Potential Implications For Patient Safety Research Articles

Interactions between X-/gamma rays and alloys used in dental braces: A study on theory and simulations

In the field of dentistry, the utilization of dental X-rays plays a pivotal role in ensuring accurate diagnoses for various dental conditions. A crucial aspect of this practice involves understanding how these X-ray emissions interact with dental braces. In the presented study, the details of how X-rays and gamma rays interact with different materials used in dental braces, namely stainless steel, nitinol, elgiloy, and beta-titanium alloys, were examined. This investigation was carried out through a combination of advanced simulation codes such as FLUKA and GEANT4, alongside theoretical calculations using the WinXCOM approach. A comprehensive analysis was conducted at fourteen distinct energy levels, ranging from 20 to 150 keV with 10 keV increments. The primary focus of this study revolves around quantifying the shielding characteristics of gamma and X rays as they traverse through these dental brace materials. To achieve this, some gamma/X-ray shielding parameters, buildup-factors, and kerma relative to air were meticulously simulated and calculated. Additionally, the energy deposits within these materials and the subsequent generation of secondary radiations are thoroughly explored. Significantly, these results highlight that elgiloy alloy demonstrates the highest attenuation of X-ray and gamma ray intensities compared to the other considered materials. This comprehensive study thus offers valuable insights into the behavior of dental braces when subjected to ionizing radiation, with potential implications for patient safety and diagnostic accuracy in dental radiology.

Implementation of Data-Driven Timelines and Visual Guidance Tools to Improve Radiation Oncology Task Completion: “Plan Readiness”

<h3>Purpose/Objective(s)</h3> The time between physician treatment plan approval and patient treatment initiation is often too short in our current Radiation Oncology practice. This reflects inconsistencies in the timeframe of task completion between CT simulation and treatment plan approval, the first and last steps in a complex, multi-step planning workflow in Radiation Oncology. This poses challenges in terms of the QA and plan checks needed prior to treatment initiation, with potential implications for patient safety. Our goal was to implement a sustainable and clear departmental process that would increase the percentage of plans approved by the attending Radiation Oncologist 1 full business day prior to treatment start for all non-urgent patients. Secondary goals included a reduction in last-minute patient delays and improvement in team member engagement and satisfaction. <h3>Materials/Methods</h3> We established realistic timelines for each task from simulation to treatment initiation, while setting a cutoff time for implementing patient appointment delay when expectations were not met. Treatment site, technique, and complexity-specific timelines were built by our team based on 4 major factors: 1) Clinical Urgency, 2) Task Complexity, 3) Evaluation of "task completion" data from a large cohort of previously treated patients, and 4) Interviews with all team members involved in the treatment planning process. These timelines were generated in a visual task management tool, and were linked as serial or parallel to keep the entire team on schedule for each patient. Prior to implementation, appropriate departmental meetings were held to discuss these changes, with extensive team member feedback utilized to generate the new policy. Timelines were generated that ranged from 5 to 12 working days, with clear goals and guidelines for each involved team member regarding their task(s). Our overarching goal, termed "Plan Readiness", was to achieve an electronically approved treatment plan 1 full working day prior to treatment start for > 90% of our patients. Appropriate exclusions were made for emergencies and special/new procedures in the department. <h3>Results</h3> For the 5 months prior to implementation, our baseline data demonstrated that 71% of plans were electronically approved in our treatment planning system greater than 24 hours prior to treatment start. After implementation of our new "Plan Readiness" process in March 2021, we have been able to stay above 90% pass rate, with a cumulative average of 94.6% over an ongoing 10-month timeframe. <h3>Conclusion</h3> The design and execution of data-driven timelines and visual guidance tools, combined with a team-based approach of communication and open feedback, has resulted in preliminary favorable outcomes in achieving timely "Plan Readiness" in our relatively large, hospital-based Department of Radiation Oncology. Future directions include the use of analytics software and automated data collection to perform more robust assessments.

'I guess I'll wait to hear'- communication of blood test results in primary care a qualitative study.

BackgroundRates of blood testing in primary care are rising. Communicating blood test results generates significant workload for patients, GPs, and practice staff.AimTo explore GPs’ and patients’ experience of systems of blood test communication.Design and settingQualitative interviews with patients and GPs in UK primary care in both urban and rural practices in the West of England.MethodA total of 28 patients and 19 GPs from six practices were recruited, with a range of socioeconomic and demographic characteristics. Patients were interviewed at two time points: a) at or soon after their blood test and b) after they had received their test results. The GPs who requested the tests were also interviewed (they could complete a maximum of two interviews about different patients). Eighty qualitative interviews were undertaken; 54 patient interviews and 26 GP interviews.ResultsMethods of test result communication varied between doctors and were based on habits, unwritten heuristics, and personal preferences rather than protocols. Doctors expected patients to know how to access their test results. In contrast, patients were often uncertain and used guesswork to decide when and how to access their tests. Patients and doctors generally assumed that the other party would make contact, with potential implications for patient safety. Text messaging and online methods of communication have benefits, but were perceived by some patients as ‘flippant’ or ‘confusing’. Delays and difficulties obtaining and interpreting test results can lead to anxiety and frustration for patients.ConclusionCurrent systems of test result communication are complex and confusing, and mostly based on habits and routines rather than clear protocols. This has important implications for patient-centred care and patient safety.

Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations

BackgroundSedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to identify and synthesize existing recommendations on sedation practices for routine gastrointestinal endoscopy procedures.MethodsWe systematically reviewed guidelines and position statements identified through a search of PubMed, guidelines databases, and websites of relevant professional associations from January 1, 2005 to May 10, 2019. We included English-language guidelines/position statements with recommendations relating to sedation for adults undergoing routine gastrointestinal endoscopy. Documents with guidance only for complex endoscopic procedures were excluded.We extracted and synthesized recommendations relating to: 1) choice of sedatives, 2) sedation administration, 3) personnel responsible for monitoring sedated patients, 4) skills and training of individuals involved in sedation, and 5) equipment required for monitoring sedated patients. We assessed the quality of included documents using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool.ResultsWe identified 19 guidelines and 7 position statements meeting inclusion criteria. Documents generally agreed that a single, trained registered nurse can administer moderate sedation, monitor the patient, and assist with brief, interruptible tasks. Documents also agreed on the routine use of pulse oximetry and blood pressure monitoring during endoscopy. However, recommendations relating to the drugs to be used for sedation, the healthcare personnel capable of administering propofol and monitoring patients sedated with propofol, and the need for capnography when monitoring sedated patients varied. Only 9 documents provided a grade or level of evidence in support of their recommendations.ConclusionsRecommendations for sedation practices in routine gastrointestinal endoscopy differ across guidelines/position statements and often lack supporting evidence with potential implications for patient safety and procedural efficiency.

Comparison of Machine Learning Algorithms for Classifying Adverse-Event Related 30-Day Hospital Readmissions: Potential Implications for Patient Safety.

Studies in the last decade have focused on identifying patients at risk of readmission using predictive models, in an objective to decrease costs to the healthcare system. However, real-time models specifically identifying readmissions related to hospital adverse-events are still to be elaborated. A supervised learning approach was adopted using different machine learning algorithms based on features available directly from the hospital information system and on a validated dataset elaborated by a multidisciplinary expert consensus panel. Accuracy results upon testing were in line with comparable studies, and variable across algorithms, with the highest prediction given by Artificial Neuron Networks. Features importances relative to the prediction were identified, in order to provide better representation and interpretation of results. Such a model can pave the way to predictive models for readmissions related to patient harm, the establishment of a learning platform for clinical quality measurement and improvement, and in some cases for an improved clinical management of readmitted patients.

Clinical Setting Differences in Third-Year Medical Students’ Perceptions of “Ownership”

Ownership in clinical settings is a construct that be described as feelings of responsibility and accountability towards a patient, which has potential implications for patient safety and care. Researchers were interested in examining differences in students' perception of ownership across main and regional campuses. The purpose of this study is to assess third-year students' perception of "ownership" during their clerkship rotations in different clinical settings. Items from a validated instrument on psychological ownership were adopted to suit a clinical environment. Scores on each of the sub-scales of: a) Territoriality, b) Accountability, c) Self-efficacy, d) Belongingness, and e) Self-Identification were calculated by averaging the items. The survey was administered to 233 third-year medical students multiple times throughout the academic year. Responses from regional campus or community provider settings were compared to the main campus. To examine students' psychological ownership scores in different clinical settings, analysis of variance (ANOVA), was performed. A Tukey-Kramer multiple comparison procedure was used to examine post hoc pair-wise differences between two clinical settings. We received 265 of responses from 95 of responders. There were no statistically significant differences between campuses for Territoriality scores. On Self-Efficacy, Accountability, Self-Identification and Belongingness scales other community providers and regional campuses had significantly higher scores than main campus (p&lt;0.05). Follow up ANOVA analysis were performed for all scales on individual items resulting in 1/5 for Accountability, 2/6 on Self-Efficacy, 5/5 on Belongingness, and 6/7 for Self-Identification been statistically significant.&#x0D; Ownership is considered an important aspect of patient care, patient safety, professional identity formation, etc., yet researchers have not examined how clinical settings impact students' perceptions of patient ownership during their clerkship years. Our study is the first step to operationalize and conceptualize ownership, its development over time, and differences in clinical experiences.&#x0D; &#x0D; None of the authors has a conflict of interest. This study was approved by our institution’s Institutional Review Board.

Clinical Setting Differences in Third-Year Medical Students’ Perceptions of “Ownership”

Ownership in clinical settings is a construct that be described as feelings of responsibility and accountability towards a patient, which has potential implications for patient safety and care. Researchers were interested in examining differences in students' perception of ownership across main and regional campuses. The purpose of this study is to assess third-year students' perception of "ownership" during their clerkship rotations in different clinical settings. Items from a validated instrument on psychological ownership were adopted to suit a clinical environment. Scores on each of the sub-scales of: a) Territoriality, b) Accountability, c) Self-efficacy, d) Belongingness, and e) Self-Identification were calculated by averaging the items. The survey was administered to 233 third-year medical students multiple times throughout the academic year. Responses from regional campus or community provider settings were compared to the main campus. To examine students' psychological ownership scores in different clinical settings, analysis of variance (ANOVA), was performed. A Tukey-Kramer multiple comparison procedure was used to examine post hoc pair-wise differences between two clinical settings. We received 265 of responses from 95 of responders. There were no statistically significant differences between campuses for Territoriality scores. On Self-Efficacy, Accountability, Self-Identification and Belongingness scales other community providers and regional campuses had significantly higher scores than main campus (p&lt;0.05). Follow up ANOVA analysis were performed for all scales on individual items resulting in 1/5 for Accountability, 2/6 on Self-Efficacy, 5/5 on Belongingness, and 6/7 for Self-Identification been statistically significant.&#x0D; Ownership is considered an important aspect of patient care, patient safety, professional identity formation, etc., yet researchers have not examined how clinical settings impact students' perceptions of patient ownership during their clerkship years. Our study is the first step to operationalize and conceptualize ownership, its development over time, and differences in clinical experiences.&#x0D; &#x0D; None of the authors has a conflict of interest. This study was approved by our institution’s Institutional Review Board.

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.

To what extent is clinical and laboratory information used to perform medication reviews in the nursing home setting? the CLEAR study.

BackgroundThe aim of this study was to evaluate to what extent laboratory data, actual medication, medical history, and/or drug indication influence the quality of medication reviews for nursing home patients.MethodsForty-six health care professionals from different fields were requested to perform medication reviews for three different cases. Per case, the amount of information provided varied in three subsequent stages: stage 1, medication list only; stage 2, adding laboratory data and reason for hospital admission; and stage 3, adding medical history/drug indication. Following a slightly modified Delphi method, a multidisciplinary team performed the medication review for each case and stage. The results of these medication reviews were used as reference reviews (gold standard). The remarks from the participants were scored, according to their potential clinical impact, from relevant to harmful on a scale of 3 to −1. A total score per case and stage was calculated and expressed as a percentage of the total score from the expert panel for the same case and stage.ResultsThe overall mean percentage over all cases, stages, and groups was 37.0% when compared with the reference reviews. For one of the cases, the average score decreased significantly from 40.0% in stage 1, to 30.9% in stage 2, and 27.9% in stage 3; no significant differences between stages was found for the other cases.ConclusionThe low performance, against the gold standard, of medication reviews found in the present study highlights that information is incorrectly used or wrongly interpreted, irrespective of the available information. Performing medication reviews without using the available information in an optimal way can have potential implications for patient safety.

Improving clinician-carer communication for safer hospital care: a study of the 'TOP 5' strategy in patients with dementia.

To examine the impact of implementing a clinician-carer communication tool for hospitalized patients with dementia. Surveys were conducted with clinicians and carers about perceptions and experiences. Implementation process and costs were explored through surveys of local staff. Time series analysis was conducted on incident-reported falls, usage of non-regular anti-psychotics and one-to-one nursing. Twenty-one hospitals in Australia. Surveys were returned by 798 clinicians, 240 carers and 21 local liaison staff involved in implementation. Implementation of a communication tool over 12 months. The process of implementation was documented. Outcome measures included clinician and carer perceptions, safety indicators (incident-reported falls and usage of non-regular anti-psychotics), resource use and costs. Clinicians and carers reported high levels of acceptability and perceived benefits for patients. Clinicians rated confidence in caring for patients with dementia as being significantly higher after the introduction of TOP 5, (M = 2.93, SD = 0.65), than prior to TOP 5 (M = 2.74, SD = 0.75); F(1,712) = 11.21, P < 0.05. When analysed together, there was no change in incident-reported falls across all hospitals. At one hospital with a matched control ward, an average of 6.85 fewer falls incidents per month occurred in the intervention ward compared with the matched control ward (B = -6.85, P < 0.05). Our findings indicate that the use of a simple, low-cost communication strategy for patient care is associated with improvements in clinician and carer experience with potential implications for patient safety. Minimally, TOP 5 represents 'good practice' with a low risk of harm for patients.

The Forgotten Role of Alcohol: A Systematic Review and Meta-Analysis of the Clinical Efficacy and Perceived Role of Chlorhexidine in Skin Antisepsis

BackgroundSkin antisepsis is a simple and effective measure to prevent infections. The efficacy of chlorhexidine is actively discussed in the literature on skin antisepsis. However, study outcomes due to chlorhexidine-alcohol combinations are often attributed to chlorhexidine alone. Thus, we sought to review the efficacy of chlorhexidine for skin antisepsis and the extent of a possible misinterpretation of evidence.MethodsWe performed a systematic literature review of clinical trials and systematic reviews investigating chlorhexidine compounds for blood culture collection, vascular catheter insertion and surgical skin preparation. We searched PubMed, CINAHL, the Cochrane Library, the Agency for Healthcare Research and Quality website, several clinical trials registries and a manufacturer website. We extracted data on study design, antiseptic composition, and the following outcomes: blood culture contamination, catheter colonisation, catheter-related bloodstream infection and surgical site infection. We conducted meta-analyses of the clinical efficacy of chlorhexidine compounds and reviewed the appropriateness of the authors′ attribution. ResultsIn all three application areas and for all outcomes, we found good evidence favouring chlorhexidine-alcohol over aqueous competitors, but not over competitors combined with alcohols. For blood cultures and surgery, we found no evidence supporting chlorhexidine alone. For catheters, we found evidence in support of chlorhexidine alone for preventing catheter colonisation, but not for preventing bloodstream infection. A range of 29 to 43% of articles attributed outcomes solely to chlorhexidine when the combination with alcohol was in fact used. Articles with ambiguous attribution were common (8–35%). Unsubstantiated recommendations for chlorhexidine alone instead of chlorhexidine-alcohol were identified in several practice recommendations and evidence-based guidelines.ConclusionsPerceived efficacy of chlorhexidine is often in fact based on evidence for the efficacy of the chlorhexidine-alcohol combination. The role of alcohol has frequently been overlooked in evidence assessments. This has broader implications for knowledge translation as well as potential implications for patient safety.

The NHS reform agenda and patient safety

Most of the current attention on the Health and Social Care Bill is on commissioning, structural changes and competition. Yet there are fundamental new duties for the Secretary of State that will have potential implications for patient safety and quality. The Francis report will add to this renewed attention to patient safety and the risk is that the NHS faces more and more regulation rather than a call for more transformational approaches that may help change the mindset from one that currently continues to ‘accept the unacceptable’ failures that are taking place in our hospitals and other healthcare settings. This article explores the relationship between the traditional governance-based approach and more proactive transformational approaches that utilize improvement science.