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Objectives: To describe the pattern of preventable in-hospital medical injury under the "no fault" system and to assess the level of serious preventable patient harm., Design: Cross sectional survey using a two stage retrospective assessment of medical records conducted by structured implicit review., Setting: General hospitals with over 100 beds providing acute care in New Zealand., Participants: A sample of 6579 patients admitted in 1998 to 13 hospitals selected by stratified systematic list sample., Main Outcome Measures: Occurrence, preventability, and impact of adverse events., Results: Over 5% of admissions were associated with a preventable in-hospital event, of which nearly half had an element of systems failure. The elderly, ethnic minority groups, and particular clinical areas were at higher risk. The chances of a patient experiencing a serious preventable adverse event subsequent to hospital admission were just under 1%, a figure close to published results from comparable studies under tort. On average, these events required an additional 4 weeks in hospital. System related issues of protocol use and development, communication, and organisation, as well as requirements for consultation and education, were pre-eminent., Conclusions: The risk of serious preventable in-hospital medical injury for patients in New Zealand, a well established "no fault" jurisdiction, is within the range reported in comparable investigations under tort.

Objectives: To estimate the relative risk of coronary heart disease (CHD) associated with exposure to environmental tobacco smoke (ETS)., Design: Population-based case-control study., Subjects: Cases were 953 people identified in a population register of coronary events, and controls were 3189 participants in independent community-based risk factor prevalence surveys from the same study populations., Setting: Newcastle, Australia and Auckland, New Zealand., Main Outcome Measures: Acute myocardial infarction or coronary death., Results: After adjusting for the effects of age, education, history of heart disease, and body mass index, women had a statistically significant increased risk of a coronary event associated with exposure to ETS (relative risk (RR) = 1.99; 95% confidence interval (CI) = 1.40-2.81). There was little statistical evidence of increased risk found in men (RR = 1.02, 95% CI = 0.81-1.28)., Conclusion: Our study found evidence for the adverse effects of exposure to ETS on risk of coronary heart disease among women, especially at home. For men the issue is unclear according to the data from our study. Additional studies with detailed information on possible confounders and adequate statistical power are needed. Most importantly, they should use methods for measuring exposure to ETS that are sufficiently accurate to permit the investigation of dose-response relationships.