Home About us Contact
|
Home About us Contact | ||
|
|
||
Severe Events (severe + event)
Selected AbstractsHypoglycaemia in Type 2 diabetesDIABETIC MEDICINE, Issue 3 2008S. A. Amiel Abstract The primary cause of hypoglycaemia in Type 2 diabetes is diabetes medication,in particular, those which raise insulin levels independently of blood glucose, such as sulphonylureas (SUs) and exogenous insulin. The risk of hypoglycaemia is increased in older patients, those with longer diabetes duration, lesser insulin reserve and perhaps in the drive for strict glycaemic control. Differing definitions, data collection methods, drug type/regimen and patient populations make comparing rates of hypoglycaemia difficult. It is clear that patients taking insulin have the highest rates of self-reported severe hypoglycaemia (25% in patients who have been taking insulin for > 5 years). SUs are associated with significantly lower rates of severe hypoglycaemia. However, large numbers of patients take SUs in the UK, and it is estimated that each year > 5000 patients will experience a severe event caused by their SU therapy which will require emergency intervention. Hypoglycaemia has substantial clinical impact, in terms of mortality, morbidity and quality of life. The cost implications of severe episodes,both direct hospital costs and indirect costs,are considerable: it is estimated that each hospital admission for severe hypoglycaemia costs around £1000. Hypoglycaemia and fear of hypoglycaemia limit the ability of current diabetes medications to achieve and maintain optimal levels of glycaemic control. Newer therapies, which focus on the incretin axis, may carry a lower risk of hypoglycaemia. Their use, and more prudent use of older therapies with low risk of hypoglycaemia, may help patients achieve improved glucose control for longer, and reduce the risk of diabetic complications. [source] Reporting of adverse events following immunization in AustraliaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2005David Isaacs Abstract: It is an important component of any immunization programme that vaccine safety is monitored by carrying out surveillance for adverse events following immunization (AEFI). Such surveillance can be active or passive. Active surveillance will detect more AEFI, but the vast majority will be minor events. Passive surveillance is probably more appropriate for routine AEFI surveillance, while active surveillance can be used to monitor a new vaccine or to test whether a specific severe event is significantly associated with immunization. Australia has a predominantly passive surveillance system. The system has recently been centralized, providing useful national data on vaccine safety. [source] Trends and determinants of severe morbidity in HIV-infected patients: the ANRS CO3 Aquitaine Cohort, 2000,2004,HIV MEDICINE, Issue 8 2007F Bonnet Objective The aim of the study was to characterize the causes, trends and determinants of severe morbidity in a large cohort of HIV-infected patients between 2000 and 2004. Method Severe morbid events were defined as medical events associated with hospitalization or death. Epidemiological and biological data were recorded at the time of the morbid event. Trends were estimated using Poisson regression. Results Among 3863 individuals followed between 2000 and 2004, 1186 experienced one or more severe events, resulting in 1854 hospitalizations or deaths. The severe events recorded included bacterial infections (21%), AIDS events (20%), psychiatric events (10%), cardiovascular events (9%), digestive events including cirrhosis (7%), viral infections (6%) and non-AIDS cancers (5%). Between 2000 and 2004, the incidence rate of AIDS events decreased from 60 to 20 per 1000 person-years, that of bacterial infections decreased from 45 to 24 per 1000 person-years, and that of psychiatric events decreased from 26 to 14 per 1000 person-years (all P<0.01), whereas the incidences of cardiovascular events and of non-AIDS cancers remained stable at 14 and 10 per 1000 person-years, on average, respectively. Conclusion Severe morbidity has shifted from AIDS-related to non-AIDS-related events during the course of HIV infection in developed countries. Limiting endpoints to AIDS events and death is insufficient to describe HIV disease progression in the era of combination antiretroviral therapy. [source] Cloud systems leading to flood events in Europe: an overview and classificationMETEOROLOGICAL APPLICATIONS, Issue 3 2003Federico Porcú Over recent years most European countries have experienced destructive precipitation events, many of which have generated floods resulting in the loss of lives and economic damage. Rather surprisingly, Europe has no common database for flood events, which continue to be monitored by different national and/or local authorities, with different criteria. In the light of this situation, the main aim of the present work is to propose a classification scheme for a European-level flood database, in which severe flood episodes are related to meteorological conditions and mesoscale settings. The meteorological systems relating to the most severe events (22 events) over a five-year period (1992,1996) were analysed using Meteosat imagery and conventional meteorological data. Most of the observed events were related to extra tropical cyclone development. The results are discussed in terms of conceptual models currently used for extra tropical cyclones: the structure and dynamics of Atlantic cyclones can very often be interpreted in terms of well- known conceptual models, while characteristics of Mediterranean systems are not fully rendered by current descriptions. Our study underpins the need to improve the knowledge of Mediterranean systems, possibly introducing new conceptual models and/or refining the current ones. Copyright © 2003 Royal Meteorological Society [source] Detecting past population bottlenecks using temporal genetic dataMOLECULAR ECOLOGY, Issue 10 2005UMA RAMAKRISHNAN Abstract Population bottlenecks wield a powerful influence on the evolution of species and populations by reducing the repertoire of responses available for stochastic environmental events. Although modern contractions of wild populations due to human-related impacts have been documented globally, discerning historic bottlenecks for all but the most recent and severe events remains a serious challenge. Genetic samples dating to different points in time may provide a solution in some cases. We conducted serial coalescent simulations to assess the extent to which temporal genetic data are informative regarding population bottlenecks. These simulations demonstrated that the power to reject a constant population size hypothesis using both ancient and modern genetic data is almost always higher than that based solely on modern data. The difference in power between the modern and temporal DNA approaches depends significantly on effective population size and bottleneck intensity and less significantly on sample size. The temporal approach provides more power in cases of genetic recovery (via migration) from a bottleneck than in cases of demographic recovery (via population growth). Choice of genetic region is critical, as mutation rate heavily influences the extent to which temporal sampling yields novel information regarding the demographic history of populations. [source] AL02 ADVERSE EVENTS: OUR RESPONSIBILITY FOR REPORTING, REVIEWING AND RESPONDINGANZ JOURNAL OF SURGERY, Issue 2009D. A. Watters An adverse event is defined as unintentional harm (to a patient) arising from an episode of healthcare and not due to the disease process itself. Surgical adverse events include death, unplanned reoperation, unplanned readmission, unplanned ICU readmission, medication errors and side-effects, falls, pressure ulcers, hospital acquired infection, and inadvertent injury during surgery. Adverse events occur in around 10% of general surgical cases. The rates also vary between specialties. Reporting: , Adverse events need to be reported through both a hospital incident reporting system (eg Riskman) and through surgical audit. Each adverse event should be graded using a Severity Assessment Code (1,4) on the basis of its effect on the patient or hospital service, and the likelihood of it recurring. Some of the more severe events will trigger an entry on the risk register, making service managers responsible for action. Reviewing: , The opportunity must be seized to improve system issues. An investigation (eg root cause analysis) should be conducted in an atmosphere of ,no-blame' with engagement of and consultation with the major stakeholders who are responsible for delivering solutions. Training in system-wide approaches and teamwork can be invaluable. Responding: , The response needs to recognise the needs of the patient who has been harmed. There should be an honest and frank discussion with the patient and/or their family, acknowledging their suffering with empathy and an apology should be offered without necessarily admitting any liability. Open disclosure has the potential to reduce risk of litigation. Surgeons need to engage in reporting, reviewing and responding if the rate of adverse events is to be reduced. [source] | ||||||||||