Revisiting Medical Errors: Collaborative Errors

Medical error is a label used to refer to preventable adverse events in the healthcare setting. Errors in medical practice and service can occur at various timepoints and contexts, driven by both human and non-human factors. As healthcare continuously evolves, particularly against the backdrop of a digital landscape, it has become even more of a necessity to conduct a comprehensive examination of the causes and potential solutions for the wide array of medical errors that can occur. Conventionally, medical errors have been studied from the clinical perspective to prevent and remedy errors such as diagnostic errors, medication errors, surgical errors, and errors in medical protocol. The digitalization of healthcare practice provides new opportunities to conduct longitudinal analysis, but also presents challenges relatively new to medical error research, but familiar in the world of data quality, including data that is siloed across different timepoints and entities. As the field moves towards prevention-focused care practice, we anticipate that longitudinal data about managed care bundled by patients will become more available. This study conducts an exploratory literature review of the factors contributing to medical errors, emphasizing the interdisciplinary nature and collaborative mode in defining and mitigating errors. The medical and healthcare literature discusses the medical practice and service within a visit, test, surgery, and transfer extensively. The error research literature identifies human errors, such as, slips and mistakes, and others from individual episodes. Other literature focuses on specific types, causes, and contexts of medical errors, such as culture, leadership, training, and systems. Many empirical medical error studies are available for certain service or project period. Other studies focus on transfers of patients. We also reviewed literature on non-medical errors, such as, nuclear plants and airlines. We reviewed many organizational process literatures that discusses errors stem from knowledge sharing and boundary shifting. We also reviewed data quality literature that embeds various contexts in quality of data. We aim to review and synthesize the literature across disciplines for studying the medical errors based on a patient over time, cross multiple services, visits, and transfers in order to account for the interdisciplinary phenomenon of medical errors and collaborative errors. Based on this review, we propose a longitudinal framework and concepts to understand collaborative medical errors based on patients’ experience over time. We present several propositions on how specialized collaborative efforts might contribute to creating and solving medical errors. In addition, this review also explores the role of automation, technology, role-based communication, and evidence-based approaches in mitigating errors. This research significantly contributes to the field by challenging traditional perspectives on medical errors, expanding the scope of error analysis, and offering practical strategies for error reduction. It underscores the critical role of interdisciplinary collaboration in healthcare and provides a solid foundation for future studies in the pursuit of safer and higher-quality patient care

Gender-specific changes in energy metabolism and protein degradation as major pathways affected in livers of mice treated with ibuprofen.

Ibuprofen, an inhibitor of prostanoid biosynthesis, is a common pharmacological agent used for the management of pain, inflammation and fever. However, the chronic use of ibuprofen at high doses is associated with increased risk for cardiovascular, renal, gastrointestinal and liver injuries. The underlying mechanisms of ibuprofen-mediated effects on liver remain unclear. To determine the mechanisms and signaling pathways affected by ibuprofen (100 mg/kg/day for seven days), we performed proteomic profiling of male mice liver with quantitative liquid chromatography tandem mass spectrometry (LC-MS/MS) using ten-plex tandem mass tag (TMT) labeling. More than 300 proteins were significantly altered between the control and ibuprofen-treated groups. The data suggests that several major pathways including (1) energy metabolism, (2) protein degradation, (3) fatty acid metabolism and (4) antioxidant system are altered in livers from ibuprofen treated mice. Independent validation of protein changes in energy metabolism and the antioxidant system was carried out by Western blotting and showed sex-related differences. Proteasome and immunoproteasome activity/expression assays showed ibuprofen induced gender-specific proteasome and immunoproteasome dysfunction in liver. The study observed multifactorial gender-specific ibuprofen-mediated effects on mice liver and suggests that males and females are affected differently by ibuprofen

Protein purification and analysis: next generation Western blotting techniques

IntroductionWestern blotting is one of the most commonly used techniques in molecular biology and proteomics. Since western blotting is a multistep protocol, variations and errors can occur at any step reducing the reliability and reproducibility of this technique. Recent reports suggest that a few key steps, such as the sample preparation method, the amount and source of primary antibody used, as well as the normalization method utilized, are critical for reproducible western blot results. Areas covered: In this review, improvements in different areas of western blotting, including protein transfer and antibody validation, are summarized. The review discusses the most advanced western blotting techniques available and highlights the relationship between next generation western blotting techniques and its clinical relevance. Expert commentary: Over the last decade significant improvements have been made in creating more sensitive, automated, and advanced techniques by optimizing various aspects of the western blot protocol. New methods such as single cell-resolution western blot, capillary electrophoresis, DigiWest, automated microfluid western blotting and microchip electrophoresis have all been developed to reduce potential problems associated with the western blotting technique. Innovative developments in instrumentation and increased sensitivity for western blots offer novel possibilities for increasing the clinical implications of western blot

Adverse Outcome in a Patient with Undiagnosed and Asymptomatic Intracranial Lesion after Total Abdominal Hysterectomy

We describe a case of 55-year-old female who had deterioration of respiratory and haemodynamic status after hysterectomy under subarachnoid block. On the second postoperative day she had to be intubated and sustained on ventilatory and inotropic support. The patient had apparently no previous cardio-respiratory-renal or neurological problem. Her CT scan revealed a space occupying intracranial lesion. The etiopathogensis and future management of such patients is discussed after review of current literature

Improving the sensitivity of traditional Western blotting via Streptavidin containing Poly-horseradish peroxidase (PolyHRP).

Immunoassays such as ELISAs and Western blotting have been the common choice for protein validation studies for the past several decades. Technical advancements and modifications are continuously being developed to enhance the detection sensitivity of these procedures. Among them, Streptavidin-containing poly-horseradish peroxidase (PolyHRP) based detection strategies have been shown to improve signals in ELISA. The use of commercially available Streptavidin and antibodies conjugated with many HRPs (PolyHRPs) to potentially enhance the detection sensitivity in Western blotting has not been previously investigated in a comprehensive manner. The use of PolyHRP-secondary antibody instead of HRP-secondary antibody increased the Western blotting sensitivity up to 85% depending on the primary antibody used. The use of a biotinylated secondary antibody and commercially available Streptavidin-conjugated with HRP or PolyHRP all resulted in increased sensitivity with respect to antigen detection. Utilizing a biotinylated secondary antibody and Streptavidin-conjugated PolyHRP resulted in as much as a 110-fold increase in Western blotting sensitivity over traditional Western blotting methods. Quantification of troponin I in rat heart lysates showed that the traditional Western blotting method only detected troponin I in ≥2 μg of lysate while Streptavidin-conjugated PolyHRP20 detected troponin I in ≥50 ng of lysate. A modified blocking procedure is also described that eliminated the interference caused by the endogenous biotinylated proteins. These results suggest that Streptavidin-conjugated PolyHRP and PolyHRP secondary antibodies are likely to be commonly utilized for Western blots in the future

Improving the sensitivity of traditional Western blotting via Streptavidin containing Poly-horseradish peroxidase (PolyHRP).

Immunoassays such as ELISAs and Western blotting have been the common choice for protein validation studies for the past several decades. Technical advancements and modifications are continuously being developed to enhance the detection sensitivity of these procedures. Among them, Streptavidin-containing poly-horseradish peroxidase (PolyHRP) based detection strategies have been shown to improve signals in ELISA. The use of commercially available Streptavidin and antibodies conjugated with many HRPs (PolyHRPs) to potentially enhance the detection sensitivity in Western blotting has not been previously investigated in a comprehensive manner. The use of PolyHRP-secondary antibody instead of HRP-secondary antibody increased the Western blotting sensitivity up to 85% depending on the primary antibody used. The use of a biotinylated secondary antibody and commercially available Streptavidin-conjugated with HRP or PolyHRP all resulted in increased sensitivity with respect to antigen detection. Utilizing a biotinylated secondary antibody and Streptavidin-conjugated PolyHRP resulted in as much as a 110-fold increase in Western blotting sensitivity over traditional Western blotting methods. Quantification of troponin I in rat heart lysates showed that the traditional Western blotting method only detected troponin I in ≥2 μg of lysate while Streptavidin-conjugated PolyHRP20 detected troponin I in ≥50 ng of lysate. A modified blocking procedure is also described that eliminated the interference caused by the endogenous biotinylated proteins. These results suggest that Streptavidin-conjugated PolyHRP and PolyHRP secondary antibodies are likely to be commonly utilized for Western blots in the future

Gender-specific changes in energy metabolism and protein degradation as major pathways affected in livers of mice treated with ibuprofen.

Ibuprofen, an inhibitor of prostanoid biosynthesis, is a common pharmacological agent used for the management of pain, inflammation and fever. However, the chronic use of ibuprofen at high doses is associated with increased risk for cardiovascular, renal, gastrointestinal and liver injuries. The underlying mechanisms of ibuprofen-mediated effects on liver remain unclear. To determine the mechanisms and signaling pathways affected by ibuprofen (100 mg/kg/day for seven days), we performed proteomic profiling of male mice liver with quantitative liquid chromatography tandem mass spectrometry (LC-MS/MS) using ten-plex tandem mass tag (TMT) labeling. More than 300 proteins were significantly altered between the control and ibuprofen-treated groups. The data suggests that several major pathways including (1) energy metabolism, (2) protein degradation, (3) fatty acid metabolism and (4) antioxidant system are altered in livers from ibuprofen treated mice. Independent validation of protein changes in energy metabolism and the antioxidant system was carried out by Western blotting and showed sex-related differences. Proteasome and immunoproteasome activity/expression assays showed ibuprofen induced gender-specific proteasome and immunoproteasome dysfunction in liver. The study observed multifactorial gender-specific ibuprofen-mediated effects on mice liver and suggests that males and females are affected differently by ibuprofen

Effects of hemin, the HO inducer and SnMP, the HO inhibitor on hepatic triglycerides, hepatic cholesterol, plasma triglycerides and plasma cholesterol.

<p>Hemin therapy markedly reduced the elevated basal levels of (A) liver triglycerides, (B) liver cholesterol, (C) plasma triglycerides and (D) plasma cholesterol in ZDFs, whereas the HO blocker, SnMP nullified the effects. Hemin therapy also lowered hepatic triglycerides/cholesterol and plasma triglycerides/cholesterol in ZLs. Bars represent means ± SEM; <i>n = 6</i> rats per group (*p<0.01 <i>vs</i> Control-ZL; ^†p<0.05, ^††p<0.01 <i>vs</i> Control-ZL or Control-ZDF).</p

Effect of hemin therapy on hepatic histo-pathological lesions.

<p>(A) Representative image after Masson’s trichrome staining revealed severe hepatocyte ballooning injury with inflammatory cell infiltration around the central vein (CV) region in ZDFs, which interestingly were attenuated in hemin-treated ZDF (Magnification×200). (B) Semi-quantitative evaluation showed that hemin therapy significantly reduced hepatocyte ballooning injury in ZDFs. Bars represent means ± SEM; <i>n = 4–6</i> rats per group (*p<0.01 <i>vs</i> all groups).</p