Patient Safety Research Articles

Corrigendum: Impact of Patient Safety Bundle and Team-Based Training on Obstetric Hypertensive Emergencies.

Corrigendum: Impact of Patient Safety Bundle and Team-Based Training on Obstetric Hypertensive Emergencies.

Use of failure mode and effect analysis to improve the monoclonal antibody drugs management process in pharmacy intravenous admixture services

Monoclonal antibodies (mAbs) constitute a new form of immunotherapy that has shown great success in long-term tumour control. These injectable drugs are managed and compounded by the Pharmacy Intravenous Admixture Services (PIVAS) staff in a specified sterile environment. This study utilized failure mode and effect analysis (FMEA) as a risk management tool to manage mAb drugs within the PIVAS. The nine-member multidisciplinary team mapped the processes; evaluated the severity, occurrence, and detection of each subprocess; and calculated the risk priority number (RPN). Further corrective actions were taken for high-risk steps, followed by re-evaluation and scoring to achieve a low-risk process. We identified seven major processes and twenty-eight subprocesses involved in the management of mAb drugs in PIVAS. A total of thirteen high-risk failure modes with an assigned RPN 1 were selected. This selection represents the first calculated RPN values, resulting in a total score of 3375. After a first round of evaluation and implementation of corrective actions, the RPN 2 score decreased to 464. Following a second round of the FMEA process, the RPN 3 score was further reduced to 51. Through refinement, we successfully mitigated the occurrence of high-risk failure modes of mAb drugs in PIVAS. These efforts are aimed at enhancing the safety and efficacy of mAb drugs, ultimately ensuring patient safety.

Identifying High-Priority Ethical Challenges for Precision Emergency Medicine: Nominal Group Study.

Precision medicine promises to revolutionize health care by providing the right care to the right patient at the right time. However, the emergency department's unique mandate to treat "anyone, anywhere, anytime" creates critical tensions with precision medicine's requirements for comprehensive patient data and computational analysis. As emergency departments serve as health care's safety net and provide a growing proportion of acute care in America, identifying and addressing the ethical challenges of implementing precision medicine in this setting is crucial to prevent exacerbation of existing health care disparities. The rapid advancement of precision medicine technologies makes it imperative to understand these challenges before widespread implementation in emergency care settings. This study aimed to identify high priority ethical concerns facing the implementation of precision medicine in the emergency department. We conducted a qualitative study using a modified nominal group technique (NGT) with emergency physicians who had previous knowledge of precision medicine concepts. The NGT process consisted of four phases: (1) silent generation of ideas, (2) round-robin sharing of ideas, (3) structured discussion and clarification, and (4) thematic grouping of priorities. Participants represented diverse practice settings (county hospital, community hospital, academic center, and integrated managed care consortium) and subspecialties (education, ethics, pediatrics, diversity, equity, inclusion, and informatics) across various career stages from residents to late-career physicians. A total of 12 emergency physicians identified 82 initial challenges during individual ideation, which were consolidated to 48 unique challenges after removing duplicates and combining related items. The average participant contributed 6.8 (SD 2.9) challenges. These challenges were organized into a framework with 3 themes: values, privacy, and justice. The framework identified the need to address these themes across 3 time points of the precision medicine process: acquisition of data, actualization in the care setting, and the after effects of its use. This systematic organization revealed interrelated concerns spanning from data collection and bias to implementation challenges and long-term consequences for health care equity. Our study developed a novel framework that maps critical ethical challenges across 3 domains (values, privacy, and justice) and 3 temporal stages of precision medicine implementation. This framework identifies high-priority areas for future research and policy development, particularly around data representation, privacy protection, and equitable access. Successfully addressing these challenges is essential to realize precision medicine's potential while preserving emergency medicine's core mission as health care's safety net.

Diagnosis Documentation Done Right: Cross-Specialty Standard for the Diagnosis Section in German Discharge Summaries - A Mixed-Methods Study.

The diagnosis section in hospital discharge summaries is critical for continuity of care and patient safety, yet it varies widely in quality, format, and content due to a lack of standards. This study aims to develop a cross-specialtystandard for the structure and content of the diagnosis section, based on the preferences of German physicians. The study examines physicians' satisfactionwith the diagnosis section, their rating of its importance,and theirpreferences for its specificelements, comparing perspectives between inpatient and outpatient physicians. This mixed-methods study integrated a scoping review, focus group discussion, and a nationwide survey of 602 physicians (317 outpatient primary care and 285 inpatient physicians; 4.1% response rate), most trained in internal medicine. Quantitative analyses evaluated physician satisfaction and preferences, while qualitative feedback provided deeper insights regarding preferred content and format. Although 95.7% of physicians considered the diagnosis section crucial for follow-up care, only 36.9% were satisfied with its current content and format. 91.2% supported standardizing the diagnosis section, identifying 18 content elements to be included for every current treatment diagnosis. Strong consensus (> 95.0% agreement) was reached for "name of the diagnosis," "severity/stage/classification/TNM," "localization/extent/pattern of involvement," "course e.g., acute, chronic, recurrent," "expression," "complications," "date of initial diagnosis," and "etiology/cause." 86.4% preferred separating current and chronic/prior diagnoses with headings. Outpatient physicians were more likely than inpatient physicians to rate "ICD-10 codes" as mandatory (46.2% vs. 14.8%, p < 0.001) and to consider "recommendations for further procedures" (76.6% vs. 63.6%, p < 0.001) and "follow-up appointments" (77.3% vs. 63.5%, p < 0.001) as necessary. Additionally, a list of practical recommendations for clinicians to better document diagnoses was derived. This study proposes a cross-specialty standard for the diagnosis section based on physician preferences for a clearly structured format and 18 key content elements.

Integrating a quality improvement experiential platform into medical student education

BackgroundThe call for quality improvement and patient safety (QI/PS) education has increased at every level of medical education. Here, the authors present a QI/PS experiential platform implemented at the University of Florida College of Medicine (UFCOM). The project established a peer-taught hands-on learning platform in a student-run clinic allowing participants to learn and apply QI/PS concepts and tools in a real-world clinic environment. The aims were to assess students’ perceptions in regard to (1) student confidence in quality improvement (QI) methodology, and (2) competency in executing QI initiatives in healthcare as measured by a post-participation survey.MethodA medical student-led quality improvement team was embedded within University of Florida’s (UF’s) existing student-run clinic network. The QI/PS student-team collaborated with clinic leaders and utilized QI/PS tools to establish, monitor, and expand impactful Plan-Do-Study-Act (PDSA) cycles. The impact of the training was then evaluated using The New World Kirkpatrick Model leveraging a post-project survey which included the Beliefs, Attitudes, Skills, and Confidence in Quality Improvement (BASiC-QI) survey and questions on overall student perceptions.ResultsThis project demonstrated positive results in all four levels of Kirkpatrick evaluation: (1) Reaction, (2) Learning, (3) Behavior, and (4) Results. This was shown through (1) a voluntary feedback survey that reported positive feedback from participants with 93% of respondents indicating they “strongly agreed” or “agreed” to positive perception questions; (2) significantly higher scores (p < 0.001) on the BASiC-QI Scale for project participants vs. non-participants; (3) the completion of 4.25 PDSA cycles per QI team; and (4) a 10.1% reduction in median patient time in clinic.ConclusionsThis study supports the utility of incorporating a student-led QI/PS interactive platform into student-run clinics to increase knowledge and attitude in implementing QI/PS endeavors while simultaneously improving clinic metrics and outcomes for patients.

Using Broken Windows Theory to Examine Flow Disruptions in Surgical Care: A Multispecialty Comparison.

Minimally invasive innovations enhance procedural technology. However, healthcare quality demands addressing mental and physical workloads. This study analyzes flow disruptions uncovering specialty-specific patterns and systemic weaknesses, to enhance quality, processes, and patient safety. Twenty-five cardiovascular, 40 orthopedic, 65 trauma care, and 30 neurosurgical cases were examined. The data were categorized using human factor taxonomy, and descriptive statistics were applied. Comparing the four specialties using RIPCORD TWA taxonomy, cardiovascular and trauma care were translated into one disruption every 2.2 minutes, followed by neurosurgery with one disruption every 2.7 minutes and orthopedics with one disruption every 3.7 minutes. Interruptions were the highest percentage for cardiovascular and orthopedics, with 54% and 46% of flow disruptions. Trauma care was heavily affected by communication flow disruption with 33%. Layout and coordination issues accumulate 26% of flow disruptions in neurosurgery. Cardiovascular, orthopedics, trauma care, and neurosurgery each feature distinct workflows, risks, and teamwork dynamics, demanding tailored process improvements. By analyzing flow disruptions and systemic weaknesses, this study highlights patterns unique to each specialty, advocating for tailored interventions to enhance communication, coordination, layout optimization, and equipment usability for improved surgical safety and quality.

Systematic Review of the Quality of Stereolithographic Three-Dimensionally Printed Materials for Provisional Dental Restorations

Background and Objectives: The use of stereolithographic (SLA) 3D printing technology in dentistry has expanded, particularly for the fabrication of provisional dental restorations. Understanding the mechanical properties and quality of SLA 3D-printed materials is essential to ensure clinical success and patient safety. This systematic review aims to critically evaluate and summarize the available evidence on the mechanical properties and quality of SLA 3D-printed materials. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Embase, Cochrane, and Web of Science up to October 2024. Studies comparing the mechanical properties of SLA 3D-printed provisional restoration materials with those of milled, conventional, or other additive manufacturing methods were included. Nine studies met the inclusion criteria. Data on flexural strength, hardness, fracture resistance, surface roughness, marginal adaptation, accuracy, cement film thickness, shear bond strength, and biofilm formation were extracted and analyzed. Results: The findings from the included studies indicate that SLA 3D-printed materials exhibit varied mechanical properties. Some studies reported that SLA 3D-printed resins had significantly lower flexural strength and hardness compared to milled PMMA and bis-acrylic resins. Other studies found that SLA 3D-printed resins showed clinically acceptable marginal adaptation, surface roughness, and fracture strength comparable to those fabricated by subtractive manufacturing and conventional methods. In terms of accuracy, build orientation influenced the dimensional accuracy of SLA-printed restorations. Studies assessing cement film thickness found that SLA-printed provisional restorations had higher cement film thickness compared to other materials. Regarding repairability and fatigue resistance, limitations were observed in some SLA resins. Conclusions: The mechanical properties and quality of SLA 3D-printed materials for provisional dental restorations vary among studies. While SLA technology holds promise for efficient fabrication of provisional restorations, inconsistencies in material properties suggest a need for further research to optimize materials and printing parameters. Standardization of protocols is necessary to ensure reliable clinical performance of SLA 3D-printed provisional restorations.

Discrepancies in safety reporting for chronic back pain clinical trials: an observational study from ClinicalTrials.gov and publications

IntroductionChronic back pain (CBP) is a leading cause of disability worldwide and is commonly managed with pharmacological, non-pharmacological, and procedural interventions. However, adverse event (AE) reporting for these therapies often lacks transparency, raising concerns about the accuracy of safety data. This study aimed to quantify inconsistencies in AE reporting between ClinicalTrials.gov and corresponding randomized controlled trial (RCT) publications, emphasizing the importance of comprehensive safety reporting to improve clinical decision-making and patient care.MethodsWe retrospectively analyzed Phase 2–4 CBP RCTs registered on ClinicalTrials.gov from 2009 to 2023. Extracted data included AE reporting, trial sponsorship, and discrepancies in serious adverse events (SAEs), other adverse events (OAEs), mortality, and treatment-related withdrawals between registry entries and publications. Statistical analyses assessed reporting inconsistencies, following STROBE guidelines.ResultsA total of 114 registered trials were identified, with 40 (35.1%) corresponding publications. Among these, 67.5% were industry-sponsored. Only 4 (10%) publications fully reported adverse events (AEs) without discrepancies, while 36 (90%) contained at least one inconsistency compared to ClinicalTrials.gov. Discontinuation due to AEs was explicitly reported in 24 (60%) of ClinicalTrials.gov entries and in 30 (75%) of publications, with discrepancies in 16 trials (40%). Serious adverse events (SAEs) were reported differently in 15 (37.5%) publications; 80% reported fewer SAEs than ClinicalTrials.gov. Other adverse events (OAEs) showed discrepancies in 37 (92.5%) publications, with 43.2% reporting fewer and 54.1% reporting more OAEs.DiscussionThis study highlights pervasive discrepancies in AE reporting for CBP trials, undermining the reliability of published safety data. Inconsistent reporting poses risks to clinical decision-making and patient safety. Adopting standardized reporting guidelines, such as CONSORT Harms, and ensuring transparent updates in publications could enhance the accuracy and trustworthiness of safety data. Journals and regulatory bodies should enforce compliance and future efforts should develop mechanisms to monitor and correct reporting inconsistencies, enhancing the trustworthiness of safety data in clinical research.

Implementing standard practices in the safe handling of gene therapy and biohazardous drugs in a health-system setting.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This publication outlines development of the infrastructure and standard operating procedures (SOPs) for handling of gene therapy drugs within an integrated health-system setting. These guidelines aim to fill the gap in occupational safety standardization, as current materials focus on precautions in a research laboratory setting and do not fully take into account occupational hazards for pharmacists, technicians, and other medical staff. Pharmacists in a large integrated healthcare system recognized the gap in knowledge as well as lack of standard procedures in handling gene therapy drugs in the pharmacy setting and sought to establish updated best practices. The objectives were to implement the necessary infrastructure and SOPs for the handling, compounding, and cleanup of gene therapy drugs and to update existing resources such as spill kits to reflect the new SOPs. Critical milestones included establishing a new biohazardous drug risk classification and standardizing medication labeling. These steps were necessary to ensure consistent and safe handling across the enterprise. With the increasing prevalence of gene therapy drugs, it is of paramount importance to establish best practices to ensure occupational safety. While existing regulations and literature outline basic handling guidelines for laboratory use, there is a limited amount of information in relation to pharmacy departments within healthcare groups. In establishing robust SOPs surrounding the handling, compounding, and management of gene therapy drugs, pharmacy groups can better ensure both patient and staff safety.

Teledermatology: Canadian dermatologists' practice patterns, perceived challenges and future recommendations.

The use of teledermatology has increased significantly in recent years. The objective of this study was to determine Canadian dermatologists' and dermatology residents' perspectives on teledermatology. An online survey was created to determine participants' teledermatology practice patterns and their perception of the challenges, education, training, and research in teledermatology. The survey was distributed through the Canadian Dermatology Association and by administrative staff at Canadian Dermatology departments. There were 33 respondents: 66.7% of respondents started using teledermatology during the COVID-19 pandemic, and 93.8% reported that teledermatology accounted for 0-25% of their practice. Convenience, access, and safety were identified as the primary advantages of teledermatology. Teledermatology was mainly utilized for medication monitoring or refills and to assess, manage, or follow up on dermatitis, other chronic inflammatory conditions, and pre-diagnosed dermatologic conditions. Poor photo quality (32.3%) and the inability to conduct physical examinations or accurately diagnose conditions (74.2%) were reported as significant challenges. Respondents recommended education on the medicolegal considerations of teledermatology and research on how teledermatology compares to in-person consultations. Overall, teledermatology offers convenience, access, and improved safety for patients and healthcare professionals. However, addressing challenges related to physical examinations, accurate diagnoses, and photo quality is essential for optimal care delivery.

The role of the nurse leader in facilitating effective support and communication to raise concerns.

This article examines several factors that can affect how raising of concerns can be supported. Nurse leaders play a vital role in this process to maintain patient safety and act accordingly within the Nursing and Midwifery Council Code. Considerations are provided to explore how the nurse leader can facilitate communication with all team members to influence organisational culture, where colleagues feel confident in voicing concerns. Professional responsibilities pertinent to this process are highlighted, including the nurse leader as an advocate and supporting constructive challenge.

Specialists Triaging Referrals to eConsult: a feasibility study including acceptability and impact of providing advice on primary health care providers

BackgroundSpecialists review referrals for appropriateness and urgency. Limited capacity results in specialists declining referrals leaving primary care providers (PCP), patients, and specialists frustrated. Since specialist availability is unlikely to improve significantly, innovative solutions are required. This study evaluated the feasibility, acceptability, safety and impact of a new referral triage option Triaging Referrals to eConsult (TReC) which enables specialists to provide advice in lieu of an appointment (advice only) or provide advice to support the PCP until the appointment occurs (advice and appointment).MethodsUtilization metrics were prospectively collected (number (%) of referrals converted, time from receipt of referral to completion (response time) and specialist self-reported billing time.To assess PCP opinions on safety (advice was clearly identified and actionable) and acceptability (comfort in patient not seeing a specialist, additional time burden and support for expansion) two surveys, one for those referrals triaged to advice only and another for those triaged to advice and appointment, were faxed 14 days after the referral response.ResultsFrom November 1, 2022, to October 31, 2023, five specialties converted 930/16,880 referrals—656 (3.8%) to Advice Only and 274 (1.6%) to Advice and Appointment for an overall conversion rate of 5.5%. 192/1010 (19%) PCPs returned the survey with over 80% agreeing that the advice was easily recognizable, conversion to eConsult was acceptable and the advice was helpful and actionable.InterpretationEnabling specialists to provide advice to PCPs, often in lieu of an appointment, was acceptable, feasible with no major patient safety concerns.

Examining the issue of corridor care, NHS patient safety and the law.

Examining the issue of corridor care, NHS patient safety and the law.

Complications of Ambulatory Procedures: Prevalence and Hospital Outpatient Department Variation.

Ambulatory procedures performed electively in hospital outpatient departments are of increasing complexity and constitute a growing share of total procedure volume. Despite their importance, little is known of the prevalence of complications from routine procedures once patients are discharged. This study utilizes a 100% Medicare Fee-for-Service claims data file for the years 2019-2022 to assess the relative frequency of hospital-based ambulatory procedures and 30-day patient postprocedure emergency room and hospitalization complication rates utilizing the Ambulatory Potentially Preventable Complication (AM-PPC) classification method. AM-PPC is a claims-based method designed to calculate comparative provider rates of complication exclusively for elective ambulatory procedures excluding procedures performed in hospital emergency departments. The authors calculated the mean rate of ambulatory complications by procedure across hospitals and then compared them for variation in hospital-specific procedure complication rates to the mean rate. About 2.1% of patients receiving a procedure performed in a hospital outpatient department had an emergency room or inpatient hospitalization visit within 30 days. Complication event rates varied widely across hospital outpatient departments and within specific procedures. Hip arthroplasty complication rates varied from 0.0% to 7.6% while those for upper genitourinary procedures varied from 1.7% to 14.2%. In conclusion, the complication rate for ambulatory procedures is seen to vary substantially across hospital outpatient departments for well-established, routine procedures. This study provides a baseline of complication rates for ambulatory procedures, which will be essential for future efforts to improve patient safety.

Analysis of Nurses' Compliance with Patient Safety in the Inpatient Room of RSI Malahayati Medan

A patient safety program is a system that ensures hospitals make care or health services for patients safer. Patient safety is concerned with patient care, incidents that can be avoided or should not occur and have been considered a discipline. However, it must be admitted that in these quality services there are still shortcomings in patient services, especially related to patient safety incidents. The purpose of the study was to analyze the factors that affect nurses' compliance with patient safety in the inpatient room at RSI Malahayati Medan. The research design used in this study is an analytical survey with a cross sectional design. The population in this study is all inpatient room nurses at Malahayati Hospital Medan. The number of nurses in the inpatient room is 45 people. The number of samples to be studied is 45 people. Data analysis was carried out by univariate, bivariate and multivariate analysis. The arial tests used are chi square and ariable regression tests. The results of the chi square test research show that there is an influence of 7 variables, namely leadership, rewards. Structure, job design, age, tenure and education have a p-value &lt;α 0.05, meaning leadership, rewards. Structure, job design, age, working period and education affect nurse compliance at RSI Malahayati Medan and the multivariate test has 7 variables affecting leadership, rewards. Structure, job design, age, working period and education with the results of the multiple variable regression test showed that the most dominant ariable-reward with an odds ratio (OR) of 6,916 means 6 times affecting nurses' compliance with patient safety. It was concluded that the reward variable had the most influence on nurses' compliance with patient safety at RSI Malahayati Medan. It is recommended for the hospital to build more positive leadership for the employee environment, facilitate employees to continue learning, pay attention to a good organizational structure, decompose employee duties and especially pay attention to income, incentives and bonuses for employees.

Improvement of Quality and Patient Safety in Anaesthesia Practice in Low-Resource Settings

In modern healthcare system, health policy makers, healthcare professionals and organizations, and patients are becoming more aware of the importance of promoting quality care and safety practices. In anaesthesia practice, the specialty has come a long way since its establishment in Dhaka Medical College Hospital in Bangladesh in 1950s by the house surgeons at that time. In last few decades, there had been incredible innovations in anaesthesia, such as the introduction of sevoflurane, isoflurane, propofol, the laryngeal mask airway, pulse oximetry, HDU and ICU facilities and many more. However, in Bangladesh, being a low-resource country, there are still many challenges that the specialty must meet especially in quality of care and patient safety culture. Following some recent anaesthesia-related fatalities, concerns about anaesthesia flared up among patients, health professionals and policy makers. Therefore, different healthcare organizations, both public and private, are now looking at the resiliency analysis of the anaesthesia practice in order to improve quality and patient safety to enhance patient satisfaction and trust building. This review paper aims to discuss quality improvement and patient safety in anesthesia practice and their contributing factors, standardized practices, and strategies to facilitate safety with a focus on teamwork and communication in low-resource settings. However, the review does not seek to be exhaustive or systematic, but to highlight current areas of concern and some potential solutions. Mugda Med Coll J. 2024; 7(2): 127-134

Evaluating the Efficacy and Safety of Mepolizumab in Elderly Patients with Severe Asthma: Insights from the REDES Study

Objective Asthma and severe asthma are problems affecting all age groups, but asthma is frequently undiagnosed in the elderly, due to the poor perception of airflow limitation, lack of fitness, and presence of multiple comorbidities. Even so, the proportion of patients with severe asthma aged ≥65 is significant, and data on efficacy of asthma medications in the elderly are sometimes limited. We report here the effectiveness and safety of mepolizumab (an IL-5 inhibitor) in elderly (≥ 65 years) patients. Methods The REDES study was an observational, multicenter study of the effectiveness and safety of mepolizumab 100mg SC every 4 weeks in 318 severe asthma patients in Spain. This post-hoc analysis compares the effectiveness and safety of patients ≥65 years old to patients <65 years after 12 months of mepolizumab treatment. Results 27% of patients were ≥65 years old, compared with 73% of patients <65 years. Elderly patients showed a trend towards less frequent comorbid nasal polyps (p = 0.06) and a lower proportion of atopic sensitization (as detected by prick test or specific IgE) (p = 0.02). Similar improvements were noted in ACT score (p < 0.0001), comparable exacerbation reductions (p < 0.0001) and lung function parameters (p < 0.04 in elder group and p < 0.0001 in younger elder group), although an apparent greater reduction of OCS daily dose was observed in elder patients (p = 0.0002). No new safety signals were reported in the elderly population. Conclusions This study further supports mepolizumab as an effective and well tolerated therapy in the difficult to treat population of elderly patients with severe asthma.

Assessment of Residual [99mTc]Tc-Tetrofosmin Activity in Routine Nuclear Medicine Practice at Hospital Kuala Lumpur.

Myocardial perfusion imaging using the radiopharmaceutical [99mTc]Tc-tetrofosmin plays a crucial role in diagnosing cardiac conditions. However, variations in the residual activity of [99mTc]Tc-tetrofosmin in plastic syringes after administration may impact imaging quality and patient safety. This study aimed to evaluate the residual activity of [99mTc]Tc-tetrofosmin in plastic syringes after administration during routine nuclear medicine procedures at Hospital Kuala Lumpur, assessing compliance with department protocols and variability among different syringe brands. Methods: A single-center prospective observational study was conducted using stratified quota sampling, encompassing 396 samples across 3 syringe brands (SJ, BD, and Ciringe). Residual activity was measured immediately after administration, and statistical analysis was performed to compare brands and assess compliance with the department dosage protocol range of 333-555 MBq. Results: All injected activities aligned with the department protocol dose, with a mean effective activity of 451.23 ± 30.73 MBq and a mean residual activity of 12.63% ± 4.73%. However, variability in residual activity was observed among syringe brands. BD exhibited the highest mean residual activity (16.45%), significantly differing from SJ (9.95%) and Ciringe (11.50%) (P < 0.001). Conclusion: Rigorous syringe selection is crucial in myocardial perfusion imaging procedures to minimize residual activity and ensure compliance with dosimetry standards, emphasizing the importance of integrating pharmacy practices into nuclear medicine protocols. Standardized protocols and quality assurance measures are essential to optimize imaging outcomes and prioritize patient safety. These findings highlight the importance of ongoing monitoring and interdisciplinary collaboration to navigate residual activity management effectively in routine nuclear medicine practice.

Strategies for Sustainability and Cost Optimization in Corneal Transplantation: From Surgeons' Perspective.

The main purpose of this review is to provide an overview of surgical strategies that can be implemented in keratoplasty to maximize resource utilization and enhance sustainability. To achieve this, we conducted a thorough search of PubMed to identify articles on sustainability and cost-effectiveness in surgical settings, as well as studies comparing the cost-effectiveness of different keratoplasty techniques. Our review shows that both penetrating keratoplasty and lamellar techniques are cost-effective. However, lamellar techniques offer greater long-term sustainability and cost efficiency in addition to improving patient vision. For corneal transplantation surgeries, strategies such as reducing operating room time, properly educating the surgical team, reusing instruments like trephines and punches, using surgical materials economically, and selecting the appropriate surgical technique are recommended to enhance sustainability and reduce costs. The strategies outlined could contribute to more sustainable practices in keratoplasty procedures. In conclusion, although ensuring the economical use of surgical materials is beneficial for improving sustainability and reducing costs during surgery, utmost care should be taken to preserve safety and effectiveness while taking measures to reduce costs, and a balance should be achieved between sustainability and patient safety.

Traceability of Surgical Instruments: A Systematic Review

Objective: This study provides a comprehensive global overview of surgical instrument traceability systems and accentuates their growing importance in healthcare. Background: Surgical instruments pose risks to patient safety, economic costs, logistical challenges, and environmental impact. The increasing focus on instrument traceability reflects its potential to address these issues. Methods: We performed a systematic review using PRISMA guidelines, analyzing articles from 2000 to 2023 across five digital libraries (PubMed, Web of Science, IEEE, ACM, Google Scholar). Our review concentrated on traceability systems’ lifecycle for reusable and sterile surgical instruments. Results: Out of 7189 articles retrieved, 22 were selected for evaluation, and only 6 were considered relevant after a thorough examination. These studies mainly deployed Radio Frequency Identification (RFID) technology. They enhance patient safety, reduce environmental impact, improve economic efficiency, and optimize logistics. Additionally, these systems encourage more responsible surgical practices. Conclusions: Our study underscores the limited applied research in this field and discusses system architectures and performance metrics. It proposes future research directions, including the development of public databases, integration of automation, and investment in artificial intelligence (AI) and computer vision to improve traceability and risk analysis.