Evaluation of the implementation of the alert issued by the UK National Patient Safety Agency on the storage and handling of potassium chloride concentrate solution

Objectives: To assess the effectiveness of the response of NHS hospital trusts to an alert issued by the National Patient Safety Agency designed to limit the availability of concentrated potassium chloride in hospitals in England and Wales, and to determine the nature of any unintended consequences. Design: Multi-method study involving interviews and a physical inspection of clinical areas. Setting: 207 clinical areas in 20 randomly selected acute NHS trusts in England and Wales between 31 October 2002 and 31 January 2003. Participants: Senior managers and ward based medical and nursing staff. Main outcome measures: Degree of staff awareness of and compliance with the requirements of the national alert, withdrawal of concentrated potassium chloride solutions from non-critical areas, provision of pre-diluted alternatives, storage and recording in accordance with controlled drug legislation. Results: All trusts required that potassium chloride concentrate be stored in a separate locked cupboard from common injectable diluents (100% compliance). Unauthorised stocks of potassium chloride were found in five clinical areas not authorised by the trust (98% compliance). All trusts required documentation control of potassium chloride concentrate in clinical areas, but errors were recorded in 20 of the 207 clinical areas visited (90% compliance). Of those interviewed, 78% of nurses and 30% of junior doctors were aware of the alert. Conclusions: The NPSA alert was effective and resulted in rapid development and implementation of local policies to reduce the availability of concentrated potassium chloride solutions. The success is likely to be partly due to the nature of the proposed changes and it cannot be assumed that future alerts will be equally effective. Continued vigilance will be necessary to help sustain the changes

Does responsibility affect the public valuation of health care interventions? A relative valuation approach to health care safety

This article is available open access through the publisher’s website at the link below. Copyright © 2012, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).Objective - Health services often spend more on safety interventions than seems cost-effective. This study investigates whether the public value safety-related health care improvements more highly than the same improvements in contexts where the health care system is not responsible. Method - An online survey was conducted to elicit the relative importance placed on preventing harms caused by 1) health care (hospital-acquired infections, drug administration errors, injuries to health care staff), 2) individuals (personal lifestyle choices, sports-related injuries), and 3) nature (genetic disorders). Direct valuations were obtained from members of the public by using a person trade-off or “matching” method. Participants were asked to choose between two preventative interventions of equal cost and equal health benefit per person for the same number of people, but differing in causation. If participants indicated a preference, their strength of preference was measured by using person trade-off. Results - Responses were obtained from 1030 people, reflecting the sociodemographic mix of the UK population. Participants valued interventions preventing hospital-acquired infections (1.31) more highly than genetic disorders (1.0), although drug errors were valued similarly to genetic disorders (1.07), and interventions to prevent injury to health care staff were given less weight than genetic disorders (0.71). Less weight was also given to interventions related to lifestyle (0.65) and sports injuries (0.41). Conclusion - Our results suggest that people do not attach a simple fixed premium to “safety-related” interventions but that preferences depend more subtly on context. The use of the results of such public preference surveys to directly inform policy would therefore be premature.Brunel University

The discovery of trapped energetic electrons in the outer cusp

We report on the POLAR/CEPPAD discovery of a trapped, 60°\u3cθ\u3c120° pitch angle electron population in the outer cusp (7−9+ Re), whose energetic electron component extends from below 30 keV to ∼2 MeV. Because the time variability in the outer cusp precludes mapping with POLAR, we have carried out test particle simulations using the Tsyganenko 1996 model (T96) to demonstrate the trapping of these energy electrons in the outer cusp region and the resonant frequencies of its trapped motion. We discuss the boundaries and regions of the cusp trap and show that it is analogous to the dipole trap. We show that the phase space densities observed there are equal or greater than the phase space densities observed in the radiation belts at constant magnetic moment, thus allowing the possibility of diffusive filling of the radiation belts from the cus

Predicting patient-reported stroke outcomes: a validation of the six simple variable prognostic model.

BACKGROUND: Case-mix represents the range of disease severity and baseline characteristics that may be the cause of variation in outcomes between individuals and populations. Adjustment for case-mix is therefore important to allow meaningful comparison of healthcare outcomes. The best available case-mix adjustment model for stroke (the Six Simple Variable [SSV] model) was developed to adjust the hard endpoints of independent survival, survival and alive and living at home. There is increasing interest in the measurement of patient-reported outcomes through self-completed questionnaires, though there are currently no robust adjustment models for any such outcome. We aimed to determine whether the SSV prognostic model derived to predict 6-month post-stroke independent survival has wider utility in case-mix adjustment of a patient-reported functional outcome measure, the Subjective Index of Physical and Social Outcome (SIPSO), collected by post 6 months after stroke onset. METHODS: We examined data from 176 patients admitted following an acute stroke and recruited into a prospective cohort study in three participating acute hospitals in Yorkshire, UK. Patients in receipt of palliative care or with transient ischaemic attack were excluded. Using the beta coefficients from the published SSV model to predict independent survival, individual probabilities of 'good' outcome as measured with the dichotomised SIPSO collected by post 6 months after stroke onset were calculated. The ability of the SSV case-mix adjustment model to discriminate patients with 'good' over 'poor' outcome was assessed through calculation of C statistics. Correct predictions were visualised with calibration plots. RESULTS: The C statistics for the SSV model to predict the physical and social subscales of the SIPSO outcome measure were 0.73 (95% CI 0.65-0.79) and 0.66 (0.58-0.82), respectively. Inclusion of patients who died prior to follow-up and ascribing them a score of 0 improved the discrimination (0.76 [0.70-0.82] and 0.70 [0.64-0.76], respectively). Calibration plots demonstrated a tendency to over-optimistic predictions, although confidence limits were wide. CONCLUSIONS: The SSV model predicts adequately the physical component of the SIPSO patient-reported outcome measure and may be useful to adjust this outcome for case-mix following stroke in survivors to follow-up. This could be of benefit in observational studies, stratified randomisation for trials, and in comparison of between-institution clinical trials. Further exploration of the generalizability of the model to adjust other patient-reported stroke outcomes may be warranted

The analysis of TRICARE Navy obstetric delivery costs within continental United States military treatment facilities

MBA Professional ReportNavy medicine spends approximately $75 million on purchased obstetric (OB) care for Navy personnel and their dependents, a sum that continues to increase each year. The purpose of this research is to compare the cost of Navy OB medical care under TRICARE Prime (civilian sector) with similar care provided in four representative Navy Medical Treatment Facilities (MTF). Specifically, the study will examine (1) the quantity of selected deliveries in TRICARE and four specific MTF catchment areas; (2) the average delivery cost for the different types of Purchased Care (PC) deliveries, and (3) best practice techniques to increase the amount of Direct Care (DC) deliveries care in Navy Medicine. The goal of this study is to compare the benefits and drawbacks of each system to gain insights for providing better and more cost-effective OB care in the Navy.http://archive.org/details/thenalysisoftric1094510397Approved for public release; distribution is unlimited

Hypersurface Bohm-Dirac models

We define a class of Lorentz invariant Bohmian quantum models for N entangled but noninteracting Dirac particles. Lorentz invariance is achieved for these models through the incorporation of an additional dynamical space-time structure provided by a foliation of space-time. These models can be regarded as the extension of Bohm's model for N Dirac particles, corresponding to the foliation into the equal-time hyperplanes for a distinguished Lorentz frame, to more general foliations. As with Bohm's model, there exists for these models an equivariant measure on the leaves of the foliation. This makes possible a simple statistical analysis of position correlations analogous to the equilibrium analysis for (the nonrelativistic) Bohmian mechanics.Comment: 17 pages, 3 figures, RevTex. Completely revised versio

Monensin causes dose dependent inhibition of Mycobacterium avium subspecies paratuberculosis in radiometric culture

<p>Abstract</p> <p>Background</p> <p><it>Mycobacterium avium </it>subspecies <it>paratuberculosis </it>(MAP) causes a chronic wasting diarrheal disease in ruminants called Johne's disease, that is evocative of human inflammatory bowel disease (IBD). Agents used to treat IBD, called "anti-inflammatories", immuno-modulators" and "immuno-suppressants" inhibit MAP growth in culture. We concluded that, unknowingly, the medical profession has been treating MAP since sulfasalazine's introduction in 1942. Monensin, called a "Growth Enhancer" in cattle, ameliorates Johne's disease without a documented mechanism of action. We hypothesized that Monensin would inhibit MAP in culture.</p> <p>Methods</p> <p>Using the radiometric ¹⁴CO₂Bactec^®system, that expresses mycobacterial growth in arbitrary growth index (GI) units, we studied the effect of Monensin on the growth kinetic of MAP isolated from humans with IBD ("Dominic", "Ben" & UCF-4) and cattle with Johne's disease (303 & ATCC 19698.) Results are expressed as percent inhibition of cumulative GI (%–ΔcGI).</p> <p>Results</p> <p>The positive control Clofazimine inhibits every strain tested. The negative controls Cycloheximide & Phthalimide, have no inhibition on any MAP strain. Monensin has dose dependent inhibition on every MAP strain tested. The most susceptible human isolate was UCF-4 (73% – ΔcGI at 1 μg/ml) and bovine isolate was 303 (73% – ΔcGI at 4 μg/ml.) Monensin additionally inhibits <it>M. avium </it>ATCC 25291 (87% – ΔcGI at 64 μg/ml) & BCG (92% – ΔcGI at 16 μg/ml).</p> <p>Discussion</p> <p>We show that in radiometric culture the "Growth Enhancer" Monensin causes dose dependent inhibition of mycobacteria including MAP. We posit that the "Growth Enhancer" effect of Monensin may, at least in part, be due to inhibition of MAP in clinical or sub-clinical Johne's disease.</p