Reporting of near-miss events for transfusion medicine: improving transfusion safety

BACKGROUND: Half of the reported serious adverse events from transfusion are a consequence of medical error. A no-fault medical-event reporting system for transfusion medicine (MERS-TM) was developed to capture and analyze both near-miss and actual transfusion-related errors. STUDY DESIGN AND METHODS: A prospective audit of transfusion-related errors was performed to determine the ability of MERS-TM to identify the frequency and patterns of errors. RESULTS: Events and near-miss events (total, 819) were recorded for a period of 19 months (median, 51/month). No serious adverse patient outcome occurred, despite these events, with the transfusion of 17,465 units of RBCs. Sixty-one events (7.4%) were potentially life-threatening or could have led to permanent injury (severity Level 1). Of most concern were 3 samples collected from the wrong patient, 13 mislabeled samples, and 22 requests for blood for the wrong patient. Near-miss events were five times more frequent than actual transfusion errors, and 68 percent of errors were detected before blood was issued. Sixty-one percent of events originated from patient areas, 35 percent from the blood bank, and 4 percent from the blood supplier or other hospitals. Repeat collection was required for 1 of every 94 samples, and 1 in 346 requests for blood components was incorrect. Education of nurses and alterations to blood bank forms were not by themselves effective in reducing severe errors. An artifactual 50-percent reduction in the number of errors reported was noted during a 6-month period when two chief members of the event-reporting team were on temporary leave. CONCLUSION: The MERS-TM allowed the recognition and analysis of errors, determination of patterns of errors, and monitoring for changes in frequency after corrective action was implemented. Although no permanent injury resulted from the 819 events, innovative mechanisms must be designed to prevent these errors, instead of relying on faulty informal checks to capture errors after they occur.     

Effects of working conditions on intravenous medication errors in a Japanese hospital

AIM: The aim of this study was to explore quantitatively which working conditions influence the occurrence of medical near-miss errors related to intravenous medication at a hospital in Japan. Background: Although working conditions such as stress, fatigue and inexperience have been reported to contribute to medical errors, countermeasures to these conditions have been delayed, and working conditions have deteriorated in many Japanese medical sites. METHODS: A self-reporting questionnaire analysing working conditions that can lead to near-miss errors relating to intravenous medication was sent to 90 nurses working in four wards of one Japanese hospital in 2001. Eighty-eight subjects responded (response rate: 97.8%). Among 534 person-days in which 88 nurses attended works, 525 person-days of data were used for the analyses. RESULTS: Among 525 person-days, the number of near-miss errors was 94 (17.9%). There was no significant difference in the occurrence of near-miss errors among the three shifts (day shift, 19.2%; evening shift, 19.2%; night shift, 12.5%). During the day shift, errors were reported at a significantly higher frequency when the nursing services were delayed longer due to workload. During the evening shift, errors were reported when the nursing services were delayed longer due to workload and when years of experience at the current ward were shorter. In addition, nurses whose perceived level of fatigue before work was lower during the day shift, and nurses whose years of experience as a nurse were longer and who had longer sleep duration during the evening shift experienced near-miss errors with a significantly higher frequency than other nurses. These latter factors could be important conditions that encourage the detection of errors before they occur. CONCLUSIONS: Workload and lack of experience at the current ward are two conditions that can lead to errors. Furthermore, lack of fatigue and long experience as a nurse may help encourage the detection of errors before they occur. It is important to improve working conditions so that health care workers can detect errors before patients are harmed and decrease the number of errors that occur.     

Computerized Bar Code–Based Blood Identification Systems and Near-Miss Transfusion Episodes and Transfusion Errors

ObjectiveTo determine whether the use of a computerized bar code–based blood identification system resulted in a reduction in transfusion errors or near-miss transfusion episodes.Patients and MethodsOur institution instituted a computerized bar code–based blood identification system in October 2006. After institutional review board approval, we performed a retrospective study of transfusion errors from January 1, 2002, through December 31, 2005, and from January 1, 2007, through December 31, 2010.ResultsA total of 388,837 U were transfused during the 2002-2005 period. There were 6 misidentification episodes of a blood product being transfused to the wrong patient during that period (incidence of 1 in 64,806 U or 1.5 per 100,000 transfusions; 95% CI, 0.6-3.3 per 100,000 transfusions). There was 1 reported near-miss transfusion episode (incidence of 0.3 per 100,000 transfusions; 95% CI, <0.1-1.4 per 100,000 transfusions). A total of 304,136 U were transfused during the 2007-2010 period. There was 1 misidentification episode of a blood product transfused to the wrong patient during that period when the blood bag and patient’s armband were scanned after starting to transfuse the unit (incidence of 1 in 304,136 U or 0.3 per 100,000 transfusions; 95% CI, <0.1-1.8 per 100,000 transfusions; P=.14). There were 34 reported near-miss transfusion errors (incidence of 11.2 per 100,000 transfusions; 95% CI, 7.7-15.6 per 100,000 transfusions; P<.001).ConclusionInstitution of a computerized bar code–based blood identification system was associated with a large increase in discovered near-miss events.     

彩色标签对麻醉危机事件处理中用药差错与时间的影响

目的评价彩色标签对麻醉危机事件处理中用药差错发生率与用药时间的影响。方法采用二阶段交叉试验设计,选择20名麻醉科一线实习医生,年龄21~24岁,随机分为A组和B组,每组10人,分别使用彩色标签或传统标签标记药物对模拟人进行麻醉危机模拟事件演练;洗脱4周后,2组交换标签进行第二阶段模拟演练。在麻醉系模拟实验中心模拟真实手术室,采集演练视频,分析用药差错率及用药时间;演练结束后,针对发生用药差错的医生进行调查问卷,以了解用药差错的促成因素。结果使用彩色标签时,有12名(60%)一线实习医生至少发生一次用药差错;使用传统标签时,有16名(80%)一线实习医生至少发生一次用药差错(P>0.05)。本研究中共发生44次(8.40%)用药差错,主要为遗漏和用药剂量错误,分别为18次(40.9%)和15次(34.1%);使用彩色标签与传统标签时的平均用药差错率分别为7.2%(95%CI 4.0%~10.3%)和9.8%(95%CI 6.2%~13.5%),差异无统计学意义(P>0.05)。用药差错促成因素分析,导致用药差错的最主要因素为匆忙(29.41%)、粗心大意(17.65%)和操作不规范(13.73%)。使用不同标签时的用药时间比较,彩色标签时的用药时间(18.4±1.3)s显著快于使用传统标签(26.3±1.6)s(P<0.05)。结论各种药品准备完善下,使用彩色标签可明显缩短麻醉危机事件处理中的用药时间,但未能降低一线医生的差错发生率。     

前交叉韧带断裂后继发性半月板以及关节软骨损伤的影响因素分析

目的探讨前交叉韧带断裂后增加内外侧半月板撕裂以及关节软骨损伤风险的相关因素。 方法回顾性分析2011年3月至2018年12月期间,因前交叉韧带断裂在南京鼓楼医院骨科关节疾病诊疗中心行韧带重建术患者的临床资料,探讨受伤时长、患者性别、年龄以及体质量指数（BMI）与继发性内外侧半月板和关节软骨损伤的相关性。根据受伤时长,将患者分成≤1个月和>1个月组;根据软骨损伤Outer-bridge分度法,将患者则分成轻度损伤（0级和1级）和重度损伤（2~4级）,根据患者年龄,将患者分成≤20岁和>20岁组。根据患者BMI将患者分成BMI≤24和BMI>24组。各组间比较采用χ²检验。差异具有统计学意义的变量进行Logistic多因素回归分析。 结果本研究共纳入607例患者,其中男性459例,女性148例。平均年龄29岁（10~52岁）,平均BMI为21.3 kg/m²,平均受伤时长1年5个月（1 d~20年）。138例患者存在单纯内侧半月板撕裂,206例患者存在单纯外侧半月板撕裂,19.3%（117/607）的患者存在关节软骨的损伤。多因素分析表明,BMI和性别是外侧半月板损伤的危险因素［P=0.040,OR：1.21,95%可信区间（CI）：0.23~1.12;P=0.005,OR：0.50,95%CI：0.34~0.73］。BMI、受伤时长和性别是内侧半月板损伤的危险因素（P=0.031,OR：1.32,95%CI：1.02~1.54;P=0.009,OR：1.63,95%CI：1.16~2.28;P=0.029,OR：0.64,95%CI：0.43~0.96）。BMI和受伤时长是软骨损伤及其严重程度的危险因素（BMI：P<0.001,OR：2.31,95%CI：1.04~2.36;P<0.001,OR：2.62,95%CI：0.68~2.55;受伤时长：P<0.001,OR：2.22,95%CI：1.39~3.55;P=0.007,OR：0.54,95%CI：0.34~0.86）。 结论前交叉韧带断裂后,随着受伤时长增加,内外侧半月板及关节软骨损伤风险显著增加,所以患者应积极尽早手术。此外由于男性患者内外侧半月板损伤风险较女性患者增加,术前谈话及制定手术计划时应充分考虑到此危险因素,对于BMI>24者,由于其内外侧半月板及关节软骨较BMI≤24者损伤加重,该类患者受伤后应该尤其重视。     

Teaching Spanish to Emergency Medicine Residents

Objective: To determine the effects of teaching medical Spanish to eight PGY1 emergency medicine residents on their subsequent interactions with Spanish-speaking patients.
Methods: Eight PGY1 residents completed a 45-hour medical Spanish course administered during their first residency month. Thirty-four subsequent physician-patient interactions by these residents were audiotaped over a six-month period at a suburban teaching ED. The tapes were transcribed and analyzed for errors by a professional medical Spanish interpreter and a native Spanish speaker.
Results: Minor errors (e.g., technically incorrect grammar or vocabulary with generally appropriate patient understanding) were found in more than half of the interactions and major errors (e.g., misunderstanding duration of symptoms, misunderstanding of vocabulary) were found in 14% of the interactions. In addition, although the course was designed to supplement, not replace, professional interpreters, the residents called for an interpreter only 46% of the time.
Conclusion: Although medical language courses may be a useful adjunct to interpreters, they are not designed to replace them. Significant errors may occur when participants in such courses assume their knowledge is sufficient to obtain a good history, give patient release instructions, and provide medical care in general without an interpreter present.     

通过互联网招募MSM的HIV新发感染及队列保持影响因素分析

目的 探讨浙江省湖州市通过互联网招募的男男性行为人群(MSM)人类免疫缺陷病毒(HIV)的新发感染状况, 同时分析队列保持的相关影响因素, 为MSM艾滋病预防策略和措施的制订和调整提供科学依据。方法 利用互联网QQ群招募研究对象, 在基线调查后的6个月对MSM进行一次随访, 随访的内容包括流行病学问卷调查和HIV抗体检测。结果 随访时, MSM人群HIV新发感染率为8.6/100人年(95%CI:0～3.3), 梅毒新发感染率为6.8/100人年(95%CI:5.9~11.3);多元logistic回归分析结果表明, 在本地居住2年以上(RR=2.97, 95%CI:1.68~5.25)、纯同性恋(RR=3.02, 95%CI:1.73~5.26)、有固定的同性性伴(RR=2.12, 95%CI:1.22~3.68)、与异性发生过性行为 (RR=1.96, 95%CI:1.05~3.69)、既往检测过艾滋病(RR=1.90, 95%CI:1.09~3.30)是MSM 6个月队列保持的独立影响因素。结论 湖州市通过互联网招募的MSM人群HIV新发感染率和队列保持率较高, 在本地居住2年以上、纯同性恋、有固定的同性性伴、与异性发生过性行为、既往检测过艾滋病是MSM队列保持的影响因素。     

Impact of Wireless Electronic Medical Record System on the Quality of Patient Documentation by Emergency Field Responders during a Disaster Mass-Casualty Exercise

Introduction: The use of wireless, electronic, medical records and communications in the prehospital and disaster field is increasing.Objective: This study examines the role of wireless, electronic, medical records and communications technologies on the quality of patient documentation by emergency field responders during a mass-casualty exercise.Methods: A controlled, side-to-side comparison of the quality of the field responder patient documentation between responders utilizing National Institutes of Health-funded, wireless, electronic, field, medical record system prototype ("Wireless Internet Information System for medicAl Response to Disasters" or WIISARD) versus those utilizing conventional, paper-based methods during a mass-casualty field exercise. Medical data, including basic victim identification information, acuity status, triage information using Simple Triage and Rapid Treatment (START), decontamination status, and disposition, were collected for simulated patients from all paper and electronic logs used during the exercise. The data were compared for quality of documentation and record completeness comparing WIISARD-enabled field responders and those using conventional paper methods. Statistical analysis was performed with Fisher's Exact Testing of Proportions with differences and 95% confidence intervals reported.Results: One hundred simulated disaster victim volunteers participated in the exercise, 50 assigned to WIISARD and 50 to the conventional pathway. Of those victims who completed the exercise and were transported to area hospitals, medical documentation of victim START components and triage acuity were significantly better for WIISARD compared to controls (overall acuity was documented for 100% vs 89.5%, respectively, difference = 10.5% [95%CI = 0.5-24.1%]). Similarly, tracking of decontamination status also was higher for the WIISARD group (decontamination status documented for 59.0% vs 0%, respectively, difference = 9.0% [95%CI = 40.9-72.0%]). Documentation of disposition and destination of victims was not different statistically (92.3% vs. 89.5%, respectively, difference = 2.8% [95%CI = -11.3-17.3%]).Conclusions: In a simulated, mass-casualty field exercise, documentation and tracking of victim status including acuity was significantly improved when using a wireless, field electronic medical record system compared to the use of conventional paper methods.     

Achieving house staff competence in emergency airway management: results of a teaching program using a computerized patient simulator

OBJECTIVES: Patient simulation is emerging as a training technique in the field of medicine. It has particular application in training responses to high-risk, low-frequency clinical events, of which a typical example is in-hospital cardiac arrest. A critical element of response by the cardiac arrest team is initial airway management. In teaching hospitals, medical interns are first responders to in-hospital cardiac arrests. Our objective was to design and test a program using a computer-controlled patient simulator to train medical interns and demonstrate their competence in initial airway management. DESIGN: Prospective, randomized, controlled, unblinded trial. SETTING: Internal medicine residency training program in an urban teaching hospital. PARTICIPANTS: All 50 starting internal medicine interns in July 2002, all Advanced Cardiac Life Support certified in June 2002. INTERVENTIONS: All interns were tested in initial airway management skills and then were randomly assigned to receive either immediate or delayed individualized training using a computer-controlled patient simulator. The computer-simulated training process consisted of a scenario of respiratory arrest. The interns were challenged with the scenario twice following testing. The interns were debriefed extensively and given hands-on training by the attending using the simulator until they achieved perfect performance. MEASUREMENTS AND MAIN RESULTS: Initial airway management was divided into specific scorable steps. Individual step scores and total scores were recorded for each intern on initial and repeat testing. For 10 months following simulator training, intern airway management skills were scored in actual patient airway events. Despite recent Advanced Cardiac Life Support training and certification, all starting medical interns demonstrated poor airway management skills. The immediate training group showed significant improvement in initial airway management when tested before and 4 wks after training. In contrast, the delayed training group showed no significant improvement. Direct observation of interns in actual initial airway events revealed excellent clinical performance. CONCLUSIONS: Individualized training of medical interns using a computer-controlled patient simulator is an effective means of achieving and measuring competence in initial airway management skills. The improvement appears to be transferable to the bedside of real patients.     

Plasma matrix metalloproteinase-3 level is an independent prognostic factor in stable coronary artery disease

BACKGROUND: Recent evidence suggests the important role of matrix metalloproteinases (MMPs) in the progression of atherosclerosis and development of clinical events. We assessed the prognostic value of different plasma MMPs in patients with stable coronary artery disease (CAD). MATERIALS AND METHODS: A total of 165 consecutive nondiabetic patients with angiographically significant CAD (n = 150) or normal coronary angiograms despite exercise-induced myocardial ischemia (cardiac syndrome X, n = 15) and 17 normal subjects were evaluated. In each subject, plasma inflammatory markers including high sensitivity C-reactive protein (hsCRP) and MMP-2, 3 and 9 were measured. In CAD patients, major cardiovascular events including cardiac death, nonfatal myocardial infarction, unscheduled coronary revascularization and hospitalization as a result of unstable angina were prospectively followed up for more than 6 months. RESULTS: Plasma levels of MMPs were significantly higher in CAD patients than in those with cardiac syndrome X and in normal subjects (MMP-2: 914.76 +/- 13.20 vs. 830.79 +/- 31.95 vs. 783.08 +/- 28.40 ng mL(-1), P = 0.002; MMP-3: 129.59 +/- 4.21 vs. 116.86 +/- 8.09 vs. 91.71 +/- 9.55 ng mL(-1), P = 0.011; MMP-9: 31.42 +/- 2.84 vs. 11.40 +/- 5.49 vs. 6.71 +/- 2.89 ng mL(-1), P = 0.006). In CAD patients, there were 48 major cardiovascular events during a mean follow-up period of 17.74 +/- 0.85 months. The numbers of diseased vessels (HR = 2.19, 95% CI 1.20-1.02, P = 0.011), plasma hsCRP (HR = 2.21, 95% CI 1.18-4.11, P = 0.013) and MMP-3 level (HR = 2.46, 95% CI = 1.15-5.28, P = 0.021) were associated with the development of cardiovascular events. However, only the plasma MMP-3 level was an independent predictor of the adverse events in CAD patients (HR = 2.47, 95% CI 1.10-5.54, P = 0.028). CONCLUSIONS: Plasma MMP levels were increased in CAD patients. Plasma MMP-3 level, rather than hsCRP, was an independent prognostic marker for future cardiovascular events, suggesting its potential role in risk stratification and clinical management of stable CAD.     

Association between Bell's palsy in pregnancy and pre-eclampsia

BACKGROUND: Previous published case series have suggested an association between the onset of Bell's palsy in pregnancy and the risk of pre-eclampsia and gestational hypertension. Aim: To evaluate the period of onset of Bell's palsy in pregnancy and the associated risk of adverse maternal and perinatal events, including the hypertensive disorders of pregnancy. Study design: Case series study of consecutive female patients. METHODS: Women presenting with Bell's palsy during pregnancy or the puerperium were identified by a hospital record review at five Canadian centres over 11 years. Information was abstracted about each woman's medical and obstetrical history, period of onset of Bell's palsy, and associated maternal complications, including pre-eclampsia and gestational hypertension as well as preterm delivery and low infant birth weight (<2500 g). These rates were compared to those previously described for the province of Ontario or for Canada. RESULTS: Forty-one patients were identified. Mean onset of Bell's palsy was 35.4 weeks gestation (SD 3.9). Nine (22.0%, 95%CI 10.8-35.7) were also diagnosed with pre-eclampsia and three (7.3%, 95%CI 1.4-17.1) with gestational hypertension, together (29.3%, 95%CI 16.5-43.9) representing nearly a five-fold increase over the expected provincial/national average. There were three twin births. The observed rates of Caesarean (43.6%) and preterm (25.6%) delivery, as well as low infant birth weight (22.7%), were also higher than expected, although the rate of congenital anomalies (4.5%) was not. CONCLUSIONS: The onset of Bell's palsy during pregnancy or the puerperium is probably associated with the development of the hypertensive disorders of pregnancy. Pregnant women who develop Bell's palsy should be closely monitored for hypertension or pre-eclampsia, and managed accordingly.     

Do medical inpatients who report poor service quality experience more adverse events and medical errors?

PURPOSE: Service quality deficiencies are common in health care. However, little is known about the relationship between service quality and the occurrence of adverse events and medical errors. We hypothesized that patients who reported poor service quality were at increased risk of experiencing adverse events and medical errors. SUBJECTS AND METHODS: Patients were interviewed during and after their admissions regarding problems experienced during the hospitalizations. We used this information to identify service quality deficiencies. We then performed a blinded, retrospective chart review to independently identify adverse events and errors. We used multivariable methods to analyze whether patients who reported service quality deficiencies (obtained by patient report) experienced any adverse event, close call, or low risk error (ascertained by chart review). RESULTS: The 228 participants (mean age 63 years, 37% male) reported 183 service quality deficiencies. Of the 52 incidents identified on chart review, patients experienced 34 adverse events, 11 close calls, and 7 low risk errors. The presence of any service quality deficiency more than doubled the odds of any adverse event, close call, or low risk error (adjusted odds ratio = 2.5; 95% confidence interval = 1.2-5.4). Service quality deficiencies involving poor coordination of care (adjusted odds ratio = 4.4; 95% confidence interval = 1.4-14.0) were associated with the occurrence of adverse events and medical errors. CONCLUSIONS: Patient-reported service quality deficiencies were associated with adverse events and medical errors. Patients who report service quality incidents may help to identify patient safety hazards.     

Risk factors for fracture in a UK population: a prospective cohort study

BACKGROUND: Common clinical risk factors for fracture in older women have been identified. To date, most of these risk factors have not been confirmed in a UK population. AIM: To confirm the important risk factors for fracture in older women. DESIGN: Comprehensive cohort study (CCS) with a nested randomized controlled trial. METHODS: The CCS included 4292 women aged >70 years. We assessed potential risk factors for fracture, and followed-up participants for 24 months for incidence of non-vertebral fractures. RESULTS: Odds ratios (ORs) for predicting any non-vertebral fracture were: previous fracture, 2.67 (95%CI 2.10-3.40); a fall in the last 12 months, 2.06 (95%CI 1.63-2.59); and age (per year increase), 1.03 (95%CI 1.01-1.05). ORs for predicting hip fracture were: previous fracture, 2.31 (95%CI 1.31-4.08); low body weight (<58 kg), 2.20 (95%CI 1.28-3.77); maternal history of hip fracture, 1.68 (95%CI 0.85-3.31); a fall in the last 12 months, 2.92 (95%CI 1.70-5.01); and age (per year increase), 1.09 (95%CI 1.04-1.13). ORs for predicting wrist fracture were: previous fracture, 2.29 (95%CI 1.56-3.34); and a fall in the last 12 months, 1.60 (95%CI 1.10-2.31). Being a current smoker was not associated with an increase in risk, and was consistent across all fracture types. DISCUSSION: Older women with the clinical risk factors identified in this study should be investigated for osteoporosis or offered preventive treatment.     

Out-of-Hospital Pediatric Patient Safety Events: Results of the CSI Chart Review

Objective: Studies of adult hospital patients have identified medical errors as a significant cause of morbidity and mortality. Little is known about the frequency and nature of pediatric patient safety events in the out-of-hospital setting. We sought to quantify pediatric patient safety events in EMS and identify patient, call, and care characteristics associated with potentially severe events. Methods: As part of the Children's Safety Initiative -EMS, expert panels independently reviewed charts of pediatric critical ambulance transports in a metropolitan area over a three-year period. Regression models were used to identify factors associated with increased risk of potentially severe safety events. Patient safety events were categorized as: Unintended injury; Near miss; Suboptimal action; Error; or Management complication (“UNSEMs”) and their severity and potential preventability were assessed. Results: Overall, 265 of 378 (70.1%) unique charts contained at least one UNSEM, including 146 (32.8%) errors and 199 (44.7%) suboptimal actions. Sixty-one UNSEMs were categorized as potentially severe (23.3% of UNSEMs) and nearly half (45.3%) were rated entirely preventable. Two factors were associated with heightened risk for a severe UNSEM: (1) age 29 days to 11 months (OR 3.3, 95% CI 1.25-8.68); (2) cases requiring resuscitation (OR 3.1, 95% CI 1.16-8.28). Severe UNSEMs were disproportionately higher among cardiopulmonary arrests (8.5% of cases, 34.4% of severe UNSEMs). Conclusions: During high-risk out-of-hospital care of pediatric patients, safety events are common, potentially severe, and largely preventable. Infants and those requiring resuscitation are important areas of focus to reduce out-of-hospital pediatric patient safety events.     

SpyGlass治疗难治性胆管结石有效性和安全性的Meta分析

目的 评价SpyGlass治疗难治性胆管结石（DBDS）的有效性和安全性,并比较第一代与第二代SpyGlass、液电碎石与激光碎石治疗DBDS的疗效差异。方法 检索多个中英文数据库建库至2021年2月的研究。通过纽卡斯尔-渥太华量表（NOS）和JADAD量表评估不同类型研究的方法学质量,并使用随机效应模型合并效应量。重要结局包括结石完全清除率、结石单次清除率、取石次数和不良事件发生率。结果 最终37项研究符合纳入标准,包含3 728例患者。结石完全清除率为0.947（95%CI：0.920～0.970）,结石单次清除率为0.747（95%CI：0.682～0.807）,取石次数为1.10次（95%CI：1.080～1.120）,不良事件发生率为0.065（95%CI：0.046～0.087）;二代SpyGlass在结石完全清除率、结石单次清除率、取石次数上优于一代SpyGlass（97.3%和92.2%、80.3%和67.8%、1.03和1.27次）;激光碎石在结石完全清除率、结石单次清除率、取石次数、不良事件发生率上优于液电碎石（97.8%和91.0%、80.4%和70.1%、1.06和1.19次、6.5%和7.8%）。结论 常规取石方法失败时,SpyGlass是治疗DBDS的一种安全有效的方法,二代SpyGlass结合激光碎石可能会得到更好的疗效。     

Analysis of ABO discrepancies occurring in 35 French hospitals

BACKGROUND: The risk of immunohemolytic reaction owing to ABO-mismatched mistransfusion is 100 to 1000 times higher than the risk of viral infection. Like analysis of incident reports, evaluation of near-miss events can provide useful insight into hazardous situations for mis-matched blood transfusion. The aim of this prospective study was to assess the incidence and root causes of all ABO discrepancies, detected by a central hematology laboratory, in blood samples referred from 35 district hospitals. STUDY DESIGN AND METHODS: ABO discrepancies were detected by comparing either two current blood specimens or a current and historical specimen collected over a 5-year study period. Discrepancies were investigated by retyping new samples, checking sample identification, and reviewing previous hospital records. RESULTS: A total of 118 ABO discrepancies were discovered in a series of 407,769 tests carried out during the study period. The incidence of ABO discrepancies was 1 per 3,400. This figure was 10 times higher than the incidence of ABO-mismatched transfusions. Most of these ABO discrepancies were due to phlebotomy errors, that is, collection from wrong patient. The second most common cause involved clerical errors during patient registration or identification. CONCLUSION: ABO discrepancies can result from errors made not only by the medical staff during phlebotomy but also to by the clerical staff during registration and identification. These findings emphasize the need to standardize data transmission between health care personnel.     

非瓣膜性心房颤动患者并发缺血性脑卒中的多因素分析

目的探索非瓣膜性心房颤动患者并发缺血性脑卒中的危险因素及保护因素。方法对入选的901例非瓣膜性心房颤动患者进行随访3年,收集其一般状况、相关疾病病史和服用药物的临床资料,按照随访期间是否发生缺血性脑卒中分为卒中组(n=39)和非卒中组(n=862),并应用多因素Logistic回归分析其发生卒中的危险因素及保护因素。结果发生缺血性脑卒中的危险因素有年龄(OR=1.087,95%CI:0.240~1.315)、心力衰竭病史(OR=2.245,95%CI:1.033~4.880)、缺血性卒中或短暂性脑缺血发作病史(OR=5.265,95%CI:2.545~10.889)、其他全身性栓塞病史(OR=5.034,95%CI:1.307~19.386)、利尿剂的应用(OR=3.505,95%CI:1.715~7.165);保护因素有血管紧张素受体阻滞剂(ARB)的应用(P0.05,OR=0.316,95%CI:0.122~0.815)。结论年龄、心力衰竭、缺血性卒中或短暂性脑缺血发作、其他全身性栓塞病史,以及利尿剂的应用,是非瓣膜性心房颤动患者并发缺血性脑卒中的独立危险因素,而ARB的应用是保护因素。