Tag Archives: brompheniramine maleate

br Introduction Patient safety has been one of the

Introduction
Patient safety has been one of the most important medical issues in the past few years, after the release of the Institute of Medicine\’s quality of care initiative, “To Err is Human: Building a Safer Health System”. Although a few reports related to emergency department (ED) adverse events/medical error have been published, relatively little is well known about the cause of ED adverse events/errors. A few studies of medical malpractice in ED cases were informative, but reviewing medical adverse events had the shortcomings of outcome biases and retrospective biases in retrospective studies, especially in closed lawsuit cases, in which many biased purposes were present. Therefore, many reports called for more data to be published about medical adverse events/error for further analysis of their patterns and causes. Our previous study showed that many of these adverse events were due to inadequacies in the basic management process (history taking, physical examinations, laboratory and radiological examinations, and observation). Therefore, our main purposes are to explore clinically significant adverse events (CSAEs), with an emphasis on those related to physicians\’ factors, through the analysis of the basic management process and provide evidences for these insufficiencies in discharged patients of emergency medicine (EM).

Methods

Discussion
In this brompheniramine maleate study, the CSAEs rate was 1.21% (1,230/101, 402, 95% CI=10.28% – 13.92%) and CSAEs rate related to physicians\’ factors was 0.7% (722/101,402, 95% CI 0.69% – 0.75%) in the discharged patients of EM. Most CSAEs related to physicians\’ factors (98.9%) had inadequacies in the basic management process and only a minority (1.1%) were determined to be caused purely by “judgment defects”. Inadequacies of history taking (34.2%, 247/722) and the lack of observation of high-risk clinical conditions and treatment response in high-risk conditions (42.4%, 306/722), were the most common. In this study, evidence present in the basic management process to support adverse events revealed clusters of common causes:
Our results had several points agreeing with or in support of previous studies. Firstly, our providing data of adverse events/errors is an act advocated by the EM. Providing more data relating to the medical error is an important issue in the EM. Our data included a rate of CSAEs (also those related to physicians\’ factors), patterns of inadequacies, and evidence (detailed analysis) of these inadequacies. There has been scarce data related to understanding and examining medical errors in the emergency medicine. Fordyce et al reported the error rate was 18/100 registered patients and the significant adverse event rate was 0.36/100 registered patients in the ED patients. Ninety-eight percent of errors in the ED do not result in adverse outcomes. Forster et al also reported a 6% adverse event rate in ED discharged patients, but many of these were mild events.
Secondly, our results re-emphasized the importance of the basic management process in preventing the adverse events/errors. In our results, a high proportion of CSAEs related to physicians\’ factors had inadequacies in history taking and testing. Previous studies have shown many adverse events or errors occurred under the situations similar to our results: oversimplified history taking and physical examinations, inadequate laboratory testing and radiological examinations, the incorrect reading of radiological films or breakdown in diagnostic processes (history taking, physical exams, ordering tests, and producing a follow-up plan). Additionally, one of the most notable findings with our results was the high proportion of the lack of observation of patients with persistent abdominal pain in CSAEs related to physician factors (111/722). Most of these cases were given diagnoses of minor diseases (gastritis, peptic ulcer, dyspepsia, irritable bowel syndrome, acute gastroenteritis and so on). Under these “definite diagnoses”, premature closure and early discharge were the rule. This inadequacy calls for the necessity of observation of many patients. Our previous study also showed cuticle early discharging of high-risk patients without observation or re-evaluation was a factor causing adverse events. Before discharging a patient, EPs have to make sure of the improvement of the patient symptoms. A serial follow-up is frequently necessary in many ED clinical conditions to make sure of the response and is also an important part in the ED practice which has a high uncertainty.

There were no significant differences in cervical length

There were no significant differences in cervical length (Fig. 2) among the three groups at 17–21 wk of brompheniramine maleate (p = 0.46); there also was no difference in cervical length between the spontaneous preterm and full-term birth groups (p = 0.39). Cervical length at 17–21 wk was not correlated with gestational age at delivery (r = 0.06, p = 0.66). With respect to cervical length at 22–26 wk of gestation (full term n = 49 and spontaneous preterm n = 8), women who delivered preterm had significantly shorter cervical lengths (3.16 cm) than women delivering full term (3.68 cm) (t = 3.04, p = 0.004). None of the women in the study had cervical lengths <2.5 cm before 27 wk, a common definition of a “short cervix” (Romero et al. 2013). These findings suggest that cervical tissue properties, as detected by attenuation, are sensitive to remodeling by 17–21 wk in women who will deliver spontaneously preterm, and before cervical shortening. The data were filtered to extract all measurements for each patient in the range 17–26 wk of gestation (full term n = 49 patients with 76 visits, spontaneous preterm n = 10 patients with 14 visits, range: 17–26 wk of gestation). A logistic regression model with exchangeable correlation structure was calculated to model the log odds of preterm birth as a function of scan attenuation, cervical length, an indicator for measurements prior to 22 wk and the interaction between attenuation and the indicators for measurements prior to 22 wk. The indicator for measurements prior to 22 wk and the interaction effect enabled estimation of separate logistic regression response curves for attenuation prior to 22 wk versus after 22 wk. The attenuation interaction coefficient was approaching statistical significance (p = 0.053), with an estimated ratio of odds ratios of 1.89 (90% confidence interval: 1.10–3.25), suggesting an association between low early attenuation measurements and preterm birth. Cervical length was not statistically significant in the model, but suggestive of an association between short cervical length and preterm birth (p = 0.12), with an estimated odds ratio of 1.75 (90% confidence interval: 0.975–3.14). Using the logistic regression model as a classifier for full-term versus preterm birth, the ROC curve is provided in Figure 3. The estimated 76.0% area under the curve (AUC) is the estimated probability of correctly classifying two randomly selected patients, one of whom delivers preterm and the other who does not, suggesting some predictive capability based on the measurements ≤26 wk. Fifteen women received weekly 17-α hydroxyprogesterone caproate (17-OHPC) injections during pregnancy because of a history of a prior preterm birth. No women in the study received vaginal progesterone. The mean gestational age was 16 wk when 17-OHPC was initiated. Of the 15 women with a history of preterm birth, 6 delivered preterm. To further understand attenuation and cervical length for women who were and were not treated without 17-OHPC, Figure 4 illustrates delivery outcomes for those who did and those who did not received 17-OHPC. However, the sample sizes were too small to yield any conclusions.
Discussion
The results of this pilot study suggest that for women who will deliver spontaneously preterm, ultrasonic attenuation was lower at 17–21 wk of gestation and before cervical length changes were detected at 22–26 wk. None of the women in our study had a cervical length <2.5 cm before 27 wk of pregnancy. A cervical length <2.5 cm is a commonly used clinical cutoff point for identifying women at risk for SPTB and eligibility for progestogen therapy (Campbell, 2011). The ultrasonic attenuation estimates of the cervix significantly provided SPTB risk assessment at 17–21 wk of gestation, weeks before the cervix shortened in length. The high positive predictive value of attenuation (PPV = 90%) at the first time point (17–21 wk) to determine which women will deliver spontaneously preterm is encouraging. Our data suggest that for women who will deliver full term, attenuation of the cervix is high at 17–21 wk and remains fairly stable throughout pregnancy. Presently, the PPV of cervical length in low-risk women ranges from 25% to 52%, although it is the current standard of care (Romero et al. 2013). It is possible that cervical length and attenuation estimates of the cervix may detect different groups of women at risk for preterm birth, as none of the women in our study had a cervical length <2.5 cm before 27 wk brompheniramine maleate of gestation.