Adverse events and near misses in medical imaging

Em 2000, o relatório do Instituto da Medicina, “To Err Is Human: Building A Safer Health System”, captou a atenção da opinião pública ao relevar a magnitude do problemática do erro médico e da inerente segurança do doente: cerca de 44 000 a 98 000 pessoas morrem por ano nos Estados Unidos da América devido a erros médicos. Actualmente, verifica-se um crescente interesse na gestão do risco na área médica, em particular na gestão dos eventos adversos. Tem sido sobretudo devido ao empenho da Organização Mundial de Saúde que este campo de investigação tem ganho cada vez mais a atenção que merece. A Imagiologia é uma das área de risco com grande potencial para o aparecimento de erros, nomeadamente devido à multiplicidade de técnicas utilizadas, aos diversos intervenientes e à complexidade de todo o circuito que envolve a realização de exames. Muitos dos métodos utilizados para analisar a segurança na prestação de cuidados de saúde foram adaptados de técnicas de gestão de risco em indústrias de alto risco (e.g. indústria química, nuclear e aeronáutica). É reconhecido que é possível apreender mais com os erros do que com êxitos e os sistemas de registo de erros destas industrias têm prestado um valioso contributo para o estudo da prevenção e gestão do erro. No mínimo os sistemas de registo de eventos adversos ajudam a identificar perigos e riscos, fornecendo informações relevantes sobre os aspectos do sistema que devem ser melhorados. Contudo, a acumulação de dados potencialmente relevantes contribui muito pouco para a melhoria do serviço de saúde. Torna-se fundamental aplicar modelos para identificar as causas subjacentes ao sistema, as causas fundamentais dos eventos e potenciar a partilha de experiência e conhecimento. Neste artigo, é sugerida uma solução para reduzir os eventos adversos, através da identificação e eliminação das causas fundamentais que estão na sua origem. Para tal, é descrito o modo como o Modelo de Classificação de Eindhoven foi adaptado e estendido especificamente para a Imagiologia. A abordagem proposta inclui a análise das causas fundamentais e introduz conceitos de informação incompleta através da utilização de operadores lógico-matemáticos formalmente sustentados. Este modelo é a base do sistema de registo e aprendizagem de eventos adversos e não conformidades que foi desenvolvido para a Imagiologia e que se encontra implementado em duas instituições de saúde Portuguesas. Os objectivos, características e modo de funcionamento deste sistema são apresentados ao longo deste artigo.In 2000, the Institute of Medicine’s report, “To Err Is Human: Building a Safer Health System”, has caught the public attention documenting the magnitude of the medical error problem and the inherent patient safety: medical errors cause between 44,000 and 98,000 deaths annually in the United States. Currently, there is a growing interest in risk management on the medical field, particularly in the management of adverse events. It has been mainly due to the commitment of the World Health Organization, that this field of research has gained increasing the attention it deserves. Medical imaging is one of the high-risk fields for the occurrence of errors, especially due to the multiplicity of techniques, the several stakeholders and the complexity of the whole circuit that involves the conduct of studies. Many of the methods used to analyze patient safety were adapted from risk-management techniques in high-risk industries (e.g. chemical, nuclear power and aviation industry). It is recognized that we can learn more from our mistakes than from our successes and the reporting systems in these industries have provided a valuable contribution to error's prevention and risk management techniques. At a minimum, adverse events reporting systems can help to identify hazards and risks, providing important information on the system aspects that should be improved. However, the accumulation of potentially relevant data contributes little to healthcare services improvement. It is crucial to apply models to identify the underlying system failures, the root causes, and enhance the sharing of knowledge and experience. In this paper, it is suggested a solution to reduce adverse events, by identifying and eliminating the root causes that are in their source. How the Eindhoven Classification Model was adapted and extended specifically for the Medical Imaging field is also presented. The proposed approach includes the root causes analysis and introduces incomplete information concepts through the use of logical-mathematical operators formally sustained. This model is the basis of the adverse event and near misses reporting and learning system that was developed for Medical Imaging and is implemented in two Portuguese healthcare institutions. The objectives, characteristics and function of this system are presented throughout this article

A logic programming approach to medical errors in imaging

Background: In 2000, the Institute of Medicine reported alarming data on the scope and impact of medical errors calling the public attention. One solution to this problem is the adoption of adverse event reporting and learning systems that can help to identify hazards and risks. The accumulation of potentially relevant data in databases contributes little to quality improvement. It is crucial to apply models to identify the adverse events root causes, enhance the sharing of knowledge and experience. The efficiency of the efforts to improve patient safety has been frustratingly slow. Some of this insufficient of progress may be assigned to the lack of systems that take into account the characteristic of the information about the real world. On our daily life, we make most of our decisions, if not all of them, based on incomplete, uncertain and even forbidden or contradictory information. Knowledge is central to the problems of modern economy and society. One’s knowledge is less based on exact facts and more on hypothesis, perceptions or indications. Purpose: From the data collected on our adverse event reporting and learning system, and through Extended Logic Programming and Knowledge Representation, we intend to generate reports that identify the most relevant causes and define improvement strategies, concluding about the impact, place of occurrence, type of form and type of event recorded in the healthcare institutions. Results and Conclusions: The Eindhoven Classification Model was extended and adapted to the medical imaging field and used to classify adverse events root causes. Extended Logic Programming was used for knowledge representation with defective information, allowing for the modelling of the universe of discourse in terms of default data and knowledge. A systematization of the evolution of the body of knowledge about Quality of Information embedded in the Root Cause Analysis was accomplished. An adverse event reporting and learning system was developed based on the presented approach to medical errors in imaging. This system was deployed in two Portuguese healthcare institutions presenting useful results. The system enabled to verify that the majority of occurrences were concentrate in a few events that could be avoided. The developed system allowed automatic knowledge extraction, enabling report generation with strategies for quality improvement

Pathogens in ornamental waters: a pilot study

In parks, ornamental waters of easy access and populated with animals are quite attractive to children and yet might hide threats to human health. The present work focuses on the microbiota of the ornamental waters of a Lisboa park, characterized during 2015. The results show a dynamic microbiota integrating human pathogens such as Klebsiella pneumoniae, Aeromonas spp. and Enterobacter spp., and also antibiotic resistant bacteria. K. pneumoniae and Aeromonas spp. were present as planktonic and biofilm organized bacteria. In vitro K. pneumoniae and Aeromonas spp. showed an enhanced ability to assemble biofilm at 25 C than at 37 C. Bacteria recovered from biofilm samples showed an increased antibiotic resistance compared to the respective planktonic counterparts.Fundação para a Ciência e Tecnologia for the grant PEst-OE/CTM/UI0084/2011

Psychometric properties of the Portuguese version of the invalidating childhood environment scale

Purpose The current study aimed to examine the psychometric properties of the Portuguese version of the invalidating childhood environment scale (ICES) in a non-clinical and clinical sample of eating disorder (ED) patients. This study also investigated the between-sample differences regarding invalidating parental behaviors and family styles and explored the associations between invalidating childhood environments and eating pathology. Methods A sample of 410 high school and college students and 101 patients with a diagnosis of ED completed self-report measures. Principal component analyses and confirmatory factor analyses were conducted to examine the factor structure of the ICES. The internal consistency and the between-sample differences and associations between invalidating childhood environments and eating pathology were also tested. Results Principal component analyses and confirmatory factor analyses indicated a two-factor solution for each parent. The ICES demonstrated high internal consistency and was able to differentiate between non-clinical and clinical samples. The perception of parental invalidation was higher in ED patients, and the clinical sample presented higher scores in the chaotic and perfect family styles and lower scores in the validating family style, in comparison with the non-clinical sample. Both maternal invalidation and invalidating styles were significantly associated with a higher ED symptomatology. Conclusions The Portuguese version of the ICES revealed adequate psychometric properties. Considering the relationship between invalidation in family and eating pathology, the ICES may be useful in clinical practice, especially among ED patients. Level of Evidence Level V, cross-sectional descriptive study.info:eu-repo/semantics/publishedVersio

Impact of COVID-19 lockdown measures on a cohort of eating disorders patients

BackgroundLockdown implemented to prevent the COVID-19 spread resulted in marked changes in the lifestyle. The objective of the current study was to assess the impact of lockdown measures on a cohort of eating disorder (ED) patients being followed as part of an ongoing naturalistic treatment study.MethodsNinety-nine patients aged 18 or older, currently or previously, in treatment at a Portuguese specialized hospital unit were contacted by phone and invited to participate in the current survey. Fifty-nine agreed to be interviewed by phone, and 43 agreed to respond to a set of self-report measures of ED symptoms, emotion regulation difficulties, clinical impairment, negative urgency, and COVID-19 impact, during the week after the end of the lockdown period.ResultsData showed that of the 26 patients currently in treatment: 8 remained unchanged (31%), 7 deteriorated (27%), and 11 reliably improved (42%). Of the 17 participants not currently in treatment: 3 deteriorated (18%), 9 remained unchanged (53%), and 5 (29%) improved after the lockdown period. The Coronavirus Impact Scale showed that most patients considered their routines moderately or extremely impacted, experienced stress related to coronavirus, and showed difficulty in maintaining physical exercise and feeding routines. Results suggest that higher impact of COVID-19 lockdown was significantly correlated with eating disorder symptoms and associated psychopathology, impulsivity, difficulties in emotion regulation and clinical impairment measured at post-lockdown. In addition, the impact of COVID-19 and lockdown measures on clinical impairment was mediated by difficulties in emotion regulation.ConclusionsFindings suggest that some ED patients may experience worsening of their condition, especially if associated with difficulties in emotion regulation, and these difficulties might be exacerbated in the context of a stressful crisis and lockdown measures, highlighting the need for intervention strategies to mitigate its negative impact.This work was conducted at the Psychology Research Centre (PSI/01662), School of Psychology, University of Minho, and partially supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education (UID/PSI/01662/2019), through the national funds (PIDDAC); and a grant by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and cofinanced by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-028145) to P. Machado PI)

The mediating role of self-criticism, experiential avoidance and negative urgency on the relationship between ED-related symptoms and difficulties in emotion regulation

Objective: Difficulties in emotion regulation are thought to play a transdiagnostic role across eating disorders (ED). In the current study, we explored with a path analysis the mediating role of self-criticism, experiential avoidance and negative urgency on the relationship between ED-related symptoms and dimensions of difficulties in emotion regulation. Method: Participants were 103 female outpatients recruited at a Portuguese ED hospital unit, diagnosed with an ED, aged 14–60 years old (M = 28.0, SD = 10.5), body mass index (BMI) ranging from 11.72 to 39.44 (M = 20.1, SD = 5.4). Results: The path analysis resulted in a model with an adequate fit to the data (SRMR = 0.05; RMSEA = 0.07 [0.00, 0.12], PCLOSE = 0.269; TLI = 0.97; IFI = 0.99; GFI = 0.95). A final model in which the relationship between ED-related symptoms and dimensions of difficulties in emotion regulation was mediated by self-criticism, experiential avoidance and negative urgency, accounted for a variance of 71% for strategies, 57% for non-acceptance, 62% for impulses, 56% for goals and 20% for clarity. Conclusion: Results suggest that self-criticism, experiential avoidance and negative urgency, combined, are relevant in the relationship between ED-related symptoms and difficulties in emotion regulation. ED treatment and emotion regulation skills may be enhanced through the inclusion of specific components that target self-criticism, experiential avoidance and negative urgency, as they become prominent during the therapeutic process.FCT - Fundação para a Ciência e a Tecnologia(POCI‐01‐0145‐FEDER‐028145

Valorization of pomace from craft cider: Nutritional value, chemical composition, and phenolic and mineral profiles

Waste recovery, in a circular economy context, is associated with clear economic and environmental benefits. Although apple pomace has been extensively studied for many applications, the valorization of pomace from emerging craft cider production is a novelty. This work is intended to determine the nutritional value, chemical composition, and phenolic and mineral profiles of pomace from craft cider waste. Levels of moisture (79.3%) and sugar contents (54.0%) stand out in their composition. Ethanol (1.56%) has been identified. Also, malic acid (2.94%), as well as α‐tocopherols (0.4 mg/100 g) were detected. The phenolic profile showed six flavonoid compounds identified mainly quercetin derivatives. The mineral analysis revealed potassium as the major constituent (58.5 mg/g). In conclusion, it is envisaged that cider pomace could be an ideal substrate for biotechnological purposes, particularly as a sustainable and alternative, cheap source to produce glycerol for application in various industries such as food, cosmetics, and pharmaceuticals.The authors are grateful to the Foundation for Science and Technology (FCT, Portugal) for financial support through national funds FCT/MCTES (PIDDAC) to CIMO (UIDB/00690/2020 and UIDP/00690/2020) and SusTEC (LA/P/0007/2020). Ana Sofia Brandão and José M. R. C. A. Santos would like to thank the FEDER under Programme PT2020 for financial support to INTERREG POCTEP project “INBEC—Circular bioeconomy. Promotion and development of a sustainable economy through innovation and business cooperation” (ref. 0627_INBEC_6_E). Maria Inês Dias and Lillian Barros would like to thank the national funding by FCT, Paula Rodrigues, through the institutional scientific employment program‐contract for their contracts; to the project Healthy—PETFOOD for the contract of Cristina Caleja (POCI‐01‐0247‐FEDER‐047073). This work is funded by the European Regional Development Fund (ERDF) through the Regional Operational Pro- gram North 2020, within the scope of Project GreenHealth—Digital strategies in biological assets to improve well‐being and promote green health, Norte‐01‐0145‐FEDER‐000042.info:eu-repo/semantics/publishedVersio

Paralytic rabies in swine

Rabies transmitted by vampire bats was diagnosed in pigs with paralysis of the pelvic limbs. Diffuse nonsuppurative encephalomyelitis, affecting mainly the spinal cord, was observed histologically. Despite the various diagnosis of rabies in pigs this is the first report of clinical signs and pathology of rabies transmitted by vampire bats