International Journal of Risk & Safety in Medicine - Volume 24, issue 3

Authors: Cuvelier, Lucie | Falzon, Pierre | Granry, Jean-Claude | Moll, Marie Christine | Orliaguet, Gilles

Article Type: Research Article

Abstract: Objective: Anticipation and planning are essential steps of risk management but the mechanisms of planning behavior are incompletely understood, especially the factors including collective work. The aim of this research is to understand how anesthetists plan safe solution to perform anesthesia. Methods: A study based on interviews was conducted in two French hospitals. Data processing focused on the main decisions made by 20 anesthetists during two simulated pre-anesthetic consultation. The main decisions made have been identified and the decision criteria have been analyzed. Results: To ensure patient safety, all anesthetists do not plan the same solution. The rejection or the …selection of solutions by each physician rests on two types of criteria: the assessment of risks for the patient and the assessment of resources available to handle the situation. For the latter, the knowledge on the individual skills of each and the adoption of “local benchmark practices” play an essential role. Conclusion: Ultra safe performance in highly variable systems cannot be achieved only through standardization but also through the possibility and ability of the subjects to adapt their practices to their own skills and to that of their colleagues. The conditions for the development of this “adaptative safety” are discussed. Show more

Keywords: Decision making, anesthesia, patient safety, human factors, teamwork

DOI: 10.3233/JRS-2012-0564

Citation: International Journal of Risk & Safety in Medicine, vol. 24, no. 3, pp. 125-136, 2012

Authors: Paczynski, Richard P. | Alexander, G. Caleb | Chinchilli, Vernon M. | Kruszewski, Stefan P.

Article Type: Research Article

Abstract: Public and private payers use drug compendia to make coverage determinations, yet the quality of evidence they contain has received little scrutiny. We examined compendia citations regarding antipsychotic drugs, an important drug class given their substantial costs and widespread use. Nearly three-fold as many off-label indications were recommended for atypical as for typical agents, a difference that did not appear to be due to differences in quality of evidence for typical and atypical off-label indications. Given the important role that compendia play in evidence synthesis, coverage decisions, and ultimately, prescription utilization, these data suggest greater efforts are needed to improve …the quality of evidence and transparency of evidence evaluations compendia contain. Show more

Keywords: Drug compendia, antipsychotics, resource utilization, conflict of interest, recommendations for use

DOI: 10.3233/JRS-2012-0567

Citation: International Journal of Risk & Safety in Medicine, vol. 24, no. 3, pp. 137-146, 2012

Authors: Posadzki, Paul | Alotaibi, Amani | Ernst, Edzard

Article Type: Review Article

Abstract: Aim: This systematic review was aimed at critically evaluating the evidence regarding the adverse effects associated with aromatherapy. Method: Five electronic databases were searched to identify all relevant case reports and case series. Results: Forty two primary reports met our inclusion criteria. In total, 71 patients experienced adverse effects of aromatherapy. Adverse effects ranged from mild to severe and included one fatality. The most common adverse effect was dermatitis. Lavender, peppermint, tea tree oil and ylang-ylang were the most common essential oils responsible for adverse effects. Conclusion: Aromatherapy has the potential to cause adverse effects some of which are serious. …Their frequency remains unknown. Lack of sufficiently convincing evidence regarding the effectiveness of aromatherapy combined with its potential to cause adverse effects questions the usefulness of this modality in any condition. Show more

Keywords: Adverse effects, safety, risk, aromatherapy, systematic review, alternative medicine

DOI: 10.3233/JRS-2012-0568

Citation: International Journal of Risk & Safety in Medicine, vol. 24, no. 3, pp. 147-161, 2012

Authors: Wheway, Jayne | Agbabiaka, Taofikat B. | Ernst, Edzard

Article Type: Research Article

Abstract: Background: Acupuncture is frequently employed to treat chronic pain syndromes or other chronic conditions. Nevertheless, there is a growing literature on adverse events (AEs) from treatments including pneumothorax, cardiac tamponade and spinal cord injury. Acupuncture is provided in almost all NHS pain clinics and by an increasing number of GP's and physiotherapists. Considering acupuncture's popularity, its safety has become an important public health issue. Objectives: To evaluate the harm caused to patients through acupuncture treatments within NHS organisations. Methods: The National Reporting and Learning System (NRLS) database was searched for incidents reported from 1st January 2009 to 31st December 2011. …The free text fields of all reports received from all healthcare settings and specialties were searched for the keyword ‘acupuncture’. All relevant incidents were reviewed to provide a qualitative theme of the harm to patients. Results: 468 patient safety incidents were identified; 325 met our inclusion criteria for analysis. Adverse events reported include retained needles (31%), dizziness (30%), loss of consciousness/unresponsive (19%), falls (4%), Bruising or soreness at needle site (2%), Pneumothorax (1%) and other adverse reactions (12%). The majority (95%) of the incidents were categorised as low or no harm. Conclusions: A number of AEs are recorded after acupuncture treatments in the NHS but the majority is not severe. However, miscategorisation and under-reporting may distort the overall picture. Acupuncture practitioners should be aware of, and be prepared to manage, any significant harm from treatments. Show more

Keywords: Acupuncture, patient safety, adverse event, pneumothorax

DOI: 10.3233/JRS-2012-0569

Citation: International Journal of Risk & Safety in Medicine, vol. 24, no. 3, pp. 163-169, 2012

Authors: Sawalha, Ansam F. | O'Malley, Gerald F. | Sweileh, Waleed M.

Article Type: Research Article

Abstract: Background and objective: The agricultural industry is the largest economic sector in Palestine and is characterized by extensive and unregulated use of pesticides. The objective of this study was to analyze phone calls received by the Poison Control and Drug Information Center (PCDIC) in Palestine regarding pesticide poisoning. Methods: All phone calls regarding pesticide poisoning received by the PCDIC from 2006 to 2010 were descriptively analyzed. Statistical Package for Social Sciences (SPSS version 16) was used in statistical analysis and to create figures. Results: A total of 290 calls regarding pesticide poisoning were received during the study period. Most calls …(83.8%) were made by physicians. The average age of reported cases was 19.6 ± 15 years. Pesticide poisoning occurred mostly in males (56.9%). Pesticide poisoning was most common (75, 25.9%) in the age category of 20–29.9 years. The majority (51.7%) of the cases were deliberate self-harm while the remaining was accidental exposure. The majority of phone calls (250, 86.2%) described oral exposure to pesticides. Approximately one third (32.9%) of the cases had symptoms consistent with organophosphate poisoning. Gastric lavage (31.7%) was the major decontamination method used, while charcoal was only utilized in 1.4% of the cases. Follow up was performed in 45.5% of the cases, two patients died after hospital admission while the remaining had positive outcome. Conclusion: Pesticide poisoning is a major health problem in Palestine, and the PCDIC has a clear mission to help in recommending therapy and gathering information. Show more

Keywords: Pesticides, insecticides, poisoning, Palestine

DOI: 10.3233/JRS-2012-0570

Citation: International Journal of Risk & Safety in Medicine, vol. 24, no. 3, pp. 171-177, 2012

Authors: Gamirova, Rimma G. | Shaimardanova, Rosa M. | Ziganshina, Lilia E.

Article Type: Research Article

Abstract: Pharmacoepidemiology analysis of efficacy and safety of antiepileptics was carried out in children (3 months–18 years old) registered with municipal children's epilepsy services: 548 children in 2005, 718 – In 2007 and 32 – In 2011. We used remission lasting for 1 year or longer, and 3 years or longer as primary effectiveness outcomes, and total number of people with adverse effects as a safety outcome. We found no advantages of newer antiepileptics over the older ones in terms of either efficacy or safety. Long-term follow up (more than 3 years) showed higher treatment response rate in patients with childhood …versus juvenile absence epilepsy. Show more

Keywords: Pharmacoepidemiology of antiepileptics, efficacy, safety

DOI: 10.3233/JRS-2012-0565

Citation: International Journal of Risk & Safety in Medicine, vol. 24, no. 3, pp. 179-185, 2012

Article Type: Research Article

DOI: 10.3233/JRS-2012-0566

Citation: International Journal of Risk & Safety in Medicine, vol. 24, no. 3, pp. 187-188, 2012