Objective: Medication safety is always having great concern in healthcare. Giving oral medication through enteral feeding tubes is not uncommon and is a well-known area that prone to error happening. These errors may lead to inadequate treatment or adverse drug reaction resulting in unnecessary health care cost and wastage of public health resources. This systematic review aims to identify contributing factors on medication errors associated with administration of oral medication via enteral feeding tubes. With better understanding of the factors, improvement measures applicable to Hong Kong situations will be suggested. Methods: Pubmed, Medline and Embase databases were searched up to February 2014 by using relevant keywords. Prospective studies with researcher analyzing the drug administration process to observe the occurrence of errors and evaluate the contributing factors and case reports on medical error with review of the place of errors and their potential root causes were considered to be potential relevant literature. Studies meeting the inclusion criteria were included and evaluated in this review. Studies were excluded based on the exclusion criteria. Results and Discussion: An initial search of medical literature by searching engines identified 682 references. After appraisal for inclusion, 11 of them were included in this systematic review. For the findings, lack of knowledge, lack of the presence or the awareness of protocol, environmental factors, inter-disciplinary communication among healthcare professionals and the ability of inadvertent connection of both IV catheter and enteral feeding system had been identified to be key contributing factors to drug administration error. Taken account with the findings, measures to improve the existing local practice through educational reinforcement, establishing guideline and inter-disciplinary communication were suggested. Conclusion: With consideration of the local situation in Hong Kong and the findings identified in this review, suggestions of improvement measures on different aspects have been made in this review. Involvement of government policy, institutional management and the collaboration of multi-disciplinary healthcare professional are essential for the success of these improvement measures. Besides, this review also revealed the lack of research on medication safety issue concerning feeding tube, further research in this area is required. / published_or_final_version / Public Health / Master / Master of Public Health

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Emotional Behavioral Disorder (EBD) is a term used within the educational system to describe those students who in spite of supports for their emotional and behavioral difficulties, continue to struggle academically and negatively impact their peers. Children with EBD are one of the most difficult segments of the education population to integrate into the regular classroom due to their disruptiveness and the individuality of their needs. Strategies that have been used to help children with EBD include those with a cognitive and/or behavioral focus (both individually or in the classroom setting), those aimed at improving parenting skills and those that use prescription medication either by itself or as an adjunct to more behaviorally oriented treatments. In spite of increased usage and proven efficacy, however, many parents are reluctant to consider medication as a treatment alternative, and those who opt to use medication perceive their child stigmatized in their educational experience. The purpose of this qualitative study is to explore parental perceptions of medication use to address Emotional Behavioral Disorders and their satisfaction with using medication to address school based difficulties. Using grounded theory methodology, in depth, open-ended interviews with seven mothers of students identified as EBD were used to obtain information about their experiences and perceptions. Interviews were analyzed using a constant comparative method. The findings suggest that parents’ decision to use medication to address a child’s behavioral difficulties were based primarily on their own history of medication use and their relationship with school personnel. Implications and recommendations for school personnel and planning are then summarized.

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The purpose of this study was to identify the pharmaceutical practices of head athletic trainers in the treatment of athletic injuries at the National Collegiate Athletic Association (NCAA) Division I level. Another purpose was to determine if head ATCs and their staffs are compliant with the Federal and State guidelines relating to the dispensing and administering of prescription and over-the-counter OTC medications.Previous research indicated that widespread problems exist with the pharmaceutical practices of athletic trainers in the athletic setting. Due to these problems, the health care of student-athletes is being compromised and athletic trainers, physicians, pharmacists and universities are at risk for legal ramifications.A packet consisting of a cover letter explaining the purpose and voluntary nature of the study, the instrument, and a self-addressed stamped envelope was mailed out to the 312 Division I head athletic trainers on March 17, 1998. The 34 item instrument was specifically developed for the study and it covered areas dealing with the pharmaceutical practices of athletic trainers. A response rate of 60% (N= 188) was obtained for the study.The results were analyzed using descriptive statistics which consisted of means, standard deviations, and frequencies. The results indicated that prescription and OTC medications are provided in a majority of the athletic training rooms. The results indicated that a large number of athletic trainers dispense and administer prescription medications to student-athletes. This means that a number of ATCs are not following the Federal and State pharmaceutical guidelines. As a result of these findings, it is evident that widespread problems still exist in the pharmaceutical practices of athletic trainers at the NCAA Division I level. These practices could lead to compromised health care for the student athletes and serious legal ramifications for ATCs, physicians, and the universities. / School of Physical Education

Emotional Behavioral Disorder (EBD) is a term used within the educational system to describe those students who in spite of supports for their emotional and behavioral difficulties, continue to struggle academically and negatively impact their peers. Children with EBD are one of the most difficult segments of the education population to integrate into the regular classroom due to their disruptiveness and the individuality of their needs. Strategies that have been used to help children with EBD include those with a cognitive and/or behavioral focus (both individually or in the classroom setting), those aimed at improving parenting skills and those that use prescription medication either by itself or as an adjunct to more behaviorally oriented treatments. In spite of increased usage and proven efficacy, however, many parents are reluctant to consider medication as a treatment alternative, and those who opt to use medication perceive their child stigmatized in their educational experience. The purpose of this qualitative study is to explore parental perceptions of medication use to address Emotional Behavioral Disorders and their satisfaction with using medication to address school based difficulties. Using grounded theory methodology, in depth, open-ended interviews with seven mothers of students identified as EBD were used to obtain information about their experiences and perceptions. Interviews were analyzed using a constant comparative method. The findings suggest that parents’ decision to use medication to address a child’s behavioral difficulties were based primarily on their own history of medication use and their relationship with school personnel. Implications and recommendations for school personnel and planning are then summarized.

With asphyxia, newborns may suffer cardiogenic shock with myocardial dysfunction and dysregulation of vasomotor tone resulting in multiorgan dysfunction. Vasoactive medications are often administered with limited evidence directing clinicians regarding the use of high-dose monotherapy with dopamine relative to combination treatment with dopamine and a second different agent. We hypothesized that the treatment of hypoxia-reoxygenated newborn piglets with combinations of vasoactive medications would improve systemic and regional hemodynamics. Instrumented newborn piglets were subjected to hypoxia-reoxygenation with subsequent infusion of high-dose dopamine or moderate-dose dopamine and one of epinephrine, milrinone or levosimendan. Treatment with high-dose dopamine improved systemic and mesenteric perfusion. The addition of low-dose epinephrine showed some benefits regarding pulmonary hypertension and should a non-catecholamine agent be added to dopamine, milrinone is preferred to levosimendan given benefits to mesenteric perfusion. We conclude that the selection of appropriate vasoactive medical therapy should be directed by the clinical effects desired. / Experimental Surgery

This simple quantitative descriptive case controlled research compared cases (subjects at risk for acute confusion) with controls (subjects without the attribute); comparison was made on the exposure to potential contributing factors suspected of causing acute confusion, for example, heavy smoking, or the number of alcoholic drinks consumed per day. Case-control studies were also retrospective, because they focused on conditions in the past that might have caused subjects to become cases, rather than controls. The basic purpose of this research design was essentially the same as that of experimental research: to determine the relationships among variables. This report demonstrates that, with relatively good adherence by the nursing team, proactive screening using a structured risk assessment protocol can be successfully implemented for medical patients. This assessment was associated with a statistically significant 50 per cent reduction in the incidence of acute confusion in the intervention group, compared with usual care retrospectively. Reduction in acute confusion was not associated with shortened length of stay, but length of stay was often predetermined by protocol or critical pathway. Correlation analysis demonstrated that risk screening appeared most effective in preventing or reducing acute confusion in patients without preadmission dementia or ADL impairment. In patients with significant preadmission impairment, the stress of hospitalisation may be sufficient to precipitate an episode, despite otherwise optimal management. Less-impaired patients may require additional insults to precipitate acute confusion, some of which are avertable by risk screening and subsequent early intervention. Determined risk indicators were consistent throughout the four year timeframe set for this research project. This demonstrated that although there were multiple patient types presenting to this clinical area, they were consistently the same over a longitudinal timeframe. It meant they were reproducible, which gave this research additional strength. Also, based on the descriptive statistics, this research has shown that in this clinical area where intervention was introduced the combination did have a positive impact on annual numbers of acute confusion. In summary, these findings suggest that without risk screening and the direction for appropriate management the likelihood of an episode can more than double. In the three subgroups expected to pose the greatest challenges for the risk assessment (i.e. those 70 years or older, those with suspected drug dependency, and those with symptomatic infection), risk assessment retained excellent sensitivity, (a) (d) specificity, and relevant correlation with reduction of episodes. This research has demonstrated throughout that high risk screening and associated intervention based on the risk indicator can decrease the annual number of actual episodes of acute confusion. Interventions to prevent or reduce an episode of acute confusion, as outlined by Wakefield (2002) and this research, definitely increases as a result of high risk screening. Beyond doubt, from both the literature reviewed and the findings of this research, is that risk screening does need to be adapted to the individual clinical setting and cannot be generic.