More review could prevent nuclear medicine errors
MALADMINISTRATIONS of radiopharmaceutical agents could be partly prevented by a nuclear medicine specialist reviewing the patient before the agent is administered, according to the authors of research published in the MJA. The authors said reconciling the patient’s clinical history with the information on the request form required specialist medical review. The authors reviewed maladministration reports from the Australian Radiation Incident Register (ARIR) between 2007 and 2011 and found 149 incidents of maladministration, an estimated incidence of 5.8 per 100 000 nuclear medicine procedures. Almost half (48%) of maladministrations were the result of an incorrect radiopharmaceutical being prepared and/or dispensed, the authors wrote. Other causes included injecting the wrong agent due to inattention (18.1%); extravasations or failures in equipment or procedure leading to a non-diagnostic study (16.8%); misinterpreting a request form and performing an incorrect procedure (8.7%); or injecting an incorrect patient (8.7%). The authors concluded that “nearly all” maladministrations occurred in a diagnostic context and that the risk of patient harm appeared low. “Our findings highlight certain vulnerabilities relating to radiopharmaceutical preparation and/or dispensation and pre-administration checking procedures”, they wrote. They called for refinement of the ARIR through more attention to latent causes, consideration of possible underreporting and securing more comprehensive Medicare Benefits Schedule data.
Teen intervention may prevent future depression
INTERVENING to shorten the duration of mental disorders in teenagers could prevent further episodes and morbidity in later life, according to an Australian study published in The Lancet. A random sample of 1943 teenagers from 44 secondary schools across Victoria were assessed at five points in adolescence and three points in young adulthood for common mental disorders. The researchers found 29% (236/821) of males and 54% (498/929) of females reported high symptom scores (Revised Clinical Interview Schedule score of ≥12) at least once during adolescence. Almost 60% (434/734) went on to report a further episode as a young adult. Importantly, for adolescents with one episode of less than 6 months’ duration, just over half had no further disorder as a young adult. Longer duration of disorder as a teen was the strongest predictor of “clear-cut” young adult disorder. “A finding that almost half of those with an adolescent disorder had no further episodes in young adulthood is striking”, the researchers wrote. “A further near-halving of risk for continuity in the late 20s suggests that many disorders resolve as people make the transition into adulthood.” The results gave “reason for optimism that interventions that shorten the duration of episodes could prevent much morbidity later in life”, the authors concluded. An accompanying commentary said interventions that shortened the duration of adolescent disorder could improve long-term outcomes, “but this notion needs to be tested”.
Men most at risk of alcohol-related death
A POPULATION-based study of 238 367 alcohol-related deaths found that the risk of men dying is disproportionately higher than that of women. The study, published in Addiction, looked at mortality data over 3 years in 16 countries in North, Central and South America. “These deaths occurred prematurely considering the corresponding life expectancy”, the authors wrote. The study found the annual average number of deaths due to a disease, condition or injury where alcohol was a necessary cause was 79 456, of which 86% were men. Most deaths were due to liver disease (63%) and neuropsychiatric disorders (32%). The age groups at highest risk were 54‒59-year-olds and 64‒69-year-olds in most countries, although in a small number of countries the rates increased earlier, in the 30‒49-year age group. The authors wrote that the mortality rates found in the study “reveal the tip of the iceberg of a broader problem. The range of diseases and conditions linked to alcohol use and heavy drinking includes tuberculosis, some cancers, ischaemic heart disease, stroke, epilepsy, gastrointestinal diseases, falls, suicides, neurological disorders, transport-related injuries and interpersonal violence, among others”. They said there was “a wealth of research” that consistently showed restrictions on the availability of alcohol, increased prices through taxation policies and marketing control were the most cost-effective interventions to reduce the harmful use of alcohol. They called for greater public health efforts to “reduce alcohol availability and consumption at national levels”.
Bowel obstruction risk after rotavirus vax
INFANTS receiving their first dose of second-generation rotavirus vaccines are at an increased risk of intussusception, but the risk is lower than that associated with first-generation vaccines, according to a study published in the NEJM. The research evaluated more than 1.2 million doses of RotaTeq (RV5, a pentavalent vaccine), of which 507 874 were first doses, and 103 098 doses of Rotarix (RV1, a monovalent vaccine), including 53 638 first doses, in infants aged from 5.0 to 36.9 weeks, to identify potential cases of intussusception and vaccine exposures. The number of excess cases of intussusception per 100 000 recipients of the first dose of RV5 was significantly elevated at both the 7-day and 21-day risk windows (attributable risk, 1.1 and 1.5 respectively), which was about one-tenth the risk from first-generation vaccines. There was no significant increase in risk after the second and third doses of RV5. After one dose of RV1 there was no significant increase in risk but a secondary analysis showed a significant risk after the second dose. “These risks must be considered in light of the demonstrated benefits of rotavirus vaccination”, the authors concluded. An accompanying editorial said that given the major impact these vaccines had on reducing hospitalisations, emergency department visits and, in some cases, deaths from diarrhoea, “policy makers have concluded that rotavirus vaccine remains a valuable addition to the national program for childhood immunizations”.
Cognitive training slows functional decline in elderly
COGNITIVE training interventions have the potential to delay the onset of functional decline and possibly dementia in the elderly, according to the authors of study published in the Journal of the American Geriatrics Society. Researchers followed 2832 community-dwelling people aged 65 years and older who were placed into one of three different cognitive training intervention groups or a no-contact control group. The intervention involved 10 training sessions for memory, reasoning or speed of processing, followed by four sessions of booster training at 11 and 35 months after initial training. The researchers found that 10–14 weeks of organised cognitive training resulted in significant improvements in cognitive abilities and better preserved functional status compared with the control group 10 years later. Participants in each intervention group reported less difficulty with instrumental activities of daily living (IADLs) (effect size for memory, 0.48; for reasoning, 0.38; for speed of processing, 0.36). The cognitive improvements dissipated slowly over time but persisted to at least 5 years for memory training and to 10 years for reasoning and speed-of-processing training. “This is the first demonstration of long-term transfer of the training effects on cognitive abilities to daily function”, the authors wrote. “If interventions that could delay onset of functional impairment by even 6 years were introduced, the number of people affected by 2050 would be reduced by 38%, which would be of great public health significance.”