***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To develop a preliminary taxonomy of primary care medical errors . Design : Qualitative analysis to identify categories of error reported during a r and omized controlled trial of computer and paper reporting methods . Setting : The National Network for Family Practice and Primary Care Research . Participants : Family physicians . Main outcome measures : Medical error category , context , and consequence . Results : Forty two physicians made 344 reports : 284 ( 82.6 % ) arose from healthcare systems dysfunction ; 46 ( 13.4 % ) were errors due to gaps in knowledge or skills ; and 14 ( 4.1 % ) were reports of adverse events , not errors . The main subcategories were : administrative failures ( 102 ; 30.9 % of errors ) , investigation failures ( 82 ; 24.8 % ) , treatment delivery lapses ( 76 ; 23.0 % ) , miscommunication ( 19 ; 5.8 % ) , payment systems problems ( 4 ; 1.2 % ) , error in the execution of a clinical task ( 19 ; 5.8 % ) , wrong treatment decision ( 14 ; 4.2 % ) , and wrong diagnosis ( 13 ; 3.9 % ) . Most reports were of errors that were recognized and occurred in reporters ' practice s. Affected patients ranged in age from 8 months to 100 years , were of both sexes , and represented all major US ethnic groups . Almost half the reports were of events which had adverse consequences . Ten errors result ed in patients being admitted to hospital and one patient died . Conclusions : This medical error taxonomy , developed from self-reports of errors observed by family physicians during their routine clinical practice , emphasizes problems in healthcare processes and acknowledges medical errors arising from shortfalls in clinical knowledge and skills . Patient safety strategies with most effect in primary care setting s need to be broader than the current focus on medication errors Background The validity and usefulness of incident reporting and other methods for identifying adverse events remains unclear . This study aim ed to compare five methods in general practice . Methods In a prospect i ve observational study , with five general practitioners , five methods were applied and compared . The five methods were physician reported adverse events , pharmacist reported adverse events , patients ' experiences of adverse events , assessment of a r and om sample of medical records , and assessment of all deceased patients .  Results A total of 68 events were identified using these methods . The patient survey accounted for the highest number of events and the pharmacist reports for the lowest number . No overlap between the methods was detected . The patient survey accounted for the highest number of events and the pharmacist reports for the lowest number . Conclusion A mix of methods is needed to identify adverse events in general practice BACKGROUND Mistakes are an inevitable part of the practice of medicine . While the frequency and severity of medical errors are documented , little is known about patients ' attitudes toward physician mistakes . OBJECTIVE To examine patient attitudes about physician errors . DESIGN A survey instrument assessed attitudes to 3 levels of physician mistakes ( minor , moderate , and severe ) and 2 fundamental physician responses : disclosure or nondisclosure .  One hundred forty-nine study subjects were r and omly selected from an academic general internal medicine outpatient clinic . RESULTS Virtually all patients ( 98 % ) desired some acknowledgment of even minor errors . Patient 's desire for referral to another physician ranged from 14 % following a minor mistake to 65 % following a severe mistake . For both moderate and severe mistakes , patients were significantly more likely to consider litigation if the physician did not disclose the error . In the moderate mistake scenario , 12 % of patients would sue if informed by the physician vs 20 % if the physician failed to disclose the error and they discovered it by some other means ( P < .001 ) . CONCLUSIONS Patients desire an acknowledgment from their physicians of even minor errors , and doing so may actually reduce the risk of punitive actions . These findings reinforce the importance of open communication between patients and physicians PURPOSE : Little is known about how well hospitalized patients can identify errors or injuries in their care . Accordingly , the purpose of this study was to elicit incident reports from hospital in patients in order to identify and characterize adverse events and near-miss errors . SUBJECTS : We conducted a prospect i ve cohort study of 228 adult in patients on a medicine unit of a Boston teaching hospital . METHODS : Investigators review ed medical records  and interviewed  patients during the hospitalization and by telephone 10 days after discharge about “ problems , ” “ mistakes , ” and “ injuries ” that occurred . Physician investigators classified patients ’ reports . We calculated event rates and used multivariable Poisson regression models to examine the factors associated with patient-reported events . RESULTS : Of 264 eligible patients , 228 ( 86 % ) agreed to participate and completed 528 interviews . Seventeen patients ( 8 % ) experienced 20 adverse events ; 1 was serious . Eight patients ( 4 % ) experienced 13 near misses ; 5 were serious or life threatening . Eleven ( 55 % ) of 20 adverse events and 4 ( 31 % ) of 13 near misses were documented in the medical record , but none were found in the hospital incident reporting system . Patients with 3 or more drug allergies were more likely to report errors compared with patients without drug allergies ( incidence rate ratio 4.7 , 95 % CI 1.7 , 13.4 ) . CONCLUSIONS : In patients can identify adverse events affecting their care . Many patient-identified events are not captured by the hospital incident reporting system or recorded in the medical record . Engaging hospitalized patients as partners in identifying medical errors and injuries is a potentially promising approach for enhancing patient safety Objective To analyse the frequency of adverse events to treatment reported by patients in relation to consultation time , attention from their usual doctor and information provided by their doctor about treatment . Design Descriptive study . Patients were invited to respond to a telephone survey . Setting 21 Primary Care health centres in Spain . Participants 15 282 patients attended by GPs or paediatricians ( error of 1 % for p = q=0.50 , α 95 % ) were selected at r and om from the total consultations recorded in 1 month . For sampling , quotas were assigned for type of attention , age and sex . In the case of children ( under 14 years ) , the survey was answered by their parents . Main outcome measures Patients ' report on frequency of unexpected or adverse reaction to a treatment ; whether informed or not about possible complications of the treatment and pre caution s to take ; consultation time ; and whether or not patient is usually seen by the same doctor . Results 1557 ( 17.6 % , CI 95 % 16.8 to 18.4 % ) of the adults and 867 ( 13.7 % , 95 % CI 12.8 to 14.5 % ) of the children reported adverse or unexpected reactions to the treatment according to patients ' reports . Consultation time ( OR 0.5 , 95 % CI 0.4 to 0.5 ) , doctor rotation at the health centre ( OR 2.04 , 95 % CI 1.85 to 2.25 ) and information on treatment pre caution s ( OR 0.47 , 95 % CI 0.43 to 0.53 ) determine the higher risk of adverse reactions to treatment . Conclusions Planning at health centres should involve the monitoring of mean consultation time and doctor rotation as indirect indicators of safety . Furthermore , protocol s related to the information provided to patients should be review ed OBJECTIVE To determine the incidence of errors anonymously reported by general practitioners in NSW . DESIGN The Threats to Australian Patient Safety ( TAPS ) study used anonymous reporting of errors by GPs  via a secure web-based question naire for 12 months from October 2003 . SETTING General practice s in NSW from three groupings : major urban centres ( RRMA 1 ) , large regional areas ( RRMA 2 - 3 ) , and rural and remote areas ( RRMA 4 - 7 ) . PARTICIPANTS 84 GPs from a stratified r and om sample of the population of 4666 NSW GPs - 41 ( 49 % ) from RRMA 1 , 22 ( 26 % ) from RRMA 2 - 3 , and 21 ( 25 % ) from RRMA 4 - 7 . Participants were representative of the GP source population of 4666 doctors in NSW ( Medicare items billed , participant age and sex ) . MAIN OUTCOME MEASURES Total number of error reports and incidence of reported errors per Medicare patient encounter item and per patient seen per year . RESULTS 84 GPs su bmi tted 418 error reports , cl aim ed 490 864 Medicare patient encounter items , and saw 166 569 individual patients over 12 months . The incidence of reported error per Medicare patient encounter item per year was 0.078 % ( 95 % CI , 0.076%-0.080 % ) . The incidence of reported errors per patient seen per year was 0.240 % ( 95 % CI , 0.235%-0.245 % ) . No significant difference was seen in error reporting frequency between RRMA groupings . CONCLUSIONS This is the first study describing the incidence of GP-reported errors in a representative sample . When an anonymous reporting system is provided , about one error is reported for every 1000 Medicare items related to patient encounters billed , and about two errors are reported for every 1000 individual patients seen by a GP In a general practice in Derbyshire 298 patients who had been given antibiotics  were question ed about possible adverse reactions to the drug prescribed . Four methods of assessing adverse effects of drugs in the community were used , and a comparison was made of the replies elicited from patients by doctor and health visitor respectively . Significant differences were shown to occur in the way in which each investigator completed the question naires . If ancillary staff are to be employed in monitoring adverse effects of drugs in the community on a large scale then they will have to use a method less reliant on the differentiation of incidental symptoms from drug side effects than is required in the present survey OBJECTIVE : Outpatient drug complications have not been well studied . We sought to assess the incidence and characteristics of outpatient drug complications , identify their clinical and non clinical correlates , and evaluate their impact on patient satisfaction . DESIGN : Retrospective chart review s and patient surveys . SETTING : Eleven Boston-area ambulatory clinics . PATIENTS : We r and omly selected 2,248 out patients , 20 to 75 years old . MEASUREMENTS AND MAIN RESULTS : Among 2,248 patients reporting prescription drug use , 394 ( 18 % ) reported a drug complication . In contrast , chart review revealed an adverse drug event in only 64 patients ( 3 % ) . In univariate analyses , significant correlates of patient-reported drug complications were number of medical problems , number of medications , renal disease , failure to explain side effects before treatment , lower medication compliance , and primary language other than English or Spanish . In multivariate analysis , independent correlates were number of medical problems ( odds ratio [ OR ] 1.17 ; 95 % confidence interval [ 95 % CI ] 1.05 to 1.30 ) , failure to explain side effects ( OR 1.65 ; 95 % CI , 1.16 to 2.35 ) , and primary language other than English or Spanish ( OR 1.40 ; 95 % CI , 1.01 to 1.95 ) . Patient satisfaction was lower among patients who reported drug complications ( P < .0001 ) . In addition , 48 % of those reporting drug complications sought medical attention and 49 % experienced worry or discomfort . On chart review , 3 ( 5 % ) of the patients with an adverse drug event required hospitalization and 8 ( 13 % ) had a documented previous reaction to the causative drug . CONCLUSIONS : Drug complications in the ambulatory setting were common , although most were not documented in the medical record . These complications increased use of the medical system and correlated with dissatisfaction with care . Our results indicate a need for better communication about potential side effects of medications , especially for patients with multiple medical problems AIMS To assess the preventability and clinical context of adverse events identified in New Zeal and public hospitals . METHODS Two-stage retrospective review of 6579 medical records r and omly sample d from admissions for 1998 in 13 generalist hospitals providing acute care . Initial screening and medical review according to a st and ardised protocol . RESULTS Eight hundred and fifty adverse events were identified , of which over one third ( 315 ) were preventable to a significant degree . Preventability of events increased with age of patient , and was more characteristic of certain diagnostic categories . Half of all events ( 413/850 ) were both preventable and occurred in hospital , giving an occurrence rate of 6.3 % . This rate increased with patient age , as did impact on patients and extended stay . There were also variations by diagnostic category . Over half of the events were associated with surgery ( 489 ) and one third with medicine ( 303 ) ; operative incidents were predominant in the former , drug-related in the latter , and system issues in both . Events in medicine had greater patient impact , and were less likely to have occurred in a public hospital . System errors featured prominently as an area for prevention , being associated with nearly half of all preventable in-hospital events . Consultation and education were also important , re sources less so . CONCLUSIONS Preventable adverse events have a major impact on patient outcomes and extended hospital stay . A substantial proportion of these are system related and , hence , in principle susceptible to quality improvement The detection of adverse drug reactions ( ADRs ) by a traditional passive reporting system and by a method involving patient and provider interviews was studied . The study sample consisted of r and omly selected out patients seen by their primary care provider during scheduled appointments in January and February 2001 at a Veterans Affairs medical center . After ambulatory care clinic sessions , patients and providers were asked ( by telephone and in person , respectively ) to identify potential ADRs . Also 
    Output:
    
Although there is evidence of good psychometric properties for a reduced number of patient reported instruments , currently available instruments do not offer a comprehensive set of re sources to measure the effects of interventions to improve patient safety in primary care from a patient perspective .