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News Article
Children with Down Syndrome at up to 10-fold higher risk of diabetes
Patient Safety Learning posted a news article in News
New research led by Queen Mary University of London (QMUL) and King's College London (KCL) has shown that children with Down Syndrome (DS) are up to 10 times more likely to be diagnosed with diabetes. Although elevated rates of both type 1 diabetes and obesity in DS were already recognised, this is the first time that the incidence of these comorbidities has been mapped across the life span, in one of the biggest DS cohorts in the world. The authors concluded: "Our study shows that patients with DS are at significantly increased risk of diabetes at a younger age than the general population, with more than four times the risk in children and young adults and more than double the risk in patients aged 25–44 years." They added: "The underlying mechanisms for this increased susceptibility for diabetes in DS still need further investigation. A combination of factors, including genetic susceptibility, predisposition to auto- immunity, mitochondrial dysfunction, increased oxidative stress, and cellular dysfunction, are thought to contribute to this risk." Corresponding author Andre Strydom, professor in intellectual disabilities at KCL, said: "This is the largest study ever conducted in Down Syndrome patients to show that they have unique needs with regards to diabetes and obesity, and that screening and intervention – including a healthy diet and physical activity – at younger ages is required compared with the general population. "The results will help to inform the work of NHSE's LeDeR programme to reduce inequalities and premature mortality in people with Down Syndrome and learning disabilities." Read full story Source: Medscape UK, 5 October 2022 -
News ArticleEven mild cases of Covid-19 during pregnancy “exhaust” the placenta and damage its immune response, new research suggests. The findings, which come as coronavirus cases are again on the rise in the UK, lend weight to multiple studies over the course of the pandemic linking the virus to a rise in dangerous pregnancy complications such as pre-eclampsia. But the results of the study – the largest yet involving the placentas of infected women – may represent the “the tip of the iceberg” of how Covid-19 affects foetal or placental development, warned Dr Kristina Adams Waldorf, the senior author on the study, which was published last month in the American Journal of Obstetrics & Gynecology. Early in the pandemic, it was widely assumed that the coronavirus did not harm the developing foetus because so few babies were born with the infection, said Dr Adams Waldorf, a professor of obstetrics and gynaecology at the University of Washington School of Medicine. “But what we’re seeing now is that the placenta is vulnerable to Covid-19, and the infection changes the way the placenta works, and that in turn is likely to impact the development of the foetus,” explained the professor. Read full story Source: The Independent, 9 October 2022
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News Article
People with recent dementia diagnosis found to have higher suicide risk
Patient Safety Learning posted a news article in News
People who have recently been diagnosed with dementia, or who are diagnosed with the condition at a younger age, are among those at increased risk of suicide, researchers have found. The findings have prompted calls for greater support for those experiencing such cognitive decline. While previous research has explored a potential link between dementia diagnosis and suicide risk, the results have been inconclusive, with some suggesting a raised risk and others a reduced risk. Now researchers say certain groups of people with dementia are at increased risk of suicide. “What it tells us is that period immediately after diagnosis is when people really need support from the services that provide the diagnosis,” said Dr Charles Marshall, co-author of the research and a clinical senior lecturer and honorary consultant neurologist at the Wolfson Institute of Population Health at Queen Mary University of London. In the first three months after being told they had dementia, those diagnosed before the age of 65 had an almost seven times greater risk of suicide compared with those without dementia – although this reduced somewhat over time. Marshall said it was unclear whether the findings were down to dementia itself causing people to feel suicidal, or factors such as people being concerned they may become a burden to their family. Read full story Source: The Guardian, 3 October 2022 -
News Article
Women with type 2 diabetes have 60% increased chance of early death
Patient Safety Learning posted a news article in News
Women in the UK with type 2 diabetes have a 60% increased risk of an early death and will live five years less than the average woman in the general population, early research suggests. Scientists have also found that men with the disease have a 44% increased risk of dying prematurely and live 4.5 years less. Results also suggest that smoking shortens the life expectancy of people with type 2 diabetes by 10 years, while diagnosis at a younger age cuts life expectancy by over eight years. The findings, presented at the European Association for the Study of Diabetes in Stockholm, Sweden, are based on a cohort of nearly 12,000 patients at the Salford Royal Hospital in Salford. “A woman with type 2 diabetes, for example, might live five years less than the average woman in the general population, while someone diagnosed at a younger age might lose eight years of life expectancy. “It is vital that the groups at the highest risk are made aware of not just the increased risk that they face but also the size of the risk." “Doing so may make the health advice they are given seem more relevant and so help them make changes that can improve their quality – and length – of life.” Read full story Source: The Independent, 21 September 2022 -
News Article
Britons of black and south Asian origin with dementia die younger, study finds
Patient Safety Learning posted a news article in News
Britons of black and south Asian origin with dementia die younger and sooner after being diagnosed than white people, research has found. South Asian people die 2.97 years younger and black people 2.66 years younger than their white counterparts, according to a study by academics from University College London and the London School of Hygiene and Tropical Medicine. A team led by Dr Naaheed Mukadam, from UCL’s division of psychiatry, reached their conclusions after studying health records covering the 21 years between 1997 and 2018 of 662,882 people across the UK who were aged over 65. They found that: Dementia rates have increased across all ethnic groups. Black people are 22% more likely to get dementia than their white peers. Dementia is 17% less common among those of south Asian background. But they have voiced concern about also discovering that south Asian and black people are diagnosed younger, survive for less time and die younger than white people. “The earlier age of dementia diagnosis in people of black and south Asian [origin] … may be related to the higher prevalence of some risk factors for dementia such as, in older south Asians, fewer years of education, and in both groups hypertension [high blood pressure], diabetes and obesity,” they write in their paper, published in the medical journal Alzheimer’s & Dementia. Read full story Source: The Guardian, 18 September 2022 -
Content ArticlePhysicians raised a concern to the Quality Department about patients who were diagnosed in the emergency department (ED) with a urinary tract infection (UTI) but who later were clinically reviewed and found to be without disease. These patients were often admitted and treated with potentially unnecessary antibiotics.
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Content ArticleSafety culture, in formal social-scientific terms, is an object of knowledge. As such, it is part of a larger discursive practice of accident prevention, together with other objects like technical failure and human error. This study examines safety culture as an object in the discourse of accident prevention based on the Foucauldian approach.
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Content ArticleA gap analysis identified the need for process improvement surrounding the identification and reporting of adverse drug reactions related to moderate sedation. A change to documentation was selected to address this gap. The challenge was disseminating the change in a meaningful way during a time of high census and limited staffing due to the COVID-19 pandemic. Complex adaptive systems theory was used to plan interventions in these conditions.
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Content ArticleAdherence to best practices for sepsis management at a small community hospital was below system, state and national benchmarks and affected vital indicators, including mortality. This study carried out by Megan Kiser aimed to improve sepsis best practice compliance by implementing human factors–influenced interventions.
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Content ArticleStudy into patient attitudes and perspectives related to viewing immediately released test results through an online patient portal. In this survey study of 8139 respondents at four US academic medical centres, 96% of patients preferred receiving immediately released test results online even if their healthcare practitioner had not yet reviewed the result. However a subset of respondents experienced increased worry after receiving abnormal results.
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Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Beverley talks to us about setting up Thrombosis UK and how it has grown to have a national impact on patient safety in hospitals. She also describes the value of combining policy work with seeing patients face-to-face, and explores the need to find new ways of working to deal with the pressures facing the healthcare system. -
Content ArticleStandard operating procedures (SOPs) should improve safety in the operating theatre, but controlled studies evaluating the effect of staff-led implementation are needed. Morgan et al. evaluated three team process measures (compliance with WHO surgical safety checklist, non-technical skills and technical performance) and three clinical outcome measures (length of hospital stay, complications and readmissions) before and after a 3-month staff-led development of SOPs. They found that SOPs when developed and introduced by frontline staff do not necessarily improve operative processes or outcomes. The inherent tension in improvement work between giving staff ownership of improvement and maintaining control of direction needs to be managed, to ensure staff are engaged but invest energy in appropriate change.
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Content ArticleThe African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality rate twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. This aim of this study in The British Journal of Anaesthesia was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was developed using data from 8799 patients in 168 African hospitals. It includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The authors concluded that the ASOS Surgical Risk Calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.
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Content ArticleThe objective of this study from Sharma et al. was to evaluate the accuracy of a new elective surgery clinical decision support system, the ‘Patient Tacking List’ (PTL) tool (C2-Ai(c)) through receiver operating characteristic (ROC) analysis. They found that the PTL tool was successfully integrated into existing data infrastructures, allowing real-time clinical decision support and a low barrier to implementation. ROC analysis demonstrated a high level of accuracy to predict the risk of mortality and complications after elective surgery. As such, it may be a valuable adjunct in prioritising patients on surgical waiting lists. Health systems, such as the NHS in England, must look at innovative methods to prioritise patients awaiting surgery in order to best use limited resources. Clinical decision support tools, such as the PTL tool, can improve prioritisation and thus positively impact clinical care and patient outcomes.
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Content ArticleCancer patients and their carers face a multitude of challenges in the treatment journey; the full scope of how they are involved in promoting safety and supporting resilient healthcare is not known. This study from Tillbrook et al. aimed to undertake a scoping review to explore, document, and understand existing research, which explores what cancer patients and their carers do to support the safety of their treatment and care.
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Content ArticleMeasures exist to improve early recognition of and response to deteriorating patients in hospital. However, management of critical illness remains a problem globally; in the United Kingdom, 7% of the deaths reported to National Reporting and Learning System from acute hospitals in 2015 related to failure to recognise or respond to deterioration. The current study from Albutt et al. explored whether routinely recording patient-reported wellness is associated with objective measures of physiology to support early recognition of hospitalised deteriorating patients. The preliminary findings suggest that patient-reported wellness may predict subsequent improvement or decline in their condition as indicated by objective measurements of physiology (NEWS). Routinely recording patient-reported wellness during observation shows promise for supporting the early recognition of clinical deterioration in practice, although confirmation in larger-scale studies is required.
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Content ArticleCovid-19 infection may lead to acute and chronic sequelae. Emerging evidence suggests a higher risk of diabetes after infection, but population-based evidence is still sparse. In this study, Naveed et al. evaluated the association between COVID-19 infection, including severity of infection, and risk of diabetes. They concluded that Covid-19 was associated with a higher risk of diabetes and may have contributed to a 3% to 5% excess burden of diabetes at a population level.
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Content ArticleWe often hear the mesh scandal blamed on poor surgeon skill. We also hear the argument that high use mesh implanting surgeons are likely to have fewer patients suffering mesh complications, than a less experienced surgeon. However, this study published in JAMA in October 2018, based on NHS data, shows that high mesh implanting surgeons produce the same or even more mesh complications compared to low volume implanters.
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Content Article
A ‘Just Culture’ aims to improve patient safety by looking at the organisational and individual factors that contribute to incidents. It encourages people to speak up about their errors and mistakes so that action can be taken to prevent those errors from being repeated. Adam Tasker and Julia Jones are graduate medical students at Warwick Medical School. They wanted to explore doctors’ perceptions of culture and identify ways to foster a Just Culture, so they conducted a qualitative research study at one of the hospitals where they were doing their medical training. We asked them about why Just Culture is important in the health and care system, and what they discovered from their research. -
Content ArticleOutpatient and daycase hysteroscopy and polypectomy (OPHP) are widely recognised methods for the treatment of endometrial polyps. There have been concerns regarding pain affecting satisfaction and tolerability of the outpatient procedure. Dr Bhawana Purwar and colleagues from the Royal Wolverhampton Hospitals NHS Trust conducted a service evaluation of their outpatient hysteroscopy and polypectomy (OPHP) and compared it with their daycase procedures. They concluded that the OPHP is cost-effective and efficient method with reasonable acceptability. It is well tolerated with remarkable success rates and excellent patient satisfaction. As compared to daycase group, it requires less time for recovery and sooner returns to work.
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Content ArticleTechnologies abstract intelligence and provide predictor and precision insight in workflows that manage disorders, similar to cardiology and hematological disease. Positive perceptions of Artificial Intelligence (AI) that support Machine Learning (ML) and Deep Learning (DL) manage transformations with a safe system that improves wellbeing. In sections, workflow introduces an eXamination (X = AI) as an end-to-end structure to culture workstreams in a step-by-step design to manage populace health in a governed system. The author undertook structure and practice reviews and appraised perspectives that impact the management of AI in public health and medicine.
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Content ArticlePatients benefit from guideline-based preventive, chronic disease, and acute care, but many do not receive it. A limitation to providing high-quality care is insufficient time for primary care providers (PCPs). The aim of this study was to quantify the time needed to provide preventive care, chronic disease care, and acute care for a nationally representative adult patient panel by a PCP alone, and by a PCP as part of a team-based care model. The authors concluded that PCPs do not have enough time to provide the guideline-recommended primary care. With team-based care the time requirements would decrease by over half, but still be excessive.
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Content ArticleTraditional approaches to patient safety and handoffs need redesigning to acknowledge the different constraints, goals, and requirements necessary for each individual patient. There is no “one size fits all” approach to patient safety, handoffs or a perfect checklist. Despite the inherit complexity present in healthcare systems, we tend to reduce our thinking about handoffs into simple solutions of checklists and cognitive aids. In studies of these tools, their association with patient outcomes is unclear with mixed results in large studies. Incorporating general resilience engineering principles of visibility, understanding, anticipation, and learning provides new opportunities for increased patient safety. This involves situating the handoff in the context of the system - understanding the process of summarising pre-handoff and of developing understanding post-handoff, tracing flows of information and patients, and considering the role of feedback and control loops in the system. Direct observations, analysis of multiple outcomes, focus on patient evolving specific exceptions, reducing the number of handoffs, taking time for two-way discussions, and user-centred design and redesign may promote acceptability and sustainability of a new view of handoffs for improved patient safety.
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Content ArticleCalculating nurse staffing in the acute hospital has become a key issue but solutions appear distant. Community, mental health and areas such as learning disability nursing have attracted less attention and remain intractable. This review from Leary and Punshon aimed to examine current approaches to the issue across many disciplines.
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Content ArticleNew study from Farr et al. into the effect of implanting polypropylene (PP) surgical mesh into patients. More evidence is needed to show the harmful effect to patients by implanting a foreign body into them, especially into the pelvic floor.
