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

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 Dutch Ministry of Health, Welfare and Sport (VWS) initiated the project and supported the project financially (without restrictions on the scientific work; grant number 313741)

The Gelfand spectrum of a noncommutative C*-algebra: a topos-theoretic approach

We compare two influential ways of defining a generalized notion of space. The first, inspired by Gelfand duality, states that the category of 'noncommutative spaces' is the opposite of the category of C*-algebras. The second, loosely generalizing Stone duality, maintains that the category of 'pointfree spaces' is the opposite of the category of frames (i.e., complete lattices in which the meet distributes over arbitrary joins). One possible relationship between these two notions of space was unearthed by Banaschewski and Mulvey, who proved a constructive version of Gelfand duality in which the Gelfand spectrum of a commutative C*-algebra comes out as a pointfree space. Being constructive, this result applies in arbitrary toposes (with natural numbers objects, so that internal C*-algebras can be defined). Earlier work by the first three authors, shows how a noncommutative C*-algebra gives rise to a commutative one internal to a certain sheaf topos. The latter, then, has a constructive Gelfand spectrum, also internal to the topos in question. After a brief review of this work, we compute the so-called external description of this internal spectrum, which in principle is a fibered pointfree space in the familiar topos Sets of sets and functions. However, we obtain the external spectrum as a fibered topological space in the usual sense. This leads to an explicit Gelfand transform, as well as to a topological reinterpretation of the Kochen-Specker Theorem of quantum mechanics, which supplements the remarkable topos-theoretic version of this theorem due to Butterfield and Isham.Comment: 12 page

Recent advances in modeling and analysis of bioelectric and biomagnetic sources

Determining the centers of electrical activity in the human body and the connectivity between different centers of activity in the brain is an active area of research. To understand brain function and the nature of cardiovascular diseases requires sophisticated methods applicable to non-invasively measured bioelectric and biomagnetic data. As it is difficult to solve for all unknown parameters at once, several strains of data analysis have been developed, each trying to solve a different part of the problem and each requiring a different set of assumptions. Current trends and results from major topics of electro- and magnetoencephalographic data analysis are presented here together with the aim of stimulating research into the unification of the different approaches. The following topics are discussed: source reconstruction using detailed finite element modeling to locate sources deep in cthe brain; connectivity analysis for the quantification of strength and direction of information flow between activity centers, preferably incorporating an inverse solution; the conflict between the statistical independence assumption of sources and a possible connectivity; the verification and validation of results derived from non-invasively measured data through animal studies and phantom measurements. This list already indicates the benefits of a unified view

Impaired Very-Low-Density Lipoprotein catabolism links hypoglycemia to hypertriglyceridemia in Glycogen Storage Disease type Ia

International audiencePrevention of hypertriglyceridemia is one of the biomedical targets in Glycogen Storage Disease type Ia (GSD Ia) patients, yet it is unclear how hypoglycemia links to plasma triglyceride (TG) levels. We analyzed whole-body TG metabolism in normoglycemic (fed) and hypoglycemic (fasted) hepatocyte-specific glucose-6-phosphatase deficient (L-G6pc-/- ) mice. De novo fatty acid synthesis contributed substantially to hepatic TG accumulation in normoglycemic L-G6pc-/- mice. In hypoglycemic conditions, enhanced adipose tissue lipolysis was the main driver of liver steatosis, supported by elevated free fatty acid concentrations in GSD Ia mice and GSD Ia patients. Plasma very-low-density lipoprotein (VLDL) levels were increased in GSD Ia patients and in normoglycemic L-G6pc-/- mice, and further elevated in hypoglycemic L-G6pc-/- mice. VLDL-TG secretion rates were doubled in normo- and hypoglycemic L-G6pc-/- mice, while VLDL-TG catabolism was selectively inhibited in hypoglycemic L-G6pc-/- mice. In conclusion, fasting-induced hypoglycemia in L-G6pc-/- mice promotes adipose tissue lipolysis and arrests VLDL catabolism. This mechanism likely contributes to aggravated liver steatosis and dyslipidemia in GSD Ia patients with poor glycemic control and may explain clinical heterogeneity in hypertriglyceridemia between GSD Ia patients

Kinetics and 28-day test-retest repeatability and reproducibility of [C-11]UCB-J PET brain imaging

[C-11]UCB-J is a novel radioligand that binds to synaptic vesicle glycoprotein 2A (SV2A). The main objective of this study was to determine the 28-day test-retest repeatability (TRT) of quantitative [C-11]UCB-J brain positron emission tomography (PET) imaging in Alzheimer's disease (AD) patients and healthy controls (HCs). Nine HCs and eight AD patients underwent two 60 min dynamic [C-11]UCB-J PET scans with arterial sampling with an interval of 28 days. The optimal tracer kinetic model was assessed using the Akaike criteria (AIC). Micro-/macro-parameters such as tracer delivery (K-1) and volume of distribution (V-T) were estimated using the optimal model. Data were also analysed for simplified reference tissue model (SRTM) with centrum semi-ovale (white matter) as reference region. Based on AIC, both 1T2k_V-B and 2T4k_V-B described the [C-11]UCB-J kinetics equally well. Analysis showed that whole-brain grey matter TRT for V-T, DVR and SRTM BPND were -2.2% +/- 8.5, 0.4% +/- 12.0 and -8.0% +/- 10.2, averaged over all subjects. [C-11]UCB-J kinetics can be well described by a 1T2k_V-B model, and a 60 min scan duration was sufficient to obtain reliable estimates for both plasma input and reference tissue models. TRT for V-T, DVR and BPND wa

Validation and test-retest repeatability performance of parametric methods for [11C]UCB-J PET

[(11)C]UCB-J is a PET radioligand that binds to the presynaptic vesicle glycoprotein 2A. Therefore, [(11)C]UCB-J PET may serve as an in vivo marker of synaptic integrity. The main objective of this study was to evaluate the quantitative accuracy and the 28-day test–retest repeatability (TRT) of various parametric quantitative methods for dynamic [(11)C]UCB-J studies in Alzheimer’s disease (AD) patients and healthy controls (HC). Eight HCs and seven AD patients underwent two 60-min dynamic [(11)C]UCB-J PET scans with arterial sampling over a 28-day interval. Several plasma-input based and reference-region based parametric methods were used to generate parametric images using metabolite corrected plasma activity as input function or white matter semi-ovale as reference region. Different parametric outcomes were compared regionally with corresponding non-linear regression (NLR) estimates. Furthermore, the 28-day TRT was assessed for all parametric methods. Spectral analysis (SA) and Logan graphical analysis showed high correlations with NLR estimates. Receptor parametric mapping (RPM) and simplified reference tissue model 2 (SRTM2) BP(ND), and reference Logan (RLogan) distribution volume ratio (DVR) regional estimates correlated well with plasma-input derived DVR and SRTM BP(ND). Among the multilinear reference tissue model (MRTM) methods, MRTM1 had the best correspondence with DVR and SRTM BP(ND). Among the parametric methods evaluated, spectral analysis (SA) and SRTM2 were the best plasma-input and reference tissue methods, respectively, to obtain quantitatively accurate and repeatable parametric images for dynamic [(11)C]UCB-J PET. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13550-021-00874-8