Care homes' use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people.

INTRODUCTION: Care home residents are at particular risk from medication errors, and our objective was to determine the prevalence and potential harm of prescribing, monitoring, dispensing and administration errors in UK care homes, and to identify their causes. METHODS: A prospective study of a random sample of residents within a purposive sample of homes in three areas. Errors were identified by patient interview, note review, observation of practice and examination of dispensed items. Causes were understood by observation and from theoretically framed interviews with home staff, doctors and pharmacists. Potential harm from errors was assessed by expert judgement. RESULTS: The 256 residents recruited in 55 homes were taking a mean of 8.0 medicines. One hundred and seventy-eight (69.5%) of residents had one or more errors. The mean number per resident was 1.9 errors. The mean potential harm from prescribing, monitoring, administration and dispensing errors was 2.6, 3.7, 2.1 and 2.0 (0 = no harm, 10 = death), respectively. Contributing factors from the 89 interviews included doctors who were not accessible, did not know the residents and lacked information in homes when prescribing; home staff's high workload, lack of medicines training and drug round interruptions; lack of team work among home, practice and pharmacy; inefficient ordering systems; inaccurate medicine records and prevalence of verbal communication; and difficult to fill (and check) medication administration systems. CONCLUSIONS: That two thirds of residents were exposed to one or more medication errors is of concern. The will to improve exists, but there is a lack of overall responsibility. Action is required from all concerned.

Prescribing analysis and cost tabulation (PACT) data: an introduction.

PACT (prescribing analysis and cost tabulation) data is a national data set which analyses prescribing data in terms of cost and number of items (volume). At an organizational level, PACT is used to monitor and control prescribing cost and to set prescribing budgets. At individual practitioner level, it is used as an educational and audit tool. The Prescription Pricing Authority (PPA) has sent general practitioners (GPs) quarterly summary reports of their own prescribing since 1988. From 2000 prescriptions written by nurse prescribers have been added to the national PACT data set, and health authorities, practices and trusts will now be analysing both nurse and GP prescribing quality. Because of differences in the way they work, nurse prescribers will not automatically receive individual reports of their own prescribing. However they should be able to access this information on request through their local health authority prescribing advisers and primary care group pharmacists. Based on GP experience, nurse prescribers should find PACT data a useful learning resource for individual and team practice development.

Correlation between plasma total homocysteine and copper in patients with peripheral vascular disease.

BACKGROUND: Increased concentrations of both plasma total homocysteine and copper are separately associated with cardiovascular disease. Correlations between plasma total homocysteine, trace elements, and vitamins in patients with peripheral vascular disease have not been investigated. METHODS: The concentrations of trace elements in plasma were determined by the multielement analytical technique of total-reflection x-ray fluorescence spectrometry. Plasma total homocysteine was determined by HPLC. RESULTS: In the univariate and multivariate regression analyses, copper was positively correlated with plasma total homocysteine in all subjects (coefficient +/- SE, 0.347 +/- 0.113; P = 0.0026 and coefficient +/- SE, 0.422 +/- 0.108; P = 0.0002, respectively), and in patients with peripheral vascular disease (coefficient +/- SE, 0.370 +/- 0.150; P = 0.016; and coefficient +/- SE, 0.490 +/- 0.151; P = 0.0025, respectively). Correlation between copper and plasma total homocysteine was not detected in healthy control subjects. The concentration of calcium in plasma (67.5 vs 80. 8 microg/g) was significantly lower in the patients than in the control subjects (P = 0.02). When the patients were divided into groups, the patients with suprainguinal lesions had significantly higher copper concentrations (P = 0.04) and significantly lower selenium and calcium concentrations (P = 0.01 and 0.008, respectively) than the healthy subjects. Patients had higher concentrations of autoantibodies against oxidized LDL and concentrations of thiobarbituric acid-reactive substance than the healthy subjects (P <0.0001 and P = 0.001, respectively). The concentrations of plasma total homocysteine and alpha-tocopherol were significantly higher, and the concentrations of vitamin B(6) and beta-carotene were lower in the patients than the healthy subjects. CONCLUSION: Our findings suggest that the atherogenicity of homocysteine may be related to copper-dependent interactions.

The effect of firm characteristics on truck accidents.

This paper expands an earlier analysis of the effect of firm characteristics and safety practices on truck accident rates. The sample size has been increased from 13,000 to 75,500. Negative binomial regressions are used in preference to the Poisson technique used previously. The current analysis confirms previous results, but provides important new insights into the safety implications of being a private carrier and hauling hazardous materials and the effect of having been in business for many years.

Demographic influences on risk perceptions.

Over the past 15 years, psychologists have empirically investigated how people perceive technological, consumer, and natural hazards. The psychometric-attitudes to risk being summarized by three factors: "dread," whether the risk is known, and personal exposure to the risk. The results have been used to suggest that certain types of hazards are viewed very differently from other hazards. The purpose of this paper is somewhat different, in that it investigates whether individual demographic characteristics influence psychometric perceptions of risk. This paper makes use of a large, professionally conducted, survey of a wide cross-section of the residents of metropolitan Chicago. One thousand adults were interviewed in a random-digit dial telephone survey, producing a useable dataset of about 800. Data on the three risk factors mentioned above were obtained on 7-point scales for four common hazards: aviation accidents, fires in the home, automobile accidents, and stomach cancer. The survey also collected demographic data on respondents' age, schooling, income, sex, and race. Regressions were then conducted to relate the demographic characteristics to risk perceptions. Some strong general conclusions can be drawn. The results suggest that women, people with lower levels of schooling and income, younger people, and blacks have more dread of hazards. The exception being age-related illnesses which, not unnaturally, are feared by older people. Unlike previous literature, we cannot substantiate the argument that these groups of people are less informed about hazards and thus less accepting of them. The most likely leading explanation of the relationship between demographic factors and dread of a hazard is the perceived personal exposure to the hazard.(ABSTRACT TRUNCATED AT 250 WORDS)

The effectiveness of motor carrier safety audits.

In 1986 the federal government expanded its program of company inspections for enforcement of motor carrier safety regulations. We find that many parts of these inspections are unrelated to the safety performance of firms. Never the less, reinspection of firms found to be unsatisfactory in a previous inspection does appear to bring about a substantial improvement in their safety performance. However, such firms represent a small fraction of the industry, and the probability of being inspected is very low. Thus, the program does not appear to have resulted in a detectable improvement in the accident rate of the industry.

The effect of airline deregulation on automobile fatalities.

This paper attempts to quantify the effects of airline deregulation in the United States on intercity automobile travel and consequently on the number of highway fatalities. A demand model is constructed for auto travel, which includes variables representing the price and availability of air service. A reduced form model of the airline market is then estimated. Finding that deregulation has decreased airfares and increased flights, it is estimated that auto travel has been reduced by 2.2% per year on average. Given assumptions on the characteristics of drivers switching modes and the types of roads they drove on, the number of automobile fatalities averted since 1978 is estimated to be in the range 200-300 per year.

The effect of diflunisal administration on platelet aggregation and cerebral blood flow.

The effect of a high dose of diflunisal (750 mg twice daily) on platelet aggregation and cerebral blood flow was investigated in 8 healthy volunteers. Diflunisal inhibited platelet aggregation consistently; this effect on platelets was reversed within 24 hours after the last dose of diflunisal. There was, however, no correlation between the anti-aggregatory effect of diflunisal and its plasma concentration. Diflunisal did not alter cerebral blood flow.

Beneficial effect of nadolol on anxiety-induced disturbances of performance in musicians: a comparison with diazepam and placebo.

The effects of 40 mg nadolol versus 2 mg diazepam on performance anxiety of 33 young music students were determined. The study had a double-blind, crossover design and was placebo controlled. Nadolol attenuated the rise in pulse rate caused by anxiety and improved those aspects of string playing that can be adversely affected by tremor. There was also a tendency for other functions requiring coordination and judgment to improve. No effect on anxiety was noted for nadolol or for 2 mg diazepam. Diazepam, however, did cause some minor deterioration of performance that was not related to anxiety change. These findings, taken with others, suggest that beta-adrenoceptor-blocking drugs such as nadolol have an important role in the correction of anxiety-induced disturbances of performance. Indeed, their use under such circumstances probably is preferable to that of the benzodiazepines.

Effect of pindolol on stress-related disturbances of musical performance: preliminary communication.

The effect of 5 mg pindolol on stress-induced disturbances of performance were assessed in 30 professional musicians. An overall inverse relationship was found between anxiety and musical performance. Reduction in anxiety by administration of pindolol was associated with a subjective improvement in performance. A stress-related tachycardia and increase in systolic blood pressure were attenuated. Pindolol had no effect on peak flow measurements.

Hypnotic accumulation and hangover in elderly inpatients: a controlled double-blind study of temazepam and nitrazepam.

The hypnotic and residual sedative effects of the first and seventh of seven regular night-time doses of nitrazepam 5 mg, temazepam 20 mg, and placebo were studied in 58 elderly inpatients. Plasma temazepam and nitrazepam concentrations rose by about 50% and 113% respectively between the mornings of day 1 and day 7. Patients reported sleeping well more often after the first dose of either hypnotic (p less than 0.05), but there was no difference after the seventh dose. Reaction time was unchanged on the morning after the first dose but was significantly prolonged after the seventh dose of both hypnotics (p less than 0.01). The time taken to eliminate the letter E from a page of prose tended to be prolonged after the first dose of both drugs (temazepam v placebo, p less than 0.05; nitrazepam v placebo, not significant) and was further prolonged on the morning after the seventh dose of nitrazepam (nitrazepam v placebo, p less than 0.05). Thus plasma accumulation of the drug was associated with a deterioration in daytime performance. This change in performance did not correlate with age, cerebral blood flow, or plasma concentration, but patients of low intelligence tended to be more severely affected.

Who counts?

PIP: The author attempts to outline what is known about the population undercount in U.S. censuses from 1787 to 1980 in order to clarify whether an adjustment of the 1980 census results is required. A series of comments by BA Bailar, SH Preston, MA Stoto, and J Trussell is also included (pp. 200-7).^ieng

Trial of three-day and ten-day courses of amoxycillin in otitis media.

A randomised double-blind controlled trial compared three-day and 10-day courses of amoxycillin (25 mg/kg daily) in children with otitis media. Seventeen doctors from five centres admitted 84 children between the ages of 2 and 10 years. Symptoms and signs were measured on admission to the trial, on day 3, and on day 15. Mother's observations were recorded daily for 10 days. Audiograms were performed at four and 12 weeks after the end of the trial. The treatment groups showed little difference in the speed of resolution of symptoms and signs, the numbers of primary treatment failures, or the frequency of recurrent ear infections. There were no complications in either group. Most children with otitis media can probably be successfully and safely treated with no more than a three-day course of amoxycillin providing their progress is reviewed about the fifth or sixth day after treatment started. This policy could save over 1 million pounds annually in antibiotic costs.

Simultaneous high-pressure liquid chromatographic determination of acetaminophen, guaifenesin, and dextromethorphan hydrobromide in cough syrup.

Acetaminophen (I), guaifenesin (II), and dextromethorphan hydrobromide (III) were separated and quantitated simultaneously in cough syrup by high-pressure liquid chromatography. A chemically bonded octadecylsilane stationary phase was used with a mobile phase of 48% (v/v) aqueous methanol. The mobile phase pH was stabilized to 4.2 by adding formic acid--ammonium formate buffer (approximately 0.4%). The internal standard was o-dinitrobenzene. Retention volumes were 4 ml for I, 6 ml for II, 11 ml for the internal standard, and 20 ml for III. Inactive syrup components did not interfere, permitting direct diluted sample injection. Results on active ingredients were essentially 100% of the claim, with standard deviations of +/- 1.5, 1.2, and 2.1% for I, II, and III, respectively.