Category: Nevin Manimala

J Adv Nurs. 2025 Jan 26. doi: 10.1111/jan.16770. Online ahead of print.

ABSTRACT

AIM(S): To adapt and validate the HSOPS 2 instrument for the Italian context and to describe the current patient safety culture amongst healthcare personnel working in Italian hospitals.

DESIGN: Cross-sectional study.

METHODS: We adapted and validated the HSOPS 2 instrument following the COSMIN guidelines: we performed a forward-backward translation, calculated the content validity index, evaluated face validity, acceptability (percentage of participants responding to all items on the questionnaire and to every specific item), construct validity (confirmatory factor analysis), and internal consistency (Cronbach’s alpha for each dimension). We then performed a cross-sectional study following the guidelines of the original instrument: we categorised the responses into “positive,” “negative,” and “midpoints.” For each dimension we calculated the average percentage of positive responses. We repeated this process, dividing the responses by various sample characteristics (e.g., profession), and compared them using the chi-square test. Data were collected between April and November 2023.

RESULTS: A total of 633 hospital personnel participated in the survey, and 473 completed the questionnaire in its entirety. The dimensions of “teamwork”, “supervisor”, “manager”, or “clinical leader support”, and “communication about error” emerged as dimensions with higher percentages of positive responses, while those that received lower percentages were “hospital management support for patient safety”, “staffing and work pace”, and “response to error”. We identified statistically significant differences in many dimensions between gender, profession, and clinical inpatient units.

CONCLUSIONS: These findings provide a comprehensive overview of challenges and opportunities within the healthcare sector as regards patient safety culture and can inform the development of targeted interventions aimed at improving patient safety across healthcare organisations.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Proper assessment of safety culture, one of the main indicators of patient safety, can inform the development of effective strategies and interventions to enhance patient safety.

IMPACT: What problem did the study address? To effectively assess patient safety culture, it is essential to use valid and reliable tools. It is crucial to proactively assess patient safety culture in hospital personnel, whether employed in clinical units, in management, or in support services, to develop initiatives aimed at improving patient safety. What were the main findings? The use of the adapted and validated version of the HSOPS 2 will produce valid and reliable evidence on patient safety culture. Perception of patient safety culture differs amongst respondents according to gender, profession, clinical setting. The dimensions of “hospital management support for patient safety”, “staffing and work pace”, and “response to error” were identified as those with the greatest need for improvement. Where and on whom will the research have an impact? Patient safety heavily impacts care at every level; therefore, this study could have an impact on healthcare organisations as well as healthcare workers, patients, and their families. By making available an instrument that can contribute to a proper assessment of patient safety culture, this study might contribute to the development of appropriate strategies and targeted interventions to improve patient safety, quality of care and satisfaction while decreasing adverse events and related costs.

REPORTING METHOD: The COSMIN guidelines were used for the validation of the instrument; the STROBE reporting guidelines were used for the cross-sectional study.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:39865467 | DOI:10.1111/jan.16770

Early Interv Psychiatry. 2025 Feb;19(2):e70004. doi: 10.1111/eip.70004.

ABSTRACT

AIM: Accurate and appropriate cognitive screening can significantly enhance early psychosis care, yet no screening tools have been validated for the early psychosis population and little is known about current screening practices, experiences, or factors that may influence implementation. CogScreen is a hybrid type 1 study aiming to validate two promising screening tools with young people with first episode psychosis (primary aim) and to understand the context for implementing cognitive screening in early psychosis settings (secondary aim). This protocol outlines the implementation study, which aims to explore the current practices, acceptability, feasibility and determinants of cognitive screening in early psychosis settings from the perspective of key stakeholders.

METHODS: Young people with first episode psychosis (n = 350), caregivers (minimum n = 10) and service providers (minimum n = 12) will be recruited from primary and specialist early psychosis services in Melbourne, Adelaide and Sydney, Australia. Two implementation science frameworks will inform data collection and analysis: the Theoretical Framework of Acceptability and the Consolidated Framework for Implementation Research. A mixed-methods design will be employed to collect and analyse data from questionnaires with young people, interviews with all stakeholder groups, and administrative processes. Quantitative data will be analysed using descriptive statistics. Qualitative data will be analysed through content analysis using deductive and inductive coding.

RESULTS AND DISCUSSION: This protocol paper presents the rationale and methods for the CogScreen implementation study.

CONCLUSION: Together with accuracy findings, results from the implementation study will provide insights about the practices, experiences, enablers and barriers to cognitive screening in early psychosis services.

PMID:39865466 | DOI:10.1111/eip.70004

Int J Nurs Pract. 2025 Feb;31(1):e13324. doi: 10.1111/ijn.13324.

ABSTRACT

BACKGROUND: Work environments that support patient safety initiatives are important for quality service and patient outcomes. The relationship between the leadership behaviours of nurse managers and safety culture, which has the potential to support these initiatives, constitutes one of the most important knowledge gaps.

OBJECTIVES: The study aimed to determine the relationship between nurses’ perceived leadership behaviours and hospital safety culture and the factors affecting them.

DESIGN: We tested the theoretical model using structural equation modelling with the AMOS 21 program.

METHODS: The research was conducted with 134 nurses in two public hospitals in the south of Türkiye. Data were collected between October and December 2021 using the Leadership Behaviour Questionnaire and the Patient Safety Culture Hospital Questionnaire. Descriptive statistical analysis used to evaluate the data of the study. Structural equation modelling analysis and confirmatory factor analysis performed to test the research hypotheses.

RESULTS: The study found that non-punitive attitudes towards the mistakes had a full mediating effect on overall perception of safety interaction with employee-oriented leadership and high-level hospital interventions (β = -0.510, 95% CI -1.006/-0.076), and change had partly mediating effect on overall perception of safety interaction with change-oriented leadership (β = -0.510, 95% CI -1.043/-0.053).

CONCLUSIONS: It is clear that if nurse managers are to improve the staff’s patient safety culture, they should develop change-oriented leadership skills by identifying adverse events and risks and motivating staff to learn from errors without taking punitive measures. In this context, healthcare organizations should evaluate the leadership qualities of managers. Managers at all levels can make plans to develop leadership behaviours that will play a facilitating role in improving patient safety.

PMID:39865458 | DOI:10.1111/ijn.13324

Knee Surg Sports Traumatol Arthrosc. 2025 Jan 26. doi: 10.1002/ksa.12579. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the rate and timing for return to football league games after anterior cruciate ligament reconstruction (ACLR) in Swedish players, examining associations with sex, age, level, graft and additional ACL surgery.

METHOD: Data from the Swedish National Knee Registry (SNKLR) and the Swedish Football Association’s IT System (FOGIS) were used. The study cohort comprised 971 football players, 64% males, who underwent primary ACLR. Demographics, graft type and surgical information were extracted from the SNKLR and game participation from FOGIS. Follow-up for return to competition (RTC) was conducted for 36 months, while additional ACLR follow-up was 3-7 years. Statistical analyses, including Kaplan-Meier survival curves and relative risk calculations, were employed to assess factors influencing RTC rates and timing.

RESULTS: Out of 971 players analyzed, 53% RTC within 3 years with no difference between males and females, at a mean of 15 months (median 14 months) from surgery to the first game. Eleven (2%) players RTC < 6 months from ACLR, 62 (12%) 6-9 months, 125 (24%) 9-12 months and 331 (63%) >12 months. Patellar tendon (PT) grafts demonstrated superior performance, showing quicker returns and higher RTC rates (p = 0.005) compared to hamstring (hazard ratio [HR]: 0.63 [0.48-0.84]) and quadriceps tendon grafts (HR: 0.53 [0.30-0.93]). Players competing in higher divisions pre-injury experienced significantly swifter and higher RTC rates (p < 0.001). Ninety-five (10%) had a registered additional ACLR. Players who RTC did not exhibit a significantly higher rate of revision (35 [7%] vs. 25 [5%]). However, those who returned faced a heightened risk of contralateral ACLRs compared to those who did not RTC (32 [6%] vs. 4 [1%] RR 1.72 [1.59-1.96], p < 0.001).

CONCLUSION: The study reveals that 53% of football players RTC after ACLR, predominantly after more than 12 months. The RTC was higher and faster in high-level players and those receiving a PT graft. The slow RTC may contribute to the relatively low rate of additional ACLRs.

LEVEL OF EVIDENCE: Level III.

PMID:39865456 | DOI:10.1002/ksa.12579

Aust N Z J Obstet Gynaecol. 2025 Jan 26. doi: 10.1111/ajo.13940. Online ahead of print.

ABSTRACT

BACKGROUND: Modern assisted reproductive technology (ART), including pre-implantation genetic testing for aneuploidy (PGT-A), has opened new avenues in understanding early embryonic events and has simultaneously raised questions about the impact of ART itself on sex ratios.

AIMS: The primary aim was to investigate whether patient demographic characteristics, ovarian stimulation protocols or laboratory characteristics in ART influence sex ratios. The secondary aim was to relate the blastocyst sex ratio (BSR) to the corresponding secondary sex ratio (SSR) in our patient cohort.

MATERIALS AND METHODS: We conducted a retrospective single-centre cohort study on consecutive PGT-A cycles from January 2019 to February 2022. We analysed demographic data, stimulation protocols, laboratory characteristics and pregnancy outcomes.

RESULTS: The euploidy rate was 45.1% (2608/5777), BSR 1.07 and euploid BSR 1.03. There was no statistical difference in the ploidy status of XX and XY blastocysts and on multivariate logistic regression analysis, there was no association between euploidy and BSR or any other variables examined, including female age and stimulation protocol. The SSR was 1.02 (1294 embryo transfers) with no statistical difference in biochemical pregnancy (p = 0.41), clinical pregnancy (p = 0.56), miscarriage (p = 0.65) or live birth rates (p = 0.40) based on embryo sex.

CONCLUSIONS: Our study indicates that the euploid BSR is not skewed by sex, and there is no relationship between BSR and euploidy, patient characteristics or stimulation protocols. Pregnancy outcomes did not vary by sex, and the SSR was consistent with the SSR of the general Australian population at birth.

PMID:39865443 | DOI:10.1111/ajo.13940

Cancer. 2025 Feb 1;131(3):e35734. doi: 10.1002/cncr.35734.

ABSTRACT

BACKGROUND: Breast cancer screening (BCS) inequities are evident at national and local levels, and many health systems want to address these inequities, but may lack data about contributing factors. The objective of this study was to inform health system interventions through an exploratory analysis of potential multilevel contributors to BCS inequities using health system data.

METHODS: The authors conducted a cross-sectional analysis within a large academic health system including 19,774 individuals who identified as Black (n = 1445) or White (n = 18,329) race and were eligible for BCS. They evaluated individual-level, provider-level, and clinic-level factors. They conducted logistic regression and Blinder-Oaxaca (BO) decomposition analyses to quantitatively estimate the contribution of factors to the mean difference in BCS outcomes between the two racialized groups. They calculated average marginal effects (AME) for the logistic regression models representing the estimated additive probability of receiving BCS in the Black versus White group.

RESULTS: BCS was completed in 63.7% of Black and 71.7% of White individuals (AME, -0.08; 95% confidence interval (CI), -0.10 to -0.04; p < .001). In the BO decomposition, observed factors explained 13.3% difference in BCS. Lower patient portal use among Black versus White patients had the greatest estimated contribution to the BCS inequity (4.6 percentage points; 95% CI, 3.0-6.2).

CONCLUSION: Racialized group differences in patient portal use had the greatest estimated contribution to the explained difference in BCS between Black and White individuals. Patient portal use promotion could be considered as a part of multifaceted health system efforts to address BCS inequities.

PMID:39865423 | DOI:10.1002/cncr.35734

Pharmacol Res Perspect. 2025 Feb;13(1):e70066. doi: 10.1002/prp2.70066.

ABSTRACT

Doxorubicin (DOXO) has long been used clinically and remains a key drug in cancer therapy. DOXO-induced cardiomyopathy (DICM) is a chronic and fatal complication that severely limits the use of DOXO. However, there are very few therapeutic agents for DICM, and there is an urgent need to identify those that can be used for a larger number of patients. The most likely pathogenic mechanism of DICM is the involvement of reactive oxygen species (ROS) and promotion of cell death. In this study, we investigated the efficacy and mechanism of action of edaravone (EDA), a known radical scavenger in DICM. Two methods of EDA administration were employed: daily and weekly. Our results showed that the daily administration group had prolonged survival periods and preserved the left ventricular ejection fraction in DICM mice. In contrast, in the weekly treatment group, slight improvements were observed in these indicators compared with those in DICM mice; however, none of them were statistically significant. These results show that the daily administration group had a higher efficacy than the weekly administration group. Gene-expression results showed that Nrf2 and its related genes were upregulated in the daily group but not in the weekly group. Based on these results, we hypothesized that the Sirt1/Nrf2/HO-1 and ABCB4 pathways were involved in EDA. However, there is limited evidence that EDA is effective against DICM. The findings obtained herein bolster the evidence in DICM by demonstrating prolonged survival and continued preservation of cardiac function and proposing a possible mechanism.

PMID:39865410 | DOI:10.1002/prp2.70066

J Ren Care. 2025 Mar;51(1):e70003. doi: 10.1111/jorc.70003.

ABSTRACT

BACKGROUND: Uremic pruritus is a quite common condition among patients with chronic kidney disease. Symptom severity and patterns are variable.

AIM: To assess how nurses in the field of nephrology perceive the issue of uremic pruritus in dialysis patients and the relevance of this condition.

DESIGN: A qualitative survey-based study.

PARTICIPANTS: Nurses working in the field of nephrology.

METHODS: Nurses were administered an online survey with a 10-item survey (5 on socio-demographics, 5 specific to nephrology). Responses were reported in descriptive form and response rates.

RESULTS: The study involved 185 nurses working in the field of nephrology, most of which were over the age of 40, and 39% had over 20 years of experience. Most perceived that uremic pruritus has decreased over the years thanks to better dialysis methods and that it is currently independent of the type of dialysis. Fifty-two percent estimate pruritus affects half or more of patients, and 47.6% that it affects only a minority. 75% estimate moderate-to-severe uremic pruritus involves between 1 and 3 cases every 10 patients (40.5% estimating ≤3/10 patients and 34.6% ≤1/10 patients), and 25% it affects at least half of patients. 41% estimate that more than half the patients do not find relief from PU to prevent it from impairing their quality of life.

CONCLUSIONS: The results highlight a large divergence in the perception of uremic pruritus among nurses. While this evidence the need for greater awareness on uremic pruritus, this also suggests a privileged role for nurses in detecting uremic pruritus occurrence and properly referring patients to nephrologist.

PMID:39865403 | DOI:10.1111/jorc.70003

Cancer Med. 2025 Feb;14(3):e70582. doi: 10.1002/cam4.70582.

ABSTRACT

INTRODUCTION: Immune checkpoint inhibitors (ICI) have improved the therapeutic arsenal in outpatient oncology care; however, data on necessity of hospitalizations associated with immune-related adverse events (irAEs) are scarce. Here, we characterized hospitalizations of patients undergoing ICI, from the prospective cohort study of the immune cooperative oncology group (ICOG) Hannover.

METHODS: Between 12/2019 and 06/2022, 237 patients were included. Clinical data and characteristics of ICI were collected during a 6-month observation period after the initiation of therapy. Descriptive statistics and Kaplan-Meier statistics were administered.

RESULTS: During the observation period, 30/237 patients were hospitalized (HA(+)). Most common underlying tumor entities were malignant melanoma (59.5%), renal cell carcinoma (13.1%), and nonsmall-cell lung carcinoma (12.7%). HA(+) patients exhibited an increased rate of pulmonary and cerebral metastases. We observed a significantly higher hospitalization rate during dual ICI with Nivolumab and Ipilimumab (p = 0.001). The predominant irAEs for hospitalization were colitis (26.7%), followed by hypophysitis (13.3%), leading to a median hospitalization of 7 (1-34) days. Interdisciplinary consultations were frequent, especially to gastroenterology (46.7%) and neurology (26.7%). Although a trend toward a prolonged overall survival in the HA(+) subgroup was identified, no statistically significant differences were found.

DISCUSSION: The hospitalization rate of 12.6% is comparable to rates reported in previous studies. There was a disproportionate admission of patients with immune-related colitis and hypophysitis compared to the prevalence described under ICI. We observed a high need for interdisciplinary consultations in line with the heterogeneity of immune-mediated side effects. Compared to non-hospitalized patients, there was no survival disadvantage in the HA(+) cohort.

CONCLUSION: With a relatively low hospitalization rate, short length of stay, and good clinical outcome, our data support the outpatient nature of ICI. The findings underscore the importance of interdisciplinary collaboration and vigilant monitoring of irAEs to ensure timely recognition and management.

PMID:39865401 | DOI:10.1002/cam4.70582

Orthod Craniofac Res. 2025 Jan 25. doi: 10.1111/ocr.12901. Online ahead of print.

ABSTRACT

OBJECTIVE: Primary aim was to analyse dentoalveolar and skeletal effects induced by an anterior open bite (AOB) treatment protocol for intrusion of maxillary buccal segment. Secondary aim was to investigate whether a subsequent change occurred in hyoid position.

MATERIALS AND METHODS: Study group included 28 non-growing subjects treated in academic setting for correction of AOB. All patients received same appliance that included bilateral acrylic bite-blocks covering posterior dentition. Intrusive force was applied between buccal bars of appliance and zygomatic multipurpose implants. Lateral cephalograms taken at pre-treatment (T0) and after intrusion (T1) were analysed using NemoCeph software. Eight skeletal, 9 dental, 6 soft tissue and 5 hyoid parameters were measured and evaluated statistically.

RESULTS: Mean open bite was -3.2 ± 2.1 mm at T0. T1-T0 duration was 9.6 ± 1.9 months. Increase in SNB (1.1° ± 2.1°) and the decrease in ANB (-1.1° ± 1.3°), Y-axis (-0.5° ± 3.5°), SN-GoGn (-2.0° ± -2.5°) and lower facial height (-1.4 ± 2.1 mm) were significant, indicating mandibular counter-clockwise rotation. Overjet and open bite decreased significantly (-1.8 ± 2.3 mm and 4.2 ± 2.1 mm, respectively). Maxillary molars intruded (U6-PP: -3.1 ± 1.3 mm) and distalised (ΔU6-TVL: -1.5 ± 2.7 mm) significantly. Mean change in L6-MP was significant (0.9 ± 1.4 mm) showing mandibular molar eruption. Lower lip-true vertical line (TVL) showed significant forward movement of lower lip (-1.8 ± 2.3 mm). Mean changes in hyoid parameters were not significant.

CONCLUSION: Significant maxillary buccal segment intrusion was achieved in a relatively short period. AOB was corrected while facial profile and smile aesthetics were improved. Distalisation of maxillary molar suggests that intrusive force vector can be modified to achieve simultaneous intrusion and distalisation.

PMID:39865400 | DOI:10.1111/ocr.12901