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Medical students as adverse drug event managers, learning about side effects while improving their reporting in clinical practice

Abstract Managing adverse drug reactions (ADRs) is a challenge, especially because most healthcare professionals are insufficiently trained for this task. Since context-based clinical pharmacovigilance training has proven effective, we assessed the feasibility and effect of a creating a team of Junior-Adverse Drug Event Managers (J-ADEMs). The J-ADEM team consisted of medical students (1st–6th year) tasked with managing and reporting ADRs in hospitalized patients. Feasibility was evaluated using questionnaires. Student competence in reporting ADRs was evaluated using a case-control design and questionnaires before and after J-ADEM program participation. From Augustus 2018 to Augustus 2019, 41 students participated in a J-ADEM team and screened 136 patients and submitted 65 ADRs reports to the Netherlands Pharmacovigilance Center Lareb. Almost all patients (n = 61) found it important that “their” ADR was reported, and all (n = 62) patients felt they were taken seriously by the J-ADEM team. Although attending physicians agreed that the ADRs should have been reported, they did not do so themselves mainly because of a “lack of knowledge and attitudes” (50%) and “excuses made by healthcare professionals” (49%). J-ADEM team students were significantly more competent than control students in managing ADRs and correctly applying all steps for diagnosing ADRs (control group 38.5% vs. intervention group 83.3%, p < 0.001). The J-ADEM team is a feasible approach for detecting and managing ADRs in hospital. Patients were satisfied with the care provided, physicians were supported in their ADR reporting obligations, and students acquired relevant basic and clinical pharmacovigilance skills and knowledge, making it a win-win-win intervention.

Reply on comments from Paul Calle on ‘Visitors of the Dutch drug checking service: Profile and drug use experience.’

The potential of training specialist oncology nurses in real‑life reporting of adverse drug reactions

Abstract Specialist oncology nurses (SONs) have the potential to play a major role in monitoring and reporting adverse drug reactions (ADRs); and reduce the level of underreporting by current healthcare professionals. The aim of this study was to investigate the long term clinical and educational efects of real-life pharmacovigilance education intervention for SONs on ADR reporting. This prospective cohort study, with a 2-year follow-up, was carried out in the three postgraduate schools in the Netherlands. In one of the schools, the prescribing qualifcation course was expanded to include a lecture on pharmacovigilance, an ADR reporting assignment, and group discussion of self-reported ADRs (intervention). The clinical value of the intervention was assessed by analyzing the quantity and quality of ADR-reports sent to the Netherlands Pharmacovigilance Center Lareb, up to 2 years after the course and by evaluating the competences regarding pharmacovigilance of SONs annually. Eighty-eight SONs (78% of all SONs with a prescribing qualifcation in the Netherlands) were included. During the study, 82 ADRs were reported by the intervention group and 0 by the control group. This made the intervention group 105 times more likely to report an ADR after the course than an average nurse in the Netherlands. This is the frst study to show a signifcant and relevant increase in the number of well-documented ADR reports after a single educational intervention. The real-life pharmacovigilance educational intervention also resulted in a long-term increase in pharmacovigilance competence. We recommend implementing real-life, context- and problem-based pharmacovigilance learning assignments in all healthcare curricula.

To check or not to check? An exploratory study on source checking by Dutch journalists.

Verifying information is one of the core activities of journalism. However, recent research shows that many stories derive from unchecked information from news agencies and PR material. That being said, reporters who do not use this pre-packaged material, but who instead produce original stories based on independent research, might be journalists who stay devoted to the verification of information. Therefore, this study focuses on in-depth stories that originated inside the newsroom. We expected that these kinds of stories would be checked and double-checked, because time constraints are less important and these stories are characteristic of independent, quality journalism. Contrary to this expectation, the results show that even these kinds of stories are not always vetted. The lack of time was seldom mentioned as an excuse. Our research points to avoidance mechanisms which inhibit journalists from verifying their information.

Triangulating Amsterdam’s illicit stimulant use trends by wastewater analysis and recreational drug use monitoring

Drug consumption estimates are of relevance because of public health effects as well as associated criminal activities. Wastewater analysis of drug residues enables the estimation of drug consumption and drug markets. Short-term and long-term trends of cocaine, MDMA (ecstasy), amphetamine (speed) and methamphetamine (crystal meth), were studied for the city of Amsterdam. MDMA (+41%) and cocaine (+26%) showed significantly higher weekend vs. week consumption, while no differences were observed for the other drugs. The consumption of MDMA, cocaine, amphetamine and methamphetamine significantly increased between 2011 and 2019. Weekly trends emerging from wastewater analyses were supported by qualitative and quantitative data from a recreational drug use monitoring scheme. However, information collected in panel interviews within nightlife networks and surveys among visitors of pubs, clubs and festivals only partially reflected the long term increase in consumption as registered from wastewater analysis. Furthermore, methamphetamine use was not well presented in survey data, panel studies and test service samples, but could be monitored trough wastewater analysis. This illustrates that wastewater analysis can function as an early warning if use and user groups are small or difficult to reach trough other forms of research. All in all, this study illustrates that wastewater-based epidemiology is complementary to research among user groups, and vice versa. These different types of information enable to connect observed trends in total drug consumption to behaviour of users and the social context in which the use takes place as well as validate qualitative signals about (increased) consumption of psychoactive substances. Such a multi angular approach to map the illicit drug situation on local or regional scale can provide valuable information for public health.

Visitors of the Dutch drug checking services: Profile and drug use experience

Background: Drug checking services (DCS) provide information about drug content and purity, alongside personalized feedback, to people who use drugs; however, the demographic and drug use characteristics of DCS clients are rarely reported. This paper describes these characteristics for clients of the Dutch DCS, the Drug Information and Monitoring System (DIMS). Methods: 1,530 participants completed a pen-and-paper questionnaire at one of eight participating DCS in the Netherlands in 2018. Results: The participants were mostly highly educated males in their twenties with no migration background. Experience with drugs prior to coming to the DCS was common. Only 0.7% indicated they had never used any of the twenty drugs studied. 93% of participants reported use of ecstasy or MDMA with an average of 6.3 years since first use. Conclusions: These results indicate that drug checking can be a valuable tool for public health services as it facilitates access to more difficult-to-reach communities who use drugs. It is unlikely that DCS encourage drug initiation, since almost all people who visit the Dutch DCS already report experience with drugs. However, DCS should be aware that their services might not be easily accessible or attractive to all demographic groups.