Leveraging Computerized Sign-Out to Increase Error Reporting and Addressing Patient Safety in Graduate Medical Education

SUMMARY Setting Electronic reporting systems are important components of the patient-safety movement but have been problematic particularly in capturing information from physicians. Objective In an attempt to increase error reporting in our community hospital residency program, we devised a convenient safety log integrated into the computerized resident-patient sign-out. Measurements and Main Results Safety-log events are discussed in weekly safety reports with emphasis on developing a safety culture and preventing further events. We report our experience implementing the safety log. The program quadrupled our contribution to the hospital quality assurance system and has led to significant system innovations. Challenges have included sharing information and improving accountability without humiliating participants or alienating co-workers, as well as sustaining the project over time. Conclusion Residents are uniquely placed to provide insight into hospital systems. An error-reporting system based in a resident sign-out can leverage this role into an important tool for safety education and care improvement.     

Two cases of pulmonary aspergillosis successfully treated with combinated micafungin and itraconazole therapy

We report 2 cases of pulmonary aspergillosis treated successfully by combining micafungin and traconazole. Case 1: A 51-year-old man with hemoptysis and dyspnea on effort treated for pulmonary tuberculosis and aspergillosis was found on chest CT on admission to have a fungus ball in the left upper lobe and increasing consolidation around the cavity of both lung fields. Bronchoscopy proved positive for aspergillus PCR in bronchial lavage. He was diagnosed with chronic necrotizing pulmonary aspergillosis, based on clinical and radiological findings and the positive reaction for aspergillus PCR. He was treated with micafungin alone at first, this proved ineffective, so itraconazole was added, resulting in improvement. Case 2: A 24-year-old woman with stabilized Hodgkin's disease (mixed). She had suffered from a cough and back pain, and chest CT showed increasing consolidation inside and around a giant bulla. She was diagnosed with chronic necrotizing pulmonary aspergillosis, based on isolation for Aspergillus sp. in sputum culture and a positive reaction for Aspergillus antigen in bronchial lavage and Aspergillus antibody in serum. She was treated with the combined micafungin and itraconazole, which rapidly improved symptoms and radiological findings. Pulmonary aspergillosis therapy is often difficult, because delivery of the drug to the infection site is limited and drug tolerance is poor. We found that combination micafungin and itraconazole therapy is tolerable and effective in these cases.     

眼部中药薰蒸穴位按摩防治视频终端视疲劳

目的观察视频终端(VDT)作业时间的累计暴露剂量(ICE)与眼表条件改变的关系,评价眼部中药薰蒸穴位按摩治疗VDT视疲劳的临床疗效。方法根据ICE将30例VDT视疲劳患者分为低暴露组(4000h)与高暴露组(≥4000h),以VDT视疲劳症状积分、泪膜破裂时间(BUT)、泪液分泌试验(SIT)及角膜荧光素染色(FL)积分为观测指标,采用眼部中药薰蒸穴位按摩治疗,隔天一次,十次为一疗程,观察一疗程。结果①高暴露组的BUT、SIT、FL异常例数均明显高于低暴露组(P0.01)。②治疗后,两组患者的症状积分、BUT、SIT、FL均有改善(P0.05),低暴露组症状积分改善程度优于高暴露组(P0.05),低暴露组疗效优于高暴露组(P0.01)。结论 VDT视疲劳患者中随着ICE的增加,眼表异常例数增加;眼部中药薰蒸穴位按摩可有效改善眼表条件及VDT视疲劳症状,且对于ICE较低者症状改善更优,疗效更好。     

How functions in leg development during Drosophila metamorphosis.

The Drosophila how gene encodes a KH RNA binding protein with strong similarity to GLD-1 from nematodes and QK1 from mice. Here, we investigate the function of how during metamorphosis. We show that how RNA and protein are present in a variety of tissues, and phenotypic analyses of how mutants reveal multiple lethal phases and defects during metamorphosis. In addition to previously reported abnormalities in muscle and wing development, how mutants exhibit defects in leg development. how mutant leg imaginal discs undergo cell shape changes associated with elongation, but are oriented improperly, do not evert normally, and often remain incased in peripodial epithelium longer than normal. Consequently, how mutants exhibit short, crooked legs. Our findings suggest that how functions in interactions between imaginal epithelium, peripodial epithelium, and larval epidermal cells during imaginal disc eversion.     

Online Availability Check of Teleradiology Components

For a region-wide teleradiology network in Germany a vendor-independent Uptime-server concept was defined. The Uptime-server was realized for the availability check and prospective error-detection of the emergency teleradiology servers and clients based on encrypted digital imaging and communication in medicine (DICOM)-e-mail transfers. The concept and the experiences of 2 years of use with more than 30 clients and servers in 15 hospitals and in nine other regional partners are shown. The Uptime-server does provide automated availability checks for all servers and clients, automated checks of the download speed of the Internet lines, and a graphical user interface for the clinical user and the system administrator. A clinical user can display the availability information from all clients and servers in the network (see ). In case of malfunctions during an emergency transfer, immediate reactions are possible, often without the need for help of a hotline or a system administrator. The chosen Uptime-server concept proofed to be reliable; it worked with products from nine different manufacturers without problems. Its statistical output can be used to fulfill the legal requirements of regular availability checks for teleradiology lines.     

Differing lung function development in infants with univentricular hearts compared with healthy infants

Aim: To compare the difference in lung function development of healthy controls and patients with univentricular hearts from birth prior to surgery and during the first year of life when cardiac shunt procedures and the cavopulmonary connection are required. Methods: Tidal flow‐volume measurements and single‐occlusion tests were performed from birth serially up to 18 months of age on 28 unsedated spontaneously breathing infants with univentricular hearts and 58 healthy control infants. Results: Infants with univentricular heart physiology had low tidal volumes, low compliance of the respiratory system and high respiratory rate at birth, which over time normalized, whereas the peak expiratory flow increased during the study period. The lung function measured at birth was predictive of later lung function measurements. Conclusion: The pattern of lung function development is different in the patients with univentricular hearts compared to healthy controls. Lung function measured at birth is predictive of later lung function.     

Curettage and multiple needle puncture-assisted methyl-aminolaevulinate photodynamic therapy of basal cell carcinoma

Background

The use of skin puncture techniques may facilitate the delivery of topically applied drugs for photodynamic therapy (PDT).

Objectives

The main aim of this prospective study was to evaluate the efficacy and cosmetic outcome of curettage, multiple needle puncture, and methyl-aminolaevulinate (MAL)-PDT in basal cell carcinoma (BCC).

Materials and methods

All tumours received curettage and 15-20 needle punctures/cm² before two sessions of MAL-PDT. The primary endpoint was clinically observed recurrence at follow-up. Overall, 284 patients with 299 histologically verified BCC (70 superficial, 190 nodular, 35 aggressive, and four not subtyped) were included. Following PDT, the mean follow-up period was 6.7 months.

Results

After follow-up, 274 (92%) of 299 treatment sites showed no clinical signs of recurrence, with >90% complete response for each BCC subtype. The cosmetic outcome was rated as excellent/good in 81% of cases.

Conclusion

Good short-term treatment results were shown following curettage, multiple needle puncture, and MAL-PDT for BCC of different subtypes.

     

Peptide-based immunotherapy: a novel strategy for allergic disease

The T-cell component of the antigen-specific immune response is the target of various novel interventions to modify chronic immunologic disorders, such as allergic diseases. Recent clinical trials have evaluated the safety and efficacy of therapeutic vaccines consisting of short, synthetic, allergen-derived peptides, corresponding to T-cell epitopes from the eliciting antigen. The main advantage of such an approach is the reduction in systemic, immunoglobulin E-mediated adverse events compared with existing whole allergen immunotherapy, often referred to as 'allergy shots'. T-cell peptide epitopes, although capable of inducing immunologic tolerance, are short linear structures that have reduced ability to cross-link mast cell- and basophil-bound immunoglobulin E. The precise mechanism of tolerance induction remains incompletely defined. However, recent data indicate that peptide therapy induces/expands a population of antigen-specific regulatory T-cells. A novel form of treatment combining efficacy with a substantially decreased occurrence of adverse events is likely to have a major impact on the management and prevalence of allergic diseases. Furthermore, the principles of epitope-specific therapy hold promise for the development of therapeutic vaccines for the treatment of autoimmune diseases.