24 research outputs found
Enhancing aviation safety: Addressing miscommunication between pilots and air traffic controllers
Miscommunication in aviation refers to the misinterpretation of instructions by the pilots or controllers that is indicated by the absence of readback or incomplete instruction. Clear communication between pilots and air traffic controllers is vital for safe and efficient aircraft operations, preventing potential disasters. In the years 1999-2019, miscommunication contributed to 37,908 aviation accidents, emphasizing the urgent need for improved communication protocols. This poster categorizes aviation miscommunications into groups such as no communication, language barriers, phraseology problems, and misunderstandings stemming from accents or vocabulary differences. The objectives of this poster are identifying forms of miscommunication and evaluating their impact on safety. Recommendations offered to enhance aviation safety include improved training and proficiency assessments, standardized phraseology, advanced frequency management technology, and language proficiency requirements for international flights. This poster benefits aviation authorities, airlines, controllers, and pilots by providing practical suggestions to mitigate miscommunication risks, ultimately ensuring passenger safety and operational efficiency
Use of Platelet Gel and Its Effects on Infection in Cardiac Surgery
The use of plasmapheresis in cardiac surgery has failed to show an unequivocal benefit. However, the further processing of plasmapheresed blood to obtain a platelet-rich concentrate, termed platelet gel, may reduce patient susceptibility to infection through poorly understood mechanisms related to a combination of platelets, white blood cell content, and expedited wound healing. The purpose of the study was to retrospectively evaluate the incidence wound infections in patients undergoing cardiac surgery. Platelet gel (PG) patients (n = 382) received topical administration of a mixture of platelet concentrated plasma, 10% calcium chloride (5 mL), and bovine thrombin (5000 units). A control group (NoPG, n = 948) operated on concurrently with the treatment group did not receive PG, but otherwise received similar wound care. A historical control (HC, n = 929) included patients operated on before the availability of PG. After Institutional Review Board approval, 20 factors reported in the literature to predispose individuals for increased infection were recorded along with infections classified either as superficial or deep sternal according to the Society of Thoracic Surgeon criteria. All data were obtained from our institutional contribution to the Society of Thoracic Surgeon database. All adult (>19 years of age) patients undergoing cardiac surgery at our institution between October 2002 and June 2005 were included in this study (n = 2259). The incidence of superficial infection was significantly lower in the PG group (0.3%) compared both with the NoPG (1.8%) and HC (1.5%) groups (p < .05). There was a similar relationship found when comparing deep sternal wound infections (PG, 0.0% vs. NoPG, 1.5%; p < .029 and PG vs. HC, 1.7%; p < .01). In conclusion, the application of PG in patients undergoing cardiac surgery seems to confer a level of protection against infection, although the mechanisms of action remain to be elucidated
EUARENAS Policy Brief: Managing Diversity, Inclusion and Long-term Engagement in Urban Participatory Processes
This Policy Brief, crafted for local authorities, European city representatives, and practitioners, serves as a guide for successfully implementing co-governance and democratic participatory processes. It is informed by preliminary results from the EUARENAS project, which emphasizes the importance of diversity, inclusion, and engagement in local-level deliberative democratic initiatives. Central to this document are case studies from pilot cities, showcasing how they navigated challenges in their participatory endeavors. Key policy messages derived from these experiences address crucial issues of inclusion, diversity, and sustained engagement. Aligned with the EU's commitment to enhancing democracy across all governance levels, EUARENAS aims to foster community trust, combat challenges like climate change, digital transformation, populism, and misinformation, and strengthen European identity. This brief spotlights three local governments involved in the EUARENAS project—Gdansk (Poland), Voru (Estonia), and Reggio Emilia (Italy)—each focusing on different aspects: inclusion, diversity, and long-term engagement, respectively. Through these case studies, the brief provides policy recommendations, suggesting the use of policy and strategy change-making tools for European cities to refine their participatory practices and drive innovation
Use of the Quest Myocardial Protection System” (MPS) for Modified Ultrafiltration During Pediatric Cardiac Surgery
Modified ultrafiltration generally is considered a standard of care for treating children undergoing cardiopulmonary bypass for congenital heat surgery. Different methods, incorporating a variety of devices and technologies, have been described. The present report describes a technique of modified ultrafiltration using arterial-venous flow with the Quest Myocardial Protection System™ (MPS)
Improved Outcomes During Cardiac Surgery: A Multifactorial Enhancement of Cardiopulmonary Bypass Techniques
Patients presenting for cardiac surgery with cardiopulmonary bypass (CPB) are more likely to have pre-existing comorbidities, which has resulted in a steady increase in the risk associated with CPB. The resulting challenge has mandated the optimization of perfusion care. The purpose of this study was to retrospectively evaluate the impact of a number of simultaneous, evidence based perfusion care changes on patient outcome. After Institutional Review Board approval, two groups of patients were compared. The control group (n = 317) included all patients undergoing CPB in a 12-month period preceding a multifaceted change in perfusion techniques. The treatment group (n = 259) included all patients undergoing CPB in the 12-month period after the changes, which included the incorporation of updated continuous blood gas monitoring, biocompatible circuitry, updated centrifugal blood propulsion, continuous autotransfusion technology, new generation myocardial protection instrumentation, plasmapheresis, topical platelet gel application, excluding hetastarch while increasing the use of albumin, viscoelastographic coagulation monitoring, and implementing a quantitative quality improvement program. After univariate analysis, propensity scoring and multiple conditional logistical regression were used to control for demographic, preoperative, operative, and postoperative parameters. Results of the primary endpoints revealed a lower mortality rate in the treatment group (4% vs. 9% [95% confidence interval 1.33, 7.72], p = 0.009), lower transfusion rate (51% vs. 59% [1.00, 2.11], p = 0.048), and lower complication rate (55% vs. 65% [1.06,2.19], p = 0.025) despite having similar predicted mortality (11 [2,22] vs. 11[3,22], p = NS) and other preoperative and operative parameters. The lower mortality rate was concurrent with a trend towards a lower incidence of complications, consistent with the differences in primary outcomes. In conclusion, the patients treated after the implementation of a multifactorial improvement plan using evidence based changes in CPB care had decreased complication and mortality rates
Reducing Anticholinergic Medication Exposure among Older Adults using Consumer Technology: Protocol for a Randomized Clinical Trial
Introduction: A growing body of scientific evidence points to the potentially harmful cognitive effects of anticholinergic medications among older adults. Most interventions designed to promote deprescribing of anticholinergics have directly targeted healthcare professionals and have had mixed results. Consumer-facing technologies may provide a unique benefit by empowering patients and can complement existing healthcare professional-centric efforts.
Methods: We initiated a randomized clinical trial to evaluate the effectiveness of a patient-facing mobile application (Brain Safe app) compared to an attention control medication list app in reducing anticholinergic exposure among community-dwelling older adults. Study participants are adults aged 60 years and above, currently using at least one prescribed strong anticholinergic, and receiving primary care. The trial plans to enroll a total of 700 participants, randomly allocated in 1:1 proportion to the two study arms. Participants will have the Brain Safe app (intervention arm) or attention control medication list app (control arm) loaded onto a smartphone (study provided or personal device). All participants will be followed for 12 months and will have data collected at baseline, at 6 months, and 12 months by blinded outcome assessors. The primary outcome of the study is anticholinergic exposure measured as total standard daily dose (TSDD) computed from medication prescription electronic records. Secondary outcomes of the study are cognitive function and health-related quality of life.
Discussion: A consumer-facing intervention to promote deprescribing of potentially high-risk medications can be part of a multi-pronged approach to reduce inappropriate medication use among older adult patients. Delivering a deprescribing intervention via a mobile app is a novel approach and may hold great promise to accelerate deployment of medication safety initiatives across diverse patient populations