Medication Safety

Benzodiazepines use in the elderly are associated with morbidity including increased falls, fractures, and mortality. The common reason for re-prescribing benzodiazepine by physicians is dependency. Our project proposal aims to enhance medication safety in the elderly. It requires a multidisciplinary approach and patient-centred care focusing on benzodiazepine deprescribing using the 3Es model of Educating, Empowering, and Engaging. The education starts with patients, providers, and the community about benzodiazepine adverse effects on the elderly and provides alternative approaches for symptoms management. Empowering patients in the decision to deprescribe will prove to be successful when the patient finds value. Engaging stakeholders in the process will facilitate adeptness and attainability in the target community. Using information technology to deliver the protocol will ensure reminders, track changes and suggest alternatives. The project goal is a 50% reduction in benzodiazepine prescription by six months. Limitations, challenges, and modifications anticipated are discussed.

Background: Very limited data have been published about the design of medication safety programmes in hospitals.

Objective: To describe a template for the structure and operation of a medication safety programme in an acute tertiary setting.

Methods/results: A model of an ideal medication safety programme was developed by combining the lessons learnt by the lead author in the role of medication safety officer in an acute teaching hospital for 7 years with the published accounts of best practice from the literature.

Conclusions: Given the limited guidance currently available regarding the structure and operation of such programmes, this template goes some way towards addressing a gap in the current patient safety literature. It should be of practical value to healthcare organisations considering either introducing a medication safety programme for the first time or expanding an existing system.

Objective: We report three experiments evaluating the proposal that highlighting sec- tions of drug names using uppercase (“tall man”) lettering and/or color may reduce the confusability of similar drug names. Background: Medication errors commonly involve drug names that look or sound alike. One potential method of reducing these errors is to highlight sections of names on labels in order to emphasize the differences between similar products. Method: In Experiments 1 and 2, participants were timed as they decided whether similar name pairs were the same name or two different names. Experiment 3 was a recognition memory task. Results: Results from Experiments 1 and 2 showed that highlighting sections of words using tall man lettering can make similar names easier to distinguish if participants are aware that this is the purpose of the intervention. Results from Experiment 3 suggested that tall man lettering and/or color does not make names less confusable in memory but that tall man letters may increase attention. Conclusion: These findings offer some support for the use of tall man letters in order to reduce errors caused by confusion between drug products with look-alike names. Application: The use of tall man letters could be applied in a vari- ety of visual presentations of drug names – for example, by manufacturers on packag- ing, labeling, and computer software, and in pharmacies on shelf labels. Additionally, this paper demonstrates two meaningful behavioral measures that can be used during product design to objectively assess confusability of packaging and labeling.

Introduction: The primary-secondary care interface provides significant opportunities for medication errors to arise. There has been limited research into mechanisms to facilitate seamless transfer across this interface. The aim of this study was to focus on the potential contribution of community pharmacy services at the interface.

Materials & Methods: The opinions of community and hospital pharmacists were sought in relation to the current situation by means of questionnaires. A log book of communications between a community pharmacy and hospitals was maintained. A comparison of new discharge and post-discharge prescriptions was also performed. The data was coded and analysed in SPSS v.16.

Results: There is currently little communication across the interface at the time of discharge, with 11% of community pharmacists reporting no contact by a hospital at this time and a further 80% stating that they were only contacted occasionally. Hospital pharmacists reported ongoing difficulties in attempting to obtain a medication history on admission. Both parties agreed that the introduction of standard protocols and a designated seamless care pharmacist would improve medication safety at the interface. Most communication occurred between the community pharmacy and hospital on a Friday and also after 3 pm in the evening. When communication did occur the issue was resolved in 81% of all cases. Medication that required a follow up prescription from a patient’s family doctor following a hospital visit was incorrectly transcribed by the family doctor in 27% of cases.

Discussions, Conclusion: The involvement of community pharmacists occurs irregularly at present. There is dissatisfaction with the current situation. Pharmacists at either side of the interface are aware of the importance of the role that the other plays in seamless care, with both parties favouring the introduction of processes to facilitate seamless care at the interface. The involvement of the community pharmacist in the discharge process, through the dispensing of hospital discharge prescriptions, helped to reduce the number of medication errors that could occur at the primary-secondary care interface.

Case Presentation: A 72-year-old man presented to the
hospital with acute onset headache, diplopia, and vomiting.
Examination was notable for hypertension and partial
left third and sixth cranial nerve palsies. No stigmata of
Cushing’s syndrome were observed. MRI revealed a 2.9 cm
pituitary macroadenoma with acute hemorrhage extending
into the left cavernous sinus. Evaluation of anterior
pituitary function approximately 30 hr after admission
revealed serum cortisol 56.4 μg/dL (8.7-22.4) and ACTH
337 pg/mL (7-69). TSH (0.92 mIU/L, 0.34-5.60), free T4
(1.0 ng/dL, 0.5-1.3), and IGF-1 (167 ng/mL, 36-215) were
unremarkable, though prolactin level was low (1.0 ng/mL,
2.6-13.2). Over the next 4 d, serum cortisol ranged from
50-60 μg/dL, and 24 hr urine free cortisol was 1,883 μg
(< 60). At hospital discharge 7 d after admission, cortisol
(24.6 μg/dL) and ACTH (148 pg/mL) were falling, and at
15 d from admission early hypopituitarism had occurred
[8 AM cortisol 5.7 μg/dL, ACTH 15 pg/mL, TSH 0.55
mIU/L, free T4 0.6 ng/dL, IGF-1 65 ng/mL, LH 2.2 mIU/
mL (1.2-8.6), testosterone 76 ng/dL (270-1070)]. The
adenoma was resected 6 wk after initial presentation, and
postoperative histology revealed neuroendocrine cells in
a background of fibrosis and pigment-laden macrophages
but no staining for ACTH.
Discussion: Pituitary apoplexy usually occurs due to
hemorrhage or infarction of an adenoma. Hypopituitarism
often occurs either at time of presentation due to
compromise of anterior pituitary blood flow or before the event due to mass effect of the adenoma. Secondary
adrenal insufficiency is reported in approximately
70% of pituitary apoplexy cases, but significant
hypercortisolemia is rare. Literature review identified
only one published case of hypercortisolemia during
apoplexy in the setting of Cushing’s disease. In this
case, hemorrhage of a corticotroph adenoma is unlikely
as corticotroph macroadenomas are rare, the patient had
no symptoms or signs of Cushing’s syndrome, and no
immunohistochemical staining for ACTH was detected
on histological evaluation of the tumor. Elevations of
ACTH and cortisol most likely reflect stress activation of
the hypothalamic-pituitary-adrenal axis, with subsequent
central hypogonadism and declines in other pituitary
functions reflecting subacute onset of hypopituitarism.
Conclusion: This case illustrates that pituitary apoplexy
may provoke a stress glucocorticoid response if corticotrophs
remain viable. There is little published to predict subsequent anterior pituitary function after hemorrhage when initial
cortisol levels are elevated, though low prolactin level
appears to have been a marker for eventual hypopituitarism
as in more typical cases of apoplexy.

Addiction Madness was thought out very well and will discuss about how the Western world has become a disability nation, why is x-raying so important especially pregnant women, will discuss what degenerative disease is, how I got myself of of disability, why it is important to know your blood type and factor, the courage of Dr. Alice Stewart who studied and her findings that x-ray radiation exposure can be passed on an unborn fetus causing the baby to be born with an autoimmune disease, when is exposure to radiation to much, will speak briefly upon the dawn of the x-rays or as I call in my paper x-beams, the history DES, will discuss my findings upon prescribed pain medication and abuse of them in the United States and other findings which will follow in the table of contents.

There are still many unanswered questions which may be answered by further research which I will be doing at a later date and writing books upon my findings and how I got myself off of prescribed medications and am now using God's healing foods along with alkaline pH water which Alkaline water helps balance the body's pH, which tends to be acidic because of our high acid food diet, stress and exposure to environmental toxins such as smog. Alkalize your body pH from acidic to alkaline pH, because cancer and many other illnesses cannot live in alkaline environments.

Also my findings are showing that our environment has a lot to do with what happens to our bodies and have research Dr. Alice Stewart and according to Gayle Greene (author) in 1943 who wrote: "The Woman Who Knew Too Much: Alice Stewart and the secrets of radiation" review by Choice Review, "Claiming radiation to be unsafe any dose."  Dr. Stewart's findings found exposure to low-level dose radiation was more serious than most scientists will admit.

Objectives: To assess the safety culture in an acute medical admissions unit (AMAU) of a teaching hospital in order to benchmark results against international data and guide a unit-based, integrated, risk management strategy. Methods: The safety attitudes questionnaire (SAQ), a validated instrument for the measurement of safety culture was applied to an AMAU. All AMAU healthcare staff (n = 92) were surveyed: doctors, nurses, healthcare assistants (HCAs) and allied healthcare professionals (AHPs). Safety attitude scores for the overall unit and individual caregiver types were assessed across six domains of safety culture. Results: When compared against an international benchmark, the AMAU scored significantly higher for four of the six safety domains: p < 0.01 for 'teamwork climate', 'safety climate' and 'stress recognition' and p < 0.05 for 'job satisfaction'. The difference between nurse manager scores and the overall mean for the study group was statistically significant for the domains of 'teamwork climate' (p < 0.05) and 'safety climate' (p < 0.01). HCAs scored significantly lower relative to staff overall with regard to 'working conditions' (p < 0.05) and 'perceptions of management' (p < 0.01). Conclusion: The SAQ was successfully applied to an AMAU setting giving a valuable insight into staff issues of concern across the safety spectrum: employee and environmental safety, clinical risk management and medication safety.

From January 2013 through October 2014, 4,065 medication errors involving pediatric patients and taking place in a
general acute care hospital not specializing in pediatrics were reported to the Pennsylvania Patient Safety Authority. Almost 18% (n = 715, 17.8%) of the reported events reached the patient
and either required additional monitoring to preclude harm or caused actual harm. These reports were analyzed to determine if the events involved unique challenges when providing medications to the pediatric patient as well as to classify the events by node, related processes, possible causes, and contributing factors. When looking at the age ranges of patients involved in events, 28.1% (n = 201) of the reports involved neonates and 60.2% (n = 431) involved patients younger than five years of age. While there were events that included unique challenges to providing medications to the pediatric patients, most events mentioned challenges similar to those encountered in providing medications to adults.  Important risk reduction strategies include dispensing medications for individual patients in a patient-specific, ready-to-administer form whenever possible and ensuring ready access to appropriate and current clinical information about patients. (Pa Patient Saf Advis 2015 Sep;12[3]:96-102.)

Purpose: Problems in safe medication practices are an important cause of mortality and morbidity. This study was planned to explore the deficiencies in safe medication practices.
Patients and Methods: This descriptive and cross sectional study was performed in a public hospital and the questionnaire was applied to 150 nurses. This questionnaire was related to safe medication practices and included subjects such
as drug supply and storage conditions, patient identification, drug-food allergy inquiry, expiration date control, frequently encountered drug administration problems, adequacy of pharmacological knowledge, pharmacological information
sources and attitudes toward adverse drug reactions were asked.
Results: Most of the nurses were careful about drug supply-storage conditions, expiration date control, patient identification and allergy inquiry before medication. The most common drug administration problems were wrong dose (21.4%), wrong time (25%) and forgotten drug (21.9%). Approximately, half of the nurses had moderate level of pharmacological knowledge about drug side effects, contraindications, drug reactions and the duration of drug effects. 80% of nurses knew the necessity of event reporting
in adverse drug reaction. However, the knowledge about event reporting to responsible of pharmacolovigilance (33.3%) and TÜFAM (Turkey Pharmacovigilance Center)(10%) was low.
Conclusion: Wrong timing, wrong dosege and forgotten drug were frequently encountered problems in drug administrations. This study suggested that empowering nurses about pharmacological knowledge and forming standard
drug protocols in clinics are important steps in safe medication practices.

Background: Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting, and analysis of medical error that often leads to adverse effects. Hospitalized patients face safety issues from different dimensions among those medication safety, infection prevention and quality of nursing care are most important once. Objective: The main objective of this study was to assess patient safety related to medication safety, infection prevention and quality of care and to explore efforts made towards controlling patient safety efforts among Addis Ababa regional hospitals, 2018 Methods: A qualitative study was conducted to assess patient safety among Addis Ababa regional Hospitals in terms of medication safety, infection prevention and quality of nursing care. Twelve interviews were conducted by principal investigator three interviews in each hospital on purposefully selected health care staffs representing the hospitals pharmacies, infection prevention team members and Head Nurses of inpatient wards on October, 2018 over a one-month period. Interviews were recorded, transcribed and results were summarized based on topics. Results and conclusions: Studies in Ethiopia showed that Patient safety related to Medication safety, infection prevention and Nursing care quality is not encouraging but still effective monitoring efforts aren't in practice among Addis Ababa regional hospitals even though recommended by the EHRIG (Ethiopian hospital reform implementation guideline, 2010).

Introduction: The overwhelming majority of inpatient prescribing is undertaken by the most junior member of the team, i.e. the intern, a fact that has previously raised concerns about the quality of prescribing. Currently, no legal requirements exist in Ireland regarding a pre-determined level of seniority or expertise to be attained before doctors are allowed to prescribe high-risk medications. Consequently, high-risk medications may legally be prescribed by the most inexperienced prescribers—newly qualified doctors.

Aim: To develop and implement a set of prescribing constraints in order to reduce the risk of harmful errors arising from the prescription of high-alert medications by junior doctors.

Materials & Methods: A set of restrictions applicable to certain classes of medication was compiled based on published evidence of high-alert medications and those medications which were known to have caused serious harm in our hospital.

Results: Four categories of constraints were proposed for high-alert medications according to the level of risk perceived to be associated with certain classes of medication or specific individual agents. The constraints for the first three categories related to the seniority of doctor required to be involved in the prescribing process. The constraints in relation to Category 4 (treatment doses of low molecular weight heparins) related to details which needed to be present on the prescription before a nurse was authorised to administer against it, i.e. dose per kg, patient weight, and total dose required.

Discussions, Conclusion: The challenge in developing these constraints was in balancing the drive for optimal patient safety with the practical demands of a major teaching hospital, i.e. the flexibility needed to manage a patient load of high complexity and turnover, and the promotion of an environment which facilitates junior doctors in learning to prescribe independently. The factors identified as critical to the successful development and implementation of the initiatives were the high level of corporate and consultant support and the multidisciplinary approach adopted throughout the process.

"BACKGROUND: High-alert medications are frequently responsible for adverse drug events and present significant hazards to inpatients, despite technical improvements in the way they are ordered, dispensed, and administered.
METHODS: A real-time surveillance application was designed and implemented to enable pharmacy review of high-alert medication orders to complement existing computerized provider order entry and integrated clinical decision support systems in a tertiary care hospital. The surveillance tool integrated real-time data from multiple clinical systems and applied logical criteria to highlight potentially high-risk scenarios. Use of the surveillance system for adult inpatients was analyzed for warfarin, heparin and enoxaparin, and aminoglycoside antibiotics.
RESULTS: Among 28,929 hospitalizations during the study period, patients eligible to appear on a dashboard included 2224 exposed to warfarin, 8383 to heparin or enoxaparin, and 893 to aminoglycosides. Clinical pharmacists reviewed the warfarin and aminoglycoside dashboards during 100% of the days in the study period-and the heparinlenoxaparin dashboard during 71% of the days. Displayed alert conditions ranged from common events, such as 55% of patients receiving aminoglycosides were missing a baseline creatinine, to rare events, such as 0.1% of patients exposed to heparin were given a bolus greater than 10,000 units. On the basis of interpharmacist communication and electronic medical record notes recorded within the dashboards, interventions to prevent further patient harm were frequent.
CONCLUSIONS: Even in an environment with sophisticated computerized provider order entry and clinical decision support systems, real-time pharmacy surveillance of high-alert medications provides an important platform for intercepting medication errors and optimizing therapy."

Oral anticoagulants, a class of high-alert medications, are widely used in the United States for varying indications, including treatment after deep-vein thrombosis or pulmonary embolism as well as prevention of stroke in valvular and non-valvular-related atrial fibrillation. Analysts reviewed medication error reports submitted from July 2013 through June 2014 through the Pennsylvania Patient Safety Reporting System (PA-PSRS) involving four oral anticoagulants: warfarin, apixaban, rivaroxaban, and dabigatran. Of the 831 errors related to oral anticoagulants analyzed from PA-PSRS, the most common event types were drug omissions (32.5%, n = 270), other (18.5%, n = 154), and extra doses (11.7%, n = 97). Medication errors categorized as “other” involved problems related to prescribing, wrong dose, wrong patient, and inaccurate medication lists. Risk reduction strategies include establishing functional hard-stop drug alerts during order entry, establishing an anticoagulant management service program, and providing continuous education for staff on anticoagulant use.

Introduction: There is ample international evidence that poor quality prescription writing increases the risk of serious medication errors. Research has confirmed that didactic sessions and passive dissemination of guidelines are not effective means of modifying prescriber behaviour. Conversely, a combination of serial audit and feedback is known to be a successful technique for improving the quality of prescribing. The aim of this study was to design, implement, and evaluate a process of serial audits combined with feedback to prescribers, at both a general and individual level, to address the quality of prescription writing in an acute teaching hospital.

Materials & Methods: A baseline audit of prescription writing quality was undertaken in September 2009. An awareness campaign was launched between November 2009 and January 2010 which promoted safe prescribing techniques by outlining acceptable prescribing standards and the risks of non-compliance with these. Standards for prescription writing were compiled and uploaded onto the medication safety intranet site to which staff were referred. Re-audits of the quality of prescription writing were undertaken in February and May 2010 and January 2011.

Results: The process of audit and feedback resulted in an overall statistically significant improvement in allergy box completion between the baseline and the first and second re-audits, respectively. However, a rebound effect was observed between the second and third re-audits, where the trend towards improved compliance began to reverse. A statistically significant decline was observed in the percentage of prescribers non-compliant with forensic identity requirements between baseline and each subsequent re-audit. The percentage of prescriptions with omission of key medication-related data and the percentage of prescriptions deemed unclear decreased significantly between the baseline and each successive audit. A significant decrease was also observed in relation to the use of unapproved abbreviations between baseline and the first and third reaudits, respectively.

Discussions, Conclusion: Audit and feedback proved to be a successful strategy in significantly improving the quality of prescription writing in our hospital in relation to a number of criteria. However, it is clear to the researchers that any improvements in the quality of prescription writing observed to date will only be sustained by an ongoing process of audit and feedback. The process of audit and feedback, although effective, was labour-intensive and requires high level corporate and consultant support to be successful.

Background To evaluate the effectiveness of a structured prescription review and prescriber feedback program in reducing prescribing errors in government primary care clinics within an administrative region in Malaysia. Methods This was a three group, pragmatic, cluster randomised trial. In phase 1, we randomised 51 clinics to a full intervention group (prescription review and league tables plus authorised feedback letter), a partial intervention group (prescription review and league tables), and a control group (prescription review only). Prescribers in these clinics were the target of our intervention. Prescription reviews were performed by pharmacists; 20 handwritten prescriptions per prescriber were consecutively screened on a random day each month, and errors identified were recorded in a standardised data collection form. Prescribing performance feedback was conducted at the completion of each prescription review cycle. League tables benchmark prescribing errors across clinics...

Summary Objectives: To analyze the attitude of physicians towards alerting in CPOE systems in different hospitals in different countries, addressing various organizational and technical settings and the view of physicians not currently using a CPOE. Methods: A cross-sectional quantitative and qualitative questionnaire survey. We invited 2,600 physicians in eleven hospitals from nine countries to participate. Eight of the hospitals had different CPOE systems in use, and three of the participating hospitals were not using a CPOE system. Results: 1,018 physicians participated. The general attitude of the physicians towards CPOE alerting is positive and is found to be mostly independent of the country, the specific organizational settings in the hospitals and their personal experience with CPOE systems. Both quantitative and qualitative results show that the majority of the physicians, both CPOE-users and non-users, appreciate the benefits of alerting in CPOE systems on medication safet...

Currently, more than 7% of admissions to acute care hospitals are related with AEMs (adverse events to medications). AEMs are the sixth cause of death, causing a cost of over $5.6 million dollars (USD) per hospital per year. There is an estimate that between 19% and 23% of hospitalized patients will have an adverse effect within the first 30 days after being discharged, 14.3% will be re-admitted and 70% of these events will be related to a medication prescription. Fortunately, at least 58% of these AEMs are preventable, since they result from a lack of information on the medication, prescription and dosage errors and from the abuse and underuse of the same. Polymedicated patients, especially the elderly with multiple pathologies and/or chronic patients that need to be admitted into the hospital more frequently, usually to internal medicine, neurology, psychiatry, rehabilitation and intensive care, are precisely the most liable to suffer from medication errors. It must be the objective to aim for the increase in the patient safety standards when it comes to medications.

Background: Older adult patients are prone to potentially inappropriate medication use (PIMU); its use has been associated with multiple adverse consequences. As a result, it is crucial to determine the magnitude and factors associated with PIMU. The present study was mainly aimed to determine and assess the magnitude and predictors of potentially inappropriate medication use in older adult patients on follow-up at the chronic care clinic of Jimma medical center. Methods: A retrospective cross-sectional study was conducted involving 219 patients aged 65 years and above on treatment follow-up. Data was collected using a checklist. The 2019 updated American Geriatric Society (AGS) Beers Criteria® and Screening Tool of Older People's Potentially Inappropriate Prescriptions criteria and Screening Tool to Alert Doctors to Right Treatment (STOPP/START) criteria (version 2) were employed to assess PIMU. SPSS IBM (v22) was used for data entry and analysis. Categorical variables were described using frequency and percentage, whereas continuous variables were described using mean with standard deviation (SD) or median with interquartile range (IQR). Logistic regression was conducted to identify predictors of PIMU. Results: The average number of medications prescribed per patient was 4.0 (IQR = 2.0). At least one PIMU was identified in 182 (83.1%) and 99 (45.2%) patients, based on Beers and STOPP criteria, respectively. Additionally, potential prescription omission (PPO) was observed in 24 (10.9%) patients. The risk of Beers PIMU was increased with age [AOR = 1.21, p < 0.001], hypertension [AOR = 4.17, p < 0.001], and polypharmacy [AOR = 14.10, p < 0.001], while a decrease in the risk was noted in patients with a diagnosis of ischemic stroke [AOR = 0.133, p = 0.01] and asthma [AOR = 0.03, p < 0.001]. Using STOPP criteria, hypertension [AOR = 2.10, p = 0.04], diabetes mellitus [AOR = 2.26, p = 0.04], ischemic heart disease [AOR = 2.84, p = 0.04], peripheral neuropathy [AOR = 10.61, p < 0.001], and polypharmacy [AOR = 6.10, p < 0.001] significantly increased the risk of PIMU.

Introduction: There is ample international evidence that poor quality prescription writing increases the risk of serious medication errors. Research has confirmed that didactic sessions and passive dissemination of guidelines are not effective means of modifying prescriber behaviour. Conversely, a combination of serial audit and feedback is known to be a successful technique for improving the quality of prescribing. The aim of this study was to design, implement, and evaluate a process of serial audits combined with feedback to prescribers, at both a general and individual level, to address the quality of prescription writing in an acute teaching hospital. Materials & Methods: A baseline audit of prescription writing quality was undertaken in September 2009. An awareness campaign was launched between November 2009 and January 2010 which promoted safe prescribing techniques by outlining acceptable prescribing standards and the risks of non-compliance with these. Standards for prescri...

Background: Intravenous (IV), intramuscular (IM), and subcutaneous (SC) are the three most frequently used injection routes in medication administration.

Read this review and sign up to receive Patient Preference and Adherence journal here: http://www.dovepress.com/articles.php?article_id=22449

Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of &quot;health smart cards&quot; that carry vital patient medical information in the form of a &quot;credit card&quot; or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart ...

The present research examined the extent to which consumers reported reading information on over-the-counter (OTC) packaging and labels. Two studies consisting of a total of 652 participants were conducted. Study 1 participants completed a survey in which they reported their OTC medication behaviors in terms of saving the packaging from the medication and the likelihood that they would contact a physician with OTC medication questions. In Study 2, participants completed a survey in which they reported the likelihood of reading information on the medication packaging and label both before and after using the product the first time. Results indicated that participants frequently discard the box after using medication and rarely call a physician with questions regarding OTC medications. Findings also indicated that information is more likely to be read prior to using medication than afterwards. Age, sex, and student status differences in reading behaviors were also found. Implications for the delivery of OTC medication information are discussed.

Crizotinib is a mesenchymal-epithelial transition/anaplastic largecell kinase (MET/ALK) multi-targeted receptor tyrosine kinase inhibitor and has been rapidly and successfully developed as an inhibitor in ALK-rearranged NSCLC (non-small cell lung cancer). Lung cancer is the major cause of cancer-related mortality, accounting for over one quarter of cancer deaths. Lung cancers are generally divided into two main categories: SCLC (small cell lung cancer) and NSCLC. NSCLC accounts for approximately 85% of all lung cancers. ALK gene rearrangements are identified and targeted resulting in promising response rates for NSCLC in early studies. Considering the significance of Crizotinib in the treatment of NSCLC, the synthesis, pharmacodynamics, pharmacokinetics, therapeutic trials and adverse events are briefly overviewed in order to make more scholars, medical workers and patients have a more clear and comprehensive recognition on Crizotinib.