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Fontan-associated liver disease (FALD) is a common complication in patients with Fontan circulation. We aimed to evaluate the red blood cell distribution width-to-platelet ratio (RPR) index as a non-invasive marker for assessing FALD severity, given its reported usefulness in in conditions such as hepatitis. This retrospective, cross-sectional study included adult Fontan patients. Laboratory tests, liver elastography, and hemodynamic parameters were analyzed. Fifty-six patients (24 females, 43%; median age 24 years, interquartile range [22-28]) were enrolled. Patients were grouped by liver stiffness (LS) stage: METAVIR ≤ F2 (22 patients, 39%) and > F2 (34 patients, 61%). The RPR index was significantly higher in the > F2 group (0.08 vs. 0.12, = 0.02), along with FIB-4 (0.68 vs. 1.06) and APRI (0.36 vs. 0.57). RPR correlated positively with liver stiffness ( = 0.27), total bilirubin ( = 0.43), cystatin C ( = 0.36), and creatinine ( = 0.38) but not with NT-proBNP, pulmonary artery pressure, or maximal oxygen consumption. The ROC curve analysis for predicting LS > F2 showed an AUC of 0.74 (95% CI: 0.61-0.87), comparable to FIB-4. Moreover, in the logistic regression model that accounted for age, gender, height, body weight, and systemic chamber morphology, RPR showed a significant association with LS > F2, with an odds ratio indicating a 1.4-fold (95% CI: 1.1-1.7) increase for every 0.01-unit increase in RPR. The RPR index is a simple, helpful tool for evaluating FALD severity in Fontan patients.

Women with single ventricle physiology after the Fontan procedure, despite numerous possible complications, can reach adulthood and give birth. Pregnancy poses a hemodynamic burden for distorted physiology of Fontan circulation, but according to the literature, it is usually well tolerated unless the patient is a “failing” Fontan. Our study aimed to assess maternal and fetal outcomes in patients after the Fontan procedure followed up in two tertiary Polish medical centers. We retrospectively evaluated all pregnancies in women after the Fontan procedure who were followed up between 1995–2022. During the study period, 15 women after the Fontan procedure had 26 pregnancies. Among 26 pregnancies, eleven ended with miscarriages, and 15 pregnancies resulted in 16 live births. Fetal complications were observed in 9 (56.3%) live births, with prematurity being the most common complication (n = 7, 43.8%). We recorded 3 (18.8%) neonatal deaths. Obstetrical complications were present in 6 (40%) out of 15 completed pregnancies—two (13.3%) cases of abruptio placentae, two (13.3%) pregnancies with premature rupture of membranes, and two (13.3%) patients with antepartum hemorrhage. There was neither maternal death nor heart failure decompensation during pregnancy. In two (13.3%) women, atrial arrhythmia developed. One (6.7%) patient in the second trimester developed ventricular arrhythmia. None of the patients suffered from systemic thromboembolism during pregnancy. Pregnancy in women after the Fontan procedure is well tolerated. However, it is burdened by a high risk of miscarriage and multiple obstetrical complications. These women require specialized care provided by both experienced cardiologists and obstetricians.

Hybrid procedures encompass surgical and catheter-based interventions aimed at enhancing survival rates and provide alternative treatment options for severely ill patients. This is a retrospective study aimed at analyzing hybrid procedures in infants with complex heart defects and duct-dependent systemic circulation at a high risk of cross-clamp circulation based on a single center's experience. We included 12 infants (7 boys, 5 girls) who were admitted to our department between 2019 and 2024 and who underwent hybrid surgery due to left-sided obstructive lesions. All neonates presented progressive heart failure and multiple organ dysfunction preceding hybrid procedures. The interventions were performed at a mean age of 8.6 days, with a mean body weight of 3.3 kg. Extracorporeal membrane oxygenation was required postoperatively in 2 patients. Early and late mortality were 8.3% and 16.6%, respectively. Interstage catheterization was performed in 7 patients requiring re-dilation of pulmonary artery bands and in 2 infants with arterial duct stent stenosis. Severe tricuspid regurgitation and progressive right ventricular dysfunction due to inadequate coronary perfusion were reported in 2 patients. Hybrid procedures are alternative options for infants with complex heart defects, especially when cross-clamp circulation poses high surgical risk. Multiple reinterventions are necessary to maintain stable hemodynamic status and relieve hypoxia or cardiac compromise. Future studies should aim to refine the timing and techniques of these interventions to improve survival and quality of life.

Objective: The objective of this study was to describe the medication errors in hospitalized patients, comparing those in neonates with medication errors across the age spectrum. Method: In tier 1, PubMed, Embase and Google Scholar were searched, using selected MeSH terms relating to hospitalized paediatric, adult and elderly populations. Tier 2 involved a search of the same electronic databases for literature relating to hospitalized neonatal patients. Results: A total of 58 articles were reviewed. Medication errors were well documented in each patient group. Overall, prescribing and administration errors were most commonly identified across each population, and mostly related to errors in dosing. Errors due to patient misidentification and overdosing were particularly prevalent in neonates, with 47% of administration errors involving at least tenfold overdoses. Unique errors were identified in elderly patients, comprising duplication of therapy and unnecessary prescribing of medicines. Overall, the medicines most frequently identified with error across each patient group included: heparin, antibiotics, insulin, morphine and parenteral nutrition. While neonatal patients experience the same types of medication errors as other hospitalized patients, the medication-use process within this group is more complex and has greater consequences resulting from error. Suggested strategies to help overcome medication error most commonly involved the integration of a clinical pharmacist into the treating team. Conclusion: This review highlights that each step of the medication-use process is prone to error across the age spectrum. Further research is required to develop targeted strategies relevant to specific patient groups that integrate key pharmacy services into wards.

With medication error rates in neonatal intensive care units (NICUs) reported to be as high as 91 medication errors per 100 patient admissions, the quality use of medicines (QUM) in this setting is important. Comprising the safe, rational, appropriate and effective use of pharmacotherapy, QUM is integral to achieving medication safety and optimal patient outcomes. To improve QUM in the NICU, the medication use process needs to undergo a quality assessment, using quality measures or indicators. As such, the objectives of this quasi-systematic literature review were to identify the measures used to evaluate QUM within the NICU and to map these against Donabedian’s traditional framework of structure, process and outcome. We searched EMBASE, PubMed, CINAHL, Google Scholar and Google for relevant published and grey literature. Overall, a total of 47 quality measures were identified and categorised: 17 structure, 19 process and 11 outcome measures. The most common measures related to the availability of medication safety technology in the NICU, written policies on the use of high-risk medications, medication error and adverse drug event reporting systems, and the provision of education for health professionals involved in the medication use process. However, there were no quality measures specifically designed for medication management in the NICU. The literature does not provide a comprehensive evaluation of the quality of care provided along the medication use process in the NICU. There is a need to develop a quality framework outlining measures that facilitate the appropriate use of medicines in the NICU.

Background Currently, there is no literature describing what a quality level of practice entails in Polish neonatal intensive care units (NICUs), nor are there any means of currently measuring the quality of pharmaceutical care provided to NICU patients. Objective To identify a set of essential pharmacist roles and pharmacy-relevant key performance indicators (KPI’s) suitable for Polish neonatal intensive units (NICUs). Setting Polish hospital pharmacies and NICUs. Method Using a modified Delphi technique, potential KPI’s structured along Donabedian’s domains as well as pharmacy services were presented to an expert panel of stakeholders. Two online, consecutive Delphi rounds, were completed by panellists between August and September 2017. Main outcome measure To identify the minimum level of pharmacy services that should be consistently provided to NICU patients. Results A total of 16 panellists contributed to the expert panel. Overall, consensus of 75% was reached for 23 indicators and for 28 roles. When considering pharmacy services for the NICU, the experts were found to highly value traditional pharmacy roles, such as dispensing and extemporaneous compounding, however, they were still eager for roles in the other domains, such as educational and clinical services, to be listed as essential for NICU practice. Panellists were found to positively value the list of indicators presented, and excluded only 9 out of the total list. Conclusion There is a need for future research to establish a minimum standard of practice for Polish pharmacists to encourage the progression and standardisation of hospital pharmacy services to meet the level of practice seen in NICUs worldwide.

Objectives The purpose of this study was to, first, investigate the perceptions of neonatal intensive care unit (NICU) pharmacists and directors of pharmacy in Australia and Poland regarding their level of preparation to perform pharmaceutical care services in the NICU, and second, identify practice barriers and ways to improve services. Method A cross-sectional, electronic-based survey was distributed among NICU pharmacists and directors of pharmacy working in hospitals with a NICU in Australia and Poland. The survey comprised 12 items, and the majority of questions were fixed binary ‘agree/disagree’ answers, supplemented by open-ended questions. Results A total of 29 participants from Australia and 20 from Poland completed the survey. Overall, it is apparent that Australian pharmacists felt more competent in clinical and educational roles than Polish participants. For 14 of the 15 clinical roles listed, more than 70% of Australian participants felt that pharmacists had a ‘good’ level of preparation to provide services to the NICU, including performing medication chart reviews (93.1%) and pharmaceutical interventions (96.6%), and collaborating with medical and nursing staff (93.1%). A significantly higher proportion of Polish than Australian pharmacists agreed that changes were needed to improve pharmacist practice in the NICU (90 vs. 53.6%; p  = 0.007). Conclusion Future efforts should focus on developing guidelines and practice standards for sub-specialties of pharmacist practice, such as neonatology, to promote the standardization of practice.

Objective Our aim was to explore Australian nurses and pharmacist’s perspectives on defining an ‘older’ patient in the context of decision making around pharmacotherapy. Design A qualitative study was conducted using semi-structured interviews, facilitated by a purpose-designed interview guide. Setting Practitioners were recruited from the primary care (i.e. registered community pharmacists, registered community nurses, general practice nurses) and tertiary care settings (i.e. referral hospitals, specialist clinics). Participants Non-prescribing health professionals directly involved in medication management (i.e. nurses, pharmacists) with experience in caring for older patients. Results This exploratory study identified three key themes: (1) defining ‘older’ patients is difficult, given the heterogeneity of the population; (2) age is more than a number and, therefore, cannot be used alone for tailoring and managing a patient’s treatment; and (3) a contemporary definition of an ‘older’ patient needs to be integrated into guidelines for treating aged patients. Overall, Australian nurses and pharmacists shared similar perspectives about defining an ‘older’ patient, favouring holistic assessments of individual patients. Conclusions Non-prescribing health practitioners, such as nurses and pharmacists, advocate an individualised approach, rather than a number-based approach, to decision making in older patients.

Background Older patients are major users of pharmacotherapy due to a higher incidence of health issues. However, there is evidence of age-biased prescribing, leading to over- or underprescribing of medication, and suboptimal clinical outcomes. Although many guidelines provide cautionary statements about the use of medicines in older patients, they fail to identify what this means in practice. There is no accepted definition of an older adult that appropriately characterises this patient group. As a result, there is potential for physicians to have variable interpretations of individuals within this patient population, leading to potential inconsistencies when making pharmacotherapeutic decisions. Objective The aim of this study was to explore how Australian medical physicians practically defined an older adult patient in the context of providing pharmacotherapeutic care to this population. Methods This was a two-stage study comprising a scenario-based questionnaire (quantitative phase) and semi-structured individual interviews (qualitative phase) with Australian physicians. Qualitative data was thematically analysed and manual inductive coding was used to generate core themes. Results A total of 15 physicians participated in the study. Overall, in regard to providing care to their older patients, the three key themes that emerged from physicians’ discussions were (1) using a number-based versus health status-based definition of an older patient; (2) patient ‘red flags’ influence prescribing decisions; and (3) lack of guideline support in prescribing for older patients. Most physicians ultimately defined older adult patients using a number-based description (i.e. age between 65 and 90 years) because they felt they needed some sort of ‘cut-off’ point to guide their decision making. However, in assessing an older patient, physicians considered a multitude of patient factors as influencers of their decision making during prescribing, including comorbidities, cognitive function, frailty, polypharmacy, etc., and did not solely focus on the patient’s age. Conclusion Physicians describe the complexity of decision making for older adult patients, and how this is influenced by a diverse range of factors, yet ultimately simplify the process by defaulting to number-based (age in years) guidelines and procedures.

ObjectivesTo describe and compare the pharmaceutical services and clinical pharmacy roles performed in neonatal intensive care units (NICUs) in Australian versus Polish hospitals.MethodsA 26-item survey was distributed electronically to directors of pharmacy as well as neonatal pharmacists in hospitals in Poland and Australia. Most questions were fixed ‘agree/disagree’ answers, supplemented by open-ended questions. The survey was distributed between January and May 2017.ResultsOverall, 30 Australian pharmacists and 22 Polish pharmacists completed the survey. Significant differences were observed in the types of pharmaceutical care services provided to NICUs between Australia and Poland. A higher proportion of Australians than Poles performed clinical roles: for example, providing medication recommendations (Aus=96.6%, Pol=9.1%, P<0.001); pharmaceutical interventions to resolve drug therapy problems (Aus=93.1%, Pol=18.2%, P<0.001); and general patient medication chart review (Aus=96.6%, Pol=13.6%, P<0.001). All (100%) Polish pharmacists did not consider themselves members of the NICU team and the majority (59.1%) felt that pharmaceutical care on the NICU was practically non-existent.ConclusionFuture research should focus on bringing practice in countries such as Poland closer in line with practice in countries such as Australia.