International Journal of Risk & Safety in Medicine - Volume 7, issue 3
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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: Meningococcal disease (MCD) is registered in two population-based information systems in Denmark because of the interest in long-term surveillance as a means of following trends, and in public health intervention such as chemoprophylaxis and vaccination. The two systems are the Notifiable System of Communicable Diseases (NSCD) and the Hospital Discharge Register for in-patients (HDR). The aim of the present study was to assess the data quality of the two systems over a 14-year period in the County of Northern Jutland, Denmark. All records of patients registered in the two systems were reviewed with respect to the criteria for the diagnosis…of MCD. In addition, records from the local clinical microbiology department, where all microbiological examinations were carried out, were reviewed. The degree of completeness for the HDR system was 89.8% and for the NSCD system was 92.2%. In the in-patient HDR, 296 cases were registered, but only 254 cases (85.8%) fulfilled the criteria for MCD. In the notifiable system, 273 cases were registered, but only 261 cases (95.6%) fulfilled the criteria for MCD. A capture-recapture analysis showed that one to two cases apparently escaped registration.
Keywords: Notifiable diseases, Data quality, Registers, Meningococcal disease, Epidemiology
Abstract: Objective: To determine how much malfunctioning there is among medical specialists attached to hospitals. Design: Retrospective and descriptive. Setting: 21 hospitals in the province of North Holland in the Netherlands. Method: After preliminary discussions with key figures in the field, the Health Inspectorate for North Holland visited 21 hospitals in North Holland between March 1992 and November 1993. Hospital managers were required to complete and return a printed questionnaire prior to the visit. Results: According to hospital managers and medical staff, 93 out of a total of approximately 2000 specialists had malfunctioned in some degree over…a period of 5 years. The main symptoms of malfunctioning mentioned were: lack of social skills, medical and technical errors of judgement, and inability to work in a team. Authorities complained about the lack of a system of sanctions. Conclusion: Hospitals are inclined to conceal the malfunctioning of specialists and readily engage in a conspiracy of silence. Since new legislation has given the health insurer contractual freedom and has conferred greater powers on the inspectorate, it might be possible to impose more effective sanctions in the future. Prevention of malfunctioning is of course to be preferred. Unfortunately, very few proposals put forward by the umbrella organisations concerning improved job application procedures and job performance discussions have actually been implemented. More research is required into malfunctioning in other health professions such as general practice and dentistry.
Keywords: Medical specialists, malfunctioning, Netherlands
Abstract: Study objective: To assess patients' willingness to accept the risks of intubation and ventilatory support (IVS) for short periods of time. Design: Cross-sectional structured interviews of patients. Setting: The Department of Veterans Affairs Medical Center, Portland, Oregon, USA, a university-based Department of Veterans Affairs Medical Center. Participants: 97 consecutive patients (mean age =67.4 years, s.d. =9.16, range =39–84) seen for continuity clinic appointments in a general medicine clinic. Measurements and Results: In a hypothetical situation of an acute exacerbation of a medical condition requiring IVS, patients were asked whether they would accept IVS if their physician…thought that their acute exacerbation was reversible (defined as being able to leave the hospital with their mental capacity minimally affected and being able to care for themselves in most activities of daily living in a nursing home environment). Patients were also asked to define what they meant by a “short period of time of IVS,” and at what chance of reversal of their acute exacerbation they would allow their physicians to act with IVS (measured by means of a lottery methodology). Ninety-seven percent (94/97) of patients reported a willingness to undergo IVS for a short period of time. Eighteen percent reported that they would allow IVS for 1–2 days; 38% reported 3–14 days; 14% reported 15–30 days; and 30% reported >30 days. One third of the patients were willing to accept IVS if the probability of reversal were ≤40%. Patients with advance directives preferred to be supported for fewer days on IVS than patients without an advance directive (P=0.014). Conclusions: We conclude that most patients are willing to allow IVS for the reversal of an acute condition as defined above. There are wide variations in the length of time patients would allow IVS and in the probability of reversal they would require before their physician intervened with IVS on their behalf. These results suggest that discussions about advance directives with patients should include assessment of patient preferences about duration of intervention and probability of successful outcome.
Abstract: All women in The Netherlands who are planning a pregnancy were recently advised to take 0.5 mg of folic acid per day for 4 weeks prior to conception and during the first 8 weeks of pregnancy. In this study we sought to determine whether women were willing to use folic acid or not, and the factors that affected this willingness. Questionnaires were sent to 327 women. The response rate was 57%. The results of this study showed that the majority of women (65.5%) were willing to use folic acid. The main reason for this is that women “would like to…have a healthy child”. Another important reason is the fear of having regrets afterwards.
Abstract: Our knowledge relating to adverse drug reactions (ADRs) of phytomedicines is highly fragmentary. The aim of this study was to define the prevalence of ADRs following medication with herbal or synthetic expectorants. In a multicentre, comparative post-marketing surveillance study of more than 3000 patients with acute bronchitis, about half were treated with a herbal remedy (SinupretR ) and the other half with various other expectorants. In ascending order of incidence, ADRs were noted during mono-medication of SinupretR (0.8%), Ambroxol (1.0%) and acetylcysteine (4.3%). When concomitant drugs were used, this rank order was unchanged but incidence rates were markedly increased…(3.4, 6.5 and 8.2%, respectively). The most frequent ADRs were gastrointestinal symptoms. It is concluded that expectorants are associated with ADRs in roughly 1–5% of cases undergoing single drug treatment and in 3–10% when more than one medication is being used. Amongst the expectorants used in this study, the herbal preparation SinupretR is associated with the lowest incidence of ADRs.
Keywords: Adverse drug reactions, Expectorants, Phytomedicines
Abstract: Femoral pseudo aneurysm is the most frequent complication produced by percutaneous femoral procedures. During a 5-year period seven patients underwent seven operative repairs for this complication. All seven patients presented with an expanding swelling in the groin. The average diameter of the aneurysms (at operation) was 5.2 cm. All seven underwent a simple arteriorrhaphy preceded by proximal and distal control. The results using this technique were good in all cases. It is against this background that new surgical and non-surgical techniques will have to be evaluated.
Abstract: Vascular graft infection is one of the most serious complications in vascular surgery. It is associated with mortality rates ranging from 25% to 75% and with morbidity in the form of amputation in approximately 30% of patients. Staphylococcus aureus is the leading pathogen. With conventional laboratory techniques, the percentage of culture-negative yet grossly infected vascular grafts seems to be increasing and is not adequately explained by the prior use of antibiotics. We have recently reported the first case of aortic graft infection with Mycoplasma. We therefore suggest the hypothesis that the large number of culture-negative yet grossly infected vascular grafts…may be due to Mycoplasma infection not detected with conventional laboratory technique.
Abstract: A case of erroneous diagnosis of left ureteric injury and its results is reported. An 86-year-old man was operated on for perforated diverticulitis. A tubular structure was injured at the left paracolic gutter and repaired over double J catheter. Six months later the proximal side of the catheter was found in the right ventricle, because it has been introduced into the spermatic vein and not into the left ureter.