Can the Heinrich ratio be used to predict harm from medication errors?

The purpose of this study was to establish whether, for medication errors, there exists a fixed Heinrich ratio between the number of incidents which did not result in harm, the number that caused minor harm, and the number that caused serious harm. If this were the case then it would be very useful in estimating any changes in harm following an intervention. Serious harm resulting from medication errors is relatively rare, so it can take a great deal of time and resource to detect a significant change. If the Heinrich ratio exists for medication errors, then it would be possible, and far easier, to measure the much more frequent number of incidents that did not result in harm and the extent to which they changed following an intervention; any reduction in harm could be extrapolated from this

Phenotypic and genetic effects of disposition on beef tenderness and quality attributes

Title from PDF of title page (University of Missouri--Columbia, viewed on June 8, 2012).The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file.Thesis advisors: Drs. Jeremy F. Taylor and Robert L. WeaberIncludes bibliographical references.M.S. University of Missouri--Columbia 2011."December 2011"Cattle temperament (exit velocity; EV) and steak tenderness (Warner-Bratzler shear force) have been shown to be associated in Bos indicus cattle (Behrends et al., 2009). Both traits potentially provide opportunities for improvement among beef herds and are profitable to producers. The American Simmental Association (ASA) provided records which included pedigree information, multiple WBSF core values, reported as average peak shear force (APSF), and a maximum of two EV measurements taken 42 days apart. Bayesian Information Criteria (Gilmour et al., 2006) values were utilized to evaluate the fit of alternative statistical models to the data. A near zero genetic correlation was estimated between APSF and EV. Moderate heritability estimates were found for both APSF and EV. DNA was extracted from tissue samples and genotyped using the Illumina BovineSNP50 BeadArray (San Diego, CA, USA; Matikumalli et al., 2009). Genome-wide association studies were conducted to identify genomic regions harboring loci associated with either of the traits. Only 70 (0.167%) of the 42,351 tested SNP markers were associated with variation in APSF (n = 957), and 2 (0.006%) of the SNP markers were associated with variation in EV (n = 599). The difference between pairs of EV measurements (n = 587) was also analyzed as a measure of habituation to human handing, and 2 (0.006%) of the SNP markers were found to be associated

Comparison of rumen microbe taxa among wild and domestic ruminants

Microbes that inhabit the rumen provide a diverse set of enzymes that degrade ingested plant material. Without microbes, ruminants could not survive. Our research has focused on identifying microbial taxa associated with environment and phenotypic traits of host animals in order to improve livestock production and efficiency. Rumen contents were collected from a total of 48 animals from five host species, both wild and domestic, consuming either a concentrate- or forage-based diet. The objectives of this study were to analyze the distribution of microbial taxa among host species and identify microbial taxa associated with host diet, species, and domestication status. DNA was extracted from rumen content and sequenced for identification of microbial taxa present within each host animal. The distribution of microbial taxa was similar among host species. Each host species contained a few highly abundant microbial taxa and many microbial taxa in lower abundance. As host species were added to the analysis, the total number of microbial taxa identified increased and the number of microbial taxa common among all host species decreased, supporting the existence of a core microbial community. In this study we identified 66, 73, and 23 microbial taxa that differed among host diet, species, and domestication status, respectively. While on farm implications are far from being offered, studies of the microbial community add to the breadth of knowledge and identify microbes associated with performance and efficiency of livestock

Targeted protein depletion in Saccharomyces cerevisiae by activation of a bidirectional degron

<p>Abstract</p> <p>Background</p> <p>Tools for <it>in vivo </it>manipulation of protein abundance or activity are highly beneficial for life science research. Protein stability can be efficiently controlled by conditional degrons, which induce target protein degradation at restrictive conditions.</p> <p>Results</p> <p>We used the yeast <it>Saccharomyces cerevisiae </it>for development of a conditional, bidirectional degron to control protein stability, which can be fused to the target protein N-terminally, C-terminally or placed internally. Activation of the degron is achieved by cleavage with the tobacco etch virus (TEV) protease, resulting in quick proteolysis of the target protein. We found similar degradation rates of soluble substrates using destabilization by the N- or C-degron. C-terminal tagging of essential yeast proteins with the bidirectional degron resulted in deletion-like phenotypes at non-permissive conditions. Developmental process-specific mutants were created by N- or C-terminal tagging of essential proteins with the bidirectional degron in combination with sporulation-specific production of the TEV protease.</p> <p>Conclusions</p> <p>We developed a system to influence protein abundance and activity genetically, which can be used to create conditional mutants, to regulate the fate of single protein domains or to design artificial regulatory circuits. Thus, this method enhances the toolbox to manipulate proteins in systems biology approaches considerably.</p

Oncology nurses' beliefs and attitudes towards the double-check of chemotherapy medications:a cross-sectional survey study

BACKGROUND: Double-checking medications is a widely used strategy to enhance safe medication administration in oncology, but there is little evidence to support its effectiveness. The proliferated use of double-checking may be explained by positive attitudes towards checking among nurses. This study investigated oncology nurses' beliefs towards double-checking medication, its relation to beliefs about safety and the influence of nurses' level of experience and proximity to clinical care. METHODS: This was a survey of all oncology nurses in three Swiss hospitals. The questionnaire contained 41 items on 6 domains. Responses were recorded using a 7-point Likert scale. Multiple regression analysis was used to identify factors linked to strong beliefs in the effectiveness of double-checking. RESULTS: Overall, 274 (70%) out of 389 nurses responded (91% female, mean age 37 (standard deviation = 10)). Nurses reported very strong beliefs in the effectiveness and utility of double-checking. They were also confident about their own performance in double-checking. Nurses widely believed that double checking produced safety (e.g., 86% believed errors of individuals could be intercepted with double-checks). In contrast, some limitations of double-checking were also recognized, e.g., 33% of nurses reported that double checking caused frequent interruptions and 28% reported that double-checking was done superficially in their unit. Regression analysis revealed that beliefs in effectiveness of double-checking were mainly associated with beliefs in safety production (p < 0.001). Nurses with experience in barcode scanning held less strong beliefs in effectiveness of double-checking (p = 0.006). In contrast to our expectations, there were no differences in beliefs between any professional sub-groups. CONCLUSION: The widespread and strong believe in the effectiveness of double-checking is linked to beliefs about safety production and co-exists with acknowledgement of the major disadvantages of double-checking by humans. These results are important factors to consider when any existing procedures are adapted or new checking procedures are implemented

The Pharmacy Game-GIMMICS® a Simulation Game for Competency-Based Education

The profile of the profession of pharmacists has profoundly changed over the last decades. Pharmacy education has moved towards competency-based education. The pharmacy game, called GIMMICS®, developed at the University of Groningen, is unique in combining simulation with serious gaming to teach a wide range of competencies. In this article, we describe the learning goals, the assessment methods, the teaching tools, and the students’ view of the pharmacy game. The learning goals are to train the competencies of collaboration, leadership, communication, and pharmaceutical expertise. The core of the game is the simulation of community pharmacy practice activities, such as patient counseling, processing of prescriptions, and collaboration with other health professionals. Students are assessed individually and as a pharmacy team. The pharmacy team, with the largest number of patients wins the game. Student evaluations show that they value the course. Currently, seven universities from around the globe have adopted the pharmacy game in their curriculum, adjusting the course to their country’s pharmacy practice and educational system

Barcode medication administration technology use in hospital practice:A mixed-methods observational study of policy deviations

Introduction Barcode medication administration (BCMA) can, if poorly implemented, cause disrupted workflow, increased workload and cause medication errors. Further exploration is needed of the causes of BCMA policy deviations. Objective To gain an insight into nurses’ use of barcode technology during medication dispensing and administration; to record the number and type of BCMA policy deviations, and to investigate their causes. Methods We conducted a prospective, mixed-methods study. Medication administration rounds on two hospital wards were observed using a digital tool and field notes. The SEIPS (Systems Engineering Initiative for Patient Safety) model was used to analyse the data. Results We observed 44 nurses administering 884 medications to 213 patients. We identified BCMA policy deviations for more than half of the observations; these related to the level of tasks, organisation, technology, environment and nurses. Task-related policy deviations occurred with 140 patients (66%) during dispensing and 152 patients (71%) during administration. Organisational deviations included failure to scan 29% of medications and 20% of patient’s wristbands. Policy deviations also arose due to technological factors (eg, low laptop battery, system freezing), as well as environmental factors (eg, medication room location, patient drawer size). Most deviations were caused by policies that interfere with proper and safe BCMA use and suboptimal technology design. Conclusion Our findings indicate that adaptations of the work system are needed, particularly in relation to policies and technology, to optimise the use of BCMA by nurses during medication dispensing and administration. These adaptations should lead to enhanced patient safety, as the absolute goal with BCMA implementation

Severe and fatal medication errors in hospitals:Findings from the Norwegian Incident Reporting System

BACKGROUND: Even with global efforts to prevent medication errors, they still occur and cause patient harm. Little systematic research has been done in Norway to address this issue. OBJECTIVES: To describe the frequency, stage and types of medication errors in Norwegian hospitals, with emphasis on the most severe and fatal medication errors. METHODS: Medication errors reported in 2016 and 2017 (n=3557) were obtained from the Norwegian Incident Reporting System, based on reports from 64 hospitals in 2016 and 55 in 2017. Reports contained categorical data (eg, patient age, incident date) and free text data describing the incident. The errors were classified by error type, stage in the medication process, therapeutic area and degree of harm, using a modified version of the WHO Conceptual Framework for the International Classification for Patient Safety. RESULTS: Overall, 3372 reports were included in the study. Most medication errors occurred during administration (68%) and prescribing (24%). The leading types of errors were dosing errors (38%), omissions (23%) and wrong drug (15%). The therapeutic areas most commonly involved were analgesics, antibacterials and antithrombotics. Over half of all errors were harmful (62%), of which 5.2% caused severe harm, and 0.8% were fatal. CONCLUSIONS: Medication errors most commonly occurred during medication administration. Dosing errors were the most common error type. The substantial number of severe and fatal errors causing preventable patient harm and death emphasises an urgent need for error-prevention strategies. Additional studies and interventions should further investigate the error-prone medication administration stage in hospitals and explore the dynamics of severe incidents