Michael Mira

Patient safety events reported in general practice: a taxonomy

Objective: To develop a taxonomy describing patient safety events in general practice from reports submitted by a random representative sample of general practitioners (GPs), and to determine proportions of reported event types. Design: 433 reports received by the Threats to Australian Patient Safety (TAPS) study were analysed by three investigating GPs, classifying event types contained. Agreement between investigators was recorded as the taxonomy developed. Setting and participants: 84 volunteers from a random sample of 320 GPs, previously shown to be representative of 4666 GPs in New South Wales, Australia. Main outcome measures: Taxonomy, agreement of investigators coding, proportions of error types. Results: A three-level taxonomy resulted. At the first level, errors relating to the processes of healthcare (type 1; n = 365 (69.5%)) were more common than those relating to deficiencies in the knowledge and skills of health professionals (type 2; n = 160 (30.5%)). At the second level, five type 1 themes were identified: healthcare systems (n = 112 (21.3%)); investigations (n = 65 (12.4%)); medications (n = 107 (20.4%)); other treatments (n = 13 (2.5%)); and communication (n = 68 (12.9%)). Two type 2 themes were identified: diagnosis (n = 62 (11.8%)) and management (n = 98 (18.7%)). The third level comprised 35 descriptors of the themes. Good inter-coder agreement was demonstrated with an overall κ score of 0.66. A least two out of three investigators independently agreed on event classification in 92% of cases. Conclusions: The proposed taxonomy for reported events in general practice provides a comprehensible tool for clinicians describing threats to patient safety, and could be built into reporting systems to remove difficulties arising from coder interpretation of events.

Iron status and anaemia in preschool children in Sydney

Abstract: The purpose of this study was to determine the iron status of preschool children in Sydney. We assessed 678 children aged 9 to 62 months living in 32 randomly selected census collection districts in central and southern Sydney for iron status using plasma ferritin; of these 678 children, 542 had zinc protoporphyrin tests, red cell indices and haemoglobin tests. Risk factors for iron deficiency were assessed by an administered questionnaire. Overall, the prevalence of iron depletion was 10.5 per cent, iron deficiency 2.8 per cent and iron deficiency anaemia 1.1 per cent. The 24‐to‐35‐month age group (176 children) had the highest prevalence of iron deficiency anaemia of 3.0 per cent, although iron depletion (18.7 per cent) and iron deficiency (5.4 per cent) were highest among the 9‐to‐23‐month age group (182 children). Low iron status was related to age of under 24 months (odds ratio (OR) 2.86, 95 per cent confidence interval (CI) 1.72 to 4.76). After adjustment for this age effect, the consumption of red meat fewer than four times a week was significantly associated with iron depletion (OR 2.27, CI 1.25 to 4.17) and there was a tendency for children who were being given a vitamin supplement to be less likely to be iron depleted (OR 4.00, CI 0.95 to 16.67). Iron deficiency and iron deficiency anaemia do not represent a major public health problem in preschool children in Sydney. However, for children in the age range of 12 to 36 months there is scope for interventions to further reduce the prevalence of iron deficiency anaemia.

Bulimia: A study of outcome

The outcome of 43 bulimia patients was assessed 14 to 72 months after presenting for treatment. Outcome was assessed in four ways: clinical interview, self-completion of a questionnaire, self-rating, and the Eating Visual Analogue (EVA). The study suggests that despite the inherent problems associated with the different methods of assessment, 29% -42 % of patients could be considered “cured.” Only commencement of binge eating before 16 years was indicative of a good outcome.

Mefenamic acid in the treatment of premenstrual syndrome.

&NA; The use of mefenamic acid in the treatment of premenstrual syndrome (PMS) was investigated in 15 women over six menstrual cycles. A randomized, double‐blind, cross‐over, placebo‐controlled design was used to overcome the methodologic criticisms of other medication trials in this condition. Mefenamic acid significantly improved many of the physical, mood, and performance symptoms associated with PMS. The physical symptoms that showed marked improvement were fatigue, headache, and general aches and pains (P < .001). Most mood symptoms were improved, the most significant being freedom from mood swings (P < .005). (Obstet Gynecol 68:395, 1986)

Should ovulation be induced in women recovering from an eating disorder or who are compulsive exercisers

The eating and exercise history of women with secondary amenorrhea and failure of ovulation using CC was studied in 14 consecutive women on a GnRH-a program. All had a history of an eating or exercise disorder. At the time of the interview, 7 women continued to have an eating or exercise disorder. There were 15 pregnancies (12 women) with 12 live births, of which 4 weighed less than 2,500 g. Infertility specialists should inquire routinely about a womans body weight and eating and exercise behaviors, and consider treatment for these before prescribing drugs to induce ovulation.

Personality Characteristics in the Menstrual Cycle

Subjects complaining of premenstrual symptoms have been reported to vary from control subjects on a number of personality characteristics. Premenstrual symptom reporters have scored more highly on scales measuring neuroticism, trait anxiety and on the General Health Questionnaire (GHQ).This study reports the scores on the Eysenck Personality Questionnaire (EPQ) N and L scale, the State Trait Anxiety Inventory (STAI) scales and the GHQ in luteal and follicular phase.Premenstrual symptom sufferers were found to have significantly higher scores on all measures in both luteal and follicular phase. Premenstrual symptom sufferers also score more highly on both the STAI State and Trait Scales in luteal phase than in follicular phase. There were no significant differences in the GHQ or EQP N or L scale between cycle phases. Control subjects showed no significant difference in scores between cycle phases.

Plasma and serum micronutrient concentrations in preschool children

Abstract The plasma concentrations of vitamin A, vitamin E, β‐carotene and serum concentrations of zinc, retinol‐binding protein and prealbumin were examined for a random cluster sample, stratified by socioeconomic status, of 467 healthy preschool children. Children were aged 9–62 months; 44% were females. The mean plasma values were: vitamin A, 1.29 µmol 1‐1; vitamin E, 18.9 µmol 1‐1; and β‐carotene, 0.30 µmol 1‐1. The mean serum values were: zinc, 13.9 µmol 1‐1; retinol‐binding protein, 25.5mg 1‐1; and prealbumin, 186.2 mg 1‐1. The mean molar ratio of vitamin A to retinol‐binding protein for the study group was 1.10. There were no differences in the mean values of any of the measured micronutrients between the genders. The results of this survey do not indicate that the prevalence of micronutrient deficiency in this preschool population is of public health significance.

Total body nitrogen as a predictor of clinical status in anorexia nervosa

It has been demonstrated that clinical outcome is positively correlated with depletion of total body nitrogen (TBN) and therefore of body protein in certain serious medical conditions such as cystic fibrosis or patients receiving dialysis for chronic renal failure. Patients with anorexia nervosa are not suffering from medical illness per se yet the illness can be chronic and severely debilitating requiring numerous hospitalizations for refeeding and/or management of medical complications. The prediction of chronicity remains an important and difficult issue that this study seeks to address by examining the correlation between several clinical indices in 18 patients suffering from anorexia nervosa with parameters of body composition, namely TBN and percentage body fat. TBN was measured using the technique of in vivo neutron-activation analysis (IVNAA) and expressed as nitrogen index. Percentage body fat was estimated using skinfold measurements. The highest correlation was between nitrogen index and number of hospitalizations (r = -.80). The data support a relationship between depletion of body nitrogen/protein and chronicity in anorexia nervosa.

L-TRYPTOPHAN AS AN ADJUNCT TO TREATMENT OF BULIMIA NERVOSA

We report the effect of 3 g L-tryptophan and 45 mg of pyridoxine daily on the eating behaviour and mood of 11 women aged 19-35 years who were being treated for bulimia nervosa. The study design was a randomised, double-blind, crossover placebo-controlled trial

Effect of Refeeding and Exercise in Restoration of Body Protein in Anorexia Nervosa

The degree of depletion of body nitrogen is related to clinical course and prognosis in serious medical conditions 1–6. These situations may be complicated by undernutrition and are characterized by the pathological process of the underlying disease. In anorexia nervosa, under-nutrition and the behaviors used to induce it represent the sole pathology, free of confounding variables. Hence body composition in this condition is of particular interest. Further, the direct measurement of total body nitrogen (TBN) by prompt neutron capture 1,2 permits the estimation of protein, possibly the most important body constituent unaffected by hydration which may be disordered in serious medical illness.