Analysis of medication errors during anaesthesia in the first 4000 incidents reported to webAIRS

Medication error is a well-recognised cause of harm to patients undergoing anaesthesia. From the first 4000 reports in the webAIRS anaesthetic incident reporting system, we identified 462 reports of medication errors. These reports were reviewed iteratively by several reviewers paying particular attention to their narratives. The commonest error category was incorrect dose (29.4%), followed by substitution (28.1%), incorrect route (7.6%), omission (6.5%), inappropriate choice (5.8%), repetition (5.4%), insertion (4.1%), wrong timing (3.5%), wrong patient (1.5%), wrong side (1.5%) and others (6.5%). Most (58.9%) of the errors resulted in at least some harm (20.8% mild, 31.0% moderate and 7.1% severe). Contributing factors to the medication errors included the presence of look-alike medications, storage of medications in the incorrect compartment, inadequate labelling of medications, pressure of time, anaesthetist fatigue, unfamiliarity with the medication, distraction, involvement of multiple people and poor communication. These data add to current evidence suggesting a persistent and concerning failure effectively to address medication safety in anaesthesia. The wide variation in the nature of the errors and contributing factors underline the need for increased systematic and multifaceted efforts underpinned by a strengthening of the current focus on safety culture to improve medication safety in anaesthesia. This will require the concerted and committed engagement of all concerned, from practitioners at the clinical workface, to those who fund and manage healthcare.

Unveiling Phase Transitions In 1D Systems With Short-Range Interactions

The statement that any phase transition is related to the appearance or disappearance of long-range spatial correlations precludes a finite transition temperature in one-dimensional (1D) systems. In this paper we demonstrate that the 1D Ising model with short-range exchange interactions exhibits a second-order phase transition at a finite temperature relying on the proper choice of the order parameter. To accomplish this, we combined analytical calculations and high-precision entropic sampling simulations and chose a slightly different order parameter, namely the module of the magnetization. Notably, we detected a phase transition with a corresponding critical temperature around 15 K, which is in excellent agreement with experimental results. Our study indicates that an inappropriate choice of the order parameter may mask phase transitions in one-dimensional systems.

Antibiotics prescription for targeted therapy of pediatric invasive pneumococcal diseases in China: a multicenter retrospective study

Background Streptococcus pneumoniae (S. pneumoniae) is a major cause of bacterial meningitis, septicemia and pneumonia in children. Inappropriate choice of antibiotic can have important adverse consequences for both the individual and the community. Here, we focused on penicillin/cefotaxime non-susceptibility of S. pneumoniae and evaluated appropriateness of targeted antibiotic therapy for children with IPD (invasive pneumococcal diseases) in China. Methods A multicenter retrospective study was conducted in 14 hospitals from 13 provinces in China. Antibiotics prescription, clinical features and resistance patterns of IPD cases from January 2012 to December 2017 were collected. Appropriateness of targeted antibiotics therapy was assessed. Results 806 IPD cases were collected. The non-susceptibility rates of S. pneumoniae to penicillin and cefotaxime were 40.9% and 20.7% respectively in 492 non-meningitis cases, whereas those were 73.2% and 43.0% respectively in 314 meningitis cases. Carbapenems were used in 21.3% of non-meningitis cases and 42.0% of meningitis cases for targeted therapy. For 390 non-meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were used in 17.9% and 8.7% of cases respectively for targeted therapy. For 179 meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were prescribed in 55.3% and 15.6% of cases respectively. Overall, inappropriate targeted therapies were identified in 361 (44.8%) of 806 IPD cases, including 232 (28.8%) cases with inappropriate use of carbapenems, 169 (21.0%) cases with inappropriate use of vancomycin and 62 (7.7%) cases with inappropriate use of linezolid. Conclusions Antibiotic regimens for IPD definite therapy were often excessive with extensive prescription of carbapenems, vancomycin or linezolid in China. Antimicrobial stewardship programs should be implemented to improve antimicrobial use.

A Retrospective Analysis of Pulmonary Cryptococcosis Following Kidney Transplantation: Clinical Presentation, Treatment and Effectiveness

Background: The use of immunosuppressors and a relatively weaken cell-mediated immunity make organ transplant recipients particularly vulnerable to cryptococcosis infection. Patients infected usually present only nonspecific symptoms, making it extremely possible for misdiagnosis and inappropriate choice of therapeutic approach. Methods: We compiled and analysed data of patients received kidney transplant in our hospital between April 2006 to January 2021. Results: 18 patients were enrolled into the study, ranging between 27-68 years old. The median time from kidney transplantation to pathologically-confirmed infection was 4.09 years. All patient’s respiratory system was affected, showing symptoms including sputum-producing cough and fever. 3 patients (16.67%) also developed central nervous system (CNS) infections. Nodule-shaped infectious sites were frequently observed (10, 58.82%) in chest CT. Blood works showed no specific changes. 7 patients received thoracoscopic lobectomy in suspicion of lung cancer. 3 patients first received antifungal therapy for a period of time and then underwent thoracoscopic lobectomy. No recurrence whatsoever was observed in all 10 surgically-intervened patients. 8 patients received only antifungal therapy, 7 of them showed a substantial reduction in the size of the infectious site. Fluconazole was most frequently prescribed for antifungal therapy. Conclusion: Most patients developed pulmonary cryptococcosis 2 years after transplantation. Patients usually demonstrate symptoms like fever and sputum-producing cough. The possibility of cryptococcal meningitis shouldn’t be ruled out if corresponding symptoms occur. CT presentation may be confused with lung cancer. Fluconazole is commonly prescribed for treatment and can usually yield satisfied outcome. In patients received unsatisfactory antifungal therapy, surgical therapy should be considered a possibility.

TOUCH® Prosthesis for Thumb Carpometacarpal Joint Osteoarthritis: A Prospective Case Series

The dual mobility concept currently represents the newest generation of thumb carpometacarpal prostheses. The aim of this study was to evaluate the short-term outcomes of TOUCH® prosthesis. From September 2019 to July 2020, 40 prosthesis were implanted in 37 patients suffering from symptomatic stage III osteoarthritis. All included patients with a median age of 57.7 (IQR: 13.6) finished the systematic follow-up regimen (4, 8, 16 weeks, 6, and 12 months postoperatively). All parameters significantly improved (p < 0.0001) compared to the preoperative status. At 1 year follow-up, median DASH Scores decreased from 54 (IQR 22) to 12 (IQR 28) and pain levels improved from 8 (IQR 2) to 1 (IQR 2). Moreover, key-pinch strength increased from 3.8 (2.0) to 5.8 (2.5), while palmar abduction, radial abduction, and opposition also significantly improved. 35/37 patients were satisfied with the functional outcomes. We observed 10 complications, of which 6 were tendon-related issues, and 2 were due to an inappropriate choice of neck size. We could detect one dislocation but no evidence of cup loosening, tilting or subsidence in any patient. Despite the occurrence of some complications, we recommend implantation of this prosthesis type due to favorable clinical and radiological performance.

Adaptive Super-Twisting Sliding Mode Control of Permanent Magnet Synchronous Motor

The work has developed an innovative speed loop controller for the permanent magnet synchronous motor (PMSM) system. The main advantage of the presented method lies in the fact that the boundary of the lumped disturbance is not required. Under this case, the severe chattering caused by the inappropriate choice of parameters can be avoided. Finally, the simulation and experimental consequences are given to demonstrate the efficiency of the proposed algorithm used to control a PMSM system subject to the lumped disturbance.

Antibiotics prescription for targeted therapy of pediatric invasive pneumococcal diseases in China: a multicenter retrospective study

Background: Streptococcus pneumoniae (S. pneumoniae) is a major cause of bacterial meningitis, septicemia and pneumonia in children. Inappropriate choice of antibiotic can have important adverse consequences for both the individual and the community. Objective: To evaluate antibiotics therapy for children with IPD (invasive pneumococcal diseases) in China.Methods: A multicenter retrospective study was conducted in 14 hospitals from 13 provinces in China. Antibiotics prescription, clinical features and resistance patterns of IPD cases from January 2012 to December 2017 were collected. Appropriateness of targeted antibiotics therapy was assessed.Results: 806 IPD cases were collected. The non-susceptibility rates of S. pneumonia to penicillin and cefotaxime were 40.9% and 20.7% respectively in 492 non-meningitis cases, whereas those were 73.2% and 43.0% respectively in 314 meningitis cases. Carbapenems were used in 21.3% of non-meningitis cases and 42.0% of meningitis cases. For 390 non-meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were used in 17.9% and 8.7% of cases respectively. For 179 meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were prescribed in 55.3% and 15.6% of cases respectively. Overall, therapies resulted inappropriate in 361 (44.8%) of 806 IPD cases, including 232 (28.8%) cases with inappropriate use of carbapenems, 169 (21.0%) cases with inappropriate use of vancomycin and 62 (7.7%) cases with inappropriate use of linezolid.Conclusions: Antibiotic regimens for IPD definite therapy were often excessive with extensive prescription of carbapenems, vancomycin or linezolid in China. Antimicrobial stewardship programs should be implemented to improve antimicrobial use.

KEEFEKTIFAN KALIMAT DALAM TEKS EKSPOSISI SISWA KELAS VIII SMP NEGERI 1 TANJUNG RAYA

ABSTRACT The purpose of this study is threefold, namely (1) the effectiveness of the sentence in the exposition essay of VIII grade students of SMP Negeri 1 Tanjung Raya in terms of sentence structure, (2) choice of words, and (3) spelling use. The type of research used is qualitative research using descriptive methods. Data of research is the results of identification of sentence ineffectiveness used in essays of exposition and sourced from the object of research. The technique of validating the data used is the thick description technique. Data were analyzed using simple statistical descriptive techniques and qualitative analysis using formats. Of 264 sentences used as research data, there were 47 effective sentences and 199 sentences were not effective. This means that there is still a lack of understanding of VII grade students of SMP Negeri 1 Tanjung Raya about effective sentences in exposition essays. The ineffectiveness of these 46 sentences is because they do not meet one or more of the indicators used in this study. Second, 42 sentences are not effective in terms of sentence structure. this is because one element is incomplete. Third, 125 sentences are not effective in terms of the use of word choices. This is due to inappropriate choice of words. Fourth, 97 sentences are not effective in terms of spelling usage. 48 sentences on the inaccuracy of the use of capital letters, 5 sentences on the inaccuracy of the use of dots, and 44 sentences on the inaccuracy of using commas. Kata kunci: Keefektifan, Kalimat, Teks Eksposisi

Absence of DOA Effect but No Proper Test of the Lumberjack Effect: A Reply to Jamieson and Skraaning (2019)

Objective The aim was to evaluate the relevance of the critique offered by Jamieson and Skraaning (2019) regarding the applicability of the lumberjack effect of human–automation interaction to complex real-world settings. Background The lumberjack effect, based upon a meta-analysis, identifies the consequences of a higher degree of automation—to improve performance and reduce workload—when automation functions as intended, but to degrade performance more, as mediated by a loss of situation awareness (SA) when automation fails. Jamieson and Skraaning provide data from a process control scenario that they assert contradicts the effect. Approach We analyzed key aspects of their simulation, measures, and results which we argue limit the strength of their conclusion that the lumberjack effect is not applicable to complex real-world systems. Results Our analysis revealed limits in their inappropriate choice of automation, the lack of a routine performance measure, support for the lumberjack effect that was actually provided by subjective measures of the operators, an inappropriate assessment of SA, and a possible limitation of statistical power. Conclusion We regard these limitations as reasons to temper the strong conclusions drawn by the authors, of no applicability of the lumberjack effect to complex environments. Their findings should be used as an impetus for conducting further research on human–automation interaction in these domains. Applications The collective findings of both Jamieson and Skraaning and our study are applicable to system designers and users in deciding upon the appropriate level of automation to deploy.