Journal of evaluation in clinical practice
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Reducing preventable harm from repeat medication prescriptions is a patient safety priority worldwide. In the United Kingdom, repeat prescriptions items issued has doubled in the last 20 years from 5.8 to 13.3 items per patient per annum. This has significant resource implications and consequences for avoidable patient harms. Consequently, we aimed to test a risk management model to identify, measure, and reduce repeat prescribing system risks in primary care. ⋯ The risk management model tested uncovered important safety concerns and facilitated the development and communication of related improvement recommendations. System-wide information on hazardous repeat prescribing and how this could be mitigated is very limited. The approach reported may have potential to close this gap and improve the reliability of general practice systems and patient safety, which should be of high interest to primary care organisations internationally.
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Diagnostic uncertainty is often encountered in a medical practice. Patients with ambiguous, uncertain, and undiagnosed problems are frequently referred for second opinions. Comparing referral diagnoses to final diagnoses provides an opportunity to determine how frequently final diagnoses vary and changes the direction of medical care. ⋯ Referrals to advanced specialty care for undifferentiated problems are an essential component of patient care. Without adequate resources to handle undifferentiated diagnoses, a potential unintended consequence is misdiagnoses resulting in treatment delays and complications leading to more costly treatments.
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Observational Study
Perioperative hypothermia during hip fracture surgery: An observational study.
Elderly patients are at high risk of accidental perioperative hypothermia. The primary objective of this study was to measure the changes in body temperature and the incidence of hypothermia in elderly patients undergoing hip fracture surgery. ⋯ These results indicate that despite the use of active warming methods for most patients, significant hypothermia is still an issue amongst elderly patients undergoing hip fracture surgery. Further improvement is necessary to prevent hypothermia in this high-risk group of patients.
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Comparative Study
A comparison of approaches for stratifying on the propensity score to reduce bias.
Stratification is a popular propensity score (PS) adjustment technique. It has been shown that stratifying the PS into 5 quantiles can remove over 90% of the bias due to the covariates used to generate the PS. Because of this finding, many investigators partition their data into 5 quantiles of the PS without examining whether a more robust solution (one that increases covariate balance while potentially reducing bias in the outcome analysis) can be found for their data. Two approaches (referred to herein as PSCORE and PSTRATA) obtain the optimal stratification solution by repeatedly dividing the data into strata until balance is achieved between treatment and control groups on the PS. These algorithms differ in how they partition the data, and it is not known which is better, or if either is better than a 5-quantile default approach, for reducing bias in treatment effect estimates. ⋯ Investigators should routinely use stratification approaches that obtain the optimal stratification solution, rather than simply partitioning the data into 5 quantiles of the PS. Moreover, MMWS (in conjunction with an optimal stratification approach) should be considered as an alternative to IPTW in studies that use PS weights.
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To evaluate the effect of an electronic medication administration record (eMAR) application on the rate of medication errors in medication administration recording (ME-MAR). ⋯ Use of the eMAR application significantly reduces the rate of ME-MAR and their potential risk. The main cause of ME-MAR was the failure to follow work procedures.