- (+970) 059 8937557
- pspsecretary@pedpal.org
- Sat - Thu 8:00 - 15:00
News
For further details about the EBP-EAP Exam, I invite you to visit our official website at URL: www.eapaediatrics.eu/ebp-exams
6/9/2020
The Pediatric Society - Palestine Statememt on:
Back to educational institutions (schools)
These days our children are returning back to school,, The return raises fears given the morbidity of the corona virus COVID-19 that still exists.
The children’s health is our top priority, the gradual and controlled return to learn is justified. The benefits of school re-opening outweigh the risks for children, provided, that we stick to rules, recommended by the MOH and WHO.
The vast majority of children in non “hot spot” areas can return to school without individual approval from a physician, and it is recommended that they do so, while adhering to the rules of physical distancing &personal hygiene and to wear masks.
For children with chronic illnesses, the Pediatric Society emphasizes, that the recommendations were written in accordance with the information available nowadays, and may change in the future.
These recommendations do not replace the Ministry of Health guidelines or individual discretion, which also takes into account parents' feelings, past experience and family unit needs.
Children with chronic illnesses:
In general, children with chronic illnesses are advised to continue with the necessary treatments, including immunosuppressive drugs, biological and radiation therapy, without dose reduction during the corona, unless there is a recommendation of the treating physician.
These children and their families need special attention to the rules of personal hygiene, social distancing and avoiding contact with patients with influenza-like respiratory illness or other febrile illnesses.
Respiratory diseases:
According to data available regarding children with COVID-19, chronic respiratory illness was not a significant risk of morbidity. Therefore, stable asthma, inhaled steroids, do not prevent children from going back to school.
For children with chronic respiratory illnesses (such as Cystic Fibrosis) accompanied with a marked decline in respiratory function tests, or severe asthma requiring systemic steroid or biological therapy.
The information currently available is insufficient to determine that they are not at risk and it is recommended to postpone their return at this time to school.
Neurological, neuro-muscular or muscular diseases:
In general, children with these illnesses can go back to school if their condition is stable, avoid school if they have impaired lung function, or heart function.
Oncological diseases:
Children receiving chemotherapy or immunosuppressive therapies, including children receiving radiation therapy to the chest are more likely to be at higher risk of serious illness and it is advisable at this point to avoid returning to school.
Children who have completed treatment a year or more ago are not defined as immunosuppressed and may return back.
Rheumatological diseases:
There is no evidence that children with rheumatic diseases, including those treated with biological drugs, are at increased risk of severe corona virus. The vast majority of children with these diseases can go back to school.
You may consider delaying the return of children if they are on high-dose steroids or receiving a combination of immunosuppressive drugs or those with active disease.
Immunedeficiencies:
There is no evidence that children with congenital immunodeficiency are at increased risk of severe morbidity in Corona. Some of these patients, especially those with chronic lung disease, are considered at risk.
Therefore, it is advisable to consult the treating physician, and discuss each case individually.
Solid organ transplant:
They can go to school, depending on the time after the transplant (usually one year after the transplant).
Bone marrow transplant:
It is recommended to postpone the return to school of bone marrow transplant children still undergoing immunosuppressive therapy, Or Graft versus host disease
Gastrointestinal inflammatory diseases:
Children with inflammatory bowel disease in remission, including those treated with biological preparations, can return back to school.
Diabetes, obesity and metabolic diseases:
There is no evidence that diabetes increases the risk of morbidity in Corona, so children with diabetes can return back to school. There are no data on corona morbidity in overweight or obese children.
It is recommended to delay at this step obese children with impaired lung function tests. Metabolic diseases are rare and different from each other, and it is advisable to consult the treating physician of the child.
Cardiovascular disease:
No specific information regarding children with cardiovascular disease. Most children with these illnesses can go back to school. There is a possibility. Avoid going back to school in the presence of significant heart failure.
Siblings and children of children with risk factors, including of children with oncological diseases:
There is no restriction for siblings and households of children with risk factors, of course while in personal hygiene, including washing hands with soap and changing clothes upon return from school.
There is no restriction for siblings and households of children with risk factors, of course while in personal hygiene, including washing hands with soap and changing clothes upon return from school.
Abdulsalam Abu-Libdeh
President of Pediatric Society - Palestine (PSP)
Secretary General of The Union of Arab Pediatric Societies (UAPS)
Dear Dr. Abdulsalam,
Ref: Gaza Neonatal network (GNN) and the GNN Website
It is a long time since we have met and talked. I hope all is going well.
After a recent conversation with Dr Nabil Barqouni, I thought it will be useful to circulate the information about the “Gaza Neonatal network” and its website to colleagues in the west bank. The website provides up-to-date information and news for families, health professionals and other interested parties about the Network and the neonatal units it encompasses along with information about the Neonatal Guidelines and Transport Service in Gaza strip. The GNN covers the 6 neonatal units in Gaza Strip who all work together closely to ensure that newborn infants and their families receive appropriate care in a setting able to meet their needs, as close to home as possible. We endeavour to keep the content up-to-date and relevant to our priorities as well.
The GNN and website have been established since 2013/2014. The membership of GNN is as follows:
Network Chair: Dr Nabil Barqouni
Deputy Chair and Network Clinical Guidelines Lead: Dr Shireen Abed
Members:
Dr Shaymaa Shurrab
Dr Allam Abu Hamda
Dr Ahmed Abu Jebara
Mr Majed Hasanain
Mr Hamdi Alkhudari
Consultancy/support: Dr Ezedin Gouta
http://gazaneonatalnetwork.
With kind regards
Ezzedin Gouta
15 January 2017
Dear Prof. Abu Libdeh,
Many thanks for your kind message and sending the completed form.
We will note following sentence at our webpage, http://childscience.org/jpid/associations.html
soon:
“JOURNAL of PEDIATRIC INFECTIOUS DISEASES is affiliated with Palestine Pediatric Society”
Again many thanks for your cooperation and support.
I hope that this cooperation would be a good initiation between Palestine and Turkiye.
Best wishes
Huseyin Caksen, MD, PhD
Necmettin Erbakan University
Meram Medical Faculty
Department of Pediatrics
Divisions of Pediatric Neurology and Genetics
42080 Meram, Konya, Turkiye
T: +90 332 223 71 04
F: +90 332 223 61 81
E: This email address is being protected from spambots. You need JavaScript enabled to view it.; This email address is being protected from spambots. You need JavaScript enabled to view it.
Medical error—the third leading cause of death in the US
BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.
1. Martin A Makary, professor1 ,
2. Michael Daniel, research fellow1
1. Correspondence to: M A Makary This email address is being protected from spambots. You need JavaScript enabled to view it.
Medical error is not included on death certificates or in rankings of cause of death. Martin Makary and Michael Daniel assess its contribution to mortality and call for better reporting
The annual list of the most common causes of death in the United States, compiled by the Centers for Disease Control and Prevention (CDC), informs public awareness and national research priorities each year. The list is created using death certificates filled out by physicians, funeral directors, medical examiners, and coroners. However, a major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death.1 As a result, causes of death not associated with an ICD code, such as human and system factors, are not captured. The science of safety has matured to describe how communication breakdowns, diagnostic errors, poor judgment, and inadequate skill can directly result in patient harm and death. We analyzed the scientific literature on medical error to identify its contribution to US deaths in relation to causes listed by the CDC.2
Death from medical care itself
Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome,3 the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning),4 or a deviation from the process of care that may or may not cause harm to the patient.5 Patient harm from medical error can occur at the individual or system level. The taxonomy of errors is expanding to better categorize preventable factors and events.6 We focus on preventable lethal events to highlight the scale of potential for improvement.
The role of error can be complex. While many errors are non-consequential, an error can end the life of someone with a long life expectancy or accelerate an imminent death. The case in the box shows how error can contribute to death. Moving away from a requirement that only reasons for death with an ICD code can be used on death certificates could better inform healthcare research and awareness priorities.
Case history: role of medical error in patient death
A young woman recovered well after a successful transplant operation. However, she was readmitted for non-specific complaints that were evaluated with extensive tests, some of which were unnecessary, including a pericardiocentesis. She was discharged but came back to the hospital days later with intra-abdominal hemorrhage and cardiopulmonary arrest. An autopsy revealed that the needle inserted during the pericardiocentesis grazed the liver causing a pseudoaneurysm that resulted in subsequent rupture and death. The death certificate listed the cause of death as cardiovascular.
How big is the problem?
The most commonly cited estimate of annual deaths from medical error in the US—a 1999 Institute of Medicine (IOM) report7—is limited and outdated. The report describes an incidence of 44 000-98 000 deaths annually.7 This conclusion was not based on primary research conducted by the institute but on the 1984 Harvard Medical Practice Study and the 1992 Utah and Colorado Study.8 9 But as early as 1993, Leape, a chief investigator in the 1984 Harvard study, published an article arguing that the study’s estimate was too low, contending that 78% rather than 51% of the 180 000 iatrogenic deaths were preventable (some argue that all iatrogenic deaths are preventable).10This higher incidence (about 140 400 deaths due to error) has been supported by subsequent studies which suggest that the 1999 IOM report underestimates the magnitude of the problem. A 2004 report of inpatient deaths associated with the Agency for Healthcare Quality and Research Patient Safety Indicators in the Medicare population estimated that 575 000 deaths were caused by medical error between 2000 and 2002, which is about 195 000 deaths a year (table 1⇓).11 Similarly, the US Department of Health and Human Services Office of the Inspector General examining the health records of hospital inpatients in 2008, reported 180 000 deaths due to medical error a year among Medicare beneficiaries alone.12 Using similar methods, Classen et al described a rate of 1.13%.13 If this rate is applied to all registered US hospital admissions in 201315 it translates to over 400 000 deaths a year, more than four times the IOM estimate.
Table 1
Studies on US death rates from medical error since the 1999 IOM report and point estimate from pooled results
Similarly, Landrigan et al reported that 0.6% of hospital admissions in a group of North Carolina hospitals over six years (2002-07) resulted in lethal adverse events and conservatively estimated that 63% were due to medical errors.14 Extrapolated nationally, this would translate into 134 581 inpatient deaths a year from poor inpatient care. Of note, none of the studies captured deaths outside inpatient care—those resulting from errors in care at home or in nursing homes and in outpatient care such as ambulatory surgery centers.
A literature review by James estimated preventable adverse events using a weighted analysis and described an incidence range of 210 000-400 000 deaths a year associated with medical errors among hospital patients.16 We calculated a mean rate of death from medical error of 251 454 a year using the studies reported since the 1999 IOM report and extrapolating to the total number of US hospital admissions in 2013. We believe this understates the true incidence of death due to medical error because the studies cited rely on errors extractable in documented health records and include only inpatient deaths. Although the assumptions made in extrapolating study data to the broader US population may limit the accuracy of our figure, the absence of national data highlights the need for systematic measurement of the problem. Comparing our estimate to CDC rankings suggests that medical error is the third most common cause of death in the US (fig 1⇓).2
Fig 1 Most common causes of death in the United States, 20132
Better data
Human error is inevitable. Although we cannot eliminate human error, we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences. Strategies to reduce death from medical care should include three steps: making errors more visible when they occur so their effects can be intercepted; having remedies at hand to rescue patients 17; and making errors less frequent by following principles that take human limitations into account (fig 2⇓). This multitier approach necessitates guidance from reliable data.
Fig 2 Model for reducing patient harm from individual and system errors in healthcare
Currently, deaths caused by errors are unmeasured and discussions about prevention occur in limited and confidential forums, such as a hospital’s internal root cause analysis committee or a department’s morbidity and mortality conference. These forums review only a fraction of detected adverse events and the lessons learnt are not disseminated beyond the institution or department.
There are several possible strategies to estimate accurate national statistics for death due to medical error. Instead of simply requiring cause of death, death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death. An early experience asking physicians to comment on the potential preventability of inpatient deaths immediately after they occurred resulted in an 89% response rate.18 Another strategy would be for hospitals to carry out a rapid and efficient independent investigation into deaths to determine the potential contribution of error. A root cause analysis approach would enable local learning while using medicolegal protections to maintain anonymity. Standardized data collection and reporting processes are needed to build up an accurate national picture of the problem. Measuring the consequences of medical care on patient outcomes is an important prerequisite to creating a culture of learning from our mistakes, thereby advancing the science of safety and moving us closer towards the Institute of Medicine’s goal of creating learning health systems.19
Health priorities
We have estimated that medical error is the third biggest cause of death in the US and therefore requires greater attention. Medical error leading to patient death is under-recognized in many other countries, including the UK and Canada.20 21 According to WHO, 117 countries code their mortality statistics using the ICD system as the primary indicator of health status.22 The ICD-10 coding system has limited ability to capture most types of medical error. At best, there are only a few codes where the role of error can be inferred, such as the code for anticoagulation causing adverse effects and the code for overdose events. When a medical error results in death, both the physiological cause of the death and the related problem with delivery of care should be captured.
To achieve more reliable healthcare systems, the science of improving safety should benefit from sharing data nationally and internationally, in the same way as clinicians share research and innovation about coronary artery disease, melanoma, and influenza. Sound scientific methods, beginning with an assessment of the problem, are critical to approaching any health threat to patients. The problem of medical error should not be exempt from this scientific approach. More appropriate recognition of the role of medical error in patient death could heighten awareness and guide both collaborations and capital investments in research and prevention.
Summary points
Death certificates in the US, used to compile national statistics, have no facility for acknowledging medical error
If medical error was a disease, it would rank as the third leading cause of death in the US
The system for measuring national vital statistics should be revised to facilitate better understanding of deaths due to medical care
Footnotes
· Contributors and sources: MM is the developer of the operating room checklist, the precursor to the WHO surgery checklist. He is a surgical oncologist at Johns Hopkins and author of Unaccountable, a book about transparency in healthcare. MD is the Rodda patient safety research fellow at Johns Hopkins and is focused on health services research. This article arose from discussions about the paucity of funding available to support quality and safety research relative to other causes of death.
· Competing interests: We have read and understood BMJ policy on declaration of interests and declare that we have no competing interests.
· Provenance and peer review: Not commissioned; externally peer reviewed.
References
1. ↵
Moriyama IM, Loy RM, Robb-
2. ↵
Deaths: final data for 2013. National vital statistics report. http://www.cdc.gov/
3. ↵
Leape LL. Error in medicine. JAMA1994;272:1851-7.
4. ↵
Reason J. Human error.Cambridge University Press, 1990. doi:10.1017/
5. ↵
Reason JT. Understanding adverse events: the human factor. In: Vincent C, ed. Clinical risk management: enhancing patient safety.BMJ, 2001:9-30.