Patient safety in dentistry: development of a candidate 'never event' list for primary care

Introduction The 'never event' concept is often used in secondary care and refers to an agreed list of patient safety incidents that 'should not happen if the necessary preventative measures are in place'. Such an intervention may raise awareness of patient safety issues and inform team learning and system improvements in primary care dentistry. Objective To identify and develop a candidate never event list for primary care dentistry. Methods A literature review, eight workshops with dental practitioners and a modified Delphi with 'expert' groups were used to identify and agree candidate never events. Results Two-hundred and fifty dental practitioners suggested 507 never events, reduced to 27 distinct possibilities grouped across seven themes. Most frequently occurring themes were: 'checking medical history and prescribing' (119, 23.5%) and 'infection control and decontamination' (71, 14%). 'Experts' endorsed nine candidate never event statements with one graded as 'extreme risk' (failure to check past medical history) and four as 'high risk' (for example, extracting wrong tooth). Conclusion Consensus on a preliminary list of never events was developed. This is the first known attempt to develop this approach and an important step in determining its value to patient safety. Further work is necessary to develop the utility of this method

Delphi-Consensus Weights for Ischemic and Bleeding Events to Be Included in a Composite Outcome for RCTs in Thrombosis Prevention

To weight ischemic and bleeding events according to their severity to be used in a composite outcome in RCTs in the field of thrombosis prevention.Using a Delphi consensus method, a panel of anaesthesiology and cardiology experts rated the severity of thrombotic and bleeding clinical events. The ratings were expressed on a 10-point scale. The median and quartiles of the ratings of each item were returned to the experts. Then, the panel members evaluated the events a second time with knowledge of the group responses from the first round. Cronbach's a was used as a measure of homogeneity for the ratings. The final rating for each event corresponded to the median rating obtained at the last Delphi round.Of 70 experts invited, 32 (46%) accepted to participate. Consensus was reached at the second round as indicated by Cronbach's a value (0.99 (95% CI 0.98-1.00)) so the Delphi was stopped. Severity ranged from under-popliteal venous thrombosis (median = 3, Q1 = 2; Q3 = 3) to ischemic stroke or intracerebral hemorrhage with severe disability at 7 days and massive pulmonary embolism (median = 9, Q1 = 9; Q3 = 9). Ratings did not differ according to the medical specialty of experts.These ratings could be used to weight ischemic and bleeding events of various severity comprising a composite outcome in the field of thrombosis prevention

Large Differences in Publicly Visible Health Behaviours across Two Neighbourhoods of the Same City

Background: There are socioeconomic disparities in the likelihood of adopting unhealthy behaviours, and success at giving them up. This may be in part because people living in deprived areas are exposed to greater rates of unhealthy behaviour amongst those living around them. Conventional self-report surveys do not capture these differences in exposure, and more ethological methods are required in order to do so. Methodology/Principal Findings: We performed 12 hours of direct behavioural observation in the streets of two neighbourhoods of the same city which were similar in most regards, except that one was much more socioeconomically deprived than the other. There were large differences in the publicly visible health behaviours observed. In the deprived neighbourhood, we observed 266 more adults smoking (rate ratio 3.44), 53 more adults drinking alcohol (rate ratio not calculable), and 38 fewer adults running (rate ratio 0.23), than in the affluent neighbourhood. We used data from the Health Survey for England to calculate the differences we ought to expect to have seen given the individual-level socioeconomic characteristics of the residents. The observed disparities between the two neighbourhoods were considerably greater than this null model predicted. There were also different patterns of smoking in proximity to children in the two neighbourhoods. Conclusions/Significance: The differences in observed smoking, drinking alcohol, and physical activity between these tw

Development of an Agrobacterium transformation system for onion (Allium cepa L.)

Onion (Allium cepa) bulbs of the New Zealand-bred cultivars 'Pukekohe Longkeeper' and 'Early Longkeeper' produced tumourous growths after inoculation with 25 virulent strains of Agrobactenum tumefaciens, A. rubi and A. rhizogenes. The majority of these tumours produced nopaline, indicating that tumour cells were transformed. Some excised tumours produced roots in sterile culture. Eight onion genotypes were screened in tissue culture for callus formation, regeneration of plantlets from callus and clonal multiplication by shoot proliferation. All genotypes could be clonally multiplied and four were readily regenerable from callus. A technique for plantlet multiplication, which uses longitudinally-bisected stems of in vitro-germinated onion seedlings as explants, was developed. Onion (‘Pukekohe Longkeeper', 'Southport White Globe', 'Japanese Saporo Yellow' and 'Hikeeper Fl ') protoplasts were isolated and cultured on a range of media. These protoplasts formed new cell walls and sometimes divided, but only first divisions were regularly seen. Kanamycin, geneticin (G418), hygromycin and chlorsulfuron were evaluated for their use as selective agents in onion transformation experiments. Tissues surveyed for sensitivity to these selective agents included seeds and seedlings on germination and callusing media, established callus on callusing and regeneration media, and shoot cultures on shoot proliferation medium. Hygromycin was shown to be the antibiotic most toxic to tissues of all the surveyed onion cultivars, with effects being obvious in all tissues after 4-5 weeks of culture on concentrations as low as 20 mgl-1. Kanamycin was shown to be the least toxic of the selection agents surveyed. The kanamycin analogue G418 was considerably more toxic to most onion cultures than kanamycin. However, responses of cultures to G418 were slower than those to hygromycin. The herbicide chlorsulfuron was also shown to be toxic to onion seedlings and shoot cultures. The ability of Agrobacterium tumefaciens to transfer foreign genes to A. cepa was demonstrated. A single, putatively transformed plantlet (RC1), was regenerated from an onion seedling stem via callus, following co-cultivation of stem explants with Agrobacterium strain LBA4404 harbouring the binary vector pKIWI110. In addition, 41 auxiliary or adventitious shoots which grew directly from basal plates injected in vitro with four strains of A. tumefaciens (each harbouring the binary vectors pKIWI110 or pGA643) exhibited resistance to G418 in culture. The binary vectors used carry the neomycin phosphotransferase II gene (nptII) controlled by the nopaline synthase (nos) promoter. Both RC1 and some of the shoots growing from basal plate explants produced roots when grown on culture media supplemented with G418. Southern analyses showed that fragments of DNA from RC1 and from five of the 41 G418-resistant shoots hybridized to a 1.25 kbp nptII probe. (β- glucuronidase (GUS) activity was detected in over half of the plantlets derived from basal plate tissue injected with A. tumefaciens strains LBA4404 or C58, both of which harboured pKIWI110. Molecular and phenotypic evidence suggested that the putatively transformed plants produced from injected basal plate tissues were chimeric

Development of a core set of outcome measures for OAB treatment

© 2017, The Author(s). Introduction and hypothesis: Standardized measures enable the comparison of outcomes across providers and treatments giving valuable information for improving care quality and efficacy. The aim of this project was to define a minimum standard set of outcome measures and case-mix factors for evaluating the care of patients with overactive bladder (OAB). Methods: The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group (WG) of leading clinicians and patients to engage in a structured method for developing a core outcome set. Consensus was determined by a modified Delphi process, and discussions were supported by both literature review and patient input. Results: The standard set measures outcomes of care for adults seeking treatment for OAB, excluding residents of long-term care facilities. The WG focused on treatment outcomes identified as most important key outcome domains to patients: symptom burden and bother, physical functioning, emotional health, impact of symptoms and treatment on quality of life, and success of treatment. Demographic information and case-mix factors that may affect these outcomes were also included. Conclusions: The standardized outcome set for evaluating clinical care is appropriate for use by all health providers caring for patients with OAB, regardless of specialty or geographic location, and provides key data for quality improvement activities and research

Functional illness in primary care: dysfunction versus disease

<p>Abstract</p> <p>Background</p> <p>The Biopsychosocial Model aims to integrate the biological, psychological and social components of illness, but integration is difficult in practice, particularly when patients consult with medically unexplained physical symptoms or functional illness.</p> <p>Discussion</p> <p>This Biopsychosocial Model was developed from General Systems Theory, which describes nature as a dynamic order of interacting parts and processes, from molecular to societal. Despite such conceptual progress, the biological, psychological, social and spiritual components of illness are seldom managed as an integrated whole in conventional medical practice. This is because the biomedical model can be easier to use, clinicians often have difficulty relinquishing a disease-centred approach to diagnosis, and either dismiss illness when pathology has been excluded, or explain all undifferentiated illness in terms of psychosocial factors. By contrast, traditional and complementary treatment systems describe reversible functional disturbances, and appear better at integrating the different components of illness. Conventional medicine retains the advantage of scientific method and an expanding evidence base, but needs to more effectively integrate psychosocial factors into assessment and management, notably of 'functional' illness. As an aid to integration, pathology characterised by structural change in tissues and organs is contrasted with dysfunction arising from disordered physiology or psychology that may occur independent of pathological change.</p> <p>Summary</p> <p>We propose a classification of illness that includes orthogonal dimensions of pathology and dysfunction to support a broadly based clinical approach to patients; adoption of which may lead to fewer inappropriate investigations and secondary care referrals and greater use of cognitive behavioural techniques, particularly when managing functional illness.</p