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This study compared the potential for personal digital assistant (PDA)-based drug information sources to minimize potential medication errors dependent on accurate and complete drug information at the point of care. A quality and safety framework for drug information resources was developed to evaluate 11 PDA-based drug information sources. Three drug information sources met the criteria of the framework: Eprocrates Rx Pro, Lexi-Drugs, and mobileMICROMEDEX. Medication error types related to drug information at the point of care were then determined. Forty-seven questions were developed to test the potential of the sources to prevent these error types. Pharmacists and physician experts from Creighton University created these questions based on the most common types of questions asked by primary care providers. Three physicians evaluated the drug information sources, rating the source for each question: 1=no information available, 2=some information available, or 3 = adequate amount of information available. The mean ratings for the drug information sources were: 2.0 (Eprocrates Rx Pro), 2.5 (Lexi-Drugs), and 2.03 (mobileMICROMEDEX). Lexi-Drugs was significantly better (mobileMICROMEDEX t test; P=0.05; Eprocrates Rx Pro t test; P=0.01). Lexi-Drugs was found to be the most specific and complete PDA resource available to optimize medication safety by reducing potential errors associated with drug information. No resource was sufficient to address the patient safety information needs for all cases.

Most patients with chronic lymphocytic leukaemia or small lymphocytic lymphoma relapse after initial therapy. Bendamustine plus rituximab is often used in the relapsed or refractory setting. We assessed the efficacy and safety of adding ibrutinib, an oral covalent inhibitor of Bruton's tyrosine kinase (BTK), to bendamustine plus rituximab in patients with previously treated chronic lymphocytic leukaemia or small lymphocytic lymphoma. The HELIOS trial was an international, double-blind, placebo-controlled, phase 3 study in adult patients (≥18 years of age) who had active chronic lymphocytic leukaemia or small lymphocytic lymphoma with measurable lymph node disease (>1·5 cm) by CT scan, and had relapsed or refractory disease following one or more previous lines of systemic therapy consisting of at least two cycles of a chemotherapy-containing regimen, an Eastern Cooperative Oncology Group (ECOG) performance status of 0–1, and adequate bone marrow, liver, and kidney function. Patients with del(17p) were excluded because of known poor response to bendamustine plus rituximab. Patients who had received previous treatment with ibrutinib or other BTK inhibitors, refractory disease or relapse within 24 months with a previous bendamustine-containing regimen, or haemopoietic stem-cell transplant were also excluded. Patients were randomly assigned (1:1) by a web-based system to receive bendamustine plus rituximab given in cycles of 4 weeks' duration (bendamustine: 70 mg/m2 intravenously on days 2–3 in cycle 1, and days 1–2 in cycles 2–6; rituximab: 375 mg/m2 on day 1 of cycle 1, and 500 mg/m2 on day 1 of cycles 2–6 for a maximum of six cycles) with either ibrutinib (420 mg daily orally) or placebo until disease progression or unacceptable toxicity. Patients were stratified according to whether they were refractory to purine analogues and by number of previous lines of therapy. The primary endpoint was independent review committee (IRC)-assessed progression-free survival. Crossover to ibrutinib was permitted for patients in the placebo group with IRC-confirmed disease progression. Analysis was by intention-to-treat and is continuing for further long-term follow-up. The trial is registered with ClinicalTrials.gov, number NCT01611090. Between Sept 19, 2012, and Jan 21, 2014, 578 eligible patients were randomly assigned to ibrutinib or placebo in combination with bendamustine plus rituximab (289 in each group). The primary endpoint was met at the preplanned interim analysis (March 10, 2015). At a median follow-up of 17 months (IQR 13·7–20·7), progression-free survival was significantly improved in the ibrutinib group compared with the placebo group (not reached in the ibrutinib group (95% CI not evaluable) vs 13·3 months (11·3–13·9) in the placebo group (hazard ratio [HR] 0·203, 95% CI 0·150–0·276; p<0·0001). IRC-assessed progression-free survival at 18 months was 79% (95% CI 73–83) in the ibrutinib group and 24% (18–31) in the placebo group (HR 0·203, 95% CI 0·150–0·276; p<0·0001). The most frequent all-grade adverse events were neutropenia and nausea. 222 (77%) of 287 patients in the ibrutinib group and 212 (74%) of 287 patients in the placebo group reported grade 3–4 events; the most common grade 3–4 adverse events in both groups were neutropenia (154 [54%] in the ibrutinib group vs 145 [51%] in the placebo group) and thrombocytopenia (43 [15%] in each group). A safety profile similar to that previously reported with ibrutinib and bendamustine plus rituximab individually was noted. In patients eligible for bendamustine plus rituximab, the addition of ibrutinib to this regimen results in significant improvements in outcome with no new safety signals identified from the combination and a manageable safety profile. Janssen Research & Development.

Three decades ago, Jackie Schut was considered one of the most prolific baby sellers in the country. She traveled all over the US, murdered women who had just borne babies, and then stole their infants. She is still imprisoned in the South. A lovely, vibrant woman in San Antonio was found dead in a vacant lot. Her mother, a popular local realtor, never stopped looking for her killer. Just months ago, a truly unlikely suspect was found many states away.

The mental health of mothers has an important impact on both the growth and development of infants and on the health of mothers themselves. Family decision-making may play an important role in mother's mental health, yet little research has explored the relationship. This paper explores the association and influential pathways between family decision-making and mental health among mothers of infants in rural western China. : Mothers with infants aged 0-6 months in four impoverished counties of a predominantly rural province in southwestern China were enrolled in 2021 from the control group of a cluster-randomized trial using a multistage sampling method and followed up 6 months later. Information on family decision-making, perceived social support, and maternal mental health was collected through household interviews. Causal mediation analysis was employed to explore the association between family decision-making and mental health, and a four-item decomposition was used to explore the control direct effect of family decision-making on mental health, the pure mediation effect of perceived social support, and the possible interaction between exposure and mediation. Baseline data was collected on 444 mother-infant pairs and 331 were followed up 6 months later. After controlling for the set of confounding factors indicated by our causal framework, the results of longitudinal causal mediation analyses showed that family decision-making was negatively associated with depression, anxiety, and stress after controlling for confounding factors ( : -1.323, -0.928, and -1.351, respectively). Perceived social support played a proportional mediating role in each of the above associations (pure indirect effects of 22.33%, 22.60%, and 27.02%, respectively), while interaction effects were not significant. Family decision-making had a direct negative effect on maternal depression, anxiety, and stress, and perceived social support played a mediating role. These findings can be used to guide future interventions to improve maternal mental health and healthy child development in rural China.

Objectives: The structure, process, and outcomes associated with planning, developing, and offering an interprofessional course on the foundations of patient safety is described, including how organizational, structural, cultural, and attitudinal barriers were overcome. Methods: Seventeen faculty members from 7 colleges and schools and medical center participated—from the fields of decision sciences and systems, dentistry, medicine, law, nursing, occupational therapy, pharmacy, physical therapy, social work, health care administration, and outcomes management in health systems. Student assessment included theme analysis of open-ended questions, descriptive analysis of multiple– response option questionnaires, and criterion-based assessment of student performance on case studies. Triangulation of student comments, final course evaluation, and student performance evaluations were performed to learn overarching themes of student experience with the course. Results: The students learned a different way of thinking, found the instructional design and active learning methods useful to learning, and felt prepared to solve problems in the future. Students believed that the content was an essential core knowledge for all health professionals (87%) and should be required for all health professions students (78%). Students achieved an application level of learning (77%) within the cognitive domain and the valuing level within the affective domain. Students agree (96%) that they can define and apply the basic principles and tenets of patient safety, including identification of tools needed to work effectively within the health system and to improve safety and strongly agree (100%) that they value patient safety as a professional practice framework. Conclusion: The universitywide implementation case may offer important lessons to others nationally in health care education.