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Ch. 2 Risk and Technology in UK Health Care The second factor contributing to the nurse's error involved her working on an understaffed shift, which consistently led ward managers to complain to management about increased workload. However, the underlying causes in each of these situations i.e. poor training and rostering ; were not considered in the institution's response. Instead the sole focus was on the specific actions of the nurse in question. She was subsequently given a formal written warning, reinstated, and retrained in the use of syringe pumps. No action was taken in regard to the widespread education of staff in how to detect and deal with the differences between the pumps, or to attempt to solve the problem of nursing shortages. Two lessons are apparent from this case study. First, the institution neglected the cascade of factors contributing to the incident, treating the error made by the nurse as the end rather than start of the investigation. Hence, the local working practices and the management systems which enabled her to make such an error were not revealed, leaving potential for repetition. This consequence is not exclusive to the healthcare industry. Other hazardous industries have shown that poor accident analysis enables the same situations to keep provoking the same kind of errors in a wide variety of people [Reason, 1997]. Notably, it is far easier to fix situations and technologies than to change people [Carthey, 2001]. Second, despite the neglect of organisational issues, the institution was left with the dangerous misconception that it has improved patient safety [Carlisle, 1996]. Reason [2001] adds that: `.the process of identifying and dealing with those "wrongdoers" responsible is often followed by a view that "it could not happen here again."' In reality, this will only occur if a thorough examination of the entire context of care is conducted. Over time, superficial and perfective incident investigation impact on reporting systems. Van Vuuren [2000] found that the perceived benefits of incident reporting and analysis affected the types of incidents reported: `Incidents due to organisational failures were rarely reported, since it was known that "nothing would change anyway."' He found that most medical incidents were primarily reported for liability reasons, not because doctors believed in the value of incident reporting. This suggests that blame culture has the knockon effect of reducing the amount of useful adverse event data received by the reporting system in the first place, and so further limits organisational learning attempts in the NHS.
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Miss a dose if you miss a dose of this medicine , take it as soon as possible and inderal. CORE ABSTRACTS 124. A model-based comparison of cost effectiveness of imiquimod versus podophyllotoxin for the treatment of external anogenital warts in France Fren ; Lafuma A. Monsonego J. Moyal-Barracco M. Pribil C. [A. Lafuma, Cemka Eval, 43, boulevard Mar chal Joffre, 92340 e Bourg la-Reine, France] - ANN. DERMATOL. VENEREOL. 2003, 130 8-9 I 731-736 ; Objectives. For the National health scheme, to compare the costs and the efficacy of treatment of external anogenital warts with imiquimod and podophyllotoxin and laser therapy in the case of failure or relapse. Patients and methods. A model simulating the two successive treatments was built. In the first phase, the two topical treatments applied by the patients: podophyllotoxin for 4 weeks and imiquimod for 16 weeks were compared. In the case of failure or relapse, laser therapy that is widely used in France in this indication and, was applied. The efficacy of the topical treatments was assessed after reanalysis of the results of two controlled clinical trials versus placebo. These two trials were retained because they were comparable in method and had been recently published at the same time. A review of the literature assessed the results of laser therapy. A survey was conducted to collect the medical resources consumed by the different treatments. Results. Imiquimod provided a clearance rate of 49.5 p. 100, i.e., the disappearance of the lesions at 16 weeks, greater than that of podophyllotoxin 28.3 p. 100 ; at 4 weeks. The relapse rate was lowest with imiquimod 13.3 p. 100 ; than with podophyllotoxin 30.9 p. 100 ; . The remission rate without relapse 3 months after the end of treatment was, including the laser, of 62 p. 100 following imiquimod and of 47 p. 100 following podophyllotoxin. The costs per patient cured was of 668 euros for imiquimod and of 689 euros for podophyllotoxin. Conclusion. Imiquimod, because of its greater initial efficacy, is at least as cost-effective as podophyllotoxin the treatment of external genital warts. 125. The interest of radiological follow-up for stage III melanoma Fren ; Kerob D. Baccard M. Dupuy A. et al. [D. Kerob, Service de Dermatologie 2, H pital Saint-Louis, 1, avenue o Claude Vellefaux, 75010 Paris, France] - ANN. DERMATOL. VENEREOL. 2003, 130 8-9 I 739-741 ; Introduction. The modalities of follow-up frequency of consultations and interest of repeated radiological examinations ; of patients presenting with glandular metastases of melanoma stage III of the AJCC classification ; have not reached a consensus. Patients and methods. Since 1995, we have proposed clinical follow-up every two months and radiological controls with a thoracic-abdominal-pelvic scan every 4 months, to patients at high risk of relapse for the early screening of an infra-clinical relapse. Results. The median follow-up was of 16 month's range: 1 to 82 months ; . Eight patients out of 24 33 100 ; followed-up in this manner, had asymptomatic metastases discovered by the radiological examinations. Among these 8 patients, three presented with a an operable, single, metastatic localization and two patients underwent surgery. One patient relapsed 3 months later, the other was still alive without relapse 24 months later. Discussion. Surgery remains the treatment of choice for all stages of melanoma. In the absence of clearly effective treatment of metastatic melanoma, the early discovery of an infra-clinical metastatic relapse presents two major advantages. The first is the discovery of a single, operable metastasis, as was the case in two of the patients out of 24. The second is to be able to suspend an eventual adjuvant therapy with interferon alpha, as soon as a relapse has been discovered, for example, dr reddy finasteride.
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The 2.5 mg ODT formulation of zolmitriptan is a nonfriable orangeflavoured tablet. This formulation was shown to have a similar clinical profile to the conventional tablet. In a placebo-controlled study, 63% of patients reported headache relief after 2 hours, with an onset of action within 1 hour Table 4.2 ; . The majority of patients 70% ; preferred the ODT to the conventional tablet. The ODT formulation of zolmitriptan was well tolerated with an adverse event profile similar to that of the conventional tablet see Q 4.xx.

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