Patient listings, creating

Which patients should be in which data set is something that should be considered before analysis data sets are created. For example, it is often decided that all analysis data sets should have a record for a subject if that subject was randomized to treatment and is considered an intent-to-treat subject. Whether this is true or not, the specifications for analysis data sets should make it clear who should be present in any analysis data set. Here is a list of common populations and their definitions ... 

Doses The initial listed doses of the reconstituted botulinum toxin type A typically create paralysis of injected muscles beginning 1 to 2 days after injection and increasing in intensity during the first week. The paralysis lasts for 2 to 6 weeks and gradually resolves over a similar time period. Overcorrections lasting over 6 months have been rare. Approximately one half of patients will require subsequent doses because of inadequate paralytic response of the muscle to the initial dose, or mechanical factors such as large deviations or restrictions, or the lack of binocular motor fusion to stabilize the alignment. 

The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLlNEplus. Within this Internet-based system are health topic pages which list links to available materials relevant to medium-chain acyl-coenzyme A dehydrogenase deficiency. To access this system, log on to http /ywww.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLlNEplus listed... 

As pharmacists, we can use evidence from patient self-administered health status surveys in caring for patients.A common model used in teaching students to monitor therapy is to first create a problem list and, for every problem on the list, develop an assessment and plan. The diagram in Fig. 4 breaks down the assessment process. It requires one to write a potential inventory of all monitoring parameters. It reminds and guides us to monitor both the efficacy and the toxicity using subjective and objective parameters appropriate for the disease and the treatment. 

Currie and colleagues devised a tool to assess the quality of pharmacists documentation. These researchers created a list of data elements after a comprehensive literature search and input from practitioners and expert panels. The elements are divided into two groups those essential to each individual patient encounter and those essential to a patient record (Table 4-2). The acquisition of each of these elements is critical to the provision of pharmaceutical care. 

List all practitioners who prescribed medications for the patient, including the patient s primary physician, orthopedist, and cardiologist. Create a list of all pharmacies providing medication to the patient. Review the expiration dates for all medications. Ask the patient how they self-medicate, if they maintain a medication schedule, and if they ever forget to take their medication. If they do, ask what medications they ve skipped and what they do when they forget or skip a dose. 

Although the MAR lists medications and the times they are to be administered, the patient may be scheduled for tests and procedures that conflict with the medication schedule. It is best to create a medication administration worksheet that schedules both medication and the patient s other activities so there is one schedule for the patient. 

One approach has been to develop strains of many of the viruses listed above as replication-defective or replication-incompetent . These viruses are cultured initially in conditions that provide some nutrient or element of the replicating machinery exogenously. Spontaneous mutations then create strains of virus that cannot replicate unless the crucial element is provided, and it is assumed that after human administration this will be the case. There is always the concern that, after injection, the virus will find some way to overcome its incompetency, e.g. by recruitment of the host cell machinery for this purpose. Similarly, non-viral vectors may offer an advantage by presenting the patient with less foreign antigen. 

In this glossary, we have collected terms and definitions used in the emerging field of safety science most of these terms are also used in this book. Some are technical and come from the various disciplines that comprise safety science. Many will be new to the health care professional who is learning about safety science in order to create a culture of safety. Other terms may be familiar from other contexts, but they are explained here as they relate to patient safety. This list is not meant to be comprehensive, and the definitions are not meant to be official. Rather, our intent is to provide helpful operational definitions, and we have based some of them on the use of these terms in the current literature on patient safety. When formal definitions do exist and are helpful, we have used them and provided their sources in the literature. 

The ICH Q9 strategy and tools can be adapted for a framework for clinical pharmacy, such as described in [5]. The very start of a QRM process is again the description of the work process. As an outcome of their stody the team list a series of decisions that have to be made and specified, for instance by creating SOPs. In this way the priority in creating SOPs is led by the risk analysis. The team realise that QRM may contribute to the protection of the clinical pharmacist who is aware that the risk of patient hazard never can be excluded but who is held to reduce that risk to an acceptable level. 

---