Identification and characterization of errors and incidents in a medical intensive care unit.

BACKGROUND: To assess the frequency, type, consequences, and associations of errors and incidents in a medical intensive care unit (ICU). METHODS: Two-hundred and sixteen consecutive patients with predominantly cardiovascular and pulmonary disorders admitted between December 2002 and February 2003 were enrolled. Demographic data, SAPS II, and TISS-28 were obtained for all patients. Prior to patient enrolment all staff members (physicians, nurses, physiotherapists) were repeatedly encouraged to make use of the Incident Report Form (IRF) and detailed descriptions on how, why and when to use the IRF were provided. RESULTS: During the observation period of 64 days, 50 errors involving 32 patients (15%) were reported. Patients subjected to errors were more severely ill (SAPS II 42 +/- 25 vs. 32 +/- 18, P < 0.05), had a higher hospital mortality (38% vs. 9%), and a longer ICU stay (11 +/- 18 vs. 3 +/- 5 days, P < 0.05). Gender, age and TISS-28 were equally distributed. Each day of ICU stay increased the risk by 8% (odds ratio 1.078, 95% confidence interval 1.034-1.125, P < 0.001), and by 2.3% per SAPS II point (odds ratio 1.023, 95% confidence interval 1.006-1.040, P < 0.001). The majority of errors and incidents were judged as 'human failures' (73%), and 46 errors and incidents (92%) as 'avoidable'. CONCLUSIONS: The identification and characterization of errors and incidents combined with contextual information is feasible and may provide sufficient background information for areas of quality improvement. Areas with a high frequency of errors and incidents need to undergo process evaluation to avoid future occurrence.

["This helps; this is good". Horse books of Tibetan Himalayas]. / "Das hilft; das ist gut". Pferdebücher aus dem tibetischen Himalaja.

The present paper summarizes our recent investigations of the so-called horse books from the High Himalayas in Nepal. These books are written in tibetan language and are essentially dealing with hippology and hippiatry and to a lesser extent with topics such as pharmacology, anatomy, methods of diagnosis, divination and magical practices for horse races. The therapeutic methods of treatment in tibetan veterinary medicine are guided by the concepts of human medicine which, on the one hand, are related to the Ayurvedic System, on other hand, to the Traditional Chinese Medicine. Concerning the structure of these manuscripts a lot of similarities could be observed with corresponding treatises on horse management and medicine from Europe.

[Veterinary medicine comment on camel medicine in Fan-mu tsuan yen-fang]. / Veterinärmedizinischer Kommentar zur Kamelheilkunde im Fan-mu tsuan yen-fang.

This short paragraph tries to identify the camel diseases compiled in the old chinese text according to modern veterinary terms. Due to the specific terminology of the camel treatise and its overall scarce symptomatology the diseases are difficult to evaluate. The majority of them obviously deal with acute infectious diseases which manifest themselves under such symptoms as high fever, depression, anorexia, cachexia, diarrhoea, general weakness, etc. But there are some diseases and ailments which can be interpreted in modern terms my means of the symptoms, descriptions and cures, e.g. mange, paradontosis and wry-neck syndrome.

[The raising and worship of monkeys in the late period of ancient Egypt]. / Affenhaltung und Affenverehrung in der Spätzeit des Alten Agypten.

New finds of pathologically altered skeletal remains of baboons originating from the galleries under the temple of the god Thot in Tuna el-Gebel/Middle Egypt enlarge the knowledge of diseases observed in these animals, which were kept in non-appropriate conditions during ancient Egyptian time. "Rickets" and chronic deformations of the joints ("arthrosis") were observed most frequently. Additional cases of bone tumors and osteomyelitis were noted.

[The book about equery, by Jordanus Ruffus (13th century), in Ms 78 C of the copper engraving collection, Berlin]. / Das Buch über die Stallmeisterei der Pferde von Jordanus Ruffus (13. Jh.) im Ms 78 C 15 des Kupferstichkabinetts in Berlin.

One of the italian translations of the "Medicina equorum" written by the major stablemaster of the Emperor Frederic II. of Hohenstaufen, JORDANUS RUFFUS, dates to the late 13th century. It forms part of a manuscript kept in the State Library of Berlin-West. It is the only copy of the "Medicina equorum" which depicts the treatments of the different horse diseases in a very instructive manner. A translation into German of this italian manuscript was carried out recently in our Institute. This paper emphasizes the historical value of this opus and makes comments on the illustrations.

[Pathologically changed skeletal remains of baboons from ancient Egyptian times]. / Krankhaft veränderte Skelettreste von Pavianen aus altägyptischer Zeit.

Numerous pathologically altered skeletal remains of baboons originating from the galleries under the temple of the god Thot in Tuna el-Gebel/Middle Egypt reveal that these animals were kept in non-appropriate conditions during ancient Egyptian time. This statement is also supported by the low average age of the baboons. Inter alia an extremely deformed skull is described.