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Cognitive bias and patient safety

Neisha Sundaram, Kathryn Duckett, Chee Fu Yung, Koh Cheng Thoon, Sucitro Sidharta, Indumathi Venkatachalam, Angela Chow, Joanne Yoong
BACKGROUND: Influenza vaccine acceptance among healthcare workers (HCWs) is a worldwide problem, but relatively little research has focussed on Asia, including Singapore. Despite widespread access and recommendations from public health authorities, influenza vaccine uptake remains suboptimal among HCWs. METHODS: Our qualitative study used focus group discussions to identify and explain factors limiting influenza vaccine acceptance among HCWs in Singapore. A total of 73 doctors, nurses, allied health and ancillary staff across three public hospitals were included...
March 5, 2018: Vaccine
Patrick Welsch, Nurcan Üçeyler, Petra Klose, Brian Walitt, Winfried Häuser
BACKGROUND: Fibromyalgia is a clinically defined chronic condition of unknown etiology characterized by chronic widespread pain that often co-exists with sleep disturbances, cognitive dysfunction and fatigue. People with fibromyalgia often report high disability levels and poor quality of life. Drug therapy, for example, with serotonin and noradrenaline reuptake inhibitors (SNRIs), focuses on reducing key symptoms and improving quality of life. This review updates and extends the 2013 version of this systematic review...
February 28, 2018: Cochrane Database of Systematic Reviews
Mathias Schlögl, Daniel Hofmänner, Robert Manka, Dagmar I Keller
We present a case of an 80-year-old Turkish female patient with diabetes who suffered an acute myocardial infarction (AMI) and underwent percutaneous coronary balloon angioplasty (PTCA)/stenting. Due to new ischaemic episodes, a second PTCA/stenting had to be preformed 6 days later, which revealed a partial restent thrombosis. This case report raises several important issues. First, language problems are an important barrier for safety and quality in healthcare. Second, gender, ethnicity and age differences in patients with AMI need to be considered in order to eliminate inequities in clinical practice...
February 5, 2018: BMJ Case Reports
Eric C Ford, Suzanne Evans
Incident learning is a key component for maintaining safety and quality in healthcare. Its use is well-established and supported by professional society recommendations, regulations and accreditation, and objective evidence. There is an active interest in incident learning systems (ILS) in radiation oncology, with over forty publications since 2010. This article is intended as a comprehensive topic review of ILS in radiation oncology, including: history and summary of existing literature, nomenclature and categorization schemas, operational aspects of ILS at the institutional level including event handling and root-cause analysis, and national and international ILS for shared learning...
February 8, 2018: Medical Physics
Jenna D Picton, Adriane Brackett Marino, Kimberly Lovin Nealy
PURPOSE: Published evidence on the relationship between benzodiazepine exposure and altered cognition in the geriatric population is reviewed. SUMMARY: Benzodiazepines constitute one of the most commonly prescribed medication classes and are used primarily for management of anxiety and insomnia. Despite strong recommendations based on high-quality evidence warning of the potential cognitive adverse effects of benzodiazepine use, particularly in patients 65 years of age or older, published literature suggests that a substantial proportion of the U...
January 1, 2018: American Journal of Health-system Pharmacy: AJHP
Maggie Lawrence, Francisco T Celestino Junior, Hemilianna Hs Matozinho, Lindsay Govan, Jo Booth, Jane Beecher
BACKGROUND: Stroke is a major health issue and cause of long-term disability and has a major emotional and socioeconomic impact. There is a need to explore options for long-term sustainable interventions that support stroke survivors to engage in meaningful activities to address life challenges after stroke. Rehabilitation focuses on recovery of function and cognition to the maximum level achievable, and may include a wide range of complementary strategies including yoga.Yoga is a mind-body practice that originated in India, and which has become increasingly widespread in the Western world...
December 8, 2017: Cochrane Database of Systematic Reviews
Yang Ye, Ling-Yong Xiao, Yi-Hua Liu, Jing-Wen Yang, Chao-Qun Yan, Xue-Rui Wang, Guang-Xia Shi, Cun-Zhi Liu
INTRODUCTION: This systematic review protocol aims to provide the methods used to evaluate the effectiveness and safety of acupuncture therapy for treating vascular dementia. METHODS AND ANALYSIS: The following eight databases will be searched from inception to July 2017: Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, EMBASE, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database and Wanfang Database. All randomised controlled trials in English or Chinese related to acupuncture for vascular dementia will be included...
December 6, 2017: BMJ Open
Fiqry Fadhlillah, David Chan
BACKGROUND: It is hypothesised that a single injection fascia iliaca compartment block (FICB) administered in the pre-operative setting provides better analgesic control for traumatic hip fractures and is not associated with major adverse effects. Systemic analgesics, whilst effective, could lead to cardiovascular, respiratory and cognitive impairment. As a consequence, undertreatment of acute pain remains prevalent in adult patients with hip fractures, with a consistent decline seen in analgesic administration with age...
December 2017: Emergency Medicine Journal: EMJ
Chris Turner, Jake Turner
: Emergency medicine is widely recognised as an intense specialty. Interruptions are known to derail thoughts, increasing cognitive load and result in longer periods before deep thought is re-established. Although approachability and warmth are regarded as important factors in clinicians we wondered what impact these characteristics had on the number of interruptions. METHODOLOGY: A team of 6 medical students were trained in the use of abespoke tool to record shop floor activities. Over 4 months we conducted 100 hours of minute by minute time and motion study of emergency medicine consultants during their clinical shifts, and noted how often they were interrupted...
December 2017: Emergency Medicine Journal: EMJ
Shashi S Seshia, G Bryan Young, Michael Makhinson, Preston A Smith, Kent Stobart, Pat Croskerry
INTRODUCTION: Although patient safety has improved steadily, harm remains a substantial global challenge. Additionally, safety needs to be ensured not only in hospitals but also across the continuum of care. Better understanding of the complex cognitive factors influencing health care-related decisions and organizational cultures could lead to more rational approaches, and thereby to further improvement. HYPOTHESIS: A model integrating the concepts underlying Reason's Swiss cheese theory and the cognitive-affective biases plus cascade could advance the understanding of cognitive-affective processes that underlie decisions and organizational cultures across the continuum of care...
November 23, 2017: Journal of Evaluation in Clinical Practice
Christopher Eccleston, Emma Fisher, Kyla H Thomas, Leslie Hearn, Sheena Derry, Cathy Stannard, Roger Knaggs, R Andrew Moore
BACKGROUND: This is the first update of the original Cochrane Review published in 2013. The conclusions of this review have not changed from the 2013 publication. People with chronic non-cancer pain who are prescribed and are taking opioids can have a history of long-term, high-dose opioid use without effective pain relief. In those without good pain relief, reduction of prescribed opioid dose may be the desired and shared goal of both patient and clinician. Simple, unsupervised reduction of opioid use is clinically challenging, and very difficult to achieve and maintain...
November 13, 2017: Cochrane Database of Systematic Reviews
Chang Yi Wang, Pei-Ning Wang, Ming-Jang Chiu, Connie L Finstad, Feng Lin, Shugene Lynn, Yuan-Hung Tai, Xin De Fang, Kesheng Zhao, Chung-Ho Hung, Yiting Tseng, Wen-Jiun Peng, Jason Wang, Chih-Chieh Yu, Be-Sheng Kuo, Paul A Frohna
INTRODUCTION: A novel amyloid β (Aβ) synthetic peptide vaccine (UB-311) has been evaluated in a first-in-human trial with patients of mild-to-moderate Alzheimer's disease. We describe translational research covering vaccine design, preclinical characterization, and phase-I clinical trial with supportive outcome that advances UB-311 into an ongoing phase-II trial. METHODS: UB-311 is constructed with two synthetic Aβ1-14-targeting peptides (B-cell epitope), each linked to different helper T-cell peptide epitopes (UBITh(®)) and formulated in a Th2-biased delivery system...
June 2017: Alzheimer's & Dementia: Translational Research & Clinical Interventions
Raghav Govindarajan
Diagnostic errors are mistakes in the diagnostic process that lead to a misdiagnosis, a missed diagnosis, or a delayed diagnosis. While the past decade's impetus to improve patient safety has focused on medication errors, health care-associated infections, and postsurgical complications, diagnostic errors have received comparatively less attention. Diagnostic errors will continue to play a major role in the patient safety and quality improvement movement because of their burden on care and their financial burden...
October 2017: Continuum: Lifelong Learning in Neurology
Mildred A Iro, Natalie G Martin, Michael Absoud, Andrew J Pollard
BACKGROUND: Encephalitis is a syndrome of neurological dysfunction due to inflammation of the brain parenchyma, caused by an infection or an exaggerated host immune response, or both. Attenuation of brain inflammation through modulation of the immune response could improve patient outcomes. Biological agents such as immunoglobulin that have both anti-inflammatory and immunomodulatory properties may therefore be useful as adjunctive therapies for people with encephalitis. OBJECTIVES: To assess the efficacy and safety of intravenous immunoglobulin (IVIG) as add-on treatment for children with encephalitis...
October 2, 2017: Cochrane Database of Systematic Reviews
Ye Jin, Qi Wang, Yan Wang, Mengxi Liu, Anji Sun, Zhongli Geng, Yiwei Lin, Xiaobai Li
BACKGROUND: Previous clinical trials of α7-nicotinic acetylcholine receptor agonists (α7-nAChR agonists) showed mixed results in treating the cognitive and negative symptoms of schizophrenia. AIMS: To assess the efficacy and safety of α7-nAChR agonists in treating the cognitive and negative symptoms in schizophrenia. METHODS: A literature search was conducted to identify randomized double-blind placebo-controlled trials for schizophrenia published before May 26, 2017, by searching PubMed, Embase, ClinicalTrials...
August 25, 2017: Shanghai Archives of Psychiatry
Carlos Pellegrini
More than 100 cognitive biases are believed to exist. They are flaws or distortions in judgment and decision making, which have become increasingly recognized as contributors to patient safety events....
December 2016: Bulletin of the American College of Surgeons
Heidemarie Haller, María M Winkler, Petra Klose, Gustav Dobos, Sherko Kümmel, Holger Cramer
BACKGROUND: The aim of this meta-analysis was to systematically update the evidence for mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) in women with breast cancer. MATERIAL AND METHODS: In October 2016, PubMed, Scopus, and Central were searched for randomized controlled trials on MBSR/MBCT in breast cancer patients. The primary outcome was health-related quality of life. Secondary outcomes were fatigue, sleep stress, depression, anxiety, and safety...
December 2017: Acta Oncologica
Łukasz Gawęda, Katarzyna Prochwicz, Martyna Krężołek, Joanna Kłosowska, Maciej Staszkiewicz, Steffen Moritz
AIM: The aim of this study was to provide a short version of the Davos Assessment of Cognitive Biases Scale (DACOBS), which is a self-report tool to assess cognitive distortions related to psychosis. METHODS: A principal component analysis (PCA) was conducted on a large non-clinical sample (n=1207) and cross-validated with a confirmatory factor analysis on an independent non-clinical sample (n=653). Discriminative validity was performed by contrasting the high risk for psychosis non-clinical sample (n=63), low risk for psychosis non-clinical sample (n=152), patients with schizophrenia (n=105), and patients with depression (n=56)...
June 7, 2017: Schizophrenia Research
Shashikant L Sholapurkar
Cardiotocography (CTG) has disappointingly failed to show good predictability for fetal acidemia or neonatal outcomes in several large studies. A complete rethink of CTG interpretation will not be out of place. Fetal heart rate (FHR) decelerations are the most common deviations, benign as well as manifestation of impending fetal hypoxemia/acidemia, much more commonly than FHR baseline or variability. Their specific nomenclature is important (center-stage) because it provides the basic concepts and framework on which the complex "pattern recognition" of CTG interpretation by clinicians depends...
April 2017: Journal of Clinical Medicine Research
Arieh Riskin, Amir Erez, Trevor A Foulk, Kinneret S Riskin-Geuz, Amitai Ziv, Rina Sela, Liat Pessach-Gelblum, Peter A Bamberger
OBJECTIVES: Rudeness is routinely experienced by medical teams. We sought to explore the impact of rudeness on medical teams' performance and test interventions that might mitigate its negative consequences. METHODS: Thirty-nine NICU teams participated in a training workshop including simulations of acute care of term and preterm newborns. In each workshop, 2 teams were randomly assigned to either an exposure to rudeness (in which the comments of the patient's mother included rude statements completely unrelated to the teams' performance) or control (neutral comments) condition, and 2 additional teams were assigned to rudeness with either a preventative (cognitive bias modification [CBM]) or therapeutic (narrative) intervention...
February 2017: Pediatrics
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