Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study

Background Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care. Methods We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014. Results The top three problems were incomplete reconciliation of medication during patient ‘hand-overs’, inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score. Conclusions Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism

A checklist for health research priority setting: nine common themes of good practice

Health research priority setting processes assist researchers and policymakers in effectively targeting research that has the greatest potential public health benefit. Many different approaches to health research prioritization exist, but there is no agreement on what might constitute best practice. Moreover, because of the many different contexts for which priorities can be set, attempting to produce one best practice is in fact not appropriate, as the optimal approach varies per exercise. Therefore, following a literature review and an analysis of health research priority setting exercises that were organized or coordinated by the World Health Organization since 2005, we propose a checklist for health research priority setting that allows for informed choices on different approaches and outlines nine common themes of good practice. It is intended to provide generic assistance for planning health research prioritization processes. The checklist explains what needs to be clarified in order to establish the context for which priorities are set; it reviews available approaches to health research priority setting; it offers discussions on stakeholder participation and information gathering; it sets out options for use of criteria and different methods for deciding upon priorities; and it emphasizes the importance of well-planned implementation, evaluation and transparency

Characterization of Functional and Structural Integrity in Experimental Focal Epilepsy: Reduced Network Efficiency Coincides with White Matter Changes

BACKGROUND: Although focal epilepsies are increasingly recognized to affect multiple and remote neural systems, the underlying spatiotemporal pattern and the relationships between recurrent spontaneous seizures, global functional connectivity, and structural integrity remain largely unknown. METHODOLOGY/PRINCIPAL FINDINGS: Here we utilized serial resting-state functional MRI, graph-theoretical analysis of complex brain networks and diffusion tensor imaging to characterize the evolution of global network topology, functional connectivity and structural changes in the interictal brain in relation to focal epilepsy in a rat model. Epileptic networks exhibited a more regular functional topology than controls, indicated by a significant increase in shortest path length and clustering coefficient. Interhemispheric functional connectivity in epileptic brains decreased, while intrahemispheric functional connectivity increased. Widespread reductions of fractional anisotropy were found in white matter regions not restricted to the vicinity of the epileptic focus, including the corpus callosum. CONCLUSIONS/SIGNIFICANCE: Our longitudinal study on the pathogenesis of network dynamics in epileptic brains reveals that, despite the locality of the epileptogenic area, epileptic brains differ in their global network topology, connectivity and structural integrity from healthy brains

La Red Internacional de Inventarios Forestales (BIOTREE-NET) en Mesoamérica: avances, retos y perspectivas futuras

Los esfuerzos de conservación en la región neotropical están limitados por la falta de información disponible sobre las especies, ya que muchas no han sido descritas o se tiene poca información sobre ellas. La Red Internacional de Inventarios Forestales (BIOTREE-NET) concentra y facilita el acceso a la información y el intercambio entre investigadores, gestores y conservacionistas, organizando y estandarizando los datos de especies de árboles procedentes de inventarios forestales en la región mesoamericana en una única base de datos que incluya información espacial. Este artículo explica el ámbito y objetivos de la red, describe la estructura de la base de datos e identifica los principales avances realizados, así como los retos y perspectivas futuras. La base de datos contiene más de 50 000 registros de árboles de unas 5000 especies, distribuidas en más de 2000 parcelas muestreadas desde el suroeste de México hasta Panamá. La información es heterogénea, tanto en su naturaleza y forma como en la cobertura geográfica de los inventarios. La base de datos tiene una estructura relacional, con 12 tablas interconectadas, incluyendo información sobre las parcelas, los nombres de las especies, el diámetro a la altura del pecho de los árboles medidos y sus atributos funcionales. Se ha desarrollado un sistema para la corrección de errores tipográficos y la estandarización taxonómica y nomenclatural utilizando como referencia The Plant List (http://theplantlist.org/). También se han generado modelos de distribución potencial para cerca de 1700 especies utilizando distintos métodos y en el futuro se prevé habilitar también el acceso público a los modelos de distribución de especies a través del portal web (http://portal.biotreenet.com). Aunque BIOTREE-NET ha contribuido al desarrollo de mejores modelos de distribución, su mayor potencial radica, en nuestra opinión, en el estudio a nivel de comunidades. Finalmente, se reconoce la necesidad de expandir la red a través de la participación de más investigadores interesados en colaborar con datos para ampliar el conocimiento sobre la biodiversidad forestal en la región neotropica

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke