Antioxidants in Atlantic Salmon on a Diurnal Basis

Atlantic salmon is a common aquaculture species that is now greatly impacted by sea lice and amoebic gill disease. Currently, one of the treatments uses hydrogen peroxide (H2O2) because it breaks down safely in water, leaving no toxic residues like some of the previous treatments. Hydrogen peroxide was an effective treatment previously, but now resistance seems to be developing amongst the disease organisms and, if too high a dose is used, it can harm the salmon. Antioxidants, specifically superoxide dismutase (SOD), catalase (CAT), and both independent and dependent glutathione peroxidase (GPx), are present in organisms to break down reactive oxygen species (ROS) like H2O2. The goal of this study was to determine if antioxidants follow a daily rhythm, so that an ideal treatment time and a higher dose of H2O2 can be used to kill harmful organisms without causing damage to the salmon, since there are clear indications that many physiological processes vary on a circadian rhythm. Three fish were sampled every four hours for fifty-two hours to determine if the levels of SOD, CAT, and GPx varied over time. Although this data showed some evidence of a daily rhythm, no statistical significance was found except in the GPx dependent levels. This experiment should be repeated using more than one tank and measuring cortisol levels to determine if stress was a possible contributing factor to the lack of statistical significance, or if human error caused the large amount of variance observed

Ambulatory chemotherapy : past, present and future

Ambulatory chemotherapy allows the delivery of short and extended chemotherapy infusions through a portable pump from the comfort of patients’ homes. It is essential to offer it for suitable candidates to ensure both their safety and the success of the treatment session. This requires a delicate balance between clinical assessment and patient acceptance. The two main components of this treatment modality are the pump and the access device. There are several pump designs and mechanisms on the market, with the latest being the portable disposable elastomeric one. Clinicians along with a multidisciplinary medical team often decide upon the type of access device; patients are also involved whenever shared decision making is practiced. Despite some reports of pump programming errors or malfunctions, research is underway to find innovative solutions to support its use

A Prescription for Improving Drug Formulary Decision Making

Gordon Schiff and colleagues present a new tool and checklist to help formularies make decisions about drug inclusion and to guide rational drug use

Paediatric patient safety and the need for aviation black box thinking to learn from and prevent medication errors

Since the publication of To Err Is Human: Building a Safer Health System in 1999, there has been much research conducted into the epidemiology, nature and causes of medication errors in children, from prescribing and supply to administration. It is reassuring to see growing evidence of improving medication safety in children; however, based on media reports, it can be seen that serious and fatal medication errors still occur. This critical opinion article examines the problem of medication errors in children and provides recommendations for research, training of healthcare professionals and a culture shift towards dealing with medication errors. There are three factors that we need to consider to unravel what is missing and why fatal medication errors still occur. (1) Who is involved and affected by the medication error? (2) What factors hinder staff and organisations from learning from mistakes? Does the fear of litigation and criminal charges deter healthcare professionals from voluntarily reporting medication errors? (3) What are the educational needs required to prevent medication errors? It is important to educate future healthcare professionals about medication errors and human factors to prevent these from happening. Further research is required to apply aviation’s ‘black box’ principles in healthcare to record and learn from near misses and errors to prevent future events. There is an urgent need for the black box investigations to be published and made public for the benefit of other organisations that may have similar potential risks for adverse events. International sharing of investigations and learning is also needed

The effects of variability in bank material properties on riverbank stability: Goodwin Creek, Mississippi

Bank retreat is an important area of research within fluvial geomorphology and is a land management problem of global significance. The Yazoo River Basin in Mississippi is one example of a system which is experiencing excessive erosion and bank instability. The properties of bank materials are important in controlling the stability of stream banks and past studies have found that these properties are often variable spatially. Through an investigation of bank material properties on a stretch of Goodwin Creek in the Yazoo Basin, Mississippi, this study focuses on: i) how and why effective bank material properties vary through different scales; ii) how this variation impacts on the outputs from a bank stability model; and iii) how best to appropriately represent this variability within a bank stability model. The study demonstrates the importance that the variability of effective bank material properties has on bank stability: at both the micro-scale within a site, and at the meso-scale between sites in a reach. This variability was shown to have important implications for the usage of the Bank Stability and Toe Erosion Model (BSTEM), a deterministic bank stability model that currently uses a single value to describe each bank material property. As a result, a probabilistic representation of effective bank material strength parameters is recommended as a potential solution for any bank stability model that wishes to account for the important influence of the inherent variability of soil properties. © 2008 Elsevier B.V. All rights reserved

How effective are incident reporting systems for improving patient safety? A systematic literature review

Context: Incident reporting systems (IRSs) are used to gather information on patient safety incidents. However, and despite the financial burden they imply, little is known about their effectiveness. This paper reviews systematically the effectiveness of IRSs as a method of improving patient safety through organizational learning. Method: This systematic literature review identified two groups of studies: a) studies comparing the effectiveness of IRSs relative to other methods of error reporting and b) studies examining the effectiveness of IRSs on settings, structures and outcomes in respect of improvements to patient safety. We used thematic analysis to compare the effectiveness of IRSs with other methods and to synthesize what was effective, where and why. Then, to assess the evidence concerning the ability of IRSs to facilitate organizational learning, we analyzed studies using the concepts of single loop and double loop learning. Findings: In total, 43 studies were identified. Eight studies compared IRSs with other methods, while 35 explored the effectiveness of IRSs on settings, structures and outcomes. We did not find strong evidence that IRSs perform better than other methods. We found some evidence of single loop learning, that is, changes to clinical settings or processes as a consequence of learning from IRSs, but little evidence either of improvements to outcomes or of changes to latent managerial factors involved in error production. In addition, there was insubstantial evidence of IRSs enabling double loop learning that is, cultural change or change of mindset. Conclusions: The results indicate IRSs could be more effective if there were explicit criteria for what counts as an incident; they are owned and led by clinical teams rather than centralized hospital departments; and embedded within organizations as part of wider safety programs

Image perception and interpretation of abnormalities; can we believe our eyes? Can we do something about it?

The radiologist’s visual impression of images is transmitted, via non-visual means (the report), to the clinician. There are several complex steps from the perception of the images by the radiologist to the understanding of the impression by the clinician. With a process as complex as this, it is no wonder that errors in perception, cognition, interpretation, transmission and understanding are very common. This paper reviews the processes of perception and error generation and possible strategies for minimising them

Systematic Review of Medicine-Related Problems in Adult Patients with Atrial Fibrillation on Direct Oral Anticoagulants

New oral anticoagulant agents continue to emerge on the market and their safety requires assessment to provide evidence of their suitability for clinical use. There-fore, we searched standard databases to summarize the English language literature on medicine-related problems (MRPs) of direct oral anticoagulants DOACs (dabigtran, rivaroxban, apixban, and edoxban) in the treatment of adults with atri-al fibrillation. Electronic databases including Medline, Embase, International Pharmaceutical Abstract (IPA), Scopus, CINAHL, the Web of Science and Cochrane were searched from 2008 through 2016 for original articles. Studies pub-lished in English reporting MRPs of DOACs in adult patients with AF were in-cluded. Seventeen studies were identified using standardized protocols, and two reviewers serially abstracted data from each article. Most articles were inconclusive on major safety end points including major bleeding. Data on major safety end points were combined with efficacy. Most studies inconsistently reported adverse drug reactions and not adverse events or medication error, and no definitions were consistent across studies. Some harmful drug effects were not assessed in studies and may have been overlooked. Little evidence is provided on MRPs of DOACs in patients with AF and, therefore, further studies are needed to establish the safety of DOACs in real-life clinical practice