Toxicological evidence in forensic pharmacology.

Laboratory evidence of the presence and concentration of a drug in a person who has come to harm is often helpful in forensic pharmacology, and may be crucial. However, its value depends on two critical interpretations by the expert. First, the expert must make a careful analysis of the relationship between the results as measured in the sample and the drug in the patient at the time that harm occurred.

Medication errors.

Medication errors cause substantial harm to patients. We need good methods for counting errors, and we need to know how errors defined in different ways and ascertained by different methods are related to the harm that patients suffer. As errors arise within the complex and poorly designed systems of hospital and primary care, analysis of the factors that lead to error, for example by failure mode and effects analysis, may encourage better designs and reduce harms.

Biochemical monitoring of patients treated with antihypertensive therapy for adverse drug reactions: a systematic review.

Biochemical monitoring of patients treated with antihypertensive therapy is recommended in order to identify potential adverse reactions to treatment. We aimed to review the literature investigating the nature of biochemical monitoring in adults treated in primary care with antihypertensive drugs. Specifically, we wished to establish (i) the proportion of patients with biochemical baseline testing prior to the initiation of antihypertensive therapy; (ii) the proportion of patients with biochemical monitoring after initiation of antihypertensive therapy; (iii) the patient characteristics associated with biochemical monitoring; (iv) the frequency of biochemical monitoring after the initiation of antihypertensive therapy; and (v) the relationship, if any, between biochemical monitoring and adverse patient outcomes.

Therapeutic misadventure.

Therapeutic misadventure can be defined as an injury or an adverse event caused by medical management rather than by an underlying disease. Within the National Health Service there were over 86,000 reported adverse incidents in 2007. In the USA medication errors have been rated as the fourth highest cause of death.

Republished paper: Where errors occur in the preparation and administration of intravenous medicines: a systematic review and Bayesian analysis.

Objective: To investigate the overall probability of error in preparing and administering intravenous medicines; to identify at which stage of the process an error is most likely to occur; and to determine the impact of error correction on the error probability. Design Systematic review and random-effects Bayesian conditional independence modelling.

Methods: Medline and EMBASE were searched for studies on intravenous medicines.

An algorithm for integrating contraindications into electronic prescribing decision support.

Background: Contraindications to medicines define circumstances in which the medicines must not be given. Computerized prescribing systems with decision support should display alerts to warn prescribers of contraindications. However, for such systems to be effective, alerts should only be displayed when relevant.

Preventability of drug-related harms - part I: a systematic review.

'Preventability' is a crucial concept in the literature on adverse drug reactions (ADRs). We have carried out a systematic review in order to identify and analyse the approaches used to define 'preventability' in relation to ADRs. We have restricted this investigation to definitions of preventability and have not dealt with other aspects.

Correlates of spontaneous reporting of adverse drug reactions within primary care: the paradox of low prescribers who are high reporters.

Aim(s): To examine Primary Care Trust (PCT) demographics influencing general practitioner (GP) involvement in pharmacovigilance.

Methods: PCT adverse drug reaction (ADR) reports to the Yellow Card scheme between April 2004 and March 2006 were obtained for the UK West Midlands region. Reports were analysed by all drugs, and most commonly reported drugs ('top drugs').

Laboratory monitoring and adverse patient outcomes with antihypertensive therapy in primary care.

Purpose: The monitoring of serum electrolyte and creatinine concentrations in patients treated with antihypertensive therapy is recommended. We wished to examine the relationship between laboratory monitoring and adverse patient outcomes.

Methods: We carried out a retrospective cohort study using the General Practice Research Database (GPRD).

Where errors occur in the preparation and administration of intravenous medicines: a systematic review and Bayesian analysis.

Objective: To investigate the overall probability of error in preparing and administering intravenous medicines; to identify at which stage of the process an error is most likely to occur; and to determine the impact of error correction on the error probability.

Design: Systematic review and random-effects Bayesian conditional independence modelling.

Methods: Medline and EMBASE were searched for studies on intravenous medicines.

EIDOS: a mechanistic classification of adverse drug effects.

The mechanisms of adverse drug effects have not been adequately classified. Here, we propose a comprehensive mechanistic classification of adverse drug effects that considers five elements: the Extrinsic chemical species (E) that initiates the effect; the Intrinsic chemical species (I) that it affects; the Distribution (D) of these species in the body; the (physiological or pathological) Outcome (O); and the Sequela (S), which is the adverse effect. This classification, which we have called EIDOS, describes the mechanism by which an adverse effect occurs; it complements the DoTS classification of adverse effects (based on clinical pharmacology), which takes into account Dose responsiveness, Time course, and Susceptibility factors.

Improving follow-up rates in spontaneous adverse drug reaction reporting: effectiveness of a targeted letter used by a regional centre in the UK.

Background: Spontaneous reports of suspected adverse drug reactions to regulatory bodies and market authorization holders are important in pharmacovigilance. Follow-up information, which can be difficult to obtain, is often required from reporters; therefore, we developed targeted follow-up letters that we hoped would make replying easier.

Objective: To examine the effects of introducing targeted letters on responses to follow-up requests from a regional pharmacovigilance centre in the UK.

The epidemiology of medication errors: the methodological difficulties.

1. Medication errors should be amenable to epidemiological analysis, giving insights into the causes of error and the effects of interventions to prevent them or reduce harm from them. 2.

The pathophysiology of medication errors: how and where they arise.

1. Errors arise when an action is intended but not performed; errors that arise from poor planning or inadequate knowledge are characterized as mistakes; those that arise from imperfect execution of well-formulated plans are called slips when an erroneous act is committed and lapses when a correct act is omitted. 2.

Should doctors who make clinical errors be charged with manslaughter? A survey of medical professionals and members of the public.

If a doctor is grossly negligent and the patient dies as a result, the doctor can be charged with manslaughter. We have investigated the difference in opinion between medical professionals and the public on whether doctors should face criminal charges following different fatal medical errors. We conducted a survey of 40 medical professionals and 40 members of public, using a set of questions about negligence and manslaughter relating to four real-life cases of doctors charged with manslaughter where eventual outcomes were known.

Post-mortem clinical pharmacology.

Clinical pharmacology assumes that deductions can be made about the concentrations of drugs from a knowledge of the pharmacokinetic parameters in an individual; and that the effects are related to the measured concentration. Post-mortem changes render the assumptions of clinical pharmacology largely invalid, and make the interpretation of concentrations measured in post-mortem samples difficult or impossible. Qualitative tests can show the presence of substances that were not present in life, and can fail to detect substances that led to death.

Over the counter medicines: proceed with caution.

and caution that the risks of increasing people’s access to over the counter medicines may outweigh the benefits

A case study of a graphical misrepresentation: drawing the wrong conclusions about the measles, mumps and rubella virus vaccine.

Graphs have been used in attempts to show a relationship between the measles, mumps and rubella virus (MMR) vaccine and autism. We examine the topic of graphical representation of data in general, and one of these graphs in particular: the one that appeared in a 1999 letter to The Lancet. That graph combined data from England and from California, USA.

e-Learning and error.

Intervention to prevent errors in medication