Medication errors (MEs) are preventable and can result in patient harm and increased expenses in the healthcare system in terms of hospitalization, prolonged hospitalizations and even death. We aimed to develop a screening tool to detect acutely admitted patients at low or high risk of MEs comprised by items found by literature search and the use of theoretical weighting. Predictive variables used for the development of the risk score were found by the literature search. Three retrospective patient populations and one prospective pilot population were used for modelling. The final risk score was evaluated for precision by the use of sensitivity, specificity and area under the ROC (receiver operating characteristic) curves. The variables used in the final risk score were reduced renal function, the total number of drugs and the risk of individual drugs to cause harm and drug-drug interactions. We found a risk score in the prospective population with an area under the ROC curve of 0.76. The final risk score was found to be quite robust as it showed an area under the ROC curve of 0.87 in a recent patient population, 0.74 in a population of internal medicine and 0.66 in an orthopaedic population. We developed a simple and robust score, MERIS, with the ability to detect patients and divide them according to low and high risk of MEs in a general population admitted at acute admissions unit. The accuracy of the risk score was at least as good as other models reported using multiple regression analysis.

This report is a follow-up to a study on fatal poisoning in drug addicts conducted in 2012 by a Nordic working group. Here we analyse data from the five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. Data on sex, number of deaths, places of death, age, main intoxicants and other drugs detected in the blood were recorded. National data are presented and compared between the Nordic countries and with data from similar studies conducted in 1991, 1997, 2002 and 2007. The death rates (number of deaths per 100,000 inhabitants) increased in drug addicts in Finland, Iceland and Sweden but decreased in Norway compared to the rates in earlier studies. The death rate was stable in Denmark from 1991 to 2012. The death rate remained highest in Norway (5.79) followed by Denmark (5.19) and Iceland (5.16). The differences between the countries diminished compared to earlier studies, with death rates in Finland (4.61) and Sweden (4.17) approaching the levels in the other countries. Women accounted for 15-27% of the fatal poisonings. The median age of the deceased drug addicts was still highest in Denmark, and deaths of addicts >45 years old increased in all countries. Opioids remained the main cause of death, but medicinal opioids like methadone, buprenorphine, fentanyl and tramadol mainly replaced heroin. Methadone was the main intoxicant in Denmark and Sweden, whereas heroin/morphine caused the most deaths in Norway. Finland differed from the other Nordic countries in that buprenorphine was the main intoxicant with only a few heroin/morphine and methadone deaths. Deaths from methadone, buprenorphine and fentanyl increased immensely in Sweden compared to 2007. Poly-drug use was widespread in all countries. The median number of drugs per case varied from 4 to 5. Heroin/morphine, medicinal opioids, cocaine, amphetamines, benzodiazepines and alcohol were the main abused drugs. However, less widely used drugs, like gamma-hydroxybutyric acid (GHB), methylphenidate, fentanyl and pregabalin, appeared in all countries. New psychotropic substances emerged in all countries, with the largest selection, including MDPV, alpha-PVP and 5-IT, seen in Finland and Sweden.

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Warfarin not only reduces the risk of stroke but is also better than placebo and antiplatelet agents in prevention of systemic embolism in patients with non-valvular AF. Warfarin increases the risk of major bleeding compared with placebo but not compared with antiplatelet agents.

To cite this article: Andersen LV, Lip GYH, Lindholt JS, Frost L. Upper limb arterial thromboembolism: a systematic review on incidence, risk factors, and prognosis, including a meta-analysis of risk-modifying drugs. J Thromb Haemost 2013; 11: 836-44.Summary. Objectives: The aim of this review is to focus on risk factors, risk-modifying drugs and prognosis for upper limb arterial thromboembolism, and the relationship between upper limb arterial thromboembolism and atrial fibrillation (AF). Methods: We searched MEDLINE for studies on the epidemiology of upper limb thromboembolism from 1965 to June 2012. We also searched for contemporary, phase III randomized trial data on systemic (non-stroke) thromboembolism comparing warfarin with new oral anticoagulants (OACs) in patients with atrial fibrillation published after the year 1999. Results: The incidence of upper limb thromboembolectomy was 3.3 per 100 000 person-years among men and 5.2 per 100 000 person-years among women; the risk of limb amputation, stroke and death after thromboembolectomy was increased. There was an increased risk of thromboembolectomy of the upper limb in patients with AF diagnosed with hypertension (hazard ratio [HR] 2.2-2.9), myocardial infarction (HR 2.9-3.9), heart failure (HR 1.6-1.9), and stroke (HR 2.2-3.8). For those diagnosed with diabetes mellitus, the risk was non-significantly increased by 1.2-1.4. Females had a 1.8-fold (95% confidence interval [CI] 1.5-2.3) fold increased risk of thromboembolectomy as compared with men. The risk reduction for systemic embolism with new OACs as compared with warfarin in patients with AF is similar to that seen with warfarin (odds ratio 0.79, 95% CI 0.38-1.64). Conclusions: Age, female sex, AF, hypertension, diabetes, myocardial infarction, heart failure and stroke are most common risk factors for thromboembolectomy of the upper limb. The availability of new OACs holds promise for reducing the risk of systemic thromboembolism, but specific data are still limited.