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BMJ Open Quality Jun 2024Patient safety learning systems play a critical role in supporting safety culture in healthcare organisations. A lack of explicit standards leads to inconsistent...
BACKGROUND
Patient safety learning systems play a critical role in supporting safety culture in healthcare organisations. A lack of explicit standards leads to inconsistent implementation across organisations, causing uncertainty about their roles and impact. Organisations can address inconsistent implementation by using a self-assessment tool based on agreed-on best practices. Therefore, we aimed to create a survey instrument to assess an organisation's approach to learning from safety events.
METHODS
The foundation for this work was a recent systematic review that defined features associated with the performance of a safety learning system. We organised features into themes and rephrased them into questions (items). Face validity was checked, which included independent pre-testing to ensure comprehensibility and parsimony. It also included clinical sensibility testing in which a representative sample of leaders in quality at a large teaching hospital (The Ottawa Hospital) answered two questions to judge each item for clarity and necessity. If more than 20% of respondents judged a question unclear or unnecessary, we modified or removed that question accordingly. Finally, we checked the internal consistency of the questionnaire using Cronbach's alpha.
RESULTS
We initially developed a 47-item questionnaire based on a prior systematic review. Pre-testing resulted in the modification of 15 of the questions, 2 were removed and 2 questions were added to ensure comprehensiveness and relevance. Face validity was assessed through yes/no responses, with over 80% of respondents confirming the clarity and 85% the necessity of each question, leading to the retention of all 47 questions. Data collected from the five-point responses (strongly disagree to strongly agree) for each question were used to assess the questionnaire's internal consistency. The Cronbach's alpha was 0.94, indicating a high internal consistency.
CONCLUSION
This self-assessment questionnaire is evidence-based and on preliminary testing is deemed valid, comprehensible and reliable. Future work should assess the range of survey responses in a large sample of respondents from different hospitals.
Topics: Humans; Surveys and Questionnaires; Patient Safety; Safety Management; Reproducibility of Results
PubMed: 38926135
DOI: 10.1136/bmjoq-2023-002738 -
European Respiratory Review : An... Apr 2024This review quantifies the mean treatment effect of exercise-based interventions on balance and falls risk in people with COPD. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
This review quantifies the mean treatment effect of exercise-based interventions on balance and falls risk in people with COPD.
METHODS
A structured search strategy (2000-2023) was applied to eight databases to identify studies evaluating the impact of exercise-based interventions (≥14 days in duration) on balance or falls in people with COPD. Pooled mean treatment effects (95% confidence intervals (CIs), 95% prediction intervals (PIs)) were calculated for outcomes reported in five or more studies. Inter-individual response variance and the promise of behaviour change techniques (BCTs) were explored.
RESULTS
34 studies (n=1712) were included. There were greater improvements in balance post intervention compared to controls for the Berg Balance Scale (BBS) (mean 2.51, 95% CI 0.22-4.80, 95% PI -4.60-9.63), Timed Up and Go (TUG) test (mean -1.12 s, 95% CI -1.69- -0.55 s, 95% PI -2.78-0.54 s), Single-Leg Stance (SLS) test (mean 3.25 s, 95% CI 2.72-3.77 s, 95% PI 2.64-3.86 s) and Activities-specific Balance Confidence (ABC) scale (mean 8.50%, 95% CI 2.41-14.58%, 95% PI -8.92-25.92%). Effect on falls remains unknown. Treatment effects were larger in male mixed-sex groups for the ABC scale and SLS test, and in balance training other exercise-based interventions for the BBS and TUG test. Falls history was not associated with changes in balance. Meta-analysis of individual response variance was not possible and study-level results were inconclusive. Eleven promising BCTs were identified (promise ratio ≥2).
CONCLUSION
Evidence for the effect of exercise-based interventions eliciting clinically important improvements in balance for people with COPD is weak, but targeted balance training produces the greatest benefits. Future exercise interventions may benefit from inclusion of the identified promising BCTs.
Topics: Humans; Accidental Falls; Postural Balance; Pulmonary Disease, Chronic Obstructive; Exercise Therapy; Male; Treatment Outcome; Female; Aged; Risk Factors; Middle Aged; Recovery of Function; Lung
PubMed: 38925795
DOI: 10.1183/16000617.0003-2024 -
BMJ Open Jun 2024This study aimed to develop a patient-centred approach to the burden of acute type A aortic dissection (ATAAD) through modelling. The main objective was to identify...
OBJECTIVES
This study aimed to develop a patient-centred approach to the burden of acute type A aortic dissection (ATAAD) through modelling. The main objective was to identify potential improvements in managing this life-threatening cardiovascular condition and to provide evidence-based recommendations to optimise outcomes.
DESIGN
We developed a predictive model along patient pathways to estimate the burden of ATAAD through the years of life lost (YLLs) metric. The model was created based on a systematic review of the literature and was parameterised using demographic data from the German healthcare environment. The model was designed to allow interactive simulation of different scenarios resulting from changes in key impact factors.
SETTING
The study was conducted using data from the German healthcare environment and results from the literature review.
PARTICIPANTS
The study included a comprehensive modelling of ATAAD cases in Germany but did not directly involve participants.
INTERVENTIONS
There were no specific interventions applied in this study based on the modelling design.
PRIMARY AND SECONDARY OUTCOME MEASURES
The single outcome measure was the estimation of YLL due to ATAAD in Germany.
RESULTS
Our model estimated 102 791 YLL per year for ATAAD in Germany, with 62 432 and 40 359 YLL for men and women, respectively. Modelling an improved care setting yielded 93 191 YLL or 9.3% less YLL compared with the current standard while a worst-case scenario resulted in 113 023 or 10.0% more YLL. The model is accessible at https://acuteaorticdissection.com/ to estimate custom scenarios.
CONCLUSIONS
Our study provides an evidence-based approach to estimating the burden of ATAAD and identifying potential improvements in the management of pathways. This approach can be used by healthcare decision-makers to inform policy changes aimed at optimising patient outcomes. By considering patient-centred approaches in any healthcare environment, the model has the potential to improve efficient care for patients suffering from ATAAD.
Topics: Humans; Aortic Dissection; Germany; Female; Male; Middle Aged; Aged; Aortic Aneurysm; Life Expectancy; Adult; Acute Disease; Aged, 80 and over; Cost of Illness
PubMed: 38925695
DOI: 10.1136/bmjopen-2023-078398 -
BMJ Open Jun 2024A vital component of a prehospital emergency care system is getting an injured patient to the right hospital at the right time. Process and information flow mapping are...
OBJECTIVE
A vital component of a prehospital emergency care system is getting an injured patient to the right hospital at the right time. Process and information flow mapping are recognised methods to show where efficiencies can be made. We aimed to understand the process and information flows used by the prehospital emergency service in transporting community emergencies in Rwanda in order to identify areas for improvement.
DESIGN
Two facilitated process/information mapping workshops were conducted. Process maps were produced in real time during discussions and shared with participants for their agreement. They were further validated by field observations.
SETTING
The study took place in two prehospital care settings serving predominantly rural and predominantly urban patients.
PARTICIPANTS
24 healthcare professionals from various cadres. Field observations were done on 49 emergencies across both sites.
RESULTS
Two maps were produced, and four main process stages were described: (1) call triage by the dispatch/call centre team, (2) scene triage by the ambulance team, (3) patient monitoring by the ambulance team on the way to the health facility and (4) handover process at the health facility. The first key finding was that the rural site had multiple points of entry into the system for emergency patients, whereas the urban system had one point of entry (the national emergency number); processes were otherwise similar between sites. The second was that although large amounts of information were collected to inform decision-making about which health facility to transfer patients to, participants found it challenging to articulate the intellectual process by which they used this to make decisions; guidelines were not used for decision-making.
DISCUSSION
We have identified several areas of the prehospital care processes where there can be efficiencies. To make efficiencies in the decision-making process and produce a standard approach for all patients will require protocolising care pathways.
Topics: Humans; Rwanda; Emergency Medical Services; Triage; Ambulances; Rural Health Services; Transportation of Patients; Patient Handoff
PubMed: 38925682
DOI: 10.1136/bmjopen-2024-085064 -
American Journal of Veterinary Research Jun 2024To collect medication error (ME) data during the perianesthetic period from small animal clinics.
OBJECTIVE
To collect medication error (ME) data during the perianesthetic period from small animal clinics.
SAMPLE
6 small animal general practice veterinary clinics.
METHODS
Small animal general practice veterinary clinics were recruited in this prospective observational study, with staff given a presentation on medical errors and instructed on how to submit medication error reports to an online reporting system. Errors were classified according to type and timing.
RESULTS
A total of 2,728 general anesthesia or sedation procedures were performed, with 49 ME reports submitted. One duplicated report of the same error was excluded, resulting in a ME rate of 1.8%. Most reports (69% [33/48]) were near misses. The remaining 31% were MEs that reached the patient but did not cause harm. Wrong dose errors were the most common type (63% [30/48]), of which 80% (24/30) were calculation errors. Premedication/sedation and maintenance were the most reported stages, at 47% (20/43) and 23% (10/43), respectively. None of the MEs reported resulted in an adverse event, with an approximately 2:1 ratio of near-miss to no-harm MEs. The observed patterns of MEs reported, including type and timing, represent a target for further education.
CLINICAL RELEVANCE
These results quantify the ME rate in general practice veterinary clinics, providing an initial benchmark for MEs during the perianesthetic period.
PubMed: 38925141
DOI: 10.2460/ajvr.24.04.0119 -
Accident; Analysis and Prevention Jun 2024Cycling, as a routine mode of travel, offers significant benefits in promoting health, eliminating emissions, and alleviating traffic congestion. Many cities, including...
Cycling, as a routine mode of travel, offers significant benefits in promoting health, eliminating emissions, and alleviating traffic congestion. Many cities, including London, have introduced various policies and measures to promote 'active travel' in view of its manifold advantages. Nevertheless, the reality is not as desirable as expected. Existing studies suggest that cyclists' perceptions of cycling safety significantly hinder the broader adoption of cycling. Our study investigates the perceived cycling safety and unpacks the association between the cycling safety level and the road environment, taking London as a case study. First, we proposed novel cycling safety level indicators that incorporate both collision and injury risks, based on which a tri-tiered cycling safety level prediction spanning the entirety of London's road network has been generated with good accuracy. Second, we assessed the road environment by harnessing imagery features of street view reflecting the cyclist's perception of space and combined it with road features of cycle accident sites. Finally, associations between road environment features and cycling safety levels have been explained using SHAP values, leading to tailored policy recommendations. Our research has identified several key factors that contribute to a risky environment for cycling. Among these, the "second road effects," which refers to roads intersecting with the road where the accident occurred, is the most critical to cycling safety levels. This would also support and further contribute to the literature on road safety. Other results related to road greenery, speed limits, etc, are also discussed in detail. In summary, our study offers insights into urban design and transport planning, emphasising the perceived cycling safety of road environment.
PubMed: 38924963
DOI: 10.1016/j.aap.2024.107677 -
International Journal of Surgery Case... Jun 2024Isolated tibiotalar dislocation is an extremely rare injury. They are most often caused by high-energy trauma.
INTRODUCTION
Isolated tibiotalar dislocation is an extremely rare injury. They are most often caused by high-energy trauma.
CASE PRESENTATION
The authors report the case of an acute pure posteromedial tibiotalar joint dislocation in a 45-year-old patient, which occurred as a result of a road traffic accident. The reduction was performed as an emergency procedure under general anesthesia, followed by a 6-week cast immobilization. Twenty months after the injury, at the last follow-up, a very good functional result was observed, with a stable and painless ankle and satisfactory mobility.
DISCUSSION
A pure dislocation of the tibiotalar joint without an associated fracture is a rare injury. The posterior type is the most common dislocation. Treatments include close reduction, short leg cast immobilization, and open dislocation. However, certain factors can lead to unfavorable outcomes, such as delayed therapy, damage to the inferior tibiotalar ligaments, anterior tibial artery rupture, and soft tissue damage.
CONCLUSION
It is rare for a tibiotalar joint dislocations to occur as an isolated injury. The necessity of immediate orthopedic intervention in the management of this lesion is demonstrated by our observation.
PubMed: 38924923
DOI: 10.1016/j.ijscr.2024.109933 -
Revista Gaucha de Enfermagem 2024To analyze the relationship between the emotional intelligence of healthcare workers in a hospital environment and their perception of the safety climate in the COVID-19...
OBJECTIVE
To analyze the relationship between the emotional intelligence of healthcare workers in a hospital environment and their perception of the safety climate in the COVID-19 pandemic.
METHOD
Cross-sectional, analytical study, carried out with 81 health workers who worked in hospitals during the pandemic, between September and November 2021. Data collection was carried out using an electronic form, which included a sociodemographic/occupational questionnaire and the Brazilian versions of the Safety Attitudes Questionnaire and the Schutte Self Test. Spearman's correlation test and simple and multiple linear regression analyses were applied.
RESULTS
An increase of 1 point in emotional intelligence levels resulted in an increase of 0.487 points in the perception of the safety climate. The most significant predictor of this perception was the ability to manage other people's emotions (β=0.334; p=0.003; R2=0.168).
CONCLUSION
A higher level of emotional intelligence in hospital healthcare workers was related to a greater perception of the safety climate during the COVID-19 pandemic.
Topics: Humans; COVID-19; Cross-Sectional Studies; Emotional Intelligence; Male; Female; Adult; Brazil; Personnel, Hospital; Middle Aged; Surveys and Questionnaires; Pandemics; Attitude of Health Personnel; Safety Management; Health Personnel; Hospitals
PubMed: 38922230
DOI: 10.1590/1983-1447.2024.20230102.en -
Revista Brasileira de Epidemiologia =... 2024To analyze the temporal trend and magnitude of national indicators of previdenciary benefits for workplace accidents issued and granted by the Social Security of Brazil.
OBJECTIVE
To analyze the temporal trend and magnitude of national indicators of previdenciary benefits for workplace accidents issued and granted by the Social Security of Brazil.
METHODS
Secondary data from Social Security from 2008 to 2019 were used. The trend and percentage variation of the indicators were estimated through Prais-Winsten generalized linear regression.
RESULTS
A total of 9,220,372 previdenciary benefits for workplace accidents were issued by the Social Security of Brazil in the period, costing approximately R$ 8.4 billion and representing about 2.0% of the net value of all benefits paid. None of the categories of previdenciary benefits for workplace accidents showed an increasing trend. The highest variation in the benefits granted and issued for workplace accidents occurred in temporary disability benefit (B91), with an annual percentage variation of -54.00% and -29.29%, respectively.
CONCLUSION
A reduction in magnitude and an overall decreasing trend were observed in the historical series of national indicators of benefits granted and benefits issued related to workplace accidents in Brazil from 2008 to 2019.
Topics: Brazil; Humans; Accidents, Occupational; Time Factors; Social Security; Workers' Compensation; Workplace
PubMed: 38922200
DOI: 10.1590/1980-549720240032 -
Frontiers in Public Health 2024We investigated the temporal trends and examined age-, period-, and cohort-specific effects of injury-related deaths among residents in Jiangsu to provide evidence for...
OBJECTIVE
We investigated the temporal trends and examined age-, period-, and cohort-specific effects of injury-related deaths among residents in Jiangsu to provide evidence for future injury prevention.
METHODS
This study included 406,936 injury deaths from the Jiangsu provincial population death registration system. The average annual percent change (AAPC) in age-standardized mortality rates (ASMRs) was analyzed using joinpoint regression. Age-period-cohort models were generated to explore the effects of age, period, and birth cohort effects on mortality risk.
RESULTS
ASMRs for all injuries (AAPC = -2.3%), road traffic accidents (AAPC = -5.3%), suicide (AAPC = -3.8%), and drowning (AAPC = -3.9%) showed a downward trend during 2012-2021(all < 0.05), while unintentional falls showed an upward trend (AAPC = 5.1%, < 0.05). From 2012 to 2021, the age-standardized mortality rates (ASMRs) for four primary types of injuries consistently exhibited higher among males compared to females, with rural regions displaying higher ASMRs than urban areas. Trends in ASMRs for road traffic accidents, drowning, and unintentional falls by sex and urban/rural areas were consistent with overall trends. Significant age, cohort, and period effects were identified in the trends of injury-related deaths for both sexes in Jiangsu. The age effect showed that the highest age effect for injury-related deaths was for the ages of 85 years and above, except for suicide, which was for the ages 80-84 years. Between 2012 and 2021, the period effect on road traffic accidents declined, while that on accidental falls increased. Initially, the period effect on suicide decreased but then rose, peaking in 2012 with a Relative Risk (RR) of 1.11 (95% : 1.04-1.19). Similarly, the period effect on drowning initially declined before rising, with the highest effect observed in 2013, at an RR of 1.12 (95% : 1.07-1.19). The highest cohort effects for road traffic accidents were observed in the 1957-1961 group, for accidental falls in the 1952-1956 group, and for both drowning and suicide in the 1927-1931 group.
CONCLUSION
The mortality rate of unintentional falls has been increasing. Older adults are at high risk for the four leading injuries. The improvements in mortality rates can be attributed to advancements in education, urbanization, and the promulgation and implementation of laws and policies.
Topics: Humans; Male; Female; China; Middle Aged; Adult; Aged; Adolescent; Child; Child, Preschool; Accidents, Traffic; Young Adult; Wounds and Injuries; Infant; Cohort Studies; Aged, 80 and over; Suicide; Drowning; Accidental Falls; Infant, Newborn; Mortality; Rural Population; Age Factors; Cause of Death
PubMed: 38919918
DOI: 10.3389/fpubh.2024.1373238