Infectious disease in the blood supply and the public health response

The consistent improvements in hemophilia care seen in the years 1960 to 1980 halted when human immunodeficiency virus (HIV) appeared in the blood supply. In the early 1980s, before HIV virulence was fully understood, a complacent blood therapy industry and its regulators waffled on an appropriate response. As a result, the period between the appearance of HIV and its effective elimination from the blood supply was lengthy and many recipients of blood therapies became infected, with devastating impact on their quality of life, quality of care, and longevity. As the decade wore on, even as they began to better understand the threat, industry and public health officials continued to stall, in part because development of interventions was costly and cumbersome. In order to protect the safety of the blood supply and blood-derived therapies, it must be recognized that new pathogens will continue to emerge. Agencies' and companies' decision-making processes in this regard must therefore be proactive rather than reactive, and should preferably implement a formalized risk-management approach. The ongoing safety of blood therapies and the blood supply will also depend on continued vigilance and research. Finally, the hemophilia community must be allowed to play an active and educated role in their own care.

Historical investigations: risk management in a New Zealand hospital 1888-1904

This article reports an historical research project in which four events within one hospital are examined from the point of view of what, today, would be termed 'risk management'. The examples involve a nurse sustaining injury in the course of her work, a fire in the hospital and two instances of patient complaints--one concerning nursing care and the other relating to a time lag between admission to hospital and receiving medical attention. All would have their counterparts in situations dealt with by today's Risk Management Departments. Analysis of the processes followed in investigating these occurrences reveals what seem to be two major differences when compared to present day practices. As well as being smaller in scale and less bureaucratic the earlier investigations were based on a culture of blame. It is argued that modern risk management approaches rather than being geared toward apportioning blame are more focused on understanding what can be learned from the incident with respect to preventing recurrence.

Brief history of patient safety culture and science

The science of safety is well established in such disciplines as the automotive and aviation industry. In this brief history of safety science as it pertains to patient care, we review remote and recent publications that have guided the maturation of this field that has particular relevance to the complex structure of systems, personnel, and therapies involved in caring for the critically ill.

The impact of pharmaceutical care practice on the practitioner and the patient in the ambulatory practice setting: twenty-five years of experience

This manuscript reviews 25 years of experience that include developing the practice of pharmaceutical care and initiating new practices. The impact this practice has on practitioners in the ambulatory setting is described as well as data that reflect its clinical and economic impact. There is a great need to prepare new practitioners to provide pharmaceutical care. A focused training program was developed and delivered to over 300 practitioners. The practitioners were prepared by providing direct patient care. They learned the philosophy of pharmaceutical care practice, to identify, resolve and prevent drug therapy problems, to document care using a specially designed software program called the Assurance Pharmaceutical Care program. The practitioners who participated in the training program reported that the average amount of time spent with patients increased three-fold, they now see four times more patients than prior to training, and the number of new patients referred by physicians increased nine-fold as a result of the program. These practitioners have now provided care to more than 25,000 patients in their practices. These data have now been consolidated and analyzed, and a portion of these results is reported here. The clinical and economic outcomes from 2,985 adult patients, who received pharmaceutical care between January, 2000 and December, 2003, are presented. At the first assessment by the pharmaceutical care practitioner, 61% of the patients had one or more drug therapy problems identified and resolved. This resulted in an improvement in the clinical status or maintaining a stable status in 83% of the patients. The health care savings realized from pharmaceutical care were $1,134,162. This represented a benefit to cost ratio of 2:1. Physicians who collaborate with pharmaceutical care practitioners have validated the work of the practitioners, and patients are recognizing the benefits of pharmaceutical care.

Jewels in the crown: The Medical Journal of Australia's 10 most‐cited articles

According to data from the Institute for Scientific Information (ISI), the most-cited MJA article is Cade's ground-breaking report on the effect of lithium in mania (1949; 888 citations), followed by Marshall et al's reports on the role of Helicobacter pylori in gastroduodenal disease (1985; 766 and 523 citations, respectively). Others in the "top 10" span decades and disciplines; all have a common grounding in Australian data of global relevance.

[The past and present history of the term "quality" in medicine]

In the medieval hospital the terms "care" and "cure" constituted a kind of hendiadys; in the XVIII century the quality of services was precisely identified for the first time, and, between the XVIII and the XIX centuries, medicine also began to assess the quality of professional competence, recognizing the need for a fair allocation of resources, and directing the health services only towards those who really needed them. In the XIX century the "Regolamenti" of hospital institutions are made compulsory in Italy, as foreseen by the Public Health Law of 1888. However, only during the XX century, and particularly in the second half of the century, quality standards are defined, together with the structuring of a health service and with the ever more widely felt need for a new relationship between the physician and the patient, and between the patient and the institution. In even more recent times, during the 1990s, Evidence Based Medicine has given a further stimulus to every currently interpreted quality systems.

Practicing beautiful medicine beautifully: Hiram Curry's vision in the 21st century

Hiram Curry's Vision and "Crossing the Quality Chasm" A generation after Hiram first spoke of "Practicing Beautiful Medicine Beautifully", with focus on medical science, understanding the patient and understanding the physician, his vision can be seen in the report's definition of quality care: "Good quality means providing patients with appropriate services in a technically competent manner, with good communication, shared decision-making, and cultural sensitivity." As we in medicine develop and adopt needed changes in the health care delivery, education, and financing systems we would do well to remember Hiram Curry's vision and strategies for "Practicing Beautiful Medicine Beautifully."

Values, qualifications, ethics and legal standards in Arabic (Islamic) medicine

Many historians claim that the Western world pioneered in the setting of ethical, legal and professional standards in the practice of medicine. Informed medical consent is proposed by some as an American invention. Others claim that patient rights and legal protection propose have stated in the early decades of the 20th century. This review is an attempt to uncover the facts regarding the way Arabs practiced medicine during the golden era of Islam. Eight hundred to fifteen hundred AD this includes the qualification of physicians according to a well designed curricula covering the science and humanity of medicine. The rules governing the quality control of health care delivery system and to some degree the principles of informed medical consent and to a lesser degree the principles of litigation are discussed. We hope that this paper will be a call to all humanity loving persons to end prejudices against other people and to stop stereotyping.

The hazards of hospitalization. 1964



 The occurrence of hospital-induced complications on a university medical service was documented in the prospective investigation of over 1000 patients. The reported episodes were the untoward consequences of acceptable medical care in diagnosis and therapy. During the 8-month study, 240 episodes occurred in 198 patients. In 105 patients, hospitalization was either prolonged by an adverse episode or the manifestations were not yet resolved at time of discharge. Thus, 20% of the patients admitted to the medical wards experienced one or more untoward episodes and 10% had a prolonged or unresolved episode. The severity of the 240 episodes was minor in 110, moderate in 82, and major in 48, of which 16 ended fatally. Patients encountering noxious episodes had a mean total hospitalization of 28.7 days compared with 11.4 days in other patients. The risk of having such episodes seemed directly related to the length of time spent in the hospital. The number and variety of these reactions emphasizes the magnitude and scope of hazards to which the hospitalized patient is exposed. A judicious selection of diagnostic and therapeutic measures can be made only with knowledge of these potential hazards as well as the proposed benefits.

Nursing research for a better care. Annie T. Altschul. 1985

Dieser Bericht möchte in Kürze die Probleme definieren, die bei der Beschreibung von guter Krankenpflege entstehen und in der Folge Methoden zur Entwicklung von besserer Pflege aufzeigen. Offensichtlich möchte jede Schwester gut pflegen. Ob dies jedoch geschieht oder nicht, ist sehr schwierig zu beweisen. Im Folgenden zeige ich einige Punkte auf, die diskutiert werden, entweder, um zu sehen, was Pflegeforschung getan hat, um diese Probleme aufzuzeigen, oder um neuerliche Fragen, die durch Pflegeforschung behandelt werden müssen, aufzuwerfen: 1. Was geschieht jetzt in der Krankenpflege? In verschiedenen Ländern – in Zusammenarbeit mit anderen professionellen Diensten – im Zusammenhang mit den verschiedenen Gruppen der Bevölkerung, die die Pflege betreut? 2. Durch welche Faktoren wird die praktische Pflege beeinflusst? Durch das bestehende Gesundheitssystem – durch ökonomische Faktoren – durch Personalfaktoren – durch die Krankenhausumgebung in Bezug auf Ausstattung etc. – durch kulturelle Unterschiede, z.B. Familienverantwortlichkeit? 3. Welche Methoden wenden Pflegepersonen an? Um Wundverbände anzulegen – um Injektionen zu geben – um Medikamente zu verabreichen – um angepasste Ernährung der Patienten sicherzustellen – bei den Ausscheidungen des Patienten – bei der Beobachtung der Vitalfunktionen? 4. Wie bewältigen Schwestern bestimmte Situationen? Patienten, die Schmerzen haben – Patienten, die verwirrt sind – Patienten, die alt sind – Kinder – Eltern dieser Kinder – Besucher der Patienten? 5. Wie treten Schwestern in Verbindung? Mit Patienten – mit Ärzten – mit Angehörigen – mit anderen? 6. Welche Kriterien wurden gesetzt, um die Pflegequalität zu messen? Von Führungskräften – in der Krankenpflegeausbildung – bei Politikern – von Patienten? 7. Welche theoretischen Grundlagen gibt es, um die Pflegequalität zu messen? Abgeleitet von biologischen Wissenschaften, von der Soziologie und anderen Wissenschaften? 8. Welche Werkzeuge gibt es zur Messung der Pflegequalität? Durch die oben angeführten Fragen werden die Hauptprobleme bei Neuerungen klar aufgezeigt. Falls es als notwendig erachtet wird, die Pflegequalität zu verbessern, gibt es Kritik an der Jetzt-Situation. In der Folge werden Pflegeforscher, die Veränderungen herbeizuführen wünschen, als eine Gefährdung angesehen. Im letzten Teil meines Berichts wird die Frage aufgeworfen, ob in der Praxis stehende Schwestern selbst Pflegeforschung durchführen sollen und wie sie dazu beitragen können, dass Forschungsergebnisse wirklich zur Verbesserung der Krankenpflege angewandt werden.

[One hundred years of the Association of Surgeons in the Netherlands. VIII. Surgical oncology]

The Dutch surgical oncologists founded the Dutch Society for Surgical Oncology in 1981 with the aim of providing the best possible level of expertise in the multidisciplinary approach to the treatment of cancer, which at that time was a new development in cancer care. Since then, many developments have contributed to improving the outcome of care for the patient suffering from malignant disease. Surgeons have often played an initiating and pivotal role in these developments. Furthermore, in recent years there has been a strong development in quality awareness. This has led to a greater degree of cooperation in which intensive contacts exist. At the same time developments have taken place in surgical oncology: the care provided has developed from a broadly based care of the patient with a malignancy to care system concentrating on organ systems. As a result of this, the multidisciplinary therapeutic approach to the patient with cancer has been further developed. This might however lead to a fragmentation of oncological care and a loss of identity for the surgical oncologist, who possibly more than any other sub-specialist plays a pivotal role in caring for the patient with a solid malignancy.

[One hundred years of the Association of Surgeons in the Netherlands. V. Traumatology]

Traumatology in the Netherlands gained considerable momentum during the last years of the twentieth century. This breakthrough was due to the creation of ten trauma care centres, each with its own 'mobile medical team'. Additionally, four of these centres dispose of a helicopter for rapid transport of this team. Furthermore, within the field of medical education and training, new courses on advanced trauma and life support (ATLS) and advanced pediatric life support (APLS), for example, not only offer more practical knowledge, but also provide a 'common language' for all those involved in the medical and organisational aspects of trauma care. Surgical treatment of trauma injuries is becoming increasingly oriented towards minimally invasive techniques. Assessment of the quality of care provided requires a broad and reliable registration system for injuries.

[One hundred years of the Netherlands Association of Surgeons. I. Introduction]

On 9 February 1902, the Association of Surgeons in the Netherlands was founded--a remarkable fact. The surgeons, who formerly worked in guilds, were by no means the first to found such a society. Some specialist disciplines had already preceded them by forming an association. During the course of these 100 years, surgery has undergone vast development and progress. This has consequences for the deployment of the surgical profession. Subspecialties have arisen, increasing the quality of surgical care. Technical possibilities enhance small access surgery. This means a very different approach in the training of young surgeons in their profession, for instance through the use of virtual reality techniques.