Common Root Cause Research Articles

Asymmetry of Authority or Information Underlying Insufficient Communication Associated with a Risk of Crashes or Incidents in Passenger Railway Transportation

Similar crashes or incidents may recur as a result of insufficient communication in uncertain and risky situations that potentially threaten safety. The common root causes of insufficient communication across a series of incidents and crashes must be explored in detail to prevent a vicious circle of similar incidents or crashes from occurring. This study summarizes a series of incidents and crashes (derailment due to excessive train speed) at JR West at the West Japan Railway Company (JR West) that are considered to have arisen from insufficient communication. The incidents included (i) resuming train service without confirming the number of passengers on board and leaving passengers behind the station at Higashi-Hiroshima station, (ii) continuing train service in spite of an apparent risk of a crash detected at Okayama station, and (iii) leaving the crack of the train hood as it was at Kokura station. We discuss the causes of insufficient communication (particularly in relation to the sharing of information) among the three branches of staff—the station staff, the conductor and train driver, and the train operation management center—that led to the incidents or crashes. Two factors contributed to the insufficient communication in the series of incidents and crashes: (a) Asymmetry of authority, which hinders the discussion of issues openly and equally among the branches concerned. (b) An unacceptable level of knowledge or information for all branches concerned.

Evaluation of Surgical Complications in a University Hospital: A Novel Root Cause Analysis Classification

Objective: To analyze general surgery morbidity and mortality in King Chulalongkorn Memorial Hospital to identify the preventability and root causes of the complications using a novel root cause analysis (RCA) classification according to the period that the corrective action could have been introduced to prevent the complications. Materials and Methods: The authors retrospectively reviewed the morbidity and mortality between October 2012 and October 2016. The data collection included diagnostic groups, organ systems, severity, preventability, and RCA of the complications. Functional outcomes of the patients were also obtained such as full recovery, residual functional impairment, and death. Results: Six hundred seventy-six surgical complications occurred out of 19,440 surgeries performed (3.47%) during the study period. The most common organ system involved was gastrointestinal system (42.8%), followed by wound complications (18.9%). According to the Clavien-Dindo classification, the severity of the complications was 20.7% as grade 1, 18.9% as grade 2, 41.6% as grade 3, 3.7% as grade 4, and 15.1% as grade 5. The authors classified 27 complications as preventable (4.0%), 573 as potentially preventable (84.8%), and 76 as unpreventable (11.2%). RCA of the preventable and potentially preventable complications using the present RCA classification revealed that root causes were defect in the diagnoses (0.5%), defect in management decision making (5.0%), defect in preoperative management (6.1%), defect in intraoperative management (61.3%), and defect in postoperative management (27.0%). The most common defect in intraoperative management was inappropriate surgical approach or technique (58.7%). Most patients (80.2%) fully recovered from the complications, while 4.7% had residual functional impairment, and 15.1% died. Conclusion: The present study demonstrated that most complications in general surgery were preventable or potentially preventable. RCA showed that the most common root cause was the defect is intraoperative management, especially inappropriate surgical approach or technique. Keywords: Surgical complications; Root cause analysis; Morbidity and mortality conference

Occupations and exposure events in acute and subacute irritant-induced asthma

BackgroundExposures leading to irritant-induced asthma (IIA) are poorly documented.MethodsWe retrospectively screened the medical records of patients with IIA diagnosed in an occupational medicine clinic during 2000–2018. We classified the cases...

Top four types of sentinel events in Saudi Arabia during the period 2016-19.

This study discusses the summary, investigation and root causes of the top four sentinel events (SEs) in Saudi Arabia (SA) that occurred between January 2016 and December 2019, as reported by the Ministry of Health (MOH) and private hospitals through the MOH SE reporting system (SERS). It is intended for use by legislators, health-care facilities and the public to shed light on areas that still need improvement to preserve patient safety. The purpose of this study is to review the most common SEs reported by the MOH and private hospitals between the years 2016 and 2019 to assess the patterns and identify risk areas and the common root causes of these events in order to promote country-wide learning and support services that can improve patient safety. In this retrospective descriptive study, the data were retrieved from the SERS, which routinely collects records from both MOH and private hospitals in SA. SEs were analyzed by type of event, location, time, patient demographics, outcome and root causes. There were 727 SEs during this period, 38.4% of which were under the category of unexpected patient death, 19.4% under maternal death, 11.7% under unexpected loss of limb or function and 9.9% under retained instruments or sponge. Common root causes were related to policies and procedures, guidelines, miscommunication between health-care facilities, shortage of staff and lack of competencies. Given these results, efforts should focus on improving the care of deteriorating patients in general wards, ICU (Intensive Care Units) admission/discharge criteria and maternal, child and surgical safety. The results also highlighted the problem of underreporting of SEs, which needs to be addressed and improved. Linking data sources such as claims and patient complaints databases and electronic medical records to the national reporting system must also be considered to ensure an optimal estimation of the number of events.

Low Rates of Preemptive Kidney Transplantation: A Root Cause Analysis to Identify Opportunities for Improvement.

BackgroundKidney transplantation success can help improve the quality of life substantially and alleviate much of the physical, social and psychological stress that comes with dialysis lifestyle. Preemptive kidney transplantation has been established to be superior with more success rates than other means of transplantation types. However, low rates of this method need more attention to address the reason and tackle the root causes affecting low preemptive kidney transplantation.MethodsThis study was undertaken at a tertiary care academic hospital. We conducted a retrospective chart review of 50 living donor kidney transplants (recipient and donor charts) between January 1, 2017 and September 30, 2018 and performed a root cause analysis on the module. A three-step algorithm was developed to divide the root cause of all preemptive kidney transplantation.ResultsOut of 50 patients included, only 11 (22%) achieved a successful preemptive kidney transplantation. Furthermore, an estimated glomerular filtration rate (eGFR) of 15 - 20 was a significant factor in achieving preemptive kidney transplantation (P = 0.042). Meanwhile, 22 recipients started dialysis before transplant and was a major cause of not achieving the preemptive transplantation despite them achieving the status. Moreover, the most common recipient root cause was incidental medical issues in 10 cases (20%) while in donor factors, the most common root cause was the delay in evaluating multiple donors to achieve the preemptive status (20%).ConclusionEven though preemptive kidney transplantation is superior when compared to other modalities, achieving such a milestone is still considered very challenging. An eGFR of 15 - 20 was a significant factor in achieving preemptive kidney transplantation, while pre-transplant dialysis was a major cause of not achieving it. Further large-scale studies are needed to identify new factors as well as validate our findings.

Preventable adverse drug events causing hospitalisation: identifying root causes and developing a surveillance and learning system at an urban community hospital, a cross-sectional observational study

ObjectivesTo identify root causes of preventable adverse drug events (pADEs) contributing to hospital admission; to develop key messages which identify actions patients/families and healthcare providers can take to prevent common...

Root causes of elective surgical case cancellation in Ethiopia: a systematic review and meta-analysis

BackgroundCancellation of elective surgical operation recognized as a major cause of emotional trauma to patients as well as their families. In Ethiopia, prevalence and root causes for elective surgical case cancellation varies from time to time in different settings. This systematic review and meta-analysis aimed to find the pooled prevalence and root causes for elective surgical case cancellation in Ethiopia.MethodsThe databases for the search were Web of Science, PubMed, and Google Scholar. The last literature search was performed on February 8, 2020. To assess publication bias Egger’s regression analysis was applied. The pooled estimation was estimated using random-effects model meta-analysis. Subgroup analysis was also done based on the root causes of surgical case cancellation.ResultsThis meta-analysis included a total of 5 studies with 5591 study participants. The pooled prevalence of elective surgical case cancellation was 21.41% (95% CI: 12.75 to 30.06%).Administration-related reason (34.50%) was the most common identified root cause, followed by surgeon (25.29%), medical (13.90%), and patient-related reasons (13.34%).ConclusionThe prevalence of elective surgical case cancellation was considerable. The most common root cause for elective surgical case cancellation was administration-related reasons, followed by the surgeon, medical and patient-related reasons. The causes for the surgical cancellations are potentially preventable. Thus, efforts should be made to prevent unnecessary cancellations through careful planning.

Actor concurrency bugs: a comprehensive study on symptoms, root causes, API usages, and differences

Actor concurrency is becoming increasingly important in the development of real-world software systems. Although actor concurrency may be less susceptible to some multithreaded concurrency bugs, such as low-level data races and deadlocks, it comes with its own bugs that may be different. However, the fundamental characteristics of actor concurrency bugs, including their symptoms, root causes, API usages, examples, and differences when they come from different sources are still largely unknown. Actor software development can significantly benefit from a comprehensive qualitative and quantitative understanding of these characteristics, which is the focus of this work, to foster better API documentation, development practices, testing, debugging, repairing, and verification frameworks. To conduct this study, we take the following major steps. First, we construct a set of 186 real-world Akka actor bugs from Stack Overflow and GitHub via manual analysis of 3,924 Stack Overflow questions, answers, and comments and 3,315 GitHub commits, messages, original and modified code snippets, issues, and pull requests. Second, we manually study these actor bugs and their fixes to understand and classify their symptoms, root causes, and API usages. Third, we study the differences between the commonalities and distributions of symptoms, root causes, and API usages of our Stack Overflow and GitHub actor bugs. Fourth, we discuss real-world examples of our actor bugs with these symptoms and root causes. Finally, we investigate the relation of our findings with those of previous work and discuss their implications. A few findings of our study are: (1) symptoms of our actor bugs can be classified into five categories, with Error as the most common symptom and Incorrect Exceptions as the least common, (2) root causes of our actor bugs can be classified into ten categories, with Logic as the most common root cause and Untyped Communication as the least common, (3) a small number of Akka API packages are responsible for most of API usages by our actor bugs, and (4) our Stack Overflow and GitHub actor bugs can differ significantly in commonalities and distributions of their symptoms, root causes, and API usages. While some of our findings agree with those of previous work, others sharply contrast.

Revisiting conduct risk management in the COVID-19 era with updated DOJ criteria

Conduct risk refers to behaviours of firms, including financial institutions, which may result in poor outcomes for the consumer. Conduct risk arises in financial institutions due to the nature of various client relationships, many of which include fiduciary duties, as well as due to the impact that financial institutions make on the world’s financial markets. Financial institutions have always managed conduct risk. In the years since the financial crisis, conduct risk has been the subject of increasing scrutiny, as regulators across jurisdictions expanded requirements to address various types of misconduct. The coronavirus disease 2019 (COVID-19) associated health and economic crisis has created new pressures, incentives and opportunities that can lead to heightened conduct risk exposure as institutions adapt to an ever-increasing volatile market and changes to their operations and control environment (eg professionals now must work from home). As individuals attempt to exploit the pandemic, both the institutions and customers are at greater risk. Regulators, aware of the changes brought about by COVID-19, continue to expect firms to take responsibility, and identify and manage their risks and regulatory obligations. COVID-19-heightened conduct risk exposes financial institutions to large fines and penalties, regulator imposed business restrictions and brand dilution. Senior management face potential regulatory disciplinary action and loss of professional reputation. On 1st June, 2020, the Criminal Division of the US Department of Justice (DOJ) published updates to its guidance on the Evaluation of Corporate Compliance Programmes. This guidance helps institutions to assess the effectiveness of their compliance programme through the consideration of various factors, including, but not limited to, the company’s size, industry, geographic footprint, regulatory landscape, and other factors, both internal and external to the company’s operations, that might impact its compliance programme. This paper suggests practical steps to identify and mitigate increased conduct risk arising from COVID-19. Financial institutions subject to US jurisdiction can apply these same steps to meet the June 2020 updated US DOJ criteria of corporate compliance programmes and enable firms to assess the effectiveness of its compliance programme in identifying and managing risks arising from COVID-19. Companies that meet the DOJ criteria earn substantially reduced penalties and stand a good chance of avoiding criminal charges and a government-imposed monitor. The first step is to transfigure (mis)perceptions that Conduct Risk Management is bad for business and convert detractors into supporters by demonstrating a positive ‘return on investment’. It is essential to include stakeholders across first line of defense business units and second line of defense control functions. Firms should fully document efforts to address conduct risk and ensure a culture of compliance and integrity so that the organisation gets full credit for its work to prevent and detect misconduct, should a regulatory inquiry arise. With this firm foundation, financial institutions should update the conduct risk assessment as an ineffective risk assessment is the common root cause for corporate scandals. Once they identify new and emerging inherent risks, financial firms should test the efficacy of responsive policies, processes and controls to determine residual risks that create a reasonable likelihood of significant legal, reputational or financial impacts arising from misconduct strengthening or expanding forensic data science and analytics can be particularly helpful in limiting opportunities for would-be wrongdoers. With this effective framework in place, financial institutions can mitigate often overlooked or underestimated conduct risks either amid a crisis or under business-as-usual conditions.

Chemical instability at chalcogenide surfaces impacts chalcopyrite devices well beyond the surface

The electrical and optoelectronic properties of materials are determined by the chemical potentials of their constituents. The relative density of point defects is thus controlled, allowing to craft microstructure, trap densities and doping levels. Here, we show that the chemical potentials of chalcogenide materials near the edge of their existence region are not only determined during growth but also at room temperature by post-processing. In particular, we study the generation of anion vacancies, which are critical defects in chalcogenide semiconductors and topological insulators. The example of CuInSe2 photovoltaic semiconductor reveals that single phase material crosses the phase boundary and forms surface secondary phases upon oxidation, thereby creating anion vacancies. The arising metastable point defect population explains a common root cause of performance losses. This study shows how selective defect annihilation is attained with tailored chemical treatments that mitigate anion vacancy formation and improve the performance of CuInSe2 solar cells.

Improving Patient Handoffs and Transitions through Adaptation and Implementation of I-PASS Across Multiple Handoff Settings.

Introduction:Communication failures are common root causes of serious medical errors. Standardized, structured handoffs improve communication and patient safety. I-PASS is a handoff program that decreases medical errors and preventable patient harm. The I-PASS mnemonic is defined as illness severity, patient information, action list, situational awareness and contingency plans, and synthesis by receiver. I-PASS was validated for physician handoffs, yet has the potential for broader application. The objectives of this quality improvement initiative were to adapt and implement I-PASS to handoff contexts throughout a pediatric hospital, including those with little or no known evidence of using I-PASS.Methods:We adapted and implemented I-PASS for inpatient nursing bedside report, physician handoff, and imaging/procedures handoff. Throughout the initiative, end-user stakeholders participated as team members and informed the adaptation of the I-PASS mnemonic, handoff processes, written handoff documents, and performance evaluation methods. Peers observed handoffs, scored performance, and provided formative feedback. Adherence to I-PASS was the primary outcome. We also evaluated changes in handoff-related error frequency and clinician attitudes about the effects of I-PASS on personal and overall handoff performance.Results:All 5 elements of the I-PASS mnemonic were used in 87% of inpatient nursing, 76% of physician, and 89% of imaging/procedures handoffs. Inpatient nurses reported reductions in handoff-related errors following I-PASS implementation. Clinicians across most handoff settings reported that using I-PASS improved both general and personal handoff performance.Conclusions:I-PASS is adaptable to many handoff settings, which expands its potential to improve patient safety. Clinicians reported reductions in errors and improvements in handoff performance. We identified broad institutional support, customized written handoff documents, and peer observations with feedback as crucial factors in sustaining I-PASS usage.

A Review of Adverse Event Reports From Emergency Departments in the Veterans Health Administration.

Previous work assessing the frequency of adverse events in emergency medicine has been limited. The emergency department (ED) provides an initial point of care for millions of patients. Given the volume of patient encounters and the complexity of medical conditions treated in the ED, it is necessary to determine the system-based issues and associated contributing factors impacting patient safety. The aim of this retrospective study were to use root cause analysis reports of adverse events occurring in Veterans Health Administration EDs to understand the range of events that were happening and to determine the primary causes of these events as well as actions to prevent them. Retrospective safety reports from EDs from Veterans Health Administration medical centers across the nation for a 2-year period (2015-2016) were coded by event type, root cause, and recommended actions. One hundred forty-four cases were included for analysis. The most common adverse events were as follows: delays in care (n = 38, 26.4%), elopements (n = 21, 14.6%), suicide attempts and deaths by suicide (n = 15, 10.4%), inappropriate discharges (n = 15, 10.4%), and errors in following procedures (n = 14, 9.7%). Overall, the most common root cause categories leading to adverse events were knowledge/educational deficits (11.4%), policies/procedures needing improvement (11.1%), and lack of standardized policies/procedures (9.4%). Root cause analysis reports are a useful tool to determine the primary systems-based factors of common adverse events in the ED. Recommendations made in this article for addressing these root causes and potentially ameliorating these events will be useful to EDs and related health systems.

Can America Reduce Highway Spending? Evidence from the States

Although infrastructure is a key input into economic growth, systematic evidence on what drives overall spending across time or place is very limited. In this paper, motivated in part by the difficulties in international comparisons, we focus on infrastructure for which we can measure spending consistently over time and space: the US Interstate system. Looking over the period of the build-out of the system from 1956 to 1993, we find that the 75th percentile state spent $8.8 million more per mile than the 25th percentile state, relative to mean spending per mile of $11.5 million (all dollar figures are 2016 dollars). If states spending over the median had limited their expenditure per mile to that of the median state, the Interstate system would have cost about 40 percent less to build. When we limit to choices within policymaker discretion, netting out pre-determined characteristics such as the slope of the terrain, a $3.3 million per mile interquartile range persists. We then show that this cross-state variation exceeds that in other related public and private spending, and examine patterns of correlation that provide evidence of common root causes. We review the evidence that does exist on the root causes of infrastructure spending and test some of these hypotheses in our cross-state setting.

Turnaround time for common clinical chemistry examinations and root cause analysis for its delay

Objectives: Measurement of turnaround time for common clinical chemistry examinations and performing root cause analysis for causes for inadequate turnaround time for examinations. Materials and Methods: The Turnaround Times (TAT) of common biochemistry tests ordered by physicians for OPD, IPD and ICU patients were evaluated. Various time periods were recorded, calculated and evaluated. Root cause analysis for delay in TAT was performed by Ishikawa fishbone method. Results and Conclusions: The study shows that average TAT for OPD patients was 22-23 hours, for indoor patient was 6-7 hours and for ICU patient was 7-8 hours. There was major contribution of report transport system in the total TAT, while actual analytical TAT contributed very small to over all TAT. The study shows that, lack of efficient sample and report transport, lack of man power and lack of electronic transport of report is root cause of delay in TAT. Keywords: Turnaround time, Root cause analysis, Ishikawa fishbone method.

5. CREATION AND IMPLEMENTATION OF A STANDARDIZED TOOL TO IMPROVE INPATIENT CONSULT COMMUNICATION

Background Communication failures are the most common root cause of patient safety events. Consults provide a significant opportunity for miscommunications to occur; however, trainees receive little education on how to effectively convey consult requests. Based on literature review and needs assessment of pediatric residents and fellows at Stanford, we identified essential consult elements (ECE) for optimal consult communication. 54 consult requests were audited, and our baseline data showed that only 9% included all ECE. At our institution, 98% of residents (n=56) and 95% of fellows (n=41) reported miscommunication around consults, 85% of which led to perceived patient safety errors. Only 13% of residents reported receiving teaching from fellows during the consultation. Aim Statement 1) Develop a standardized consult communication tool that includes all ECE 2) Increase consult requests containing all ECE by pediatric residents from 9% to 40% within a 6-month period. Interventions A consult communication tool containing ECE was developed using modified SBAR (Situation, Background, Assessment, Recommendations) and taught to pediatric residents from July-Aug 2018 through a series of workshops. Multimedia interventions (flyers, screen savers, name badge cards) were disseminated throughout the hospital. During the initial PDSA cycle, residents and fellows were queried to inform subsequent cycle changes, such as targeting faculty engagement and monthly reminder emails. Measures The primary outcome measure was the percentage of inpatient consult requests containing all ECE by pediatric residents. The process measure was adherence to the modified SBAR tool. Secondary outcomes included clarity of consult question, perceived teaching and learning, and miscommunication. Resident and fellow satisfaction was used as a balancing measure. Results Post intervention from Sep-Dec 2018, 51 consults were audited and consults including ECE increased from 9% to 49%. SBAR was used in 76% of consultations. With SBAR, 96% of consult questions were clear/very clear and 100% of fellows reported being satisfied/very satisfied with communication. Conclusions and Next Steps Our modified SBAR tool resulted in increased inclusion of essential elements for consult communication. It led to greater clarity of consult question and satisfaction by pediatric fellows. Data regarding its effect on teaching, learning, and patient safety will be available in March 2019.

Surgical Confusions in Ophthalmology: Description, Analysis, and Prevention of Errors from 2006 through 2017

To characterize surgical confusions in ophthalmology to determine their incidence, root causes, and impact on patients and physicians. Retrospective cohort study of errors in ophthalmic surgical procedures between January 1, 2006, and December 31,2017. One hundred forty-three cases involving surgical confusions. Cases were identified by the Ophthalmic Mutual Insurance Company from closed case files and by the New York State Health Department from the New York Patient Occurrence Reporting and Tracking program that identified the surgical confusions. Incidence and impact by intended surgery, error type, and root cause as well as preventability by the Universal Protocol. Of the 143 cases of surgical confusions identified, 92 cases (64.3%) were deemed preventable by the Universal Protocol. Approximately two thirds, 95 cases (66.4%), were cases of incorrect implants being used during cataract surgery (cataract extraction and intraocular lens implantation), of which 33 cases (34.7%) were not preventable by the Universal Protocol. Wrong eye blocks or anesthesia accounted for 20 cases (14.0%), incorrect eye procedures accounted for 10 cases (7.00%), incorrect refractive surgery measurements accounted for 6 cases (4.20%), incorrect patient or procedure accounted for 5 cases (3.50%), incorrect intraocular gas concentration accounted for 4 cases (2.80%), and incorrect medication in surgery accounted for 3 cases (2.10%). The most common root cause of confusion was an inadequately performed time out, which was responsible for nearly one third of all surgical confusions, 46 cases (32.2%). Incorrect lens orders or calculations before surgery (so-called upstream errors) were the second most common cause of surgical confusion, involving 31 cases (21.7%). The average legal indemnity for incorrect implant during cataract surgery was $57 514 (United States dollars). The average indemnity for incorrect refractive surgery measurement was $123 125, that for incorrect eye procedure was $50 000, and that for incorrect gas concentration was $220 844. Most surgical confusions could have been prevented by following the Universal Protocol properly. However, upstream errors, originating in the clinic or office before surgery, and ineffective communication during time outs suggest a need for modification of the Universal Protocol.

Indazole-Cl inhibits hypoxia-induced cyclooxygenase-2 expression in vascular smooth muscle cells.

Atherosclerosis is the most common root cause of arterial disease, such as coronary artery disease and carotid artery disease. Hypoxia is associated with the formation of macrophages and increased inflammation and is known to be present in lesions of atherosclerotic. Vascular smooth muscle cells (VSMCs) are one of the major components of blood vessels, and hypoxic conditions affect VSMC inflammation, proliferation and migration, which contribute to vascular stenosis and play a major role in the atherosclerotic process. Estrogen receptor (ER)-β is thought to play an important role in preventing the inflammatory response in VSMCs. In this report, we studied the anti-inflammatory effect of indazole (In)-Cl, an ERβ-specific agonist, under conditions of hypoxia. Expression of cyclooxygenase-2 reduced by hypoxia was inhibited by In-Cl treatment in VSMCs, and this effect was antagonized by an anti-estrogen compound. Additionally, the production of reactive oxygen species induced under conditions of hypoxia was reduced by treatment with In-Cl. Increased cell migration and invasion by hypoxia were also dramatically decreased following treatment with In-Cl. The increase in cell proliferation following treatment with platelet-derived growth factor was attenuated by In-Cl in VSMCs. RNA sequencing analysis was performed to identify changes in inflammation-related genes following In-Cl treatment in the hypoxic state. Our results suggest that ERβ is a potential therapeutic target for the suppression of hypoxia-induced inflammation in VSMCs.

Changes in the geomagnetic field and the evolution of marine biota

The ideas about the influence of the geomagnetic field on evolution and biodiversity are controversial. The quantitative distribution of datum levels of oceanic microplankton during the last 2.0 million years shows a correlation with geomagnetic inversions. Lowering of the field intensity increases cosmic irradiation of the Earth's surface, which can activate mutagenesis leading to new species emergence. Moreover, since the correlation of the geomagnetic field intensity with the composition of the atmosphere, temperature, climate, volcanism and other environmental conditions is revealed, it is possible to assume its influence on evolutionary processes as a part of the general complex of environmental conditions. Geomagnetic polarity superchrons ended by mantle plume formation which produced the trap eruptions and initiated Phanerozoic faunal mass extinctions. The sources of the geomagnetic field and plume formation leading to trap volcanism are at the boundaries of the inner spheres of the Earth, which explains their correlation. And their correlation with impact events as one of the causes of extinction can be explained by the common cosmic root cause located outside the solar system.

Qualitative and quantitative research of medication review and drug-related problems in Hungarian community pharmacies: a pilot study

BackgroundPharmaceutical care is the pharmacist’s contribution to the care of individuals to optimize medicines use and improve health outcomes. The primary tool of pharmaceutical care is medication review. Defining and classifying Drug-Related Problems (DRPs) is an essential pillar of the medication review. Our objectives were to perform a pilot of medication review in Hungarian community pharmacies, a DRP classification was applied for the first time. Also, our goal was the qualitative and quantitative description of the discovered DRPs, and of the interventions for their solution in order to prove the safety relevance of the service and to map out the competence limits of GPs and community pharmacists to drug therapy.MethodsThe project took place in Hungarian community pharmacies. The study was performed with patients taking vitamin K antagonist (VKA) and/or ACE inhibitor and NSAID simultaneously (ACEI-NSAID). 61 pharmacists and 606 patients participated in the project. Pharmacists reviewed the medication for 3 months and the classification of DRPs was performed (category of DRP1 – DRP6). Patient data were statistically analyzed.ResultsPatients consumed on average 7.9 ± 3.1 medications and other products. 571 DRPs were detected in 540 patients, averaging 1.06 DRPs per patient (SD = 1.07). The highest frequency category was DRP5 (non-quantitative safety problem; 51.0%). The most common root cause was an interaction (42.0%) and non-adherence (19.4%.). The most commonly used intervention was education (25.4%) and medication replacement by the pharmacist (20.1%). The changing of the frequency and dosage in any direction were negligible.ConclusionsPatients are struggling with many DRPs that can be assessed and categorized by this system and which remain unrecognizable without pharmacists. Further projects need to be developed to assist in the development of physician-pharmacist cooperation and the widespread dissemination of pharmaceutical care.

Toward Improved Environmental Stability of Polymer:Fullerene and Polymer:Nonfullerene Organic Solar Cells: A Common Energetic Origin of Light- and Oxygen-Induced Degradation.

With the emergence of nonfullerene electron acceptors resulting in further breakthroughs in the performance of organic solar cells, there is now an urgent need to understand their degradation mechanisms in order to improve their intrinsic stability through better material design. In this study, we present quantitative evidence for a common root cause of light-induced degradation of polymer:nonfullerene and polymer:fullerene organic solar cells in air, namely, a fast photo-oxidation process of the photoactive materials mediated by the formation of superoxide radical ions, whose yield is found to be strongly controlled by the lowest unoccupied molecular orbital (LUMO) levels of the electron acceptors used. Our results elucidate the general relevance of this degradation mechanism to both polymer:fullerene and polymer:nonfullerene blends and highlight the necessity of designing electron acceptor materials with sufficient electron affinities to overcome this challenge, thereby paving the way toward achieving long-term solar cell stability with minimal device encapsulation.