Implications For Patient Safety Research Articles

Developing, Implementing, and Evaluating a Multimedia Patient Decision Aid Program to Reform the Informed Consent Process of a Peripherally Inserted Central Venous Catheter Procedure: Protocol for Quality Improvement.

BackgroundInformed consent has considerable clinical, ethical, and legal implications for patient safety and liability. Little information is available about the use of multimedia patient decision aids (PtDA) in the consent process for therapeutic invasive procedures such as the peripherally inserted central venous catheter (PICC). In addition, none of the available studies have designed their multimedia PtDAs based on the Agency for Healthcare Research and Quality’s (AHRQ) comprehensive guide for informed consent.ObjectiveThis paper describes a patient-centered, systematic, multidisciplinary approach to develop, implement, and alpha test a multimedia PtDA to reform the informed consent process of a PICC for patients in 10 acute and intensive care units.MethodsThe development, implementation, and evaluation processes of the PtDA followed the phases in the Multimedia Production Framework: preproduction, production, and postproduction. Within this framework, we applied the criteria for judging the quality of PtDAs, the AHRQ’s Health Literacy Universal Precautions Toolkit, and the AHRQ’s Patient Education Materials Assessment Tool Guide. The methodology was guided by the Interprofessional Shared Decision-Making Model and the AHRQ’s Making Informed Consent an Informed Choice guide. In the preproduction phase, we (1) reviewed the current consent form; (2) observed 18 consent processes; (3) surveyed the vascular access team (N=6 nurses) about their perception of the current process; (4) surveyed 30 patients for knowledge recall and retention, overall satisfaction, and attitude toward using a multimedia PtDA; and (5) wrote and reviewed the script for the multimedia program. The production phase focused on filming the PtDA in English and Spanish languages. The postproduction phase included integrating the multimedia programs into the care processes, developing a modified workflow for the consent process, and alpha testing of the English and Spanish PtDAs by (1) a group of 5 patients for clarity and understandability of the information; (2) nurses using the AHRQ’s Patient Education Materials Assessment Tool Audio and Video; and (3) by the multidisciplinary change team.ResultsBased on the alpha testing, patients indicated that the content was easy to follow and read; nurses provided positive feedback, and their comments were mainly related to the changes in the workflow in the consent process of the PICC after using the PtDA; and the multidisciplinary change team suggested edits related to changing a few scenes. The final multimedia program consisted of 7 min and 37 s demonstrating detailed information about the PICC.ConclusionsA systematic development of PtDAs for nonurgent invasive procedures may eliminate many limitations of the conventional consent process by ensuring comprehensive, standardized, and easy-to-comprehend information and providing sufficient time for the patients to reflect on the information. To be effective, PtDAs should follow a systematic, patient-centered, evidence-based, and rigorous approach in the development, implementation, and evaluation processes.International Registered Report Identifier (IRRID)RR1-10.2196/10709

Cubital Tunnel Decompression: Equivalent Outcome Scores when Procedure Performed with Local versus General Anesthetic

Background Ulnar nerve compression at the cubital tunnel is the second commonest upper limb neuropathy. Unlike carpal tunnel surgery, most of decompression procedures for this condition are undertaken using general anesthesia (GA). This has inherent economic and patient safety implications. We aimed to assess if there is a difference in early and medium-term outcome scores in patients who have cubital tunnel decompression under general versus local anesthesia (LA).Materials and Methods We undertook a patient outcome evaluation of patients who were under the care of two upper limb surgeons. Patients were evaluated postoperatively using the patient-related ulnar nerve evaluation (PRUNE) questionnaire. Patients were contacted by phone, mail, and face to face in clinics.Results A total of 34 patients were identified in the study. Eleven were excluded from the study. Thirteen patients underwent surgery under LA. The LA group had their procedures performed using local infiltration of the surgical site with 20 mL of 0.5% bupivacaine with adrenaline. Ten patients had their procedures using standard GA and tourniquet. The average PRUNE score in the LA group was 33.8, and that in the GA group was 34.1. This difference in PRUNE score was not statistically significant p > 0.05.Discussion Our data suggest that there is no significant difference in early and midterm outcomes between patients who undergo cubital tunnel decompression using either GA or LA. We advocate the use of LA as it does lead to decreased anesthetic risk and has obvious economic benefits such as lowering the demands on theater and anesthetic resources.

Alarm fatigue and the implications for patient safety.

To measure the response time of health professionals before sound alarm activation and the implications for patient safety. This is a quantitative and observational research conducted in an Adult Intensive Care Unit of a teaching hospital. Three researchers conducted non-participant observations for seven hours. Data collection occurred simultaneously in 20 beds during the morning shift. When listening the alarm activation, the researchers turned on the stopwatches and recorded the motive, the response time and the professional conduct. During collection, the unit had 90% of beds occupied and teams were complete. We verified that from the 103 equipment activated, 66.03% of alarms fatigued. Nursing was the professional category that most provided care (31.06%) and the multi-parameter monitor was the device that alarmed the most (66.09%). Results corroborate the absence or delay of the response of teams, suggesting that relevant alarms might have been underestimated, compromising patient safety.

Safety and Feasibility of Outpatient Liposomal Daunorubicin and Cytarabine (Vyxeos) Induction and Management in Patients with Secondary AML

▪Introduction:Liposomal daunorubicin and cytarabine (Vyxeos®) improves overall survival and remission rates compared to conventional daunorubicin and cytarabine (7+3) induction in older patients with secondary acute myeloid leukemia (AML). The safety profiles are similar, despite prolonged time to neutrophil and platelet count recovery with liposomal daunorubicin and cytarabine (Lancet et al, JCO 2018). There are other potential benefits of the liposomal combination, such as the feasibility of outpatient (OP) administration which can improve patient satisfaction and healthcare costs. Herein we show preliminary results of a pilot program based on OP liposomal daunorubicin and cytarabine administration to safely decrease inpatient (IP) days, with close OP monitoring throughout treatment phase until recovery.Methods:The objective of this study is to compare the IP hospital days between patients induced with liposomal daunorubicin and cytarabine in the Inpatient/Outpatient (IPOP) program vs. IP setting. The IPOP program involves administration of chemotherapy and close monitoring of patients in the OP setting who receive traditionally IP chemotherapy regimens. All patients received liposomal daunorubicin and cytarabine induction at a dose of daunorubicin 44 mg/m2 and cytarabine 100 mg/m2 via intravenous infusion over 90 minutes on days 1, 3 and 5. Patients were excluded for IPOP liposomal daunorubicin and cytarabine if they had signs or symptoms of active infection, cardiopulmonary disease, at risk for tumor lysis syndrome, ECOG > 2 or did not have an appropriate caregiver or transportation to the cancer center. Eligible patients received liposomal daunorubicin and cytarabine in the IPOP program and were monitored at least every other day until count recovery. Patients who developed complications such as febrile neutropenia were hospitalized with the goal of de-escalating antibiotic therapy and when appropriate, discharged to IPOP for continued care. Ineligible patients for IPOP treatment received IP liposomal daunorubicin and cytarabine induction and discharged to OP care prior to count recovery if clinically appropriate. A t-test of unequal variance was utilized to determine statistical significance between number of IP days between IPOP and IP groups.Results:Over the study period, 12 patients received induction therapy with liposomal daunorubicin and cytarabine. Seven patients (58%) received IPOP induction and 5 received IP induction (Median age: 72, 67 respectively). One patient was admitted prior to completing the third induction dose, the other six IPOP patients (86%) tolerated OP treatment well. All IPOP patients were eventually admitted, with median of 9 OP days prior to admission (range 4-17 days). All admissions were due to infectious complications: 5 were febrile neutropenia and one was due to a complicated skin/soft tissue abscess. Overall, the IPOP patients were only hospitalized for 46% of total days from start of induction until remission (CR, CRi, PR), progression, or recovery of neutrophils (≥500/µL) and platelets (≥50,000/µL). Mean cumulative days of IP and OP care were 19 and 22 days, respectively. Patients induced in the IP setting were hospitalized for 82% of their induction course with cumulative mean of 31 IP and 7 OP days. Mean cumulative IP hospital days was significantly less in the IPOP group as compared to the IP group (19 vs. 31 days, p=0.034). The overall response rate among the entire cohort was 75% (CR + CRi 50%) and was similar between the IPOP and IP groups. The median time to recover counts in patients who achieved CR + CRi was 36 days for both groups. The overall safety profile was similar between both groups. No patient died during the induction period and two patients successfully underwent hematopoietic stem cell transplantation. Two patients did not respond to therapy and both were eventually discharged with hospice care.Conclusions:In this pilot program, IPOP liposomal daunorubicin and cytarabine induction and management appears to be safe and to significantly reduce the length of hospitalization in patients with secondary AML. Future analyses with larger samples of patients are needed to further evaluate patient outcomes, safety and financial implications based on decreased inpatient hospital utilization. DisclosuresNo relevant conflicts of interest to declare.

Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting

BackgroundParamedics work in a highly complex and unpredictable environment which is characterized by ongoing decision-making. Decisions made by paramedics in the prehospital setting have implications for patient safety, transport, treatment, and health resource utilization. The objective of this study was; a) to understand how paramedics conduct decision-making in the field, and b) to develop a grounded theory of paramedic decision-making in the prehospital setting.MethodThis study was conducted using classical grounded theory. Paramedics (n = 13) with five or more years’ experience, who worked in a large urban center in Western Canada were interviewed. Field observations were conducted, each lasting 12 h, with five different ambulance crews. The data were analyzed and coded using the constant comparative method.ResultsThe resultant theory, Creative Adapting in a Fluid Environment, indicates paramedic decision-making is a fluid iterative process. Unpredictable and dynamic features of the prehospital environment require paramedics to use a flexible and creative approach to decision-making. The model consists of the three categories constructing a malleable model, revising the model, and situation-specific action. Two additional components, safety and extrication, are considered at each stage of the call. These two components in conjunction with the three categories influence how decisions are made and enacted.ConclusionParamedic decision-making is highly contextual and requires accurate interpretation and flexible cognitive constructs that are rapidly adaptable. Evaluation of paramedic decision-making needs to account for the complex and dynamic interaction between the environment, patient characteristics, available resources, and provider experience and knowledge.

Commentary: Paradigms, Axiology, and Praxeology in Medical Education Research.

This supplement includes 11 research papers accepted by the 2018 Research in Medical Education Committee. In this Commentary, the authors draw the attention of medical educators and researchers to questions about the researcher's philosophical paradigm. Such questions fundamentally guide research-the choice of conceptual frameworks, methods, and methodology. The authors provide a brief overview of research paradigms and the related concept of axiology and praxeology in medical education research. The authors map the 11 accepted research articles, describing the researchers' stated or implied worldviews and the impact on chosen methods. The authors close by encouraging researchers to state the research paradigm behind their research, comment on how they ensured that the methods used displayed consistency with that paradigm, and highlight the value the research adds to everyday education.

OPTIMIZING OTC MEDICATION USE: PACKAGING, HUMAN FACTORS, PHARMACY REDESIGN

Older adults are at high risk of significant harm associated with over-the-counter (OTC) medication use. Of the estimated 2.2 million older adults who are at risk of a major adverse drug event, more than 50% of these interactions involve an OTC medication. Given the complexity and limited understanding of how older adults select and use OTC medications, different approaches are necessary to support safe OTC medication selection and use. This symposium will provide an overview of research conducted to improve OTC medication use for older adults from the perspective of three disciplines: Packaging, human factors engineering, and pharmacy. The first presentation will share results of projects that focus on the impact of OTC product labeling and packaging on older adult information processing in order to help them make safe OTC medication choices. Results of this work can inform the development of OTC medication labeling that draws attention to critical safety information. The second presentation builds on the first presentation by discussing how all older adults do not make OTC medication decisions the same way. A mobile application tool that accommodates for different decision making processes will be introduced. The third presentation will introduce an intervention that targets systems barriers in retail community pharmacies, where older adults often purchase OTC medications. Finally, the findings will be summarized by the discussant, who will discuss the presented findings in terms of patient safety implications and impact.

\u201cI see myself as part of the team\u201d \u2013 family caregivers\u2019 contribution to safety in advanced home care

BackgroundThe use of medical technology and the various contributing and interdepending human factors in home care have implications for patient safety. Although family caregivers are often involved in the provision of advanced home care, there is little research on their contribution to safety. The study aims to explore family caregivers in Home Mechanical Ventilation (HMV) safety experiences and how safety is perceived by them in this context. Furthermore, it seeks to understand how family caregivers contribute to the patients’ and their own safety in HMV and what kind of support they expect from their health care team.MethodsAn explorative, qualitative study was applied using elements from grounded theory methodology. Data were collected through individual interviews with 15 family caregivers to patients receiving HMV in two regions in Germany. The audiotaped interviews were then subject to thematic analysis.ResultsThe findings shows that family caregivers contribute to safety in HMV by trying to foster mutual information sharing about the patient and his/her situation, coordinating informally health care services and undertaking compensation of shortcomings in HMV.ConclusionConsequently, family caregivers take on considerable responsibility for patient safety in advanced home care by being actively and constantly committed to safety work.Nurses working in this setting should be clinically and technically skilled and focus on building partnership relations with family caregivers. This especially encompasses negotiation about their role in care and patient safety. Support and education should be offered if needed. Only skilled nurses, who can provide safe care and who can handle critical situations should be appointed to HMV. They should also serve as professional care coordinators and provide educational interventions to strengthen family caregivers’ competence.

The patient safety implications of excessive dilator use

Presenter: John Ferrier

A computationally efficient formal method for discovering simultaneous masking in medical alarms

Numerous patient injuries and deaths have been caused by medical practitioners failing to respond to medical alarms. Simultaneous masking, where concurrently sounding medical alarms result in one or more being unhearable, is partially responsible for this problem. In previous work, we introduced a computational formal method capable of proving (formally verifying) if masking could occur in a modeled configuration of medical alarms. However, the scalability of the method limited the applicability and completeness of its analyses. In the work presented here, we show how we re-implemented the method to address these shortcomings. We evaluated the detection capabilities and scalability of the new version of the method with a series of realistic and synthetic case studies. Our results show that the new version of the method replicates and improves detection capabilities compared to the legacy method and does so with significant reductions in verification times. We discuss the patient safety implications of our results and explore directions for future research.

Equipment failure: conducts of nurses and implications for patient safety.

To identify equipment failures during handling by nurses and analyze the conduct of the professionals when these failures occur. Descriptive, exploratory and qualitative study, whose field was the intensive care unit of a public institution, and the participants were day nurses that worked providing direct care to patients. Data were produced in 2014 through systematic observation and interviews and were examined with thick description and content analysis. The outcomes evinced the inadequate functioning of infusion bombs, users' errors related to the design of equipment and problems with batteries of artificial fans. These failures related to the management of equipment in the unit. It is necessary to strengthen the monitoring systems of safety conditions of equipment in intensive nursing care to prevent incidents.

A Four-Stage Method for Optimizing and Standardizing a Crash Cart Configuration

OCCUPATIONAL APPLICATION An optimized crash cart configuration was developed through the use of human factors principles and by involving front-line users of crash carts in the design process from start to finish. The crash cart configuration was spread to four rural health care sites and received positive post-evaluation scores by clinical staff. The methodology used to develop the standardized crash cart, and the template for the configuration of the crash cart, can be adopted or adapted for use at any health care facility and can help in the mitigation of human error. Specifically, disorganized and/or inconsistent crash carts pose a patient safety risk due to the fact that retrieval of items may be delayed during critical situations. Implementing a tested, standardized crash cart configuration can increase the usability of the carts, which has significant patient safety implications during time-sensitive incidents such as code blue events.

Innovative Advances in Connectivity and Community Pharmacist Patient Care Services: Implications for Patient Safety.

The scope of community pharmacy practice has expanded beyond the provision of drug product to include the provision of patient care services. Likewise, the community pharmacist's approach to patient safety must also expand beyond prevention of errors during medication dispensing to include optimization of medications and prevention of adverse events throughout the entire medication use process. Connectivity to patient data and other health care providers has been a long-standing challenge in community pharmacy with implications for the delivery and safety of patient care. We describe three innovative advances in connectivity in community pharmacy practice that enhance patient safety in the provision of community pharmacist patient care services across the entire medication use process. Specifically, we discuss the growing use of immunization information systems, quality improvement platforms, and health information exchanges in community pharmacy practice and their implications for patient safety.

The professional culture among physicians in Sweden: potential implications for patient safety

BackgroundPatient safety culture, i.e. a subset of an organization’s culture, has become an important focus of patient safety research. An organization’s culture consists of many cultures, underscoring the importance of studying subcultures. Professional subcultures in health care are potentially important from a patient safety point of view. Physicians have an important role to play in the effort to improve patient safety. The aim was to explore physicians’ shared values and norms of potential relevance for patient safety in Swedish health care.MethodsData were collected through group and individual interviews with 28 physicians in 16 semi-structured interviews, which were recorded and transcribed verbatim before being analysed with an inductive approach.ResultsTwo overarching themes, “the competent physician” and “the integrated yet independent physician”, emerged from the interview data. The former theme consists of the categories Infallible and Responsible, while the latter theme consists of the categories Autonomous and Team player. The two themes and four categories express physicians’ values and norms that create expectations for the physicians’ behaviours that might have relevance for patient safety.ConclusionsPhysicians represent a distinct professional subculture in Swedish health care. Several aspects of physicians’ professional culture may have relevance for patient safety. Expectations of being infallible reduce their willingness to talk about errors they make, thus limiting opportunities for learning from errors. The autonomy of physicians is associated with expectations to act independently, and they use their decisional latitude to determine the extent to which they engage in patient safety. The physicians perceived that organizational barriers make it difficult to live up to expectations to assume responsibility for patient safety. Similarly, expectations to be part of multi-professional teams were deemed difficult to fulfil. It is important to recognize the implications of a multi-faceted perspective on the culture of health care organizations, including physicians’ professional culture, in efforts to improve patient safety.

Regulatory Gaps in Drug Compounding: Implications for Patient Safety, Innovation, and Fraud

Drug compounding is the practice of mixing, combining, or altering drug ingredients to create a product that meets the medical needs of a patient whose needs cannot otherwise be met with commercially-available products. Although drug compounding fills a critical need for many patients, it has also given rise to significant drug safety concerns, fraud, and anticompetitive practices. Every year, many patients experience harmful side effects and even death from compounded drugs that are contaminated or made in excessive potency because of pharmacist error. The ability of pharmacies to make and dispense drugs outside of the typical channels has also given rise to extensive fraud. In addition, some rogue pharmacies earn significant profits by mass-producing compounded drugs that are essentially copies of commercially-available drugs. Many of the drug safety problems, fraudulent practices, and anti-competitive behaviors are facilitated by regulatory gaps in the oversight of drug compounding. Traditional drug manufacturers must prove that their drugs are safe and effective and manufactured in accordance with current good manufacturing practices (CGMPs) in order to obtain FDA approval. In contrast, compounders need not obtain FDA approval for their drugs before selling them, and most compounders do not have to produce drugs in accordance with CGMPs. Moreover, traditional drug manufacturing facilities are subject to routine inspection by the FDA to ensure they are in compliance with CGMPs and that there are no other safety or quality concerns. In contrast, most compounders are not primarily overseen by the FDA but by state boards of pharmacy that are less consistent in their oversight — fewer than half of the states even conduct routine inspections of compounding pharmacies. Finally, whereas traditional manufacturers are required to report adverse events involving their drugs to the FDA, most compounders do not have to report adverse events to either the FDA or state regulatory authorities. This Article explains the regulatory gaps in drug compounding that give rise to drug safety problems, fraud, and anti-competitive behavior and proposes various measures that could be taken to close the gaps in order to protect patients, payors, and innovation.

Persistence of a Posaconazole-Mediated Drug-Drug Interaction With Ranolazine After Cessation of Posaconazole Administration: Impact of Obesity and Implications for Patient Safety.

The antianginal agent ranolazine (Ranexa®) is metabolized primarily by cytochrome P450-3A (CYP3A) enzymes. Coadministration with strong CYP3A inhibitors, such as ketoconazole and posaconazole, is contraindicated due to risk of QT prolongation from high levels of ranolazine. This study evaluated the time course of recovery from the posaconazole drug interaction in normal-weight and otherwise healthy obese subjects. Subjects received single doses of ranolazine in the baseline control condition, again during coadministration of posaconazole, and at 4 additional time points during the 2 weeks after posaconazole discontinuation. With posaconazole coadministration, the geometric mean ratio of ranolazine area under the concentration curve (AUC) increased by a factor of 3.9 in normals and by 2.8 in obese subjects. Posttreatment washout of posaconazole was slow in normals (mean half-life 36 hours) and further prolonged in obese subjects (64 hours). Recovery of ranolazine AUC toward baseline was delayed. AUC remained significantly elevated above baseline in normal-weight and obese subjects for 7-14 days after stopping posaconazole. Current product labeling does not address the need for delay or a reduced dose of ranolazine after discontinuation of a strong CYP3A inhibitor before ranolazine can be safely administered. We recommend that administration of ranolazine should be limited to 500 mg twice daily for 7 days after posaconazole discontinuation in patients with body mass index 18.5-24.9 kg/m2 and for 12 days in patients with body mass index ≥35 kg/m2 after ranolazine is resumed.

Cervical spine movement during intubation

There have been growing concerns following documented instances of neurological deterioration in patients with cervical spine injury as a result of intubation. A significant body of evidence has since evolved with the primary objective of ascertaining the safest way of securing the endotracheal tube in patients with suspected and proven cervical injury. The search for a mode of intubation producing the least movement at the cervical spine is an ongoing process and is limited by logistic and ethical issues. The ensuing review is an attempt to review available evidence on cervical movements during intubation and to comprehensively outline the movement at the cervical spine with a wide plethora of intubation aids. Literature search was sourced from digital libraries including PubMed, Medline and Google Scholar in addition to the standard textbooks of Anaesthesiology. The keywords used in literature search included 'cervical spine motion,' 'neurological deterioration,' 'intubation biomechanics,' 'direct laryngoscopy,' 'flexible fibreoptic intubation,' 'video laryngoscopes' and 'craniocervical motion.' The scientific information in this review is expected to assist neuroanaesthesiologists for planning airway management in patients with neurological injury as well as to direct further research into this topic which has significant clinical and patient safety implications.

Fluid balance in peri-operative and critical care staff

Dehydration is known to have detrimental effects on cognitive function and physical performance, as well as increasing the long-term risk of hypertension, coronary heart disease and stroke.1 A number of studies have shown inadequate nutritional and fluid intake in doctors.2,3 There is increasing evidence and interest in the importance of healthcare staff wellbeing and its implications for patient safety.4 A prospective, observational cohort study was conducted on medical and nursing staff working in peri-operative and critical care medicine at a tertiary teaching hospital over a 24 hour period. Fluid balance charts were distributed to staff who were asked to complete these for the duration of their shift. Using 2500 mls as the recommended daily fluid intake1 and average waking hours as 17,5 147 mls/hour was used as the standard with which to compare our results. Analysis was conducted using an unpaired Student t test. One-hundred-and-thirty-five fluid balance charts were distributed and 79 completed, giving a response rate of 58%. Only 3.8% of staff met the recommended fluid intake (n=3). The mean fluid intake was 76 mls/hr (± SD 32). On-call staff had a significantly lower fluid intake than those on normal shifts (24 vs. 78 mls/hr (p=0.005)). Night staff had a higher fluid intake than day staff (93 vs. 72 mls/hr (p=0.043)). Forty-seven percent of drinks consumed were caffeinated (± SD 35%). Staff passed urine 2.2 times per shift (± SD 1.0). This study found inadequate fluid intake amongst most medical and nursing staff. Study participants suggested reasons such as lack of time, limited availability of drinking facilities and staffing shortages. In spite of the small sample size, with over 96% of staff not meeting the recommended fluid intake, our results have potential implications for staff and patient safety. Dehydrated staff may be unable to perform as well cognitively and risk potentially detrimental effects on their short and long-term health. This study adds weight to existing research and highlights the need for fluid promotion among healthcare staff. 1.Benelam B, Wyness L. Nutrition Bulletin. 2010; 35: 3–25.2.Parshuram CS. Canadian Medical Assocociation Journal. 2004; 170: 965–970.3.Lemaire JB, Wallace JE, Dinsmore K, Roberts D. Nutrition Journal. 2011; 10: 18.4.Hamidi MS, Boggild MK, Cheung AM. Postgraduate Medical Journal. 2016; 92: 478–481.5.Nathaniel W, Badr MS, Belenky G, Bliwise DL, Buxton OM. Sleep. 2015; 38: 843–844.

Polypharmacy and Potentially Inappropriate Medication in People with Dementia: A Nationwide Study.

Polypharmacy (use of ≥5 different medications) and potentially inappropriate medication (PIM) are well-known risk factors for numerous negative health outcomes. However, the use of polypharmacy and PIM in people with dementia is not well-described. To examine the prevalence of polypharmacy and PIM in older people with and without dementia in a nationwide population. Cross-sectional study of the Danish population aged ≥65 in 2014 (n = 1,032,120) based on register data, including information on diagnoses and dispensed prescriptions. Polypharmacy and PIM use among people with (n = 35,476) and without dementia (n = 994,231) were compared, stratified by living situation and adjusted for age, sex, and comorbidity. The red-yellow-green list from the Danish Institute for Rational Pharmacotherapy and the German PRISCUS list were used to define PIM. People with dementia were more frequently exposed to polypharmacy (dementia: 62.6% versus no-dementia: 35.1%, p < 0.001) and likewise PIM (red-yellow-green: 45.0% versus 29.7%, p < 0.001; PRISCUS: 24.4% versus 13.2%, p < 0.001). After adjustments for age, sex, and comorbidity, the likelihood of polypharmacy and PIM was higher for community-dwelling people with dementia than without dementia (odds ratio (OR); [95% confidence interval (CI)] polypharmacy: 1.50 [1.45-1.55]; red-yellow-green: 1.27 [1.23-1.31]; PRISCUS: 1.25 [1.20-1.30]). In contrast, dementia slightly decreased the odds of polypharmacy and PIM in nursing home residents. Use of polypharmacy and PIM were widespread in the older population and more so in people with dementia. This could have negative implications for patient-safety and demonstrates the need for interventions to improve drug therapy in people with dementia.

Enhancing Anatomy Education Through Student‐led Team Dynamics Initiatives

BackgroundIn anatomy education, reliance upon fellow classmates and more senior students sharing similar experiences can foster academic success and prepare students for the emotional intensity of cadaver dissection. At the Icahn School of Medicine at Mount Sinai, the first course, Structures, requires medical students to put collaboration into practice. Because of the emotionally and academically challenging nature of the Structures course, students must rely on their teams and supportive peers for psychosocial wellness and academic success.HypothesisStudent‐led initiatives focusing on team dynamics enhance anatomy education of medical students.MethodsFirst‐year medical students (n=140) participated in a student‐developed and led team dynamics session during orientation week, immediately before Structures began. Students met their teams for the course, collaborated in team activities, and discussed how teams foster psychoemotional well‐being and academic performance. During Structures, second‐year medical students conducted review sessions and debriefed Structures teams regarding their performance. Self‐reported team assessments (n=81) throughout the course and a final course evaluation (n=74) gauged team performance and efficacy of student‐led initiatives.ResultsStudents reported that the orientation session was helpful before the Structures course began, and subsequent course evaluations revealed continued consciousness about the team dynamics they experienced. Team self‐assessments revealed that team dynamics tended to improve from the beginning to the end of the course, especially along domains of conflict resolution (p=0.017) and learning and development (p=0.035). At the end of Structures, most respondents (71/74, 95.95%) expressed feeling more comfortable working as a part of a team.ConclusionsThese findings suggest the importance of student‐led team dynamics initiatives in anatomy education and in encouraging collaboration. This approach toward medical education also holds broad implications for patient safety, quality of care, and health improvement, areas in which collaboration serves a major role. Further investigation correlating academic performance on team practical exams and quality of team collaboration may underscore these findings. Student‐driven curricular enhancements in team dynamics may facilitate fellow students' success in anatomy education and beyond.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.