Case note review

Adverse effects are more likely to occur with metformin at the start of therapy. In retrospective case note review comparison of modified-release and immediate-release metformin 9.2% of those newly started on modified-release metformin (n — 65) had gastrointestinal adverse effects compared with 20% of those who started on immediate-release metformin (n — 363) (126). The main gastrointestinal adverse effect was diarrhea. The mean doses were 1258 mg/day for modified-release metformin and 1282 mg/day for immediate-release metformin. 

A distal sensory neuropathy is the commonest neurological complication in HIV-infected individuals, and has been documented in up to 30% of patients with AIDS. There is evidence from a retrospective case-note review in 30 individuals that co-administration of stavudine and isoniazid increases the incidence of distal sensory neuropathy. Of 22 patients taking stavudine in combination with other drugs, all took isoniazid for tuberculosis and 12 developed a distal sensory neuropathy, with a median time to onset of 5 months (7). Those taking stavudine alone had an incidence of 11%. 

Sari, A.B.-A., Sheldon, T.A., Cracknell, A. andTnrnbull, A. (2007) Sensitivity of routine system for reporting patient safety incidents in an NHS hospital retrospective patient case note review. British Medical Journal, 334(7584), 79. 

We found that 23 % of hospital admissions in eight specialties were associated with patient safety incidents and 11% with adverse events. This is similar to rates found in studies using similar methods in the United Kingdom and internationally. The routine reporting system as implemented in this large hospital missed most patient safety incidents that were identified by case note review and detected only 5% of those incidents that resulted in patient harm. This suggests that the routine reporting system considerably under-reports the scale and severity of patient safety incidents. 

REPRODUCED FROM BRIUSH MEDICAL JOURNAL, AU BABA-AKBARI SARI, TREVOR A SHELDON, ALISON CRACKNBLL BT AL. "SENSIITVITY OF ROUTINE SYSTEM FOR REPORTING PATIENT SAFETY INCIDENTS IN AN NHS HOSPITAL RETROSPECTIVE PATIENT CASE NOTE REVIEW". 334, NO. 7584, [79], 2007, WITH PERMISSION FROM BMJ PUBLISHING GROUP LTD.)... 

Case note review is sometimes viewed as time consuming and comparatively expensive. Nevertheless, with experience and refinement and the development of training packages (Olsen et al 2007), it can be carried out relatively inexpensively, producing systematic, detailed analyses. A few organizations, such as Royal North Shore in Sydney (Harrison, personal communication) carry out formal, annual case note reviews and use these as the basis of their quality assurance and improvement systems. Record reviews could be repeated over time, and trends studied, particularly as we would now be able to define and monitor specific types of adverse events rather than just assess the overall rates. Reliability and validity of judgement of adverse events is not as good as we would wish but could certainly be improved if specific definitions of particular classes of adverse events were developed. 

Observational studies In a retrospective case note review of 36 patients who had received pristinamycin for resistant Grampositive bacterial infections, 11 reported adverse reactions [111 ]. Seven required drug withdrawal after a median of 31 days because of intolerable adverse reactions, three because of gastrointestinal reactions, one because of a rash, and one because of neutropenia. 

Pancreas Propofol can reportedly cause pancreatitis, perhaps because of alterations in lipid metabolism, leading to hypertriglyceridemia, release of free fatty acids, and chylomicron plugging of pancreatic capillaries. In a retrospective case note review of 479 children with acute leukemia who underwent general anesthesia for a... 

A possible effect of intrathecal baclofen on intestinal motility has been proposed (10). Triggered by two cases of paraljdic Ueus in patients receiving continuous intrathecal baclofen, the authors reviewed the case notes of 14 patients and summed the days without bowel movements before and after intrathecal baclofen therapy. Intestinal function deteriorated in 10 patients, was unchanged in one, and improved in three. They therefore... 

A retrospective review of the case-notes of 44 patients with dmg-indnced hepatotoxicity diagnosed in 1978-96 fonnd only one case attribntable to halothane (31). Antibiotics, non-steroidal anti-inflammatory drugs, and psychotropic drugs accounted for 73% of the cases. 

As noted in Section 3.1.2, the introduction of the crown ethers in the late 1960s gave legitimacy to the concept of stable coordination complexes of the alkali metals. Their presence, and that of many other macrocyclic counterparts (e.g., porphyrins) and three-dimensional chelators (e.g., cryptands, calixar-enes) is now pervasive in both alkali and alkaline-earth coordination chemistry, and the literature on these complexes is vast. Early work in this area was summarized in CCC (1987), and examined in a more focused manner in Comprehensive Supramolecular Chemistry. It is not the intent of this section to repeat such material, but rather to highlight new developments since the mid-1990s. In some cases, specialist reviews are available on these subjects they will be noted where relevant. 

Medication reviews can be conducted by either community or clinical pharmacists or clinical pharmacologist depending on local circumstances, but both need further training. Community pharmacists need their clinical knowledge updating and must learn how to read case notes, whereas clinical pharmacists and pharmacologists need to become familiar with the structure and processes of primary care general practice. 

Wihon V. Nepstad, at 674. A discussion on this case is beyond the scope of this work. For a case note, see Carla A. Scholten, C.A. (1979-1980) Torts - a municipality is liable for tortious commissions and omissions when authority and conhol over the hre safety of apartments have been delegated to it by statue and breach of that duty involves a foreseeable risk of injury to an identifiable class to which the plaintiff belongs - Wilson v. Nepstad (Iowa 1979) , Drake Law Review, 29 207. 

Hale and Hovden (1998) described management and culture as the third age of safety. The first age was about technical measures, the second about human factors and individual behaviour (Hale and Glendon 1987) and these merged with the technological approaches. Catchpole et al. (2011) in their summary of the development of patient safety research in healthcare, characterised early human factors work in patient safety as focusing on attempts to locate the source of error within medicine. Other exploratory work, took a number of forms, including review of patient s case notes (Vincent et al. 

NOTE -- Manufacturers are using a variety of terms to indicate the abiiity of devices to achieve a particuiar SIL. They may refer to a device as suitable for use in an SIL X application, fit for use in an SIL X application, SIL qualified, or SIL rated. In these cases, additional review is often required to define the SIL claim limit because these terms are not used by the standard and, therefore, do not have a consensus definition. 

Now you can reconsider the material balance equations by adding those additional factors identified in the previous step. If necessary, estimates of unaccountable losses will have to be calculated. Note that, in the case of a relatively simple manufacturing plant, preparation of a preliminary material-balance system and its refinement (Steps 14 and 15) can usefully be combined. For more-complex P2 assessments, however, two separate steps are likely to be more appropriate. An important rule to remember is that the inputs should ideally equal the outputs - but in practice this will rarely be the case. Some judgment will be required to determine what level of accuracy is acceptable, and we should have an idea as to what the unlikely sources of errors are (e.g., evaporative losses from outside holding ponds may be a materials loss we cannot accurately account for). In the case of high concentrations of hazardous wastes, accurate measurements are needed to develop cost-effective waste-reduction options. It is possible that the material balance for a number of unit operations will need to be repeated. Again, continue to review, refine, and, where necessary, expand your database. The compilation of accurate and comprehensive data is essential for a successful P2 audit and subsequent waste-reduction action plan. Remember - you can t reduce what you don t know is therel... 

If the control valve size is critical to the overpressure protection of the downstream equipment, and must not be increased, then this is clearly noted in all relevant documentation (specification sheets, flow diagram, operating manual, etc.,) and a warning notice plate is welded to the valve body. In such cases, an actual check of the valve installed or purchased should be made during the startup review. 

To start the review of the PIMC results [328], we note that the detailed study of the quantum APR model (Eq. (41)) was partly motivated by the strong changes in shape of the orientational order parameter as a function of temperature as the rotational constant was increasing from its classical value 0 = 0 (see Fig. 3 in Ref. 327). For small enough 0 it was found that the order parameter decays monotonically with increasing temperature, similarly to the classical case. This is qualitatively different for larger 0, where T ) becomes a non-monotonic function of temperature. 

Reference should be made to Threshold Limit Values, Guidance Note EHl7/78, issued by the Health and Safety Executive (HSE), or Industrial Ventilation (American Conference of Governmental Industrial Hygienists). In all cases, proposals should be reviewed by and submitted to the relevant local authority agencies. 

Since these assumptions are not always justifiable when applied to plastics, the classic equations cannot be used indiscriminately. Each case must be considered on its merits, with account being taken of such factors as the time under load, the mode of deformation, the service conditions, the fabrication method, the environment, and others. In particular, it should be noted that the traditional equations are derived using the relationship that stress equals modulus times strain, where the modulus is a constant. From the review in Chapter 2 it should be clear that the modulus of a plastic is generally not a constant. Several approaches have been used to allow for this condition. The drawback is that these methods can be quite complex, involving numerical techniques that are not attractive to designers. However, one method has been widely accepted, the so-called pseudo-elastic design method. 

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