Effect of computerisation on the quality and safety of chemotherapy prescription.

BACKGROUND: Chemotherapy is prescribed according to protocols of several cycles. These protocols include not only therapeutic agents but also adjuvant solvents and inherent supportive care measures. Multiple errors can occur during the prescription, the transmission of documents and the drug delivery processes, and lead to potentially serious consequences. OBJECTIVE: To assess the effect of a computerised physician order entry (CPOE) system on the number of errors in prescription recorded by the centralised chemotherapy unit of a pharmacy service in a university hospital. PATIENTS AND METHODS: Existing chemotherapy protocols were standardised by a multidisciplinary team (composed of a doctor, a pharmacist and a nurse) and a CPOE system was developed from a File Maker Pro database. Chemotherapy protocols were progressively introduced into the CPOE system. The effect of the system on prescribing errors was measured over 15 months before and 21 months after starting computerised protocol prescription. Errors were classified as major (dosage and drug name) and minor (volume or type of infusion solution). RESULTS: Before computerisation, 141 errors were recorded for 940 prescribed chemotherapy regimens (15%). After introduction of the CPOE system, 75 errors were recorded for 1505 prescribed chemotherapy regimens (5%). Of these errors, 69 (92%) were recorded in prescriptions that did not use a computerised protocol. A dramatic decrease in the number of errors was noticeable when 50% of the chemotherapy protocols were prescribed through the CPOE system. CONCLUSION: Errors in chemotherapy prescription nearly disappeared after implementation of CPOE. The safety of chemotherapy prescription was markedly improved.

Diabetic patients who report receiving processes of diabetic care do not express a better quality of life

Background: Chronic disease management initiatives emphasize patient-centered care, and quality of life (QoL) is increasingly considered a representative outcome in that context. In this study we evaluated the association between receipt of processes of diabetic care and QoL. Methods: This cross-sectional population-based study (2011) used self-reported data from non-institutionalized, adult diabetics, recruited from randomly selected community pharmacies in Vaud. Outcomes included the physical and mental composites of the SF-36 (PCS, MCS) and the disease-specific Audit of Diabetes-Dependent QoL (ADDQoL). Main exposure variables were receipt of six diabetes processes-of care in the past 12 months. We also evaluated whether the association between care received and QoL was congruent with the chronic care model, when assessed by the Patient Assessment of Chronic Illness Care (PACIC). We used linear regressions to examine the association between process measures and the three composites of health-related QoL. Analyses were adjusted for age, gender, socioeconomic status, living companion, BMI, alcohol, smoking, physical activity, co-morbidities and diabetes mellitus (DM) characteristics (type, insulin use, complications, duration). Results: Mean age of the 519 diabetic patients was 64.4 years (SD 11.3), 60% were male and 73% had a living companion; 87% reported type 2 DM, half of respondents required insulin treatment, 48% had at least one DM complication, and 48% had DM over 10 years. Crude overall mean QoL scores were PCS: 43.4 (SD 10.5), MCS: 47.0 (SD 11.2) and ADDQoL: -1.56 (SD 1.6). In bivariate analyses, patients who received the influenza vaccine versus those who did not, had lower ADDQoL and PCS scores; there were no other indicator differences. In adjusted models including all processes, receipt of influenza vaccine was associated with lower ADDQoL (β= - 0.41, p=.01); there were no other associations between process indicators and QoL composites. There was no process association even when these were reported as combined measures of processes of care. PACIC score was associated only with the MCS (β= 1.57, p=.004). Conclusions: Process indicators for diabetes care did not show an association with QoL. This may represent an effect lag time between time of process received and quality of life; or that treatment may be related with inconvenience and patient worry. Further research is needed to explore these unexpected findings.

Effect of supplemental vitamin E on the performance of growing-finishing pigs fed stored versus freshly harvested barley and on the storage stability and eating quality of frozen pork

Lihasikojen E-vitamiinin tarve ruokittaessa vastapuidulla ohralla ja rehuun lisätyn E-vitamiinin vaikutus lihan pakastussäilyvyyteen ja syöntilaatuun

The effect of intrinsic soil properties on soil quality assessments

The assessment of soil quality is based on indicators and indices derived from soil properties. However, intrinsic soil properties may interfere with other soil properties that vary under different land uses and are used to calculate the indices. The aim of this study was to assess the extent to which intrinsic soil properties (clay and iron oxide contents) explain variable soil properties (sum of bases, potential acidity, organic carbon, total porosity, and bulk density) under different land uses (native forest, no-tillage and conventional agriculture) on small family farms in Southern Brazil. The results showed that the five properties evaluated can be included in soil quality assessments and are not influenced by the clay and iron oxide contents. It was concluded that for little weathered 1:1 and 2:1 phyllosilicate rich-soils, if the difference between the maximum and the minimum clay content under the different land uses is less than about 200 g kg-1 and the iron oxide content less than about 15 g kg-1, the physico-chemical soil properties in the surface layer are determined mostly by the land use.

Physical quality of an Oxisol after different periods of management systems

Management systems may lead to a loss of soil physical quality as a result of removal of the plant cover and excessive agricultural mechanization. The hypothesis of this study was that the soil aggregate stability, bulk density, macro- and microporosity, and the S index and saturated hydraulic conductivity may be used as indicators of the soil physical quality. The aim was to study the effects of different periods and managements on the physical attributes of a medium-textured Red Oxisol under soybean and corn for two growing seasons, and determine which layers are most susceptible to variations. A completely randomized experimental design was used with split plots (five treatments and four layers), with four replications. The treatments in 2008/09 consisted of: five years of no-tillage (NTS5), seven years of no-tillage (NTS7), nine years of no-tillage (NTS9), conventional tillage (CTS) and an adjacent area of native forest (NF). The treatments were extended for another year, identified in 2009/10 as: NTS6, NTS8, NTS10, CTS and NF. The soil layers 0-0.05, 0.05-0.10, 0.10-0.20 and 0.20-0.30 m were sampled. The highest S index values were observed in the treatment CTS in the 0-0.05 m layer (0.106) and the 0.05-0.10 m layer (0.099) in 2008/09, and in the 0-0.05 m layer (0.066) in 2009/10. This fact may be associated with soil turnover, resulting in high macroporosity in this treatment. In contrast, in the NTS, limiting macroporosity values were observed in some layers (below 0.10 m³ m-3). Highest aggregate stability as well as the highest saturated hydraulic conductivity (Kθ) values were observed in NF in relation to the other treatments. In 2009/10, the Kθ in NF differed only from NTS10. This study showed that the use of the S index alone cannot be recommended as an absolute indicator of the soil physical quality, even at values greater than 0.035.