International Journal of Risk & Safety in Medicine - Volume 20, 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 increase in medical negligence litigation and costs during the past two decades has prompted health care providers, governments and the World Health Organization (WHO) to seek new approaches for the prevention of medical error and the protection of patient safety. The study and practice of clinical risk management has gradually been taken up by medicine, risk management, and even law in the world. Their participation has developed rapidly in recent years. This essay surveys contemporary research in clinical risk management, medical negligence prevention and relevant legal issues, examines their interrelationship, identifies the main categories of research topics and methodologies…and explores the appropriate direction for further research.
Abstract: This essay, using case studies from an interdisciplinary approach to medicine, clinical risk management and the law, explores the interrelationship between unreasonable clinical risk and medical negligence (prevention) under the law of negligence. For this purpose, the essay analyzes the judgment criteria of predictability and preventability of clinical risk, discusses suitable evidence for the determination of reasonable/unreasonable clinical risk, sums up the conditions for the transformation from reasonable clinical risk to unreasonable clinical risk, and presents unreasonable clinical risk in medical processes. The paper is aimed at both healthcare providers and legal professionals. It aims to raise the study of…the relationships between clinical risk management and the law to a higher level.
Abstract: Objective: The objective of this study was to investigate self-medication practices with antibiotics among school teachers in Palestine. Methods: A survey was conducted via a structured questionnaire among governmental school teachers regarding their practices and attitude toward antibiotics. All data were entered and analyzed using SPSS 15. Results: A total of 1039 teachers completed and returned the questionnaire; giving a response rate of 64.9%. Respondents were divided as follows: group I (19.4%) were those who used antibiotics through self-medication only, group II (12.4%) used antibiotics by prescription only, group III (44.7%) used antibiotics by self-medication and prescription while those in…group IV (23.3%) were those who did not report using antibiotics in the past six months. Antibiotic utilization among respondents was 76.7% in the past six months. Respondents in the 4 groups had comparable demographic characteristics. Respondents in group I were more likely (42.2%) to administer antibiotics to children without medical consultation, store antibiotic leftover (52.3%) for further use, stack antibiotics at home (59.7%) to be used whenever needed and had the least attitude to finish the entire antibiotic course when prescribed to them (59.9%). Across the four groups, male and female respondents had comparable attitude toward antibiotic use except that males tend to store antibiotic leftover more than females while females tend to finish the entire antibiotic course when taken by self-medication more than males. Respondents in groups I and III mainly consulted pharmacists on self-medication and obtained the antibiotics mainly from community pharmacy. Penicillin was the major class utilized by respondent either by self-medication or by prescription in groups I (74.3%), II (70.5%) and III (68.9%). Sore throat was the most common (30.3%) clinical condition that respondents self-treat with antibiotics, followed by symptoms of common cold (24.4%). Conclusion: Our study showed that self-medication practices with antibiotics are common and that most of these practices were inappropriate. These results should trigger health policy makers in Palestine to take action in order to prevent antibiotic misuse. Public awareness about proper use of antibiotics is needed. Furthermore, strengthening pharmacy laws and pharmacy control over non-prescription sale of antibiotics is highly recommended.
Abstract: Background: The incidence rates of cervical carcinoma are closely associated with the degree of promiscuous sexuality experienced by a population. Methods: The study reviews the registered incidence and mortality data of this malignancy in the Maltese population and relates the observed trends to the increasing sexual promiscuity and HPV infections experienced by the population. Results: The observed recent fall in malignancy rates have been offset by an apparent rise in premalignant conditions identified by the cervical screening program in force on the Islands. Much of the observed rise in premalignant conditions appears to be related to the influence…of HPV cervical infection. Conclusions: Strict vigilance to identify potentially malignant conditions and institute timely treatment remains the cornerstone for maintaining control of this disease. The introduction of protective vaccines against HPV should serve to reduce the size of the problem further.
Abstract: Five patients with hepatitis C (HCV), three of whom were treated with interferon alpha 2 (IFN) and two who were not treated with IFN, developed homicidal ideation (HI) during a four-year period. Following accepted rules for determining causation, there appeared to be a causal relatedness between IFN use and the development of homicidal ideation for those patients taking IFN. None of these patients attempted a homicidal act while on treatment with IFN, nor in the follow up period after treatment. The incidence of HI while treated with IFN in our patient population is estimated to be <1%. The ability of…prescription medication to cause homicidal ideation is reviewed, and legal implications are discussed.
Abstract: Misplacement of nasogastric feeding tubes into the respiratory tract often results in tremendous complications such as pneumonia, empyema and pleural effusion. The National Health Service issued advice to prevent these errors in 2005, describing that verification of pH 5.5 or lower of the aspirate fluid or X-ray confirmation is a prerequisite condition for feeding. However, the usefulness and feasibility of this advice has not been well evaluated. Our experience to implement this advice revealed the problem that in about 30% of the instances before feeding, such verification is infeasible. Therefore, we suggest the following recommendations by reviewing the literature and…caregivers' opinions. 1. Placement of newly inserted tubes should always be confirmed by X-ray before use for feeding or medication. 2. At re-insertion of the tube, verification of pH 5.5 or lower of the aspirate fluid or X-ray confirmation should essentially be performed before medication or feeding. 3. Before every feeding, checking the external length of the tube from the nostril and observing the inside of the mouth should be done to determine if the tube is partially removed or not. If there is no suspicion of tube removal, feeding can be started.
Keywords: Medical errors, feeding tube, misplacement, enteral nutrition