Rural Hospital Nursing Skill Mix and Work Environment Associated with Frequency of Adverse Events.

Introduction: Though rural hospitals serve about one fifth of the United States (U.S.), few studies have investigated relationships among nursing resources and rural hospital adverse events. Objectives: The purpose was to determine relationships among nursing skill mix (proportion of Registered Nurses (RNs) to all nursing staff), the work environment and adverse events (medication errors, patient falls with injury, pressure ulcers, and urinary tract infections) in rural hospitals. Methods: Using a cross-sectional design, nurse survey data from a large study examining nurse organizational factors, patient safety, and quality from four U.S. states were linked to the 2006 American Hospital Association data. The work environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Nurses reported adverse event frequency. Data analyses were descriptive and inferential. Results: On average, 72% of nursing staff were RNs (range = 45% to 100%). Adverse event frequency ranged from 0% to 67%, across 76 hospitals. In regression models, a 10-point increase in the proportion of RNs among all nursing staff and a one standard deviation increase in the PES-NWI score were significantly associated with decreased odds of frequent adverse events. Conclusion: Rural hospitals that increase the nursing skill mix and improve the work environment may achieve reduced adverse event frequency

Cessation of dual antiplatelet therapy and cardiovascular events following acute coronary syndrome

Objective: To assess whether cardiovascular events are increased after cessation of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) and to explore predictors for recurrent events after DAPT cessation during long-term follow-up. Methods: We did a retrospective observational cohort study. We included consecutive people with ACS who were discharged from Scottish hospitals between January 2008 and December 2013 and who received DAPT after discharge followed by antiplatelet monotherapy. The rates of cardiovascular events were assessed during each 90-day period of DAPT treatment and 90-day period after stopping DAPT. Cardiovascular events were defined as a composite of death, ACS, transient ischaemic attack or stroke. Cox regression was used to identify predictors of cardiovascular events following DAPT cessation. Results: 1340 patients were included (62% male, mean age 64.9 (13.0) years). Cardiovascular events occurred in 15.7% (n=211) during the DAPT period (mean DAPT duration 175.1 (155.3) days) and in 16.7% (n=188) following DAPT cessation (mean of 2.7 years follow-up). Independent predictors for a cardiovascular event following DAPT cessation were age (HR 1.07; 95% CI 1.05 to 1.08; p<0.001), DAPT duration (HR 0.997; 95% CI 0.995 to 0.998; p<0.001) and having revascularisation therapy during the index admission (HR 0.58; 95% CI 0.39 to 0.85; p=0.005). Conclusions: The rate of cardiovascular events was not significantly increased in the early period post-DAPT cessation compared with later periods in this ACS population. Increasing age, DAPT duration and lack of revascularisation therapy were associated with increased risk of cardiovascular events during long-term follow-up after DAPT cessation

A National Network of Safe Havens:A Scottish Perspective

For over a decade, Scotland has implemented and operationalized a system of Safe Havens, which provides secure analytics platforms for researchers to access linked, deidentified electronic health records (EHRs) while managing the risk of unauthorized reidentification. In this paper, a perspective is provided on the state-of-the-art Scottish Safe Haven network, including its evolution, to define the key activities required to scale the Scottish Safe Haven network’s capability to facilitate research and health care improvement initiatives. A set of processes related to EHR data and their delivery in Scotland have been discussed. An interview with each Safe Haven was conducted to understand their services in detail, as well as their commonalities. The results show how Safe Havens in Scotland have protected privacy while facilitating the reuse of the EHR data. This study provides a common definition of a Safe Haven and promotes a consistent understanding among the Scottish Safe Haven network and the clinical and academic research community. We conclude by identifying areas where efficiencies across the network can be made to meet the needs of population-level studies at scale

A profile of the Grampian Data Safe Haven, a regional Scottish safe haven for health and population data research

Funding for DaSH is provided by the University of Aberdeen and NHS Grampian. Past and current grants from Research Data Scotland also contribute to DaSH’s funding, along with funding provided by DaSH researchers for use of the facility. The authors also acknowledge the DaSH Team (DaSH Clinical Lead Dr Shantini Paranjothy; DaSH Research Coordinators Joanne Lumsden, Vicky Munro and Diane Brown; DaSH Analysts Helen Rowlands, Adrian Martin, Jaroslaw Dymiter, and Michael Lackenby; and DaSH Information Security Manager Gary Cooper), without whom the work would not be possible.Peer reviewedPublisher PD

Capital\u27s Offense: Law\u27s Entrenchment of Inequality

Reviewing Thomas Piketty, Capital in the Twenty-First Century (Harvard University Press, 2014) Piketty’s Capital in the Twenty-First Century is a rare scholarly achievement. It weaves together description and prescription, facts and values, economics, politics, and history, with an assured and graceful touch. So clear is Piketty’s reasoning, and so compelling the enormous data apparatus he brings to bear, that few can doubt he has fundamentally altered our appreciation of the scope, duration, and intensity of inequality. This review explains Piketty’s analysis and its relevance to law and social theory, drawing lessons for the re-emerging field of political economy. The university enables interdisciplinary work, and political economy is an ideally hybrid discursive space for this process of mutual inspiration and correction. Lawyers are particularly well-suited to the task of studying political economy, because we are the ones drafting, interpreting, and applying the rules governing the interface between state actors and firms. Integrating the long-divided fields of politics and economics, a renewal of modern political economy could unravel problems inadequately addressed by narrower specializations. Piketty’s work shows how inquiries in both law and political economy will be enriched by their interaction

Violence Against Women Act: History and Federal Funding

[Excerpt] The Violence Against Women and Department of Justice Reauthorization Act of 2005 (VAWA 2005) (P.L. 109-162) was enacted on January 5, 2006. Among other things, VAWA 2005 reauthorized existing VAWA programs and created many new programs. The act encourages collaboration among law enforcement, judicial personnel, and public and private service providers to victims of domestic and sexual violence; increases public awareness of domestic violence; addresses the special needs of victims of domestic and sexual violence, including the elderly, disabled, children, youth, and individuals of ethnic and racial communities; authorizes long-term and transitional housing for victims; makes some provisions gender-neutral; and requires studies and reports on the effectiveness of approaches used for certain grants in combating violence. VAWA programs are funded through annual appropriations for both the Departments of Justice (DOJ) and Health and Human Services (HHS). President Barack Obama released his FY2011 budget on February 2, 2011, requesting funding of $649.36 million for violence against women programs. For programs administered by DOJ, the President requests$457.00 million, of which $187.50 million is for Services-Training-Officers-Prosecutors (STOP) formula grants and$25.00 million is for Transitional Housing Assistance grants. The FY2011 funding request for programs administered by HHS is $192.36 million, of which$140.00 million is for Family Violence Prevention/Grants for Battered Women’s Shelters and $5.00 million is for the National Domestic Violence Hotline. The Obama Administration requests FY2011 funding of$500,000 each for two new efforts to address sexual and domestic violence and stalking in Indian Country: (1) Indian Country—Sexual Assault Clearinghouse and (2) Indian Country—Regional Summits. On December 16, 2009, the Consolidated Appropriations Act, 2010 (P.L. 111-117; H.R. 3288) was enacted, providing total FY2010 funding of $625.91 million for violence against women programs, of which$444.50 million is for VAWA programs administered by DOJ and $181.41 million is for domestic violence programs under the Department of Health and Human Services. The original VAWA, enacted in 1994 as Title IV of the Violent Crime Control and Law Enforcement Act (P.L. 103-322), established within DOJ and HHS formula and discretionary grant programs for state, local, and Indian tribal governments. The Violence Against Women Act of 2000 (VAWA 2000; P.L. 106-386), reauthorized many VAWA programs, set new funding levels, and created new grant programs to address sexual assaults on campuses and assist victims of domestic abuse. The Keeping Children and Families Safe Act of 2003 (P.L. 108-36) and the PROTECT Act (P.L. 108-21) authorized funding of both HHS and DOJ transitional housing assistance programs for victims of domestic violence. This report will be updated to reflect legislative activity

Data Safe Havens and Trust: Toward a Common Understanding of Trusted Research Platforms for Governing Secure and Ethical Health Research

In parallel with the advances in big data-driven clinical research, the data safe haven concept has evolved over the last decade. It has led to the development of a framework to support the secure handling of health care information used for clinical research that balances compliance with legal and regulatory controls and ethical requirements while engaging with the public as a partner in its governance. We describe the evolution of 4 separately developed clinical research platforms into services throughout the United Kingdom-wide Farr Institute and their common deployment features in practice. The Farr Institute is a case study from which we propose a common definition of data safe havens as trusted platforms for clinical academic research. We use this common definition to discuss the challenges and dilemmas faced by the clinical academic research community, to help promote a consistent understanding of them and how they might best be handled in practice. We conclude by questioning whether the common definition represents a safe and trustworthy model for conducting clinical research that can stand the test of time and ongoing technical advances while paying heed to evolving public and professional concerns