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Content Article
Greater risk of severe COVID-19 in Black, Asian and minority ethnic populations is not explained by cardiometabolic, socioeconomic or behavioural factors, or by 25(OH)-vitamin D status: study of 1326 cases from the UK Biobank (29 June 2020)
Patient Safety Learning posted an article in Health inequalities
Research has found that variations in cardiometabolic factors, vitamin D levels and socioeconomic or behavioural factors do not adequately explain why COVID-19 disproportionately affects black, Asian and minority ethnic populations. In this study published in the Journal of Public Health, Raisi-Estabragh et al. examined whether the greater severity of coronavirus disease 2019 (COVID-19) amongst men and Black, Asian and Minority Ethnic (BAME) individuals is explained by cardiometabolic, socio-economic or behavioural factors. They found ethnicity differential pattern of COVID-19 was not adequately explained by variations in cardiometabolic factors, vitamin D levels, or socioeconomic or behavioural factors. This, the researchers said, suggests that alternative biological pathways or genetic susceptibilities may have importance in driving the higher rates of severe COVID-19 in BAME populations and should be investigated. -
Content ArticleSome innovations spread fast. How do you speed the ones that don’t? Atul Gawande, a professor of public health and a surgeon, is the founder and chair of Ariadne Labs, takes a look at the history of medicine and why some innovative ideas and treatments take off and others don't.
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Content ArticleInadequate medication adherence is a widespread problem that contributes to increased chronic disease complications and healthcare expenditures. Packaging interventions using pill boxes and blister packs have been widely recommended to address the medication adherence issue. This meta-analysis review from Conn et al. determined the overall effect of packaging interventions on medication adherence and health outcomes. In addition, the authors tested whether effects vary depending on intervention, sample, and design characteristics. Overall, meta-analysis findings support the use of packaging interventions to effectively increase medication adherence.
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News ArticleThe architects behind the new NHS Race and Health Observatory have vowed that it will deliver actionable recommendations within months to tackle the structural racism that exists throughout healthcare. Victor Adebowale and Mala Rao called for an observatory to tackle the ethnic health inequalities in the UK in a special issue of The BMJ that they co-edited in February (bmj.com/racism-in-medicine) and NHS England confirmed at the end of the May that the centre would go ahead. Speaking at a meeting to discuss the aims of the observatory on 12 June, Adebowlae told more than 20 assembled stakeholders that he wanted the new centre “to fire on all cylinders,” making recommendations for changes to services that are likely to affect the health outcomes of people from black and ethnic minority backgrounds “within a couple of months.” Read full story Source: BMJ, 15 June 2020
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Content ArticleThe call for meaningful patient and family engagement in healthcare and research is gaining impetus. Healthcare institutions and research funding agencies increasingly encourage clinicians and researchers to work actively with patients and their families to advance clinical care and research. Engagement is increasingly mandated by healthcare organizations and is becoming a prerequisite for research funding. In this article, Burns et al. review the rationale and the current state of patient and family engagement in patient care and research in the ICU. The authors identify opportunities to strengthen engagement in patient care by promoting greater patient and family involvement in care delivery and supporting their participation in shared decision-making. They also identify challenges related to patient willingness to engage, barriers to participation, participant risks, and participant expectations. To advance engagement, clinicians and researchers can develop the science behind engagement in the ICU context and demonstrate its impact on patient- and process-related outcomes. In addition, the authors provide practical guidance on how to engage, highlight features of successful engagement strategies, and identify areas for future research. At present, enormous opportunities remain to enhance engagement across the continuum of ICU care and research.
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Content ArticleIn order to obtain compensation for harm arising out of medical treatment received within the NHS in Scotland, the elements needed to establish negligence under the law of delict must be satisfied. The Scottish government has expressed the view that a no-fault compensation scheme in relation to clinical negligence claims made against the NHS in Scotland could be simpler than the existing litigation system and could support the development of the concept of a mutual NHS, as well as a positive feedback and learning culture. With this in mind, the government considers that such a scheme is the favoured way forward for the NHS in Scotland. This report reviews and analyses existing no-fault schemes in a number of countries/jurisdictions: New Zealand (NZ); Nordic countries (Sweden, Finland, Denmark, Norway); and the schemes operating in Virginia and Florida (United States) for birth-related neurological injury.
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Content ArticleIn April 2009 a 'considerative checklist' was developed to ensure that all important aspects of care on a team's routine and post-take general internal medicine ward rounds had been addressed and in order to answer the question: How long should a ward round take, when conducted to high standards of quality and safety at the point of care? The checklist has been used on 120 ward rounds: 90 routine ward rounds and 30 post-take ward rounds. Overall, the average time per patient was 12 minutes (10 minutes on routine rounds and 14 minutes on post-take rounds). The considerative checklist has encouraged and enabled documented evidence of high quality and safe medical care, and anecdotally improved team working, communication with patients, and team and patient satisfaction.
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Content ArticleAn increasing number of studies show that when patterns of care are widely divergent, clinical outcomes suffer and, as a result, safety and reliability may be compromised. This article from Rozich et al. discusses how standardisation may help to increase uniformity of practice, increase safety, and possibly reduce costs. Also described is an effort made by Luther Midlefort, Mayo Health System, to reduce variation by creating a system-wide protocol for insulin use. After six weeks, Luther Midelfort achieved a great reduction in the number of hypoglycaemic events as a result of standardised practices.
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Content ArticleThe biopsychosocial model outlined in Engel’s classic Science paper four decades ago emerged from dissatisfaction with the biomedical model of illness, which remains the dominant healthcare model. Engel’s call to arms for a biopsychosocial model has been taken up in several healthcare fields, but it has not been accepted in the more economically dominant and politically powerful acute medical and surgical domains. This editorial from Wade and Haligan reviews the historical context, achievements and recent developments of the biopsychosocial model, with a view to explaining how the model could be better employed to help (re-)organise and improve both the efficiency and the effectiveness of healthcare systems. This could improve patient outcome while also controlling costs.
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Content ArticleThe PneuX System is a novel endotracheal tube and tracheal seal monitor, which has been designed to minimise the aspiration of oropharyngeal secretions. Doyle et al. aimed to determine the incidence of ventilator-associated pneumonia (VAP) in patients who were intubated with the PneuX System and to establish whether intermittent subglottic secretion drainage could be performed reliably and safely using the PneuX System.
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Content ArticleAround £240m of taxpayers’ money has been spent on government inquiries since 2005, but evidence that recommendations from these high profile investigations have been adopted is lacking, the UK public spending watchdog has concluded. The report by the National Audit Office into government funded inquiries, including those on NHS matters, describes uncertainty and variation in the relative costs of inquiries, the effects they had, and how they were carried out.1 In all, the watchdog found that the government spent at least £239m on the 26 inquiries that have concluded since 2005 and that they lasted on average 40 months
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Content ArticleBlood pressure (BP) has been measured with a cuff for over a 100 years. Recently, ‘tricorders’ and smartwatches that measure BP without a cuff using pulse transit time (PTT) have become available. These BP measurements are based on the inverse relationship between BP and PTT. PTT can be measured as the timing delay in a QRS complex on an EKG and the onset of a photoplethysmography wave, for example measured from a finger. Since these measurements are relatively more user‐friendly than conventional cuff‐based measurements they may aid in more frequent BP monitoring. Using a guidelines‐based protocol, Bard et al. investigated the accuracy and precision of two popular PTT‐based BP measuring devices: the Everlast TR10 fitness watch (Everlast, New York City, NY) and the BodiMetrics tricorder (BodiMetrics, Manhattan Beach, CA).
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Content ArticleShabazz et al. explore incidents of bullying and undermining among obstetrics and gynaecology consultants in the UK, to add another dimension to previous research and assist in providing a more holistic understanding of the problem in medicine.
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Content Article
Research: Why managers ignore employees’ ideas (8 April 2019)
Patient Safety Learning posted an article in Culture
When employees share novel ideas and bring up concerns or problems, organisations innovate and perform better. But managers do not always promote employees’ ideas. In fact, they can even actively disregard employee concerns and act in ways that discourage employees from speaking up at all. While much current research suggests that managers are frequently stuck in their own ways of working and identify so strongly with the status quo that they are fearful of listening to contrary input from below, new research offers an alternative perspective: managers fail to create speak-up cultures not because they are self-focused or egotistical, but because their organisations put them in impossible positions. They face two distinct hurdles: they are not empowered to act on input from below, and they feel compelled to adopt a short-term outlook to work. -
Content ArticleAmiri et al. analysed the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD). They found that a higher proportion of nurses is associated with higher patient safety resulting from lower surgical complications and adverse clinical outcomes in OECD countries.
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Content ArticleThe medical symptom 'iceberg' and 'trivia' were defined in terms of people's own perceptions of their symptoms and their subsequent referral behaviour. The data were collected by household interviews of patients registered at a health centre and included information on personal and environmental characteristics. Bivariate and multivariate analysis was used to explore associations between those who were part of the symptom 'iceberg' or 'trivia', and factors which might have caused such incongruous referral behaviour.
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Content ArticleIn this blog, Julie Rehmeyer discusses the impact that flawed research results had on patients with chronic fatigue syndrome.
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Content ArticleCorporate interests have the potential to influence public debate and policymaking by influencing the research agenda, namely the initial step in conducting research, in which the purpose of the study is defined and the questions are framed. Fabbri et al. conducted a scoping review to identify and synthesise studies that explored the influence of industry sponsorship on research agendas across different fields. The authors concluded that corporate interests can drive research agendas away from questions that are the most relevant for public health. Strategies to counteract corporate influence on the research agenda are needed, including heightened disclosure of funding sources and conflicts of interest in published articles to allow an assessment of commercial biases. The authors also recommend policy actions beyond disclosure such as increasing funding for independent research and strict guidelines to regulate the interaction of research institutes with commercial entities.
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Content ArticleThe mortality rates for people with autism spectrum disorder (ASD) are double those of the general population and researchers believe unmet mental health needs may be a factor. The researchers’ results were derived from an Australian-first University of New South Wales (UNSW) study, which analysed linked data sets on death rates, risk factors and cause of death for 36,000 people on the autism spectrum. While cancer and circulatory diseases are the leading cause of deaths in the general population, injury and poisoning – including accidents, suicide and deaths related to self-harm – were the most common causes for people with ASD. GP and autism advocate Dr James Best told newsGP he was not surprised by the results, but that they did confirm people with ASD have a different set of health risk factors.
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Content ArticleAs the number of Pennsylvanians diagnosed with autism spectrum disorder (ASD) continues to grow, healthcare facilities are seeing an increase in the number of these individuals seeking care. Negative interactions with the healthcare system and concerns about the quality of care provided to this population have been reported by individuals with ASD, their families, and healthcare providers. The Pennsylvania Patient Safety Authority received 138 reports of events involving patients with ASD from July 2004 through August 2014. Qualitative analysis of event report narratives revealed 12 patient safety concern themes involving patients with ASD. Injury to self or potential injury to self was identified as the most frequently reported concern (n = 75), followed by interference or lack of cooperation with care (n = 30). Other events included aggressive behavior and/or injury to others, use of chemical or physical restraints, patient communication difficulties, and caregiver communication difficulties and/or consent issues. The patient safety concerns commonly encountered by ASD patients and their families as reported to the Authority are consistent with the concerns cited in the published literature. Resources such as those developed by the Western Pennsylvania Autism Services, Education, Resources, and Training Collaborative are available to help healthcare facilities improve care for this population.
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Content Article“Sunshine” policy, aimed at making financial ties between health professionals and industry publicly transparent, has gone global. Given that transparency is not the sole means of managing conflict of interest, and is unlikely to be effective on its own, it is important to understand why disclosure has emerged as a predominant public policy solution, and what the effects of this focus on transparency might be.
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Content ArticleThis innovative, practical guide introduces researchers to the use of the video reflexive ethnography in health and health services research. This methodology has enjoyed increasing popularity among researchers internationally and has been inspired by developments across a range of disciplines: ethnography, visual and applied anthropology, medical sociology, health services research, medical and nursing education, adult education, community development, and qualitative research ethics.
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Content ArticleThis international review from the Health Information and Quality Authority highlights the considerable variation in place across countries in relation to patient safety reporting. It is clear however, that the coordination and triangulation of patient safety intelligence for risk profiling is extremely important. Incidents need to be combined with other quality and patient safety sources of information.
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Content Article
Bulletin of the World Health Organization
Patient Safety Learning posted an article in WHO
The Bulletin of the World Health Organization is a fully open-access monthly journal of public health with a special focus on low and middle-income countries. -
Content ArticleScienceDirect uses heuristic and machine-learning approaches to extract relevant information from their extensive collection of content. They compile this information on a topic-by-topic basis providing the reader both depth and breadth on a specific area of interest. This collection of research and data focuses on safety risk management.
