2011 December 25

Risk modification for postoperative pulmonary embolism: Timing of postoperative prophylaxis.

Dec 252011

Risk modification for postoperative pulmonary embolism: Timing of postoperative prophylaxis.

Thromb Res. 2011 Dec 20;

Authors: van Lier F, van der Geest PJ, Hol JW, Leebeek FW, Hoeks SE

Abstract
INTRODUCTION: Risk factors for postoperative pulmonary embolism can often not be modified and are patient related. The purpose of this case control study was to identify possible modifiable risk factors for postoperative pulmonary embolism. MATERIALS AND METHODS: We undertook a case control study among 210,269 patients who underwent noncardiac surgery from 2000 to 2009 at the Erasmus Medical Center. Case subjects were all 199 (0.09%) patients who experienced a pulmonary embolism within 30days after surgery. From the remaining patients, 1 control was selected for each case and was stratified according to calendar year. For cases and controls, information was obtained regarding risk factors and the type and dose of thromboprophylaxis as well as the time of postoperative initiation. RESULTS: Overweight, surgery for malignancy, a history of cerebrovascular disease and a history of thromboemblic diseases, intraoperative blood transfusions and delayed use of thromboprophylaxis were more common in cases than in controls. After correction delayed use of thromboprophylaxis was associated with a 4 fold increased risk (OR 4.1; 95% CI: 2.1 - 7.7) for postoperative pulmonary embolism. CONCLUSION: Delayed timing of postoperative thromboprophylaxis is an important modifiable risk factor for postoperative pulmonary embolism after noncardiac surgery. This study emphasises the importance of on time administration of thromboprophylaxis.

PMID: 22192155 [PubMed - as supplied by publisher]

Link to Article at PubMed

Medicines reconciliation using a shared electronic health care record.

J Patient Saf Start a Discussion »

Dec 252011

Medicines reconciliation using a shared electronic health care record.

J Patient Saf. 2011 Sep;7(3):148-54

Authors: Moore P, Armitage G, Wright J, Dobrzanski S, Ansari N, Hammond I, Scally A

Abstract
OBJECTIVE: : This study aimed to evaluate the use of a shared electronic primary health care record (EHR) to assist with medicines reconciliation in the hospital from admission to discharge.
METHODS: : This is a prospective cross-sectional, comparison evaluation for 2 phases, in a short-term elderly admissions ward in the United Kingdom. In phase 1, full reconciliation of the medication history was attempted, using conventional methods, before accessing the EHR, and then the EHR was used to verify the reconciliation. In phase 2, the EHR was the initial method of retrieving the medication history-validated by conventional methods.
RESULTS: : Where reconciliation was led by conventional methods, and before any access to the EHR was attempted, 28 (28%) of hospital prescriptions were found to contain errors. Of 99 prescriptions subsequently checked using the EHR, only 50 (50%) matched the EHR. Of the remainder, 25% of prescriptions contained errors when verified by the EHR. However, 26% of patients had an incorrect list of current medications on the EHR.Using the EHR as the primary method of reconciliation, 33 (32%) of 102 prescriptions matched the EHR. Of those that did not match, 39 (38%) of prescriptions were found to contain errors. Furthermore, 37 (36%) of patients had an incorrect list of current medications on the EHR.The most common error type on the discharge prescription was drug omission; and on the EHR, wrong drug. Common potentially serious errors were related to unidentified allergies and adverse drug reactions.
CONCLUSIONS: : The EHR can reduce medication errors. However, the EHR should be seen as one of a range of information sources for reconciliation; the primary source being the patient or their carer. Both primary care and hospital clinicians should have read-and-write access to the EHR to reduce errors at care transitions. We recommend further evaluation studies.

PMID: 21857238 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Physicians’ attitudes toward reporting medical errors-an observational study at a general hospital in Saudi Arabia.

J Patient Saf Start a Discussion »

Dec 252011

Physicians' attitudes toward reporting medical errors-an observational study at a general hospital in Saudi Arabia.

J Patient Saf. 2011 Sep;7(3):144-7

Authors: Alsafi E, Bahroon SA, Tamim H, Al-Jahdali HH, Alzahrani S, Al Sayyari A

Abstract
OBJECTIVE: : Accurate medical error reporting is crucial for reducing the occurrence of such errors and their adverse consequences. This study aims to investigate the views of physicians about medical error reporting in a tertiary care hospital in Saudi Arabia.
METHODS: : This is a cross-sectional self-administrated survey study. All physicians in the hospital were invited to complete an anonymous survey questionnaire addressing demographic details, as well as attitudes, practice, and views on medical error reporting.
RESULTS: : One hundred seven physicians completed the questionnaires (66.5% response rate). Mean (SD) age was 39.8 (9.0) years. One-fifth of the respondents worked in the emergency department, and half had a workload of 40 to 59 h/wk. The reason given by 41.1% for not reporting a medical error by a colleague was that "it is not their responsibility." However, the gravity of the outcome of a medical error by a colleague to the patient was thought to be an important incentive for reporting. Of the physicians, 43% agreed that they would conceal the occurrence of a medical error they incurred to "avoid punishment." Nevertheless, most of the respondents held the view that there exists an ethical underpinning for reporting medical errors and that reporting of medical errors serve a valuable purpose.
CONCLUSIONS: : The physicians in our study are likely to disclose errors made by a colleague only if the error resulted in a severe damage to the patient, and as such, medical errors go underreported for a variety of reasons. It was felt that assurance of confidentiality and protection from backlash would promote medical error disclosure.

PMID: 21857239 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Incidence, etiology and predictors of adverse outcomes in 43,315 patients presenting to the Emergency Department with syncope: An international meta-analysis.

Int J Cardiol Start a Discussion »

Dec 252011

Incidence, etiology and predictors of adverse outcomes in 43,315 patients presenting to the Emergency Department with syncope: An international meta-analysis.

Int J Cardiol. 2011 Dec 20;

Authors: D'Ascenzo F, Biondi-Zoccai G, Reed MJ, Gabayan GZ, Suzuki M, Costantino G, Furlan R, Del Rosso A, Sarasin FP, Sun BC, Modena MG, Gaita F

Abstract
BACKGROUND: Syncope remains challenging for Emergency Department (ED) physicians due to difficulties in assessing the risk of future adverse outcomes. The aim of this meta-analysis is to establish the incidence and etiology of adverse outcomes as well as the predictors, in patients presenting with syncope to the ED. METHODS: A systematic electronic literature review was performed looking for eligible studies published between 1990 and 2010. Studies reporting multivariate predictors of adverse outcomes in patients presenting with syncope to the ED were included and pooled, when appropriate, using a random-effect method. Adverse events were defined as 'incidence of death, or of hospitalization and interventional procedures because of arrhythmias, ischemic heart disease or valvular heart disease'. RESULTS: 11 studies were included. Pooled analysis showed 42% (CI 95%; 32-52) of patients were admitted to hospital. Risk of death was 4.4% (CI 95%; 3.1-5.1) and 1.1% (CI 95%; 0.7-1.5) had a cardiovascular etiology. One third of patients were discharged without a diagnosis, while the most frequent diagnosis was 'situational, orthostatic or vasavagal syncope' in 29% (CI 95%; 12-47). 10.4% (CI 95%; 7.8-16) was diagnosed with heart disease, the most frequent type being bradyarrhythmia, 4.8% (CI 95%; 2.2-6.4) and tachyarrhythmia 2.6% (CI 95%; 1.1-3.1). Palpitations preceding syncope, exertional syncope, a history consistent of heart failure or ischemic heart disease, and evidence of bleeding were the most powerful predictors of an adverse outcome. CONCLUSION: Syncope carries a high risk of death, mainly related to cardiovascular disease. This large study which has established the most powerful predictors of adverse outcomes, may enable care and resources to be better focused at high risk patients.

PMID: 22192287 [PubMed - as supplied by publisher]

Link to Article at PubMed

The biasing effect of clinical history on physical examination diagnostic accuracy.

Med Educ Start a Discussion »

Dec 252011

The biasing effect of clinical history on physical examination diagnostic accuracy.

Med Educ. 2011 Aug;45(8):827-34

Authors: Sibbald M, Cavalcanti RB

Abstract
CONTEXT: Literature on diagnostic test interpretation has shown that access to clinical history can both enhance diagnostic accuracy and increase diagnostic error. Knowledge of clinical history has also been shown to enhance the more complex cognitive task of physical examination diagnosis, possibly by enabling early hypothesis generation. However, it is unclear whether clinicians adhere to these early hypotheses in the face of unexpected physical findings, thus resulting in diagnostic error.
METHODS: A sample of 180 internal medicine residents received a short clinical history and conducted a cardiac physical examination on a high-fidelity simulator. Resident Doctors (Residents) were randomised to three groups based on the physical findings in the simulator. The concordant group received physical examination findings consistent with the diagnosis that was most probable based on the clinical history. Discordant groups received findings associated with plausible alternative diagnoses which either lacked expected findings (indistinct discordant) or contained unexpected findings (distinct discordant). Physical examination diagnostic accuracy and physical examination findings were analysed.
RESULTS: Physical examination diagnostic accuracy varied significantly among groups (75?±?44%, 2?±?13% and 31?±?47% in the concordant, indistinct discordant and distinct discordant groups, respectively (F(2,177) ?=?53, p?<?0.0001). Of the 115 Residents who were diagnostically unsuccessful, 33% adhered to their original incorrect hypotheses. Residents verbalised an average of 12 findings (interquartile range: 10-14); 58?±?17% were correct and the percentage of correct findings was similar in all three groups (p?=?0.44).
CONCLUSIONS: Residents showed substantially decreased diagnostic accuracy when faced with discordant physical findings. The majority of trainees given discordant physical findings rejected their initial hypotheses, but were still diagnostically unsuccessful. These results suggest that overcoming the bias induced by a misleading clinical history may involve two independent steps: rejection of the incorrect initial hypothesis, and selection of the correct diagnosis. Educational strategies focused solely on prompting clinicians to re-examine their hypotheses may be insufficient to reduce diagnostic error.

PMID: 21752079 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

December 2011
M	T	W	T	F	S	S
« Nov				Jan »
			1	2	3	4
5	6	7	8	9	10	11
12	13	14	15	16	17	18
19	20	21	22	23	24	25
26	27	28	29	30	31