Clinical risk and patient safety: a multicenter cross-sectional study to explore knowledge, attitudes and practice of hospital nurses

Objectives: To investigate knowledge, attitudes, and behavior of nurses working in acute care hospitals regarding clinical risk and patient safety, and to identify predisposing factors. Design: Cross-sectional multicenter study. Methods: The study was conducted in thirteen non-teaching acute public and private hospitals of a region of southern Italy from September through December 2015. A structured self-report questionnaire was administered to clinical nurses working in the hospitals involved. Three multivariate linear and logistic regression models have been constructed: knowledge of the definition of an adverse event; attitude towards risk of making an error while working and nurses who reported at least one error in the past 12 months. Results: The sample consisted of 484 respondents out of 670 (72.2%) nurses approached. The final multivariable model showed that educational courses about patient safety play a significant role in nurses gaining knowledge of adverse events. In the absence of organization-wide patient safety programs, nurses with low knowledge levels showed a significantly higher perceived risk. Nurses (n=96) who made errors over the past 12 months had discussed them with head nurses (75%) and colleagues (41.7%). Anonymous reporting to the organization was very low, with only 8.3% of nurses who had made an error submitting an anonymous report. Conclusions: Managers should implement multimodal improvement strategies aimed at enabling nurses’ to recognize the critical issues of the system and to increase their reporting, in order to make the organizations safer

Methodological issues in the observational studies conducted in older population: a narrative review

Introduction Well-conducted observational studies may represent valuable tools for getting insight to disease etiology, detecting the effect of age-related changes, and providing an important perspective on health risk factors and disabilities in an aging population. Nevertheless, this kind of research poses several challenges for researchers. The main aim of this narrative review was to address the potential methodological issues in performing the observational studies in the elderly, the factors that influence their participation, and the possible solutions for overcoming the barriers to research in this population. Methods Comprehensive search for the papers published in the period from January 1st 1980 until 31st July 2016 in English or Italian was conducted through MEDLINE, Scopus and Web of Science electronic databases. Findings from the included papers were finally summarized. Results In cohort studies, the following barriers were addressed: sample size calculation, ascertainment of the target population, frequency of data collection, exposure determination, multifactorial loss to follow-up (drop-outs), cognitive impairment, definition of confounders, and ethical aspects. Case-control studies were reported to be prone to the issues like ascertainment of cases and controls, willingness to participate, data accuracy, recall bias, issues related to patients’ multimorbidity, and cognitive impairment. Conclusions Important factors to consider in research in elderly people include: precise definition of the study population, well conducted recruitment process, engagement with family and home care staff, cognitive impairment assessment and the consequent relevant ethical and legal issues, relief of participant burden in order to minimize withdrawal, and engagement with the media

The Role of Pathological Method and Clearance Definition for the Evaluation of Margin Status after Pancreatoduodenectomy for Periampullary Cancer. Results of a Multicenter Prospective Randomized Trial

Simple SummaryThere is no clear evidence on the most effective method of pathological analysis and clearance definition (0 vs. 1 mm) to define R1 resection after pancreatoduodenectomy (PD). However, several studies showed that the R1 resection is a poor prognostic factor in patients that have undergone PDs for periampullary cancers. In this randomized clinical trial, specimens were randomized with two pathological methods, the Leeds Pathology Protocol (LEEPP) or the conventional method adopted before the study. The 1 mm clearance is the most effective factor in determining R1 rate after PD but only when adopting the LEEP, the R1 resection represents a significant prognostic factor.Background: There is extreme heterogeneity in the available literature on the determination of R1 resection rate after pancreatoduodenectomy (PD); consequently, its prognostic role is still debated. The aims of this multicenter randomized study were to evaluate the effect of sampling and clearance definition in determining R1 rate after PD for periampullary cancer and to assess the prognostic role of R1 resection. Methods: PD specimens were randomized to Leeds Pathology Protocol (LEEPP) (group A) or the conventional method adopted before the study (group B). R1 rate was determined by adopting 0- and 1-mm clearance; the association between R1, local recurrence (LR) and overall survival (OS) was also evaluated. Results. One-hundred-sixty-eight PD specimens were included. With 0 mm clearance, R1 rate was 26.2% and 20.2% for groups A and B, respectively; with 1 mm, R1 rate was 60.7% and 57.1%, respectively (p > 0.05). Only in group A was R1 found to be a significant prognostic factor: at 0 mm, median OS was 36 and 20 months for R0 and R1, respectively, while at 1 mm, median OS was not reached and 30 months. At multivariate analysis, R1 resection was found to be a significant prognostic factor independent of clearance definition only in the case of the adoption of LEEPP. Conclusions. The 1 mm clearance is the most effective factor in determining the R1 rate after PD. However, the pathological method is crucial to accurately evaluate its prognostic role: only R1 resections obtained with the adoption of LEEPP seem to significantly affect prognosis

From COVID-19 Pandemic to Patient Safety: A New "Spring" for Telemedicine or a Boomerang Effect?

During the Covid-19 health emergency, telemedicine was an essential asset through which health systems strengthened their response during the critical phase of the pandemic. According to the post-pandemic economic reform plans of many countries, telemedicine will not be limited to a tool for responding to an emergency condition but it will become a structural resource that will contribute to the reorganization of Healthcare Systems and enable the transfer of part of health care from the hospital to the home-based care. However, scientific evidences have shown that health care delivered through telemedicine can be burdened by numerous ethical and legal issues. Although there is an emerging discussion on patient safety issues related to the use of telemedicine, there is a lack of reseraches specifically designed to investigate patient safety. On the contrary, it would be necessary to determine standards and specific application rules in order to ensure safety. This paper examines the telemedicine-risk profiles and proposes a position statement for clinical risk management to support continuous improvement in the safety of health care delivered through telemedicine

Bayesian networks for the analysis of inpatient admissions

Inpatient admissions in different wards/clinics between 1998 and 2014 are considered. A Bayesian network (BN) structure is estimated, directly, from data in order to compute the joint probabilities of the different patient profiles as one of the main objective is to identify the most probable configurations of the wards/clinics. Knowing which wards/clinics are more interrelated could be useful for a better organization of the hospital. Once the Bayesian network is estimated, evidence for some nodes (in our case the history of a patient up to a certain stage) can be propagated through the graph, and the BN shows how such evidence changes the marginal distributions of the remaining nodes. Therefore, it is possible to predict in which ward/clinic there will be a next admission, assuming that there is one. Cross-validation are also performed to test the predictive ability of the BN

Bayesian networks for the analysis of inpatient admissions

A care pathway is defined as a complex intervention for the organisation of care processes for a specific group of patients during a specific period. Although the analysis of care pathways has been shown its benefits in clinical practices, little attention has been devoted to study how it can contribute to the optimization of the use of resources. In particular here we focus on the analysis of the history of a large number of patients' admissions, i.e. of data that belong to the routine flow of information that all hospital provide to the Local Healthcare Agency. One goal is the identification of the most likely sequence of wards/clinics for a patient; in fact, knowing which wards/clinics are more interrelated can be useful for a better hospital organization. Moreover we suggest the use of Bayesian Networks to predict the care pathway that each patient will undertake, given his/her history

Bayesian networks for the analysis of inpatient admissions

A care pathway is defined as a complex intervention for the organisation of care processes for a specific group of patients during a specific period. Although the analysis of care pathways has been shown its benefits in clinical practices, little attention has been devoted to study how it can contribute to the optimization of the use of resources. In particular here we focus on the analysis of the history of a large number of patients' admissions, i.e. of data that belong to the routine flow of information that all hospital provide to the Local Healthcare Agency. One goal is the identification of the most likely sequence of wards/clinics for a patient; in fact, knowing which wards/clinics are more interrelated can be useful for a better hospital organization. Moreover we suggest the use of Bayesian Networks to predict the care pathway that each patient will undertake, given his/her history

Clinical risk and patient safety: a multicenter cross-sectional study to explore knowledge, attitudes and practice of hospital nurses

Objectives: To investigate knowledge, attitudes, and behavior of nurses working in acute care hospitals regarding clinical risk and patient safety, and to identify predisposing factors. Design: Cross-sectional multicenter study. Methods: The study was conducted in thirteen non-teaching acute public and private hospitals of a region of southern Italy from September through December 2015. A structured self-report questionnaire was administered to clinical nurses working in the hospitals involved. Three multivariate linear and logistic regression models have been constructed: knowledge of the definition of an adverse event; attitude towards risk of making an error while working; and nurses who reported at least one error in the past 12 months. Results: The sample consisted of 484 respondents out of 670 (72.2%) nurses approached. The final multivariable model showed that educational courses about patient safety play a significant role in nurses gaining knowledge of adverse events. In the absence of organization-wide patient safety programs, nurses with low knowledge levels showed a significantly higher perceived risk. Nurses (n=96) who made errors over the past 12 months had discussed them with head nurses (75%) and colleagues (41.7%). Anonymous reporting to the organization was very low, with only 8.3% of nurses who had made an error submitting an anonymous report. Conclusions: Managers should implement multimodal improvement strategies aimed at enabling nurses’ to recognize the critical issues of the system and to increase their reporting, in order to make the organizations safe

Microbiological Laboratory Diagnosis of Human Brucellosis: An Overview

Brucella spp. are Gram-negative, non-motile, non-spore-forming, slow-growing, facultative intracellular bacteria causing brucellosis. Brucellosis is an endemic of specific geographic areas and, although underreported, represents the most common zoonotic infection, with an annual global incidence of 500,000 cases among humans. Humans represent an occasional host where the infection is mainly caused by B. melitensis, which is the most virulent; B. abortus; B. suis; and B. canis. A microbiological analysis is crucial to identifying human cases because clinical symptoms of human brucellosis are variable and aspecific. The laboratory diagnosis is based on three different microbiological approaches: (i) direct diagnosis by culture, (ii) indirect diagnosis by serological tests, and (iii) direct rapid diagnosis by molecular PCR-based methods. Despite the established experience with serological tests and highly sensitive nucleic acid amplification tests (NAATs), a culture is still considered the “gold standard” in the laboratory diagnosis of brucellosis due to its clinical and epidemiological relevance. Moreover, the automated BC systems now available have increased the sensitivity of BCs and shortened the time to detection of Brucella species. The main limitations of serological tests are the lack of common interpretative criteria, the suboptimal specificity due to interspecies cross-reactivity, and the low sensitivity during the early stage of disease. Despite that, serological tests remain the main diagnostic tool, especially in endemic areas because they are inexpensive, user friendly, and have high negative predictive value. Promising serological tests based on new synthetic antigens have been recently developed together with novel point-of-care tests without the need for dedicated equipment and expertise. NAATs are rapid tests that can help diagnose brucellosis in a few hours with high sensitivity and specificity. Nevertheless, the interpretation of NAAT-positive results requires attention because it may not necessarily indicate an active infection but rather a low bacterial inoculum, DNA from dead bacteria, or a patient that has recovered. Refined NAATs should be developed, and their performances should be compared with those of commercial and home-made molecular tests before being commercialized for the diagnosis of brucellosis. Here, we review and report the most common and updated microbiological diagnostic methods currently available for the laboratory diagnosis of brucellosis

Endovesical instillation of platelet rich fibrin for treatment of interstitial cystitis: case report of two patients

Interstitial cystitis, also called painful bladder syndrome, is a chronic condition causing bladder pain and sometimes pelvic pain. The exact cause of interstitial cystitis is not known. Often, signs and symptoms are hard to elucidate and no single treatment works for everyone. We report two cases of patients affected by interstitial cystitis treated with endovesical instillation of platelets rich fibrin (PRF). PRF is an autologous component that promotes angiogenesis, tissue growth and repair. This report presents the safety and the efficacy of PRF instillations in controlling clinical symptoms and restoring quality of life