Author
Alan Merry
Other affiliations: Wellington Hospital, Royal Brisbane and Women's Hospital, Royal Melbourne Hospital ...read more
Bio: Alan Merry is an academic researcher from University of Auckland. The author has contributed to research in topics: Patient safety & Checklist. The author has an hindex of 45, co-authored 260 publications receiving 11735 citations. Previous affiliations of Alan Merry include Wellington Hospital & Royal Brisbane and Women's Hospital.
Papers published on a yearly basis
Papers
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TL;DR: Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.
Abstract: The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P = 0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001). Conclusions Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.
4,764 citations
TL;DR: Current evidence suggests that a combination of paracetamol and an NSAID may offer superior analgesia compared with either drug alone.
Abstract: Background There has been a trend over recent years for combining a nonsteroidal antiinflammatory drug (NSAID) with paracetamol (acetaminophen) for pain management. However, therapeutic superiority of the combination of paracetamol and an NSAID over either drug alone remains controversial. We evaluated the efficacy of the combination of paracetamol and an NSAID versus either drug alone in various acute pain models. Methods A systematic literature search of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and PubMed covering the period from January 1988 to June 2009 was performed to identify randomized controlled trials in humans that specifically compared combinations of paracetamol with various NSAIDs versus at least 1 of these constituent drugs. Identified studies were stratified into 2 groups: paracetamol/NSAID combinations versus paracetamol or NSAIDs. We analyzed pain intensity scores and supplemental analgesic requirements as primary outcome measures. In addition, each study was graded for quality using a validated scale. Results Twenty-one human studies enrolling 1909 patients were analyzed. The NSAIDs used were ibuprofen (n = 6), diclofenac (n = 8), ketoprofen (n = 3), ketorolac (n = 1), aspirin (n = 1), tenoxicam (n = 1), and rofecoxib (n = 1). The combination of paracetamol and NSAID was more effective than paracetamol or NSAID alone in 85% and 64% of relevant studies, respectively. The pain intensity and analgesic supplementation was 35.0% +/- 10.9% and 38.8% +/- 13.1% lesser, respectively, in the positive studies for the combination versus paracetamol group, and 37.7% +/- 26.6% and 31.3% +/- 13.4% lesser, respectively, in the positive studies for the combination versus the NSAID group. No statistical difference in median quality scores was found between experimental groups. Conclusion Current evidence suggests that a combination of paracetamol and an NSAID may offer superior analgesia compared with either drug alone.
559 citations
TL;DR: In this article, the authors assess the relationship between changes in clinician attitude and changes in postoperative outcomes following a checklist-based surgical safety intervention and find that improvements in post-operative outcomes were associated with improved perception of teamwork and safety climate among respondents, suggesting that changes in these may be partially responsible for the effect of the checklist.
Abstract: Objectives To assess the relationship between changes in clinician attitude and changes in postoperative outcomes following a checklist-based surgical safety intervention.
Design Pre- and post intervention survey.
Setting Eight hospitals participating in a trial of a WHO surgical safety checklist.
Participants Clinicians actively working in the designated study operating rooms at the eight hospitals.
Survey instrument Modified operating-room version Safety Attitudes Questionnaire (SAQ).
Main outcome measures Change in mean safety attitude score and correlation between change in safety attitude score and change in postoperative outcomes, plus clinician opinion of checklist efficacy and usability.
Results Clinicians in the preintervention phase (n=281) had a mean SAQ score of 3.91 (on a scale of 1 to 5, with 5 representing better safety attitude), while the postintervention group (n=257) had a mean of 4.01 (p=0.0127). The degree of improvement in mean SAQ score at each site correlated with a reduction in postoperative complication rate (r=0.7143, p=0.0381). The checklist was considered easy to use by 80.2% of respondents, while 19.8% felt that it took a long time to complete, and 78.6% felt that the programme prevented errors. Overall, 93.4% would want the checklist used if they were undergoing operation.
Conclusions Improvements in postoperative outcomes were associated with improved perception of teamwork and safety climate among respondents, suggesting that changes in these may be partially responsible for the effect of the checklist. Clinicians held the checklist in high regard and the overwhelming majority would want it used if they were undergoing surgery themselves.
460 citations
TL;DR: The global distribution of operating theatres and the availability of pulse oximetry were estimated and quantified and it was suggested that around 77,700 theatres worldwide were not equipped with pulse oximeters.
369 citations
TL;DR: It is concluded that drug administration error during anaesthesia is considerably more frequent than previously reported.
Abstract: We aimed to establish the frequency and nature of drug administration error in anaesthesia (a significant subset of error in medicine) at two hospitals. Anaesthetists were asked to return a study form anonymouslyfor every anaesthetic, indicating whether or not a drug administration error or pre-error (defined as any incident with potential to become an error) had occurred. Further details were sought if the response was affirmative. From 10,806 anaesthetics, 7794 study forms were returned, representing response rates of 80% from Hospital A and 57% from Hospital B (72% overall). The frequency (95% confidence intervals) of drug administration error; of any type, per anaesthetic was 0.0075 (0.006 to 0.009), of i.v. bolus errors was 0.005 (0.0035 to 0.006) and of pre-errors was 0.004 (0.003 to 0.005), with no significant difference between hospitals. Overall, one drug administration error was reported for every 133 anaesthetics. The two largest individual categories of error involved incorrect doses (20%) and substitutions (20%) with i.v. boluses of drug. Of the i.v. bolus substitutions, 69% occurred between different pharmacological classes. One patient was aware while under muscle relaxation, and two required prolonged ventilation. In addition, 47 transient physiological effects were reported, of which five required intervention. We conclude that drug administration error during anaesthesia is considerably more frequent than previously reported.
284 citations
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TL;DR: This 5-year evaluation provides strong evidence that the classification of complications is valid and applicable worldwide in many fields of surgery, and subjective, inaccurate, or confusing terms such as “minor or major” should be removed from the surgical literature.
Abstract: Background and Aims:The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the co
7,537 citations
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TL;DR: Some of the major results in random graphs and some of the more challenging open problems are reviewed, including those related to the WWW.
Abstract: We will review some of the major results in random graphs and some of the more challenging open problems. We will cover algorithmic and structural questions. We will touch on newer models, including those related to the WWW.
7,116 citations
31 Oct 2001
TL;DR: The American Society for Testing and Materials (ASTM) as mentioned in this paper is an independent organization devoted to the development of standards for testing and materials, and is a member of IEEE 802.11.
Abstract: The American Society for Testing and Materials (ASTM) is an independent organization devoted to the development of standards.
3,792 citations
TL;DR: It is concluded that multiple Imputation for Nonresponse in Surveys should be considered as a legitimate method for answering the question of why people do not respond to survey questions.
Abstract: 25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.
3,216 citations
Boston Children's Hospital1, Harvard University2, King's College London3, Lund University4, Massachusetts Eye and Ear Infirmary5, University of São Paulo6, University of California, San Diego7, Imperial College London8, Partners In Health9, Brigham and Women's Hospital10, Royal North Shore Hospital11, Medical College of Wisconsin12, Nanyang Technological University13, Monash University14, University of Sierra Leone15, University of Oxford16, Mongolian National University17, Flinders University18, University of Malawi19, Beth Israel Deaconess Medical Center20, Bhabha Atomic Research Centre21, Royal Australasian College of Surgeons22, Stanford University23, University of California, San Francisco24
TL;DR: The need for surgical services in low- and middleincome countries will continue to rise substantially from now until 2030, with a large projected increase in the incidence of cancer, road traffic injuries, and cardiovascular and metabolic diseases in LMICs.
2,209 citations