Exploring the Relationship between Reporting Medication Errors and Nurse Fear of Retribution

Studies have shown that medication administration errors are a critical issue in healthcare and more importantly preventing this type of error depends on precise reporting. Analysis of medication errors can lead to healthcare system improvement and reduced risk if the errors are detected, reported, and used to formulate improved patient care practices and systems. Nurses are the front line of defense to intercept and report errors. Through a review of the literature, it has been determined that nurses possibly fear blame and punishment when a Medication Administration Error (MAE) occurs; therefore, the purpose of this Master of Science in Nursing (MSN) Thesis was to examine whether nurses avoid reporting MAEs due to perceived fears of retribution. A quantitative cross-section correlative design was used to implement the study. The Medication Administration Error (MAE) Reporting Survey was utilized as the survey instrument. The study sample was comprised of registered nurses working on various inpatient units. The subjects were recruited through convenience sampling, with 48 participants being used for the study. The data was analyzed by calculating means and standard deviations for individual items and for subscales, and correlational analyses were conducted to determine if an association exists between perceived reporting barriers and perceived frequency of reporting. The study identified that the primary perceived barriers to reporting MAEs were fear related. Nurses indicated that additional barriers to reporting are due to not receiving positive feedback for passing medications correctly and that nurses may not think that the error is important enough to be reported. Also identified in this study, is the fact that nurses perceive that medication errors are underreported; although no correlation was found to exist between perceived reporting barriers and nurses\u27 perceptions of the frequency of medication error reporting

Telling a trusted adult: Factors associated with the likelihood of disclosing child sexual abuse prior to and during a forensic interview

Background: Many child sexual abuse (CSA) survivors delay or withhold disclosure of their abuse, even when presenting for formal investigation interviews. Objective: This study examined factors that relate to the CSA disclosure process. Participants and Settings: Participants were CSA victims (N = 1,732) presenting to a Child Advocacy Center (CAC) for a forensic interview. Method: We tested a structural model to predict disclosure before and during a forensic interview using secondary data analysis. Results: Youth were less likely to disclose before a forensic interview if they witnessed domestic violence (β = -.233, p \u3c .05). Caregivers were less likely to believe the abuse allegation if the alleged perpetrator resided in the home β = -.386, p \u3c .05) and more likely to believe if the youth made a prior disclosure (β = .286, p \u3c .05). Youth were more likely to disclose during the forensic interview if they were older (β=.388, p \u3c .05), if the alleged perpetrator resided in their home (β=.209, p \u3c .05), if they disclosed prior (β=.254, p \u3c .05), and if their caregiver believed the allegation (β=.213, p \u3c . 05). The alleged perpetrator residing in the youth’s home (β=-0.082, p\u3c.05) and making a prior disclosure (β=0.060, p\u3c.05) were both indirectly associated with forensic interview disclosure through caregiver belief. Conclusions: Findings highlight the importance of the family context and caregiver belief in the disclosure process for youth involved in formal CSA investigations

Virulence Factors of Pseudomonas aeruginosa Induce Both the Unfolded Protein and Integrated Stress Responses in Airway Epithelial Cells.

Pseudomonas aeruginosa infection can be disastrous in chronic lung diseases such as cystic fibrosis and chronic obstructive pulmonary disease. Its toxic effects are largely mediated by secreted virulence factors including pyocyanin, elastase and alkaline protease (AprA). Efficient functioning of the endoplasmic reticulum (ER) is crucial for cell survival and appropriate immune responses, while an excess of unfolded proteins within the ER leads to "ER stress" and activation of the "unfolded protein response" (UPR). Bacterial infection and Toll-like receptor activation trigger the UPR most likely due to the increased demand for protein folding of inflammatory mediators. In this study, we show that cell-free conditioned medium of the PAO1 strain of P. aeruginosa, containing secreted virulence factors, induces ER stress in primary bronchial epithelial cells as evidenced by splicing of XBP1 mRNA and induction of CHOP, GRP78 and GADD34 expression. Most aspects of the ER stress response were dependent on TAK1 and p38 MAPK, except for the induction of GADD34 mRNA. Using various mutant strains and purified virulence factors, we identified pyocyanin and AprA as inducers of ER stress. However, the induction of GADD34 was mediated by an ER stress-independent integrated stress response (ISR) which was at least partly dependent on the iron-sensing eIF2α kinase HRI. Our data strongly suggest that this increased GADD34 expression served to protect against Pseudomonas-induced, iron-sensitive cell cytotoxicity. In summary, virulence factors from P. aeruginosa induce ER stress in airway epithelial cells and also trigger the ISR to improve cell survival of the host

Data Linkage to Improve Geriatric Oncology Research: A Feasibility Study

Older adults (aged 65 years and older) diagnosed with cancer account for most cancer‐related morbidity and mortality in the United States but are often underrepresented on clinical trials. Recent attention from a variety of professional, research, regulatory, and patient advocacy groups has centered on data linkage and data sharing as a means to capture patient information and outcomes outside of clinical trials to accelerate progress in the fight against cancer. The development of a more robust observational research data infrastructure would help to address gaps in the evidence base regarding optimal approaches to treating cancer among the growing and complex population of older adults. To demonstrate the feasibility of building such a resource, we linked information from a sample of older adults with cancer in North Carolina using three distinct, but complementary, data sources: (a) the Carolina Senior Registry, (b) the North Carolina Central Cancer Registry, and (c) North Carolina fee‐for‐service Medicare claims data. A description of the linkage process, metrics, and characteristics of the final cohort is reported. This study highlights the potential for data linkage to improve the characterization of health status among older adults with cancer and the possibility to conduct passive follow‐up for outcomes of interest over time. Extensions of these linkage efforts in partnership with other institutions will enhance our ability to generate evidence that can inform the management of older adults with cancer

Antibacterial, Remineralising and Matrix Metalloproteinase Inhibiting Scandium-doped Phosphate Glasses for Treatment of Dental Caries

Objectives: Antibiotic resistance is increasingly a growing global threat. This study aimed to investigate the potential use of newly developed scandium-doped phosphate-based glasses (Sc-PBGs) as an antibacterial and anticariogenic agent through controlled release of Sc3+ ions. Methods: Sc-PBGs with various calcium and sodium oxide contents were produced and characterised using thermal and spectroscopic analysis. Degradation behaviour, ion release, antibacterial action against Streptococcus mutans, anti-matrix metalloproteinase-2 (MMP-2) activity, remineralisation potential and in vivo biocompatibility were also investigated. Results: The developed glass system showed linear Sc3+ ions release over time. The released Sc3+ shows statistically significant inhibition of S. mutans biofilm (1.2 log10 CFU reduction at 6 h) and matrix metalloproteinase-2 (MMP-2) activity, compared with Sc-free glass and positive control. When Sc-PBGs were mounted alongside enamel sections, subjected to acidic challenges, alternating hyper- and hypomineralisation layers consistent with periods of re- and demineralisation were observed demonstrating their potential remineralising action. Furthermore, Sc-PBGs produced a non-toxic response when implanted subcutaneously for 2 weeks in Sprague Dawley rats. Significance: Since Sc3+ ions might act on various enzymes essential to the biological mechanisms underlying caries, Sc-PBGs could be a promising therapeutic agent against cariogenic bacteria

Pulp, Vol. 2 No. 1

This is the second issue of Pulp.https://scholarworks.sfasu.edu/pulp/1001/thumbnail.jp

Pulp, Vol. 2 No. 1

This is the second issue of Pulp.https://scholarworks.sfasu.edu/pulp/1001/thumbnail.jp

Diagnostics to Support Elimination of Lymphatic Filariasis-Development of Two Target Product Profiles

As lymphatic filariasis (LF) programs move closer to established targets for validation elimination of LF as a public health problem, diagnostic tools capable of supporting the needs of the programs are critical for success. Known limitations of existing diagnostic tools make it challenging to have confidence that program endpoints have been achieved. In 2019, the World Health Organization (WHO) established a Diagnostic Technical Advisory Group (DTAG) for Neglected Tropical Diseases tasked with prioritizing diagnostic needs including defining use-cases and target product profiles (TPPs) for needed tools. Subsequently, disease-specific DTAG subgroups, including one focused on LF, were established to develop TPPs and use-case analyses to be used by product developers. Here, we describe the development of two priority TPPs for LF diagnostics needed for making decisions for stopping mass drug administration (MDA) of a triple drug regimen and surveillance. Utilizing the WHO core TPP development process as the framework, the LF subgroup convened to discuss and determine attributes required for each use case. TPPs considered the following parameters: Product use, design, performance, product configuration and cost, and access and equity. Version 1.0 TPPs for two use cases were published by WHO on 12 March 2021 within the WHO Global Observatory on Health Research and Development. A common TPP characteristic that emerged in both use cases was the need to identify new biomarkers that would allow for greater precision in program delivery. As LF diagnostic tests are rarely used for individual clinical diagnosis, it became apparent that reliance on population-based surveys for decision making requires consideration of test performance in the context of such surveys. In low prevalence settings, the number of false positive test results may lead to unnecessary continuation or resumption of MDA, thus wasting valuable resources and time. Therefore, highly specific diagnostic tools are paramount when used to measure low thresholds. The TPP process brought to the forefront the importance of linking use case, program platform and diagnostic performance characteristics when defining required criteria for diagnostic tools