What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.Objective To investigate the epidemiology of medication errors and error-related adverse events in adults in primary care, ambulatory care and patients’ homes. Design Systematic review. Data source Six international databases were searched for publications between 1 January 2006 and 31 December 2015. Data extraction and analysis Two researchers independently extracted data from eligible studies and assessed the quality of these using established instruments. Synthesis of data was informed by an appreciation of the medicines’ management process and the conceptual framework from the International Classification for Patient Safety. Results 60 studies met the inclusion criteria, of which 53 studies focused on medication errors, 3 on error-related adverse events and 4 on risk factors only. The prevalence of prescribing errors was reported in 46 studies: prevalence estimates ranged widely from 2% to 94%. Inappropriate prescribing was the most common type of error reported. Only one study reported the prevalence of monitoring errors, finding that incomplete therapeutic/safety laboratory-test monitoring occurred in 73% of patients. The incidence of preventable adverse drug events (ADEs) was estimated as 15/1000 person-years, the prevalence of drug–drug interaction-related adverse drug reactions as 7% and the prevalence of preventable ADE as 0.4%. A number of patient, healthcare professional and medication-related risk factors were identified, including the number of medications used by the patient, increased patient age, the number of comorbidities, use of anticoagulants, cases where more than one physician was involved in patients’ care and care being provided by family physicians/general practitioners. Conclusion A very wide variation in the medication error and error-related adverse events rates is reported in the studies, this reflecting heterogeneity in the populations studied, study designs employed and outcomes evaluated. This review has identified important limitations and discrepancies in the methodologies used and gaps in the literature on the epidemiology and outcomes of medication errors in community settings.Peer reviewe

Identification de caractéristiques agronomiques pour le diagnostic et la prise de décision de régénération des vergers de cacaoyers en Côte d'Ivoire

La régénération des vieux vergers de cacaoyers (Theobrama cacao L.) est une des stratégies mises en place en Côte d'Ivoire pour assurer une production durable de cacao. Une étude a été conduite en vue d'élaborer un guide pour réaliser un diagnostic rapide et adéquat des vergers et prendre la bonne décision de régénération, en optant judicieusement pour la réhabilitation ou la replantation. Un échantillon de 90 plantations de cacaoyers réhabilitées et de 75 autres replantées a été enquêté dans 12 départements représentatifs des trois principales zones de production de cacao du pays. Des données ont été collectées sur les caractéristiques agronomiques majeures de ces cacaoyères. Il s'est agi de la variété de cacaoyer, la superficie de la plantation, l'âge, le rendement, la densité de plantation, le nombre d'arbre d'ombrage permanent et le niveau des dégâts des insectes et des maladies. Les résultats ont montré que les critères discriminants des vergers régénérés sont l'âge, la densité de plantation et le rendement. Leurs valeurs moyennes sont comprises entre 25 et 30 ans pour l'âge, 800 et 1 000 arbres ha-1 pour la densité et entre 250 et 400 kg ha-1 an-1 pour la production. A partir de ces trois critères et de leurs valeurs moyennes, un guide a été élaboré pour le diagnostic des vergers de cacaoyers et la prise de décision. Selon ce guide, les vieilles plantations de cacaoyers (plus de 25 ans), dégradées et improductives doivent être replantés. Cependant, les cacaoyères plus jeunes ayant des densités de plantation et des rendements plus élevés que les valeurs moyennes ci-dessus devraient être réhabilitées. (Résumé d'auteur

Fungal dysbiosis predicts the diagnosis of pediatric Crohn's disease

AIM: To investigate the accuracy of fungal dysbiosis in mucosa and stool for predicting the diagnosis of Crohn’s disease (CD). METHODS: Children were prospectively enrolled in two medical centers: one university hospital and one private gastroenterology clinic in the city of Riyadh, Kingdom of Saudi Arabia. The children with confirmed diagnosis of CD by standard guidelines were considered cases, and the others were considered non-inflammatory bowel disease controls. Mucosal and stool samples were sequenced utilizing Illumina MiSeq chemistry following the manufacturer’s protocols, and abundance and diversity of fungal taxa in mucosa and stool were analyzed. Sparse logistic regression was used to predict the diagnosis of CD. The accuracy of the classifier was tested by computing the receiver operating characteristic curves with 5-fold stratified cross-validation under 100 permutations of the training data partition and the mean area under the curve (AUC) was calculated. RESULTS: All the children were Saudi nationals. There were 15 children with CD and 20 controls. The mean age was 13.9 (range: 6.7-17.8) years for CD children and 13.9 (3.25-18.6) years for controls, and 10/15 (67%) of the CD and 13/20 (65%) of the control subjects were boys. CD locations at diagnosis were ileal (L1) in 4 and colonic (L3) in 11 children, while CD behavior was non-stricturing and non-penetrating (B1) in 12 and stricturing (B2) in 3 children. The mean AUC for the fungal dysbiosis classifier was significantly higher in stools (AUC = 0.85 ± 0.057) than in mucosa (AUC = 0.71 ± 0.067) (P < 0.001). Most fungal species were significantly more depleted in stools than mucosal samples, except for Saccharomyces cerevisiae and S. bayanus, which were significantly more abundant. Diversity was significantly more reduced in stools than in mucosa. CONCLUSION: We found high AUC of fungal dysbiosis in fecal samples of children with CD, suggesting high accuracy in predicting diagnosis of CD. Key Words: Fungiome, Mycobiome, Crohn’s disease, Inflammation, Saudi children Core tip: We found high accuracy of fungal dysbiosis in predicting diagnosis of Crohn’s disease (CD), a finding similar to bacterial dysbiosis. However, the higher area under the curve for the fungal dysbiosis classifier in stool (0.85 ± 0.057) than in mucosa (0.71 ± 0.067) (P < 0.001), contrasts with bacterial studies, suggesting higher accuracy of stool samples. Although the clinical application of this finding is limited at present by the high cost of fungal analysis, such information is important from a scientific viewpoint, to increase the understanding of the role of fungal flora in CD and to stimulate further studies.The authors extend their appreciations to the Deanship of Scientific Research at King Saud University in Riyadh, Kingdom of Saudi Arabia for funding this work through Research Group No [RGP-1436-007]. This work was also supported by a grant from the Simons Foundation [No. 409704] to Kirill Korolev) and by the startup fund from Boston University to Kirill Korolev. Simulations were carried out on Shared Computing Cluster at Boston University. Rajita Menon was partially supported by a Hariri Graduate Fellowship from Boston University. Harland Winter, MD received support from Martin Schlaff and the Diane and Dorothy Brooks Foundation. (RGP-1436-007 - King Saud University in Riyadh, Kingdom of Saudi Arabia; 409704 - Simons Foundation; Boston University; Hariri Graduate Fellowship from Boston University; Diane and Dorothy Brooks Foundation)Published versio

Spread, circulation, and evolution of the Middle East respiratory syndrome coronavirus

The Middle East respiratory syndrome coronavirus (MERS-CoV) was first documented in the Kingdom of Saudi Arabia (KSA) in 2012 and, to date, has been identified in 180 cases with 43% mortality. In this study, we have determined the MERS-CoV evolutionary rate, documented genetic variants of the virus and their distribution throughout the Arabian peninsula, and identified the genome positions under positive selection, important features for monitoring adaptation of MERS-CoV to human transmission and for identifying the source of infections. Respiratory samples from confirmed KSA MERS cases from May to September 2013 were subjected to whole-genome deep sequencing, and 32 complete or partial sequences (20 were ≥99% complete, 7 were 50 to 94% complete, and 5 were 27 to 50% complete) were obtained, bringing the total available MERS-CoV genomic sequences to 65. An evolutionary rate of 1.12 × 10−3 substitutions per site per year (95% credible interval [95% CI], 8.76 × 10−4; 1.37 × 10−3) was estimated, bringing the time to most recent common ancestor to March 2012 (95% CI, December 2011; June 2012). Only one MERS-CoV codon, spike 1020, located in a domain required for cell entry, is under strong positive selection. Four KSA MERS-CoV phylogenetic clades were found, with 3 clades apparently no longer contributing to current cases. The size of the population infected with MERS-CoV showed a gradual increase to June 2013, followed by a decline, possibly due to increased surveillance and infection control measures combined with a basic reproduction number (R0) for the virus that is less than 1

Les caractéristiques agronomiques des vergers de cacaoyer (Theobroma cacao L.) en Côte d'Ivoire

Dans le cadre du projet PIC-Cacao, un diagnostic du verger cacao ivoirien a été réalisé en effectuant une enquête dans dix départements représentatifs des trois grandes zones productrices de cacao. Un échantillon de 800 producteurs a été enquêté. L'objectif était de décrire les caractéristiques agronomiques des plantations de cacaoyers en Côte d'Ivoire. Les résultats obtenus ont montré que ces producteurs sont en majorité analphabètes et ont un âge moyen de 49 ans. Quatre vingt pour cent (80 %) sont des petits planteurs possédant des vergers de moins de 10 ha. La cacaoyère est caractérisée par un verger mature dont plus de 60 % de la superficie est constituée de plantations de 11 à 30 ans. Ces vergers sont essentiellement installés après forêt, par semis direct à forte densité, en utilisant un matériel végétal " tout venant ". A l'âge adulte, 70 à 90 % sont conduits en " plein soleil " ou sous un léger ombrage permanent. Leur entretien est insuffisant. En effet, les fréquences de désherbage et de traitement phytosanitaire sont limitées à deux ou trois nettoyages par an et, à un ou deux applications d'insecticides par an. L'engrais est rarement utilisé. Ainsi, le verger est peu productif. Les rendements moyens sont compris entre 260 et 560 kg/ha/an. Ces résultats démontrent la faible productivité du verger cacao ivoirien. (Résumé d'auteur

MERS-CoV spillover at the camel-human interface

Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic virus from camels causing significant mortality and morbidity in humans in the Arabian Peninsula. The epidemiology of the virus remains poorly understood, and while case-based and seroepidemiological studies have been employed extensively throughout the epidemic, viral sequence data have not been utilised to their full potential. Here, we use existing MERS-CoV sequence data to explore its phylodynamics in two of its known major hosts, humans and camels. We employ structured coalescent models to show that long-term MERS-CoV evolution occurs exclusively in camels, whereas humans act as a transient, and ultimately terminal host. By analysing the distribution of human outbreak cluster sizes and zoonotic introduction times, we show that human outbreaks in the Arabian peninsula are driven by seasonally varying zoonotic transfer of viruses from camels. Without heretofore unseen evolution of host tropism, MERS-CoV is unlikely to become endemic in humans.</jats:p

Assessment of bone loss adjacent to lower second molar in case of third molar impaction and other findings using Orthopantomography (OPG)

Programa de Doctorat en Medicina i Recerca Translacional[eng] INTRODUCTION: Dental impaction is a pathological situation in which a tooth is totally or partially included in the jaw or maxilla bone. Different teeth are noticeably prone to impaction phenomena, including the canine and upper third molar, third molar, and lower canine. However, the lower third molar is considered the most common impacted tooth, accounting for 98% compared to other impacted teeth. It usually erupts between the ages of 17 and 24. The overall prevalence of impaction of the lower third molar is estimated to be around 24%, with no gender predilection between men and women. There are factors that cause a tooth to not erupt in the expected time, including lack of space, poorly positioned dental germs, abnormal eruption pathway, and alterations in jaw development. Mandibular third molar impaction has many complications in the adjacent soft tissue and second molar. Thus, pericoronitis is one of the consequences caused by impaction, which manifests itself as inflammation of the gum tissue that covers it. Other complications include distal caries, bone loss adjacent to the second molar, cystic formation, and neoplastic changes. The different positions of impacted mandibular third molars can complicate the maintenance of oral hygiene and control plate. Therefore, the periodontium manifests the formation of pockets that facilitate bone loss on the distal aspect of the second molar. In addition, the mandibular third molar is located near the inferior mandibular canal which contains the inferior alveolar nerve, the artery and the corresponding vein. Surgical extraction of such a tooth may pose a risk of nerve injury leading to dysesthesia or paresthesia. In addition, the third molar removal procedure can put pressure on the bone that can lead to fracture of the angle of the jaw. Finally, extraction can affect the lower 2nd molar. Therefore, clinical and diagnostic procedures are essential to address the position of the impacted tooth, the associated pathology, the proximity to the nerve canal, and the decision to intervene. Orthopantomography (OPG) is an imaging technique routinely used in the dental office, representing the jawbone and jaw in a single image. It has the advantage of exposing dental and bone changes in the oral cavity, including impacted teeth. Among the advantages of OPG are its speed and ease, especially the 2nd molar and the canal inside the realization, better patient cooperation and acceptance, complete coverage of dental arches and related structures (more anatomical structures can be seen on a panoramic film than in a full series of intraoral x-rays), simplicity, and low radiation exposure for the patient, compared to the most advanced imaging tool, cone beam computed tomography (CBCT). As impaction of the third molar is one of the dental pathologies that dentists frequently see, the determination of the position and relationship with nearby structures, especially the 2nd molar and the lower dental canal, can be predicted using OPG. HYPOTHESIS: Impaction of the third molar causes bone loss distal to the second molar, therefore there will be bone gain distal to the second molar after extraction of the third molar. OBJECTIVE: To determine the distal bone loss of the lower second molar associated with impaction of the third molar and to analyze its evolution after the extraction of the third molar.[spa] INTRODUCCIÓN: la impactación dental es una situación patológica en la que un diente se incluye total o parcialmente en el hueso de la mandíbula o del maxilar. Diferentes dientes son notablemente propensos a los fenómenos de impactación, incluyendo el canino y el tercer molar superior, el tercer molar y el canino inferior. Sin embargo, el tercer molar inferior se considera el diente impactado más común, representando el 98% en comparación con otros dientes impactados. Por lo general, entra en erupción entre los 17 y 24 años. La prevalencia global de impactación del tercer molar inferior se estima en torno al 24%, sin predilección de género entre hombres y mujeres. Hay factores que hacen que un diente no erupcione en el tiempo esperado, incluida la falta de espacio, los gérmenes dentales mal posicionados, la vía de erupción anormal y las alteraciones del desarrollo de la mandíbula. La impactación del tercer molar mandibular tiene muchas complicaciones en el tejido blando adyacente y en el segundo molar. Así, la pericoronaritis es una de las consecuencias causadas por la impactación, que se manifiesta como inflamación del tejido gingival que la recubre. Otras complicaciones incluyen la caries distal, la pérdida ósea adyacente al segundo molar, formación quística y cambios neoplásicos. Las diferentes posiciones de los terceros molares mandibulares impactados pueden complicar el mantenimiento de la higiene oral y la placa control. Por lo tanto, el periodonto manifiesta la formación de bolsas que facilitan la perdida oseas en la cara distal del segundo molar. Además, el tercer molar mandibular está ubicado cerca del canal mandibular inferior el cual contiene el nervio alveolar inferior, la arteria y la vena correspondiente. La extracción quirúrgica de dicho diente puede ejercer un riesgo de lesión nerviosa que conduzca a disestesia o a parestesia. Además, el procedimiento de extracción del tercer molar puede ejercer una presión sobre el hueso que puede conducir a la fractura del ángulo de la mandíbula. Finalmente, la extracción puede afectar al 2º molar inferior. Por lo tanto, los procedimientos clínicos y diagnósticos son esenciales para abordar la posición del diente impactado, la patología asociada, la proximidad al canal nervioso y la decisión de intervención. La ortopantomografía (OPG) es una técnica de diagnóstico por la imagen utilizada rutinariamente en el consultorio dental, que representa al maxilar y la mandíbula en una sola imagen. Tiene la ventaja de exponer los cambios dentales y óseos en la cavidad oral, incluidos los dientes impactados. Entre las ventajas de la OPG, se encuentran su rapidez y facilida, en especial el 2º molar y el canal dentro de realización, mejor cooperación y aceptación del paciente, cobertura completa de las arcadas dentales y estructuras relacionadas (se pueden ver más estructuras anatómicas en una película panorámica que en una serie completa de radiografías intraorales), simplicidad y baja exposición a la radiación para el paciente, en comparación con la herramienta de imagen más avanzada, la tomografía computarizada de haz cónico (CBCT). Como la impactación del tercer molar es una de las patologías dentales que los odontólogos ven con frecuencia, la determinación de la posición y la relación con las estructuras cercanas, en especial el 2º molar y el canal dentario inferior, se puede predecir utilizando OPG. HIPÓTESIS: La impactación del tercer molar causa pérdida ósea distal al segundo molar, por lo tanto, habrá ganancia ósea distal al segundo molar después de la extracción del tercer molar. molar impactado. OBJETIVO: determinar la pérdida ósea distal del segundo molar inferior asociada a impactación del tercer molar y analizar su evolución tras la extracción del tercer molar