Root cause analysis of medication errors at a multi-specialty hospital in Western India

Background: Medication use is a complex process in a medical setting, it starts with physician prescribing, followed by nurse transcribing, pharmacist dispensing, medication administration, and patient monitoring. There is a definite role of clinical pharmacists in reduction of Medication errors by examining and evaluating its causes and communicate the results to physicians and caregivers. The aim of the present study was study of medication errors for the safety & the health benefit of the patient visiting multi specialty hospital. Methods: The Observational study was carried out at in-patient appointments at multi specialty hospital during the period of June 2012 to April 2013 at Baroda. Results: Total of 300 patients were observed out of which medication error has occurred in 117 (39%) cases considering 62% were males & 38% female patients. Out of 117 cases 28% of transcription errors, 62% of prescription errors, 11% of dispensing errors & 16 % Administration errors. 51% of medication errors were occurring in the age group of 40-60. Root cause analysis showed that prescription error was due to Illegible handwriting, No dosage form prescribed, the Wrong Brand name prescribed; transcription error due to Wrong drug is transcribed; administrative error due to Wrong dose is administered, Drug administered through wrong route, Wrong drug is administered while dispensing error due to Urgent dispensation not done within 10 to 15 minutes, Wrong dose dispensed.Conclusion: Most common medication errors were Prescription error & Transcription error which accounts for almost 77% of the total error, which is according to Pareto 80:20 Principle

Machine Vision Using Cellphone Camera: A Comparison of deep networks for classifying three challenging denominations of Indian Coins

Indian currency coins come in a variety of denominations. Off all the varieties Rs.1, RS.2, and Rs.5 have similar diameters. Majority of the coin styles in market circulation for denominations of Rs.1 and Rs.2 coins are nearly the same except for numerals on its reverse side. If a coin is resting on its obverse side, the correct denomination is not distinguishable by humans. Therefore, it was hypothesized that a digital image of a coin resting on its either size could be classified into its correct denomination by training a deep neural network model. The digital images were generated by using cheap cell phone cameras. To find the most suitable deep neural network architecture, four were selected based on the preliminary analysis carried out for comparison. The results confirm that two of the four deep neural network models can classify the correct denomination from either side of a coin with an accuracy of 97%.Comment: 6 Pages, 4 Figures, 6 Tables, Conference pape

Lead acid battery recycling for the twenty-first century

There is a growing need to develop novel processes to recover lead from end-of-life lead-acid batteries, due to increasing energy costs of pyrometallurgical lead recovery, the resulting CO2 emissions and the catastrophic health implications of lead exposure from lead-to-air emissions. To address these issues, we are developing an iono-metallurgical process, aiming to displace the pyrometallurgical process that has dominated lead production for millennia. The proposed process involves the dissolution of Pb salts into the deep eutectic solvent (DES) Ethaline 200, a liquid formed when a 1 : 2 molar ratio of choline chloride and ethylene glycol are mixed together. Once dissolved, the Pb can be recovered through electrodeposition and the liquid can then be recycled for further Pb recycling. Firstly, DESs are being used to dissolve the lead compounds (PbCO3, PbO, PbO2 and PbSO4) involved and their solubilities measured by inductively coupled plasma optical emission spectrometry (ICP-OES). The resulting Pb2+ species are then reduced and electrodeposited as elemental lead at the cathode of an electrochemical cell; cyclic voltammetry and chronoamperometry are being used to determine the electrodeposition behaviour and mechanism. The electrodeposited films were characterized by scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS). We discuss the implications and opportunities of such processes

A systematic review and meta-analysis of randomized trials of carotid endarterectomy vs stenting

ObjectiveThe purpose of this systematic review and meta-analysis was to synthesize the available evidence derived from randomized controlled trials (RCTs) regarding the relative efficacy and safety of endarterectomy vs stenting in patients with carotid artery disease.MethodsWe searched MEDLINE, EMBASE, Current Contents, and Cochrane CENTRAL through July 2010 to update previous systematic reviews. Two reviewers determined trial eligibility and extracted descriptive, methodologic, and outcome data (death, nonfatal stroke, and nonfatal myocardial infarction). Random-effects meta-analysis was used to pool relative risks and the I2 statistic was used to assess heterogeneity.ResultsThirteen RCTs proved eligible enrolling 7484 patients, of which 80% had symptomatic disease. Methodological quality was moderate to high, with better quality among RCTs published after 2008. Compared with carotid endarterectomy, stenting was associated with increased risk of any stroke (relative risk [RR], 1.45; 95% confidence interval [CI], 1.06-1.99; I2 = 40%), decreased risk of periprocedural myocardial infarction (MI; RR, 0.43; 95% CI, 0.26- 0.71; I2 = 0%), and nonsignificant increase in mortality (RR, 1.40; 95% CI, 0.85-2.33; I2 = 5%). When analysis was restricted to the two most recent trials with the better methodology and more contemporary technique, we found stenting to be associated with a significant increase in the risk of any stroke (RR, 1.82; 95% CI, 1.35-2.45) and mortality (RR, 2.53; 95% CI, 1.27-5.08) and a nonsignificant reduction of the risk of MI (RR, 0.39; 95% CI, 0.12-1.23). For every 1000 patients opting for stenting rather than endarterectomy, 19 more patients would have strokes and 10 fewer would have MIs. Outcome data in asymptomatic patients were sparse and imprecise; hence, these conclusions apply primarily to symptomatic patients.ConclusionCompared with endarterectomy, carotid artery stenting (CAS) significantly increases the risk of any stroke and decreases the risk of MI

Differences in demographic composition and in work, social, and functional limitations among the populations with unipolar depression and bipolar disorder: results from a nationally representative sample

<p>Abstract</p> <p>Background</p> <p>Existing literature on mood disorders suggests that the demographic distribution of bipolar disorder may differ from that of unipolar depression, and also that bipolar disorder may be especially disruptive to personal functioning. Yet, few studies have directly compared the populations with unipolar depressive and bipolar disorders, whether in terms of demographic characteristics or personal limitations. Furthermore, studies have generally examined work-related costs, without fully investigating the extensive personal limitations associated with diagnoses of specific mood disorders. The purpose of the present study is to compare, at a national level, the demographic characteristics, work productivity, and personal limitations among individuals diagnosed with bipolar disorder versus those diagnosed with unipolar depressive disorders and no mood disorder.</p> <p>Methods</p> <p>The Medical Expenditure Panel Survey 2004-2006, a nationally representative survey of the civilian, non-institutionalized U.S. population, was used to identify individuals diagnosed with bipolar disorder and unipolar depressive disorders based on ICD-9 classifications. Outcomes of interest were indirect costs, including work productivity and personal limitations.</p> <p>Results</p> <p>Compared to those with depression and no mood disorder, higher proportions of the population with bipolar disorder were poor, living alone, and not married. Also, the bipolar disorder population had higher rates of unemployment and social, cognitive, work, and household limitations than the depressed population. In multivariate models, patients with bipolar disorder or depression were more likely to be unemployed, miss work, and have social, cognitive, physical, and household limitations than those with no mood disorder. Notably, findings indicated particularly high costs for bipolar disorder, even beyond depression, with especially large differences in odds ratios for non-employment (4.6 for bipolar disorder versus 1.9 for depression, with differences varying by gender), social limitations (5.17 versus 2.85), cognitive limitations (10.78 versus 3.97), and work limitations (6.71 versus 3.19).</p> <p>Conclusion</p> <p>The bipolar disorder population is distinctly more vulnerable than the population with depressive disorder, with evidence of fewer personal resources, lower work productivity, and greater personal limitations. More systematic analysis of the availability and quality of care for patients with bipolar disorder is encouraged to identify effectively tailored treatment interventions and maximize cost containment.</p

Differences in Healthcare Utilization and Associated Costs Between Patients Prescribed vs. Nonprescribed Opioids During an Inpatient or Emergency Department Visit

Objectives Compare healthcare resource utilization ( HCRU ) and costs between patients prescribed opioids ( R x OP ) and those who were not ( N o R x OP ) during an emergency department ( ED ) or inpatient visit. Methods Retrospective cohort analysis was performed ( J anuary 2006 to S eptember 2010). Continuously eligible R x OP patients in ED /inpatient settings ( J anuary 2007 to S eptember 2009) were included if age was ≥ 12 years by initial prescription date (or random date between first ED /inpatient admission and S eptember 30, 2009 [ N oRx OP patients]). Healthcare resource utilization and costs for 12 months after initial prescription were compared. Univariate descriptive analyses were performed for baseline and outcome variables and compared using appropriate tests. Risk adjustment compared HCRU between R x OP and N o R x OP cohorts for the postindex period. Results Of 27,599 eligible patients, R x OP patients ( n  = 18,819) were younger, less likely to be male, more likely to reside in southern U nited S tates and to have Preferred Provider Organization health plans, and had lower comorbidity index scores, compared with N o R x OP patients ( n  = 8,780). R x OP patients were less likely to have nonpain‐related comorbidities and more frequently diagnosed with pain‐related comorbidities. Unmatched and propensity‐matched R x OP patients experienced higher HCRU and costs in all subcategories (total, inpatient, outpatient ED , physician, pharmacy, other outpatient settings). Opioid abuse frequency was low in patients with common diagnoses/procedures within 3 months before initial prescription (0.48%). Average time to abuse was < 1 year (201 days). Conclusion Most patients were prescribed opioids initially during ED /inpatient visits and incurred higher HCRU than those not prescribed opioids. Among those with diagnosed opioid abuse after initiating opioids, time to diagnosis was rapid (range: 14 to 260 days) for patients with common diseases and procedures.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107375/1/papr12098.pd

Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006-2013.

ObjectiveTo examine temporal trends in utilization of glucose-lowering medications, glycemic control, and rate of severe hypoglycemia among patients with type 2 diabetes (T2DM).Research design and methodsUsing claims data from 1.66 million privately insured and Medicare Advantage patients with T2DM from 2006 to 2013, we estimated the annual 1) age- and sex-standardized proportion of patients who filled each class of agents; 2) age-, sex-, race-, and region-standardized proportion with hemoglobin A1c (HbA1c) &lt;6%, 6 to &lt;7%, 7 to &lt;8%, 8 to &lt;9%, ≥9%; and 3) age- and sex-standardized rate of severe hypoglycemia among those using medications. Proportions were calculated overall and stratified by age-group (18-44, 45-64, 65-74, and ≥75 years) and number of chronic comorbidities (zero, one, and two or more).ResultsFrom 2006 to 2013, use increased for metformin (from 47.6 to 53.5%), dipeptidyl peptidase 4 inhibitors (0.5 to 14.9%), and insulin (17.1 to 23.0%) but declined for sulfonylureas (38.8 to 30.8%) and thiazolidinediones (28.5 to 5.6%; all P &lt; 0.001). The proportion of patients with HbA1c &lt;7% declined (from 56.4 to 54.2%; P &lt; 0.001) and with HbA1c ≥9% increased (9.9 to 12.2%; P &lt; 0.001). Glycemic control varied by age and was poor among 23.3% of the youngest and 6.3% of the oldest patients in 2013. The overall rate of severe hypoglycemia remained the same (1.3 per 100 person-years; P = 0.72), declined modestly among the oldest patients (from 2.9 to 2.3; P &lt; 0.001), and remained high among those with two or more comorbidities (3.2 to 3.5; P = 0.36).ConclusionsDuring the recent 8-year period, the use of glucose-lowering drugs has changed dramatically among patients with T2DM. Overall glycemic control has not improved and remains poor among nearly a quarter of the youngest patients. The overall rate of severe hypoglycemia remains largely unchanged

Why Do Women Reject Bisphosphonates for Osteoporosis? A Videographic Study

Despite access to effective, safe, and affordable treatment for osteoporosis, at-risk women may choose not to start bisphosphonate therapy. Understanding the reasons women give for rejecting a clinician's offer of treatment during consultations and how clinician's react to these reasons may help clinicians develop more effective strategies for fracture prevention and medication adherence.We conducted a videographic evaluation of encounters in the Osteoporosis Choice randomized trial of a decision aid about bisphosphonates vs. usual primary care. Eligible videos involved consultations with women with an estimated 10-year fragility fracture risk >20% who verbalized at least one reason to not take bisphosphonates. Two reviewers independently reviewed eligible videos and verbatim transcripts, classifying patient views about bisphosphonate use, clinicians response to those views, and patient adherence at 6 months post visit.Eighteen video recordings (12 with decision aid) were eligible for analyses. We identified 37 reasons for and against bisphosphonate therapy. Eleven patients rejected treatment, offering 9 (average of 2 per patient) unique reasons against initiating bisphosphonates (most common: side effects 39% and distrust of medications in general 33%). When physicians conceded to patient views the outcome was no bisphosphonate use. Adherence to choices at 6 months was 100%.The expression of patient preferences is sometimes unfavorable to bisphosphonates treatment even among well-informed patients at high risk for osteoporotic fractures. At 6 months, patients who expressed concerns about these medicines behaved consistently with the decision made during the visit

Comparative Effectiveness and Safety of Anti–Tumor Necrosis Factor Agents in Biologic-Naive Patients With Crohn’s Disease

Inhibitors of tumor necrosis factor (anti-TNF agents) are the most effective therapy for Crohn’s disease (CD). We evaluated the real-world comparative effectiveness and safety of different anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) in biologic-naïve patients with CD in a retrospective, propensity-matched cohort study using a national administrative claims database (Optum Labs Data Warehouse)