International Journal of Risk & Safety in Medicine - Volume 10, issue 4
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The International Journal of Risk and Safety in Medicine is concerned with rendering the practice of medicine as safe as it can be; that involves promoting the highest possible quality of care, but also examining how those risks which are inevitable can be contained and managed.
This is not exclusively a drugs journal. Recently it was decided to include in the subtitle of the journal three items to better indicate the scope of the journal, i.e. patient safety, pharmacovigilance and liability and the Editorial Board was adjusted accordingly. For each of these sections an Associate Editor was invited. We especially want to emphasize patient safety. Our journal wants to publish high quality interdisciplinary papers related to patient safety, not the ones for domain specialists. For quite some time we have also been devoting some pages in every issue to what we simply call WHO news. This affinity with WHO underlines both the International character of the journal and the subject matter we want to cover. Basic research, reports of clinical experience and overviews will all be considered for publication, but since major reviews of the literature are often written at the invitation of the Editorial Board it is generally advisable to consult with the Editor in advance. Submission of news items will be appreciated, as will be the contribution of letters on topics which have been dealt with in the journal.
Abstract: The aim of the study was to determine the effect on long-term survival of the location of DVT in relation to age groups and side of operation. 1310 patients undergoing total hip arthroplasty and who participated in one of 7 randomized, prospective clinical trials with thromboprophylaxis were included in this analysis. A trend analysis showed that the incidence of proximal and distal DVT increased significantly with age (p<0.05). In patients older than 64 years of age the relative risk of death was non-significantly higher when proximal DVT was present compared to patients without DVT and the relative risk of death…was non-significantly higher in patients older than 74 years of age when distal thrombi was present compared to patients without DVT. The test for trend showed an increase with age in the incidence of both ipsi- and contralateral DVT; the increase was significant in patients with contralateral DVT (p<0.05). The relative risk of death was higher (of borderline significance) in patients older than 74 years of age with contralateral DVT. In conclusion, the pattern of location of asymptomatic deep vein thrombosis changes with increasing age. The location of asymptomatic and treated DVT has no significant influence on long-term survival.
Keywords: Deep vein thrombosis, hip arthroplasty, survival
Abstract: The first 21 years of monitoring of congenital malformations by a hospital-based program affiliated to the International Clearinghouse is analyzed. The foundation activities, methodology, data and time trends are presented and precautions in interpretation of this information are emphasized. The great majority of congenital malformations, including Down syndrome, have stable rates making the search of their causes and the development of intervention methods much harder. The practical implications of these data and the appropriate recommendations are discussed.
Keywords: Congenital malformations, monitoring, birth defects monitoring systems
Abstract: The Björk-Shiley convexo-concave artificial heart valve has a significant risk of failure which is often fatal. Elective explantation has a mortality of approximately 5%. Follow-up studies provide the basis for clinical decision making whether or not to explant the valve. So far, the contribution of technical, organizational, ethical, and professional considerations to success or failure of any risk control strategy have hardly been considered. A string of six consecutive deaths due to valve failure initiated a systemic rather than an epidemiological analysis of the problem. Systemic failure analysis not only yields sound explanations, but also warrants acceptable solutions on…the basis of assembling multidisciplinary knowledge and experience.
Abstract: We evaluated the known metabolic effects of aspirin in pregnant hypertensive patients. Eighty-seven pregnant women (12th–24th gestational week) were randomly allocated to low-dose aspirin or placebo treatment. Between the 24th–28th gestational week the following tests were performed: oral glucose tolerance test, venous blood pH and base excess, coagulation profile, platelet count, morning (8 a.m.) cortisol, creatinine clearance and serum uric acid. A significantly higher serum uric acid level was detected in the low-dose aspirin group (5.6±2.2 mg/dl) compared with the placebo group (4.7±1.2 mg/dl, p=0.048). No other significant difference was found for any of the other parameters tested. We conclude…that low-dose aspirin treatment during the second half of pregnancy in hypertensive patients seems safe in terms of its effect on various maternal metabolic effects.