Reasons for not reporting patient safety incidents in general practice: A qualitative study

Objective

To explore the reasons for not reporting patient safety incidents in general practice.

Design

Qualitative interviews with general practitioners and members of the project group.

Setting

General practice clinics in the Region of Northern Jutland in Denmark.

Subjects

Twelve general practitioners.

Main outcome measures

The experiences and reflections of the involved professionals with regard to system use and non-use.

Results

While most respondents were initially positive towards the idea of reporting and learning from patient safety incidents, they actually reported very few incidents. The major reasons for the low reporting rates are found to be a perceived lack of practical usefulness, issues of time and effort in a busy clinic with competing priorities, and considerations of appropriateness in relation to other professionals.

Conclusion

The results suggest that the visions of formal, comprehensive, and systematic reporting of (and learning from) patient safety incidents will be quite difficult to realize in general practice. Future studies should investigate how various ways of organizing incident reporting at the regional level influence local activities of reporting and learning in general practice.Key Words: Denmark, general practice, incident reporting, interviews, patient safety, qualitative researchPrevious studies have reported positive attitudes to incident reporting among Danish GPs.

• The results suggest, however, that formal reporting of patient safety incidents may be more attractive to GPs as an idea than as an integrated activity in a busy clinic. While most GPs in this study were initially positive towards the idea of reporting, they actually reported very few incidents.
• The reasons for the low reporting rates were found to be a perceived lack of usefulness, issues of time and effort, and considerations of appropriateness.
• Future research should compare how various ways of implementing and organizing incident reporting influence local activities of reporting and learning.

     

Illness, everyday life and narrative montage: the visual aesthetics of cancer in Sara Bro's Diary

This article presents a study of Sara Bro's Diary (2004), a book montage of images and texts recording the experiences of a Danish breast cancer survivor, Sara Bro. It examines two montages of photography and text, drawing on Roland Barthes' concept of 'the third meaning' to explain and discuss the effect of the layered meanings in the montage alongside their multi-medium and self-referential expression. The discussion is centred on the aesthetic practices that are invited by Bro's book montage. The article considers how the juxtaposition of images and texts are experienced and co-created by the reader. It points to the effect of the aesthetics of disguise and carnival implicit in the visual-verbal montage and argues that these generate a third meaning. This meaning is associated with the breast cancer experience but is not directly discernible in the montage. The article concludes by discussing how Bro's montage acts as an ideological statement, subverting or 'poaching on' the health care system.     

Activation of PAR‐2 Elicits NO‐Dependent and CGRP‐Independent Dilation of the Dural Artery

(Headache 2010;50:1017‐1030) Objectives.— The goal of this study was to determine the vascular effects of protease‐activated receptor‐2 (PAR‐2) activation in the rat cranial vasculature. Background.— The role of PAR‐2 in pain and inflammatory conditions has been established but the information available on its effects and receptor distribution in the trigeminal vascular axis is limited. We studied the dilatory function and expression of PAR‐2 in the neuro‐vascular circuit, critical in migraine pathogenesis. We also investigated the interaction of PAR‐2 with calcitonin gene‐related peptide (CGRP) and dural mast cells. Methods.— We used an improved model of intravital microscopy on the closed cranial window in rats to study the vascular effects of PAR‐2 activating peptides (PAR‐2 APs; SLIGRL‐NH₂, 2‐Furoyl‐LIGRLO‐NH₂) in the dural vasculature. Measurement of immunoreactive CGRP in skull halves and in trigeminal nucleus caudalis was done by using an enzyme‐linked immunosorbent assay. We also analyzed the presence of PAR‐2 in different migraine relevant tissues by quantitative real‐time PCR and Western blot analysis. Results.— PAR‐2 APs and trypsin induced a dose‐dependent increase in dural artery diameter. The topical application of a nonspecific nitric oxide synthase (NOS) inhibitor, L‐N^G‐Nitroarginine methyl ester, attenuated SLIGRL‐NH₂ responses. Olcegepant, a CGRP receptor antagonist, did not a have significant effect on the SLIGRL‐NH₂ responses, though exogenous CGRP responses were completely blocked. There was no significant release of CGRP from skull halves incubated with SLIGRL‐NH₂ as compared with those incubated with the corresponding negative peptide. Chronic mast cell degranulation did not change the vascular effects of PAR‐2 APs. mRNA and protein expression of PAR‐2 were found throughout trigeminovasuclar axis. Conclusion.— PAR‐2 activation leads to vasodilation of dural arteries and these responses are partially mediated by nitric oxide. As PAR‐2 is present throughout trigeminovasuclar axis, it may have a role in migraine pathogenesis, independent of CGRP and mast cell mediated mechanism.     

Altering β-cell number through stable alteration of miR-21 and miR-34a expression

Aim: An insufficient functional β-cell mass is a prerequisite to develop diabetes. Thus, means to protect or restore β-cell mass are important goals in diabetes research. Inflammation and proinflammatory cytokines play important roles in β-cell dysfunction and death, and recent data show that 2 miRNAs, miR-21 and miR-34a, may be involved in mediating cytokine-induced β-cell dysfunction. Therefore, manipulation of miR-21 and miR-34a levels may potentially be beneficial to β cells. To study the effect of long-term alterations of miR-21 or miR-34a levels upon net β-cell number, we stably overexpressed miR-21 and knocked down miR-34a, and investigated essential cellular processes.   Materials and Methods: miRNA expression was manipulated using Lentiviral transduction of the β-cell line INS-1. Stable cell lines were generated, and cell death, NO synthesis, proliferation, and total cell number were monitored in the absence or presence of cytokines. Results: Overexpression of miR-21 decreased net β-cell number in the absence of cytokines, and increased apoptosis and NO synthesis in the absence and presence of cytokines. Proliferation was increased upon miR-21 overexpression. Knockdown of miR-34a increased net β-cell number in the absence of cytokines, and reduced apoptosis and NO synthesis in the absence and presence of cytokines. Proliferation was decreased upon miR-34a knockdown. Conclusion: As overexpression of miR-21 increased proliferation, but also apoptosis and NO synthesis, the potential of miR-21 as a therapeutic agent to increase β-cell survival is doubtful. Knockdown of miR-34a slightly decreased proliferation, but as apoptosis and NO synthesis were highly reduced, miR-34a may be further investigated as a therapeutic target to reduce β-cell death and dysfunction.     

Glucose clearance is higher in arm than leg muscle in type 2 diabetes

Insulin-mediated glucose clearance (GC) is diminished in type 2 diabetes. Skeletal muscle has been estimated to account for essentially all of the impairment. Such estimations were based on leg muscle and extrapolated to whole body muscle mass. However, skeletal muscle is not a uniform tissue and insulin resistance may not be evenly distributed. We measured basal and insulin-mediated (1 pmol min⁻¹ kg⁻¹) GC simultaneously in the arm and leg in type 2 diabetes patients (TYPE 2) and controls (CON) ( n = 6 for both). During the clamp arterio-venous glucose extraction was higher in CON versus TYPE 2 in the arm (6.9 ± 1.0 versus 4.7 ± 0.8%; mean ± s.e.m. ; P = 0.029), but not in the leg (4.2 ± 0.8 versus 3.1 ± 0.6%). Blood flow was not different between CON and TYPE 2 but was higher ( P < 0.05) in arm versus leg (CON: 74 ± 8 versus 56 ± 5; TYPE 2: 87 ± 9 versus 43 ± 6 ml min⁻¹ kg⁻¹ muscle, respectively). At basal, CON had 84% higher arm GC ( P = 0.012) and 87% higher leg GC ( P = 0.016) compared with TYPE 2. During clamp, the difference between CON and TYPE 2 in arm GC was diminished to 54% but maintained at 80% in the leg. In conclusion, this study shows that glucose clearance is higher in arm than leg muscles, regardless of insulin resistance, which may indicate better preserved insulin sensitivity in arm than leg muscle in type 2 diabetes.     

Storytelling as part of cancer rehabilitation to support cancer patients and their relatives

ABSTRACT

Previous research on psychosocial support for cancer-related concerns has primarily focused on either patients or their relatives, although limited research is available on how patients and their relatives can be supported together. The aim of this article is to explore the use of storytelling as a part of a residential cancer rehabilitation intervention for patients together with their relatives, with a specific focus on their management of cancer-related concerns. Ten pairs participated in the intervention and data were generated through ethnographic fieldwork, including participant observations, informal conversations and follow-up interviews conducted one month after completing the intervention. Analysis was performed drawing on narrative theory combined with social practice theory. The results demonstrate that the use of storytelling and metaphors intertwined with other course activities, such as dancing and arts & crafts, provided the patients and their relatives with strategies to manage cancer-related concerns, which they were later able to apply in their everyday lives. The study results may be useful to other professionals in clinical practice for rehabilitation purposes for addressing issues of fear and worry.