-
BMJ Open Quality May 2024Stress ulcer prophylaxis is started in the critical care unit to decrease the risk of upper gastrointestinal ulcers in critically ill persons and to decrease mortality...
UNLABELLED
Stress ulcer prophylaxis is started in the critical care unit to decrease the risk of upper gastrointestinal ulcers in critically ill persons and to decrease mortality caused by stress ulcer complications. Unfortunately, the drugs are often continued after recovery through discharge, paving the way for unnecessary polypharmacy.
STUDY DESIGN
We conducted a retrospective cross-sectional study including patients admitted to the adult critical care unit and started on the stress ulcer prophylaxis with a proton pump inhibitor (PPI) or histamine receptor 2 blocker (H2 blocker) with an aim to determine the prevalence of inappropriate continuation at discharge and associated factors.
RESULT
3200 people were initiated on stress ulcer prophylaxis, and the medication was continued in 1666 patients upon discharge. Indication for long-term use was not found in 744 of 1666, with a 44% prevalence of inappropriate continuation. A statistically significant association was found with the following risk factors: discharge disposition (home vs other medical facilities, p=0.002), overall length of stay (more than 10 days vs less than or equal to 10 days, p<0.0001), mechanical ventilator use (p<0.001), number of days on a mechanical ventilator (more than 2 days vs less than or equal to 2 days, p<0.001) and class of stress ulcer prophylaxis drug used (H2 blocker vs PPI, p<0.001).
CONCLUSION
The prevalence of inappropriate continuation was found to be higher than prior studies. Given the risk of unnecessary medication intake and the associated healthcare cost, a web-based quality improvement initiative is being considered.
Topics: Humans; Male; Retrospective Studies; Female; Cross-Sectional Studies; Middle Aged; Prevalence; Peptic Ulcer; Patient Discharge; Proton Pump Inhibitors; Aged; Histamine H2 Antagonists; Adult; Risk Factors; Anti-Ulcer Agents; Intensive Care Units; Inappropriate Prescribing
PubMed: 38729753
DOI: 10.1136/bmjoq-2023-002678 -
BMJ Open Quality May 2024Safe practice in medicine and dentistry has been a global priority area in which large knowledge gaps are present.Patient safety strategies aim at preventing unintended...
INTRODUCTION
Safe practice in medicine and dentistry has been a global priority area in which large knowledge gaps are present.Patient safety strategies aim at preventing unintended damage to patients that can be caused by healthcare practitioners. One of the components of patient safety is safe clinical practice. Patient safety efforts will help in ensuring safe dental practice for early detection and limiting non-preventable errors.A valid and reliable instrument is required to assess the knowledge of dental students regarding patient safety.
OBJECTIVE
To determine the psychometric properties of a written test to assess safe dental practice in undergraduate dental students.
MATERIAL AND METHODS
A test comprising 42 multiple-choice questions of one-best type was administered to final year students (52) of a private dental college. Items were developed according to National Board of Medical Examiners item writing guidelines. The content of the test was determined in consultation with dental experts (either professor or associate professor). These experts had to assess each item on the test for language clarity as A: clear, B: ambiguous and relevance as 1: essential, 2: useful, not necessary, 3: not essential. Ethical approval was taken from the concerned dental college. Statistical analysis was done in SPSS V.25 in which descriptive analysis, item analysis and Cronbach's alpha were measured.
RESULT
The test scores had a reliability (calculated by Cronbach's alpha) of 0.722 before and 0.855 after removing 15 items.
CONCLUSION
A reliable and valid test was developed which will help to assess the knowledge of dental students regarding safe dental practice. This can guide medical educationist to develop or improve patient safety curriculum to ensure safe dental practice.
Topics: Humans; Psychometrics; Patient Safety; Surveys and Questionnaires; Educational Measurement; Reproducibility of Results; Students, Dental; Education, Dental; Male; Female; Clinical Competence
PubMed: 38719519
DOI: 10.1136/bmjoq-2023-002384 -
Anaesthesia, Critical Care & Pain... May 2024Reporting and analysis of adverse events (AE) is associated with improved health system learning, quality outcomes, and patient safety. Manual text analysis is...
BACKGROUND
Reporting and analysis of adverse events (AE) is associated with improved health system learning, quality outcomes, and patient safety. Manual text analysis is time-consuming, costly, and prone to human errors. We aimed to demonstrate the feasibility of novel machine learning and natural language processing (NLP) approaches for early predictions of adverse events and provide input to direct quality improvement and patient safety initiatives.
METHODS
We used machine learning to analyze 9559 continuously reported AE by clinicians and healthcare systems to the French National Health accreditor (HAS) between January 1, 2009, and December 31, 2020 . We validated the labeling of 135,000 unique de-identified AE reports and determined the associations between different system's root causes and patient consequences. The model was validated by independent expert anesthesiologists.
RESULTS
The machine learning (ML) and Artificial Intelligence (AI) model trained on 9559 AE datasets accurately categorized 8800 (88%) of reported AE. The three most frequent AE types were "difficult orotracheal intubation" (16.9% of AE reports), "medication error" (10.5%), and "post-induction hypotension" (6.9%). The accuracy of the AI model reached 70.9% sensitivity, 96.6% specificity for "difficult intubation", 43.2% sensitivity, and 98.9% specificity for "medication error."
CONCLUSIONS
This unsupervised ML method provides an accurate, automated, AI-supported search algorithm that ranks and helps to understand complex risk patterns and has greater speed, precision, and clarity when compared to manual human data extraction. Machine learning and Natural language processing (NLP) models can effectively be used to process natural language AE reports and augment expert clinician input. This model can support clinical applications and methodological standards and used to better inform and enhance decision-making for improved risk management and patient safety.
TRIAL REGISTRATION
The study was approved by the ethics committee of the French Society of Anesthesiology (IRB 00010254-2020-20) and the CNIL (CNIL: 118 58 95) and the study was registered with ClinicalTrials.gov (NCT: NCT05185479).
PubMed: 38718923
DOI: 10.1016/j.accpm.2024.101390 -
Frontiers in Pharmacology 2024Unsafe medication practices and medication errors are a major cause of harm in healthcare systems around the world. This study aimed to explore the factors that...
OBJECTIVE
Unsafe medication practices and medication errors are a major cause of harm in healthcare systems around the world. This study aimed to explore the factors that influence the risk of medication and provide medication risk evaluation model for adults in Shanxi province, China.
METHODS
The data was obtained from the provincial questionnaire from May to December 2022, relying on the random distribution of questionnaires and online questionnaires by four hospitals in Shanxi Province. Multiple linear regression analysis was used to explore the factors affecting the KAP score of residents. Univariate and multivariate logistic regression was used to determine the independent risk factors, and the nomogram was verified by receiver operating characteristic curve, calibration and decision curve analysis.
RESULTS
A total of 3,388 questionnaires were collected, including 3,272 valid questionnaires. The average scores of drugs KAP were 63.2 ± 23.04, 33.05 ± 9.60, 23.67 ± 6.75 and 33.16 ± 10.87, respectively. On the evaluation criteria of the questionnaire, knowledge was scored "fair", attitude and practice were scored "good". Sex, monthly income, place of residence, insurance status, education level, and employment were regarded as independent risk factors for medication and a nomogram was established by them.
CONCLUSION
Males, low-income, and low-educated people are important factors affecting the risk of medication. The application of the model can help residents understand the risk of their own medication behavior and reduce the harm of medication.
PubMed: 38711987
DOI: 10.3389/fphar.2024.1302274 -
BMC Health Services Research May 2024Previous studies have identified substantial regional variations in outpatient antibiotic prescribing in Germany, both in the paediatric and adult population. This...
BACKGROUND
Previous studies have identified substantial regional variations in outpatient antibiotic prescribing in Germany, both in the paediatric and adult population. This indicates inappropriate antibiotic prescribing in some regions, which should be avoided to reduce antimicrobial resistance and potential side effects. The reasons for regional variations in outpatient antibiotic prescribing are not yet completely understood; socioeconomic and health care density differences between regions do not fully explain such differences. Here, we apply a behavioural perspective by adapting the Theoretical Domains Framework (TDF) to examine regional factors deemed relevant for outpatient antibiotic prescriptions by paediatricians and general practitioners.
METHODS
Qualitative study with guideline-based telephone interviews of 40 prescribers (paediatricians and general practitioners) in outpatient settings from regions with high and low rates of antibiotic prescriptions, stratified by urbanity. TDF domains formed the basis of an interview guide to assess region-level resources and barriers to rational antibiotic prescription behaviour. Interviews lasted 30-61 min (M = 45 min). Thematic analysis was used to identify thematic clusters, and relationships between themes were explored through proximity estimation.
RESULTS
Both paediatricians and general practitioners in low-prescribing regions reported supporting contextual factors (in particular good collegial networks, good collaboration with laboratories) and social factors (collegial support and low patient demand for antibiotics) as important resources. In high-prescribing regions, poor coordination between in-patient and ambulatory health services, lack of region-level information on antimicrobial resistance, few professional development opportunities, and regional variations in patient expectations were identified as barriers to rational prescribing behaviour.
CONCLUSIONS
Interventions targeting professional development, better collaboration structures with laboratories and clearer and user-friendly guidelines could potentially support rational antibiotic prescribing behaviour. In addition, better networking and social support among physicians could support lower prescription rates.
Topics: Humans; Anti-Bacterial Agents; Germany; Qualitative Research; Practice Patterns, Physicians'; Male; Female; Adult; Interviews as Topic; General Practitioners; Pediatricians; Inappropriate Prescribing; Outpatients; Ambulatory Care; Middle Aged
PubMed: 38711087
DOI: 10.1186/s12913-024-11059-z -
Cureus Apr 2024Background and objectives Discectomy for lumbar disc herniation is the most common spinal surgical procedure. Technological advances have led to the emergence of...
Background and objectives Discectomy for lumbar disc herniation is the most common spinal surgical procedure. Technological advances have led to the emergence of minimally invasive surgical approaches such as tubular microdiscectomy (TMD) and percutaneous endoscopic lumbar discectomy (PELD). The purpose of this study was to compare the clinical outcomes of PELD to those of TMD at one-year follow-up. Materials and methods This observational registry-based (Spine Tango) cohort study included patients with symptomatic lumbar disc herniation submitted to PELD or TMD. The inclusion criteria were patients who underwent minimally invasive lumbar discectomy (PELD or TMD), patients who attended a follow-up after a minimum of 12 months post surgery, and valid pre- and postoperative questionaries. The primary endpoint was defined as the difference between pre- and postoperative Core Outcome Measures Index (COMI) for the back. The matching was based on a 1:1 nearest neighbor matching without replacement. Results A total of 109 patients were included in this study. Propensity score matching (PSM) was performed achieving 86 patients in the matched sample. Regarding COMI improvement, we found no significant difference between the PELD and TMD groups (paired t-test: estimate, -0.23; standard error, 0.6; p=0.7), and we also did not find any significant difference between groups concerning Oswestry Disability Index (ODI) and EuroQol 5 Dimension (EQ-5D). Medication usage and return to work were similar among the matched groups. Conclusions PELD is a technique that minimizes tissue damage achieving good clinical outcomes similar to TMD. This was observed one year after surgery from patient-reported outcome measures (PROMs) that measured pain improvement, disability, and quality of life.
PubMed: 38707033
DOI: 10.7759/cureus.57589 -
The Journal of Pediatrics May 2024The objective of this study was to examine associations between patient age and medication errors among pediatric inpatients.
OBJECTIVE
The objective of this study was to examine associations between patient age and medication errors among pediatric inpatients.
STUDY DESIGN
Secondary analysis of data sets generated from 2 tertiary pediatric hospitals: (1) prescribing errors identified from chart reviews for patients on 9 general wards at hospital A during April 22 to July 10, 2016, June 20 to September 20, 2017, and June 20 to September 30, 2020; prescribing errors from 5 wards at hospital B in the same periods and (2) medication administration errors assessed by direct prospective observation of 5137 administrations on 9 wards at hospital A. Multilevel models examined the association between patient age and medication errors. Age was modeled using restricted cubic splines to allow for nonlinearity.
RESULTS
Prescribing errors increased nonlinearly with patient age (P = .01), showing little association from ages 0 to 3 years and then increasing with age until around 10 years and remaining constant through the teenage years. Administration errors increased with patient age, with no association from 0 to around 8 years and then a steady rise with increasing age (P = .03). The association differed by route: linear for oral, no association for intravenous infusions, and U-shaped for intravenous injections.
CONCLUSIONS
Older age is an unrecognized risk factor for medication error on general wards in pediatric hospitals. Contributors to risk may be the clinical profiles of these older children or the general level of attention paid to medication practices for this group. Further investigation may allow the design of more targeted interventions to reduce errors.
PubMed: 38705229
DOI: 10.1016/j.jpeds.2024.114087 -
AMA Journal of Ethics May 2024Antimicrobial resistance is a global threat that inequitably affects minoritized populations, including Black, Latinx, and Indigenous people-especially in carceral...
Antimicrobial resistance is a global threat that inequitably affects minoritized populations, including Black, Latinx, and Indigenous people-especially in carceral settings-and is largely driven by inappropriate antimicrobial prescribing practices. People whose identities are minoritized are more likely to be incarcerated, and people who are incarcerated experience higher disease risk than people who are not incarcerated. This article draws on a case of dental infection suffered by a woman who is incarcerated to consider key ethical and clinical complexities of antimicrobial prescribing in carceral settings.
Topics: Humans; Antimicrobial Stewardship; Female; Anti-Bacterial Agents; Prisoners; Inappropriate Prescribing; Prisons; Adult
PubMed: 38700524
DOI: 10.1001/amajethics.2024.399 -
Toxicology Reports Jun 2024We present the extraordinary circumstance of a female patient in her sixties who suffered a massive lignocaine overdose while undergoing treatment with Veno-Arterial...
We present the extraordinary circumstance of a female patient in her sixties who suffered a massive lignocaine overdose while undergoing treatment with Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) following an emergency coronary artery bypass graft (CABG). The patient was initially admitted to the Intensive Care Unit (ICU) due to unstable angina and a history of insulin-dependent type two diabetes mellitus, hypertension, hypercholesterolemia, carotid artery stenosis, and an extensive smoking history. Despite initial improvements following surgery, she experienced repeated episodes of nonsustained polymorphic ventricular tachycardia (VT) that were refractory to conventional antiarrhythmic medications. The overdose occurred due to a medication administration error, leading to the infusion of lignocaine at a rate eight times higher than intended, over the course of 36 h (total dose of 9964 mg, or 153 mg/kg). Remarkably, the patient remained haemodynamically stable throughout the overdose period, with normal sinus rhythm, requiring minimal ECMO support and no vasoactive agents. Further investigation into the pharmacokinetics of lignocaine during VA ECMO treatment suggested that the patient's unexpected stability and survival could be attributed to the adsorption of lignocaine onto the components of the ECMO circuit. This phenomenon potentially mitigated the cardiotoxic effects typically associated with such high doses of lignocaine, thus presenting an unusual but critical aspect of pharmacokinetics in the context of ECMO support. This case underscores the importance of investigating the complex interactions between medications and extracorporeal circuits, which can significantly alter drug pharmacokinetics and toxicity profiles.
PubMed: 38699074
DOI: 10.1016/j.toxrep.2024.04.005 -
Cadernos de Saude Publica 2024Brazil presents high maternal and perinatal morbidity and mortality. Cases of severe maternal morbidity, maternal near miss, and perinatal deaths are important health...
Brazil presents high maternal and perinatal morbidity and mortality. Cases of severe maternal morbidity, maternal near miss, and perinatal deaths are important health indicators and share the same determinants, being closely related to living conditions and quality of perinatal care. This article aims to present the study protocol to estimate the perinatal mortality rate and the incidence of severe maternal morbidity and maternal near miss in the country, identifying its determinants. Cross-sectional study integrated into the research Birth in Brazil II, conducted from 2021 to 2023. This study will include 155 public, mixed and private maternities, accounting for more than 2,750 births per year, participating in the Birth in Brazil II survey. We will collect retrospective data from maternal and neonatal records of all hospitalizations within a 30-day period in these maternities, applying a screening form to identify cases of maternal morbidity and perinatal deaths. Medical record data of all identified cases will be collected after hospital discharge, using a standardized instrument. Cases of severe maternal morbidity and maternal near miss will be classified based on the definition adopted by the World Health Organization. The perinatal deaths rate and the incidence of severe maternal morbidity and maternal near miss will be estimated. Cases will be compared to controls obtained in the Birth in Brazil II survey, matched by hospital and duration of pregnancy, in order to identify factors associated with negative outcomes. Results are expected to contribute to the knowledge on maternal morbidity and perinatal deaths in Brazil, as well as the development of strategies to improve care.
Topics: Humans; Brazil; Female; Pregnancy; Perinatal Mortality; Cross-Sectional Studies; Near Miss, Healthcare; Maternal Mortality; Infant, Newborn; Pregnancy Complications; Retrospective Studies; Incidence; Adult; Socioeconomic Factors
PubMed: 38695462
DOI: 10.1590/0102-311XPT248222