Clinical risk最新文献

{"title":"Promoter methylation of matrix metallopeptidase 9 in peripheral blood mononuclear cells: A novel biomarker in a promising source for noninvasive colorectal cancer diagnosis.","authors":"Alireza Shaygannejad, Behnoush Sohrabi, Shima Rahimi Rad, Farzaneh Yousefisadr, Hossein Darvish, Mohsen Soosanabadi","doi":"10.4103/jcrt.jcrt_2188_21","DOIUrl":"10.4103/jcrt.jcrt_2188_21","url":null,"abstract":"<p><strong>Objectives: </strong>Colorectal cancer (CRC) has been described as a \"silent disease,\" which can be readily treated in most patients when discovered in its early stages. Considering the limitations of the current conventional tests for the diagnosis of CRC, researchers strive to find noninvasive and more valid biomarkers for the early detection of CRC. It has been shown that tumor-specific methylation patterns can also be identified in peripheral blood mononuclear cells (PBMCs) and are reliable sources of methylation analysis for CRC screening.</p><p><strong>Materials and methods: </strong>We carried out a quantitative methylation analysis on matrix metallopeptidase 9 (MMP9) promoter using methylation quantification endonuclease-resistant DNA (MethyQESD) method. A total of 70 patients with CRC and 70 normal controls were enrolled in this study for methylation analysis in the PBMCs.</p><p><strong>Results: </strong>Our findings discovered a considerable hypermethylation of MMP9 promoter in CRC patients compared with healthy controls (mean: 47.30% and 20.31%, respectively; P > 0.001). The sensitivity and specificity of the MMP9 gene for the diagnosis of CRC were 88% and 78%, respectively. In addition, on the basis of area under the curve values, the diagnostic power of the MMP9 gene was 0.976 (P < 0.001). Moreover, our analysis established that MMP9 methylation was significantly different between the different stages of CRC (P: 0.034).</p><p><strong>Conclusions: </strong>Our results showed that MMP9 promoter methylation in PBMCs can be used as an outstanding biomarker for CRC diagnosis. Besides, we confirmed that PBMCs are reliable sources of methylation analysis for CRC screening and MethyQESD is an accurate and fast method for quantitative methylation analyses.</p>","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"7 1","pages":"1797-1802"},"PeriodicalIF":1.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88433573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconciliation of hospital discharge summaries and changes in patient medications","authors":"L. Piggott","doi":"10.1177/1356262217696416","DOIUrl":"https://doi.org/10.1177/1356262217696416","url":null,"abstract":"Family doctors will regularly have patients who are admitted to hospital. On discharge, many of these patients may have alterations to the medications that require attention by their family doctor, to either start a new repeat prescription or amend previous ones. This action should be clearly documented, so it can be recognised easily that the discharge summary has been reviewed. This study looks at the action taken and coding related to hospital discharge summaries in a general practice in the United Kingdom. The practice was very accurate and safe in making correct changes to medications but had low rates of documenting and coding that the discharge summary has been reviewed and actioned as required. A uniform code was recommended, and required documentation related to discharge summaries included in the practice’s training materials for locum and training doctors.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"94 - 96"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262217696416","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65478018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incident reporting and a culture of safety","authors":"Jonathan E. Hazan","doi":"10.1177/1356262216682893","DOIUrl":"https://doi.org/10.1177/1356262216682893","url":null,"abstract":"Incident reporting has long been established as a key component of patient safety in almost all healthcare and related settings. The analysis of incidents to determine why they happen and put in place corrective actions enables us to learn from things that go wrong and protect patients from harm in the future. The introduction of electronic incident reporting using web forms to replace paper has improved efficiency and increased the number of reports collected. There still remain significant barriers to learning from incidents, however. These include issues to do with the design of the systems as well as issues concerning organisational culture. This article revisits the background and purpose of incident reporting in healthcare, discusses some of the barriers to effective reporting and suggests some approaches that can increase its usefulness in protecting patients from harm.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"83 - 87"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262216682893","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65477929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Safe space’ or ‘secret space’? Proposals for safety investigations in England","authors":"P. Walsh","doi":"10.1177/1356262217701341","DOIUrl":"https://doi.org/10.1177/1356262217701341","url":null,"abstract":"","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"11 1","pages":"81 - 82"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262217701341","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65478044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Killer’s claim dismissed: E H v Dorset Healthcare NHS Foundation Trust (High Court, 19 December 2016 – Jay J)","authors":"J. Mead","doi":"10.1177/1356262217703438a","DOIUrl":"https://doi.org/10.1177/1356262217703438a","url":null,"abstract":"On the balance of probabilities, the thrombolysis service would have been available to Mr Lowe at Doncaster that morning, within a 3 hour window from the onset of his symptoms. However, whether the claimant would have had a better outcome had he received such treatment divided the relevant experts. Professor Ford, for the claimant, estimated that Mr Lowe would have had a 50% to 60% probability of making a good functional recovery. Dr Hassan, a consultant stroke physician instructed by the trust, considered that the chance of a good outcome would have been between 40% and 50%.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"109 - 110"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262217703438a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65478148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Battram v Dr Geoghegan","authors":"C. Maunder","doi":"10.1177/1356262217695626","DOIUrl":"https://doi.org/10.1177/1356262217695626","url":null,"abstract":"","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"105 - 107"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262217695626","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65478012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post Brexit crystal ball gazing: What the future holds for Phase I Clinical Trials in the UK","authors":"G. Matthews, N. Williams","doi":"10.1177/1356262217702814","DOIUrl":"https://doi.org/10.1177/1356262217702814","url":null,"abstract":"EU Regulation 536/2014 (“Regulations”) is due to take practical effect across the Eurozone by the end of 2017 at the earliest and no later than October 2018 following the implementation of procedural requirements. It will replace the EU Clinical Trials Directive 2001/20/EC. The Regulations are designed to reverse what regulators described as a downward trend in the conduct of clinical trials within Europe because of the “lengthy and cumbersome application process and the failure of the pre-existing regime to accommodate the global scope of clinical trials.” The purpose of the Regulations is to simplify and harmonise the administrative provisions governing clinical trials in the EU. With pleasing Pharmaceutical companies high on the political agenda, the pertinent question that arises is whether patient and public interests will be overlooked to cater to industry concerns? This article will outline the changes effected by the Regulation. It will evaluate the impact these changes will have on patient safety in the context of Phase I or First-in-human (FIH) trials by examining the TGN1412 clinical drug trial (also known as the Northwick Park drug trial). The second part of this article will discuss whether there is a place for the Regulations in the post Brexit landscape. The continuing uncertainty surrounding Brexit means that it remains difficult to come to any definitive conclusions but there are significant issues that require closer examination at this time.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"104 - 97"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262217702814","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65478096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulance crew not negligent in choice of hospital: Stephen Lowe v Yorkshire Ambulance Service NHS Trust (Sheffield County Court, 12 February 2016 – Recorder P W Miller)","authors":"J. Mead","doi":"10.1177/1356262217703438","DOIUrl":"https://doi.org/10.1177/1356262217703438","url":null,"abstract":"The claimant lived in Mexborough in Yorkshire. On 19 June 2009 at approximately 07:00, hewas in his kitchen at home when his wife noted that he was neither walking nor talking normally and was showing weakness on the right side. She promptly telephoned for an ambulance. One of the trust’s ambulances arrived at 07:14. It was staffed by two paramedics who examined Mr Lowe and agreed that he had probably suffered a stroke. By 07:20, therefore, they were aware that the patient was in urgent need of emergency medical treatment and that they had, without delay, to decide upon and telephone an alert to the most appropriate accident and emergency (A&E) department. There were only two possibilities: Rotherham District Hospital and Doncaster Royal Infirmary, each of which possessed an A&E department and stroke unit. The crew were very familiar with local traffic conditions and calculated that it would have taken them between 20 and 22min to reach Doncaster, whereas Rotherham could be reached in 5min less. They were also aware that in the event the patient required onward referral to the neurological department at the Royal Hallamshire Hospital in Sheffield, the further ambulance journey would take 10 to 11min from Rotherham but 25 to 26min from Doncaster. An important distinction between the stroke units at the two hospitals was that at certain times of the day Doncaster, but not Rotherham, offered thrombolysis. In 2009, this was a relatively new treatment involving the use of drugs to break down blood clots. However, the service was only available from 08:00 h until 20:00 h at Doncaster, and the ambulance staff knew that prior to 08:00 h, it was not possible to contact the relevant department by telephone. Furthermore, the Ambulance Service’s guidance in respect of the period 20:00 to 08:00 h was to ‘‘Manage the patient as their condition dictates, with a pre-alert to emergency department as per local protocol’’. In view of all the above considerations, the crew took Mr Lowe to Rotherham District Hospital.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"108 - 109"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262217703438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65478140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving healthcare through the use of ‘medical manslaughter’? Facts, fears and the future","authors":"M. Brazier, S. Devaney, D. Griffiths, Alex Mullock, Hannah Quirk","doi":"10.1177/1356262217696623","DOIUrl":"https://doi.org/10.1177/1356262217696623","url":null,"abstract":"The criminal law looks set to play a larger role in regulating healthcare. Until recently, health professionals only faced the prospect of criminal liability if it could be proved that their gross negligence resulted in the death of a patient. In such a case, the professional could face a charge of gross negligence manslaughter (GNM). Prosecutions for ‘medical manslaughter’ have generated concern among doctors worried about what is perceived as a rise in the number of doctors facing criminal prosecution and the impact prosecutions are having on healthcare practice. May more frequent resort to the criminal process damage rather than promote better health care? In seeking to try to answer this question, the first problem is that reliable data in this area about how many prosecutions are brought and how they fare are limited due to the way cases are recorded. What evidence does exist is often based on media reports or samples that are not representative. This paper will argue that, while the real risk of being prosecuted for medical manslaughter remains low, such fears should not be dismissed because, as Donald Berwick has argued, ‘fear is toxic’ – for health professionals and their patients.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"88 - 93"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262217696623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65478023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trust liable for brain damage to baby: F E v St George’s University Hospitals NHS Trust (High Court, 18 March 2016 – McGowan J)","authors":"J. Mead","doi":"10.1177/1356262217703438b","DOIUrl":"https://doi.org/10.1177/1356262217703438b","url":null,"abstract":"from an abnormality of the mind, namely paranoid schizophrenia, such that her mental responsibility should be regarded as ‘‘substantially impaired.’’ The claimant pleaded guilty to the offence of manslaughter on the ground of diminished responsibility, and this plea was accepted by the Crown. Mr Justice Jay held that these facts meant that the conviction was conclusive evidence that EH’s mental functioning was substantially impaired at the time of the offence. He also interpreted the sentencing remarks of the trial judge, Mr Justice Foskett, as supporting the interpretation that this case fell towards the lower end of the spectrum of personal responsibility. In his judgment, it was not open to the claimant to undermine or impugn the findings of Foskett J and he therefore proceeded on the basis that the claimant’s personal responsibility was low and/or less than significant. The judge then turned to relevant case-law. In Clunis v Camden and Islington Health Authority [1998] QB 978 Mr Clunis, a man with a history of mental health problems including schizoaffective disorder, killed a man by stabbing him and pleaded guilty to manslaughter on the ground of diminished responsibility. The Court of Appeal struck out the whole of his claim against the Health Authority, holding that it was barred by public policy. There were no discernible matters or aspects of factual differentiation between the present claim and that of Mr Clunis. In Gray v Thames Trains Limited [2009] 1 AC 1339, the claimant developed post-traumatic stress disorder as a result of the Ladbroke Grove rail disaster in 1999. While suffering from this disorder he killed a man. His plea to the offence of manslaughter on the ground of diminished responsibility was accepted by the Crown. The House of Lords held that his claim for loss of liberty, loss of earnings, etc. failed on the basis that he was seeking to obtain compensation for his own criminal conduct. The claimant’s lawyers endeavoured to argue that subsequent observations of the Supreme Court cast doubt upon these rulings, and that therefore it was appropriate for EH’s claim to continue. Mr Justice Jay disagreed. He held that it was clear that these subsequent Supreme Court rulings made no express criticism of either Clunis or Gray. In particular, Clunis had not been expressly disapproved by the Supreme Court. As a consequence, case-law supported the trust’s position and this claim would therefore be struck out. The Judge refused permission for either a ‘‘leap frog’’ appeal to the Supreme Court or a reference to the Court of Appeal. Nicholas Bowen QC and Katie Scott (instructed by Russell-Cooke) appeared for the claimant. Angus Moon QC, Judith Ayling and Cecily White (instructed by DAC Beachcroft) appeared for the trust.","PeriodicalId":89664,"journal":{"name":"Clinical risk","volume":"22 1","pages":"110 - 112"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1356262217703438b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65478156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}