The prevalence and nature of prescribing and monitoring errors in English general practice – a retrospective case note review

Objective To determine the prevalence and nature of prescribing and monitoring errors in general practices in England. Design Retrospective case note review of unique medication items prescribed over a 12 month period to a 2% random sample of patients. Mixed effects logistic regression was used to analyse the data. Setting Fifteen general practices across three primary care trusts in England. Data sources Examination of 6048 unique prescription items prescribed over the previous 12 months for 1777 patients. Main outcome measures Prevalence of prescribing and monitoring errors, and severity of errors, using validated definitions. Results Prescribing and/or monitoring errors were detected in 4.9% (296/6048) of all prescription items (95% confidence interval 4.4 - 5.5%). The vast majority of errors were of mild to moderate severity, with 0.2% (11/6048) of items having a severe error. After adjusting for covariates, patient-related factors associated with an increased risk of prescribing and/or monitoring errors were: age less than 15 (Odds Ratio (OR) 1.87, 1.19 to 2.94, p=0.006) or greater than 64 years (OR 1.68, 1.04 to 2.73, p=0.035), and higher numbers of unique medication items prescribed (OR 1.16, 1.12 to 1.19, p<0.001). Conclusion Prescribing and monitoring errors are common in English general practice, although severe errors are unusual. Many factors increase the risk of error. Having identified the most common and important errors, and the factors associated with these, strategies to prevent future errors should be developed based on the study findings.

Absence of Association of Metabolic Syndrome with PPARGC1A, PPARG and UCP1 Gene Polymorphisms in Asian Indians

The objective of this study was to evaluate the association of PPARG coactivator1 alpha (PPARGC1A), peroxisome proliferator activated receptor gamma (PPARG), and uncoupling protein1 (UCP1) gene polymorphisms with the metabolic syndrome (MS) in an Asian Indian population. Nine common polymorphisms were genotyped via polymerase chain reaction restriction fragment length polymorphism and direct sequencing in 950 normal glucose-tolerant subjects and 550 type 2 diabetic subjects, chosen randomly from the Chennai Urban Rural Epidemiological Study, an ongoing population based study in Southern India. Among the 9 polymorphisms examined, only the Thr394Thr variant of the PPARGC1A gene was significantly associated with diabetes and obesity. The genotype frequency of GA of Thr394Thr variant was 16% (138/887) in the nonMS group and 22% (136/613) in the MS group, and this genotype frequency was significantly higher with MS both in males (p = 0.01) and females (p = 0.05), compared to the without-MS group. Logistic regression analysis revealed that the odds ratio for MS for the susceptible genotype GA of Thr394Thr was 1.411 [95% CI: 1.03-1.84, p = 0.012]. In the multiple logistic regression analysis, however, there was no association of this polymorphism as an independent factor with MS. Hence, the study shows that the polymorphisms in the PPARGC1A, PPARG and UCP1 genes are not associated with MS in Asian Indians.

Ovid, Remedia amoris 95: uerba dat omnis amor

Anagrams and syllabic wordplay of the kind championed by Frederick Ahl in his Metaformations have not always been favourably received by scholars of Latin poetry; I would hesitate to propose the following instance, were it not for the fact that its occurrence seems peculiarly apposite to the context in which it appears. That Roman poets were prepared to use such techniques to enhance the presentation of an argument by exemplifying its operation at a verbal level is demonstrated by the famous passage of Lucretius (DRN 1.907–14; also 1.891–2) in which the poet seeks to illustrate the tendency of semina … ardoris to create fire in wood by the literal presence of elements from the word for ‘fires’ (IGNes) in that denoting wood (lIGNum). A similar conception may underlie the association insinuated by the love elegists between amor and mors, suggesting that death is somehow ‘written into’ love: so Propertius declares laus in amore mori (2.1.47), while Tibullus appears to point to the lurking presence of death in the pursuit of love in the lines interea, dum fata sinunt, iungamus amores: | iam ueniet tenebris Mors adoperta caput (1.1.69–70) – so swift and unexpected is death's approach that it is already present in aMOReS in the preceding line. Ovid's awareness of the poetic potential of this kind of play (if that is the right word for it) is fully exhibited in his celebrated account of Echo and Narcissus in Metamorphoses 3, where the subject matter gives the poet ample scope to exploit the humorous and pathetic possibilities afforded by Echo's fragmented repetitions of the frustrated entreaties of her beloved.

L’illustration marginale d’un ouvrage profane : étude du manuscrit Paris, Bibliothèque nationale de France, français 95, xiiie siècle (1290)

BnF fr. 95 is a late 13th century manuscript containing Arthurian romances and other fictional and didactic texts. The Estoire del saint Graal and Merlin section is the most highly illuminated, with a rich marginal iconography, an unusual feature in the illustration of lay works and in these texts’ manuscript tradition. This article shows how in Merlin and its Vulgate Sequel marginal scenes overlap with widespread subjects in courtly and chivalric vernacular romances, in contrast with Latin and religious works. The reuse of similar patterns in principal and marginal miniatures, examined in the episode of the Battle of Danablaise, where King Arthur fights the Saxon King Rion, highlights the need for a comprehensive reading of text and images, taking into account the mise en page and the different levels of illustration in the manuscript.