Medical error disclosure: a pressing agenda for Public Health researchers

Medical errors are not a prevalent discussion topic in the current public health literature. However, their impact on patient lives across the world is alarming. In the United States alone, more than 1.3 million patients are harmed every year by medical treatments that are intended to help them. About three quarters of these adverse events are caused by preventable human error....

Kissing in Marital and Cohabiting Relationships: Effects on Blood Lipids, Stress, and Relationship Satisfaction

Affection exchange theory and previous research suggest that affectionate behavior has stress-ameliorating effects. On this basis, we hypothesized that increasing affectionate behavior would effect improvements in physical and psychological conditions known to be exacerbated by stress. This study tested this proposition by examining the effects of increased romantic kissing on blood lipids, perceived stress, depression, and relationship satisfaction. Fifty-two healthy adults who were in marital or cohabiting romantic relationships provided self-report data for psychological outcomes and blood samples for hematological tests, and were then randomly assigned to experimental and control groups for a 6-week trial. Those in the experimental group were instructed to increase the frequency of romantic kissing in their relationships; those in the control group received no such instructions. After 6 weeks, psychological and hematological tests were repeated. Relative to the control group, the experimental group experienced improvements in perceived stress, relationship satisfaction, and total serum cholesterol

Attenuation of Experimental Aortic Aneurysm Formation in P-Selectin Knockout Mice

The aim of this study was to determine the role of P-selectin, an adhesion molecule found on the surface of activated platelets and endothelial cells during experimental aortic aneurysm formation. Infrarenal abdominal aortas of C57 black wild-type (WT) mice and P-selectin knockout (PKO) mice were measured in situ and then perfused with porcine pancreatic elastase (0.332 U mL). Whole blood was drawn from the tail artery on day 2 pre-perfusion to determine total and differential white blood cell (WBC) counts. On day 14 postperfusion, aortic diameters (AD) of WT mice ( N 19) and PKO mice ( N 9) were measured. An aortic aneurysm was defined as a 100 or greater increase in AD from pre-perfusion measurement. Immunohistochemistry, including H&E, trichrome and von Gieson staining, was performed on harvested aortic tissue. Statistical analysis was performed by t -test and Fisher's exact test. There were no significant differences in peripheral leukocyte counts at baseline between the two groups. WT mice had significantly larger AD compared to PKO mice at day 14 postperfusion (116 vs. 38 , P < 0.001). Aortic aneurysm penetrance was 52 in WT mice, while 0 ( P 0.01) of PKO mice formed aneurysms. On histologic examination, WT mouse aortas were associated with a significant inflammatory response and degradation of elastin and collagen fibers, while PKO mouse aortas lacked signs of inflammation or vessel wall injury. P-selectin deficiency attenuates aneurysm formation in the elastase aortic perfusion model. This was associated with a blunting of the inflammatory response and preserved vessel wall intergrity following elastase perfusion in the P-selectin knockout mice. Further investigation to elucidate the independent contributions of endothelial cell and platelet P-selectin in experimental aortic aneurysm formation is required.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73125/1/annals.1383.014.pd

The aspects of healthcare quality that are important to health professionals and patients: A qualitative study.

OBJECTIVE: Existing quality of care frameworks insufficiently integrate the perspectives of physicians, nurses and patients. We collected narrative accounts from these three groups to explore if their perspectives might add new content to these existing definitions. METHODS: Ninety-seven descriptions of "good" and "poor" care episodes were collected from a convenience sample of physicians, nurses and outpatients at eight regional hospitals. Two coders classified the narrative contents into themes related to structures, processes and outcomes of care. RESULTS: The physicians, nurses and patients raised the following "quality of care" aspects: Successful communication among staff, with patients and care companions; staff motivation; frequency of knowledge errors; prioritization of patient-preferred outcomes; institutional emphasis on building "quality cultures"; and organizational implementation of fluid system procedures. CONCLUSION: Respondents primarily referred to care processes in their descriptions of "quality of care." "Hippocratic pride" (in response to care successes) and "Rapid reactivity" (in response to (near) failures) emerged as two new outcome indicators of high-quality care. PRACTICE IMPLICATIONS: This study provides a first qualitative fundament for understanding the components of "quality of care" from a triangulated frontline perspective. Future research needs to validate our findings with quantitative data to explore their usefulness for completing existing quality frameworks

Outcomes and outcome measures used in evaluation of communication training in oncology - a systematic literature review, an expert workshop, and recommendations for future research

BACKGROUND: Communication between health care provider and patients in oncology presents challenges. Communication skills training have been frequently developed to address those. Given the complexity of communication training, the choice of outcomes and outcome measures to assess its effectiveness is important. The aim of this paper is to 1) perform a systematic review on outcomes and outcome measures used in evaluations of communication training, 2) discuss specific challenges and 3) provide recommendations for the selection of outcomes in future studies. METHODS: To identify studies and reviews reporting on the evaluation of communication training for health care professionals in oncology, we searched seven databases (Ovid MEDLINE, CENTRAL, CINAHL, EMBASE, PsychINFO, PsychARTICLES and Web of Science). We extracted outcomes assessed and the respective assessment methods. We held a two-day workshop with experts (n = 16) in communication theory, development and evaluation of generic or cancer-specific communication training and/or outcome measure development to identify and address challenges in the evaluation of communication training in oncology. After the workshop, participants contributed to the development of recommendations addressing those challenges. RESULTS: Out of 2181 references, we included 96 publications (33 RCTs, 2 RCT protocols, 4 controlled trials, 36 uncontrolled studies, 21 reviews) in the review. Most frequently used outcomes were participants\u27 training evaluation, their communication confidence, observed communication skills and patients\u27 overall satisfaction and anxiety. Outcomes were assessed using questionnaires for participants (57.3%), patients (36.0%) and observations of real (34.7%) and simulated (30.7%) patient encounters. Outcomes and outcome measures varied widely across studies. Experts agreed that outcomes need to be precisely defined and linked with explicit learning objectives of the training. Furthermore, outcomes should be assessed as broadly as possible on different levels (health care professional, patient and interaction level). CONCLUSIONS: Measuring the effects of training programmes aimed at improving health care professionals\u27 communication skills presents considerable challenges. Outcomes as well as outcome measures differ widely across studies. We recommended to link outcome assessment to specific learning objectives and to assess outcomes as broadly as possible

Tuberculosis in the news: How do Portuguese media cover TB

Introduction From a public health perspective, media can influence public perceptions towards the severity of an illness, the risks of becoming ill, change seek-care behaviours or reduce disease related stigma. Material and methods With the aim analysing the media coverage of tuberculosis in the Portuguese press, we analyzed all news texts published between 2012 and 2014 in six National newspapers (Expresso, Público and Diário de Notícias – broadsheets; Sol, Jornal de Notícias and Correio da Manhã – tabloids). Our corpus was composed of 10,736 news pieces and 23,495 news sources. We then conducted a quantitative analysis based on descriptive statistics, through the data analysis software SPSS. Results Tumours, HIV-Aids, Influenza, Transplants, Hepatitis, Obesity, Dengue, Mental Disorders and Heart Diseases were the most media covered pathologies, ahead of tuberculosis. Tumours represented 22% of all news, tuberculosis only represented 1.9% – there is a noteworthy difference among media treatment. When it comes to the news themes, Tuberculosis was mainly news due to alarm and risk situations (53.4% of all texts). This also means that stories were usually negative, which may lead to a stigmatization of this disease. Even though the numbers were not very expressive, there was some media attention thrown at prevention. Conclusion Media intervention is a fundamental public health tool that could be more developed – it would be important to understand what are the interventions with higher impact on health and how to better use them.info:eu-repo/semantics/publishedVersio

Dispatcher-assisted cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest

Aim To evaluate communication issues during dispatcher-assisted cardiopulmonary resuscitation (DACPR) for paediatric out-of-hospital cardiac arrest in a structured manner to facilitate recommendations for training improvement. Methods A retrospective observational study evaluated DACPR communication issues using the SACCIA ® Safe Communication typology (Sufficiency, Accuracy, Clarity, Contextualization, Interpersonal Adaptation). Telephone recordings of 31 cases were transcribed verbatim and analysed with respect to encoding, decoding and transactional communication issues. Results Sixty SACCIA communication issues were observed in the 31 cases, averaging 1.9 issues per case. A majority of the issues were related to sufficiency (35%) and accuracy (35%) of communication between dispatcher and caller. Situation specific guideline application was observed in CPR practice, (co)counting and methods of compressions. Conclusion This structured evaluation identified specific issues in paediatric DACPR communication. Our training recommendations focus on situation and language specific guideline application and moving beyond verbal communication by utilizing the smart phone’s functions. Prospective efforts are necessary to follow-up its translation into better paediatric DACPR outcomes

Communication and patient safety in gynecology and obstetrics - study protocol of an intervention study.

BACKGROUND: Patient safety is a key target in public health, health services and medicine. Communication between all parties involved in gynecology and obstetrics (clinical staff/professionals, expectant mothers/patients and their partners, close relatives or friends providing social support) should be improved to ensure patient safety, including the avoidance of preventable adverse events (pAEs). Therefore, interventions including an app will be developed in this project through a participatory approach integrating two theoretical models. The interventions will be designed to support participants in their communication with each other and to overcome difficulties in everyday hospital life. The aim is to foster effective communication in order to reduce the frequency of pAEs. If communication is improved, clinical staff should show an increase in work satisfaction and patients should show an increase in patient satisfaction. METHODS: The study will take place in two maternity clinics in Germany. In line with previous studies of complex interventions, it is divided into three interdependent phases. Each phase provides its own methods and data. Phase 1: Needs assessment and a training for staff (n = 140) tested in a pre-experimental study with a pre/post-design. Phase 2: Assessment of communication training for patients and their social support providers (n = 423) in a randomized controlled study. Phase 3: Assessment of an app supporting the communication between staff, patients, and their social support providers (n = 423) in a case-control study. The primary outcome is improvement of communication competencies. A range of other implementation outcomes will also be assessed (i.e. pAEs, patient/treatment satisfaction, work satisfaction, safety culture, training-related outcomes). DISCUSSION: This is the first large intervention study on communication and patient safety in gynecology and obstetrics integrating two theoretical models that have not been applied to this setting. It is expected that the interventions, including the app, will improve communication practice which is linked to a lower probability of pAEs. The app will offer an effective and inexpensive way to promote effective communication independent of users' motivation. Insights gained from this study can inform other patient safety interventions and health policy developments. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03855735; date of registration: February 27, 2019

The Nitric Oxide Donor DETA-NONOate Decreases Matrix Metalloproteinase-9 Expression and Activity in Rat Aortic Smooth Muscle and Abdominal Aortic Explants

Our objective was to examine the role of an exogenous nitric oxide (NO) donor, DETA-NONOate (DETA), on matrix metalloproteinase (MMP)-9, MMP-2, and tissue inhibitor of matrix metalloproteinases (TIMP)-1 expression and activity in interleukin (IL)-1β-induced rat aortic smooth muscle cells (RA-SMCs) and rat aortic explants (RAEs). RA-SMCs were incubated with IL-1β (2 ng/ml), an inflammatory cytokine known to induce MMP-9 expression, and increasing concentrations of DETA (0, 1.0, 10, 100 μM; n = 3/group) for 48 hr. RAEs were incubated with IL-1β (2 ng/mL) and increasing concentrations of DETA (0, 5.0, 50, 100, and 500 μM; n = 3/group) for 48 hr. Media were collected and assayed for NO x by the Griess reaction and MMP-9 activity by zymography. Messenger RNA (mRNA) was extracted from cells and analyzed for MMP-9, MMP-2, and TIMP-1 expression levels by quantitative real-time reverse-transcriptase polymerase chain reaction. All statistical analyses were performed by analysis of variance. In RA-SMCs and RAEs, DETA administration resulted in a dose-dependent increase in media NO x concentration (RA-SCM p < 0.01, RAE p < 0.01) and a concurrent decrease in both MMP-9 expression (RASMC p = 0.01, RAE p = 0.01) and activity (RASMC p = 0.04, RAE p = 0.006). There were no significant differences seen in MMP-2 and TIMP-1 expression or activity in response to DETA exposure. DETA decreased IL-1β-induced MMP-9 expression and activity in both RA-SMCs and RAEs in a dose-dependent fashion. In addition, DETA administration had no effect on MMP-2 or TIMP-1 expression or activity in vitro. These data suggest that NO donors may be beneficial in decreasing MMP-9 levels and might serve to inhibit MMP-9-dependent vessel wall remodeling seen during abdominal aortic aneurysm formation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41371/1/10016_2005_Article_9429.pd