Study on the performance enhancement of biomedical implants: in vitro test under UV irradiation of titanium anodised in mixed electrolyte

Titanium (Ti) recently has widely been used in the biomedical applications due to its high performance. Therefore, surface modifications of titanium have attracted a lot of interest to provide better osseointegration. Ti was subjected to anodic oxidation process and in vitro testing to assess the bioactivity of titanium oxide (TiO2) coating. TiO2 coating has been anodised at room temperature in different electrolyte; in sulphuric acid (H2SO4); phosphoric acid (H3PO4); and a mixture of H2SO4 and H3PO4 acids. The parameters used in anodization were: concentration of the electrolytes, applied voltage and current density. The coated surface is then evaluated using different testing techniques; the microstructure using scanning electron microscope (SEM); the elemental analysis using Energy-dispersive x-ray spectroscopy (EDX); mineralogical and crystal structure using x-ray diffraction (XRD); absorption analysis using Fourier transform infrared spectroscopy (FT-IR); and the hydrophilicity using water contact angle (WCA). TiO2 was then subjected in vitro testing to assess the bioactivity of TiO2 surface; that is the apatite formation ability. The apatite formation of the TiO2 coating was precipitated by using simulated body fluid (SBF) in the dark and under the ultraviolet (UV) irradiation to mimic the reactions that may occur with the human bone-like cells layer. The testing was done to evaluate the apatite’s microstructure, mineralogy, elements and absorption. From the results it was found that higher apatite was obtained with the increased of the immersion time; higher apatite formation and crystallization was found at earlier time of immersion for the TiO2 that was immersed in SBF under the UV; higher apatite was obtained on the TiO2 coatings that were anodised in H2SO4, H3PO4 and mixture electrolyte at lower electrolyte concentration. The increased apatite on these coatings can be related to the strong Ti-O- functional groups on the coating surface. The highest apatite was obtained on the TiO2 coating that was anodised in a mixture electrolyte that has obtained Ti-OH functional group. The UV has resulted in the increased Ti-O- and Ti-OH groups, thus higher apatite precipitation ability

Enhancing patient safety by integrating ethical dimensions to Critical Incident Reporting Systems

Background Critical Incident Reporting Systems (CIRS) provide a well-proven method to identify clinical risks in hospitals. All professions can report critical incidents anonymously, low-threshold, and without sanctions. Reported cases are processed to preventive measures that improve patient and staff safety. Clinical ethics consultations offer support for ethical conflicts but are dependent on the interaction with staff and management to be effective. The aim of this study was to investigate the rationale of integrating an ethical focus into CIRS. Methods A six-step approach combined the analysis of CIRS databases, potential cases, literature on clinical and organizational ethics, cases from ethics consultations, and experts' experience to construct a framework for CIRS cases with ethical relevance and map the categories with principles of biomedical ethics. Results Four main categories of critical incidents with ethical relevance were derived: (1) patient-related communication; (2) consent, autonomy, and patient interest; (3) conflicting economic and medical interests; (4) staff communication and corporate culture. Each category was refined with different subcategories and mapped with case examples and exemplary related ethical principles to demonstrate ethical relevance. Conclusion The developed framework for CIRS cases with its ethical dimensions demonstrates the relevance of integrating ethics into the concept of risk-, quality-, and organizational management. It may also support clinical ethics consultations' presence and effectiveness. The proposed enhancement could contribute to hospitals' ethical infrastructure and may increase ethical behavior, patient safety, and employee satisfaction

How effective are incident reporting systems for improving patient safety? A systematic literature review

Context: Incident reporting systems (IRSs) are used to gather information on patient safety incidents. However, and despite the financial burden they imply, little is known about their effectiveness. This paper reviews systematically the effectiveness of IRSs as a method of improving patient safety through organizational learning. Method: This systematic literature review identified two groups of studies: a) studies comparing the effectiveness of IRSs relative to other methods of error reporting and b) studies examining the effectiveness of IRSs on settings, structures and outcomes in respect of improvements to patient safety. We used thematic analysis to compare the effectiveness of IRSs with other methods and to synthesize what was effective, where and why. Then, to assess the evidence concerning the ability of IRSs to facilitate organizational learning, we analyzed studies using the concepts of single loop and double loop learning. Findings: In total, 43 studies were identified. Eight studies compared IRSs with other methods, while 35 explored the effectiveness of IRSs on settings, structures and outcomes. We did not find strong evidence that IRSs perform better than other methods. We found some evidence of single loop learning, that is, changes to clinical settings or processes as a consequence of learning from IRSs, but little evidence either of improvements to outcomes or of changes to latent managerial factors involved in error production. In addition, there was insubstantial evidence of IRSs enabling double loop learning that is, cultural change or change of mindset. Conclusions: The results indicate IRSs could be more effective if there were explicit criteria for what counts as an incident; they are owned and led by clinical teams rather than centralized hospital departments; and embedded within organizations as part of wider safety programs

Centralized and distributed learning methods for predictive health analytics

The U.S. health care system is considered costly and highly inefficient, devoting substantial resources to the treatment of acute conditions in a hospital setting rather than focusing on prevention and keeping patients out of the hospital. The potential for cost savings is large; in the U.S. more than $30 billion are spent each year on hospitalizations deemed preventable, 31% of which is attributed to heart diseases and 20% to diabetes. Motivated by this, our work focuses on developing centralized and distributed learning methods to predict future heart- or diabetes- related hospitalizations based on patient Electronic Health Records (EHRs). We explore a variety of supervised classification methods and we present a novel likelihood ratio based method (K-LRT) that predicts hospitalizations and offers interpretability by identifying the K most significant features that lead to a positive prediction for each patient. Next, assuming that the positive class consists of multiple clusters (hospitalized patients due to different reasons), while the negative class is drawn from a single cluster (non-hospitalized patients healthy in every aspect), we present an alternating optimization approach, which jointly discovers the clusters in the positive class and optimizes the classifiers that separate each positive cluster from the negative samples. We establish the convergence of the method and characterize its VC dimension. Last, we develop a decentralized cluster Primal-Dual Splitting (cPDS) method for large-scale problems, that is computationally efficient and privacy-aware. Such a distributed learning scheme is relevant for multi-institutional collaborations or peer-to-peer applications, allowing the agents to collaborate, while keeping every participant's data private. cPDS is proved to have an improved convergence rate compared to existing centralized and decentralized methods. We test all methods on real EHR data from the Boston Medical Center and compare results in terms of prediction accuracy and interpretability

An integrated management system for quality and information security in healthcare

Health service organizations are increasingly required to deliver quality healthcare services without increasing costs. The adoption of health information technologies can assist these organizations to deliver a quality service; however, this again exposes the health information to threats. The protection of personal health information is critical to ensure the privacy of patients in the care of health service organizations. Therefore both quality and information security are of importance in healthcare. Organisations commonly use management system standards to assist them to improve a particular function (e.g. quality or security) through structured organizational processes to establish, maintain and optimise a management system for the particular function. In the healthcare sector, the ISO 9001, ISO 9004 and IWA 1 standards may be used for the purpose of improving quality management through the establishment of a quality management system. Similarly, the ISO 27001 and ISO 27799 standards may be used to improve information security management through the establishment of an information security management system. However, the concurrent implementation of multiple standards brings confusion and complexity within organisations. A possible solution to the confusion is to introduce an integrated management system that addresses the requirements of multiple management systems. In this research, various standards relevant to the establishment of management systems for quality and security are studied. Additionally, literature on integrated management systems is reviewed to determine a possible approach to establishing an IMS for quality and information security in healthcare. It will be shown that the quality management and information security management standards contain commonalities that an integration approach can be based on. A detailed investigation of these commonalities is done in order to present the final proposal of the IMSQS, the Integrated Management System for Quality and Information Security in healthcare

An integrated management system for quality and information security in healthcare

Health service organizations are increasingly required to deliver quality healthcare services without increasing costs. The adoption of health information technologies can assist these organizations to deliver a quality service; however, this again exposes the health information to threats. The protection of personal health information is critical to ensure the privacy of patients in the care of health service organizations. Therefore both quality and information security are of importance in healthcare. Organisations commonly use management system standards to assist them to improve a particular function (e.g. quality or security) through structured organizational processes to establish, maintain and optimise a management system for the particular function. In the healthcare sector, the ISO 9001, ISO 9004 and IWA 1 standards may be used for the purpose of improving quality management through the establishment of a quality management system. Similarly, the ISO 27001 and ISO 27799 standards may be used to improve information security management through the establishment of an information security management system. However, the concurrent implementation of multiple standards brings confusion and complexity within organisations. A possible solution to the confusion is to introduce an integrated management system that addresses the requirements of multiple management systems. In this research, various standards relevant to the establishment of management systems for quality and security are studied. Additionally, literature on integrated management systems is reviewed to determine a possible approach to establishing an IMS for quality and information security in healthcare. It will be shown that the quality management and information security management standards contain commonalities that an integration approach can be based on. A detailed investigation of these commonalities is done in order to present the final proposal of the IMSQS, the Integrated Management System for Quality and Information Security in healthcare

An integrated management system for quality and information security in healthcare

Health service organizations are increasingly required to deliver quality healthcare services without increasing costs. The adoption of health information technologies can assist these organizations to deliver a quality service; however, this again exposes the health information to threats. The protection of personal health information is critical to ensure the privacy of patients in the care of health service organizations. Therefore both quality and information security are of importance in healthcare. Organisations commonly use management system standards to assist them to improve a particular function (e.g. quality or security) through structured organizational processes to establish, maintain and optimise a management system for the particular function. In the healthcare sector, the ISO 9001, ISO 9004 and IWA 1 standards may be used for the purpose of improving quality management through the establishment of a quality management system. Similarly, the ISO 27001 and ISO 27799 standards may be used to improve information security management through the establishment of an information security management system. However, the concurrent implementation of multiple standards brings confusion and complexity within organisations. A possible solution to the confusion is to introduce an integrated management system that addresses the requirements of multiple management systems. In this research, various standards relevant to the establishment of management systems for quality and security are studied. Additionally, literature on integrated management systems is reviewed to determine a possible approach to establishing an IMS for quality and information security in healthcare. It will be shown that the quality management and information security management standards contain commonalities that an integration approach can be based on. A detailed investigation of these commonalities is done in order to present the final proposal of the IMSQS, the Integrated Management System for Quality and Information Security in healthcare

Recording and utilising patient-based data in clinical settings: The pressure ulcer case.

Pressure ulcers (PUs) are a very common health problem. Nurses in clinical practice collect large volumes of PU data every day, which must be recorded and used appropriately. With this in mind, this research explored how PU data is recorded and used in clinical settings. In addition, the magnitude of PU problem in Jordan was assessed. A mixed methods approach was utilised to address the research objectives. As a first stage, Tissue Viability Nurses (TVNs) in the UK from the Tissue Viability Society (TVS) and the National Health Service (NHS) were asked to complete an online questionnaire. Subsequently, a number of them (n=16) participated in semi-structured interviews in order to complement and explain the questionnaire responses. In Jordan, a cross sectional point prevalence survey employing the European Pressure Ulcer Advisory Panel (EPUAP) methodology was conducted to measure the prevalence rate of pressure ulcers. Integration between the questionnaire and interview results occurred on a number of different occasions. The questionnaire findings (n=167) showed there to be a difference in the prevalence rate between the primary and secondary settings (X2=20.59, df=3, p<0.001), with an overall mean of 7%, and a range of 0.5-25%. It was also found that the prevalence survey and clinical audits (71.8%, n=120), conducted annually (40.9%, n=67) or monthly (22.6%, n=37) by TVNs (63.6%, n=105), were the most common methods of calculating the reported prevalence rate. The field notes taken during the interviews, which were analysed thematically using the template analysis approach, highlighted that PU audits can be conducted via additional methods to those reported in the questionnaires. These include: actual audits where patients are inspected by TVNs or link nurses; relying on the nurses to complete audit forms; and, finally, reviewing the recording systems to generate reports. Moreover, the questionnaire findings showed that PU data is mainly recorded on a combination system (48.2%, n=79), or in some cases recorded on a computerised system (9.8%, n=16). The interviews again complement these findings by expanding that PU data can be recorded, reported and referred using paper, electronic or combination records. The advantages and disadvantages of each recording system were explored and defined into separate themes. Additionally, conducting a PU audit requires certain tools. It was clear from the questionnaire that the Waterlow risk assessment scale (RAS) (88.8%, n=142), and the EPUAP classification tool (83%, n=132) were the most commonly used in the UK. Regarding the uses of PU data, the interview findings showed that there are several. For example, it can be used to generate reports about PU in a given organisation, and these reports can be used to provide feedback to the nurses, TVNs, and management, and could also prompt decisions about purchasing equipment, employing nurses or offering training in areas where there are high levels of PU cases. Prevalence and incidence data, in particular, can be used to evaluate intervention, to monitor quality, to ensure best practice is provided, as educational tools for conducting audits, and for initiating safeguarding and investigating procedures. Despite all these potential uses, however, some interviewees think that some PU data, especially the prevalence data, is useless and difficult to capture, and that incidence data is more reliable and powerful. In Jordan, the researcher examined the skin of all inpatients aged eighteen or above, except patients in the emergency, day care and maternity wards, in both university and general hospitals. This yielded a sample of 302 patients. Any PU identified was graded according to the EPUAP grading scale (GS). The risk of PU development was assessed using the Braden scale. Data was also collected on preventive measures used in the clinical setting. Of the patients examined, 11.9% (n=36) had PU grade 1-4 (excluding grade 1: 6.6%, n=20). Interestingly, this PU prevalence rate is lower than that published in most studies which have employed the same methodology but it is thought that the differences in age and frailty in the Jordanian sample, compared with most others, could explain the low prevalence. The sacrum and heel were the most commonly affected sites (55.6%, n=20). Grade one was the most common grade (44.4%, n=16) and 85 (28.1%) patients were considered at risk of developing pressure damages. Despite the relatively low prevalence, very few patients at risk received adequate prevention measures (16.5%, n=14), and there is therefore a need to raise awareness of the need for PU prevention in Jordan