Twelfth Interagency Registry for Mechanically Assisted Circulatory Support Report: Readmissions After Left Ventricular Assist Device

The twelfth annual report from The Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) highlights outcomes for 26 688 continuous-flow left ventricular assist device (LVAD) patients over the past decade (2011-2020). In 2020, we observed the largest drop in yearly LVAD implant volumes since the registry's inception, which reflects the effects of the COVID-19 pandemic on cardiac surgical volumes in the United States. The 2018 heart transplant allocation policy change in the United States continues to affect LVAD implantation volumes and device strategy, with 78.1% of patients now receiving LVAD implants as destination therapy. Despite an older and sicker patient cohort, survival in the recent era (2016-2020) at 1 and 2 years continues to improve at 82.8% and 74.1%. Patient adverse event profile has also improved in the recent era, with significant reductions in stroke, gastrointestinal bleeding, infection, and device malfunction/pump thrombosis. Finally, we review the burden of readmissions after LVAD implant and highlight an opportunity to improve patient outcomes by reducing this frequent and vexing problem.

Patient safety reports analysis: post COVID-19

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham discusses the recently published Cumberlege report on medicines and medical devices safety.

Patient safety reports and crisis events round up

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses some recent patient reports and crisis events.

The state of NHS care in England

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses the Care Quality Commission's annual assessment of health care and social care in England.

An end-of-year report card for the Care Quality Commission

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses the Annual Report and Accounts 2018-2019 of the health and social care regulator.

Poisoning in Israel: Annual Report of the Israel Poison Information Center, 2017

BACKGROUND

The Israel Poison Information Center (IPIC), Rambam Health Care Campus, provides 24-hour telephone consultations on clinical toxicology and drug and reproductive toxicology. It participates in research, teaching and regulatory activities, and provides laboratory services. In 2014, nurse specialists in poison information joined the IPIC.

OBJECTIVES

To report the epidemiology of poison exposures in Israel.

METHODS

We present computerized queries and a descriptive analysis of the medical records database of the IPIC for 2017.

RESULTS

A total of 39,928 poison exposure cases were recorded, reflecting increases of 226.3% and 26.7% compared with 1995 and 2012, respectively. Children < 6 years of age were involved in 47.0% of cases; 80.4% of calls were made by the public and 17.8% by physicians; 74.2% of exposures were unintentional and 7.3% intentional. Pharmaceuticals were involved in 51.4% of cases, chemicals in 36.9%, bites and stings in 2.2%, and plants and mushrooms in 1.5%. Substances most frequently involved were analgesics, cleaning products, and antimicrobials. Clinical severity was moderate/major in 3.3%, mainly due to insecticides, drugs of abuse, and corrosives. Three fatalities were recorded (due to colchicine, organophosphates, and volatile substance inhalant abuse).

CONCLUSIONS

Poison exposures and poisonings have markedly increased in Israel, contributing substantially to morbidity. The IPIC prevented unnecessary referrals to emergency departments. Its database is a valuable national resource for collecting and monitoring poisoning exposure cases. It can be used as a real-time surveillance system for the benefit of public health. It is recommended that reporting to the IPIC become mandatory, and its activities adequately supported by national resources.

End of year report cards from NHS Resolution and the CQC

John Tingle, Associate Professor (Teaching and Scholarship), Nottingham Trent University, discusses two reports looking at the beginning and end stages of patient safety failures.

Report of the 2017-2018 Strategic Engagement Standing Committee

EXECUTIVE SUMMARY Student engagement is key to the success of schools and colleges of pharmacies in meeting their mission and programmatic needs. Student engagement in the pharmacy profession often occurs before acceptance to pharmacy school and is essential during students' formal period of study both for the student's professional growth and in meeting the mission of the school. Alumni engagement is vital to a school's continued success in regard to engaging with current students and support of their alma mater. The committee offers best practice recommendations for engaging students in service, scholarship, education, professional practice and continuing professional development.

Report of the 2017-2018 Student Affairs Standing Committee

The 2017-2018 American Association of Colleges of Pharmacy (AACP) Student Affairs Standing Committee addressed charges related to student wellness and resilience and identified ways where AACP can assist member organizations to build positive wellbeing in students. The Committee report provides nine recommendations to AACP, three suggestions for colleges and schools of pharmacy, and one proposed policy statement related to student wellness and resilience. The report focuses on themes of consequences of burnout and declining resilience, culture shift around wellness, creating community around times of grief, partnerships with member organizations to create campus cultures that promote overall wellbeing and strategies to help students to manage stress in healthy ways. Committee members challenge AACP, and other professional organizations, to include the student voice when future programs and strategies are developed. Finally, this report provides future recommendations for the Student Affairs Standing Committee.

Vital Directions for Pharmacy Education and Practice: Report of the 2017-18 Argus Commission

The Argus Commission examined the National Academy of Medicine's publication "Vital Directions for Health and Health Care" and engaged with six guests from outside academic pharmacy to identify the salience of the key issues and recommendations for pharmacy education and practice. To be part of the changing health care system we must prepare graduates and faculty to be patient- and community-centered, to command electronic systems of communication with members of interprofessional teams and to create and apply real-world evidence. Sustainable practice models will depend upon the measurement of performance and the assessment of the value produced by clinicians. To that end, the Commission advances a proposed policy related to the knowledge graduates must possess in key areas, including informatics, data analytics, genomics and value-based payment schemes. This will require new forms of faculty development and engagement between AACP members and their communities.

The Report of the 2017-2018 Professional Affairs Standing Committee: The Development of the Preceptor Self-Assessment Tool for Entrustable Professional Activities for New Graduates

The 2017-2018 AACP Professional Affairs Committee addressed the charges of (1) developing a self-reflection/self-assessment tool for pharmacy faculty and preceptors to allow them to assess their capability and confidence with Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes, the Pharmacists' Patient Care Process (PPCP), and the Entrustable Professional Activities (EPAs) for New Pharmacy Graduates and (2) creation of a plan for AACP to utilize in the development of preceptor continuing education and training programs. This report describes the framework, rationale and process for the development of the Preceptor Self-Assessment Tool for Entrustable Professional Activities for New Pharmacy Graduates (PSAE Tool), the pre-test for the PSAE tool, and the online pilot test and its results for the PSAE Tool. The committee provides recommendations for AACP in the continued development and distribution of the PSAE Tool to the schools of pharmacy. Considerations for AACP and the schools of pharmacy to consider in the continuing professional development (CPD) for all preceptors are also discussed. The committee provides a policy statement, adopted by the AACP House of Delegates, regarding the commitment of AACP regarding the CPD for all preceptors. The committee also provides several recommendations to AACP and suggestions to schools of pharmacy and other stakeholder groups pertaining to the committee charges.

Breaking Down Barriers to Pharmacy Graduate Education: The Report of the 2017-2018 Research and Graduate Affairs Committee

EXECUTIVE SUMMARY The 2017-2018 Research and Graduate Affairs Committee (RGAC) was given three charges aimed at helping academic pharmacy address barriers that must be overcome by both students and schools to attract, retain, and support the development of a diverse, well-rounded, and successful graduate student population. These charges were (1) identifying teaching methodologies, tools and opportunities that graduate programs can introduce into curriculum to overcome barriers to success of today's and tomorrow's learners; (2) developing a strategy for achieving member support of the 2016-2017 recommended graduate competencies by identifying gaps in and existing examples of courses or opportunities that achieve competency-based pharmacy graduate education; and (3) identifying potential strategies to address identified barriers to pursuing graduate education, especially among under-represented student populations. This report describes attitudes toward and opportunities related to competency-based education in graduation education in colleges and schools of pharmacy, identifies types of tools schools could use to enhance training towards the competency framework developed by the 2016-2017 RGAC, particularly with regards to the so-called power skills, and outlines a role for AACP in facilitating this training. This report also considers a number of barriers, both perceived and real, that potential students encounter when considering graduate training and suggests strategies to understand the impact of and mitigate these barriers. To strengthen competency-based graduate education, the RGAC puts forth two recommendations that AACP develop a toolkit supporting the training of power skills and that AACP should develop or curate programs or tools to support the use of individual development plans (IDPs). The RGAC also puts forth a suggestion to schools that IDPs be implemented for all students. In considering the barriers to pursuing graduate education, the Committee proposes one policy statement that AACP supports the training and development of an increasingly diverse population of researchers at pharmacy schools through active efforts to promote M.S. and Ph.D. education along with Pharm.D. education. Additionally, the Committee provides recommendations that AACP should expand its efforts in career tracking of graduate students to include collection and/or analysis of data that could inform the Academy's understanding of barriers to pursuing graduate education in pharmacy schools, the AACP Office of Institutional Research and Effectiveness should expand upon graduate program data described in the annual Profile of Pharmacy Students report, and finally that AACP should include graduate programs in efforts to increase diversity of students at pharmacy schools.

Equity reporting: a framework for putting knowledge mobilization and health equity at the core of population health status reporting

The National Collaborating Centres for Public Health (NCCPH) collaborated on the development of an action framework for integrating equity into population health status reporting. This framework integrates the research literature with on-the-ground experience collected using a unique collaborative learning approach with public health practitioners from across Canada. This article introduces the Action Framework, describes the learning process, and then situates population health status reporting (PHSR) in the current work of the public health sector. This is followed by a discussion of the nature of evidence related to the social determinants of health as a key aspect of deciding what and how to report. Finally, the connection is made between data and implementation by exploring the concept of actionable information and detailing the Action Framework for equity-integrated population health status reporting. The article concludes with a discussion of the importance of putting knowledge mobilization at the core of the PHSR process and makes suggestions for next steps. The purpose of the article is to encourage practitioners to use, discuss, and ultimately strengthen the framework.

[A Perspective on the OECD Report "Health at a Glance 2017"]

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Australian Meningococcal Surveillance Programme annual report, 2016

In 2016, there were 243 laboratory-confirmed cases of invasive meningococcal disease analysed by the Australian National Neisseria Network. This number was the highest number of laboratory confirmed cases since 2008. Probable and laboratory confirmed invasive meningococcal disease (IMD) are notifiable in Australia, and there were 252 IMD cases notified to the National Notifiable Diseases Surveillance System in 2016, the highest number reported since 2010. Meningococcal serogrouping was able to be determined for 98% (237/243) of laboratory confirmed IMD cases. Serogroup B infections accounted for 87 cases (37%), the lowest number and proportion reported since inception of the Australian Meningococcal Surveillance Programme (AMSP) in 1997. In contrast, the number and proportion of serogroup W infections (44%, 107 cases) in 2016 was the highest since the AMSP began. In addition, the number and proportion of serogroup Y infections (16%, 40 cases) was also the highest recorded by the AMSP. Molecular typing results were available for 225 of the 243 IMD cases. Of the serogroup W IMD strains that were able to be genotyped, 92% (97/105) have the PorA antigen encoding gene type P1.5,2 and of these, 72% (70/97) were sequence type 11, the same type as the hypervirulent serogroup W strain that has been circulating in the UK and South America since 2009. The primary IMD age peak was observed in adults aged 45 years or more, whilst secondary disease peaks were observed in those aged less than 5 years, and in adolescents aged 15-19 years. Serogroup B infections predominated in the age groups less than 1 year and 20-24 years, whereas serogroup W infections predominated in those aged 45 years or more. For all other age groups, distribution of serogroup B and W infections was roughly equal. Of the IMD isolates tested for antimicrobial susceptibility, 6% (11/189) were resistant to penicillin, and decreased susceptibility to penicillin was observed in a further 90% (170/189) of isolates. One Men W isolate demonstrated an elevated minimum inhibitory concentration (MIC) to ceftriaxone (0.125mg/L), the highest reported in Australia. All isolates tested were susceptible to rifampicin and ciprofloxacin.

Annual report of the National Influenza Surveillance Scheme, 2010

The 2010 influenza season was moderate overall, with more laboratory-confirmed cases than in earlier years (with the exception of 2009). That said, self-reported influenza-like illness (ILI) was equal to or lower than 2008 and earlier years. In 2010, the number of laboratory-confirmed notifications for influenza was 0.8 times the 5-year mean. High notification rates were reflected in an increase in presentations with ILI to sentinel general practices and emergency departments. Notification rates were highest in the 0-4 year age group. Infections during the season were predominantly due to influenza A(H1N1)pdm09, with 90% of notifications being influenza A (56% A(H1N)1pdm09, 30% A(unsubtyped) and 4% A(H3N2)) and 10% being influenza B. The A(H1), A(H3) and B influenza viruses circulating during the 2010 season were antigenically similar to the respective 2010 vaccine strains. Almost all (99%) of the circulating influenza B viruses that were analysed were from the B/Victoria lineage.

Annual Report of the National Influenza Surveillance Scheme, 2009

The 2009 influenza season was considered a significant season triggered by the April 2009 emergence of a novel influenza A virus prompting a World Health Organization (WHO) declaration of a public health emergency of international concern. The overall number of notifications in the Australian 2009 influenza season was the highest since national reporting to the National Notifiable Diseases Surveillance System (NNDSS) began in 2001, and substantially higher than in prior years. Over 59,000 notifications were reported to the NNDSS, almost ten times the five year mean and representing a crude notification rate of 272.1 per 100,000. Australia's first case of confirmed influenza A(H1N1) pdm09 was identified in early May 2009. By the end of 2009, there were 37,755 laboratory confirmed cases, including 5,085 hospitalisations and 188 deaths notified. Traditionally the age distribution of influenza notifications has rates highest in very young children and the elderly, however in 2009 with the predominance of the pandemic virus, notifications were highest in older children and younger adults. Although influenza can cause very severe and fatal illness, particularly in the elderly, the impact of influenza A(H1N1) pdm09 in younger healthy adults, Aboriginal and Torres Strait Islander peoples, pregnant women and people with existing medical co-morbidities was proportionally greater than normal seasonal outbreaks, even though the absolute number of such cases remained low.1 The establishment of a number of surveillance systems during the pandemic enabled an enhanced assessment of the epidemiological, clinical and virological characteristics to inform public health responses.

Report of the 2016-2017 Student Affairs Standing Committee

The 2016-2017 AACP Student Affairs Standing Committee addressed charges related to recruitment to the profession of pharmacy and a national awareness campaign for pharmacy careers, as well as promotion of student wellness and stress management. The Committee report provides six recommendations to the American Association of Colleges of Pharmacy (AACP) and one proposed policy statement for the AACP House of Delegates related to recruitment to the pharmacy profession. The Committee report also provides three recommendations to AACP and one proposed policy statement for the AACP House of Delegates related to student wellness and stress management. In addition, this report provides recommendations for future AACP Student Affairs Standing Committee work.

The Report of the 2016-2017 Advocacy Standing Committee

Based on the growing importance of community engagement and the recognition of its importance by the American Association of Colleges of Pharmacy (AACP), the committee offers several examples of community engagement activities for consideration and replication by our academy and beyond. These activities, including those of winning institutions of the Lawrence J. Weaver Transformational Community Engagement Award, can be mapped to the core components of community engagement presented in Table 1. The committee, using an implementation readiness framework, provides the reader with insight into the challenges that may impact successful community engagement and encourages our academy to continue its work to support faculty capacity in this area. Toward that end, the committee offers a policy statement that encourages schools and colleges of pharmacy to have an office or designate a faculty member whose focus is specifically on community engagement. The committee also offers a recommendation that the core components be included in the criteria for the Weaver Award.

Aligning the AACP Strategic Engagement Agenda with Key Federal Priorities in Health: Report of the 2016-17 Argus Commission

The Argus Commission identified three major federal priorities related to health care, including the precision medicine initiative, the Cancer Moonshot and the opioid abuse epidemic. Current activities at the federal level were summarized and an analysis of activities within the profession, and academic pharmacy specifically, was prepared. The implications for pharmacy education, research and practice are compelling in all three areas. Recommendations, suggestions and two policy statements aim to optimize the attention to these priorities by the academy. Further, aligning the AACP Strategic Engagement agenda with the opportunities and threats acknowledged in the analysis is essential.

Coming to a resolution: dealing with clinical negligence cases in the NHS

John Tingle, Associate Professor of Law, Nottingham Trent University, discusses the latest annual report from NHS Resolution, which provides useful information on recent clinical negligence cases.

Australian Paediatric Surveillance Unit Annual Report, 2016

This report summarises the cases reported to the Australian Paediatric Surveillance Unit (APSU) of rare infectious diseases or rare complications of more common infectious diseases in children. During the calendar year 2016, there were approximately 1500 paediatricians reporting to the APSU and the monthly report card return rate was 90%. APSU continued to provide unique national data on the perinatal exposure to HIV, congenital rubella, congenital cytomegalovirus, neonatal and infant herpes simplex virus, and congenital and neonatal varicella. APSU contributed 10 unique cases of Acute Flaccid Paralysis (a surrogate for polio) - these data are combined with cases ascertained through other surveillance systems including the Paediatric Active Disease Surveillance (PAEDS) to meet the World Health Organisation surveillance target. There was a decline in the number of cases of juvenile onset Recurrent Respiratory Papillomatosis which is likely to be associated with the introduction of the National HPV Vaccination Program. The number of cases of severe complications of influenza was significantly less in 2016 (N=32) than in 2015 (N=84) and for the first time in the last nine years no deaths due to severe influenza were reported to the APSU. In June 2016 surveillance for microcephaly commenced to assist with the detection of potential cases of congenital Zika virus infection and during that time there were 21 confirmed cases - none had a relevant history to suspect congenital Zika virus infection, however, these cases are being followed up to determine the cause of microcephaly.

Australian National Enterovirus Reference Laboratory annual report, 2014

Following the World Health Organization (WHO) recommendation, Australia conducts surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age as the main method to monitor its polio-free status. Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2014, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.4 non-polio AFP cases per 100,000 children, meeting the WHO performance criterion for a sensitive surveillance system. Non-polio enteroviruses can also be associated with AFP and enterovirus A71 and echovirus types 6 and 7 were identified from clinical specimens from cases of AFP. Globally, 359 cases of polio were reported in 2014, with the 3 endemic countries, Afghanistan, Nigeria and Pakistan, accounting for 95% of the cases. In May 2014, the WHO declared the international spread of wild poliovirus to be a public health emergency of international concern and has since maintained recommendations for polio vaccination of travellers from countries reporting cases of wild polio.

Influenza viruses received and tested by the Melbourne WHO Collaborating Centre for Reference and Research on Influenza annual report, 2015

As part of its role in the World Health Organization's (WHO) Global Influenza Surveillance and Response System, the WHO Collaborating Centre for Reference and Research on Influenza in Melbourne received a total of 5,557 influenza positive samples during 2015. Viruses were analysed for their antigenic, genetic and antiviral susceptibility properties. In 2015, influenza B viruses predominated over influenza A(H1)pdm09 and A(H3) viruses, accounting for a total of 58% of all viruses analysed. The vast majority of A(H1)pdm09, A(H3) and influenza B viruses analysed at the Centre were found to be antigenically similar to the respective WHO recommended vaccine strains for the Southern Hemisphere in 2015. However, phylogenetic analysis of a selection of viruses indicated that the majority of circulating A(H3) viruses were genetically distinct from the WHO recommended strain for 2015, resulting in an update to the recommended vaccine strain for the Southern Hemisphere for 2016. With an increasing predominance of B/Victoria lineage viruses over B/Yamagata lineage viruses through the course of 2015, WHO also updated the recommended influenza B strain in the trivalent influenza vaccine for 2016. Of more than 3,300 samples tested for resistance to the neuraminidase inhibitors oseltamivir and zanamivir, only 1 A(H1)pdm09 virus showed highly reduced inhibition by oseltamivir. The Centre undertook primary isolation of candidate vaccine viruses directly into eggs, and in 2015 a total of 45 viruses were successfully isolated in eggs.

Immunisation coverage annual report, 2014

This 8th annual immunisation coverage report shows data for 2014 derived from the Australian Childhood Immunisation Register and the National Human Papillomavirus Vaccination Program Register. This report includes coverage data for 'fully immunised' and by individual vaccines at standard age milestones and timeliness of receipt at earlier ages according to Indigenous status. Overall, 'fully immunised' coverage has been mostly stable at the 12- and 24-month age milestones since late 2003, but at 60 months of age, it has increased by more than 10 percentage points since 2009. As in previous years, coverage for 'fully immunised' at 12 months of age among Indigenous children was 3.7% lower than for non-Indigenous children overall, varying from 6.9 percentage points in Western Australia to 0.3 of a percentage point in the Australian Capital Territory. In 2014, 73.4% of Australian females aged 15 years had 3 documented doses of human papillomavirus vaccine (jurisdictional range 67.7% to 77.4%), and 82.7% had at least 1 dose, compared with 71.4% and 81.5%, respectively, in 2013. The disparity in on-time vaccination between Indigenous and non-Indigenous children in 2014 diminished progressively from 20.2% for vaccines due by 12 months to 11.5% for those due by 24 months and 3.0% at 60 months of age.

Australian Gonococcal Surveillance Programme annual report, 2015

The Australian Gonococcal Surveillance Programme (AGSP) has continuously monitored antimicrobial resistance in clinical isolates of Neisseria gonorrhoeae from all Australian states and territories since 1981. In 2015, there were 5,411 clinical isolates of gonococci from public and private sector sources tested for in vitro antimicrobial susceptibility by standardised methods. Current treatment recommendations for the majority of Australian states and territories is a dual therapeutic strategy of ceftriaxone and azithromycin. Decreased susceptibility to ceftriaxone (minimum inhibitory concentration or MIC value 0.06-0.125 mg/L) was found nationally in 1.8% of isolates, which was lower than that reported in the AGSP annual report 2014 (5.4%). The highest proportions were reported from South Australia and New South Wales (3.6% and 2.7% respectively). High level resistance to azithromycin (MIC value ≥ 256 mg/L) was again reported in 2015, with 1 strain in each of New South Wales and urban Western Australia. There was no reported Azithromycin resistance in the Australian Capital Territory, the Northern Territory, or remote Western Australia. The proportion of strains resistant to penicillin in urban and rural Australia ranged from 8.7% in Tasmania to 33% in the Australian Capital Territory. In rural and remote Northern Territory, penicillin resistance rates remain low (2.2%). In remote Western Australia relatively low numbers of strains are available for testing, however there is now widespread molecular testing for penicillin resistance in Western Australia to monitor resistance and inform guidelines and these data are included in the AGSP annual report. Quinolone resistance ranged from 11% in the urban and rural areas of the Northern Territory, to 41% in South Australia. Quinolone resistance rates remain comparatively low in remote areas of the Northern Territory (3.3%) and remote areas of Western Australia (3.4%). There was no reported quinolone resistance in Tasmania, but the number of isolates tested was relatively low. Azithromycin resistance ranged from 1.8% in Victoria to 5.8% in Queensland.