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Patient safety

David Sweet, Julian Marsden, Kendall Ho, Christina Krause, James A Russell
Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality...
May 2012: BC medical journal: BCMJ
Hui Yin Lim, Harshal Nandurkar, Prahlad Ho
The advent of direct oral anticoagulants (DOACs) has revolutionized anticoagulation management in both stroke prevention and venous thromboembolism (VTE) treatment/prevention. Clinical trials and secondary real-world data have shown that DOACs have similar efficacy and, in some cases, improved bleeding safety profiles compared with vitamin K antagonists. Together with benefits of patient convenience, this has shifted the risk-benefit ratio toward long-term anticoagulation. However, current VTE risk assessment models are based on vitamin K antagonists and do not take into account the new paradigm of DOACs...
March 20, 2018: Seminars in Thrombosis and Hemostasis
Elizabeth M White, Jessica G Smith, Rebecca L Trotta, Matthew D McHugh
OBJECTIVES: To investigate whether care in a hospital with more nurses holding at least a Bachelor of Science in Nursing (BSN) degree is associated with lower mortality for individuals with Alzheimer's disease and related dementias (ADRD) undergoing surgery ADRD. DESIGN: Cross-sectional data from 2006-07 Medicare claims were linked with the Multi-State Nursing Care and Patient Safety Survey of nurses in 4 states. SETTING: Adult, nonfederal, acute care hospitals in California, Florida, New Jersey, and Pennsylvania (N=531)...
March 20, 2018: Journal of the American Geriatrics Society
Reshma Jagsi, Kent A Griffith, Jennifer R Bellon, Wendy A Woodward, Janet K Horton, Alice Ho, Felix Y Feng, Corey Speers, Beth Overmoyer, Michael Sabel, Anne F Schott, Lori Pierce
Purpose Locoregional control for inflammatory breast cancers and chest wall recurrences is suboptimal, which has motivated interest in radiosensitization to intensify therapy. Preclinical studies have suggested a favorable therapeutic index when poly (ADP-ribose) polymerase inhibitors are used as radiosensitizers; clinical investigation is necessary to establish appropriate dosing and confirm safety. Patients and Methods We conducted a multi-institutional phase I study of veliparib and concurrent radiotherapy (RT) to the chest wall and regional lymph nodes in 30 patients with inflammatory or locally recurrent breast cancer after complete surgical resection...
March 20, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
M Hasib Sidiqi, Mohammed A Aljama, Francis K Buadi, Rahma M Warsame, Martha Q Lacy, Angela Dispenzieri, David Dingli, Wilson I Gonsalves, Shaji Kumar, Prashant Kapoor, Taxiarchis Kourelis, William J Hogan, Morie A Gertz
Purpose Autologous stem-cell transplantation (ASCT) has been used in patients with immunoglobulin light chain (AL) amyloidosis for more than two decades. Early experience raised concerns regarding safety with high early-mortality rates. Patients and Methods We report 20 years of experience with ASCT for AL amyloidosis at the Mayo Clinic Rochester. In all, 672 consecutive patients receiving ASCT for AL amyloidosis were divided into three cohorts on the basis of date of transplantation (cohort 1, 1996-2002 [n = 124]; cohort 2, 2003-2009 [n = 302]; and cohort 3, 2010-2016 [n = 246])...
March 20, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Colin B Page, Lachlan E Parker, Stephen J Rashford, Emma Bosley, Katherine Z Isoardi, Frances E Williamson, Geoffrey K Isbister
STUDY OBJECTIVE: Acute behavioral disturbance is a common problem for emergency medical services. We aimed to investigate the safety and effectiveness of droperidol compared to midazolam in the prehospital setting. METHODS: This was a prospective before and after study comparing droperidol to midazolam for prehospital acute behavioral disturbance, when the state ambulance service changed medications. The primary outcome was the proportion of adverse effects (airway intervention, oxygen saturation < 90%, respiratory rate < 12, systolic blood pressure < 90 mmHg, sedation assessment tool score -3 and dystonic reactions) in patients receiving sedation...
March 20, 2018: Prehospital Emergency Care
Sławomir Jeka, Bogdan Batko, Mariusz Korkosz, Maria Majdan, Brygida Kwiatkowska, Iwona Dankiewicz-Fares, Jerzy M Sobiecki, Włodzimierz Samborski
BACKGROUND: The GO-MORE study was an open-label, multinational, prospective study that investigated the efficacy and safety of adding golimumab to synthetic disease-modifying antirheumatic drugs (sDMARDs) in patients with active rheumatoid arthritis (RA). OBJECTIVES: The aim of this study was to assess the efficacy and safety of golimumab add-on therapy in the Polish subpopulation of the GO-MORE study. MATERIAL AND METHODS: Patients were administered 50 mg subcutaneous doses of golimumab once a month for 6 months, while continuing therapy with sDMARDs and/or glucocorticoids (GCS)...
March 20, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Filip M Szymański, Anna E Płatek, Rafał Dziadziuszko, Paweł Łęgosz, Piotr Palczewski
No abstract text is available yet for this article.
2018: Kardiologia Polska
Olga Dergachyova, Yulong Zhao, Claire Haegelen, Pierre Jannin, Caroline Essert
PURPOSE: Deep brain stimulation (DBS) is a procedure requiring accurate targeting and electrode placement. The two key elements for successful planning are preserving patient safety by ensuring a safe trajectory and creating treatment efficacy through optimal selection of the stimulation point. In this work, we present the first approach of computer-assisted preoperative DBS planning to automatically optimize both the safety of the electrode's trajectory and location of the stimulation point so as to provide the best clinical outcome...
March 20, 2018: International Journal of Computer Assisted Radiology and Surgery
Alessandro di Luca, Giuseppe Vetrugno, Vincenzo Lorenzo Pascali, Antonio Oliva, Al Ozonoff
OBJECTIVES: Italy is experiencing a crisis of malpractice litigation with important repercussions on the insurance industry (e.g., lower profits), physicians (e.g., defensive medicine), and the courts (e.g., work backlog, lengthy proceedings). We searched for common ground between legal systems in Italy and the United States and considered the implications for international collaborations in patient safety. METHODS: We examined the judicial frameworks of medical malpractice litigation in two countries with different legal foundations: the United States (a public-private system governed by common law) and Italy (a publicly financed healthcare system governed by civil law)...
March 19, 2018: Journal of Patient Safety
Rashi I Mehta, Rupal I Mehta
Hydrophilic polymers are ubiquitously applied as surface coatings on catheters and intravascular medical technologies. Recent clinical literature has heightened awareness on the complication of hydrophilic polymer embolism, the phenomenon wherein polymer coating layers separate from catheter and device surfaces, and may be affiliated with a range of unanticipated adverse reactions. Significant system barriers have limited and delayed reporting on this iatrogenic complication, the full effects of which remain underrecognized by healthcare providers and manufacturers of various branded devices...
March 19, 2018: Journal of Patient Safety
Kendra E Brett, Lindsay J Ritchie, Emily Ertel, Alexandria Bennett, Greg A Knoll
BACKGROUND: The best approach for determining whether a transplant program is delivering high-quality care is unknown. This review aims to identify and characterize quality metrics in solid organ transplantation. METHODS: Medline, Embase, and Cochrane Central Register of Controlled Trials were searched from inception until February 1 2017. Relevant full text reports and conference abstracts that examined quality metrics in organ transplantation were included. Two reviewers independently extracted study characteristics and quality metrics from 52 full text reports and 24 abstracts...
March 20, 2018: Transplantation
Sarah T Ward, Justin B Dimick, Wenying Zhang, Darrell A Campbell, Amir A Ghaferi
OBJECTIVE: To identify hospital staffing models associated with failure to rescue (FTR) rates at low- and high-performing hospitals. BACKGROUND: FTR is an important quality measure in surgical safety and is a metric that hospitals are seeking to improve. Specific unit-level determinants of FTR, however, remain unknown. METHODS: Retrospective, observational study using data from the Michigan Quality Surgical Collaborative, which is a prospectively collected and clinically audited database in the state of Michigan...
March 19, 2018: Annals of Surgery
Zhi-Hua Zhang, Li Xin Li, Ping Li, Shao-Cheng Lv, Bing Pan, Qiang He
Previous studies have indicated that sirolimus (SRL) may be effective for HCC patients undergoing liver transplantation (LT). However, the following results are still contradictory and do not have a clear conclusion. Therefore, we conducted an updated meta-analysis by retrieving published data in EMBASE, PubMed, and the Cochrane Library up to October 2017. Both efficiency and safety of SRL were analyzed using pooled odds ratio (ORs) with 95% confidence interval (CIs). A total of 11 studies involving 7,695 HCC patients were included...
March 20, 2018: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
Erin E Burke, Jonathan S Zager
Introduction Current treatment of advanced melanoma is rapidly changing with the introduction of new and effective therapies including systemic as well as locoregional therapies. An example of one such locoregional therapy is intralesional injection with talimogene laherparepvec (T-VEC). Areas Covered T-VEC has been shown in a number of studies to be an effective treatment for patients with stage IIIB, IIIC and IVM1a melanoma. In this article the effectiveness, pharmacokinetics and safety profile of TVEC is reviewed...
March 20, 2018: Expert Opinion on Drug Metabolism & Toxicology
Stefano Francesco Crinò, Mirko D'Onofrio, Laura Bernardoni, Luca Frulloni, Michele Iannelli, Giuseppe Malleo, Salvatore Paiella, Alberto Larghi, Armando Gabbrielli
BACKGROUND AND AIMS: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a promising technique for the treatment of pancreatic neoplasm. We evaluated the feasibility, safety, and technical success of pancreatic EUS-RFA performed in a single center. METHODS: 9 consecutive patients (8 with pancreatic adenocarcinoma and 1 with renal cancer metastasis) were referred for EUS-RFA between November 2016 and July 2017. EUS-RFA was performed using 18-gauge internally cooled electrode with a 5 or 10 mm exposed tip...
March 2018: Journal of Gastrointestinal and Liver Diseases: JGLD
Maurits Boon, Colin Huntley, Armin Steffen, Joachim T Maurer, J Ulrich Sommer, Richard Schwab, Erica Thaler, Ryan Soose, Courtney Chou, Patrick Strollo, Eric J Kezirian, Stanley Chia, Kirk Withrow, Mark Weidenbecher, Kingman Strohl, Karl Doghramji, Benedikt Hofauer, Clemens Heiser
Objective Upper airway stimulation (UAS) is an alternative treatment option for patients unable to tolerate continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). Studies support the safety and efficacy of this therapy. The aim of this registry is to collect retrospective and prospective objective and subjective outcome measures across multiple institutions in the United States and Germany. To date, it represents the largest cohort of patients studied with this therapy...
March 1, 2018: Otolaryngology—Head and Neck Surgery
Marlene Seegräber, Jerome Srour, Alexandra Walter, Macarena Knop, Andreas Wollenberg
Dupilumab is a new treatment option for patients with moderate-to-severe atopic dermatitis. It blocks IL-4/IL13-signaling and thereby inhibits receptor signaling downstream the JAK-STAT-pathway. Three of the main disease mechanisms of atopic dermatitis are affected by blocking this pathway; the decrease of skin barrier function, the class switch to IgE and the TH2-differentiation. Areas Covered: Dupilumab showed promising results in clinical trials of phase I-III. Clinical outcome parameters such as SCORAD, EASI, IGA and BSA improved with dupilumab...
March 20, 2018: Expert Review of Clinical Pharmacology
Hanifi Şahin, Oya Soylu Karapınar, Eda Adeviye Şahin, Kenan Dolapçıoğlu, Ali Baloğlu
A broader range of more effective compression techniques are needed in the patients who have an intractable postpartum haemorrhage due to uterine atony despite medical treatment and B-Lynch sutures. The aim of this study was to report the outcome of a series of patients with haemorrhage who were managed by double B-Lynch suture. Fourteen patients who were treated in a tertiary hospital between July 2010 and February 2015 were included in the study. The intractable haemorrhage rate was 0.35% over 5 years (14/4000 births)...
March 20, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Yundai Chen, Xinchun Yang, Shi'an Huang, Guosheng Fu, Xiaoping Chen, Yu Yang, Shaowen Liu, Haiyan Xu, Tianrong Ma, Xuchen Zhou, Zhan Lv, Ming Yang, Xuedong Gan, Dong Xu, Feng Cao, Huiliang Liu, Junxia Li, Qiangsun Zheng, Ningfu Wang, Yong Yuan, Wenxian Liu, Tianlun Yang
OBJECTIVE: We evaluated change in resting heart rate (RHR) and its impact on the prognosis in Chinese coronary artery disease (CAD) patients treated with bisoprolol and also assessed the drug safety and tolerability. METHODS: This phase IV, single arm observational study was a sub-study of the BISO-CAD study conducted across 20 hospitals in China, between October 2011 to July 2015 with follow-up at 6, 12 and 18 months after baseline. The primary endpoint was occurrence of composite cardiac events...
March 20, 2018: Current Medical Research and Opinion
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