The Relationship between Organizational Leadership for Safety and Learning from Patient Safety Events

ObjectiveTo examine the relationship between organizational leadership for patient safety and five types of learning from patient safety events (PSEs).ConclusionsWe find support for the relationship between patient safety leadership and patient safety behaviors such as learning from safety events. Formal leadership support for safety is of particular importance in small organizations where the economic burden of safety programs is disproportionately large and formal leadership is closer to the front lines.     

Exposure to Potentially Traumatic Life Events in Children with Special Needs

A series of studies of potentially-traumatic life-events (PTLE) in children and youth with special needs (CSN) was conducted after parents of 102 CSN from interdisciplinary pediatric clinics listed PTLE at significantly higher rates on the Pediatric Emotional Distress Scale (PEDS) compared to parents 58 students with no diagnoses. Subsequent studies replicated this disparity in 213 5–15 year-olds sampled through school-distributed parent PTLE checklists instead of PEDS. Results from school samples suggested significantly more PTLE in CSN, t (211) = −3.39, p < .001. In both studies some of PTLE reported significantly more in CSN were potentially related to the special needs of the child (e.g., hospitalizations, school problems) but others were not (e.g., traumatic events such as vehicular accidents and disasters). Children exposed to more PTLE were rated as having significantly more behavior problems across measures. Suggested cost-effective screening for PTLE may enable clinicians to enhance differential diagnosis, medical management, and psychosocial interventions for CSN by taking into account PTLE and symptoms related to recent disruptive events.     

Anaesthetic Simulators: Training for the Broader Health‐Care Profession

Background : The use of high‐fidelity patient simulators for training health‐care professionals has increased rapidly in recent years. Approximately 150 simulation training centres operate internationally. Australasia has acquired four centres since 1997. A large component of simulator‐based training is experiential. Methods : Participants manage clinical scenarios on lifelike computer‐controlled mannikins within realistic clinical environments. Afterwards they actively reflect upon the experience, an exercise that is facilitated by observation of a video replay of the event. Results : This approach to training promotes a consideration of broader issues which can influence clinical practice and patient outcomes. This has particular relevance to emergencies. Here, events that are by nature infrequent and unscheduled can be addressed in a controlled fashion, in an environment that is supportive and separated from actual patients. Conclusions : A broad range of skills can be addressed with this resource. Of key importance are situational management and team effectiveness skills. Deficiencies with respect to these ‘non‐clinical’ skills are being increasingly identified for their contribution to preventable adverse events within the health‐care environment. Multidisciplinary operation‐room team training has the potential to address these issues as they relate to the perioperative environment.     

Levetiracetam extended release and levetiracetam immediate release as adjunctive treatment for partial-onset seizures: An indirect comparison of treatment-emergent adverse events using meta-analytic techniques

The safety profiles of once-daily adjunctive levetiracetam (LEV) extended release (XR) (1000 mg/day) and adjunctive LEV immediate release (IR) (500 mg twice daily) were compared using data from three randomized, placebo (PBO)-controlled phase III clinical trials in patients with partial-onset seizures. MedDRA 9.0 treatment-emergent adverse events (TEAEs) were indirectly compared using meta-analytic techniques, including calculation of risk difference (RD) and mixed-effects analysis. Statistical significance was set at 10% alpha risk, the normative value for these analyses. Data from 555 patients older than 16 (204 LEV IR, 70 LEV XR, 281 PBO) were analyzed. Following adjustment for incidence of placebo TEAEs, LEV XR showed statistically significantly lower rates of TEAEs than LEV IR across nervous system disorders (RD = −18%, P = 0.03), psychiatric disorders (RD = −11%, P = 0.08), and metabolism and nutrition disorders (RD = −3%, P = 0.08). Among nervous system disorders, the RD for headache favored LEV XR (RD = −11%, P = 0.08). These results suggest that adjunctive LEV XR may be associated with a lower incidence of nervous system, psychiatric, and nutritional and metabolic TEAEs as compared with LEV IR. However, this difference was observed at a broad scale and not at a specific TEAE level except for headache.     

Effects of terfenadine and pseudoephedrine,alone and in combination in a nasal provocation test and in perennial rhinitis

Summary The effects of terfenadine and pseudoephedrine, alone and in combination, have been assessed in a nasal provocation test and in perennial rhinitis.In a double-blind, placebo-controlled cross-over nasal provocation test, twelve men allergic to grass pollen were treated with two daily doses of placebo, terfenadine 60 mg, pseudoephedrine 120 mg, or the combination of the two, for 2 days preceding each test. The allergic reaction threshold, based on rhinorrhoea, sneezing and nasal inspiratory peak flow rate, was raised significantly both by terfenadine and pseudoephedrine, and their effects appeared additive (repeated measures analysis of variance).In a double-blind, randomized clinical study of perennial rhinitis two parallel groups, the efficacy and tolerability of terfenadine and terfenadine-pseudoephedrine were compared in 50 patients. Symptoms and signs in both groups were improved after 14 days of treatment. Differences between groups showed a trend in favour of terfenadine-pseudoephedrine, for swelling of the nasal mucosa (rhinoscopy) they were statistically significant. Both medications were well tolerated overall, although adverse events and reactions were more frequent in the terfenadine-pseudoepherine group.In conclusion, terfenadine-pseudoephedrine and its constituents taken alone were effective. The combination performed better, but adverse events were somewhat more frequent with the combination than with terfenadine alone.     

Aspects of quality of life on treatment with felodipine

Summary Quality of life has been assessed in a double-blind four week study comparing felodipine 5, 10, 20 mg and placebo added to metoprolol by adding two self-administered questionnaires to the conventional procedure for the evaluation of adverse events.None of the aspects related to general well-being was affected by felodipine. The subjective symptoms reported were mostly dose-related and so here mainly observed at the highest dose. Some of them, e.g. headache, were transient.It is concluded that felodipine in combination with metoprolol CR did not negatively influence the feeling of well-being of the patients. When the drug was given in low, individually adjusted doses, the symptoms normally associated with Ca antagonists were likely to be minimised.     

Induction of adhesion molecule expression on blood vessels and keratinocytes in recurrent oral ulceration

Adhesion molecules are known to play a crucial role in the recruitment of inflammatory cells to sites of inflammation. In this study endothelial cell and keratinocyte adhesion molecule expression in recurrent oral ulcers (ROU) ( n =13) was compared with that found in normal oral mucosa (NOM) ( n =11) and experimentally induced ulcers (EIU) ( n =5) by using immunohistochemistry. Significantly greater expression of both vascular cell adhesion molecule-1 (VCAM-1) and E-selectin was demonstrated on vasculature in ROU compared with that found in both NOM and EIU. Induction of keratinocyte intercellular adhesion molecule-1 (ICAM-1) was also a prominent feature of ROU. The expression of VCAM-1 and E-selectin on blood vessels in ROU is likely to be important in the accumulation of lymphocytes that characterise early aphthous lesions. The induction of keratinocyte ICAM-1 may facilitate lymphocyte invasion of the epithelium in ROU, which may ultimately result in ulcer formation.     

反复自然流产与精子DNA完整性的相关性研究

目的 探讨反复自然流产与精子DNA完整性的相关性。方法 按纳入标准将研究对象分成反复自然流产患者丈夫组（n=58）和正常生育男性对照组（n=50），采用吖啶橙实验（AOT）对研究对象精子DNA完整性进行检测，并对研究对象精液进行常规分析。砖果两组研究对象年龄、吸烟史、饮酒史无统计学差异（P〉0．05）；反复自然流产患者丈夫组精液的精子密度、精子活力显著低于正常生育对照组（P〈O．05）；反复自然流产患者丈夫组精子DNA的完整性低于正常生育对照组，差异有统计学意义（P〈O．05）。砖论精子DNA完整性损伤是反复自然流产的可能原因，精子DNA完整性损伤导致反复自然流产的致病机理尚需进一步研究。