Harm Scores Research Articles

The effect of paranoia on the judging of harmful events

Objective. Social psychological research has indicated that intentional harm may be perceived as causing greater damage than unintentional harm. It has been proposed that this harm magnification is a consequence of a need to blame, condemn and punish (“blame motivation”). The objective of the current study was to replicate these findings and to test whether such judgements about harmful events are associated with the level of an individual's paranoia.Method. Three hundred adults read a scenario in which a head of a company causes a reduction in employees' pay. Participants were randomly allocated to versions in which the outcome of the executive's action was intended or unintended. Ratings were made of intent, harm caused and blame motivation. Participants also completed assessments of paranoia and anxiety.Results. Intentional harm was judged as causing worse outcomes than unintentional harm, explaining a small amount of variance in harm scores. Paranoia moderated judgements of intent and blame motivation but not the degree of harm caused; high paranoia, relative to low paranoia, was associated with the unintentional scenario generating higher attributions of intent and blame and the intentional scenario generating lower attributions of intent and blame. Anxiety levels did not affect judgements.Conclusions. The study supports the theory that there is a reasoning bias that magnifies the consequences of intentional harm relative to unintentional harm. In the initial judgement about intent, people with paranoia are less accurate in their use of contextual information.

Changes in Meal Participation, Attendance, and Test Scores Associated with the Availability of Universal Free School Breakfasts

This study investigates student outcomes associated with changes in the availability of universal free breakfasts at elementary schools in the Guilford County Schools (GCS) in North Carolina. In 2007–8, the GCS offered universal free breakfasts in schools with high proportions of economically disadvantaged students. In 2008–9, the GCS reduced its universal free programs, with the affected schools returning to eligibility-based programs. We examine how breakfast and lunch participation, attendance, and reading, math, and science test scores changed across years at affected and unaffected schools. We find that the switch from a universal free to an eligibility-based School Breakfast Program reduced breakfast participation substantially with the largest changes occurring among students who were not eligible for free or reduced-price meals. The changes to eligibility-based provision were associated with decreases in lunch participation for paid-eligible students but not for other students. The changes to eligibility-based provision did not harm test scores or attendance.

Nurse Practitioners in Community Pharmacies: A Model for Collaborative Health Services

believed that medications were generally harmful; this was in contrast to findings found in diabetes mellitus Type 2 patients (56.1%). Only hypertensive and diabetes mellitus Type 2 patients with positive beliefs towards medications was found to have significant correlation with higher medication adherence (r 1⁄4-0.146 and r1⁄4-0.169, p!0.05). Patients negative beliefs domains was significantly correlated with lower medication adherence with significant relationship was noted among hypertensive and diabetes mellitus Type 2 in specific concerns scores (r1⁄4 0.183 and r1⁄40.258 p!0.05) and general harm scores (r1⁄40.246 and r1⁄40.275 p!0.05). Conclusions: Patients’ belief could potentially influence patients’ medication adherence among chronic disease patients.

Assessing EMS Scope of Practice for Utility and Risk: the New Mexico EMS Interventions Assessment Project, Phase One Results

Few emergency medical services (EMS) interventions in New Mexico have been assessed for efficacy, potential harm, or potential benefit. There is concern that many interventions added over the years may be outdated, harmful, or ineffective in the EMS setting. A formal process for reviewing the state EMS scope of practice using literature review and expert consensus is discussed. In Phase One of the project, interventions in the New Mexico EMS scope of practice were prioritized for further review by surveying a national cadre of EMS experts to evaluate EMS interventions using a utilitarian harm/benefit metric. An electronic survey based on the 2010 New Mexico EMS Scope of Practice statute was administered from March through June, 2011. A national cadre of 104 respondents was identified. Respondents were either State EMS medical directors or EMS fellowship directors. Respondents were asked to rate the potential harm and the potential benefit of specific EMS interventions on a 5-point ordinal scale. Median harm and benefit scores were calculated. A total of 88 completed surveys were received following 208 emailed invitations to 104 respondents (43% response rate). Twenty-two (22) highest-priority interventions (those with a harm/benefit median score ratio of >1) were identified. Seven additional second-priority interventions were also identified. These interventions will be advanced for formal literature review and expert consensus. The New Mexico EMS Interventions Project offers a novel model for assessing a prehospital scope of practice.

Reducing Error and Improving Efficiency during Vascular Interventional Radiology: Implementation of a Preprocedural Team Rehearsal

To determine the type and frequency of errors during vascular interventional radiology (VIR) and design and implement an intervention to reduce error and improve efficiency in this setting. Ethical guidance was sought from the Research Services Department at Imperial College London. Informed consent was not obtained. Field notes were recorded during 55 VIR procedures by a single observer. Two blinded assessors identified failures from field notes and categorized them into one or more errors by using a 22-part classification system. The potential to cause harm, disruption to procedural flow, and preventability of each failure was determined. A preprocedural team rehearsal (PPTR) was then designed and implemented to target frequent preventable potential failures. Thirty-three procedures were observed subsequently to determine the efficacy of the PPTR. Nonparametric statistical analysis was used to determine the effect of intervention on potential failure rates, potential to cause harm and procedural flow disruption scores (Mann-Whitney U test), and number of preventable failures (Fisher exact test). Before intervention, 1197 potential failures were recorded, of which 54.6% were preventable. A total of 2040 errors were deemed to have occurred to produce these failures. Planning error (19.7%), staff absence (16.2%), equipment unavailability (12.2%), communication error (11.2%), and lack of safety consciousness (6.1%) were the most frequent errors, accounting for 65.4% of the total. After intervention, 352 potential failures were recorded. Classification resulted in 477 errors. Preventable failures decreased from 54.6% to 27.3% (P < .001) with implementation of PPTR. Potential failure rates per hour decreased from 18.8 to 9.2 (P < .001), with no increase in potential to cause harm or procedural flow disruption per failure. Failures during VIR procedures are largely because of ineffective planning, communication error, and equipment difficulties, rather than a result of technical or patient-related issues. Many of these potential failures are preventable. A PPTR is an effective means of targeting frequent preventable failures, reducing procedural delays and improving patient safety.

Associations between household and neighborhood income and anxiety symptoms in young adolescents.

A better understanding of the role of both family- and neighborhood-level socioeconomic characteristics in the development of anxiety disorders is important for identifying salient target populations for intervention efforts. Little research has examined the question of whether associations between anxiety and socioeconomic status (SES) differ depending upon the level at which SES is measured or way in which anxiety manifests. We studied associations between both household- and neighborhood-level income and four different manifestations of anxiety in a community sample of young adolescents. We conducted a cross-sectional analysis of data on 498 subjects aged 11-13 from a cohort study of Seattle-area middle school students. Generalized estimating equations were used to examine the association between both annual household income and neighborhood median income and each of four anxiety subscale scores from the multidimensional anxiety scale for children (MASC): physical symptoms, harm avoidance, social anxiety, and separation/panic anxiety. A negative association was found between household income and scores on two of the four MASC subscales--physical symptoms and separation/panic anxiety. In contrast, at equivalent levels of household income, adolescents living in higher income neighborhoods reported higher physical and harm avoidance symptom scores. The role that SES plays in the development of childhood anxiety appears to be complex and to differ depending on the specific type of anxiety that is manifest and whether income is evaluated at the household or neighborhood level.

Abstract 275: Effect of Customized Cardiovascular Education on Patient Beliefs and Behaviors Around Cardiovascular Medications

Objective: The objective of this project was to describe the effect of tailored cardiovascular (CV) patient education on beliefs and knowledge about medication in a nurse managed CV risk reduction clinic. Methods: This prospective project was conducted on patients 18 years of age or older referred to usual care at a risk reduction clinic. The primary analysis was change in scores on the Beliefs about Medications Questionnaire (BMQ) pre and post customized CV education. Education included a background/risk assessment, personalized general information, disease management education, and therapeutic lifestyle intervention. The BMQ evaluates 2 domains: necessity and concerns about medications; and general overuse and harm of medications. Secondary analysis included pre/post scores on a patient knowledge assessment (2 questions: I have received education on the importance of continuing (1) cholesterol medications and (2) antiplatelet medications) and the relationship between specific demographics and BMQ scores pre/post. A power calculation determined 45 patients were needed. Data were analyzed using paired t-tests. Results Forty-five patients were enrolled and 40 completed the project. Average age was 64 years, 55% were male, and average number of medications was 4.5. Results of the BMQ demonstrated significant improvements in response to the following (scale 1 [strongly disagree] - 5 [strongly agree]): “my medications are a mystery to me” (average score pre=2.7 vs. post=2.2, p&lt;0.05) and medications do more harm than good (average score pre = 2.1 vs. post = 2.0; p&lt;0.05). Scores on all other questions were not significantly different pre/post. A higher number of patients responded “yes” that they were instructed on the importance of continuing cholesterol medications and antiplatelet medications pre/post (p&lt;0.05 for both). Age, gender, and education level did not correlate with BMQ scores pre/post. Patients receiving primary prevention therapies showed significant improvements in score in 4 components of the specific necessity and concerns (p&lt;0.05 for all). In 2 areas of general overuse and harm, there were both increases and decreases in scores, respectively (p&lt;0.05 for all). Patients receiving secondary prevention therapies showed significant changes in scores in 12 components. With regard to specific necessity and concern, scores improved in 4 components (p&lt;0.05 for all). A decrease in perception was seen in 1 component (p&lt;0.05). General overuse and harm scores showed improvements in 5 components (p&lt;0.05 for all). A decrease in perception was seen in 2 components (p&lt;0.05 for all). Conclusions: Customized CV education results in improvements in patients’ beliefs and knowledge about medications. These data have provided a basis to further evaluate education methods in this CV practice. Future implications are to investigate changes in BMQ scores with clinical markers such as LDL and blood pressure goal attainment.

IMPROVED RANKING OF DRUGS ON HARMFULNESS CAN BRING SENSE AND ORDER TO A FAILED SYSTEM

The publication 4 years ago by Nutt et al. 1 of a scale to assess drug-related harms brought with it a storm of reactions from scientists and the public at large. Of particular interest was the finding that an independent assessment of drug harms was inconsistent with the current system of drug classification, in that harm scores for some legal substances (alcohol and tobacco) were higher than scores for many of the classified substances (e.g. cannabis). The controversy has continued unabated, much of it fuelled by Professor Nutt himself in press interviews and public lectures 2. In a 2010 report presented as an improvement on the 2007 study, Nutt and colleagues 3 used an expert consensus approach to assess drug harms and arrived at a similar conclusion that the way drugs are classified is not supported by scientific evidence regarding the level of harm associated with the drugs. As expected, the second study has been as controversial as the first. In their reaction to the paper, Caulkins, Reuter & Coulson 4 argue that attempts to rank-order drugs on the basis of harm is ‘fundamentally misguided’, and that even if a method produced perfect rankings the exercise ‘would not provide sufficient basis’ for scheduling or other policy decisions. Thus, the problems with the study as seen by Caulkins and colleagues are both on the methodology and relevance of its findings. Calling the exercise ‘misguided’ and ‘pseudo-scientific’ might be a little harsh, but it is fair to question the method used to establish harm. Determining harm by consensus can be problematic, as assessments of this nature are likely to be influenced by personal biases and levels of expertise. The method of multi-criteria decision analysis as used by Nutt et al. also did not take into account the benefits of drug use (especially in the case of alcohol), differential availability of illegal substances and polydrug use, all of which are factors that might affect how harm is defined and measured. This should be a concern in the UK context but more so if, as is likely to happen, the findings of this study are generalized to other settings. Caulkins and colleagues are opposed to rankings, but they seem to recognize the basic human motivation for order that drives efforts to compare different types of harm. They have, therefore, proposed an alternative ‘harm matrices’ (as opposed to ‘harm ratings’) approach that would be more multi-dimensional by taking into consideration the context of drug use, among other factors. What they have suggested is a more complex version of Nutt et al., a version that I suspect will produce similar (but not comparable) results, and one they hope would serve as a ‘flexible’ tool for policy. The implications for international drug control policy and the suspicion that a political agenda might be at play seem to have contributed to the controversy surrounding the work by Nutt et al., who are obviously critical of the current classification system because it ignores drug-related harms. Of course, a system based on harms alone would be problematic. What, for example, should be done about alcohol, a drug that is well known to be associated with high levels of physical and social harm 5, 6? While the majority in most countries would hardly recommend banning alcohol, the findings by Nutt et al. at least call for greater attention to this drug, including the implementation of interventions that are effective in reducing alcohol-related harm 7. In spite of the critical response by Caulkins and colleagues to the rank-ordering of drugs according to physical, psychological and social harms, I suspect that rankings of this nature will continue, albeit with refined methods. If the system of harm matrices proposed by the authors can produce more useful information for policy, that would be an important contribution. None.

The frequency and importance of reported errors related to parenteral nutrition in a regional paediatric centre

Summary Aim To determine the frequency and significance of reported errors related to parenteral nutrition (PN) in a regional paediatric centre. Methods In our children’s centre, it is policy that “any unexpected event with an actual or potential detrimental effect on a patient is formally reported on an incident report (IR1) form” by staff. We therefore reviewed all IR1 forms related to PN between January’06 and June’09. The errors were categorised according to where in the PN process they occurred. Harm scores (severity of the error in relation to patient safety) were based on the framework of the American ‘National Coordinating Council for Medication Error Reporting and Prevention’ (NCC MERP). Results Over 18,588 PN days, 46 errors were identified, giving an error frequency of 0.24%. Of these, 5 (11%) occurred during the prescription process, 9 (20%) during the transcription process, 11 (24%) during dispensing, 7 (15%) during delivery of PN to the ward and 14 (30%) during the administration process. No errors were reported during the preparation/compounding process. 43 (94%) errors did not result in patient harm, while 3 (6%) errors resulted in temporary harm. Conclusions Reported PN related errors resulting in harm appear to be rare. Most occur during dispensing and administration suggesting that more robust checking procedures are required during these phases. The widespread reporting of non harmful errors indicates that staff have an appropriately low threshold for completing IR1 forms; these represent a valuable audit tool for improving patient safety.

The frequency and significance of errors related to parenteral nutrition (PN) in children

ObjectiveTo determine the nature, frequency and significance of errors related to the PN process in a tertiary paediatric unit.MethodsIn our children's centre, it is policy that ‘any unexpected event with...

Alcohol outlet density, levels of drinking and alcohol-related harm in New Zealand: a national study

BackgroundPrevious research shows associations of geographical density of alcohol outlets with a range of alcohol-related harms. Socioeconomic conditions that are associated with both outlet density and alcohol-related outcomes may confound...

A New Approach to Tracking the Harmfulness of Medical Errors in Health Care Systems

A variety of approaches are available to monitor and quantify the frequency of medical errors and the harm associated with them. The University HealthSystem Consortium Patient Safety Net provides a categorical, rank-ordered approach for designating harm associated with medical errors but does not lend itself to routine monitoring of change over time. A brief questionnaire was developed and given to hospital administrators to collect ratings about the harmfulness of events occurring in each of the 10 University HealthSystem Consortium harm-score categories. Results revealed a high degree of agreement among raters for harmfulness ratings for each category. A cubic model fit the data best and provided weights for each of the harm-score categories. This preliminary study proposes a methodology for quantifying harm scores.

Frequency and Severity of Harm of Medication Errors Related to the Parenteral Nutrition Process in a Large University Teaching Hospital

To determine the frequency of medication errors, as well as the severity of harm resulting from these errors, related to the prescription, transcription, preparation, and administration of parenteral nutrition formulations. Prospective, observational study. 471-bed, academic teaching hospital. All adult and pediatric inpatients receiving parenteral nutrition between November 1, 2002 and May 31, 2004. The occurrence of incorrect prescribing practices, wrong formulation preparation, operational system errors, order entry errors related to automated technology, and incorrect administration practices were documented. In addition, the specific step in the drug process--prescription, transcription, preparation, and administration--at the time that the error occurred was noted. Harm scores, to assess the severity of the error in relation to the safety of the patient, were assigned based on the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). The rate of errors with parenteral nutrition was then compared with the rate of errors with other high-alert drugs, both at our institution and at a health care consortium. A total of 4730 prescriptions for parenteral nutrition were written during the study period; 74 (1.6%) were associated with a medication error. Of these errors, 1 (1%) occurred during the prescription process (and was detected before preparation), 29 (39%) occurred during the transcription process, 18 (24%) during preparation, and 26 (35%) during the administration process. Sixty-seven (91%) of the 74 errors were considered nonharmful, as defined by NCC MERP, whereas 6 (8%) contributed to or resulted in temporary harm to a patient. The rate of errors was similar between our institution and the consortium, both for parenteral nutrition formulations and for other high-alert drugs. The overall incidence of medication errors during the study was 15.6 errors/1000 parenteral nutrition prescriptions compounded. Our results demonstrate that medication errors related to the prescription, transcription, preparation, and administration of parenteral nutrition formulations occur and occasionally result in harm. Health care institutions should develop quality assurance programs to document compliance with published safe practice guidelines for parenteral nutrition.

Site-specific disease profiles in fish and their use in environmental monitoring

MEPS Marine Ecology Progress Series Contact the journal Facebook Twitter RSS Mailing List Subscribe to our mailing list via Mailchimp HomeLatest VolumeAbout the JournalEditorsTheme Sections MEPS 381:1-15 (2009) - DOI: https://doi.org/10.3354/meps07947 FEATURE ARTICLE Site-specific disease profiles in fish and their use in environmental monitoring G. D. Stentiford*, J. P. Bignell, B. P. Lyons, S. W. Feist Centre for Environment, Fisheries and Aquaculture Science (Cefas), Weymouth Laboratory, Weymouth, Dorset DT4 8UB, UK *Email: grant.stentiford@cefas.co.uk ABSTRACT: Clinical fish disease and liver pathology are high-level indicators of ecosystem health. Internationally agreed protocols for their measurement have allowed for the comparison of datasets that transcend international marine boundaries and have promoted the collection of quality assured data by several countries bordering the northeast Atlantic and associated seas. Here, grossly visible diseases and liver lesions (including tumours) were recorded between 2002 and 2006 from UK Clean Seas Environmental Monitoring Programme sites in the Irish and North Seas and in the English Channel. Diagnosis followed protocols developed by the International Council for the Exploration of the Sea and the Biological Effects Quality Assurance in Monitoring Programmes. Multivariate data analysis revealed a stable disease profile at most sites sampled. Sites with the highest levels of grossly visible diseases and liver lesions consistently grouped together within a given year, and distinctly from those sites displaying a lower prevalence of disease. Between-year analyses for these sites demonstrated the repetitive nature of these patterns, suggesting a relatively consistent disease profile between years, even at open ocean sites. Assessment of prevalence for the different diseases allowed for development of a grading system that assigned relative harm scores for populations existing at a particular site. Grading of harm scores into site types may provide an assessment tool for managers to identify sites of concern and to cross-correlate disease with potential causal factors. The use of disease data in marine environment status monitoring is discussed. KEY WORDS: Epidemiology · Grossly visible fish diseases · Histopathology · Liver pathology · Monitoring · Neoplasia · Quality assurance Full text in pdf format Information about this Feature Article Supplementary appendix NextCite this article as: Stentiford GD, Bignell JP, Lyons BP, Feist SW (2009) Site-specific disease profiles in fish and their use in environmental monitoring. Mar Ecol Prog Ser 381:1-15. https://doi.org/10.3354/meps07947Export citation RSS - Facebook - Tweet - linkedIn Cited by Published in MEPS Vol. 381. Online publication date: April 17, 2009 Print ISSN: 0171-8630; Online ISSN: 1616-1599 Copyright © 2009 Inter-Research.

Beliefs about medicines in patients with rheumatoid arthritis and systemic lupus erythematosus: a comparison between patients of South Asian and White British origin

To assess whether patients with RA and SLE who are of South Asian origin have different beliefs about medicines in general, and about DMARDs in particular, compared with patients of White British/Irish origin. One hundred patients of South Asian origin (50 RA; 50 SLE) and 100 patients of White British/Irish origin (50 RA; 50 SLE) were recruited. Demographic and disease-related details and responses to the Beliefs about Medicines Questionnaire (BMQ), the SF-36 and the HAQ were collected. Patients of South Asian origin had significantly higher General Overuse (GO), General Harm (GH) and Specific Concern (SC) scores compared with patients of White British/Irish origin. Forward stepwise multivariable regression analysis showed that ethnic origin was an independent predictor of the GO, GH and SC scores with patients of South Asian origin having higher scores in these three scales of the BMQ. RA and SLE patients of South Asian origin have very high levels of concern about DMARDs and are generally worried about prescribed medicines. This may have an impact on adherence in this group of patients and further work is needed to understand the reasons underlying these beliefs.

Moral Antecedents of Smoking Behavior and Risk Beliefs Among Overseas Asian Students

Instead of focusing on the misconduct of multinational cigarette manufacturers, this research project broadens the discussion of cigarette consumption by focusing on the moral antecedent variables that shape young adults' smoking behavior and risk beliefs. It especially challenges current wisdom among anti-smoking advocates that by increasing consumer knowledge of the medical risks associated with smoking will lead to significant reductions in young adult smoking prevalence rates. Empirical results of this study suggest that although increasing smoking risk knowledge does not significantly reduce Asian students' smoking behavior, increasing their risk assessment beliefs does produce the desirable public policy effect of reducing current smoking. Furthermore, only among rules-driven individuals does an increase in no harm scores significantly reduce student smoking risk assessment beliefs. Thus, current anti-smoking advertising campaigns among overseas Asian students may be more effective if they attempt to change these students' smoking risks assessment beliefs especially if they are targeted to rules-driven student market segments.