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Frigga lives with her parents on their farm. Unable to speak after being horrifically raped by an elderly man when she was young, her parents spend the majority of their money on speech therapy classes for their daughter in the hope that one day, she will speak again. One day, Frigga misses the bus …to get to her speech therapy class. She accepts a ride off a suave looking gentlemen named Tony who pulls up beside her. Once they are in town, he takes her for a meal. Afterwards, he takes Frigga back to what appears to be his bachelor pad. He gives her wine that has probably been drugged, as she passes out after drinking it. The man then takes no time in bringing a crooked doctor in to get her fixed on high class heroin. After announcing to Frigga that she is now dependent on heroin and cannot last more than 48 hours without it, she must work as a prostitute for him. Frigga, obviously not thrilled by this news, attempts escape twice, but to no avail. On getting her very first client, she reacts by scratching down his face. Tony punishes her for this by removing an eye (the infamous supposed cadaver eye scene). Having found out that Tony sent a fake letter to her parents announcing in it that she hates her parents, Frigga makes her way home one Monday (her day off) only to discover that they have both apparently suicided from the lost of their only daughter. After this and the death of her friend and fellow prostitute Sally, Frigga seeks revenge on those who have wronged her, name… (Read More)
b moviecoming of agecult filmmartial artsindependent film
murder of a police officerself sacrificedrug addictionvengeancecrueltyexploitationsadisminsanitybrutalityseductiontorturelesbianismrapesuiciderevenge …deathmurder (See All)
self justicepimplustfemale protagonistpolice
sexual perversionheroin addictsexual desireanal penetrationvaginal penetrationslow motion shootoutchild rapeanal raperape victimpanties pulled downno pantiesgirl in pantiesblack pantieswhite pantiesexploding chest …erotic 70smaster apprentice relationshipabuse against womenman girl relationshipgun saushooting a womangun katafemale vigilantehot dog vendorgoreshedviolent deathforced prostitutiongun violencedark heroinespitting bloodsexual predatorsnorricamstreet vendorsexual humiliationexit woundpunchingloss of parentsbody partgun duelfemale victimwhite slaverysimulated sexhead cut offcarnagesawed off shotgunjointdouble barreled shotgunfallingbullet balletscalpelfemale genitaliafemale removes her dressforced to stripvigilantismdirector cameobeheadingshot multiple timesbullet timemurder of a childchildhood memorybloodbathsexual assaultcopulationstabbed in the eyesodomyeye patcheye gougingslaughterperversionsexploitationbroken glassgunshot woundpsychotronicgun battlegun fusufferingsocial commentaryfemale killercoitusgrindhousecaptivesexual attractionshot in the stomachsexual abusemutilationragedesirekissing while having sexhateheroinhandgunfemale removes her clothessensualityevil manvaginal sexmini skirtscreamingkaratepainshot in the legcontroversyscantily clad femalesevered headfemale pubic hairvagina spreadingmassacrecleavagedecapitationshot in the backkung fucombatlow budget filmgunfightpunched in the faceslow motion sceneshot in the headshot in the chestpenetrationblood splattershootouttopless female nuditypistollabiapantieserectionleg spreadinglesbian kissmale full frontal nuditynipplesfemale full frontal nudityfemale frontal nuditymale frontal nudityfemale rear nuditymale rear nudityfemale nuditymale nuditybare breastsflashbackmasturbationbloodviolencesexgunnudity (See All)
The film follows Jennifer, a writer who is working on a new novel and needs to get out of the city to finish it. She rents a riverside cabin in upstate New York to work on her novel, attracting the attention of a number of rowdy male locals. They catch Jennifer one day and strip her naked for the vi …llage idiot (Matthew) and rape her. Jennifer is later attacked and raped a further two times by the four degenerates, and her novel is also destroyed. But Jennifer recovers, and in her now-twisted, psychotic state, she begins to seek revenge on the men. (Read More)
b moviecult filmindependent film
self justicelustfemale protagonist
sexual perversionanal raperape victimpanties pulled downwhite pantiesfemale vigilanteviolent deathsexual humiliationfemale victimcarnagefemale removes her dressvigilantismperversionsexploitationfemale killer …grindhousesexual abusemutilationragehandgunfemale removes her clothesevil manscreamingcontroversyscantily clad femalefemale pubic haircleavagelow budget filmpantiesleg spreadingmale full frontal nuditynipplesfemale full frontal nudityfemale frontal nuditymale frontal nudityfemale rear nudityfemale nuditymale nuditybare breastsviolencebloodgun (See All)
Events over the course of one traumatic night in Paris unfold in reverse-chronological order as the beautiful Alex is brutally raped and beaten by a stranger in the underpass. Her boyfriend and ex-lover take matters into their own hands by hiring two criminals to help them find the rapist so that th …ey can exact revenge. A simultaneously beautiful and terrible examination of the destructive nature of cause and effect, and how time destroys everything. (Read More)
cult filmindependent film
sexual perversionanal raperape victimpanties pulled downwhite pantiessnorricamsexual assaultsodomyperversionsufferingsexual abusehateheroinevil manscreaming …painfemale pubic haircleavagepunched in the faceslow motion sceneblood splatterpantieserectionleg spreadingfemale full frontal nudityfemale frontal nuditymale frontal nudityfemale rear nuditymale rear nudityfemale nuditymale nuditybare breastsmasturbationsexviolenceblood (See All)
Trained since childhood to be a lethal killer, Raizo has since turned his back on the Ozunu clan that raised him and now seeks revenge for their heartless murders. Teaming up with Europol investigator Mika, Raizo steadily butchers his enemies while inching ever closer to the long-awaited bloody reun …ion with his former master. (Read More)
martial arts
murder of a police officercrueltyexploitationbrutalitydeathrevengemurder
gun saugun katagoreshedexit woundcarnagebullet balletbeheadingbloodbathslaughtergun battlegun fupainsevered headmassacredecapitation …shot in the backkung fucombatgunfightslow motion sceneshot in the headshot in the chestblood splattershootoutpistolgunflashbackbloodviolence (See All)
On the eve of her seventeenth birthday, Mari Collingwood tells her parents that she is going to the concert of underground band Bloodlust in New York with her friend Phyllis Stone. She borrows the family's car and heads with her friend to a dangerous neighborhood in the city. Meanwhile, the sadistic … and cruel escapees Krug Stillo and Fred 'Weasel' Podowski are hidden in a hideout with their partners Sadie (Jeramie Rain) and Krug's addicted son Junior Stillo (Marc Sheffler) after killing two guards and one shepherd in their runaway. The two girls seek marijuana near the theater and meet Junior that offers some Colombian grass to them. They go to his apartment and are subdued by the criminals that rape Phyllis. On the next morning, they hide the girls in the trunk of their convertible and head to Canada. However, they have a problem with the car's rod and they stop on the road close to Mari's house. When Phyllis tries to escape, the gang stabs her to death and shots Mari after humiliating and raping them. They seek shelter in Mari's home, but during the night, her mother overhears a conversation of the criminals telling that they have killed her daughter. She tells her husband and they plot a scheme to revenge the death of their princess. (Read More)
cult filmindependent film
self justicepolice
sexual perversionrape victimwhite pantiessexual predatorcarnagedouble barreled shotgunforced to stripshot multiple timesmurder of a childbloodbathsexual assaultperversionsufferingfemale killergrindhouse …sexual abusemutilationhandgunfemale removes her clothesevil manscreamingcontroversyscantily clad femalefemale pubic hairblood splatterpantiesfemale full frontal nudityfemale frontal nudityfemale rear nudityfemale nuditygunviolenceblood (See All)
Upon moving to Britain to get away from American violence, astrophysicist David Sumner and his wife Amy are bullied and taken advantage of by the locals hired to do construction. When David finally takes a stand it escalates quickly into a bloody battle as the locals assault his house.
cult filmindependent film
sexual desireanal raperape victimexit woundpunchinggun duelcarnagesexual assaultbroken glasssexual attractionshot in the stomachsexual abuseragedesiresensuality …mini skirtpaincontroversyscantily clad femalecombatgunfightslow motion sceneshot in the chestblood splattershootoutpantiesfemale nuditysexflashbackbloodviolencegun (See All)
After his partner Tom Lone and family are killed apparently by the infamous and elusive assassin Rogue, FBI agent John Crawford becomes obsessed with revenge as his world unravels into a vortex of guilt and betrayal. Rogue eventually resurfaces to settle a score of his own, setting off a bloody crim …e war between Asian mob rivals Chang of the Triad's and Yakuza boss Shiro. When Jack and Rogue finally come face to face, the ultimate truth of their pasts will be revealed. (Read More)
martial arts
murder of a police officervengeancebrutalitydeathrevenge
black pantiesgun saugun kataexit woundgun duelcarnagebullet balletbeheadingbullet timegun battlefemale killersevered headmassacredecapitationshot in the back …kung fucombatgunfightslow motion sceneshot in the headshot in the chestblood splattershootoutlesbian kissfemale nudityviolencebloodsex (See All)
Writer Jennifer Hills (Butler) takes a retreat from the city to a charming cabin in the woods to start on her next book. But Jennifer's presence in the small town attracts the attention of a few morally depraved locals who set out one night to teach this city girl a lesson. They break into her cabin … to scare her. However, what starts out as terrifying acts of humiliation and intimidation, quickly and uncontrollably escalates into a night of physical abuse and torturous assault. But before they can kill her, Jennifer sacrifices her broken and beaten body to a raging river that washes her away. As time passes, the men slowly stop searching for her body and try to go back to life as usual. But that isn't about to happen. Against all odds, Jennifer Hills survived her ordeal. Now, with hell bent vengeance, Jennifer's sole purpose is to turn the tables on these animals and to inflict upon them every horrifying and torturous moment they carried out on her... only much, much worse. (Read More)
female protagonist
sexual perversionanal raperape victimpanties pulled downno pantiesgirl in pantiesblack pantieswhite pantiesfemale vigilantesexual humiliationforced to stripvigilantismsodomyfemale killersexual abuse …mini skirtscantily clad femalefemale pubic haircleavageshot in the chestpantiesleg spreadingfemale full frontal nudityfemale frontal nudityfemale rear nuditymale rear nudityfemale nuditymale nudityflashbackviolenceblood (See All)
When a Yakuza boss named Anjo disappears with 300 million yen, his chief henchman, a sadomasochistic man named Kakihara, and the rest of his mob goons go looking for him. After capturing and torturing a rival Yakuza member looking for answers, they soon realize they have the wrong man and begin look …ing for the man named Jijii who tipped them off in the first place. Soon enough Kakihara and his men encounter Ichi, a psychotic, sexually-repressed young man with amazing martial arts abilities and blades that come out of his shoes. One by one Ichi takes out members of the Yakuza and all the while Kakihara intensifies his pursuit of Ichi and Ichi's controller Jijii. What will happen as the final showdown happens between the tortured and ultra-violent Ichi and the pain-craving Kakihara? (Read More)
cult filmmartial artsindependent film
sexual perversionviolent deathsexual humiliationfemale victimmurder of a childslaughterperversionsexual abusemutilationrageevil manpainshot in the legcontroversysevered head …massacredecapitationkung fublood splatternipplesfemale nuditymale nuditygunviolencemasturbationbloodflashback (See All)
While being transported by two detectives in a car, the dangerous criminal Krug is rescued by his brother Francis and his girlfriend Sadie, and they brutally kill the detectives. Meanwhile Emma, her husband John, and their daughter Mari Collingwood head to their summer home near the lake. Mari borro …ws the family car to meet her friend Paige that is working in a store in the town. While in the store, they befriend a teen boy named Justin, who offers some marijuana to Paige in the motel where he is lodged. While they are smoking marijuana in Justin's room, Krug, Francis, and Sadie arrive and abduct the girls. Krug drives Mari's car and she causes them to crash into a tree. Krug stabs Paige and rapes Mari; however Mari manages to escape, swimming in the lake, but Krug shoots her in the back. They walk through the isolated road in the woods and they reach Collingwood's house telling that they have just had a car accident. Emma and John welcome the strangers until they discover what has happened to their beloved daughter. (Read More)
murder of a police officervengeancecrueltysadismbrutalitytorturerapedeathmurderrevenge
rape victimpanties pulled downno pantiesgirl in pantieswhite pantiessexual predatorsexual humiliationfemale victimsexual assaultcopulationperversiongunshot woundfemale killercoitusrage …scantily clad femalecleavageshot in the backpunched in the faceshot in the headshot in the chestblood splatterpistolpantiesfemale frontal nudityfemale rear nudityfemale nudityviolenceblood (See All)
A down and out cynical detective teams up with a down and out ex-quarterback to try and solve a murder case involving a pro football team and a politician.
cult filmmartial arts
murder of a police officerself sacrificedrug addictionbrutalitytorturesuicidedeathmurderrevenge
gun saugun kataexit woundgun duelcarnagesawed off shotgunbullet balletgun battlegun fucaptivekarateshot in the legmassacreshot in the backcombat …gunfightpunched in the faceslow motion sceneshot in the headshot in the chestblood splattershootouttopless female nuditypistolfemale rear nudityfemale nuditybare breastsbloodflashbackgunviolence (See All)
A violent Hong Kong action film, this is the story of an assassin, Jeffrey Chow (aka Mickey Mouse) who takes one last job so he can retire and care for his girlfriend Jenny. When his employers betray him, he reluctantly joins forces with Inspector Lee (aka Dumbo), the cop who is pursuing him. Togeth …er, the new friends face the final confrontation of the gangsters out to kill them. (Read More)
cult filmmartial arts
murder of a police officerself sacrificebrutalitymurderdeathrevenge
man girl relationshipgun saugun kataexit woundgun duelcarnagebullet balletbullet timegunshot woundpsychotronicgun battlegun fusocial commentaryshot in the legshot in the back …kung fucombatgunfightpunched in the faceslow motion sceneshot in the headshot in the chestblood splattershootoutpistolviolencebloodgunflashback (See All)
While taking a shower, Kate Miller, a middle-aged, sexually frustrated New York City housewife, has a rape fantasy while her husband stands at the sink shaving. Later that day, after complaining to her psychiatrist Dr. Robert Elliott about her husband's pathetic performance in bed, she meets a stran …ge man at a museum and returns to his apartment where they continue an adulterous encounter that began in the taxicab. Before she leaves his apartment, she finds papers which certify that the man has a venereal disease. Panicked, Kate rushes into the elevator, but has to return to his apartment when she realizes she's forgotten her wedding ring. When the elevator doors open, she's brutally slashed to death by a tall blonde woman wearing dark sunglasses. Liz Blake, a high-class call girl, is the only witness to the murder and she becomes the prime suspect and the murderess's next target. Liz is rescued from being killed by Kate's son Peter, who enlists the help of Liz to catch his mother's killer as Detective Marino who's in charge of the case is uncooperative in the investigation. (Read More)
cult filmindependent film
sexual perversionsexual desirepanties pulled downno pantiesblack pantieswhite pantiesfemale victimfemale removes her dresscopulationperversionbroken glasscoitusmutilationdesirefemale removes her clothes …sensualityevil mancontroversyscantily clad femalefemale pubic haircleavagetopless female nuditypantiesleg spreadingnipplesfemale full frontal nudityfemale frontal nudityfemale rear nudityfemale nuditymale nuditybare breastssexnudityviolence (See All)
Alexia travels with her friend Marie to spend a couple of days with her family in their farm in the country. They arrive late and they are welcomed by Alexia's father. Late in the night, a sadistic and sick killer breaks into the farmhouse, slaughters Alexia's family--including their dog--and kidnap …s Alexia. Marie hides from the criminal and tries to help the hysterical and frightened Alexia, chase the maniac, and disclose his identity in the end. (Read More)
b movieindependent film
female protagonistpolice
rape victimsexual predatorfemale victimmurder of a childsexual assaultslaughterperversionbroken glassfemale killergrindhousemutilationevil manscantily clad femalesevered headmassacre …decapitationshot in the backlow budget filmslow motion sceneshot in the headblood splatterlesbian kissfemale frontal nudityfemale nuditybare breastsbloodmasturbationflashbackgunviolence (See All)
In 2035, technophobic homicide detective Del Spooner of the Chicago PD heads the investigation of the apparent suicide of leading robotics scientist, Dr. Alfred Lanning. Unconvinced of the motive, Spooner's investigation into Lanning's death reveals a trail of secrets and agendas within the USR (Uni …ted States Robotics) corporation and suspicions of murder. Little does he know that his investigation would lead to uncovering a larger threat to humanity. (Read More)
martial arts
gun saugun kataexit woundpunchinggun duelcarnagebullet balletbullet timegun battlegun fushot in the backcombatgunfightslow motion sceneshot in the head …shot in the chestblood splattershootoutpistolmale nuditygunflashbackbloodviolencenudity (See All)
Natasha Binder comes to New Orleans looking for her father, who has gone missing. In doing so, she meets a very hard man called Chance. He helps her find out that her father was killed by an organisation who sell the opportunity to hunt human prey. They are taking advantage of a police strike in New … Orleans. Will the Muscles from Brussels win through? (Read More)
cult filmmartial arts
murder of a police officerbrutalitydeathmurderrevenge
goreshedgun violenceexit woundgun duelsawed off shotgunbullet balletbullet timebloodbathgunshot woundgun battlegun fukaratekung fugunfightpunched in the face …slow motion sceneblood splattershootoutpistolbloodviolence (See All)
The lead character, called 'The Bride,' was a member of the Deadly Viper Assassination Squad, led by her lover 'Bill.' Upon realizing she was pregnant with Bill's child, 'The Bride' decided to escape her life as a killer. She fled to Texas, met a young man, who, on the day of their wedding rehearsal … was gunned down by an angry and jealous Bill (with the assistance of the Deadly Viper Assassination Squad). Four years later, 'The Bride' wakes from a coma, and discovers her baby is gone. She, then, decides to seek revenge upon the five people who destroyed her life and killed her baby. The saga of Kill Bill Volume I begins. (Read More)
cult filmmartial artsindependent film
self sacrificebrutalitytorturerapedeathrevengemurder
female protagonist
dark heroinegun duelbullet balletshot multiple timesbullet timeeye patcheye gouginggun battlefemale killerhateevil manmini skirtpainsevered headmassacre …decapitationkung fucombatgunfightslow motion sceneblood splattershootoutpistolgunbloodsexviolenceflashback (See All)
Lula's psychopathic mother goes crazy at the thought of Lula being with Sailor, who just got free from jail. Ignoring Sailor's probation, they set out for California. However their mother hires a killer to hunt down Sailor. Unaware of this, the two enjoy their journey and themselves being together.. …. until they witness a young woman dying after a car accident - a bad omen. (Read More)
cult filmindependent film
sexual perversionsexual desirerape victimviolent deathperversionsexual attractiondesirehatesensualitymini skirtscreamingshot in the legsevered headshot in the chestblood splatter …nipplesfemale frontal nudityfemale rear nudityfemale nuditymale nudityflashbackviolenceblood (See All)
A young man transporting a car to another state is stalked along the road by a cunning and relentless serial killer who eventually frames the driver for a string of murders. Chased by police and shadowed by the killer, the driver's only help comes from a truck stop waitress.
cult film
murder of a police officersadismbrutalitydeathmurder
exit woundgun duelcarnagemurder of a childslaughtergunshot woundgun battlemassacreshot in the backcombatgunfightslow motion sceneshot in the headshot in the chestblood splatter …shootoutpistolviolencebloodgun (See All)
Mobsters are smuggling guns into Hong Kong. The police orchestrate a raid at a teahouse where an ace detective loses his partner. Meanwhile, the two main gun smugglers are having a war over territory, and a young new gun is enlisted to wipe out informants and overcome barriers to growth. The detecti …ve, acting from inside sources, gets closer to the ring leaders and eventually must work with the inside man directly. (Read More)
cult filmmartial arts
murder of a police officerbrutalitydeath
gun saugun kataexit woundgun duelcarnagebullet balletbullet timebloodbatheye patchgun battlegun fusocial commentaryshot in the stomachevil manshot in the leg …massacreshot in the backcombatgunfightpunched in the faceslow motion sceneshot in the chestblood splattershootoutpistolgunviolenceblood (See All)
Loosely based on serial killer 'Henry Lee Lucas' (qv), the film follows Henry and his roommate Otis who Henry introduces to murdering randomly selected people. The killing spree depicted in the film starts after Otis' sister Becky comes to stay with them. The people they kill are strangers and in on …e particularly gruesome attack, kill all three members of a family during a home invasion. Henry lacks compassion in everything he does and isn't the kind to leave behind witnesses - of any kind. (Read More)
cult filmindependent film
child rapemurder of a childstabbed in the eyeslaughterperversionpsychotronicmutilationrageevil mancontroversysevered headdecapitationlow budget filmshot in the chestblood splatter …female nuditybare breastsgunviolencenudityblood (See All)
In Serbia, the retired porn star Milos is married with his beloved wife Marija and they have a little son, Peter, that is their pride and joy. The family is facing financial difficulties, but out of the blue, Milos is contacted by the porn actress Lejla that offers him a job opportunity in an art fi …lm. Milos is introduced to the director Vukmir that offers a millionaire contract to Milos to act in a film. However, Vukmir neither show the screenplay nor tell the story to Milos. Milos discuss the proposal with Marija and he signs the contract. But sooner he finds that Vukmir and his crew are involved in sick snuff films of pedophilia, necrophilia and torture and there is no way back to him and maybe it is too late to protect his family. (Read More)
independent film
sexual perversionanal rapepanties pulled downsodomyperversionsufferingmutilationsexual abuseevil manpaincontroversydecapitationshot in the chestblood splattererection …leg spreadingmale full frontal nuditynipplesfemale full frontal nudityfemale frontal nuditymale frontal nudityfemale nuditymale nuditymasturbationflashbackgunviolenceblood (See All)
A former rock star, Johnny Boz, is brutally killed during sex, and the case is assigned to detective Nick Curran of the SFPD. During the investigation, Nick meets Catherine Tramell, a crime novelist who was Boz's girlfriend when he died. Catherine proves to be a very clever and manipulative woman, a …nd though Nick is more or less convinced that she murdered Boz, he is unable to find any evidence. Later, when Nilsen, Nick's rival in the police, is killed, Nick suspects of Catherine's involvement in it. He then starts to play a dangerous lust-filled mind game with Catherine to nail her, but as their relationship progresses, the body count rises and contradicting evidences force Nick to start questioning his own suspicions about Catherine's guilt. (Read More)
sexual desirepanties pulled downno pantiesgirl in pantiesblack pantiesperversionfemale killersexual attractiondesirekissing while having sexfemale removes her clothesmini skirtcontroversyscantily clad femalefemale pubic hair …cleavageshot in the headtopless female nuditypantiesleg spreadinglesbian kissnipplesfemale full frontal nudityfemale frontal nuditymale frontal nudityfemale rear nuditymale rear nudityfemale nuditymale nuditybare breastsgunsexviolencebloodnudity (See All)
Hardcore Henry is an action film told from a first person perspective: You remember nothing. Mainly because you've just been brought back from the dead by your wife (Haley Bennett). She tells you that your name is Henry. Five minutes later, you are being shot at, your wife has been kidnapped, and yo …u should probably go get her back. Who's got her? His name's Akan; he's a powerful warlord with an army of mercenaries, and a plan for world domination. You're also in an unfamiliar city of Moscow, and everyone wants you dead. Everyone except for a mysterious British fellow called Jimmy. He may be on your side, but you aren't sure. If you can survive the insanity, and solve the mystery, you might just discover your purpose and the truth behind your identity. Good luck, Henry. You're likely going to need it... (Read More)
martial artsindependent film
self sacrificeexploitationsadisminsanitybrutalitytorturerapemurderdeathrevenge
rape victimspitting bloodsawed off shotgunshot multiple timesbullet timestabbed in the eyeeye gouginggun battlegun fugrindhouseevil manshot in the legsevered headmassacredecapitation …shot in the backcombatgunfightpunched in the faceslow motion sceneshot in the headshot in the chestblood splattershootouttopless female nuditypistolfemale rear nudityfemale nuditybare breastsflashbackgunbloodviolence (See All)
Open-minded architect Paul Kersey returns to New York City from vacationing with his wife, feeling on top of the world. At the office, his cynical coworker gives him the welcome-back with a warning on the rising crime rate. But Paul, a bleeding-heart liberal, thinks of crime as being caused by pover …ty. However his coworker's ranting proves to be more than true when Paul's wife is killed and his daughter is raped in his own apartment. The police have no reliable leads and his overly sensitive son-in-law only exacerbates Paul's feeling of hopelessness. He is now facing the reality that the police can't be everywhere at once. Out of sympathy his boss gives him an assignment in sunny Arizona where Paul gets a taste of the Old West ideals. He returns to New York with a compromised view on muggers... (Read More)
cult film
self justicepolice
rape victimpanties pulled downgirl in pantieswhite pantiesvigilantismsexual assaultgunshot woundshot in the stomachragemini skirtscantily clad femalecleavageshot in the backgunfightpunched in the face …shot in the chestblood splattershootoutpistolpantiesfemale frontal nudityfemale nudityviolencegunblood (See All)
The church has long known that vampires exist. However, it is discovered that a group of vampires are searching for a powerful doom for mankind. The Vatican then secretly enlists a team of vampire-hunters, led by Jack Crow, to hunt down and destroy the vampires before they find the crucifix.
cult filmmartial arts
murder of a police officervengeancetorturerevengedeathmurder
no pantiessawed off shotgunslaughtermutilationmini skirtpainshot in the legscantily clad femalesevered headmassacrecleavagedecapitationshot in the backpunched in the faceslow motion scene …shot in the chestblood splattertopless female nuditypistolfemale frontal nudityfemale rear nudityfemale nuditybare breastsnudityviolenceblood (See All)
"Broken Arrow" is the term used to describe a nuclear device that has been lost. In this movie, two nuclear missiles are stolen by rogue US pilot Deakins, but hot on his trail is his co-pilot Hale and a Park Ranger, Terry. The action takes place in Utah's canyon country; a high stakes game of cat an …d mouse. (Read More)
martial arts
gun saugun katapunchinggun duelcarnagefallingbullet balletbullet timegun battlegun fuscreamingshot in the legcombatgunfightpunched in the face …slow motion sceneshot in the chestblood splattershootoutpistolgunbloodviolence (See All)
With this sequel to his prize-winning independent previous film, "El Mariachi," director Robert Rodriquez joins the ranks of Sam Peckinpah and John Woo as a master of slick, glamorized ultra-violence. We pick up the story as a continuation of "El Mariachi," where an itinerant musician, looking for w …ork, gets mistaken for a hitman and thereby entangled in a web of love, corruption, and death. This time, he is out to avenge the murder of his lover and the maiming of his fretting hand, which occurred at the end of the earlier movie. However, the plot is recapitulated, and again, a case of mistaken identity leads to a very high body count, involvement with a beautiful woman who works for the local drug lord, and finally, the inevitable face-to-face confrontation and bloody showdown. (Read More)
cult filmmartial arts
black pantiesspitting bloodsawed off shotgundouble barreled shotgunvigilantismgun battlegun fukissing while having sexevil manshot in the legscantily clad femalemassacrecleavageshot in the backgunfight …shot in the headshot in the chestblood splattershootoutpistolpantiesfemale frontal nudityfemale rear nudityfemale nuditygunbloodviolenceflashback (See All)
When the hit-man Chev Chelios is poisoned by the criminal Verona, his friend and doctor Miles advises him that he must keep his adrenaline levels elevated to stay alive. Chev meets his girlfriend Eve and together they look for Verona to kill him.
cult film
sexual desiregirl in pantieswhite pantiesbody partcopulationcoitussexual attractionhandgunscantily clad femalecleavageshot in the headshot in the chestblood splattershootoutpistol …pantieserectionleg spreadinglesbian kissfemale frontal nudityfemale nuditymale nuditybare breastsblood (See All)
One summer at Camp Crystal Lake, a group of young counselors begin to get ready to lead campers. Unfortunately for the former, someone isn't happy about what's going on in the camp and enjoys playing kill the counselor. As bodies fall to the ground in the camp, no one is safe.
cult filmindependent film
sexual perversiongirl in pantiesfemale victimbeheadingslaughterperversionpsychotronicgrindhousedesirekissing while having sexscreamingmassacredecapitationlow budget filmslow motion scene …blood splatterpantiesnipplesfemale rear nuditymale rear nudityfemale nuditymale nuditybare breastssexviolence (See All)
A poetic guitarist Eric Draven is brought back to life by a crow a year after he and his fiancee are murdered. The crow guides him through the land of the living, and leads him to his killers: knife thrower Tin-tin, drugetic Funboy, car buff T-Bird, and the unsophisticated Skank. One by one, Eric gi …ves these thugs a taste of their own medicine. However their leader Top-Dollar, a world-class crime lord who will dispatch his enemies with a Japanese sword and joke about it later, will soon learn the legend of the crow and the secret to the vigilante's invincibility. (Read More)
cult filmmartial arts
slow motion shootoutgun saugun kataexit woundgun duelbullet balleteye gougingslaughtergun battlegun fushot in the backkung fucombatgunfightslow motion scene …shot in the headshot in the chestblood splattershootoutfemale rear nudityfemale nudityflashbackgunviolenceblood (See All)
Corky, a lesbian ex con hired to work in an apartment as a plumber, meets neighbors Caesar, who launders money for the Mafia, and his girlfriend Violet. The two women have a love affair and decide to steal $2,000,000 that Caesar has in custody before he gives them back to Mafia boss Gino Marzone. Ca …esar is set up by the two scheming women as a scapegoat but things start to go wrong when he reacts in an unexpected way... (Read More)
cult filmindependent film
lustfemale protagonistpolice
girl in pantiesshot multiple timesshot in the stomachrageevil manshot in the legscantily clad femalecleavagepunched in the faceshot in the chestblood splatterpantiesleg spreadinglesbian kissfemale frontal nudity …female nuditygunbloodviolenceflashback (See All)
Three backpackers travel into the Australian Outback, only to find themselves stranded at Wolf Creek crater. Once there they are encountered by a bushman, Mick Taylor, who offers them a ride back to his place. Little do the three know that their adventure into the Outback, would be a complete nightm …are after the backpackers find a way to escape. (Read More)
cult filmindependent film
female victimbloodbathsexual assaultslaughterperversionbroken glassgunshot woundsufferingcaptivemutilationevil manpaincontroversymassacreshot in the back …low budget filmslow motion sceneshot in the headshot in the chestblood splattergunviolenceblood (See All)
For the last 8 years the brothers have been living with their father on a sheep farm deep in isolated Ireland. One day their uncle tells them that they have been framed for the murder of a Bostonian Catholic priest. The boys must return to Boston to not only clear their names but find the men who fr …amed them. (Read More)
cult film
gun dueldouble barreled shotgunbullet balletshot multiple timesbullet timegun battleshot in the stomachheroinhandgunshot in the legshot in the backgunfightslow motion sceneshot in the headshot in the chest …blood splattershootoutpistolmale frontal nuditymale rear nuditygunbloodflashbackviolence (See All)
In 1993, the Search for Extra Terrestrial Intelligence Project receives a transmission detailing an alien DNA structure, along with instructions on how to splice it with human DNA. The result is Sil, a sensual but deadly creature who can change from a beautiful woman to an armour-plated killing mach …ine in the blink of an eye. Government agent Xavier Fitch assembles a team of scientists and mercenaries to locate and destroy Sil before she manages to find a mate and breed. (Read More)
sexual desirerape victimsexual assaultbroken glasssexual attractiondesirekissing while having sexsensualityscreamingdecapitationpantiesleg spreadingfemale full frontal nudityfemale frontal nudityfemale rear nudity …male rear nudityfemale nuditymale nuditybloodsex (See All)
Thought to be killed by the sole survivor of the last massacre at Camp Crystal Lake, Jason Voorhees kills his way back to the camp to once again murder its inhabitants. This time, has Jason met his match in the little boy Tommy Jarvis?
cult film
slaughtergrindhousesexual attractionmutilationrageevil mansevered headmassacredecapitationlow budget filmblood splatterpantiesfemale frontal nudityfemale rear nuditymale rear nudity …female nuditymale nuditybare breastsmasturbationsexviolenceblood (See All)
Dalton is the Cooler in bars; He backs up and directs the bouncers. He takes a job in a Road House that has gotten far too rough. His attempts to clean things up put him in conflict with Brad Wesley, the town bully and rich person. Things heat up.
cult filmmartial arts
no pantiesgirl in pantieswhite pantiesfemale removes her dresscopulationkissing while having sexfemale removes her clothesmini skirtkaratescantily clad femalecleavagekung fublood splatterpistolpanties …leg spreadingfemale frontal nudityfemale rear nuditymale rear nudityfemale nuditymale nuditybloodviolencegun (See All)
Jean Claude Van Damme plays a dual role as Alex and Chad, twins separated at the death of their parents. Chad is raised by a family retainer in Paris, Alex becomes a petty crook in Hong Kong. Seeing a picture of Alex, Chad rejoins him and convinces him that his rival in Hong Kong is also the man who … killed their parents. Alex is suspicious of Chad, especially when it comes to his girlfriend. (Read More)
cult filmmartial artsindependent film
exit woundloss of parentscarnagebullet balletgun battlekissing while having sexevil mankarateshot in the legshot in the backcombatgunfightpunched in the faceslow motion sceneshot in the chest …blood splattershootoutpistolfemale frontal nuditygunbloodviolence (See All)
3 backpackers are in Amsterdam where they get locked out of their youth hostel. They are invited into a man's house where he tells them of a hostel somewhere in eastern Europe where the women are all incredibly hot and have a taste for American men. When they get there, everything is too good to be …true - the hostel is "to die for" (Read More)
cult film
sexual desirescalpeleye gougingmutilationscreamingpaincontroversysevered headshot in the backshot in the chestblood splatterpistolpantiesfemale frontal nudityfemale rear nudity …male rear nudityfemale nudityviolenceblood (See All)
The next installment in the blockbuster franchise, UNDERWORLD: BLOOD WARS follows Vampire death dealer, Selene (Kate Beckinsale) as she fends off brutal attacks from both the Lycan clan and the Vampire faction that betrayed her. With her only allies, David (Theo James) and his father Thomas (Charles … Dance), she must stop the eternal war between Lycans and Vampires, even if it means she has to make the ultimate sacrifice. (Read More)
martial arts
self sacrificebrutalityseductiontorturemurderdeath
female protagonist
dark heroinebullet timestabbed in the eyegun fufemale killerhandgunevil manshot in the legsevered headmassacredecapitationshot in the backcombatgunfightpunched in the face …slow motion sceneshot in the headshot in the chestblood splattershootoutpistolbloodviolenceflashback (See All)
A young girl (Baby Doll) is locked away in a mental asylum by her abusive stepfather where she will undergo a lobotomy in five days' time. Faced with unimaginable odds, she retreats to a fantastical world in her imagination where she and four other female inmates at the asylum, plot to escape the fa …cility. The lines between reality and fantasy blur as Baby Doll and her four companions, as well as a mysterious guide, fight to retrieve the five items they need that will allow them to break free from their captors before it's too late... (Read More)
cult filmmartial arts
self sacrificemurderdeath
pimpfemale protagonistpolice
dark heroinesexual predatorbullet timestabbed in the eyesexploitationsexual abuseevil manmini skirtshot in the legsevered headdecapitationshot in the backcombatpunched in the faceslow motion scene …shot in the headshot in the chestblood splattershootoutpistolflashbackviolencebloodgun (See All)
Seventeen year-old Kim is the pride and joy of her father Bryan Mills. Bryan is a retired agent who left the Central Intelligence Agency to be near Kim in California. Kim lives with her mother Lenore and her wealthy stepfather Stuart. Kim manages to convince her reluctant father to allow her to trav …el to Paris with her friend Amanda. When the girls arrive in Paris they share a cab with a stranger named Peter, and Amanda lets it slip that they are alone in Paris. Using this information an Albanian gang of human traffickers kidnaps the girls. Kim barely has time to call her father and give him information. Her father gets to speak briefly to one of the kidnappers and he promises to kill the kidnappers if they do not let his daughter go free. The kidnapper wishes him "good luck," so Bryan Mills travels to Paris to search for his daughter and her friend. (Read More)
cult filmmartial arts
drug addictiontorturemurderdeathrevenge
girl in pantieswhite pantiesforced prostitutionwhite slaveryvigilantismshot multiple timessexual assaultslaughtersexploitationshot in the stomachscreamingshot in the legscantily clad femalecleavageshot in the back …punched in the faceshot in the chestblood splattershootoutpantiesflashbackbloodgunviolence (See All)
After a drug-op gone bad, Joey Gazelle is put in charge of disposing the gun that shot a dirty cop. But things go wrong for Joey after a neighbor kid stole the gun and used it to shoot his abusive father. Now Joey has to find that kid and the gun before the police and the mob do.
cult film
girl in pantieswhite pantiesshot multiple timesshot in the stomachkissing while having sexshot in the legshot in the backgunfightslow motion sceneshot in the headshot in the chestblood splattershootoutpistolpanties …female frontal nudityfemale rear nuditybloodviolencegun (See All)
Lake Victoria's annual Spring party by 50,000 young revelers is about to turn into a feeding frenzy with prehistoric hunger-pains. With knee-trembler's above the waves and tremors below, released from their dormant sleep, thousands upon thousands of flesh-eating nippers are released into the lake wi …th whetted appetites and razor-sharp teeth. With a motley crew of strangers thrown together to defend these shores, it is now up to them to prevent the largest eat-out in human, and piranha, history. (Read More)
self sacrificeexploitationdeath
no pantieswhite pantiesfemale removes her dresscopulationeye gougingslaughtercoitusfemale removes her clothesmini skirtscantily clad femalesevered headmassacrecleavagedecapitationblood splatter …topless female nuditypistolpantiesleg spreadinglesbian kissfemale full frontal nudityfemale frontal nudityfemale rear nuditymale rear nudityfemale nuditymale nuditybare breastsnudityviolenceblood (See All)
In a world ravaged by a virus infection, turning its victims into the Undead, Alice (Jovovich), continues on her journey to find survivors and lead them to safety. Her deadly battle with the Umbrella Corporation reaches new heights, but Alice gets some unexpected help from an old friend. A new lead …that promises a safe haven from the Undead takes them to Los Angeles, but when they arrive the city is overrun by thousands of Undead - and Alice and her comrades are about to step into a deadly trap. (Read More)
martial arts
female protagonist
exit woundgun duelsawed off shotgundouble barreled shotgunbullet balletbullet timegun battlegun fusocial commentaryevil manshot in the legsevered headmassacredecapitationshot in the back …combatpunched in the faceslow motion sceneshot in the headshot in the chestblood splattershootoutpistolflashbackviolencegunblood (See All)
An elite team of soldiers has been used against terrorists where they use astounding physical capabilities to overcome them. Victoria, a reporter, follows them and discovers a part of their secret. When one of the team kills her cameraman she tries to escape. Luc, one of the soldiers begins to have …flashbacks and turns sides and helps her as the remainder of the team follows to protect their secrets. (Read More)
b moviecult filmmartial artsindependent film
gun duelbullet balleteye gouginggun battlegun fuevil mankaratemassacrekung fucombatgunfightslow motion sceneblood splattershootoutpistol …male rear nuditymale nuditynudityviolencegunbloodflashback (See All)
Tells the story of Evey Hammond and her unlikely but instrumental part in bringing down the fascist government that has taken control of a futuristic Great Britain. Saved from a life-and-death situation by a man in a Guy Fawkes mask who calls himself V, she learns a general summary of V's past and, …after a time, decides to help him bring down those who committed the atrocities that led to Britain being in the shape that it is in. (Read More)
cult filmmartial arts
murder of a police officerbrutalitytorturelesbianismrapemurderdeathrevenge
rape victimno pantieswhite pantiesexit woundgun duelshot multiple timesbullet timechildhood memorybloodbathgunshot woundsocial commentaryscantily clad femalecleavagecombatgunfight …punched in the faceslow motion sceneblood splatterpantieslesbian kissfemale rear nuditymale rear nudityfemale nuditymale nuditygunbloodviolenceflashback (See All)
Picking up immediately after the events in Resident Evil: Retribution, Alice (Milla Jovovich) is the only survivor of what was meant to be humanity's final stand against the undead. Now, she must return to where the nightmare began - The Hive in Raccoon City, where the Umbrella Corporation is gather …ing its forces for a final strike against the only remaining survivors of the apocalypse. (Read More)
martial arts
self sacrificeinsanitybrutalitymurderdeathrevenge
female protagonist
sawed off shotgunbullet timestabbed in the eyebroken glassgun fusocial commentaryevil manshot in the legsevered headmassacredecapitationshot in the backkung fucombatgunfight …punched in the faceslow motion sceneshot in the headshot in the chestblood splattershootoutpistolflashbackbloodviolence (See All)
When the Chase family moves to an isolated house in the middle of nowhere in Detroit, Arkin is hired to fix the windows and the doors. Later he meets his daughter and his wife that has a debt with dangerous sharks and needs money, but his week payment is not enough to pay her debts. Arkin plots to h …eist the safe of Michael Chase during the night to raise the necessary money. However, when he arrives in the house, he finds that a sadistic criminal has imprisoned the family and planted traps everywhere. Arkin seeks a way out of the deadly house to save his life. (Read More)
independent film
murder of a police officercrueltyexploitationsadisminsanitybrutalitytorturedeathmurder
violent deathcarnagebloodbathstabbed in the eyeslaughterperversionpsychotronicmutilationevil manscreamingscantily clad femalepunched in the faceslow motion sceneblood splatterpistol …lesbian kissnipplesfemale frontal nudityfemale nuditybare breastsbloodflashbackviolence (See All)
Five years after killing the goalie hockey-masked killer Jason Voorhees, Tommy Jarvis has grown up in various mental hospitals unable to get over the nightmares about Jason's return. When Tommy is sent to a rural halfway house in New Jersey for mentally disturbed teenagers, a series of grisly murder …s begin anew as another hockey-masked killer begins killing off all people at and around the residence. Has Jason returned from the dead to re-start his killing spree? Has Tommy decided to take over the reign of Jason, or has someone else? (Read More)
cult filmindependent film
female victimstabbed in the eyeeye gougingslaughterpsychotronicgrindhousemutilationkissing while having sexevil manmassacredecapitationlow budget filmblood splatterpantiesfemale frontal nudity …female nuditybare breastssexbloodviolence (See All)


text:
11 Houses For Sale In Nova Scotia That Prove It's The Perfect Place For A Cheap Mini-Mansion
Many of these homes cost less than $300,000! 😵
If the Canadian housing market is getting you down, how about a move to Canada's Ocean Playground? These houses for sale in Nova Scotia prove that it's the perfect place to get a mini-mansion, even if you're on a budget!
Whether you've been dreaming of a multi-bedroom home, a giant yard or panoramic waterfront views, this province has a bunch of houses that cost less than $500,000.
In fact, you can even find some real gems for less than $250,000.
The best part is that Nova Scotia has been looking for newcomers since 2021, and it's promising glorious coastlines, endless beaches, bustling urban cities and affordable housing to anybody who moves there.
Sounds pretty nice, right?
Before you call your mom and pack your bags, here's a look at what you can get across the region right now.
Paula Leslie | Engel & Völkers Nova Scotia Annapolis
Price: $289,000
Address: Middleton, NS
Description: This affordable and adorable home in Middleton comes with four bedrooms and two bathrooms, as well as an entirely separate living space for your family or besties.
It needs updating a little bit in some rooms, but that's hardly surprising when it's got a price tag of less than $300,000.
Cam Samson | Engel & Völkers Halifax
Price: $249,000
Address: Boudreauville, NS
Description: Yes, really! This five-bedroom home comes with a panoramic view of the harbour in Boudreauville, is move-in ready as it is and costs just under $250,000.
It's also within walking distance of a marina and has a giant balcony for you to sit out and enjoy sunsets, whale-spotting and more. What's not to love?
Church Point
Sheila Deveau | Engel & Völkers Nova Scotia Chester
Price: $289,000
Address: Church Point, NS
Description: Described as a "classic with a charming facade," this big home comes with three bedrooms and two bathrooms, as well as a large kitchen/living/dining area.
It's also got a sea-facing deck with extraordinary views of St. Mary's Bay, so you'll be able to enjoy stunning sunsets every night.
"The land extends back to the shore, so you will never lose your view," the listing notes. Lovely.
Kristen Crocker | Engel & Völkers Nova Scotia Annapolis
Price: $349,000
Address: Westport, NS
Description: Although this impressive property needs a little updating, it's brimming with potential and would be a great project for anybody with a little vision.
The listing says this 1852 home is "one of the most historic homes in Digby County," and it's oozing with character.
In addition to three bedrooms and two bathrooms, it's got a winding staircase, incredible dramatic windows and a private greenhouse.
Nearby, you'll be able to "observe different species of migratory whales from the shoreline, start a collection of sea glass from the surrounding beaches or take a scenic walk along the family favorite, Pond Cove Beach."
Mahone Bay
Joe Baum | Engel & Völkers Nova Scotia Lunenburg
Price: $465,000
Address: Mahone Bay, NS
Description: For less than $500,000, this historic home in Nova Scotia could be all yours. It comes with five bedrooms and two bathrooms, in addition to "manicured grounds" and a full basement.
It doesn't need much work either, so you're all set if it's right at the top of your budget!
Sheila Deveau | Engel & Völkers Nova Scotia Chester
Price: $475,000
Address: Weymouth, NS
Description: This gigantic property has 10 bedrooms and 10 bathrooms, so there's enough space for all of your besties to move in.
Admittedly, it needs a lot of renovation and it is a little dated inside. That said, you could split the cost with nine of your friends and make this huge mansion your home for just $47,500 each.
If that wasn't enough to convince you, the views outside are stellar, too!
Meisners Section
Jeff Everett | Engel & Völkers Nova Scotia Lunenburg
Price: $299,000
Address: Meisners Section, NS
Description: This incredible three-bedroom property in Meisners Section will let you live out your holiday home dreams 24/7 for less than $300,000.
Say goodbye to skyscrapers and neighbours and say hello to nature and natural vistas, as this property offers "the best of rural living in Nova Scotia."
It's situated on over six acres and comes with two spring-fed ponds. It's also just across the road from the "pristine waters" of the Lahave River, and you can enjoy scenic views from every single bedroom.
Central Argyle
Eva Stara Krebser | Engel & Völkers Nova Scotia Chester
Price: $299,900
Address: Central Argyle, NS
Description: At just under $300,000, you get so much home for your money here.
This property is situated on over four acres of oceanfront property, with 220 feet of frontage and a "deep buffer of trees making the setting very private and peaceful."
You'll get sunset views of the estuary, which is where the Argyle River meets the Atlantic Ocean, as well as a traditional yet modern property. Are you in love yet?
Kristen Crocker | Engel & Völkers Nova Scotia Annapolis
Price: $295,000
Address: Westport, NS
Description: This huge home has more space than most people will ever need, with four giant bedrooms and two sizable bathrooms.
It's currently used as a seasonal guest house, but could easily be transformed into a dream home by somebody who can see the potential.
Even better, it comes fully furnished, so you could save a few bucks on furniture (although those sofas may not quite be to your taste!).
Michael Wilson | Engel & Völkers Nova Scotia Lunenburg
Price: $99,000
Address: Blockhouse, NS
Description: Yup, you read that right. This home is asking $99,000 and has three bedrooms and two bathrooms.
Unsurprisingly, it needs extensive renovation, but it's in a wonderful location and could be perfect for somebody looking for a challenge.
According to the listing, it is one of the oldest homes in Blockhouse, so this vintage property will need a little TLC.
Marriotts Cove
Tim Harris | Engel & Völkers Nova Scotia Chester
Price: $450,000
Address: Marriotts Cove, NS
Description: OK — this home is not cheap and it does need a bit of work, so it would be a project for somebody.
However, it's an impressive and sizable blank slate for a new owner that could be renovated into the house of your dreams.
As for the area, it's located in the seaside community of Marriotts Cove, where nature lovers will find walking trails galore.
Packed your bags yet?
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subset: commoncrawl


text:
By Mohammed Yabagi.
For Maureen Adah, a sex worker in Lokoja, the Kogi State Capital, the curent currency crunch is a bad business for her and her colleagues, as they have become frustrated and can't wait to see it end.
The same with Mariah Andrew and one of their colleagues who simply identified herself as Hannah.
The visibly angry Hannah recalled how a man spent a night with at a hotel near Phase II Area of Lokoja, only to tell her the next morning that he had no cash on him and that he would do transfer.
In her words, "Could you believe that the transfer turned to be fake? It was unfortunate for me not to have taken my ATM ATM Card with me that day. It was after I got back that I went to the POS operator only to be told there was insufficient funds in my account.
"It was so frustrating, but knowing the man was only a guest at the hotel, there was no way I could have gone back to look for him. That was why how the man went away with my sweat. But in the end, if not for the unfortunate policy, I am sure he would not have escaped with my money."
On her part, Mariah said she had been duped twice by men as a result of the policy. "The first was a 'short-term.' The man just whipped out his phone and pretended to transfer the money. He said he could not withdraw money from the ATM points and that there was network problem, but showed me his phone and said he had made the transfer, but till today, I have not seen my money. Any day I see the man, I am going to collect my money.
"The second one was the issue of fake transfer. I even got an alert for that one, not knowing it was a scam alert. The man even used my place for the work. We were together from seven O'Clock in the evening, until 12 midnight and after 'three rounds,' only for him to do that to me."
Others who spoke with our reporter said they no longer accept transfer and have made up their minds that any man that requires their services would have to get physical cash.
Others stated that a few of their colleagues have down tools after the harrowing experiences they have been through in the hands of unscrupulous customers until the cash situation in the country stabilizes.
Monica James sums it more succinctly by saying, "For now it is money for hand and back for ground. We have all learnt our lessons and we no longer want to allow any man to defraud us in the name of 'no cash'."


text:
Become a Peer Coach
Date(s) - 01/21/2021 - 03/31/2021
KVCC is looking for Peer Coaches!
KVCC Student Success Team is currently exploring the concept of peer coaches. Please fill out the form below to indicate interest or ask any questions you might have. We anticipate that this role would include training and no more than 1-2 hours per week of your time.
Peer Coach Interest Form
The KVCC Student Success Team is asking you these questions to get to know you better.


text:
Turning into a millionaire with Sky Vegas feels surreal2017-04-13 12:12:43
Scott Clydesdale, a 40-year-old builder from Durham, thought little of it when he put down £1 in the Sky Vegas casino and with it received a £20 Sky Vegas bonus. He began playing the slot game Toy Factory. What happened then, after 22 minutes and 36 seconds, was unbelievable: Scott turned his initial stake of £1 into £1.6 million.
Scott's Disbelief
Sky Vegas presented Scott with a cheque over £1.6 million at the Redworth Hall Hotel in Durham. At the occasion, Scott said: 'I've never had a holiday before – I've not got a passport.' The Durham man that is due to get married this year plans to go to Florida for his first holiday.
'I'm a bit cynical and never thought that a real person won the big jackpots. Obviously now I know it's real,' recounted Scott his thoughts as he won big after 125 spins on Sky Vegas.
Aside from fulfilling his dream of a holiday, the County Durham builder will also be able to follow his biggest hobby, the darts, more closely. As a big fan of Peter Wright, Scott will be able to attend events more often and maybe even place a bet or two on Wright.
The darts Premier League continues through to May 2017 with many opportunities for Scott to enjoy his Sky Vegas winnings.
Sky Vegas congratulates Scott on his huge win
'Massive congratulations to Scott on picking up the £1.6 million jackpot and joining an exclusive club of Sky Vegas millionaires,' commented Sarah Hackett, spokesperson for Sky Vegas.
While each and every minutes £5,000 are won, and on average £250,000 every hour, millionaires aren't made every day at Sky Vegas.
Nevertheless, Sarah Hackett feels that their new selection of games helps: 'We have new games to play and jackpots in excess of a million waiting to be won as we speak, so it's only a matter of time until we change somebody else's life for good,' commented the spokesperson at the occasion in Durham.
Winning the Sky Vegas jackpot felt surreal to Scott
A video published by The Sun shows Scott Clydesdale talking to a journalist. The original phone conversation that Scott had with Sky Vegas support staff is played. Scott asks whether the jackpot has gone through, and notes that he is 'just a bit unsure.' The staff member reassures Scott and congratulates him. In disbelief, Scott checks again: '£1.6 million, is it?'
Scott remembers that he could hear staff members in the background whispering that the jackpot had been won. It was surreal. He expected that such a huge win would make him go to the pub to celebrate, instead, Scott was too excited to eat and found it hard to sleep.
As one would do, he told his partner Sandra first.
Largest Jackpot Ever?
While Scott certainly got lucky, the luckiest slot player ever was a software engineer from Los Angeles. In March 2003, the 25-year-old American turned $100 into nearly $40 million playing Megabucks. The lucky winner came to Excalibur Casino to pass the time while waiting on a basketball game he had tickets for. Rather sensibly, the winner decided to take a yearly payout of $1.5 million a year over the next 25 years.
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text:
Watch Cleopatrick share the video for 'Family Van'
Their debut album 'Bummer' arrives next month.
With their debut album 'Bummer' landing on 4th June, Cleopatrick are sharing the video for their latest single 'Family Van'.
Speaking about the video, frontman Luke explains, "Vannah Montana is Ian's mini-van we've spent the last three years touring North America in. This video was conceptualized by us, and shot and directed by Boy Wonder. We filmed it in the parking lot of our rundown hometown mall in the middle of the night. We didn't have a permit to film there, and almost didn't finish the video because someone called the cops on us after seeing the strobe lights from the road - but in a classic small town twist of fate, the officer that rolled up to kick us out happened to have played hockey as a child with one of our friends in the video, so he let us finish filming. This was our last take."
Continuing about their forthcoming debut, the pair add, "This album is about growing up. It's about being alone. It's about getting ripped off. It's about finding a voice you didn't know you had. It's about holding on to the innocence and purity in your world. It's about trying to be a man. It's about getting pushed around. It's a rock album made by some kids in a basement with no old dudes around. It's bass and drums and lyrics — carefully designed to catalyze moshpits and cauterize doubters. We worked nonstop to find this sound. Hunching over laptops and Les Pauls alike. Running full tracks through shoe-bruised fuzz pedals and cigarette-box speakers while our best friends played Skate 3 in the next room. We were on a mission; searching for the honesty, power, and aggression that's missing from today's guitar music. We pushed with everything we had. breaking boundaries, spinning knobs, and blowing speakers until we found it, and we did find it. We made some real shit. We made a rock album for kids like us — kids that understand the primal-cry of an electric guitars fuzz-fucked-feedback, just as well as they comprehend the euphoria stored within a 21st century sub-bass chorus drop.coming to you with love, from nowhere special — this is our debut LP."
Watch the video for 'Family Van' below.
Read More
Cleopatrick announce new EP 'Doom'
They've also shared the video for their latest single 'OK'.
Pretty Sick drop new track 'Heaven'
It's the third preview of debut album 'Makes Me Sick Makes Me Smile', due this month.
Wednesday share giant new eight-minute song 'Bull Believer'
It comes alongside the news that they've signed to Dead Oceans.
Paramore are teasing their return on social media
The trio's last album came in 2017 with 'After Laughter'.


text:
Article Text
Objectives Despite recognition of clinical deterioration and medication-related harm as patient safety risks, the frequency of medication-related Rapid Response System activations is undefined. We aimed to estimate the incidence and preventability of medication-related Medical Emergency Team (MET) activations and describe the associated adverse medication events.
Methods A case review study of consecutive MET activations at two acute, academic teaching hospitals in Melbourne, Australia with mature Rapid Response Systems was conducted. All MET activations during a 3-week study period were assessed for a medication cause including identification of the contributing adverse medication event and its preventability, using validated tools and recognised classification systems.
Results There were 9439 admissions and 628 MET activations during the study period. Of these, 146 (23.2%) MET activations were medication related: an incidence of 15.5 medication-related MET activation per 1000 admissions. Medication-related MET activations occurred a median of 46.6 hours earlier (IQR 22–165) in an admission than non-medication-related activations (p=0.001). Furthermore, this group also had more repeat MET activations during their admission (p=0.021, OR=1.68, 95% CI 1.09 to 2.59). A total of 92 of 146 (63%) medication-related MET activations were potentially preventable. Tachycardia due to omission of beta-blocking agents (10.9%, n=10 of 92) and hypotension due to cumulative toxicity (9.8%, n=9 of 92) or inappropriate use (10.9%, n=10 of 92) of antihypertensives were the most common adverse medication events leading to potentially preventable medication-related MET activations.
Conclusions Medications contributed to almost a quarter of MET activations, often early in a patient's admission. One in seven MET activations were due to potentially preventable adverse medication events. The most common of these were omission of beta-blockers and clinically inappropriate antihypertensive use. Strategies to prevent these events would increase patient safety and reduce burden on the MET.
- Patient safety
- Adverse events, epidemiology and detection
- Hospital medicine
- Medical emergency team
- Medication safety
Data availability statement
No data are available. Not applicable.
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- Patient safety
- Adverse events, epidemiology and detection
- Hospital medicine
- Medical emergency team
- Medication safety
Medications have been shown to contribute to clinical deterioration of patients in hospital; however, the incidence and preventability of medication-related Medical Emergency Team activations have not been quantified.
Almost a quarter of Medical Emergency Team activations were medication related and more than half of these were preventable.
Omission and inappropriate use of cardiovascular medications were the most common causes of potentially preventable medication-related Medical Emergency Team activations.
Prevention and increased recognition of medication-related Medical Emergency Team activations, particularly early in a patient's hospital stay, present opportunities to improve patient safety and relieve pressure on the Medical Emergency Team.
Intervention strategies to prevent the most common medication-related Medical Emergency Team activations should be designed and tested.
Patient safety is a global health priority.1 Clinical deterioration and medication-related harm are recognised risks to patient safety.2–4 Understanding the nature, aetiology and potential preventability of patient harms is necessary to design solutions that increase patient safety as well as reduce the burden on healthcare providers and systems.
Medical Emergency Teams (METs) respond to episodes of clinical deterioration detected by the Rapid Response System (RRS) to stabilise and triage patients.5 METs have been demonstrated to reduce in-hospital cardiac arrest and mortality.6–9 Despite this, patients who require MET activation have an advanced degree of deterioration and an increased risk of dying in hospital.10 Thus, strategies that identify potential for deterioration prior to MET activation are desirable.11
Harm resulting from adverse medication events may contribute to up to one-third of clinical deterioration in acute hospitals.12 The most accurate estimate to date of 33% arises from a large (n=830) multicentre case review study.13 This study used a broad definition of clinical deterioration, likely reflective of local contemporaneous practice, which included 115 MET activations not requiring intensive care unit (ICU) transfer combined with a much larger number of patients requiring unplanned admission to the ICU.13 Hence, it provided an incidence of medication-related clinical deterioration but not specifically MET activations. The contribution of medications to clinical deterioration leading to MET activation is less defined.12 Reports of medication-related MET activation rates have varied more than 10-fold, and have been limited to single-centre studies.12
Many adverse medication events, particularly errors, are considered highly preventable.14–16 However, the preventability of medication-related MET activations is not known.12 A small observational study of surgical Rapid Response Team activations assessed almost all activations due to medication errors as preventable.17 These findings are limited by the small, selective sample and a focus only on errors. Marquet et al 16 found a similarly high proportion of preventable errors contributed to clinical deterioration. They did not assess adverse medication reactions for preventability. The interpretation of these findings is limited by the risk of classification error with retrospective review and the potential that some adverse medication reactions are preventable.18 19 Development of strategies to prevent medication-related MET activations requires more generalisable data from larger cohorts of patients requiring MET activation.
The aim of this study was to provide a more robust estimate of the incidence of medication-related MET activations. Further, this study aimed to determine the preventability of these activations and describe the medications and adverse medication events leading to medication-related MET activations.
Study design
This was an observational cohort study involving retrospective case review of a prospectively identified sample of consecutive MET activations from two tertiary hospitals.
Study setting
The study sites were the acute hospitals of two academic health services in Melbourne, Australia. Both hospitals had approximately 400 beds and offered a full range of medical, surgical and psychiatric services as well as tertiary and quaternary referral services including solid organ and bone marrow transplantation. One hospital had no electronic medical records at point of care and one had manual electronic documentation of nursing observations and medication prescribing and administration without decision support. At both hospitals, records were scanned at the end of care episodes to provide an electronic history.
Clinical pharmacy and medication management services at both hospitals were delivered according to national standards and were considered practice leading.20 Clinical pharmacists achieved medication reconciliation rates within 24 hours of admission exceeding 80%, charted admission medications for some medical teams, provided daily inpatient clinical reviews and were integrated into multidisciplinary team rounds. Both hospitals had multidisciplinary medication safety teams and practices that met national accreditation standards.21 Routine practices included barcode scanning for dispensed patient medications, use of smart pump technology with drug libraries for all infusion administration and medication incident reporting, investigation and targeted improvement initiatives.
Both study sites had very similar, mature two-tier RRSs with mandatory activation against specified criteria (online supplemental file 1).22–25 No automated monitoring or early warning systems were in place. Any staff member could activate the RRS, for an inpatient in any location in the hospital, 24 hours a day, via the hospital switchboard which sent MET personnel pages and overhead address across the hospital. At low levels of physiological abnormality, an 'urgent clinical review' was triggered; this involved a time-critical review by the treating medical and nursing team within 15 minutes. At higher levels of abnormality or concern, there was mandatory activation of the MET for immediate attendance (online supplemental file 1).
Supplemental material
The MET was led by a critical care-trained doctor and senior critical care nurse and also included treating team senior medical and nursing staff. Neither site had pharmacist or other allied health MET members. At both study sites, the MET responded to all patients admitted to the hospital. Admissions included multiday encounters (>24 hours) and same-day encounters (ie, day cases or up to 23-hour stays), but excluded ambulatory outpatients. A separate code blue team responded to arrest calls as well as deterioration of outpatients, staff and visitors. These practices were consistent with national guidelines and standards.21 26 27
Both sites maintained a prospective database where for each activation, MET clinicians captured the triggers, clinical assessment, management and immediate outcome and disposition of patients. The dataset also captured factors potentially contributing to clinical deterioration, including a medication-related flag, repeat activations and logistical data such as attendees and delays.
All consecutive MET activations for adult patients (≥18 years) during the study period were included. MET activations for paediatric patients (<18 years) and other RRS activation types (code blue or urgent clinical reviews) were excluded. Based on the annual MET activation rate at each hospital, a sample size of 371 activations across both study sites was calculated to provide a statistically representative sample with a margin of error less than 5%. This equated to approximately 17 days, so a 3-week study period was used. No power calculation was undertaken. Each hospital nominated its own study period that occurred on 21 consecutive days between April and June 2018, late autumn to early winter in Australia, thus excluding the winter peak period but avoiding holiday periods with reduced activity.
Data collection
MET activation data were extracted from each hospital's existing database. Case reviews were completed using clinical information sourced from the MET database and medical records. These medical records included ambulance, emergency department and ward medical and nursing notes, physiological observations, investigations and therapies including medications, medication reconciliation at admission, operative reports and discharge documentation. Clinical records from outside the treating hospital (eg, primary care, other hospital) were not available. A case report form (online supplemental file 2) guided the case reviews including patient demographics and clinical data from: admission to hospital including best possible medication history; prior to MET activation including significant events, medications prescribed and administered in the previous 24 hours and the last set of observations recorded prior to deterioration; and at and during MET activation including observations, assessment and management.
Supplemental material
Case reviews of all activations were conducted by an experienced clinical pharmacist investigator (XX). A senior intensivist investigator (XX, XX) from each site conducted an independent, blinded case review of approximately 40% of activations comprising all activations identified as medication related by the pharmacist reviewer, plus any activations flagged by clinicians as medication related, plus a random 10% sample of other activations. This additional random sample ensured reliability of the review process and blinding of intensivist review. Prior to undertaking case reviews, reviewers were provided with the case report forms as a spreadsheet and briefed on accessing any available clinical information and use of the study tools.
For each case, reviewers assessed (1) whether the activation was medication related, (2) the contributing medication(s) and adverse medication event, and (3) the preventability of the activation. For determining whether an activation was medication related, reviewers used the 6-point causality scale from landmark adverse event studies,28 29 with a score of 4 or more considered medication related. All adverse medication events were rated for preventability using the previously published methodology by Marquet et al 16 based on the landmark studies,28 29 with a rating of four or more considered preventable. The two reviewers resolved any rating disagreements by discussion and review of all available information. Other patient and admission data linked to each MET activation were provided directly from each hospital's administration systems.
The primary outcome was the frequency of medication-related MET activations per 1000 admissions. The secondary outcomes included the proportion of these activations that were potentially preventable, differences in characteristics between medication-related and non-medication-related activations and description of medications and adverse medication events contributing to medication-related MET activations.
Data handling and analysis
Data were extracted into Microsoft Excel (Office 2019, Microsoft Corporation, Redmond, California, USA) for cleaning and coding. Where multiple activation triggers were recorded, the trigger matching the patient's clinical condition and vital signs at the time of the activation was analysed. Medications were coded using the WHO Anatomical Therapeutic Chemical (ATC) categories (https://www.whocc.no/atc_ddd_index/Accessed 19 May 2021). Adverse medication events were categorised using 14 categories as described previously.30 For adverse medication reactions, an international standard classifying six types of reactions (A–F) was used.19 Medication errors were classified using local adaptations of the nursing rights of medication safety 31 that had seven classifications: incorrect patient, incorrect drug, incorrect dose, incorrect time/frequency, incorrect route/formulation, omission and incorrect clinical scenario. The latter is when a medication was prescribed and/or administered when a clinical parameter or diagnosis would have precluded its use, for example, an antihypertensive being administered despite evidence of shock. An additional category of other adverse medication event included patient-initiated actions such as self-medication.
Statistical analyses were completed using IBM SPSS Statistics V.26 (IBM Corporation). Categorical data were presented as counts (%) and distributed data as median (IQR or range). Differences were assessed with the Χ2 test for proportions and Mann-Whitney U tests for continuous data. Agreement between case reviewers was assessed dichotomously using Fleiss' multirater kappa. A two-sided p<0.05 was considered statistically significant.
During the study periods, there were 9439 admissions across the two hospitals (figure 1). There were 628 MET activations for 403 patients during 406 admissions included for analysis. The MET activation incidence was 66.5 per 1000 admissions. The most common activation triggers were low blood pressure (n=167 of 628, 26.6%) and high heart rate (n=125 of 628, 19.9%). After the majority of MET activations (n=565 of 628, 90%), patients remained on the ward.
In total, 43.6% (n=274 of 628) MET activations were reviewed by two reviewers, including 187 (n=187 of 628, 29.8%) activations flagged by the pharmacist reviewer as potentially medication related. Initial agreement between case reviewers on causality and preventability was low (kappa=0.143 and kappa=0.069). However, agreement for all reviewed cases (n=274) was reached following discussion between reviewers. By the end of the case review process, 133 (n=133 of 187, 71.1%) cases flagged by the pharmacist reviewer were confirmed as potentially medication related.
Medication-related MET activations
There were 146 (n= 146 of 628, 23.2%) medication-related MET activations identified (figure 1), with an incidence of 15.5 medication-related MET activations per 1000 admissions. The most common triggers were low blood pressure (n=63 of 146, 43.2%) and high heart rate (n=18 of 146, 12.3%) (table 1).
Comparisons of activation, patient and admission factors
Compared with non-medication-related MET activations, medication-related MET activations occurred a median of 46.6 hours earlier in a patient's admission (p=0.001) (table 1). Repeat MET activations during an admission were more likely for patients who experienced a medication-related MET activation (OR=1.68, 95% CI 1.09 to 2.59). There were no other differences in patient characteristics, disposition or outcomes (table 1).
Medications and adverse medication events
Medications from nine of the 14 anatomical/pharmacological ATC first level categories contributed to the 146 medication-related MET activations (figure 1). The most common ATC first level categories were cardiovascular system (ATC C) (n=81 of 146, 55.5%) and nervous system (ATC N) (n=37 of 146, 25.3%).
The most common ATC second level category medications were beta-blocking agents (C07) (n=25 of 146, 17.1%), analgesics (N02) (n=20 of 146, 13.7%), diuretics (C03) (n=20 of 146, 13.7%) and agents acting on the renin–angiotensin system (C09) (n=17 of 146, 11.6%).
Medication errors contributed to 81 (n=81 of 146, 55.5%,) medication-related MET activations (figure 1). Errors of omission (n=47 of 146, 32.2%) were the most common adverse medication events leading to MET activation (online supplemental file 3). Cardiovascular system (ATC C) medication omission (n=29 of 146, 19.9%) was the most common of these. Specifically, 7.5% (n=11 of 146) of medication-related MET activations were due to omission of one beta-blocking agent (ATC C07), metoprolol (table 2). Medication-related MET activations for hypotension due to inappropriate use of cardiovascular (ATC C) medications during acute illness (error=incorrect clinical scenario, n=13 of 146, 8.9%) were common.
Supplemental material
Adverse medication reactions contributed to 63 (n=63 of 146, 43.2%) medication-related MET activations (figure 1). Dose-related (type A) reactions (n=27 of 146, 18.5%) and dose and time-related (type C) reactions (n=26 of 146, 17.8%) commonly contributed to medication-related MET activations (online supplemental file 3). These were due to predominantly cardiovascular system (ATC C) medications (type A n=14 of 146, 9.6% and type C n=15 of 146, 10.3%) (table 2). Hypotension was the trigger for the 15 (n=15 of 146, 10.3%) medication-related MET activations due to cumulative toxicity (type C) of cardiovascular (ATC C) medications.
Of the 146 medication-related MET activations, 92 (n=92 of 146, 63%) activations were rated as preventable (figure 1). This gave an incidence of 9.7 potentially preventable medication-related MET activations per 1000 admissions, or one in seven MET activations were due to potentially preventable adverse medication events.
The most common MET activation triggers for potentially preventable medication-related MET activations were low blood pressure (n=35 of 92, 38%) and high heart rate (n=15 of 92, 16.3%) . Five (n=5 of 92, 5.4%) of these activations resulted in patients needing escalation of care to high dependency care or the ICU.
The most common medications (ATC first level categories) leading to potentially preventable medication-related MET activations were cardiovascular system (ATC C) agents (n=55 of 92, 59.8%) (figure 2). The most common ATC second level category medications were beta-blocking agents (C07) (n=19 of 92, 20.7%), analgesics (N02) (n=13 of 92, 14.1%), agents acting on the renin–angiotensin system (C09) (n=12 of 92, 13%) and diuretics (C03) (n=11 of 92, 12%) (table 2).
Medication errors contributed to 66 (n=66 of 92, 71.7%) potentially preventable medication-related MET activations (figure 1). Potentially preventable medication-related MET activations due to omission (n=42 of 92, 45.7%) were most common. Cardiovascular system (ATC C) medications (n=27 of 92, 29.3%) were most commonly omitted (figure 2). Ten (n=10 of 92, 10.9%) of these events were omission of metoprolol leading to tachycardia; the remaining omission of a beta-blocking agent (C07), also metoprolol, leading to tachycardia was rated non-preventable.
Adverse medication reactions contributed to 24 (n=24 of 92, 26.1%) potentially preventable medication-related MET activations (figure 1). Dose and time-related (type C) reactions (n=15 of 92, 16.3%) were the most common. Cardiovascular system (ATC C) medications leading to hypotension contributed to nine (n=9 of 15, 60%) of these events (figure 2).
Errors of cardiovascular system (ATC C) medication use in incorrect clinical scenarios (n=10 of 92, 10.9%) were also common potentially preventable adverse medication events (figure 2). All of these were hypotension due to inappropriate use of medications with antihypertensive effects during acute illness (table 2).
Two (n=2 of 92, 2.2%) potentially preventable medication-related MET activations for change in conscious state were due to patient actions: self-administered oxazepam or zopiclone not prescribed for use during their hospital admission.
Major findings
This study of 628 MET activations in a heterogeneous population from two hospitals identified almost a quarter of MET activations as medication related. At a rate of almost seven medication-related MET activations per day across the two hospitals, this presents a considerable burden to patients and healthcare resources. These events occurred almost 2 days earlier in a patient's hospital stay than MET activations unrelated to medications, and these patients were more than 50% more likely to require repeat MET activations.
One in seven MET activations was due to a potentially preventable medication adverse event. Almost all omissions of cardiovascular medications were rated as preventable and the most common were MET activations for tachycardia due to omission of one beta-blocker, metoprolol, the most commonly used beta-blocker in both institutions. As the biggest contributor to medication-related MET activations, these omissions, along with hypotension due to inappropriate use of antihypertensive medications, presented targets for interventions to improve patient safety and reduce burden on the RRS.
Comparison with other literature
We are aware of only one previous multicentre study that provided an estimate of medication-related clinical deterioration.13 They defined clinical deterioration as unplanned ICU admission or MET activation, and observed over one-third of clinical deterioration to be medication related.13 While not specific to MET activations, this estimate is slightly higher than our finding of 23.2%, considering the relative similarity of the methods used in both studies this difference may relate to our specific inclusion of only MET activations. Our study hospitals would have very few unplanned admissions to the ICU without a MET activation occurring first. This is reinforced by the lower rate of escalation of care than observed by Marquet et al 16 in their substudy, suggesting the RRS may have detected these patients early and MET activation allowed prompt management. Differences in healthcare delivery between the two countries, particularly the types of patients eligible for RRS activation, mandatory MET activation and clinical pharmacy services, may have also contributed.
The remaining previous reports provided specific estimates of medication-related MET activations from single-centre studies and all reported lower proportions of medication-related MET activations.12 30 The MET activation rates in these studies were generally comparable with those in our study, suggesting this was unlikely a dilution effect. Studies that relied on data collected by clinicians during the activation30 32 33 likely captured only the most obvious associations with medications. Studies using case review methodologies focused on adverse medication reactions when categorising activations according to clinical syndromes.34 35 Therefore, these estimates did not include MET activations due to medication errors, which were the largest group of adverse medication events detected in our study.
Our finding that medication-related MET activations occurred earlier in a patient's hospital stay was consistent with our previous results.30 Transitions of care such as hospital admission are recognised as high risk for medication-related harm.4 36 Therefore, this observation is important as early in an admission, patients are generally less stable so less able to tolerate adverse events. This finding is a key consideration for designing strategies to prevent medication-related MET activation.
We believe ours is the first study to quantify the preventability of medication-related MET activations in a non-selective acute hospital population. A small study of surgical patients requiring Rapid Response Team activations found approximately 90% of the errors involving medications were thought to be preventable17 but did not assess adverse reactions. Similarly, the substudy of adverse medication events by Marquet et al 16 classified adverse drug reactions as not preventable and all other adverse medication events as preventable by definition. In our study, medication-related MET activations due to any type of adverse medication event were assessed for preventability and almost 40% of activations due to adverse medication reactions were rated as preventable. One in five medication errors were rated as not preventable.
Strengths and limitations
This study exceeded, almost by double, the required sample size ensuring a highly representative sample of consecutive MET activations and a high level of accuracy to avoid selection bias and to increase the generalisability of the findings. However, the sample could not account for seasonal effects or other variations over time. Blinded, independent case review and validated tools to systematically detect medication-related MET activations were used to increase reliability. All events were assessed for preventability avoiding bias introduced by classification error that may have occurred due to the acknowledged lack of distinction between some medication errors and adverse medication reactions.18 19 The use of internationally recognised medication and adverse medication event classification systems further increases generalisability of our findings, and with the expression of incidence per 1000 admissions, allows for future comparisons.
The study design has limitations. Case review studies rely on secondary use of clinical information. Hence, reviews may have been compromised by poor documentation. The impact of this was minimised by allowing reviewers to use any clinical information available. The subjectivity of the medication-related causality and preventability assessments cannot be discounted.37 38 Low agreement between reviewers was overcome with case discussion to reach consensus which was more likely reflective of multidisciplinary clinical decision-making. The sample size and inclusive population of the study prevented the calculation of the total number of medications or medication doses prescribed or administered during the study. Without this denominator, we were unable to quantify the proportion of all medications used that resulted in medication-related MET activations. These data would be important for assessment of the feasibility and efficacy of interventions to prevent specific adverse medication events. The study was conducted in two government-funded, academic teaching hospitals in Melbourne, Australia, with mature RRSs and comprehensive clinical pharmacy services, and did not analyse variables such as patient case-mix, and clinical service standards or practices. Thus, the findings may not be directly applicable but warrant investigation in other settings, particularly as our study setting represented a 'better case' scenario than institutions with less resources, different safety cultures, non-mandatory RRS activation and less integrated clinical pharmacy services.
Implications for practice and future research
The findings of this study highlighted that medications are a major contributor to clinical deterioration leading to MET activation. The potential preventability of so many activations, particularly early in a patient's hospital stay, presents the opportunity to improve patient safety and relieve pressure on the MET. In the study hospitals where clinical pharmacy services had a heavy focus on patient admission, clinical pharmacists likely had already influenced these rates, but also could play an important role in these improvements.
Intervention strategies to prevent the most common medication-related MET activations should be designed and tested. In this study, these activations were (1) omission of metoprolol leading to MET activations for tachycardia and (2) cumulative toxicity and inappropriate continuation of cardiovascular agents with antihypertensive effects. These are logical targets for clinical improvements focusing on medication management early in a patient's admission. However, caution and careful evaluation is necessary as strategies to encourage changes in prescribing or administration of medications may have unintended consequences, including increasing MET activations for other triggers such as bradycardia, hypertension, high respiratory rate or even tachycardia. This evaluation could be achieved using either clinical trial or quality improvement methodologies.
The considerable contribution of medications to MET activation in this study and the lower frequency found in studies relying on clinician detection30 32 33 suggest clinicians need support to recognise medication-related MET activations at the bedside. Increased awareness through education may have short-term effects. Ideally, more durable interventions should be implemented to ensure medications are routinely considered in differential diagnoses for patients who clinically deteriorate. This may present a role for clinical pharmacists either working as part of the attending MET or a prompted follow-up review of patients who triggered a MET activation. Either service could be prioritised by MET activation trigger as the findings of this study demonstrated medication-related activations were commonly triggered for high heart rate and fluctuations in blood pressure and conscious state. The local priorities of clinical pharmacy services would influence the development of these roles. However, these considerations should also be influenced by the potential impacts of undetected medication-related causes of MET activations, and the risk of adverse medication events occurring during MET activations particularly as a result of emergent situations where a team unfamiliar with each other and the patient are working in an unfamiliar environment.39
Medications contribute to almost a quarter of MET activations, often early in a patient's admission. One in seven MET activations were due to potentially preventable medication adverse events. These events were most commonly beta-blocker omission or clinically inappropriate antihypertensive use. Strategies to prevent the most common medication-related MET activations would increase patient safety and reduce patient morbidity as well as reduce burden on the MET.
Data availability statement
No data are available. Not applicable.
Ethics statements
Patient consent for publication
Ethics approval
This study received institutional approval and need for consent was waived by the reviewing ethics committee (The Alfred Ethics Committee HREC/17/Alfred/192, Alfred Health SSA/18/Alfred/48, Austin Health SSA/18/Austin/133, Monash University Human Research Ethics Committee 12577).
The authors acknowledge the contribution of XXXX to supporting the case reviews. The authors also acknowledge the work of the nurses and doctors of the METs at the two sites where this study was conducted: XXXX and XXXX.
Supplementary materials
Supplementary Data
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Twitter @BiancaJL22
Contributors All authors have made substantial contributions to the planning and conduct of this study and drafting and revision of the manuscript. Bianca J Levkovich is the guarantor of the study.
Funding BIanca J Levkovich was supported by an Australian Government Research Training Programme Scholarship. D James Cooper was supported by an Australian National Health and Medical Research Council Practitioner.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.