the extent to which patients feel they have received enough information on cardiovascular drugs and experienced counseling at the pharmacy. In addition, to identify factors that are predictors for patient satisfaction with the information received.

Methods

Fifteen community pharmacies participated. New and chronic users of cardiovascular medication received a questionnaire containing sociodemographic and health questions, a measure of satisfaction with information received (SIMS), beliefs about medication (BMQ), and frequency of pharmacy counseling.

Results

Of the 578 respondents, 335 (58%) indicated to be unsatisfied with the information received on 3 or more SIMS items. Patients’ age, beliefs about medication, duration of cardiovascular treatment and use of antithrombotics predicted patients’ satisfaction with information received. Two-thirds of patients reported ‘never’ to have experienced 5 of 8 counseling activities at the pharmacy.

Conclusions

A considerable proportion of patients are unsatisfied with the information received on cardiovascular medication. The majority of patients have only received a limited scope of medication counseling at the pharmacy.

Practice implications

Information and counseling should be tailored to patients’ needs and concerns about cardiovascular medication and the experience patients already have with treatment. Pharmacists could enhance their role in supporting patients using cardiovascular medication.