Quality of medication use in primary care - mapping the problem, working to a solution: a systematic review of the literature

Background: The UK, USA and the World Health Organization have identified improved patient safety in healthcare as a priority. Medication error has been identified as one of the most frequent forms of medical error and is associated with significant medical harm. Errors are the result of the systems that produce them. In industrial settings, a range of systematic techniques have been designed to reduce error and waste. The first stage of these processes is to map out the whole system and its reliability at each stage. However, to date, studies of medication error and solutions have concentrated on individual parts of the whole system. In this paper we wished to conduct a systematic review of the literature, in order to map out the medication system with its associated errors and failures in quality, to assess the strength of the evidence and to use approaches from quality management to identify ways in which the system could be made safer. Methods: We mapped out the medicines management system in primary care in the UK. We conducted a systematic literature review in order to refine our map of the system and to establish the quality of the research and reliability of the system. Results: The map demonstrated that the proportion of errors in the management system for medicines in primary care is very high. Several stages of the process had error rates of 50% or more: repeat prescribing reviews, interface prescribing and communication and patient adherence. When including the efficacy of the medicine in the system, the available evidence suggested that only between 4% and 21% of patients achieved the optimum benefit from their medication. Whilst there were some limitations in the evidence base, including the error rate measurement and the sampling strategies employed, there was sufficient information to indicate the ways in which the system could be improved, using management approaches. The first step to improving the overall quality would be routine monitoring of adherence, clinical effectiveness and hospital admissions. Conclusion: By adopting the whole system approach from a management perspective we have found where failures in quality occur in medication use in primary care in the UK, and where weaknesses occur in the associated evidence base. Quality management approaches have allowed us to develop a coherent change and research agenda in order to tackle these, so far, fairly intractable problems

Repair of Parastomal Hernias with Biologic Grafts: A Systematic Review

Contains fulltext : 98303.pdf (publisher's version ) (Open Access)BACKGROUND: Biologic grafts are increasingly used instead of synthetic mesh for parastomal hernia repair due to concerns of synthetic mesh-related complications. This systematic review was designed to evaluate the use of these collagen-based scaffolds for the repair of parastomal hernias. METHODS: Studies were retrieved after searching the electronic databases MEDLINE, EMBASE and Cochrane CENTRAL. The search terms 'paracolostomy', 'paraileostomy', 'parastomal', 'colostomy', 'ileostomy', 'hernia', 'defect', 'closure', 'repair' and 'reconstruction' were used. Selection of studies and assessment of methodological quality were performed with a modified MINORS index. All reports on repair of parastomal hernias using a collagen-based biologic scaffold to reinforce or bridge the defect were included. Outcomes were recurrence rate, mortality and morbidity. RESULTS: Four retrospective studies with a combined enrolment of 57 patients were included. Recurrence occurred in 15.7% (95% confidence interval [CI] 7.8-25.9) of patients and wound-related complications in 26.2% (95% CI 14.7-39.5). No mortality or graft infections were reported. CONCLUSIONS: The use of reinforcing or bridging biologic grafts during parastomal hernia repair results in acceptable rates of recurrence and complications. However, given the similar rates of recurrence and complications achieved using synthetic mesh in this scenario, the evidence does not support use of biologic grafts

Shear wave velocity prediction using seismic attributes and well log data

Formation’s properties can be estimated indirectly using joint analysis of compressional and shear wave velocities. Shear wave data isnot usually acquired during well logging, which is most likely for costsaving purposes. Even if shear data is available, the logging programs provide only sparsely sampled one-dimensional measurements: this informationis inadequate to estimate reservoir rock properties. Thus, if the shear wave data can be obtained using seismic methods, the results can be used across the field to estimate reservoir properties. The aim of this paper is to use seismic attributes for prediction of shear wave velocity in a field located in southern part of Iran. Independent component analysis(ICA) was used to select the most relevant attributes to shear velocity data. Considering the nonlinear relationship between seismic attributes and shear wave velocity, multi-layer feed forward neural network was used for prediction of shear wave velocity and promising results were presented

Evaluation of interpupillary distance in the Turkish population

Yildiray Yildirim,1 Ibrahim Sahbaz,2 Taner Kar,1 Gamze Kagan,3 Mehmet Tolga Taner,4 Ilker Armagan,2 Begum Cakici21Department of Ophthalmology, Gulhane Military Medical Academy Haydarpasa Training Hospital, Istanbul, Turkey; 2Department of Opticianry, 3Department of Occupational Health and Safety, 4Department of Healthcare Management, Uskudar University, Istanbul, TurkeyPurpose: The aim of this study was to report normative values and ranges of interpupillary distance (IPD) in different age groups of a Turkish population.Methods: A total of 756 healthy subjects were included in this prospective study. After a complete ophthalmic evaluation, subjects were divided into four age groups to assess differences between age groups in relation to IPD. The age groups were 20–30, 31–50, 51–70, and 71–89 years. Far IPD measurements were performed using an autorefractometer (Topcon RM-8800).Results: The mean age was 48.42±20.55 years, ranging from 19 to 89 years. The mean IPD was calculated as 62.5±4.1 mm (range 49–76). The mean IPD value was observed to be significantly higher among males compared to females (P<0.001). The difference among groups in terms of mean IPD was statistically significant (P<0.001). IPD increased by 4.19 mm in males and 3.11 mm in females from the young adults (20–30 years) to older adults (51–70 years), and then a decrease (2.6 and 0.19 mm for males and females, respectively) occurred between 70 and 89 years of age.Conclusion: The current study offers the population-specific normative data on far IPD in different age groups. Our study showed that sex and age had a significant effect on IPD. Knowledge of normal values in this population subgroup may be useful in studying orbito-cranial growth patterns, syndrome diagnosis, surgical management of cranio-facial deformities and trauma, and manufactures of optical frames and lenses.Keywords: interpupillary distance, age, sex, Turkish population, refractio

Clinical-Evaluation of Metastases of Malignant-Melanoma Imaging With Tc-99(M)-Glutathione and Tc-99(M)-Anti-Melanoma Antibody - a Comparative-Study

WOS: A1995TE34900009PubMed ID: 8587759The aim of this investigation was to test for the scintigraphic detection of metastases of malignant melanoma with a new radiopharmaceutical, Tc-99(m)-glutathione (Tc-99(m)-GSH), in comparison with Tc-99(m)-anti-melanoma antibody (Tc-99(m)-AMAb). Glutathione was labelled with Tc-99(m) by a Sn2+ reduction method with an efficiency of > 99% as determined by instant thin layer chromatography (ITLC). Anti-melanoma antibody was obtained as a kit from SORIN (Italy) and labelled with (TcO4-)-Tc-99-O-m. Forty-three patients with a total of 55 biopsy-proven metastatic melanoma foci, 1 ocular melanoma and 20 benign pathologic foci, also confirmed by ultrasound, computed tomography and magnetic resonance imaging, were included in the study after giving their informed consent. Following the intravenous (i.v.) injection of 500 MBq Tc-99(m)-AMAb, scintigraphic images of the involved areas were obtained 6 h post-injection. Three days later, the same patients were given 500 MBq Tc-99(m)-GSH i.v, and images were obtained 6 and 24 h post-injection. The images were classified as positive (focal abnormal accumulation) or negative. Quantitative evaluation was also applied. Regions of interest were drawn over the involved areas and nearby soft tissues and the target-to-nontarget (T/NT) ratios obtained with Tc-99(m)-AMAb (T/NT: 1.92 +/- 0.2) and Tc-99(m)-GSH (T/NT: 1.84 +/- 0.2) were compared (0.1 < P less than or equal to 0.3). The sensitivity (and specificity) of Tc-99(m)-AMAb and Tc-99(m)-GSH in the detection of malignant melanoma metastases were 91% (95%) and 84% (90%), respectively. Compared with Tc-99(m)-AMAb, the advantages of Tc-99(m)-GSH are lower levels of blood radioactivity, lower costs and easy in-house preparation. In conclusion, our results show that Tc-99(m)-GSH is a potentially useful radiopharmaceutical for the detection of metastases of malignant melanoma