Interruptions to intensive care nurses and clinical errors and procedural failures: A controlled study of causal connection

Objectives. Interruptions occur frequently in the Intensive Care Unit (ICU) and are associated with errors. To date, no causal connection has been established between interruptions and errors in healthcare. It is important to know if interruptions directly cause errors before implementing interventions designed to reduce interruptions in ICUs. Our objective was to investigate whether ICU nurses who receive a higher number of workplace interruptions commit more clinical errors and procedural failures than those who receive a lower number of interruptions. Methods. We conducted a prospective controlled trial in a high -fidelity ICU simulator. A volunteer sample of ICU nurses from a single unit prepare d and administered intravenous medications for a patient manikin. Nurses received either 3 (n=35) or 12 (n=35) scenario - relevant interruptions and were allocated to either condition in an alternating fashion. Primary outcomes were the number of clinica l errors and procedural failures committed by each nurse. Results . The rate ratio of clinical errors committed by nurses who received 12 interruptions compared to nurses who received 3 interruptions was 2.0 (95% CI [1.41, 2.83]), p < .001. The rate ratio of procedural failures committed by nurses who received 12 interruptions compared to nurses who were interrupted 3 times was 1.2 (95% CI [1.05, 1.37]), p = .006. Conclusions. More workplace interruptions during medication preparation and administration le ad to more clinical errors and procedural failures. Reducing the frequency of interruptions may reduce the number of errors committed; however, this should be balanced against important information that interruptions communicat

Preterm birth after loop electrosurgical excision procedure (LEEP). how cone features and microbiota could influence the pregnancy outcome

OBJECTIVE: In the last years, the mean age of women who underwent cervical treatment for high-grade cervical intraepithelial neoplasia (CIN 2-3) is similar to the age of women having their first pregnancy. The aim of this study was to evaluate the risk of preterm birth in subsequent pregnancies after loop electrosurgical excision procedure (LEEP). PATIENTS AND METHODS: From January 2013 to January 2016 the study identified a total of 1435 women, nulliparous, who underwent LEEP for CIN 2-3, and who wished to have their first pregnancy. Before surgery, the lengths of the cervix were calculated by transvaginal sonography. After the treatment, the dimension of the removed tissue was evaluated. During the pregnancy, all women carried out periodic transvaginal sonography and vaginal-cervical swabs. RESULTS: The average age of patients was 31.96±5.24 years; the interval between the surgical procedure and pregnancy was 12.04±4.67 months; the gestational age at births was 37.53±2.91 weeks. The first vaginal and cervical swab performed during pregnancy was negative in 81.8% of patients. The most prevalent infections were related to C. Albicans, G. Vaginalis, and Group B Streptococcus (GBS). The rate of preterm delivery was significantly higher in women with a minor cervical length. CONCLUSIONS: The length and the volume of cervical tissue excised have been shown to be directly related to the risk for preterm birth. Furthermore, vaginal infections and their persistence during pregnancy in women with a history of LEEP may be associated with an increased risk for preterm birth, compared with women with no history of LEEP

AUTHENTICATION OF WILD AND REARED SEA BASS BY INFRARED SPECTROSCOPY NIRs (NEAR INFRARED REFLECTANCE SPECTROSCOPY)

The aim of this study was to evaluate NIRs (Near Infrared Reflectance Spectroscopy) performances in the prediction of Farmed vs.Wild production method in European sea bass. Samples collected (n=39) were submitted to analysis in order to assess chemical composition and fatty acids profile of fillets. Aliquots of wet and ground freeze-dried minced samples were scanned in duplicates (1100 to 2498 nm; 2 nm intervals) in reflectance mode using a monochromator NIRsystem 5000. NIRs technique showed a satisfactory accurateness in predicting Protein, Lipids and Fatty acids profile in raw samples. Sample lyophilisation increased some predicting values (r2: coefficient of determination on cross-validation range from 0,671 to 0,992; SECV: standard error of cross-validation range from 0,864 to 2,981). Results showed that NIRs technique was able to discriminate between Wild (94,7% samples recognized) and Farmed (100% samples recognized) using wet muscles, and 100% for both classes on ground freeze-dried fillet

The cost-effectiveness of banning highly hazardous pesticides to prevent suicides due to pesticide self-ingestion across 14 countries:a model-based economic evaluation

Background: Reducing suicides is a key Sustainable Development Goal target for improving global health. Highly hazardous pesticides are among the leading causes of death by suicide in low-income and middle-income countries. National bans of acutely toxic highly hazardous pesticides have led to substantial reductions in pesticide-attributable suicides across several countries. This study evaluated the cost-effectiveness of implementing national bans of highly hazardous pesticides to reduce the burden of pesticide suicides.Methods: A Markov model was developed to examine the costs and health effects of implementing a national ban of highly hazardous pesticides to prevent suicides due to pesticide self-poisoning, compared with a null comparator. We used WHO cost-effectiveness and strategic planning (WHO-CHOICE) methods to estimate pesticide-attributable suicide rates for 100 years from 2017. Country-specific costs were obtained from the WHO-CHOICE database and denominated in 2017 international dollars (I$), discounted at a 3$0&middot;007 per capita (95% UI 0&middot;006&ndash;0&middot;008). In the population-standardised results for the base case analysis, national bans produced cost-effectiveness ratios of $94 per HLYG (95$237 per HLYG (95% UI 191&ndash;303) across upper-middle-income and high-income countries. Bans were more cost-effective in countries where a high proportion of suicides are attributable to pesticide self-poisoning, reaching a cost-effectiveness ratio of $75 per HLYG (95% UI 58&ndash;99) in two countries with proportions of more than 30%.Interpretation: National bans of highly hazardous pesticides are a potentially cost-effective and affordable intervention for reducing suicide deaths in countries with a high burden of suicides attributable to pesticides. However, our study findings are limited by imperfect data and assumptions that could be improved upon by future studies.Funding: WHO

Interruptions to intensive care nurses lead to clinical errors

Introduction: Interruptions occur frequently in the Intensive Care Unit (ICU), and are associated with clinical errors. However, a potential causal connection between workplace interruptions and medical errors has not been investigated. It is important to know if a causal link exists before designing and implementing interventions to reduce interruption rates. Objectives: The purpose of this study was to test whether nurses who receive a high number of interruptions commit more clinical errors than nurses who receive a low number of interruptions. Methods: We carried out a controlled trial in a high-fidelity ICU simulator at a tertiary Queensland hospital. ICU nurses (N = 70) prepared and administered intravenous medications for a simulated patient manikin. Participants received 3 or 12 interruptions and were allocated to either condition in an alternating fashion. Interruptions were relevant to the scenario and delivered via either a confederate playing an Access Nurse or from patient, bedside phone, and equipment alarms. Video recordings were analysed for clinical errors, which were deviations from the medication order or procedure that resulted in the patient directly receiving a medication inconsistent with what was prescribed. Results: A Poisson regression revealed that nurses who received 12 interruptions (M = 2.74, 95% CIs [2.19, 3.29]) committed clinical errors 2.00 times (95% CIs [1.41, 2.83]) more frequently than nurses who received 3 interruptions (M = 1.37, 95% CIs [0.99, 1.75]), p < 0.001. Conclusions: This study was the first to directly test the causal connection between interruptions and errors in the ICU. Nurses who received a high number of interruptions committed twice the number of clinical errors as nurses who received a low number of interruptions. Interventions designed to reduce the frequency of interruptions may be effective at reducing clinical errors, but further research should investigate potential unintended consequences of eliminating interruptions in the ICU

Prognosis of selected triple negative apocrine breast cancer patients who did not receive adjuvant chemotherapy

Background: Triple negative breast cancer encompasses several biological entities with different outcomes and is a priority to identify which patients require more treatment to reduce the risk of recurrence and which patients need less treatment. Patients and methods: Among the 210 women with first primary invasive apocrine non metastatic breast cancer operated on between January 1998 and December 2016 at the European Institute Oncology, Milan, we identified 24 patients with a pT1-pT2, node-negative, triple negative subtype and Ki-67 64 20% who did not receive adjuvant chemotherapy (CT). We compared the outcome of this cohort with a similar group of 24 patients with ductal tumors who received adjuvant chemotherapy, matched by pathological stage and biological features and also with a similar group of 12 patients with apocrine tumors who received adjuvant chemotherapy. Results: The median age was 64 and 61 years in the apocrine (w/o CT) and ductal group, respectively. The median value of Ki-67 expression was 12% in the apocrine group (w/o CT) and 16% in the ductal group (p &lt; 0.001). After a median follow-up of 7.5 years, no patients in the apocrine group (w/o CT) experienced a breast cancer related event compared with 4 events in the ductal carcinoma group (Gray test p-value = 0.11). Conclusions: The outcome of selected apocrine triple negative breast cancer patients who did not received adjuvant chemotherapy is excellent and supports a treatment de-escalation. Multicenter projects focusing on the possibility of avoiding adjuvant chemotherapy in selected subtypes of triple negative breast cancers with favorable outcome are warranted

Role of semiautomatic defibrillators in a general hospital: "Naples Heart Project".

In Italian hospitals, 85% of patients hospitalized in general medical wards who experience cardiac arrest die, while the incidence is much lower in patients in intensive care units. Defibrillation, in Italian hospitals, often occurs very late, either due to a lack of defibrillators, or due to architectural and structural barriers. The object of an in-hospital emergency service is to prevent and treat cardiac arrest without subsequent complications, such as brain damage, renal failure etc. The Naples Heart Project was based on a feasibility study of the in-hospital emergency service to evaluate and analyze problems associated with type of structure, departmental and institutional dislocation, internal practicability (architectural features and preferential ways), staff numbers and distribution, the calling system for emergency, and the equipment available. The Naples Heart Project began in July 2001, since then it has already created 835 BLSD first responders among the hospital staff; 440 were physicians and physicians still in training, 310 were nurses and 85 were administrative staf

Erythropoietin reduces the expression of myostatin in mdx dystrophic mice

Erythropoietin (EPO) has been well characterized as a renal glycoprotein hormone regulating red blood cell production by inhibiting apoptosis of erythrocyte progenitors in hematopoietic tissues. EPO exerts regulatory effects in cardiac and skeletal muscles. Duchenne muscular dystrophy is a lethal degenerative disorder of skeletal and cardiac muscle. in this study, we tested the possible therapeutic beneficial effect of recombinant EPO (rhEPO) in dystrophic muscles in mdx mice. Total strength was measured using a force transducer coupled to a computer. Gene expression for myostatin, transforming growth factor-beta 1 (TGF-beta 1), and tumor necrosis factor-alpha (TNF-alpha) was determined by quantitative real time polymerase chain reaction. Myostatin expression was significantly decreased in quadriceps from mdx mice treated with rhEPO (rhEPO = 0.60 +/- 0.11, control= 1.07 +/- 0.11). On the other hand, rhEPO had no significant effect on the expression of TGF-beta 1 (rhEPO = 0.95 +/- 0.14, control= 1.05 +/- 0.16) and TNF-alpha (rhEPO = 0.73 +/- 0.20, control= 1.01 +/- 0.09). These results may help to clarify some of the direct actions of EPO on skeletal muscle.Fac Med ABC, BR-09060650 Santo Andre, SP, BrazilUniv São Paulo, Inst Ciencias Biomed, BR-05508 São Paulo, BrazilUniversidade Federal de São Paulo, Inst Ciencias Quim Ambientais & Farmaceut, Diadema, SP, BrazilUniversidade Federal de São Paulo, Inst Ciencias Quim Ambientais & Farmaceut, Diadema, SP, BrazilWeb of Scienc