Patient Safety in the World

AbstractPatient safety is a fundamental principle of health care. However, many medical practices and risks associated with health care are emerging as major challenges for patient safety globally and contribute significantly to the burden of harm due to unsafe care. Available evidence suggests hospitalizations in low- and middle-income countries lead annually to 134 million adverse events, contributing to 2.6 million deaths. About 134 million adverse events worldwide give rise to 2.6 million deaths every year. Estimates indicate that in high-income countries, about 1 in 10 patients is harmed while receiving hospital care. This problem affects both high-income countries and low- and middle countries even if priorities and issues may differ. The most important adverse events concern medication procedures, healthcare-associated infections, surgical procedures, injection safety, blood transfusions, venous thromboembolism, sepsis, and diagnostic and radiation errors. Since 1999 when the Institute of Medicine (IOM) published its report "To err is human," some progress has been made but patient harm is still a daily problem in healthcare. As a matter of fact, new threats are emerging due to population aging, along with new treatments and technologies which must be dealt with in addition to still-unresolved, long-standing problems. In this context, it is very important to adopt an international common strategy that creates networks, shares knowledge, programs, tools, good practices and develop and track indicators focusing on the specific priorities of each country and region

Effectiveness and cost effectiveness of pharmacist input at the ward level: a systematic review and meta-analysis

Background Pharmacists play important role in ensuring timely care delivery at the ward level. The optimal level of pharmacist input, however, is not clearly defined. Objective To systematically review the evidence that assessed the outcomes of ward pharmacist input for people admitted with acute or emergent illness. Methods The protocol and search strategies were developed with input from clinicians. Medline, EMBASE, Centre for Reviews and Dissemination, The Cochrane Library, NHS Economic Evaluations, Health Technology Assessment and Health Economic Evaluations databases were searched. Inclusion criteria specified the population as adults and young people (age >16 years) who are admitted to hospital with suspected or confirmed acute or emergent illness. Only randomised controlled trials (RCTs) published in English were eligible for inclusion in the effectiveness review. Economic studies were limited to full economic evaluations and comparative cost analysis. Included studies were quality-assessed. Data were extracted, summarised. and meta-analysed, where appropriate. Results Eighteen RCTs and 7 economic studies were included. The RCTs were from USA (n=3), Sweden (n=2), Belgium (n=2), China (n=2), Australia (n=2), Denmark (n=2), Northern Ireland, Norway, Canada, UK and Netherlands. The economic studies were from UK (n=2), Sweden (n=2), Belgium and Netherlands. The results showed that regular pharmacist input was most cost effective. It reduced length-of-stay (mean= -1.74 days [95% CI: -2.76, -0.72], and increased patient and/or carer satisfaction (Relative Risk (RR) =1.49 [1.09, 2.03] at discharge). At £20,000 per quality-adjusted life-year (QALY)-gained cost-effectiveness threshold, it was either cost-saving or cost-effective (Incremental Cost Effectiveness Ratio (ICER) =£632/ QALY-gained). No evidence was found for 7-day pharmacist presence. Conclusions Pharmacist inclusion in the ward multidisciplinary team improves patient safety and satisfaction and is cost-effective when regularly provided throughout the ward stay. Research is needed to determine whether the provision of 7-day service is cost-effective.Peer reviewe

Infection Prevention and Control

AbstractHealthcare-associated infections (HAI) are adverse events exposing patients to a potentially avoidable risk of morbidity and mortality. Antimicrobial resistance (AMR) is increasingly contributing to the burden of HAIs and emerging as of the most alarming challenges for public health worldwide. Practically, harm mitigation and risk containment demand cross-sectional initiatives incorporate both approaches to infection prevention and control and methodologies from clinical risk management

Guidelines and Safety Practices for Improving Patient Safety

AbstractThis chapter explains why clinical practice guidelines are needed to improve patient safety and how further research into safety practices can successfully influence the guideline development process. There is a description of the structured process by which guidelines that aim to increase the likelihood of a higher score are created. Proposals are made relating to (a) the live updating of individual guideline recommendations and (b) tackling challenges related to the improvement of guidelines

Citogeneticheskie issledovanija u krupnogo rogatogo skota v Pol'she

In the years 1979-84, cytogenetic investigations were carried out on 1703 animals, sp. Bos taurus of different breeds. In 1505 young and adult bulls two cases of 61,XXY syndrome, 22 caces of 60,XX/60,XY chimerism carriers and 3 centric fusions 1/29 have been found. In cows and heifers with fertility disturbances, 37 cases of XX/XY chimerism have been observed. In one cow the pericentric inversion of X chromosome has been found. A case of true hermaphroditism with 60,XY karyotype, and male pseudohermaphroditism in an animal with polyorchism have been diagnosed. A necessity of introducing cytogenetic examination in selection of animals for bredding purpose is postulated.В 1978-1984 годах проведено цитогенетические исследования 1703 животных вида Bos taurus, различных пород. Среди 1505 бычков диагностировано два случая синдрома 61,ХХУ. 22 особей с химеризмом 60,ХХ/60/,ХУ и три случая центрических слияний 1/29. У коров и яловок с нарушениями плодовитости определено 37 случаев химеризма ХХ/ХУ. У одной коровы была замечена перицентрическая инверсия Х-хромосома. Замечен случай настоящего гермафродитизма с кариотипом 60,ХУ а также мужского псевдогермафродитизма у особи с полиорхией. Считается целесообразным введение цитогенетических исследований при селекции скота

MECHANICAL INVESTIGATIONS ON ARTIFICIAL HEMODIALYSIS

The studies on cardiovascular system introduced by Max Anliker and coll have been very important because have opened a new method to look to determine the mechanical properties of the wall of the large vessels. The data have given the constant phase velocities for the pressure, axial and torsion waves, also the laws of attenuation of these waves were egual with exponential law with a negative constant multiplied by proportion of distance and wavelength. The law of attenuation has open a great problem of discussion, because the biological tissues have viscous-elastic properties but not linear as everybody who knows such materials knows. Now if a biological soft tissue has a deformation to return to the original condition is not given by a curve of presenting an egual shape but the presence of Coulomb resistance to deformation gives the particular low damping of the return to original dimension. The Knopoff theory has been used to arrive to a solution and explication of the experimental results by Anliker. We do not discuss now the mathematical problems and the equations connected to this theoretical biomechanical analysis, but if somebody is interested to discuss we have no problems of fit, because wee must see the interest of this medical people present now. When a transplant of organ is made we have the arteries of two different persons are connected and we are in presence of two similar but not egual wall are sutured, if the second is more soft then the previous part, will generate to a short period of time a stenosis due to a turbulent movement of the blood in the initial part of the new artery, with the process of sedimentation of the blood cells and obviously the sutured part is closed, the blood has at first difficulty to enter in the donor organs and day by day the blood stops and the donor organ is out owing to a necrosis. We have seen how this process can arrive to interest tilt 10% of patient, when the different age between patient and donor is of 15 years and the donor is younger in kidney transplantation. The definition of this effect was called Bononiensis Control Parameter (BCP). In conclusion, the importance of the determination of the viscous-elastic properties of the great vessels of cardiovascular system of a patient is very important to define and know when a transplant is necessary, looking for and selecting the more similar condition of the donor vessels or prosthesis

MECHANICAL INVESTIGATIONS ON ARTIFICIAL HEMODIALYSIS

The studies on cardiovascular system introduced by Max Anliker and coll have been very important because have opened a new method to look to determine the mechanical properties of the wall of the large vessels. The data have given the constant phase velocities for the pressure, axial and torsion waves, also the laws of attenuation of these waves were egual with exponential law with a negative constant multiplied by proportion of distance and wavelength. The law of attenuation has open a great problem of discussion, because the biological tissues have viscous-elastic properties but not linear as everybody who knows such materials knows. Now if a biological soft tissue has a deformation to return to the original condition is not given by a curve of presenting an egual shape but the presence of Coulomb resistance to deformation gives the particular low damping of the return to original dimension. The Knopoff theory has been used to arrive to a solution and explication of the experimental results by Anliker. We do not discuss now the mathematical problems and the equations connected to this theoretical biomechanical analysis, but if somebody is interested to discuss we have no problems of fit, because wee must see the interest of this medical people present now. When a transplant of organ is made we have the arteries of two different persons are connected and we are in presence of two similar but not egual wall are sutured, if the second is more soft then the previous part, will generate to a short period of time a stenosis due to a turbulent movement of the blood in the initial part of the new artery, with the process of sedimentation of the blood cells and obviously the sutured part is closed, the blood has at first difficulty to enter in the donor organs and day by day the blood stops and the donor organ is out owing to a necrosis. We have seen how this process can arrive to interest tilt 10% of patient, when the different age between patient and donor is of 15 years and the donor is younger in kidney transplantation. The definition of this effect was called Bononiensis Control Parameter (BCP). In conclusion, the importance of the determination of the viscous-elastic properties of the great vessels of cardiovascular system of a patient is very important to define and know when a transplant is necessary, looking for and selecting the more similar condition of the donor vessels or prosthesis

Study on the Mechanical Properties of the Tissues of the Great Arteries

The studies on cardiovascular system introduced by Max Anliker and coll have been very important because have opened a new method to look to determine the mechanical properties of the wall of the large vessels. The data have given the constant phase velocities for the pressure, axial and torsion waves, also the laws of attenuation of these waves were egual with exponential law with a negative constant multiplied by proportion of distance and wavelength. The law of attenuation has open a great problem of discussion, because the biological tissues have viscous-elastic properties but not linear as everybody who knows such materials knows. Now if a biological soft tissue has a deformation to return to the original condition is not given by a curve of presenting an egual shape but the presence of Coulomb resistance to deformation gives the particular low damping of the return to original dimension. The Knopoff theory has been used to arrive to a solution and explication of the experimental results by Anliker. We do not discuss now the mathematical problems and the equations connected to this theoretical biomechanical analysis, but if somebody is interested to discuss we have no problems of fit, because wee must see the interest of this medical people present now. When a transplant of organ is made we have the arteries of two different persons are connected and we are in presence of two similar but not egual wall are sutured, if the second is more soft then the previous part, will generate to a short period of time a stenosis due to a turbulent movement of the blood in the initial part of the new artery, with the process of sedimentation of the blood cells and obviously the sutured part is closed, the blood has at first difficulty to enter in the donor organs and day by day the blood stops and the donor organ is out owing to a necrosis. We have seen how this process can arrive to interest tilt 10% of patient, when the different age between patient and donor is of 15 years and the donor is younger in kidney transplantation. The definition of this effect was called Bononiensis Control Parameter (BCP). In conclusion, the importance of the determination of the viscous-elastic properties of the great vessels of cardiovascular system of a patient is very important to define and know when a transplant is necessary, looking for and selecting the more similar condition of the donor vessels or prosthesis

STUDY ON THE MECHANICAL PROPERTIES OF THE TISSUES OF THE GREAT ARTERIES

The studies on cardiovascular system introduced by Max Anliker and coll have been very important because have opened a new method to look to determine the mechanical properties of the wall of the large vessels. The data have given the constant phase velocities for the pressure, axial and torsion waves, also the laws of attenuation of these waves were egual with exponential law with a negative constant multiplied by proportion of distance and wavelength. The law of attenuation has open a great problem of discussion, because the biological tissues have viscous-elastic properties but not linear as everybody who knows such materials knows. Now if a biological soft tissue has a deformation to return to the original condition is not given by a curve of presenting an egual shape but the presence of Coulomb resistance to deformation gives the particular low damping of the return to original dimension. The Knopoff theory has been used to arrive to a solution and explication of the experimental results by Anliker. We do not discuss now the mathematical problems and the equations connected to this theoretical biomechanical analysis, but if somebody is interested to discuss we have no problems of fit, because wee must see the interest of this medical people present now. When a transplant of organ is made we have the arteries of two different persons are connected and we are in presence of two similar but not egual wall are sutured, if the second is more soft then the previous part, will generate to a short period of time a stenosis due to a turbulent movement of the blood in the initial part of the new artery, with the process of sedimentation of the blood cells and obviously the sutured part is closed, the blood has at first difficulty to enter in the donor organs and day by day the blood stops and the donor organ is out owing to a necrosis. We have seen how this process can arrive to interest tilt 10% of patient, when the different age between patient and donor is of 15 years and the donor is younger in kidney transplantation. The definition of this effect was called Bononiensis Control Parameter (BCP). In conclusion, the importance of the determination of the viscous-elastic properties of the great vessels of cardiovascular system of a patient is very important to define and know when a transplant is necessary, looking for and selecting the more similar condition of the donor vessels or prosthesis