Nursing - Research Publications

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    Medication-based Refill Adherence Among Pregnant Women Living With HIV in Nigeria
    Omonaiye, O ; Nicholson, P ; Kusljic, S ; Mohebbi, M ; Manias, E (ELSEVIER, 2020-11-01)
    PURPOSE: A major global public health challenge is the continuance of new pediatric HIV infections primarily because of mother to child transmission of HIV occurring mainly in sub-Saharan African countries. The purpose of this study was to examine antiretroviral therapy (ART) refill adherence and its determinants among pregnant women living with HIV in Nigeria. METHODS: A retrospective review of pharmacy refill records was undertaken to examine adherence data on 275 pregnant women undergoing ART in 4 high-volume HIV treatment sites in Nigeria. A pharmacy refill adherence measure was used to assess medication refill behavior of pregnant women living with HIV who had received an ART refill during a period of 3 months. Medication-based ART refill adherence was categorized as % adherence (100% adherence) or % nonadherence (<100% adherence) to the ART refill scheduled dates. Refill appointments were scheduled on a 28-day cycle. Multivariable logistic regression analysis was performed. FINDINGS: Of the 275 women, 59.3% (95% CI, 53.1%-65.5%) were adherent to their ART refill schedule. Women who initiated ART during the third trimester of their current pregnancy had the lowest adherence rate of 30.8% (95% CI, 7.7%-53.8%) compared with women who commenced ART before conception or during the first or second trimester. The availability of a treatment support person was significantly associated with ART refill adherence. The odds of medication-based refill adherence were 2.9 times higher for participants who had a treatment support person (odds ratio = 2.9; 95% CI, 1.6-5.2; p = 0.001). IMPLICATIONS: Results indicate that having a treatment support person could contribute to improving ART adherence in pregnant women living in Nigeria.
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    Interventions to reduce medication errors in adult medical and surgical settings: a systematic review
    Manias, E ; Kusljic, S ; Wu, A (SAGE PUBLICATIONS LTD, 2020-11-01)
    BACKGROUND AND AIMS: Medication errors occur at any point of the medication management process, and are a major cause of death and harm globally. The objective of this review was to compare the effectiveness of different interventions in reducing prescribing, dispensing and administration medication errors in acute medical and surgical settings. METHODS: The protocol for this systematic review was registered in PROSPERO (CRD42019124587). The library databases, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched from inception to February 2019. Studies were included if they involved testing of an intervention aimed at reducing medication errors in adult, acute medical or surgical settings. Meta-analyses were performed to examine the effectiveness of intervention types. RESULTS: A total of 34 articles were included with 12 intervention types identified. Meta-analysis showed that prescribing errors were reduced by pharmacist-led medication reconciliation, computerised medication reconciliation, pharmacist partnership, prescriber education, medication reconciliation by trained mentors and computerised physician order entry (CPOE) as single interventions. Medication administration errors were reduced by CPOE and the use of an automated drug distribution system as single interventions. Combined interventions were also found to be effective in reducing prescribing or administration medication errors. No interventions were found to reduce dispensing error rates. Most studies were conducted at single-site hospitals, with chart review being the most common method for collecting medication error data. Clinical significance of interventions was examined in 21 studies. Since many studies were conducted in a pre-post format, future studies should include a concurrent control group. CONCLUSION: The systematic review identified a number of single and combined intervention types that were effective in reducing medication errors, which clinicians and policymakers could consider for implementation in medical and surgical settings. New directions for future research should examine interdisciplinary collaborative approaches comprising physicians, pharmacists and nurses. LAY SUMMARY: Activities to reduce medication errors in adult medical and surgical hospital areas. INTRODUCTION: Medication errors or mistakes may happen at any time in hospital, and they are a major reason for death and harm around the world. OBJECTIVE: To compare the effectiveness of different activities in reducing medication errors occurring with prescribing, giving and supplying medications in adult medical and surgical settings in hospital. METHODS: Six library databases were examined from the time they were developed to February 2019. Studies were included if they involved testing of an activity aimed at reducing medication errors in adult medical and surgical settings in hospital. Statistical analysis was used to look at the success of different types of activities. RESULTS: A total of 34 studies were included with 12 activity types identified. Statistical analysis showed that prescribing errors were reduced by pharmacists matching medications, computers matching medications, partnerships with pharmacists, prescriber education, medication matching by trained physicians, and computerised physician order entry (CPOE). Medication-giving errors were reduced by the use of CPOE and an automated medication distribution system. The combination of different activity types were also shown to be successful in reducing prescribing or medication-giving errors. No activities were found to be successful in reducing errors relating to supplying medications. Most studies were conducted at one hospital with reviewing patient charts being the most common way for collecting information about medication errors. In 21 out of 34 articles, researchers examined the effect of activity types on patient harm caused by medication errors. Many studies did not involve the use of a control group that does not receive the activity. CONCLUSION: A number of activity types were shown to be successful in reducing prescribing and medication-giving errors. New directions for future research should examine activities comprising health professionals working together.
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    Enablers and barriers affecting medication-taking behaviour in aging men with benign prostatic hyperplasia
    Kusljic, S ; Manias, E ; Tran, B ; Williams, A (TAYLOR & FRANCIS LTD, 2013-09-01)
    OBJECTIVES: To identify the enablers and barriers affecting medication-taking behaviour in aging men with benign prostatic hyperplasia. METHODS: A total of 40 patients attending the urology outpatient clinic in Melbourne in 2012 were screened. Patients who successfully met the inclusion criteria were interviewed using a structured interview schedule. Information regarding the patient's medication, demographic data and presence of co-morbidities was collected. Content analysis was compared with patient demographic and medical data, contributing to the analysis. RESULTS: Problems with medication-taking were reported in 58% of patients. All patients without co-morbidities reported issues regarding their medications, whereas only 27% of patients with co-morbidities reported concerns regarding their medications. Statistical analysis revealed that patients without co-morbidities were significantly more likely (p = 0.002) to have complaints with their medications compared to those with co-morbidities. Furthermore, patients with co-morbidities who required help of caregivers to assist with their medication-taking were significantly less likely (p = 0.05) to have complaints with their medications compared to patients who self-managed. CONCLUSIONS: Older patients with caregivers who assisted managing their medication-taking had better adherence. Those receiving aid from their caregivers were significantly less likely to have complaints regarding their medications as opposed to those not requiring a caregiver. This highlights the importance of having support for medication-taking in patients with co-morbidities to assist with better adherence.
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    Medication adherence in pregnant women with human immunodeficiency virus receiving antiretroviral therapy in sub-Saharan Africa: a systematic review
    Omonaiye, O ; Kusljic, S ; Nicholson, P ; Manias, E (BMC, 2018-06-27)
    BACKGROUND: The use of antiretroviral therapy (ART) is a core strategy proposed by the World Health Organization in preventing mother to child transmission (MTCT) of HIV. This systematic review aimed to examine the enablers and barriers of medication adherence among HIV positive pregnant women in sub-Saharan Africa. METHODS: We used the following keywords: HIV AND (Pregnancy OR Pregnant*) AND (PMTCT OR "PMTCT Cascade" OR "Vertical Transmission" OR "Mother-to-Child") AND (Prevent OR Prevention) AND (HAART OR "Antiretroviral Therapy" OR "Triple Therapy") AND (Retention OR Concordance OR Adherence OR Compliance) to conduct electronic searches in the following databases: MEDLINE Complete (1916-Dec 2017), Embase (1947-Dec 2017), Global Health (1910-Dec 2017) and CINAHL Complete (1937-Dec 2017). Of the four databases searched, 401 studies were identified with 44 meeting the inclusion criteria. Seven studies were added after searching reference lists of included articles, resulting in 51 articles in total. RESULTS: The review demonstrated that stigma, cost of transportation, food deprivation and a woman's disclosure or non-disclosure of her HIV status to a partner, family and the community, could limit or define the extent of her adherence to prescribed antiretroviral drugs during pregnancy. Furthermore, the review indicated that knowledge of HIV status, either before or during pregnancy, was significantly associated with medication adherence. Women who knew their HIV status before pregnancy demonstrated good adherence while women who found out their HIV infection status during pregnancy were linked with non-adherence to ART. CONCLUSION: This review revealed several barriers and enablers of adherence among pregnant women taking ART in sub-Saharan Africa. Major barriers included the fear of HIV infection status disclosure to partners and family members, stigma and discrimination. A major enabler of adherence in women taking ART was women's knowledge of their HIV status prior to becoming pregnant. Enhanced effort is needed to facilitate women's knowledge of their HIV status before pregnancy to enable disease acceptance and management, and to support pregnant women and her partner and family in dealing with fear, stigma and discrimination about HIV.
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    Corticosteroid-induced psychiatric disturbances: It is time for pharmacists to take notice
    Kusljic, S ; Manias, E ; Gogos, A (ELSEVIER SCIENCE INC, 2016-03-01)
    Corticosteroids are widely used to relieve signs and symptoms arising from many diseases, including common inflammatory and autoimmune disorders affecting a number of organ systems. However, corticosteroids also induce significant adverse effects; in particular, a range of severe psychiatric adverse effects may occur including delirium, depression, mania, psychosis and cognitive/memory impairment. These adverse effects occur in up to 60% of patients taking corticosteroids and recent studies show an increased rate of psychopathologies in this population. Long-term adverse effects on mood and behavior are severely debilitating, thereby influencing the quality of life, employment and health status of individuals taking corticosteroids. Strategies used to manage corticosteroid-induced psychiatric disturbances through psychotropic drugs vary significantly. This commentary summarizes existing literature on mechanisms underlying corticosteroid-induced psychiatric adverse effects and evidence associated with using psychotropic drugs to manage these effects. Despite its importance, there is an absolute dearth in the literature examining pharmacists' understanding and perceptions of psychiatric adverse effects of corticosteroids. Educational programs need to be implemented so that pharmacists can counsel patients about how to recognize corticosteroid-induced psychiatric disturbances. Physicians do not consistently alert patients to watch for behavioral changes, and patients may feel that mood changes they experience fall within the category of 'normal behavior,' and thus are less likely to report them. Given that patients taking corticosteroids usually have complex medical histories, discussions of adverse effects with pharmacists are vital to improve health outcomes in this population.
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    Incidence of complications in men undergoing transurethral resection of the prostate
    Kusljic, S ; Aneja, J ; Manias, E (ELSEVIER SCIENCE BV, 2017-01-01)
    Objectives: To examine the link between medication use and the risk of bleeding complications following transurethral resection of the prostate from the second postoperative day until hospital discharge. Method: Using a retrospective observational study design, the medical records of all patients who underwent transurethral resection of the prostate over a 24-month period were examined. Comprehensive data regarding patients’ medication history, comorbidities and complications that occurred either during or after surgery were collected from medical records. Inferential statistical analysis was used to examine associations between demographic and medication variables and the risk of complications. Results: Complications arising after surgery occurred in 48/135 (36%) of patients. The most common complications postoperatively were hematuria, occurring in 41/48 (85%) and hematuria with clot retention, occurring in 24/48 (50%) of patients who suffered complications. There was a significant association between the number of medications prescribed and postoperative complications; for hematuria, χ2 (12) = 21.50, p = 0.04; and for hematuria with clot retention χ2 (12) = 24.97, p = 0.015. Conclusions: Demographic data relating to patients’ age, comorbid state and the number of standard medications prescribed is associated with an increase in macroscopic hematuria and macroscopic hematuria with clot retention after transurethral resection of the prostate. These findings emphasize the importance of nursing practice in both preoperative and postoperative care of patients undergoing surgery. Nurses need to be very vigilant in assessing patients at risk of increased bleeding from a transurethral resection of the prostate by examining their medication regimen.
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    The impact of medication adherence on men's health.
    Kusljic, S ; Williams, A ; Manias, E ( 2013-11)
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    Age-dependent physiological changes, medicines and sex-influenced types of falls
    Kusljic, S ; Perera, S ; Manias, E (TAYLOR & FRANCIS INC, 2018-01-01)
    Background/Study context: We investigated various parameters related to falls including age-dependent physiological changes, regular medicine use and different types of falls experienced. There is a lack of research investigating the impact of health status, sex, polypharmacy and ageing on different types of falls such as unspecified fall on the same level, mechanical fall on the same level relating to slipping, tripping or loosing balance, fall from a chair, vehicle and fall as a result of syncope, fall from steps or stairs and fall from the height. METHODS: The study included a random sample of 250 older patients, which comprised 10% of the total number of patients (n = 2,492), admitted to a large-scale academic hospital following a fall. Patients' medicine and illness history, types of falls, liver, renal and sensory function were collected. Univariate analysis was used to examine associations between the type of fall and explanatory variables, followed by multinominal logistic regression analysis. RESULTS: There was a significant association between the type of fall and sex, p = 0.01, and between the type of fall and regular medicine use, p = 0.002. The multinominal logistic regression analysis revealed that the full model, which considered all explanatory variables together, was statistically significant, p < 0.001. The strongest predictor of all types of falls except 'fall from the height' was female sex followed by the regular medicine use. CONCLUSION: This study identified predictors for various types of falls in older people; the strongest predictor being a female sex followed by regular medicine use. Based on these findings, the medicine prescribing practice in this older population must be carefully reviewed.