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Megumi Takahashi,1 Hiroshi Okudera,2 Masahiro Wakasugi,2 Mie Sakamoto,2 Hiromi Shimizu,3 Tokie Wakabayashi,3 Tsuneaki Yamanouchi,3 Hisashi Nagashima2 1Department of Quality and Patient Safety, Tokyo Medical University, Tokyo, Japan; 2Department of Crisis Medicine and Clinical Safety, University of Toyama, Toyama, Japan; 3Department of Medical Management Office, Toyama University Hospital, Toyama, JapanCorrespondence: Megumi Takahashi, Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku, Tokyo, Japan, Tel +81 3 3342 6111 Ext 3939, Fax +81 3 5339 3791, Email megu3@tokyo-med.ac.jpPurpose: Our aim was to inform a new definition of wrong-patient errors, obtained through an analysis of incident reports related to medication errors.Methods: We investigated wrong-patient medication errors in incident reports voluntarily reported by medical staff using a web-based incident reporting system from 2015 to 2016 at a university hospital in Japan. Incident report content was separately evaluated by four evaluators using investigational methods for clinical incidents from the Clinical Risk Unit and the Association of Litigation and Risk Management. They investigated whether it was the patient or drug that was incorrectly chosen during wrong-patient errors in drug administration in incident reports and assessed contributory factors which affected the error occurrence. The evaluators integrated the results and interpreted them together.Results: Out of a total 4337 IRs, only 30 cases (2%) contained wrong-patient errors in medication administration. The cases where the intended drugs were administered to incorrect patients occurred less frequently than cases where the wrong drugs were administered to the intended patients through the investigation of wrong targets. After a discussion, the evaluators concluded that the patient - drug/CPOE screen mismatch, caused by choosing the wrong patient, drug, or CPOE screen (mix-ups), occurred in the wrong-patient medication errors. These errors were caused by three conditions: (1) where two patients/drugs were listed next to one another, (2) where two patients’ last names/drugs’ names were the same, and (3) where the patient/drug/CPOE screen in front of the staff involved was believed to be the correct one. Additionally, these errors also involved insufficient confirmation, which led to failure to detect and correct the mismatch occurrences.Conclusion: Based on our study, we propose a new definition of wrong-patient medication errors: they consisted of choosing a wrong target and insufficient confirmation. We will investigate other types of wrong-patient errors to apply this definition.Keywords: wrong-patient error, medication error, web-based incident reporting system, computerized physician order entry, human error

Shinya Abe1,2, Gaku Inoue1,2, Satoru Yamada1,3, Junichiro Irie1,3, Hiroyuki Nojima2, Kaoru Tsuyusaki2, Kensuke Usui2, Koichiro Atsuda2, Toshikazu Yamanouchi41Diabetes Center, Kitasato Institute Hospital, 2Center for Clinical Pharmacy and Clinical Sciences, Kitasato University, 3Department of Internal Medicine, Keio University School of Medicine, 4Department of Internal Medicine, University of Teikyo School of Medicine, Tokyo, JapanObjective: This study aimed to compare the glucose-lowering effect and glycemic variability of insulin glargine with those of insulin detemir.Material and methods: This was an open-label, single-center, randomized, two-way crossover study in patients with diabetes on basal-bolus insulin therapy, with neutral protamine Hagedorn (NPH) insulin as basal insulin. Patients switched from NPH insulin to a course either of insulin glargine followed by insulin detemir, or insulin detemir followed by insulin glargine, continuing the same dose of the prior bolus of insulin. To evaluate the glucose-lowering effect, daily glycemic profiles were recorded for 72 hours by continuous glucose monitoring (CGM) in an outpatient setting. The mean amplitude of glycemic excursions, standard deviation (SD), and the mean of daily difference (MODD) were used to assess intraday and day-to-day glycemic variability.Results: Eleven patients were enrolled and nine completed the study. Mean blood glucose calculated from CGM values was significantly lower with insulin glargine compared with insulin detemir (9.6 ± 2.4 mmol/L versus 10.4 ± 2.8 mmol/L, P = 0.038). The SD was significantly lower with insulin glargine versus insulin detemir (2.5 ± 0.9 mmol/L vs 3.5 ± 1.6 mmol/L, P = 0.011). The MODD value was significantly lower with insulin glargine than with insulin detemir (2.2 ± 1.1 mmol/L vs 3.6 ± 1.7 mmol/L, P = 0.011). There was no significant difference between the two insulin analogs in terms of hypoglycemia.Conclusion: This study suggests that insulin glargine leads to more effective and more stable glycemic control than the same dose of insulin detemir.Keywords: continuous glucose monitoring, insulin detemir, insulin glargine

The horizontal structure of processes causing increases in ozone in the Antarctic polar vortex was examined using data measured in 2003 from an ozonesonde observation campaign at Syowa Station (39.6[degrees]E, 69.0[degrees]S) and from the Improved Limb Atmospheric Spectrometer II (ILAS-II) onboard the Advanced Earth Observing Satellite II. The ILAS-II data are daily and distributed uniformly at 14 points in the zonal direction, mostly at polar latitudes. The Antarctic ozone hole that developed in 2003 was one of the largest recorded. The period of focus in this study is 26 September through 24 October, when a strong polar vortex was situated in the stratosphere. An ozone mixing ratio contour (1.0 ppmv) moved downward near a height of 20 km during the period of focus. This increase in ozone is likely to result from downward transport of ozone-rich air originating from lower latitudes by Brewer-Dobson circulation. First, the descent rate of the mixing ratio contour was estimated by taking the geometric height as the vertical coordinate for the deep vortex interior around 20 km. A significant longitudinal dependence was observed. An analysis using ECMWF operational data shows that this dependence can be approximately explained by longitudinally dependent vertical movements of the isentropes caused by a zonal wavenumber-1 quasi-stationary planetary wave with amplitude and phases varying on a seasonal time scale. Next, the descent rate was calculated around 500 K (around 20 km) by taking the potential temperature (isentrope) as the vertical coordinate. The longitudinal dependence was still present using this coordinate, meaning that the ozone mixing ratio and its increase are not constant on the isentropic layer even in the interior of the polar vortex. A backward trajectory analysis showed that air parcels with large ozone mixing ratios were mostly transported from the polar vortex boundary region. This result suggests that lateral transport/mixing is important even before the breakup of the polar vortex. Results from a tracer-tracer correlation analysis of [O.sub.3] and long-lived constituent [N.sub.2]O were also consistent with this inference. The contribution of lateral mixing to the increase in ozone was estimated at about 17% [+ or -] 4% that of the Brewer-Dobson circulation around 20 km, using the calculated descent rates. The results of this study also imply that Lagrangian downward motions in the vortex interior are not correctly estimated without accounting for lateral mixing, even if the polar vortex is dynamically stable.