Exploring the Role of Guidelines in Contributing to Medication Errors: A Descriptive Analysis of National Patient Safety Incident Data.

INTRODUCTION: Clinical guidelines can contribute to medication errors but there is no overall understanding of how and where these occur. OBJECTIVES: We aimed to identify guideline-related medication errors reported via a national incident reporting system, and describe types of error, stages of medication use, guidelines, drugs, specialties and clinical locations most commonly associated with such errors. METHODS: Retrospective analysis of reports to the National Reporting and Learning System for England and Wales. A hierarchical task analysis (HTA) was developed, describing expected practice when using guidelines. A free-text search was conducted of medication incident reports (2016-2021) using search terms related to common guidelines. All identified reports linked to moderate-severe harm or death, and a random sample of 5100 no/low-harm reports were coded to describe deviations from the HTA. A random sample of 500 cases were independently double-coded. RESULTS: In total, 28,217 reports were identified, with 608 relating to moderate-severe harm or death. Fleiss' kappa for interrater reliability was 0.46. Of the 5708 reports coded, 642 described an HTA step discrepancy (including four linked to a death), suggesting over 3200 discrepancies in the entire dataset of 28,217 reports. Discrepancies related to finding guidelines (n = 300 reports), finding information within guidelines (n = 166) and using information (n = 176). Discrepancies were most frequently identified for guidelines produced by a local organisation (n = 405), and most occurred during prescribing (n = 277) or medication administration (n = 241). CONCLUSION: Difficulties finding and using information from clinical guidelines contribute to thousands of prescribing and medication administration incidents, some of which are associated with substantial patient harm

Does higher vocational education matter for rural revitalization? Evidence from China

Abstract The association between higher vocational education and rural revitalization is an essential economic and social issue, especially in a country with a large population and a developing education system like China. This study uses panel data from 30 provinces in China from 2007 to 2020 to explore the association between higher vocational education and rural revitalization. The empirical results show that, at the national level, both the scale and the quality of higher vocational education significantly promote rural revitalization; the effects of higher vocational education on rural revitalization vary by region: in the eastern and central regions, the scale of higher vocational education significantly promotes rural revitalization, while in the western regions, the quality of higher vocational education significantly promotes rural revitalization; the scale of higher vocational education has a positive spatial spillover effect on rural revitalization, while the quality of higher vocational education only has a significant positive effect on the local level of rural revitalization. Furthermore, the effects of higher vocational education on rural revitalization exhibit a threshold effect based on the economic development level and the urban-rural income gap. This study reveals relationships between higher vocational education and rural revitalization, providing references for policymakers and investors

Protective effects of low temperature on the risk of hospitalization for mental and behavioral disorders: a time series study

The high incidence of mental illness worldwide is a substantial economic burden on society. Temperature and the occurrence of mental and behavioral disorders (MDs) seem to have a relationship, but this has not been widely researched. Therefore, this study aimed to investigate the effect of temperature on the hospitalization rate of patients with MDs in a temperate monsoon climate region of northern China. Patients with MDs hospitalized in the Mental Health Center of Hebei Medical University and Psychology Department in The third Hospital of Shijiazhuang, China, from January 2014 to December 2019 were included in the study. The delayed exposure – response relationship between temperature and the number of hospitalized MDs patients was analyzed using a quasi-Poisson generalized additive model combined with a distributed lag nonlinear model. With the reference of 15.3°C (temperature with the minimum hospitalizations), the single lag effect of low temperature (−2°C, 10th percentile) increased the hospitalization of patients with MDs, while the cumulative effect decreased the risk of hospitalization for some MD subtypes; it was an acute protective effect. The single and cumulative lag effect of high temperature statistically increased the hospitalization rates of patients with MDs. The optimum temperature for each subtype was different, and the males and the younger age group were more susceptible to high temperatures. Low temperature has an acute protective effect on the hospitalization of patients with MDs. In comparison, high temperature increases hospitalization rates. Men and younger people are more affected by temperature, which provides early warning and health intervention measures for patients with corresponding temperature changes.</p

Variations of clinical target volume delineation for primary site of nasopharyngeal cancer among five centers in China

Purpose: The purpose of this study is to investigate the current status of clinical target volume (CTV) delineation for primary site of nasopharyngeal cancer (NPC) among five large tertiary cancer centers in China. Materials and Methods: The simulation CT and MR images of a patient with T3N2M0 NPC were sent to the centers participating. Fourteen experienced physicians contoured the targets independently, and the outlined structures were compared. The consistency and differences among these 14 CTVs are discussed. Results: Two different CTV designs were used in the centers. “One-CTV” design defines one CTV with a dose of 60 Gy, whereas “two-CTV” design has a high-risk CTV with dose of 60 Gy and a medium risk CTV with dose of 54 Gy. We found that the coverage of prophylactic area is very consistent between these two designs. The variances on the coverage of some sites were also significant among physicians, including covering cavernous sinus at un-involved side, posterior space of styloid process, and caudal border on posterior pharyngeal wall. Conclusions: Standardization is the main requirement for personalization of care; our study shows that among the 14 physicians in the five centers the coverage of prophylactic areas is in excellent agreement. Two distinct strategies on CTV design are currently being used, and multiple controversies were found, suggesting further optimization of CTV for primary site of NPC is needed.</p

Dataset for "Exploring the Role of Guidelines in Contributing to Medication Errors: A Descriptive Analysis of National Patient Safety Incident Data"

The National Reporting and Learning System (NRLS) collects data on national patient safety incident reports that are voluntarily and anonymously reported by staff working in the National Health Service (NHS) and other healthcare organisations in England and Wales. The reports include incidents and near misses. The report template allows the input of categorical data (e.g. incident type and location) as well as free text fields that allow staff to describe the incident, its perceived causes and the actions taken. Incidents within the database are classified by the reporter as having been linked to death, severe harm, moderate harm, low harm or no harm. These data describe medication errors reported to the NRLS from 1st January 2016 to 31st December 2021, that might be associated with difficulties finding or understanding information in clinical guidelines. They includes details of the context of each incident (e.g. location, clinical speciality, drug involved) and additional coding of free-text variables (now redacted) showing whether the incident was related to difficulties finding or understanding information in clinical guidelines