Patients death

Consider this example. There are two manufacturing facilities in central North Carolina facing each other on opposite sides of the street. One facility manufactures implantable pacemakers the other cuts stripped pine into tongue depressors. Both utilize the same software package to track shipments and potentially to recall problem deliveries. A pacemaker recall must be perfect and timely, or a patient death is the likely result. A tongue depressor recall (hard to imagine) has little or no impact on health and safety. 

Let s look at an example of what might happen in the following data set of patient deaths when we assume a zero result in place of a missing result. Here is a data set of subject death information (death) by treatment (trt), where death = 0 if a patient did not die and death = 1 if the patient did die. If we are not certain that a patient died, then we assume that the patient did not die and use death = 0. 

Pyrogens are substances that, when they enter the blood stream, influence hypothalamic regulation of body temperature, usually resulting in fever. Medical control of pyrogen-induced fever proves very difficult, and in severe cases results in patient death. 

Puimonary disorders Dyspnea, pulmonary infiltrates, pneumonia, bronchiolitis obliterans, interstitial pneumonitis, and sarcoidosis, some resulting in respiratory failure and/or patient deaths, may be induced or aggravated by peginterferon alfa-2a or alpha interferon therapy. 

A variety of diseases can affect bone and its structure. Paget s disease, for example, is a disorder arising from abnormal osteoclasts, characterized by exeessive bone resorption followed by replacement of the normal mineralized bone with structurally weak, poorly mineralized tissue. However, the most important bone disease is osteoporosis. This is a skeletal bone disease characterized hy microarchitectural deterioration of bony tissue and loss of bone mass, yielding increased susceptibility to bone fracture and bone fragility. In the United States, osteoporosis results in 1.5 million hone fractures annually, with 250,000 of these being hip fractures that sometimes ultimately culminate in patient death. There is a variety of therapies for the prevention and treatment of osteoporosis. 

In 1860, the histological lesions of the kidneys were described by Samuel Wilks in London but he did not consider them as the cause of patients death [12]. 

The absorption of drugs in solution from intramuscular and subcutaneous sites of injection is limited by the perfusion rate. Failure to recognize this important concept has resulted in patient death. For example, morphine sulfate is often administered subcutaneously in a dose of 10 mg per 70 kg of body weight. This dose is sufficient to produce analgesia in 70% of patients with moderate to severe pain. However, in the setting of circulatory collapse and shock (e.g., septic shock in bacteremia due to release of endotoxin) in which the peripheral circulation may be impaired, morphine is not absorbed. Cases have been reported in which the lack of analgesia prompted the additional injection of morphine, all of which remained at the injection site and in the subcutaneous capillary bed. When the peripheral circulation improved, the massive amount of morphine that had collected became absorbed and death ensued, which was primarily due to respiratory depression. 

Tierney M. 2004. Lessons from patient deaths An Ontario pharmacist responds to Calgary s patient safety review. 

Patients, Public Need, 1995), declaring that the long-term effects can be devastating. They include confusion, memory loss, heart failure, and, in some patients, death. In more recent years, the shock doctors have been working hard to promote this barbaric treatment and have received less criticism from the media. 

In response to voluntary reports from physicians to the FDA or the manufacturer, the FDA has issued warnings, made label changes, required manufacturers to conduct postmarketing studies, and ordered product withdrawals that have ultimately prevented patient deaths and suffering. 

On the other hand, data strongly imply that PVCs documented in the convalescence period of MI do carry important long-term prognostic significance. PVCs occurring after an MI seem to be a risk factor for patient death that is independent of the degree of LV dys-... 

The locations in a marketing application of individual narratives of subject/patient deaths, other SAEs, and other significant AEs should be referenced. These narratives themselves will normally be a part of the applicable clinical study report. In cases where no clinical study report has been generated, narratives can be placed in an appropriate... 

A. Hematopoietic Syndrome. Patients who have received doses of radiation in the low to mid-lethal range will have depression of bone-marrow function with cessation of blood-cell production leading to pancytopenia. Among treated patients, deaths should be minimal. 

Noble WH, Baker A. MAO inhibitors and coronary artery surgery a patient death. CanJ Anaesfft (1992) 39,1061-6. 

In Sect. 5.3.1 we discussed the concepts of slips and lapses and there are a number of design principles which can be employed to reduce the incidence of these. Slips for example can be addressed by avoiding common but not identical action sequences. Suppose viewing or cancelling an appointment requires an almost an identical series of mouse clicks. Should one of these activities be much more common than the other it is likely that from time to time an error will be made when actioning the infrequent task. Similarly buttons with unrecoverable consequences should be separated from more benign, frequently used functions. For example, it would be wise to design in some physical distance between buttons entitled Record patient death and Update patient address . 

Valproic acid (2-propyl-n-pentanoic acid, VP A) is an anticonvulsant widely used in the treatment of various epileptic disorders. It has been known that VPA administration caused severe hepatic dysfunction similar to Reye s syndrome in a small number of patients. Deaths from hepatotoxicity were also reported. VPA affects carnitine and ammonia levels and other metabolic parameters related to fatty acid oxidation. The potential hepatotoxicity by VPA is caused by its unsaturated metabolites, such as 4-en-... 

Patient death or serious disability associated with the use of contaminated drugs, devices or biologies provided by the healthcare facility ... 

Patient death or serious disability associated with a medication error ... 

The risk of patient death or morbidity as the result of inadequate or poor testing ... 

Professionals such as surgeons, anesthetists, surgical nurses, anesthetic nurses, and individuals from the support services form the operating room teams [18]. These teams usually work under time pressure, and the effectiveness of team performance in the operating room environment is very important, as surgical tasks require the coordinated efforts of all involved individuals. The occurrence of a human error in such an environment can result in patient death or permanent damage to a patient. 

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