Acknowledgement of "no fault" medical injury: review of patients' hospital records in New Zealand.
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ABSTRACT:
SUBMITTER: Davis P
PROVIDER: S-EPMC139935 | biostudies-literature | 2003 Jan
REPOSITORIES: biostudies-literature
Publications
Acknowledgement of "no fault" medical injury: review of patients' hospital records in New Zealand.
Davis Peter P Lay-Yee Roy R Scott Alastair A Briant Robin R Schug Stephan S
BMJ (Clinical research ed.) 20030101 7380
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Project description:Current descriptions add natives Aporodrilus aoteasp. n., Aporodrilus pongasp. n. and Notoscolex repangasp. n., plus new exotic records to the numbers of megadrile earthworms known from New Zealand, which are now raised from 193 to 222 species in five families, viz: Acanthodrilidae, Octochaetidae and Megascolecidae, plus Lumbricidae and Glossoscolecidae for exotics. Overlooked spermathecal diverticula have been located for Notoscolex equestris Benham, 1942 and for Megascolex animae Lee, 1959 and non-tubular prostrates were misconstrued as tubular in Megascolides tasmani Lee, 1959. Of these latter three species, a lectotype is designated for Notoscolex equestris and holotypes of the other two are briefly redescribed. Whereas Megascolides tasmani now belongs in Notoscolex Fletcher, 1887 and Megascolides animae belongs in Anisochaeta Beddard, 1890, further lack of dorsal pores in Notoscolex equestris as with Notoscolex esculentus (Benham, 1904) and Notoscolex mortenseni (Michaelsen, 1924) newly qualifies all three as additional combs. novae in primarily Tasmanian genus Aporodrilus Blakemore, 2000.
| S-EPMC3253629 | biostudies-literature
Project description:ObjectivesTo determine the epidemiology of healthcare harm observable in general practice records.DesignRetrospective cohort records review study.Setting72 general practice clinics were randomly selected from all 988 New Zealand clinics stratified by rurality and size; 44 clinics consented to participate.Participants9076 patient records were randomly selected from participating clinics.InterventionEight general practitioners examined patient records (2011-2013) to identify harms, harm severity and preventability. Analyses were weighted to account for the stratified sampling design and generalise findings to all New Zealand patients.Main outcome measuresHealthcare harm, severity and preventability.ResultsReviewers identified 2972 harms affecting 1505 patients aged 0-102 years. Most patients (82.0%, weighted) experienced no harm. The estimated incidence of harm was 123 per 1000 patient-years. Most harms (2160; 72.7%, 72.4% weighted) were minor, 661 (22.2%, 22.8% weighted) were moderate, and 135 (4.5%, 4.4% weighted) severe. Eleven patients died, five following a preventable harm. Of the non-fatal harms, 2411 (81.6%, 79.4% weighted) were considered not preventable. Increasing age and number of consultations were associated with increased odds of harm. Compared with patients aged ≤49 years, patients aged 50-69 had an OR of 1.77 (95% CI 1.61 to 1.94), ≥70 years OR 3.23 (95% CI 2.37 to 4.41). Compared with patients with ≤3 consultations, patients with 4-12 consultations had an OR of 7.14 (95% CI 5.21 to 9.79); ≥13 consultations OR 30.06 (95% CI 21.70 to 41.63).ConclusionsStrategic balancing of healthcare risks and benefits may improve patient safety but will not necessarily eliminate harms, which often arise from standard care. Reducing harms considered 'not preventable' remains a laudable challenge.
| S-EPMC8276280 | biostudies-literature
Project description:The Alpine Fault, New Zealand, is a major plate-bounding fault that accommodates 65-75% of the total relative motion between the Australian and Pacific plates. Here we present data on the hydrothermal frictional properties of Alpine Fault rocks that surround the principal slip zones (PSZ) of the Alpine Fault and those comprising the PSZ itself. The samples were retrieved from relatively shallow depths during phase 1 of the Deep Fault Drilling Project (DFDP-1) at Gaunt Creek. Simulated fault gouges were sheared at temperatures of 25, 150, 300, 450, and 600°C in order to determine the friction coefficient as well as the velocity dependence of friction. Friction remains more or less constant with changes in temperature, but a transition from velocity-strengthening behavior to velocity-weakening behavior occurs at a temperature of T = 150°C. The transition depends on the absolute value of sliding velocity as well as temperature, with the velocity-weakening region restricted to higher velocity for higher temperatures. Friction was substantially lower for low-velocity shearing (V < 0.3 µm/s) at 600°C, but no transition to normal stress independence was observed. In the framework of rate-and-state friction, earthquake nucleation is most likely at an intermediate temperature of T = 300°C. The velocity-strengthening nature of the Alpine Fault rocks at higher temperatures may pose a barrier for rupture propagation to deeper levels, limiting the possible depth extent of large earthquakes. Our results highlight the importance of strain rate in controlling frictional behavior under conditions spanning the classical brittle-plastic transition for quartzofeldspathic compositions.
| S-EPMC4994769 | biostudies-literature
Project description:BackgroundKnowing where and why harm occurs in general practice will assist patients, doctors, and others in making informed decisions about the risks and benefits of treatment options. Research to date has been unable to verify the safety of primary health care and epidemiological research about patient harms in general practice is now a top priority for advancing health systems safety.ObjectiveWe aim to study the incidence, distribution, severity, and preventability of the harms patients experience due to their health care, from the whole-of-health-system lens afforded by electronic general practice patient records.Methods"Harm" is defined as disease, injury, disability, suffering, and death, arising from the health system. The study design is a stratified, 2-level cluster, retrospective records review study. Both general practices and patients will be randomly selected so that the study's results will apply nationally, after weighting. Stratification by practice size and rurality will allow comparisons between 6 study groups (large, medium-sized, small; urban and rural practices). Records of equal numbers of patients from each study group will be included in the study because there may be systematic differences in patient harms in different types of practices. Eight general practitioner investigators will review 3 years of electronic general practice health records (consultation notes, prescriptions, investigations, referrals, and summaries of hospital care) from 9000 patients registered in 60 general practices. Double-blinded reviews will check the concordance of reviewers' assessments. Study data will comprise demographic data of all 9000 patients and reviewers' assessments of whether patients experienced harm arising from health care. Where patient harm is identified, their types, preventability, severity, and outcomes will be coded using the Medical Dictionary for Regulatory Activities (MedDRA) 18.0.ResultsWe have recruited practices and collected electronic records from 9078 patients. Reviews of these records are under way. The study is expected to be completed in August 2017.ConclusionsThe design of this complex study is presented with discussion on data collection methods, sampling weights, power analysis, and statistical approach. This study will show the epidemiology of patient harms recorded in general practice records for all of New Zealand and will show whether this epidemiology differs by rural location and clinic size.
| S-EPMC5296619 | biostudies-literature
Project description:electronic Medical Records & Genomics (eMERGE)
| PRJNA158491 | ENA
Project description:ObjectivesAcute kidney injury (AKI) in hospitalized patients puts them at much higher risk for developing future health problems such as chronic kidney disease, stroke, and heart disease. Accurate AKI prediction would allow timely prevention and intervention. However, current AKI prediction researches pay less attention to model building strategies that meet complex clinical application scenario. This study aims to build and evaluate AKI prediction models from multiple perspectives that reflect different clinical applications.Materials and methodsA retrospective cohort of 76 957 encounters and relevant clinical variables were extracted from a tertiary care, academic hospital electronic medical record (EMR) system between November 2007 and December 2016. Five machine learning methods were used to build prediction models. Prediction tasks from 4 clinical perspectives with different modeling and evaluation strategies were designed to build and evaluate the models.ResultsExperimental analysis of the AKI prediction models built from 4 different clinical perspectives suggest a realistic prediction performance in cross-validated area under the curve ranging from 0.720 to 0.764.DiscussionResults show that models built at admission is effective for predicting AKI events in the next day; models built using data with a fixed lead time to AKI onset is still effective in the dynamic clinical application scenario in which each patient's lead time to AKI onset is different.ConclusionTo our best knowledge, this is the first systematic study to explore multiple clinical perspectives in building predictive models for AKI in the general inpatient population to reflect real performance in clinical application.
| S-EPMC6447093 | biostudies-literature
Project description:ImportanceAlthough federal law has long promoted patients' access to their protected health information, this access remains limited. Previous studies have demonstrated some issues in requesting release of medical records, but, to date, there has been no comprehensive review of the challenges that exist in all aspects of the request process.ObjectiveTo evaluate the current state of medical records request processes of US hospitals in terms of compliance with federal and state regulations and ease of patient access.Design, setting, and participantsA cross-sectional study of medical records request processes was conducted between August 1 and December 7, 2017, in 83 top-ranked US hospitals with independent medical records request processes and medical records departments reachable by telephone. Hospitals were ranked as the top 20 hospitals for each of the 16 adult specialties in the 2016-2017 US News & World Report Best Hospitals National Rankings.ExposuresScripted interview with medical records departments in a single-blind, simulated patient experience.Main outcomes and measuresRequestable information (entire medical record, laboratory test results, medical history and results of physical examination, discharge summaries, consultation reports, physician orders, and other), formats of release (pick up in person, mail, fax, email, CD, and online patient portal), costs, and request processing times, identified on medical records release authorization forms and through telephone calls with medical records departments.ResultsAmong the 83 top-ranked US hospitals representing 29 states, there was discordance between information provided on authorization forms and that obtained from the simulated patient telephone calls in terms of requestable information, formats of release, and costs. On the forms, as few as 9 hospitals (11%) provided the option of selecting 1 of the categories of information and only 44 hospitals (53%) provided patients the option to acquire the entire medical record. On telephone calls, all 83 hospitals stated that they were able to release entire medical records to patients. There were discrepancies in information given in telephone calls vs on the forms between the formats hospitals stated that they could use to release information (69 [83%] vs 40 [48%] for pick up in person, 20 [24%] vs 14 [17%] for fax, 39 [47%] vs 27 [33%] for email, 55 [66%] vs 35 [42%] for CD, and 21 [25%] vs 33 [40%] for online patient portals), additionally demonstrating noncompliance with federal regulations in refusing to provide records in the format requested by the patient. There were 48 hospitals that had costs of release (as much as $541.50 for a 200-page record) above the federal recommendation of $6.50 for electronically maintained records. At least 6 of the hospitals (7%) were noncompliant with state requirements for processing times.Conclusions and relevanceThe study revealed that there are discrepancies in the information provided to patients regarding the medical records release processes and noncompliance with federal and state regulations and recommendations. Policies focused on improving patient access may require stricter enforcement to ensure more transparent and less burdensome medical records request processes for patients.
| S-EPMC6324595 | biostudies-literature
Project description:The Mw 7.8 2016 Kaikoura earthquake ruptured the Kekerengu-Needle fault resulting in the loading of its eastern continuation, the Wairarapa fault. Since the most recent earthquake on Wairarapa occurred in 1855 and is one of the strongest continental earthquakes ever observed, it is critical to assess the seismic potential of the Wairarapa fault, which might be prone to break. Using Lidar data, we examine its bare-earth morphology and reveal ~650 mostly undiscovered offset geomorphic markers. Using a code we developed in earlier work, we automatically measure the lateral and vertical offsets of these markers providing more than 7000 well constrained measurements. The data document the lateral and vertical slip profiles of the 1855 earthquake for the first time and show its total slip reached ~20 m at surface. Modeling the entire offset dataset reveals 7 prior earthquakes ruptured the entire fault, each similarly producing 16.9 ± 1.4 m dextral slip and ~0.6 m vertical slip at surface in the same central bend zone of the fault. Thus, the Wairarapa fault repeatedly produced giant earthquakes and is likely able to produce a similarly strong forthcoming event. The extreme large size of the Wairarapa earthquakes questions our understanding of earthquake physics.
| S-EPMC7005692 | biostudies-literature
Project description:ObjectiveLittle is known about differences in hospital harm (injury, suffering, disability, disease or death arising from hospital care) when people from rural and urban locations require hospital care. This study aimed to assess whether hospital harm risk differed by patients' rural or urban location using general practice data.DesignSecondary analysis of a 3-year retrospective cross-sectional general practice records review study, designed with equal numbers of rural and urban patients and patients from small, medium and large practices. Hospital admissions, interhospital transfer and hospital harm were identified.SettingNew Zealand (NZ) general practice clinical records including hospital discharge data.ParticipantsRandomly selected patient records from randomly selected general practices across NZ. Patient enrolment at rural and urban general practices defined patient location.OutcomesAdmission and harm risk and rate ratios by rural-urban location were investigated using multivariable analyses adjusted for age, sex, ethnicity, deprivation, practice size. Preventable hospital harm, harm severity and harm associated with interhospital transfer were analysed.ResultsOf 9076 patient records, 1561 patients (17%) experienced hospital admissions with no significant association between patient location and hospital admission (rural vs urban adjusted risk ratio (aRR) 0.98 (95% CI 0.83 to 1.17)). Of patients admitted to hospital, 172 (11%) experienced hospital harm. Rural location was not associated with increased hospital harm risk (aRR 1.01 (95% CI 0.97 to 1.05)) or rate of hospital harm per admission (adjusted incidence rate ratio 1.09 (95% CI 0.83 to 1.43)). Nearly half (45%) of hospital harms became apparent only after discharge. No urban patients required interhospital transfer, but 3% of rural patients did. Interhospital transfer was associated with over twice the risk of hospital harm (age-adjusted aRR 2.33 (95% CI 1.37 to 3.98), p=0.003).ConclusionsRural patient location was not associated with increased hospital harm. This provides reassurance for rural communities and health planners. The exception was patients needing interhospital transfer, where risk was more than doubled, warranting further research.
| S-EPMC8103933 | biostudies-literature
Project description:BackgroundIn-hospital delirium is associated with adverse outcomes and is underdiagnosed, limiting research and clinical follow-up.ObjectiveTo compare the incidence of in-hospital delirium determined by chart-based review of electronic medical records (D-CBR) with delirium discharge diagnoses (D-DD). Furthermore, to identify differences in symptoms, treatments and delirium triggers between D-CBR and D-DD.MethodThe community-based cohort included 2,115 participants in the Hordaland Health Study born between 1925 and 1927. Between 2018 and 2022, we retrospectively reviewed hospital electronic medical records from baseline (1997-99) until death prior to 2023. D-DD and D-CBR were validated using The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for delirium.ResultsOf the 2,115 participants, 638 had in-hospital delirium. The incidence rate (IR) of D-CBR was 29.8 [95% confidence interval 28, 32] per 1,000 person-years, whereas the IR by D-DD was 3.4 [2.8, 4.2]. The IR ratio was 9.14 (P < 0.001). Patients who received pharmacological treatment for delirium (n = 121, odds ratio (OR) 3.4, [2.1, 5.4], P < 0.001), who were affected by acute memory impairment (n = 149, OR 2.8, [1.8, 4.5], P < 0.001), or change in perception (n = 137, OR 2.9, [1.8, 4.6] P < 0.001) had higher odds for D-DD. In contrast, post-operative cases (OR 0.2, [0.1, 0.4], P < 0.001) had lower odds for D-DD.ConclusionUnderdiagnosis of in-hospital delirium was a major issue in our study, especially in less severe delirium cases. Our findings emphasise the need for integrating systematic delirium diagnostics and documentation into hospital admission and discharge routines.
| S-EPMC10859244 | biostudies-literature