Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study

Introduction Intravenous medication administration has traditionally been regarded as error prone, with high potential for harm. A recent US multisite study revealed few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error. Objectives To determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation, including the contribution of smart pumps. Methods We conducted an observational point prevalence study of intravenous infusions in 16 National Health Service hospital trusts. Observers compared each infusion against the medication order and local policy. Deviations were classified as errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs. Results Data were collected from 1326 patients and 2008 infusions. Errors were observed in 231 infusions (11.5%, 95% CI 10.2% to 13.0%). Discrepancies were observed in 1065 infusions (53.0%, 95% CI 50.8% to 55.2%). Twenty-three errors (1.1% of all infusions) were considered potentially harmful; none were judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of errors and discrepancies varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or patient need. Smart pumps, as currently implemented, had little effect, with similar error rates observed in infusions delivered with and without a smart pump (10.3% vs 10.8%, p=0.8). Conclusion Errors and discrepancies are relatively common in everyday infusion administrations but most have low potential for patient harm. Better understanding of performance variability to strategically manage risk may be a more helpful tactic than striving to eliminate all deviations

The obesity paradox in surgical patients

In the Netherlands, 16 million inhabitants undergo about 1 million surgical procedures annually. The percentage of serious adverse advents is a burden to society and stresses the need for adequate preoperative assessment in order to select and optimize surgical patients. The clinical course of surgical patients have been the subject of research focusing on perioperative outcome. [1-6] The influenced time frame expanded from merely improving the direct postoperative surgical outcome to infl uencing the long term outcome of the surgical patient. [7-14] Consequently, advances in perioperative care emphasize a more important role of the preoperative evaluation and a more comprehensive risk stratifi cation by the anesthesiologist. Recognition and optimization of chronic disease processes prior to surgery could prove benefi cial by reducing the risk of complications, not only in the perioperative stage, but also on longer-term follow up. With the growing number of surgical procedures performed yearly in modern societies we believe anesthesiologists have a golden opportunity to infl uence the health and quality of life of their patients not only during the perioperative phase, but also in order to lower the incidence of long-term adverse outcome

Pharaonic necrostratigraphy : a review of geological and archaeological studies in the Theban Necropolis, Luxor, West Bank, Egypt

Author Posting. © The Author(s), 2009. This is the author's version of the work. It is posted here by permission of John Wiley & Sons for personal use, not for redistribution. The definitive version was published in Terra Nova 21 (2009): 237-256, doi:10.1111/j.1365-3121.2009.00872.x.We present a review of archeological and geological studies on the West Bank as a basis for discussing the geological setting of the tombs and geologically related problems with a view to providing archeologists with a framework in which to conduct their investigations on the restoration, preservation and management of the antique monuments. Whereas the geology of the Upper Nile Valley appears to be deceptively simple, the lithologic succession is vertically variable, and we have recognized and defined several new lithologic units within the upper Esna Shale Formation. We have been able to delineate lithologic (shale/limestone) contacts in several tombs and observed that the main chambers in some were excavated below the Esna Shale in the Tarawan Chalk Formation. We have been able to document changing dip in the strata (warping) in several tombs, and to delineate two major orientations of fractures in the field. Investigations behind the Temple of Hatshepsut, in the Valley of the Kings and around Deir El Medina, have revealed four broad regional structures. We confirm that the hills located near the Nile Valley, such as Sheik Abel Qurna, do not belong to the tabular structure of the Theban Mountain, but are discrete displaced blocks of the Thebes Limestone and overlying El Miniya, as supported by Google Earth photographs

Multicentre results of stereotactic body radiotherapy for secondary liver tumours

AbstractBackgroundSurgical resection is the standard treatment for liver metastases, although for the majority of patients this is not possible. Stereotactic body radiotherapy (SBRT) is an alternative local-regional therapy. The purpose of this study was to evaluate the results of SBRT for secondary liver tumours from a combined multicentre database.MethodsVariables from patients treated with SBRT from four Academic Medical Centres were entered into a common database. Local tumour control and 1-year survival rates were calculated.ResultsIn total, 153 patients (91 women) 59±8.4 years old with 363 metastatic liver lesions were treated with SBRT. The underlying primary tumour arose from gastrointestinal (GI), retroperitoneal and from extra-abdominal primaries in 56%, 8% and 36% of patients, respectively. Metastases, with a gross tumour volume (GTV) of 138.5±126.8cm3, were treated with a total radiation dose of 37.5±8.2Gy in 5±3 fractions. The 1-year overall survival was 51% with an overall local control rate of 62% at a mean follow-up of 25.2±5.9 months. A complete tumour response was observed in 32% of patients. Grade 3–5 adverse events were noted in 3% of patients.ConclusionSecondary liver tumours treated with SBRT had a high rate of local control with a low incidence of adverse events

An in vitro evaluation of the inhibitory effects of an aqueous extract of Acacia nilotica on Eimeria tenella.

Eimeria tenella is one of the most important species of Eimeria that infect domestic fowl, causing coccidiosis in the poultry industry associated with drastic economic loss. Alternative treatment options are often necessary since anticoccidial drugs are prohibitively expensive, have serious side effects, or develop resistance. The role that herbal therapy plays in basic healthcare has been rediscovered worldwide. Consequently, our research assessed the in vitro inhibitory effect of escalated concentrations (6.25 mg, 12.5 mg, 25 mg, 50 mg, and 100 mg/ml) of Acacia nilotica aqueous extract (ANAE) on Eimeria tenella sporulation. Statistical analysis revealed that ANAE decreased the percentage of oocyst sporulation in a dose-dependent manner. Furthermore, ANAE showed abnormal sporulation and morphological deterioration of E. tenella oocytes. Area Under the Curve (AUC) calculation was used to determine the efficacy of ANAE and revealed that ANAE concentrations significantly reduced the coccidial score index. At 100 mg/ml, ANAE completely suppressed the sporulation of E. tenella oocysts, with obvious changes to their morphology and size. The phytochemical analysis of ANAE has shown that ANAE contains several active principles that possess anthelmintic activities. These compounds include tannins, saponins, flavonoids, terpenoids, and alkaloids, which can be attributed to the anticoccidial activity of ANAE. Considering our findings, we recommend that ANAE be used to prevent and control Eimeria

Egyptian consensus on treat-to-target approach for osteoporosis: a clinical practice guideline from the Egyptian Academy of bone health and metabolic bone diseases

Background: This study was carried out to achieve an Egyptian expert consensus on a treat-to-target managementstrategy for osteoporosis using Delphi technique. A scientific committee identified researchers and clinicians with expertise in osteoporosis in Egypt. Delphi process was implemented (2 rounds) to establish a consensus on 15 clinical standards: (1) concept, (2) diagnosis, (3) case identification, (4) whom to treat, (5) who should treat?, (6) case stratification and intervention thresholds, (7) falls risk, (8) investigations, (9) treatment target, (10) management, (11) optimum treatment duration, (12) monitoring, (13) drug holiday, (14) osteoporosis in men, and (15) post-fracture care and fracture liaison service. Results: The surveys were sent to an expert panel (n = 25), of whom 24 participated in the two rounds. Respondents were drawn from different governorates and health centres across Egypt including the Ministry of Health. Most of the participants were rheumatologists (76%), followed by internists (8%), orthopaedic doctors (4%), rehabilitation doctors (4%), primary care (4%), and ortho-geriatrics (4%) physicians. Seventy-two recommendations, categorised into 15 sections, were obtained. Agreement with the recommendations (rank 7–9) ranged from 83.4 to 100%. Consensus was reached (i.e. ≥ 75% of respondents strongly agreed or agreed) on the wording of all 15 clinical standards identified by the scientific committee. An algorithm for the management of postmenopausal osteoporosis has been suggested. Conclusion: A wide and representative panel of experts established a consensus regarding the management of osteoporosis in Egypt. The developed guidelines provide a comprehensive approach to the assessment and management of osteoporosis for all Egyptian healthcare professionals who are involved in its management