Frequency of and harm associated with primary care safety incidents

To assess frequency and severity of patient safety incidents in primary care. Study Design: Cross-sectional survey of health-care professionals in Swiss primary care offices.

Sozialversicherungen

Die Regierung kündigte eine umfassende Reform der 1. und 2. Säule an. – Das erste Massnahmenpaket der 6. IV-Revision trat in Kraft. – Grosse Teile des zweiten Massnahmenpakets für die 6. IV-Revision wurden in den Ratsverhandlungen zerzaust. – Die Räte verabschiedeten einzig die neue Regelung der Kostenvergütung bei stationären Spitalaufenthalten von IV-Beziehenden. – Die Volksinitiative „Für eine öffentliche Krankenkasse“ kam zustande; der Bundesrat begann mit der Erarbeitung eines indirekten Gegenvorschlags. – Das Volk lehnte die Revision des Krankenversicherungsgesetzes (Managed Care) wuchtig ab.

Modifying Post-Operative Medical Care after EBV Implant May Reduce Pneumothorax Incidence.

OBJECTIVE Endoscopic lung volume reduction (ELVR) with valves has been shown to improve COPD patients with severe emphysema. However, a major complication is pneumothoraces, occurring typically soon after valve implantation, with severe consequences if not managed promptly. Based on the knowledge that strain activity is related to a higher risk of pneumothoraces, we asked whether modifying post-operative medical care with the inclusion of strict short-term limitation of strain activity is associated with a lower incidence of pneumothorax. METHODS Seventy-two (72) emphysematous patients without collateral ventilation were treated with bronchial valves and included in the study. Thirty-two (32) patients received standard post-implantation medical management (Standard Medical Care (SMC)), and 40 patients received a modified medical care that included an additional bed rest for 48 hours and cough suppression, as needed (Modified Medical Care (MMC)). RESULTS The baseline characteristics were similar for the two groups, except there were more males in the SMC cohort. Overall, ten pneumothoraces occurred up to four days after ELVR, eight pneumothoraces in the SMC, and only two in the MMC cohorts (p=0.02). Complicated pneumothoraces and pneumothoraces after upper lobe treatment were significantly lower in MMC (p=0.02). Major clinical outcomes showed no significant differences between the two cohorts. CONCLUSIONS In conclusion, modifying post-operative medical care to include bed rest for 48 hours after ELVR and cough suppression, if needed, might reduce the incidence of pneumothoraces. Prospective randomized studies with larger numbers of well-matched patients are needed to confirm the data.