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***Occurrence and disclosure of medical errors

1. Why error rate so high?
- lack of awareness to severity of problem
- most errors do little / no harm
- punitive approach to errors —> fail to report
- complicated procedures

2. How to lower medical errors
- Root-cause analysis
- Reporting system
- educational resource about patient safety
- creating a non-punitive environment
- ensure compliance of systems and guidelines
- review patient feedback

3. Disclosing medical error
- The legal right of patient
- maintain trust between doctor and patient
1. Begin by stating there has been an error
2. Describe the course of events, using nontechnical language
3. State the nature of the mistake, consequences, and corrective action
4. Express personal regret and apologize
5. Elicit questions or concerns and address them
6. Plan the next step and next contact with the patient


Fluid distribution

See lecture


Sensible and insensible fluid losses

- liquid
- food
- metabolically production

- insensible water loos (skin and lungs)
- sweat
- urine
- faeces


Ways of fluid and solutes move inside body

- Physical
—> bulk flow
—> simple diffusion
—> osmosis

- Biological
—> facilitated diffusion
—> active transport
—> vesicular transport (exocytosis, endocytosis, pinocytosis, receptor mediated clarthrin coated vesicles)


Osmolarity vs Osmolality

Osmolarity: number of Osmoles of solute per volume of solution

Osmolality: number of Osmoles of solute per kg of water


Electrolyte composition of extra- and intra-cellular fluid


ECF: Na, Cl


Roles of hormones and kidneys in water and electrolyte balance

See CPRS lecture


Importance of electrolytes on resting membrane potential and action potential in excitable cells

See lecture


Signs and symptoms of dehydration

- thirst
- cramps
- postural dizziness
- confusion
- coma
- nausea, voluminous

- loss of skin tugor
- postural hypotension
- low JVP
- peripheral vasoconstriction
- tachycardia

- haemorrhage
- burns
- GI losses (vomiting, diarrhoea)
- renal loss


Signs and symptoms of water intoxication

- increases intracranial pressure (ICP)
- Hyponatremia
—> confusion
—> seizure
—> cardiac failure
—> oedema
—> muscle weakenss


Risk factors for fluid imbalance

- diarrhoea
- vomiting
- fever
- diabetes
- renal disease


How to interpret serum electrolyte results

Electrolyte panel: Na, K, Cl, HCO3
—> identify electrolyte / acid-base imbalance
—> monitor effect of treatment


Scientific approaches for determining effective diagnostics, treatments and interventions

See EBP:
1. Spans the field of Evidence Based Medicine
2. Principles of EBP
3. Level of evidence
4. Foundation of any medical decision are scientific evidences from clinical research —> clinical experience are of great help, but not the main basis


How reliable is health information provided through the media

1. Depends on source
- fact-checking
- sensationalism
- publication bias
- social media: ulterior motives
- News truncated?
- conflict of interest, personal agenda

2. Generalisability
- not always generalisable
- Knowledge-gap hypothesis:
—> infusion of mass media information into a social system increases
—> higher socioeconomic status tend to acquire this information at a faster rate than the lower status segments
—> gap in knowledge between these segments tends to increase rather than decrease


Issues involved in public heath message which encourage people to drink more water

1. Definition (at least 8 glasses of 8 ounces water)
- no scientific basis
- many publications state the opposite
- risk of hyponatremia
- mean daily fluid intake of many healthy people is below 8x8

Myths about water intake
- thirst is too late: rise in plasma osmolality of 2% trigger thirst, however at least 5% to lead to dehydration
- “dark urine means dehydration”: moderately yellow urine is normal
- letting thirsty be guide is adequate
- In general, 2.7L/day for women, 3.7L/day for men


Issues involved in public heath message which encourage people to reduce SALT intake

Beneficial effects of K:
Lower BP
- reduces risk of stroke and prevents renal disease
- reduce water reabsorption
- reduce urinary calcium excretion —> prevent osteoporosis, reduce risk of stone


Health concern of caffeine-containing beverages

Stimulant: caffeine, taurine, ginseng, guarana
- caffeine intoxication
- sleep disturbance
- increased BP
- liver damage
- kidney failure
- seizures

Marketing to kids:
- increased energy, improved athletic performance, support weight loss
- dietary supplment
- cool and sporty image
- attractive bottles and packaging
- celebrity involvement
- claim to be healthy —> less guilt in consumption
- ease of access