Tag: pubmed

Am J Public Health. 2022 May 26:e1-e5. doi: 10.2105/AJPH.2022.306853. Online ahead of print.

ABSTRACT

A Fruit and Vegetable Prescription program (12-16 weeks, 2018-2020) was implemented at community health centers serving rural communities in the northwestern United States. The impact of the program on type 2 diabetes control was evaluated. Reductions in mean hemoglobin A1C were statistically significant (P < .01). The percentage of participants with critically high blood glucose levels (A1C > 9%) decreased from 76% (114/151) to 41% (62/151; P < .01). The findings mirror those of similar programs. The sustainability of these beneficial interventions, however, relies on improved access to preventive care. (Am J Public Health. Published online ahead of print May 26, 2022: e1-e5. https://doi.org/10.2105/AJPH.2022.306853).

PMID:35617654 | DOI:10.2105/AJPH.2022.306853

J Patient Saf. 2022 May 25. doi: 10.1097/PTS.0000000000001044. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate the association between nursing care left undone in pediatrics and factors related to nursing staff characteristics and work environment.

METHODS: The data of the present study were extracted from our RN4CAST@IT-Ped database, a cross-sectional observational study, which included 13 hospitals belonging to the Italian Association of Paediatric Hospitals. Through convenience sampling, nurses and pediatric nurses providing direct care in routine pediatric wards were enrolled in the study. Data aggregated by clinical care area were analyzed, through descriptive and inferential statistics methods using IBM SPSS 22.0 software.

RESULTS: We collected data from 399 pediatric nurses working in surgical wards, 1208 in medical wards, and 631 in critical care units. Some of the investigated factors have shown an association with the risk of omitting essential nursing activities, like health care judged of poor quality, patient safety judged as poor, and nurses’ intention-to-leave the job. For every nursing activity under investigation, we found some significant statistical associations.

CONCLUSIONS: Our results are consistent with the international literature showing that nurses miss some activities more frequently. Understanding the associations underpinning care left undone could be a starting point for the implementation of patient-centered care and the improvement of the quality and safety of care in pediatric settings, as well as the work environment.

PMID:35617633 | DOI:10.1097/PTS.0000000000001044

J Am Acad Orthop Surg. 2022 May 25. doi: 10.5435/JAAOS-D-21-01272. Online ahead of print.

ABSTRACT

INTRODUCTION: Although regarded as conservative treatment, casting is not without risk. Injuries may be sustained during application, during cast valving, through the immobilization process, or during cast removal. We developed an experimental model to investigate safe parameters for the appropriate length of time between fiberglass cast application and bivalving for cast saw use.

METHODS: A hospital sheet was rolled into a mock “arm” on which short-arm fiberglass casts were formed. An appropriate cast saw technique was used with complete withdrawal of the saw blade from the cast material between cuts. A total of 10 casts were made for control/no vacuum (N = 5) and study/vacuum (N = 5) groups. The temperature of the saw blade was measured at 1-minute increments beginning at 3 minutes after fiberglass submersion in water. A mixed factor analysis of variance assessed differences in temperature change over time between groups with a statistical threshold of P < 0.05.

RESULTS: Casts that set for 7 minutes were associated with lower blade temperatures compared with casts that set for 3, 4, 5, and 6 minutes. The average temperature increases for the 3- to 7-minute set times without the use of vacuum were 10.08 (± 1.42), 9.38 (±1.31), 9.32 (±1.85), 8.54 (±2.10), and 5.62°F (±2.42), respectively, and with the use of vacuum, they were 9.40 (±1.14), 8.36 (±1.64), 7.84 (±2.05), 7.30 (±3.14), and 4.82°F (±2.59), respectively. Independent of vacuum use, the change in temperature was significantly different from the maximum temperature (3 minutes) beginning at 7 minutes (all P < 0.043).

DISCUSSION: A minimum of 7 minutes of set time for a fiberglass cast before attempting to bivalve using segmented cuts is associated with the smallest increase in temperature of the saw blade. Blade temperature was not affected with the vacuum enabled. Clinicians can demonstrate best practices to minimize the risk of cast saw injuries.

PMID:35617643 | DOI:10.5435/JAAOS-D-21-01272

J Patient Saf. 2022 May 22. doi: 10.1097/PTS.0000000000001045. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to measure the patient safety culture and the current practice of patient safety goals in China.

METHODS: This cross-sectional survey was conducted between November 2020 and November 2021. The 12-dimensions Hospital Survey on Patient Safety Culture questionnaire and the 14-items Survey on the Current Practice of Patient Safety Goal questionnaire were electronically distributed to 8164 healthcare providers across 26 provinces in China. Data were analyzed using descriptive statistics, correlation analysis, and multivariate linear regression.

RESULTS: A total of 8164 surveys were received, of which 7765 were valid and analyzed. The average positive response rate for the Hospital Survey on Patient Safety Culture survey was 69.68% (43.41%-91.54%). The percentage of positive responses in 5 dimensions (organizational learning, teamwork within units, feedback about error, management support for safety, and teamwork across units) was above the control limits, and 3 (nonpunitive response to error, staffing, and frequency of event reporting) were below the control limits. The average positive response rate for the Survey on the Current Practice of Patient Safety Goal survey was 96.11%. Patient safety culture was positively related to the current practice of patient safety goals (r = 0.34, P < 0.001).

CONCLUSIONS: Our study concludes that although healthcare providers in China feel positively toward patient safety culture and practicably toward patient safety goals, considerable work is still needed to promote a patient safety movement.

PMID:35617631 | DOI:10.1097/PTS.0000000000001045

J Patient Saf. 2022 May 22. doi: 10.1097/PTS.0000000000001041. Online ahead of print.

ABSTRACT

OBJECTIVES: Patients admitted to the intensive care unit (ICU) are at high risk for hazardous medical radiation exposure. However, the cumulative annual radiation exposure in ICU survivors remains unknown.

METHODS: This was a single-center retrospective study of all critically ill adult patients admitted to the 64-bed adult medical ICU at a quaternary medical center. The study included patients aged 18 to 39 years admitted through the year 2013 (January 1, 2013-December 31, 2013) who survived their respective ICU admission.

RESULTS: A total of 353 patients were included in the study. The median cumulative effective dose (CED) for the calendar year was 9.14 mSv (interquartile range, 1.74-27 mSv). In 11.6% of the patients (n = 41), CED was more than 50 mSv, while 5.1% of the patients (n = 18) exceeded annual CED of 100 mSv. Overall, radiation exposure from ICU-related imaging studies was lower than those from other medical settings (mean difference, -9.2 ± 83.6; P < 0.05). However, there was no statistically significant difference in exposure (ICU versus non-ICU) when restricting the analysis to patients with a CED of greater than 50 and greater than 100 mSv. Eighty-seven percent of the original cohort was alive at the end of the year.

CONCLUSIONS: Young ICU survivors are at risk for high annual radiation exposure from both ICU and non-ICU sources. A subset is exposed to hazardous annual radiation exposure in excess of 100 mSv.

PMID:35617610 | DOI:10.1097/PTS.0000000000001041

J Patient Saf. 2022 Jun 1;18(4):e801-e809. doi: 10.1097/PTS.0000000000000918.

ABSTRACT

OBJECTIVES: Continuous infusions of sedatives and/or opioids (continuous infusions) are frequently used in end-of-life care. Available data indicate challenges in nonspecialist palliative care settings. We aimed to assess the use of continuous infusions during the last week of life in different hospital departments.

METHODS: In a sequential mixed-methods design, a retrospective cohort study was followed by consecutive qualitative interviews in 5 German hospital departments. Medical records of 517 patients who died from January 2015 to December 2017 were used, and 25 interviews with physicians and nurses were conducted. Recorded sedatives were those recommended in guidelines for “palliative sedation”: benzodiazepines, levomepromazine, haloperidol (≥5 mg/d), and propofol. Exploratory statistical analysis (R 3.6.1.) and framework analysis of interviews (MAXQDA 2018.2) were performed.

RESULTS: During the last week of life, 359 of 517 deceased patients (69%) received continuous infusions. Some interviewees reported that continuous infusions are a kind of standard procedure for “palliative” patients. According to our interviewees’ views, equating palliative care with continuous infusion therapy, insufficient experience regarding symptom control, and fewer care needs may contribute to this approach. In addition, interviewees reported that continuous infusions may be seen as an “overall-concept” for multiple symptoms. Medical record review demonstrated lack of a documented indication for 80 of 359 patients (22%). Some nurses experienced concerns or hesitations among physicians regarding the prescription of continuous infusions.

CONCLUSIONS: Continuous infusions seem to be common practice. Lack of documented indications and concerns regarding the handling and perception of a “standard procedure” in these highly individual care situations emphasize the need for further exploration and support to ensure high quality of care.

PMID:35617602 | DOI:10.1097/PTS.0000000000000918

J Patient Saf. 2022 Jun 1;18(4):e753-e759. doi: 10.1097/PTS.0000000000000942.

ABSTRACT

OBJECTIVES: The purposes of this article were to describe the perceptions of the culture of safety in pediatric primary care and evaluate whether organizational factors and staff roles are associated with perceptions of the culture of safety.

METHODS: We conducted a secondary data analysis using 2020 Agency for Healthcare Research and Quality Medical Office Survey on Patient Safety Culture to examine the culture of safety and quality in pediatric primary care practices. We used descriptive statistics and calculated differences in perceptions of patient safety and quality based on practice size, ownership, and staff roles using bivariate and logistic regressions.

RESULTS: The sample included 99 pediatric primary care practices and 1228 staff (physicians n = 169, advanced practice providers n = 70, nurses n = 338, and administration/management n = 651). The “teamwork” domain had the highest positive ratings (≥81.6% positive responses), whereas the “work pressure and pace” domain had the lowest positive ratings (≤28.6% positive response). There were no differences in perceptions of safety or quality based on practice size or ownership. However, there were differences based on staff roles, specifically between administration/management and direct care staff.

CONCLUSIONS: Overall, perceptions of the culture of safety and quality in pediatric primary care practices were positive. Differences in perceptions existed based on staff role. Future studies are needed to determine whether differences are clinically meaningful and how to narrow differences in perceptions among staff and improve of the culture of safety as a mechanism to improve the safety and quality of pediatric primary care.

PMID:35617600 | DOI:10.1097/PTS.0000000000000942

J Patient Saf. 2022 Jun 1;18(4):e714-e721. doi: 10.1097/PTS.0000000000000939. Epub 2021 Dec 17.

ABSTRACT

OBJECTIVES: The primary aim of this study was to evaluate whether a high Medication Risk Score (MERIS) upon admission to an emergency department is associated with increased risk of 30-day readmission in patients discharged directly home. Mortality, visit to general practitioner, and drug changes within 30 days were included as secondary outcomes.

METHODS: This is a historical cohort study with data from the Danish population-based open-cohort CROSS-TRACKS. Cox regression analyses were used to determine whether a high MERIS score was associated with increased risk of 30-day readmission and mortality. Visit to general practitioner and drug changes were tested with χ2 test and Wilcoxon rank sum test.

RESULTS: A total of 2106 patients were eligible: 2017 had a MERIS score lower than 14 (low-risk group), and 89 had a score of 14 or higher (high-risk group). The proportion of patients in the high-risk group who were readmitted was 21.3% compared with 16.3% in the low-risk group, resulting in a hazard ratio for readmission of 1.43 (95% confidence interval, 0.9-1.3). The hazard ratio for mortality was 8.3 (95% confidence interval, 3.0-22.8). No statistical significant difference was found in general practitioner visits; however, significantly more drug changes were observed in the high-risk group.

CONCLUSIONS: A high MERIS score was associated with increased risk of readmissions and can potentially assist healthcare professionals in the prioritizing of patients who may benefit from further exam, for example, additional medication review in acute care setting. Further investigation of MERIS and exploration of causal inferences between medication-related harm and medication-related readmissions are warranted.

PMID:35617596 | DOI:10.1097/PTS.0000000000000939

Am Surg. 2022 May 26:31348221105575. doi: 10.1177/00031348221105575. Online ahead of print.

ABSTRACT

BACKGROUND: The National Accreditation Program for Rectal Cancer recommends a pelvic MRI to assess the response to neoadjuvant therapy for advanced rectal cancers. However, there is no single restaging modality that can identify all patients with complete tumor response. At our institution, we perform both a pelvic MRI and a flexible sigmoidoscopy (FS) after neoadjuvant therapy prior to surgical resection.

OBJECTIVE: The objective is to elucidate the correlation of tumor response between FS and MRI in patients undergoing neoadjuvant therapy for locally advanced rectal cancer.

DESIGN: Single institution from 2010 to 2019. Retrospective cohort study comparing local tumor response on FS to MRI utilizing final pathology as the gold standard for comparison.

PATIENTS: Patients with confirmed locally advanced rectal adenocarcinoma (stage II or III) who underwent neoadjuvant therapy prior to surgical intervention and underwent flexible endoscopy and a standardized rectal cancer protocol MRI to evaluate tumor response.

RESULTS: A total of 48 patients were evaluated. Seven (14%) patients had a complete pathological response. MRI adequately reported 1 (14%), while FS found 4 (57.14%) out of the 7 complete responders. Nevertheless, this did not reach statistical significance (P = .06). On logistic regression analysis, flexible sigmoidoscopy had a 5.5 higher likelihood to report an accurate complete response (OR 5.5, 95% CI: 1.02-29.64; P = .047).

CONCLUSIONS: Flexible sigmoidoscopy should be used in conjunction with MRI in the work up of patients who have received neoadjuvant therapy for advanced rectal cancer prior to surgical resection.

PMID:35617529 | DOI:10.1177/00031348221105575

Dimens Crit Care Nurs. 2022 Jul-Aug 01;41(4):171-177. doi: 10.1097/DCC.0000000000000532.

ABSTRACT

BACKGROUND: Advances in medical care for oncology patients have heightened the complexity of this patient population, leading to an increased need for lifesaving, critical care. Yet, there is a lack of literature on education to prepare nurses to provide care to critically ill oncology patients.

OBJECTIVES: The purpose of this quality improvement project was to evaluate oncology nurses’ mastery of basic and oncology-specific critical care knowledge after an evidence-based supplemental training intervention.

METHODS: An 8-hour supplemental training intervention was developed to increase oncology nurses’ knowledge about basic and oncology critical care by addressing score deficiencies noted on the Basic Knowledge Assessment Tool (9r version). Seventeen oncology nurses completed the supplemental training intervention. The Basic Knowledge Assessment Tool and an Oncology Knowledge Survey were administered pre and post supplemental training, and significant changes were detected with Wilcoxon signed rank tests.

RESULTS: Mean total Basic Knowledge Assessment Tool scores significantly improved from 65.7 before initial course to 73.7 post supplemental training (P = .002). Oncology Knowledge Survey total scores increased from 75.3% to 80.9%, which was a statistically significant improvement (P = .039).

CONCLUSIONS: Critical care training is imperative for oncology nurses preparing to care for high-acuity oncology patients. Adequate knowledge of basic and oncology-specific critical care is important to prevent adverse events and improve outcomes for this complex patient population.

PMID:35617579 | DOI:10.1097/DCC.0000000000000532