What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.Objective To investigate the epidemiology of medication errors and error-related adverse events in adults in primary care, ambulatory care and patients’ homes. Design Systematic review. Data source Six international databases were searched for publications between 1 January 2006 and 31 December 2015. Data extraction and analysis Two researchers independently extracted data from eligible studies and assessed the quality of these using established instruments. Synthesis of data was informed by an appreciation of the medicines’ management process and the conceptual framework from the International Classification for Patient Safety. Results 60 studies met the inclusion criteria, of which 53 studies focused on medication errors, 3 on error-related adverse events and 4 on risk factors only. The prevalence of prescribing errors was reported in 46 studies: prevalence estimates ranged widely from 2% to 94%. Inappropriate prescribing was the most common type of error reported. Only one study reported the prevalence of monitoring errors, finding that incomplete therapeutic/safety laboratory-test monitoring occurred in 73% of patients. The incidence of preventable adverse drug events (ADEs) was estimated as 15/1000 person-years, the prevalence of drug–drug interaction-related adverse drug reactions as 7% and the prevalence of preventable ADE as 0.4%. A number of patient, healthcare professional and medication-related risk factors were identified, including the number of medications used by the patient, increased patient age, the number of comorbidities, use of anticoagulants, cases where more than one physician was involved in patients’ care and care being provided by family physicians/general practitioners. Conclusion A very wide variation in the medication error and error-related adverse events rates is reported in the studies, this reflecting heterogeneity in the populations studied, study designs employed and outcomes evaluated. This review has identified important limitations and discrepancies in the methodologies used and gaps in the literature on the epidemiology and outcomes of medication errors in community settings.Peer reviewe

Development of Morphology in Hatchery-Reared Rutilus Frisii Kutum Larvae

Most fish are poorly developed at hatching. They undergo important functional and morphological changes during the early larval period. This study was conducted to monitor the morphological changes of Caspian kutum Rutilus frisii kutum larvae in early life stages. Fertilized kutum eggs were incubated at 16-19ºC in 8 l glass incubators for 9.5 days. At first feeding (3 days after hatch) larvae were fed two times per day with egg yolk for 5 days, and then Artemia nauplii and egg yolk until day 30. The juveniles were then transferred to an outdoor fish hapa nets and further reared until day 60. Larval development, growth, and some morphological changes were described from day 0 to end of experiment. The results showed that there were 3 main stages and 18 sub-stages of ontogenetic development in Caspian kutum from hatching to juvenile stage. The most important change in these stages was change from endogenous to exogenous feeding. During post hatch development, the various organs gradually differentiated and became identifiable

An examination of the motivations for the foreign acquisitions of the local banks : a case study of the Egyptian banks

Opposite to the 1970s, 1980s, 1990s, where there were several foreign banks joint ventures and branches of foreign banks established; the initial years of 2000s, in particular, between 2005-2010, had witnessed of established a wave of foreign banks M&As in the country –Egypt-. Here is an example of a debatable thesis that tries to investigate the main drivers and factors behind the recent wave of foreign M&As within the country –Egypt-.As a matter of fact, the literature review indicates that there are drivers and factors at each of the host-country, and the local-firm, as well as at the foreign-firm, itself, that motivated the foreign entrants to adopt M&As across the borders.Because of this, this thesis adopted the recent view of the OLI-paradigm of John Dunning that has emerged recently in 2006. This recent development of the OLI- paradigm emphasises on the effective role of the host countries‟ institutional features as a whole in adopting international strategies more than considering the country‟s risk-level and its market state(as suggested in the old OLI-paradigm). This recent development considered to be a theoretical hypothesis that needs to be verified.As illustrated in the recent development of OLI-paradigm: the current study adopted the Locational-advantage that reflecting the institutional theory, to refer to the host- country institutional features; Ownership-advantage that reflecting the Resource- Based view, to refer to resources and capabilities for each of the international-partner and local-partner, and implicitly Internationalisation-advantage that reflecting the transaction-costs-view, which could be handled effectively through the country‟s high quality institutional features. So, the thesis‟ theoretical triangulation is achieved.To verify that, the thesis adopted a positivism paradigm that tended to the realism paradigm, as a research route. A case study and a purposive sample of 6 case studies are adopted. A pattern-matching is employed, in which the emerging factors from the literature are set in order to be verified through a number of theoretical propositions. So, the current study adopted mix research methods, quantitative and qualitative methods, in order to link the empirical data to the study‟s proposed theoretical propositions. Quantitative data was collected through distributing Likert Five-Scale questionnaire and qualitative data was obtained through carrying out semi-structured interviews with the representative‟ staff of the acquiring banks and secondary data was obtained from international and local reports. So primary data and secondary data are used in the current thesis, and this achieved another triangulation in the methodology and the coolecting data of the current study.The quantitative data was analysed by using parametric tests(one-sample t-test) since the study sample size =33 and the study‟s questionnaires data meet the normal distribution requirements.The study results show that with the new millennium, no longer the old view of OLI- paradigm could interpret the entry of FDI into other countries, and instead of that the recent development of OLI-paradigm is suggested. This refers to the important role of the host country‟s preparations of the institutional features in attracting FDI to the country. Since the host country‟s institutional features are considered the only able to exploit the Ownership-advantage of the international banks abroad and to take advantage of the local-partner‟s resources, otherwise, the international banks couldn‟t expolit their resources. Since the international banks are encouraging to move towards a specific country, which its institutional features were prepared well, which involves regulatory quality features, legal and infrastructure, social and transparency features. But, this only possible when the foreign entrant has Ownership-advantage that attracting the local actors to select it, particularly amongst the other international banks. As well, it is also possible only when the local -partner has distinctive resources that attracting the international-partner to select a specific local bank amongst the other local banks.In view of that, Dunning‟s recent development view of OLI-paradigm is verified in explaining the existence of expansionary activities by international banks in the country –Egypt-. However, still this topic needs more investigation since the current study discovered that each of the home countries‟ regulations and cultural influences may have an effect, as an initial mechanism, on the international banks‟ going abroad

Influence of chimney effect on the radon effective dose of the lung simulated for radon prone areas of Ramsar in winter season

One of the well-known radon prone areas of the world is Ramsar in Iran, which is surrounded by the Alborz Mountain in its southern part and Caspian Sea on the north. The annual effective dose in the district of Talesh-Mahalleh is higher than the annual dose limits for radiation workers. In this study, the indoor radon level and effective dose of the lung were estimated using a Prassi portable radon gas survey meter in a model house containing top soil samples from different parts of Ramsar. For the extremely hot samples, the effective dose of the lung in winter season was 27.75±2.55mSv, when the windows and exhaust part of chimney were closed. However, when the chimney was turned on and the exhaust part of chimney was open, the effective dose of the lung was reduced to 1.27±0.23mSv. Also the seasonal radon effective doses of the lung with other samples were reduced to low values. The results suggest by using chimney effect and chimney heaters a significant lessening of the radon seasonal effective dose in dwellings of Ramsar can be achieved

The Influence of Exchangeable Ions and Their Concentration in the Pore Fluid on Plastic and Strength Properties of Cohesive Soil

A study was conducted to find out both the effect of different exchangeable cations and the concentration of ions in the soil pore fluid on strength and plastic properties of a sample of cohesive soil taken from the bank of an open drain ditch at the Utah State University Irrigation and Drainage Farm. The experimental results of this study may be summarized by the following points: A general decrease of liquid limit and an increase in both shear strength and modulus of elasticity, with increasing salt concentration in the pore fluid, were observed for all samples, with the exception of HC1-treated samples for which shear strength was independent of HCI concentration in the pore water. An increase in both shear strength and modulus of elasticity with decreasing exchangeable sodium percentage was definite. The increase of soil shear strength caused by different exchangeable cations with distilled water in the soil pores was in the order Na + \u3c Ca ++ \u3c Mg ++ \u3c K + \u3c HCl-treated soil, whereas the modulus of elasticity increased in order Na + \u3c K + \u3c Ca ++\u3c HCI-treated soll \u3c ++ Mg A decrease in the liquid limit with decreasing exchangeable sodium was found. The influence of the different exchangeable cations used on soil liquid limit was in the order Na + \u3e HCl-treated sample \u3e Mg++ \u3e Ca ++ \u3e K+ . From this study it could be concluded that: The strength and plastic properties of cohesive soils are affected greatly by the type and concentration of adsorbed ions as well as by the ions concentration in the pore fluid. The failure of the sloping sides of drain ditches may be attributed at least in part to increasing exchangeable sodium percentage. For satisfactory and economical design of earth structures, a knowledge of chemical as well as physical properties of cohesive soils is essential. The boundary conditions which may change the soil physico-chemical properties with time should be considered. Strength properties of HCl-treated soils are controlled by aluminum rather than hydrogen ions. Exchangeable aluminum was liberated as a result of the breakdown of the clay fraction in soils when treated with HC1. The experimental results are not completely explained in terms of the Gouy-Chapman theory of double layers. However, the Stern theory which considers the specific adsorption of ions on clay surfaces is a better alternative and does explain the results adequately

Signaling mechanisms of a water soluble curcumin derivative in experimental type 1 diabetes with cardiomyopathy

BACKGROUND: Curcumin exhibits anti-diabetic activities, induces heme-oxygenase-1 (HO-1) and is an inhibitor of transcriptional co-activator p300. A novel water soluble curcumin derivative (NCD) has been developed to overcome low invivo bioavailability of curcumin. We evaluated the effect of the NCD on signaling mechanisms involved in cardiomyocyte hypertrophy and studied whether its action is mediated via inducible HO-1. MATERIALS AND METHODS: Rats were divided into controls, controls receiving NCD, diabetic, diabetic receiving NCD, diabetic receiving pure curcumin, diabetic receiving HO inhibitor, zinc protoporphyrin IX (ZnPP IX) and diabetic receiving NCD and ZnPP IX. NCD and curcumin were given orally. After 45 days, cardiac physiologic parameters, plasma glucose, insulin, glycated hemoglobin (GHb), HO-1 gene expression and HO activity in pancreas and cardiac tissues were assessed. Gene expression of p300, atrial natriuretic peptide (ANP) and myocyte enhancer factor 2 (MEF2A and MEF2C) were studied. RESULTS: NCD and curcumin decreased plasma glucose, GHb and increased insulin levels significantly in diabetic rats. This action may be partially mediated by induction of HO-1 gene. HO-1 gene expression and HO activity were significantly increased in diabetic heart and pancreas. Diabetes upregulated the expression of ANP, MEF2A, MEF2C and p300. NCD and curcumin prevented diabetes-induced upregulation of these parameters and improved left ventricular function. The effect of the NCD was better than the same dose of curcumin

The Interaction of Water and Salt Flow in Unsaturated Soils

The movements of salt and water, particularly in fairly dry soils or compacted shales, are important processes in both agronomic studies and hydraulics of deep ground water which is important in the location of oil