Mix of methods is needed to identify adverse events in general practice: A prospective observational study

Contains fulltext : 69425.pdf ( ) (Open Access)BACKGROUND: The validity and usefulness of incident reporting and other methods for identifying adverse events remains unclear. This study aimed to compare five methods in general practice. METHODS: In a prospective observational study, with five general practitioners, five methods were applied and compared. The five methods were physician reported adverse events, pharmacist reported adverse events, patients' experiences of adverse events, assessment of a random sample of medical records, and assessment of all deceased patients. RESULTS: A total of 68 events were identified using these methods. The patient survey accounted for the highest number of events and the pharmacist reports for the lowest number. No overlap between the methods was detected. The patient survey accounted for the highest number of events and the pharmacist reports for the lowest number. CONCLUSION: A mix of methods is needed to identify adverse events in general practice

Prevalence and consequences of patient safety incidents in general practice in the Netherlands: a retrospective medical record review study

Contains fulltext : 97252.pdf (publisher's version ) (Open Access)BACKGROUND: Patient safety can be at stake in both hospital and general practice settings. While severe patient safety incidents have been described, quantitative studies in large samples of patients in general practice are rare. This study aimed to assess patient safety in general practice, and to show areas where potential improvements could be implemented. METHODS: We conducted a retrospective review of patient records in Dutch general practice. A random sample of 1,000 patients from 20 general practices was obtained. The number of patient safety incidents that occurred in a one-year period, their perceived underlying causes, and impact on patients' health were recorded. RESULTS: We identified 211 patient safety incidents across a period of one year (95% CI: 185 until 241). A variety of types of incidents, perceived causes and consequences were found. A total of 58 patient safety incidents affected patients; seven were associated with hospital admission; none resulted in permanent disability or death. CONCLUSIONS: Although this large audit of medical records in general practices identified many patient safety incidents, only a few had a major impact on patients' health. Improving patient safety in this low-risk environment poses specific challenges, given the high numbers of patients and contacts in general practice

The effects of oral pretreatment with zofenopril, an angiotensin-converting enzyme inhibitor, on early reperfusion and subsequent electrophysiologic stability in the pig

The effects of oral zofenopril pretreatment were investigated in a chronic closed-chest pig model of ischemia and reperfusion. Pigs (25–35 kg) were pretreated orally with zofenopril (15 mg/day) on the 2 days prior to ischemia, which was evoked by the inflation of a catheter balloon in the left anterior descending coronary artery over 45 minutes. The catheter was then removed and the myocardium was reperfused. After 2 weeks, infarct properties were assessed by signal averaging of the body surface electrocardiogram and the inducibility of malignant ventricular tachyarrhythmias was tested with a programmed electrical stimulation protocol. A significant increase in the pressure-rate product (43±11%, mean±SEM), indicating the oxygen demand of the heart, was prevented by zofenopril (19±8%, p<0.05). Zofenopril reduced the peak efflux of adrenaline (1302±213 vs. 3201±760 pg/ml; p<0.05), noradrenaline (402±54 vs. 902±282 pg/ml; p<0.05), and of the adenosine catabolites inosine and hypoxanthine (56±4 vs. 78±9, pg/ml; p<0.05) in the coronary venous effluent. The efflux of the cytoplasmatic enzyme creatine phosphokinase was not significantly reduced after zofenopril (p=0.08). No difference in plasma renin levels between the groups were found. After 2 weeks, late potentials were found only in the surviving animals from the untreated group, i.e., the voltage vector magnitude was more reduced, and a prolongation of the QRS duration and of the terminal low-amplitude part of the high-frequency QRS were found. Moreover, zofenopril had caused a significant reduction of the inducibility of sustained ventricular tachyarrhythmias. These findings support the view that catecholamine and purine efflux, and an adverse increase in the oxygen demand during early reperfusion are reduced by zofenopril pretreatment, leading to a higher electrophysiologic stability of the subsequently developed infarct after 2 weeks

Factors associated with indicator outcomes: outcome within target level.

<p># reference categories: female, less than median diabetes related contacts per year, without funds for deprived area, no multi-morbidities.</p><p>Factors associated with indicator outcomes: outcome within target level.</p

Factors associated with indicator processes: measure recorded within study period.

<p># reference categories: female, less than median diabetes related contacts per year, without funds for deprived area, no multi-morbidities.</p><p>Factors associated with indicator processes: measure recorded within study period.</p

Patient characteristics and overall scores on indicators.

<p>source data on the Dutch population:</p><p>A. RIVM. National Compass Population Health (Nationaal Kompas Volksgezondheid). 2011 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121845#pone.0121845.ref006" target="_blank">6</a>–<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121845#pone.0121845.ref019" target="_blank">19</a>–<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121845#pone.0121845.ref014" target="_blank">14</a>]; Available from: <a href="http://www.nationaalkompas.nl/gezondheid-en-ziekte/ziekten-en-aandoeningen/endocriene-voedings-en-stofwisselingsziekten-en-immuniteitsstoornissen/diabetes-mellitus/omvang/" target="_blank">http://www.nationaalkompas.nl/gezondheid-en-ziekte/ziekten-en-aandoeningen/endocriene-voedings-en-stofwisselingsziekten-en-immuniteitsstoornissen/diabetes-mellitus/omvang/</a>.</p><p>B. Ubink-Veltmaat LJ, Bilo HJ, Groenier KH, Houweling ST, Rischen RO, Meyboom-de Jong B. Prevalence, incidence and mortality of type 2 diabetes mellitus revisited: a prospective population-based study in The Netherlands (ZODIAC-1). European journal of epidemiology. 2003;18(8):793–800. Epub 2003/09/17.</p><p>C. Transparancy in multidisciplinary care. In Dutch: Transparantie ketenzorg Diabetes Mellitus. Rapportage zorggroepen 2010. Utrecht, The Netherlands: Dutch National Organization for multidisciplinary care, 2012.</p><p>D. van Doorn-Klomberg A, Braspenning J, Bouma M. Report Dutch Practice Accreditation. Medical care in 2012. In Dutch: Rapportage NHG-Praktijkaccreditering: gegevens over het medisch handelen in 2012. Nijmegen, The Netherlands: Radboud University Medical Center, IQ healthcare, 2013.</p><p>^ Several characteristics of our study population could not be contrasted with the Dutch population or other comparable study populations because no suitable data could be found.</p><p>Patient characteristics and overall scores on indicators.</p

Risks of SARS-CoV-2 transmission between free-ranging animals and captive mink in the Netherlands

In the Netherlands, 69 of the 126 (55%) mink farms in total became infected with SARS-CoV-2 in 2020. Despite strict biosecurity measures and extensive epidemiological investigations, the main transmission route remained unclear. A better understanding of SARS-CoV-2 transmission between mink farms is of relevance for countries where mink farming is still common practice and can be used as a case study to improve future emerging disease preparedness. We assessed whether SARS-CoV-2 spilled over from mink to free-ranging animals, and whether free-ranging animals may have played a role in farm-to-farm transmission in the Netherlands. The study encompassed farm visits, farm questionnaires, expert workshops and SARS-CoV-2 RNA and antibody testing of samples from target animal species (bats, birds and free-ranging carnivores). In this study, we show that the open housing system of mink allowed access to birds, bats and most free-ranging carnivores, and that direct and indirect contact with mink was likely after entry, especially for free-ranging carnivores and birds. This allowed SARS-CoV-2 exposure to animals entering the mink farm, and subsequent infection or mechanical carriage by the target animal species. Moreover, mink can escape farms in some cases, and two SARS-CoV-2-positive mink were found outside farm premises. No other SARS-CoV-2-RNA-positive free-ranging animals were detected, suggesting there was no abundant circulation in the species tested during the study period. To investigate previous SARS-CoV-2 infections, SARS-CoV-2 antibody detection using lung extracts of carcasses was set up and validated. One tested beech marten did have SARS-CoV-2 antibodies, but the closest SARS-CoV-2-infected mink farm was outside of its home range, making infection at a mink farm unlikely. Knowing that virus exchange between different species and the formation of animal reservoirs affects SARS-CoV-2 evolution, continued vigilance and monitoring of mink farms and surrounding wildlife remains vital