scholarly journals The Risk Assessment of Adverse Events of Nursing Activities as the Element of Quality Management in Healhcare

2015 ◽  
Vol 6 (1) ◽  
pp. 79-86
Author(s):  
Malgorzata Z. Wiśniewska ◽  
Piotr Grudowski ◽  
Emila Konieczyńska
Keyword(s):  
Risk Assessment ◽  
Adverse Events ◽  
District Hospital ◽  
First Aid ◽  
Poor Quality ◽  
Pareto Analysis ◽  
Management Commitment ◽  
Life Threatening ◽  
Staff Supervision

Abstract The purpose of the paper is to present MedCARVER+Shock method and Pareto analysis and its usability for the risk assessment of adverse events of nursing activities. 888 activities carried out by all 190 nurses working at the District Hospital X located in Poland were taken into account. During the research the qualitative approach was used. As the result sixteen groups of nursing activities causing the highest risk of adverse events were selected. Special attention required in: admission of a patient to the ward, sterilization, verbal communication with the patient, using of intravenous cannulas, needles, syringes, devices for transfusion of infusion liquids, servicing of hospital rooms, first aid in life-threatening situations, using medical devices and equipment. Ten basic causes of the risk of adverse events were identified, among others: lack of trainings, of modern equipment, of staff, failure to comply with procedures, lack of staff supervision, poor quality of ancillary materials, lack of management commitment. Finally MedCARVER+Shock method and Pareto analysis usability has been confirmed but it appeared that it is time-consuming and requires support from skilled professionals. Several suggestions have been put forward to improve the utility of MedCARVER+Shock.

Proton Pump Inhibitors in 2021: Pros, Cons, and Everything in Between

2021 ◽  
pp. 263451612110217
Author(s):  
Joshua A. Sloan ◽  
Philip O. Katz
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Adverse Events ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Drug Class ◽  
Life Threatening

The medical and lay literature has exploded with reports of adverse events associated with proton pump inhibitors over the last 10 to 15 years. The dissemination of these reports to patients and clinicians have created substantial concerns regarding what has been an exceptionally valuable drug class, dramatically improving patient quality of life, and in many cases preventing life threatening side effects of other medication. Patients are more frequently seeking to avoid these medications, and practitioners are reducing or discontinuing them to the patient’s detriment due to a misunderstanding of the data. This review will discuss the data regarding the most commonly publicized adverse events and attempt to put them in perspective.

scholarly journals Tocilizumab for the Treatment of Mevalonate Kinase Deficiency

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Nadia K. Rafiq ◽  
Helen Lachmann ◽  
Frodi Joensen ◽  
Troels Herlin ◽  
Paul A. Brogan
Keyword(s):  
Autoinflammatory Disease ◽  
Energy Levels ◽  
Poor Quality ◽  
Mevalonate Kinase Deficiency ◽  
Mevalonate Kinase ◽  
Recessive Mutations ◽  
Limited Experience ◽  
Life Threatening ◽  
Important Addition

Mevalonate kinase deficiency (MKD) is a severe autoinflammatory disease caused by recessive mutations in MVK resulting in reduced function of the enzyme mevalonate kinase, involved in the cholesterol/isoprenoid pathway. MKD presents with periodic episodes of severe systemic inflammation, poor quality of life, and life-threatening sequelae if inadequately treated. We report the case of a 12-year-old girl with MKD and severe autoinflammation that was resistant to IL-1 and TNF-αblockade. In view of this, she commenced intravenous tocilizumab (8 mg/kg every 2 weeks), a humanised monoclonal antibody targeting the IL-6 receptor (IL-6R) that binds to membrane and soluble IL-6R, inhibiting IL-6-mediated signaling. She reported immediate cessation of fever and marked improvement in her energy levels following the first infusion; after the fifth dose, she was in complete clinical and serological remission, now sustained for 24 months. This is one of the first reported cases of a child with MKD treated successfully with tocilizumab and adds to the very limited experience of this treatment for MKD. IL-6 blockade could therefore be an important addition to the armamentarium for the treatment of this rare monogenic autoinflammatory disease.

Association Between Elevated Hemolysis at Diagnosis and Early Mortality and Risk of Thrombosis In Paroxysmal Nocturnal Hemoglobinuria (PNH) Patients with Cytopenia

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4241-4241 ◽  
Author(s):  
Jin Seok Kim ◽  
Jong Wook Lee ◽  
Sung-Soo Yoon ◽  
Je-Hwan Lee ◽  
Deog-Yeon Jo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factor ◽  
Abdominal Pain ◽  
Conflicts Of Interest ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Poor Quality ◽  
Severe Fatigue ◽  
Life Threatening

Abstract Abstract 4241 Introduction: PNH is a rare, progressive and life threatening disease driven by chronic hemolysis leading to thrombosis, renal impairment, pain, severe fatigue, poor quality of life and premature death. Thrombosis is the leading cause of death (accounting for 40–67% of PNH-related deaths) and was recently identified as a significant risk factor for mortality in Asian PNH patients. Abdominal pain is a common and distressing symptom in PNH and has also been found to be risk factor for thrombosis and mortality in PNH patients. In PNH patients with concomitant aplasia/cytopenias (PNH-cytopenia), the symptoms associated with hemolytic PNH (i.e., severe fatigue and anemia) may be attributed to a hypocellular marrow, potentially masking the life threatening risk of hemolysis-mediated thrombosis and abdominal pain. Here we evaluate the correlation of clinical risk factors with hemolytic symptoms in cytopenic PNH patients. Methods: We retrospectively analyzed medical charts of 286 PNH patients from the National Data Registry in South Korea to identify aplastic PNH patients with evidence of hemolytic symptoms at the time of diagnosis. We defined PNH-cytopenia patients with evidence of at least 2 of the following hematological values at diagnosis: Hgb <10 g/dL; ANC <1.5×109/L; thrombocytopenia <100×109/L. Hemolysis was defined as LDH °Ã1.5 fold above the upper limit of normal (ULN). Results: The median patient age was 37 years (range: 8 to 88 years) and median PNH duration was 7.8 years. At diagnosis, median PNH granulocyte clone was 49% and LDH was 3.9-fold above ULN. Median platelet count was 99×109/L and median ANC was 1.2×109/L, 21% with ANC <1.0×109/L. PNH-cytopenia was identified at diagnosis in 42% of PNH patients. PNH-cytopenic patients experienced a similar prevalence of hemolytic symptoms and mortality compared to PNH patients with no evidence of cytopenia (PNH) (see table below). Thrombosis was equally prevalent in PNH-cytopenia compared to PNH (12% vs18%; P=0.175). Abdominal pain was equally prevalent in PNH-cytopenia and PNH (52% vs 42%; P=0.112) and there was similar mortality between the 2 groups (13% vs 11%; P=0.631). There was a significantly higher prevalence of mortality (14% vs 4%; p=0.048), thrombosis (22% vs 4%; p=0.003) and abdominal pain (53% vs 32%; p=0.007) in patients with elevated hemolysis (°Ã LDH 1.5 above ULN) compared to patients without hemolysis. We found that 69% of PNH-cytopenia patients demonstrated elevated hemolysis at diagnosis. Thrombosis was identified in 17% of PNH-cytopenia patients with elevated hemolysis compared to 3% with no evidence of elevated LDH (p=0.051); abdominal pain (59% vs 32%; p= 0.012) and death (16% vs 3%; p=0.070) were higher in PNH-cytopenia patients with hemolysis compared to PNH-cytopenia patients without hemolysis. CONCULSION: These data demonstrate that the presence of hemolysis at diagnosis is associated with of life-threatening thrombosis, poor quality of life, and mortality in PNH patients. Despite the evidence of hypoplasia, PNH-cytopenia patients with hemolysis demonstrate a higher risk of life-threatening thrombosis, pain, and mortality. These data indicate that hemolysis is a potential risk factor for life- threatening complications independent of the presence of cytopenia in patients with PNH. Treatment for PNH patients with cytopenias should focus on both controlling hemolysis as well as improving hypoplasia. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Endoscopic closure of refractory esophageal fistula after esophagectomy using polyglycolic acid sheets: a pilot study

2020 ◽  
Vol 08 (05) ◽  
pp. E591-E595 ◽  
Author(s):  
Yasuaki Nagami ◽  
Masaki Ominami ◽  
Taishi Sakai ◽  
Shusei Fukunaga ◽  
Fumio Tanaka ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Fibrin Glue ◽  
Polyglycolic Acid ◽  
Poor Quality ◽  
Esophageal Fistula ◽  
Fistula Closure ◽  
Prospective Pilot Study ◽  
Endoscopic Closure

Abstract Background and study aims Esophageal fistulas after esophagectomy are associated with high mortality and poor quality of life. They are sometimes intractable to conservative management and surgery that increases mortality. Few studies have assessed use of polyglycolic acid (PGA) sheets with fibrin glue for esophageal fistulas. We investigated the safety of using PGA sheets with fibrin glue for esophageal fistulas after esophagectomy. Patients and methods This was a single-center prospective pilot study. Patients who had refractory esophageal fistulas after esophagectomy were included. PGA sheets were filled in the fistula using biopsy forceps. Fibrin glue was applied to the PGA sheets. We repeated the procedure 1 week later. The outcome measures were the incidence of adverse events (AEs) and closure of the fistula. Results Five patients were assessed. No adverse events were observed. The esophageal fistula was closed with the application of PGA sheets four times in 40 % (2/5) of the cases. Conclusions PGA sheets with fibrin glue were safe for esophageal fistula closure after esophagectomy and do not involve the risk of AEs.

scholarly journals Hypoglycaemia in Type 2 Diabetes – Clinical Consequences and Impact on Treatment

2010 ◽  
Vol 06 ◽  
pp. 29
Author(s):  
Chantal Mathieu ◽  
Claudia Filozof ◽  
Anthony H Barnett ◽  
◽  
◽  
...  
Keyword(s):  
Quality Of Life ◽  
Poor Quality ◽  
Careful Monitoring ◽  
Patients With Diabetes ◽  
Clinical Consequences ◽  
Life Threatening ◽  
Treatment Of Diabetes ◽  
Impact On Treatment

For patients with diabetes, hypoglycaemia can present a number of risks ranging from mild to life-threatening in severity. Frequently occurring hypoglycaemia is associated with increased morbidity and mortality. Recent studies have found associations between intensive glycaemia treatment and an increased incidence of hypoglycaemia, prompting much discussion concerning the clinical significance of hypoglycaemia in the treatment of diabetes, especially considering that many hypoglycaemic episodes are subclinical and unrecognised. Hypoglycaemia has also been linked to an increased probability of developing dementia and, not surprisingly, poor quality of life as well. It may be helpful to try to prevent hypoglycaemic episodes through careful monitoring of patients with risk factors that predispose them to hypoglycaemia, while also selecting therapies that can minimise the incidence of hypoglycaemic episodes

scholarly journals Prospects for improving primary health care to children with thermal injuries

2021 ◽  
Vol 25 (3) ◽  
pp. 174-178
Author(s):  
D. S. Oborkina ◽  
D. D. Dolotova ◽  
L. I. Butkevich
Keyword(s):  
Surgical Treatment ◽  
Burn Injury ◽  
Medical Personnel ◽  
First Aid ◽  
Medical Documentation ◽  
Thermal Lesion ◽  
Life Threatening ◽  
Thermal Injuries ◽  
Treatment Of Wounds

Introduction. Burn injury in children has been and remains one of the most significant cause of disability and death in the world. An important aspect in relation to the prognosis and course of the wound process is the quality of the first aid provided at the prehospital stage. Untimely diagnosed shock, inadequately prescribed anesthesia, attempts to perform surgical treatment of wounds at the site of the accident can fatally affect the prognosis of the disease.Material and methods. A retrospective analysis of medical documentation of 328 children who were treated at the burn center from 2016 to 2019 was made. Selection criteria were: arrival to the center by ambulance, shock, transfer to ICU. To analyze actions performed in the prehospital stage, a number of parameters were identified: diagnosis, length of transportation, specialists in the ambulance team, TBSA (total burn surface area), thermal inhalation lesion, and others.Results. The overwhelming majority of errors refer to diagnostics: shock (94.5%), incorrect TBSA assessment (63.7%), inadequate pain relief (61.9%), etc. A reliable correlation was revealed between ineffective analgesia and incorrect assessment of thermal lesion area. Life-threatening conditions develop in case of incorrect primary surgical treatment of wounds, incorrect vascular puncture, tracheal intubation, etc.Conclusions. The revealed difficulties in providing the primary medical aid to burnt patients at the site of accident require the development of a clearer and more understandable algorithm for medical personnel who provide the first aid to children with burns.  

scholarly journals The Incidence of Depression and the Decrease of Quality of Life in Patients with Moderate-Severe Inflammatory Acne

2019 ◽  
Vol 2 (4) ◽  
pp. 143-149
Author(s):  
C.A. Verdeja-Robles ◽  
C.E. Velazquez-De la Rosa ◽  
A. Gutiérrez-Morgas
Keyword(s):  
Quality Of Life ◽  
Skin Diseases ◽  
Acne Vulgaris ◽  
Poor Quality ◽  
Cross Sectional ◽  
Severe Acne ◽  
Long Time ◽  
Life Threatening ◽  
The Impact

Abstract Objective: to know the prevalence of depression in patients with moderate-severe acne vulgaris. Hypothesis: the incidence of depression increases in patients with moderate-severe acne vulgaris and will therefore decrease the quality of life. Background: acne is a very frequent dermatosis in the outpatient clinic, it is not considered a life-threatening disease. It has been associated with negative emotional status. Also, suffering from it for a long time has been associated with depression, anxiety and frustration. The complications of acne in the psychosocial aspect are related to academic or vocational performance, self-esteem and adolescents’ quality of life. Materials and Methods: the type of study was retrospective cross-sectional descriptive observational study. The sampling was carried out at the facilities of the Popular Autonomous University of the State of Puebla, taking into account any person within the institutional organisation within the range of 12-20 years of age, with a total of 50 participants. The Hamilton assessment scale of depression and the Cardiff Acne disability index were applied to all patients with dermatological diagnosis of moderate-severe vulgar acne in a period between February-October 2019. Results: a total of 50patients were analysed, of which 28 were women aged 12 to 20 years and 22 men (28 women and 13 men) and severe acne in 9 patients, all over 17 years of age and male. According to the degree of depression, 28% (n = 14) of the patients were obtained without some degree of depression; 60% (n = 30) with minor depression; 12% (n = 6) with moderate depression. Regarding the quality of life: 40% (n = 20) of the patients showed good quality of life, 46% (n = 23) regular quality of life and 14% (n = 7) showed poor quality of life. Conclusion: orderly study of the psychic impact of acne and other skin diseases on people suffering them is recent and is carried out through questionnaires that try to measure the impact the diseases have on the patients’ quality of life.

scholarly journals Ossification of the Anterior Longitudinal Ligament with Dysphagia as the First Symptom: Rehabilitation of Two Cases

2021 ◽  
Vol 11 (16) ◽  
pp. 7300
Author(s):  
Norihiro Nishida ◽  
Hiroyoshi Ogasa ◽  
Kazushige Seki ◽  
Tomohiro Kato ◽  
Yasuaki Imajo ◽  
...  
Keyword(s):  
Treatment Options ◽  
Poor Quality ◽  
Timing Of Surgery ◽  
Screening Tests ◽  
Posterior Fixation ◽  
Anterior Longitudinal Ligament ◽  
Posterior Decompression ◽  
Pharyngeal Cavity ◽  
Life Threatening

Dysphagia is associated with poor quality of life, and pneumonia due to aspiration is life-threatening. Cervical ossification of the anterior longitudinal ligament (C-OALL) is one of the causes of dysphagia, and we report two cases in which dysphagia improved after surgery. Case 1: A 76-year-old man had C-OALL of greater than 16 mm and dysphagia and developed myelopathy. A fall resulted in upper and lower limb insufficiency paralysis, and posterior decompression fixation was performed. Pressure on the pharynx by C-OALL remained, but dysphagia improved. Improvement in this case was considered to be due to the loss of intervertebral mobility. Case 2: A 62-year-old man developed dysphagia 6 years ago. It gradually exacerbated, and the C-OALL increased. Laryngeal fiberscope and swallowing angiography revealed that the pharyngeal cavity was compressed and narrowed anteriorly due to ossification. Resection of the ossification was performed, and the patient’s symptoms improved. Direct decompression was successful in this case. Several evaluation methods for dysphagia have been reported, including screening tests, endoscopy, contrast studies, and radiological evaluation. In case 1, extensive ossification was improved by posterior fixation, albeit incidentally, whereas in case 2, a patient with extensive ossification exhibited symptoms. It is necessary to examine the cervical mobility, extent and morphology of ossification, and timing of surgery stenosis to determine the risk factors and treatment options, including rehabilitation.

HUBUNGAN KUALITAS KEHIDUPAN KERJA TERHADAP KINERJA PERAWAT PELAKSANA

2019 ◽  
Vol 9 (4) ◽  
pp. 413-420
Author(s):  
Amella Gusty ◽  
Dachriyanus Dachriyanus ◽  
Leni Merdawati
Keyword(s):  
District Hospital ◽  
Simple Random Sampling ◽  
Work Life ◽  
Quality Of Work Life ◽  
P Value ◽  
Work Context ◽  
Cross Sectional ◽  
Quality Of Work ◽  
The Relationship

Kinerja perawat merupakan hasil yang dicapai dalam melaksanakan asuhan keperawatan di rumah sakit. Terciptanya asuhan keperawatan yang optimal sangat diperlukan dukungan dari pihak rumah sakit salah satunya adalah menciptakan kualitas kehidupan kerja baik bagi perawat. Penelitian ini bertujuan untuk mengetahui hubungan antara kualitas kehidupan kerja terhadap kinerja perawat pelaksana di RSUD Teluk Kuantan. Jenis penelitian kuantitatif dengan pendekatan cross sectional. Jumlah sampel 120 responden yang diperoleh melalui proportionate simple random sampling. Hasil penelitian menunjukkan kualitas kehidupan kerja perawat RSUD Teluk Kuantan berada pada kategori sedang, kinerja perawat berada pada kategori kurang baik. Berdasarkan analisis kedua variabel teridentifikasi bahwa tidak ada hubungan antara kualitas kehidupan kerja dengan kinerja perawat pelaksana dengan  p value 0,817. Dimensi work context merupakan komponen yang memiliki hubungan dengan kinerja perawat pelaksana dengan p value 0,008, dimensi work life  tidak berhubungan secara signifikan dengan kinerja perawat. Kesimpulan penelitian diketahui tidak ada hubungan antara kualitas kehidupan kerja dengan kinerja perawat pelaksana. Ada hubungan dimensi work context dengan kinerja perawat pelaksana. Tidak ada hubungan dimensi work life dengan kinerja perawat.   Kata kunci: kualitas kehidupan kerja, kinerja, perawat pelaksana   THE RELATIONSHIP BETWEEN THE QUALITY OF WORK LIFE AND THE PERFORMANCE OF IMPLEMENTERS NURSES   ABSTRACT Nurse performance is the result achieved in implementing nursing care in a hospital. The creation of optimal nursing care is very much needed support from the hospital, one of which is to create a good quality of work life for nurses. This study aims to determine the relationship between the quality of work life and the performance of nurses at the Kuantan District Hospital. This type of quantitative research with cross sectional approach. The number of samples of 120 respondents obtained through proportionate simple random sampling. The results showed that the quality of work life of nurses at the Kuantan District Hospital was in the medium category, the nurses' performance was in the unfavorable category. Based on the analysis of the two variables, it was identified that there was no relationship between the quality of work life with the performance of implementing nurses with a p value of 0.817. The work context dimension is a component that has a relationship with the performance of nurses implementing with p value 0.008, the dimension of work life does not significantly correlate with nurse performance. The conclusion of the research is that there is no relationship between the quality of work life and the performance of the implementing nurses. There is a relationship between the dimensions of the work context and the performance of the nurses. There is no relationship between the dimensions of work life and nurse performance.   Keywords: quality of work life, performance, implementers nurse

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