scholarly journals The Rowan Hillson Inpatient Safety Award 2018 for the best inpatient diabetes educational programme for healthcare professionals

2020 ◽  
Vol 20 (2) ◽  
pp. 151-154
Author(s):  
Umesh Dashora ◽  
Mike Sampson ◽  
Erwin Castro ◽  
Debbie Stanisstreet ◽  
Christine Jones ◽  
...  
Keyword(s):  
Improve Patient Safety ◽  
Feedback System ◽  
Teaching Hospitals ◽  
University Hospitals ◽  
Pharmacy Staff ◽  
Prescribing Error ◽  
North West ◽  
Inpatient Diabetes ◽  
Hospitalised Patients ◽  
Inpatient Safety

Introduction: The annual National Diabetes Inpatient Audit (NaDIA) in the UK continues to show a high incidence of insulin errors in patients admitted to hospital with diabetes. It is clear that new initiatives are urgently required to mitigate this risk.Method: The Joint British Diabetes Societies for Inpatient Care (JBDS-IP) organised the fifth national Rowan Hillson Inpatient Safety Award on the theme of the best inpatient diabetes educational initiative to improve patient safety in hospitals.Result: The winner was Kath Higgins and the team from the University Hospitals of Leicester NHS Trust for their ITS Diabetes – Inpatient Diabetes Training & Support programme – an educational toolkit accessible to medical, nursing and pharmacy staff. Components included face-to-face training, e-learning module, monthly newsletter social media communications with competency document and flashcards. The initiative reduced insulin errors and in-hospital diabetic ketoacidosis. There were two teams in second position. Michael Lloyd and colleagues from St Helens and Knowsley Teaching Hospitals NHS Trust received the award for their individualised and shared insulin prescribing error feedback system, Safe Insulin TipS (SIPS), and multi-professional simulation-based training. Ruth Miller and colleagues in North West London were commended for the project to implement Diabetes 10 Point Training in Acute Hospitals across North West London. This clinically-based teaching programme provided quick training specifically designed for all hospital settings to address the commonest diabetes errors.Conclusion: These and similar schemes need to be developed, promoted and shared to reduce insulin errors in hospitalised patients with diabetes.

scholarly journals Cross-sectional observational study of epidemiology of COVID-19 and clinical outcomes of hospitalised patients in North West London during March and April 2020

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044384
Author(s):  
Guduru Gopal Rao ◽  
Alexander Allen ◽  
Padmasayee Papineni ◽  
Liyang Wang ◽  
Charlotte Anderson ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Severe Infection ◽  
Older Age ◽  
Cross Sectional ◽  
North West ◽  
Icu Admission ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk

ObjectiveThe aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London.DesignObservational cohort study.SettingLondon North West Healthcare NHS Trust (LNWH).ParticipantsPatients tested and/or admitted for COVID-19 at LNWH during March and April 2020Main outcome measuresDescriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19.ResultsThe outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients.ConclusionThe findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.

scholarly journals Mortality and high risk of major adverse events in patients with COVID-19 and history of cardiovascular disease

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001526
Author(s):  
Elena Tessitore ◽  
David Carballo ◽  
Antoine Poncet ◽  
Nils Perrin ◽  
Cedric Follonier ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Male Gender ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
University Hospitals ◽  
Adverse Cardiovascular Event ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
History Of

ObjectiveHistory of cardiovascular diseases (CVDs) may influence the prognosis of patients hospitalised for COVID-19. We investigated whether patients with previous CVD have increased risk of death and major adverse cardiovascular event (MACE) when hospitalised for COVID-19.MethodsWe included 839 patients with COVID-19 hospitalised at the University Hospitals of Geneva. Demographic characteristics, medical history, laboratory values, ECG at admission and medications at admission were collected based on electronic medical records. The primary outcome was a composite of in-hospital mortality or MACE.ResultsMedian age was 67 years, 453 (54%) were males and 277 (33%) had history of CVD. In total, 152 (18%) died and 687 (82%) were discharged, including 72 (9%) who survived a MACE. Patients with previous CVD were more at risk of composite outcomes 141/277 (51%) compared with those without CVD 83/562 (15%) (OR=6.0 (95% CI 4.3 to 8.4), p<0.001). Multivariate analyses showed that history of CVD remained an independent risk factor of in-hospital death or MACE (OR=2.4; (95% CI 1.6 to 3.5)), as did age (OR for a 10-year increase=2.2 (95% CI 1.9 to 2.6)), male gender (OR=1.6 (95% CI 1.1 to 2.3)), chronic obstructive pulmonary disease (OR=2.1 (95% CI 1.0 to 4.2)) and lung infiltration associated with COVID-19 at CT scan (OR=1.9 (95% CI 1.2 to 3.0)). History of CVD (OR=2.9 (95% CI 1.7 to 5)), age (OR=2.5 (95% CI 2.0 to 3.2)), male gender (OR=1.6 (95% CI 0.98 to 2.6)) and elevated C reactive protein (CRP) levels on admission (OR for a 10 mg/L increase=1.1 (95% CI 1.1 to 1.2)) were independent risk factors for mortality.ConclusionHistory of CVD is associated with higher in-hospital mortality and MACE in hospitalised patients with COVID-19. Other factors associated with higher in-hospital mortality are older age, male sex and elevated CRP on admission.

scholarly journals Disease characteristics and management of hospitalised adolescents and adults with community-acquired pneumonia in China: a retrospective multicentre survey

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018709 ◽  
Author(s):  
Liang Chen ◽  
Fei Zhou ◽  
Hui Li ◽  
Xiqian Xing ◽  
Xiudi Han ◽  
...  
Keyword(s):  
Southern China ◽  
Pneumonia Severity Index ◽  
Community Acquired Pneumonia ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Standard Case ◽  
Risk Class ◽  
Illness Onset ◽  
Hospitalised Patients ◽  
Clinical Stability

ObjectivesTo describe the clinical characteristics and management of patients hospitalised with community-acquired pneumonia (CAP) in China.DesignThis was a multicentre, retrospective, observational study.Setting13 teaching hospitals in northern, central and southern China from 1 January 2014 to 31 December 2014ParticipantsInformation on hospitalised patients aged ≥14 years with radiographically confirmed pneumonia with illness onset in the community was collected using standard case report forms.Primary and secondary outcome measuresResource use for CAP management.ResultsOf 14 793 patients screened, 5828 with radiographically confirmed CAP were included in the final analysis. Low mortality risk patients with a CURB-65 score 0–1 and Pneumonia Severity Index risk class I–II accounted for 81.2% (4434/5594) and 56.4% (2034/3609) patients, respectively. 21.7% (1111/5130) patients had already achieved clinical stability on admission. A definite or probable pathogen was identified only in 12.7% (738/5828) patients. 40.9% (1575/3852) patients without pseudomonal infection risk factors received antimicrobial overtreatment regimens. The median duration between clinical stability to discharge was 5.0 days with 30-day mortality of 4.2%.ConclusionsThese data demonstrated the overuse of health resources in CAP management, indicating that there is potential for improvement and substantial savings to healthcare systems in China.Trial registration numberNCT02489578; Results.

scholarly journals Detection of enterovirus D68 in patients hospitalised in three tertiary university hospitals in Germany, 2013 to 2014

2016 ◽  
Vol 21 (19) ◽  
Author(s):  
Sindy Böttcher ◽  
Christiane Prifert ◽  
Benedikt Weißbrich ◽  
Ortwin Adams ◽  
Souhaib Aldabbagh ◽  
...  
Keyword(s):  
Binding Sites ◽  
Sequence Data ◽  
Phylogenetic Analyses ◽  
University Hospitals ◽  
Capsid Region ◽  
Hospitalised Patients ◽  
Significant Difference ◽  
Tertiary Hospitals ◽  
Enterovirus D68 ◽  
Viral Protein 1

Enterovirus D68 (EV-D68) has been recognised as a worldwide emerging pathogen associated with severe respiratory symptoms since 2009. We here report EV-D68 detection in hospitalised patients with acute respiratory infection admitted to three tertiary hospitals in Germany between January 2013 and December 2014. From a total of 14,838 respiratory samples obtained during the study period, 246 (1.7%) tested enterovirus-positive and, among these, 39 (15.9%) were identified as EV-D68. Infection was observed in children and teenagers (0–19 years; n=31), the majority (n=22) being under five years-old, as well as in adults > 50 years of age (n=8). No significant difference in prevalence was observed between the 2013 and 2014 seasons. Phylogenetic analyses based on viral protein 1 (VP1) sequences showed co-circulation of different EV-D68 lineages in Germany. Sequence data encompassing the entire capsid region of the genome were analysed to gain information on amino acid changes possibly relevant for immunogenicity and revealed mutations in two recently described pleconaril binding sites.

scholarly journals Cerebral Venous Sinus Thrombosis Associated with COVID-19: A Case Series and Literature Review

2020 ◽  
Author(s):  
Vahid Reza Ostovan ◽  
Razieh Foroughi ◽  
Mahtab Rostami ◽  
Mostafa Almasi-Dooghaee ◽  
Manouchehr Esmaili ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Clinical Manifestations ◽  
Case Series ◽  
Cerebral Venous Sinus Thrombosis ◽  
Hemorrhagic Transformation ◽  
Venous Sinus ◽  
Teaching Hospitals ◽  
Venous Sinus Thrombosis ◽  
North West ◽  
Confirmatory Tests

Abstract Background: Since the COVID-19 pandemic, several cases of cerebral venous sinus thrombosis (CVST) have been reported in SARS-CoV-2 infected individuals. This study provides a series of patients with CVST and SARS-CoV-2 infection.Methods: Consecutive patients with documented SARS-CoV-2 infection, as well as clinical and radiological characteristics of CVST, were reported from three teaching hospitals in the South West, North West, and the center of Iran from June to July 2020. We also searched the abstract archives until the end of August 2020 and gathered 28 reported cases. The diagnostic criteria for SARS-CoV-2 infection were determined according to SARS-CoV-2 detection in oropharyngeal or nasopharyngeal samples in clinically suspected patients. Demographics, main COVID-19 symptoms, confirmatory tests for SARS-CoV-2 infection diagnosis, the interval between the diagnosis of SARS-CoV-2 infection and CVST, clinical and radiological features of CVST, therapeutic strategies, CVST outcomes, rate of hemorrhagic transformation, and mortality rate were investigated.Results: Six patients (aged 31 to 62 years old) with confirmed CVST and SARS-CoV-2 infection were admitted to our centers. Four patients had no respiratory symptoms of SARS-CoV-2 infection. Five out of six patients developed the clinical manifestations of CVST and SARS-CoV-2 infection simultaneously. Three patients had known predisposing factors for CVST. Despite receiving CVST and SARS-CoV-2 infection treatments, four out of six patients passed away.Conclusions: The role of SARS-CoV-2 as a “cause” versus an “additive contributor” remains to be elucidated. Practitioners should be aware of the possibility of CVST in SARS-CoV-2 infection.

scholarly journals Descriptive Analysis of Azacitidine Use in Four Adult University Teaching Hospitals in Quebec, Canada

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5244-5244
Author(s):  
Ghislain Bérard ◽  
Nathalie Marcotte ◽  
Marie-Claude Michel ◽  
Paul Farand ◽  
Louise Deschenes ◽  
...  
Keyword(s):  
Adverse Events ◽  
Median Time ◽  
Stable Disease ◽  
Real Life ◽  
Management Program ◽  
University Teaching ◽  
Teaching Hospitals ◽  
International Prognostic Scoring System ◽  
Therapeutic Drug ◽  
University Hospitals

Abstract Background: Azacitidine (5-AZA; Vidaza®), a pyrimidine nucleoside analog, is used in the treatment of myelodysplastic syndrome (MDS) and other hematological malignancies. Pharmacy directors gave the Therapeutic Drug Management Program (TDMP - www.pgtm.qc.ca) the mandate to evaluate 5-AZA use in four University Hospitals in Quebec, Canada. Objectives: Describe and review 5-AZA use for all indications in our hospitals. Methods: A review of pharmacy databases was performed to identify patients who received 5-AZA between January 1st 2010 and May 31st 2013. Files and medical records of every patient who received 5-AZA during the study period were reviewed to assess diagnostic (including International Prognostic Scoring System (IPSS) scores), treatment, response and non-hematological adverse events. Results: A total of 77 patients received 5-AZA during the study period, 56 (72.7 %) for the treatment of MDS, 15 (19.5 %) for acute myeloid leukemia (AML) and 6 (7.8 %) for chronic myelomonocytic leukemia (CMML). At the end of the study period, 31 patients were alive (14 were still on treatment), 35 patients had died and 11 were lost to follow up. Excluding the 14 patients still on treatment, 32 patients (50.8 %) received at least 6 cycles of 5-AZA. In the MDS population (76.7 % with an intermediate-2 or higher IPSS score), patients received a mean of 8.0 cycles (median = 6) and the overall benefit rate (OBR) (complete remission, partial remission, hematological improvement or stable disease) was 48.2 %. The median overall survival (OS) was 17.8 months and the median time to progression (TTP) was 9.7 months. MDS transformation to AML occurred in 16 patients after a mean of 9.9 months. Median time to transformation or death in the MDS population was 14.4 months. In the AML population, patients received a mean of 6.6 cycles (median = 5) and the OBR was 26.7 %. The median OS was 12.2 months and the median TTP was 6.5 months. In the CMML population, patients received a mean of 10 cycles (median = 5.5) and the OBR was 50% (3 of the 6 patients achieved stable disease). Across all patient populations, a 5-AZA dose of 75 mg/m2 for 7 days every 28 days was used in 77.8% of patients. Non-hematological adverse events were seen in 67 patients (87 %) but were mostly mild and most did not lead to delays or dose reductions (treatment intensity of 96 %). Conclusions: Our results show that 5-AZA had a more limited benefit in our real-life population when compared to published clinical trials (OBR of 44.2 % in MDS, AML and CMML populations combined compared to 60% and 61% and a mean exposition of 8.1 months compared to 10.3 to 11.4 months in the pivotal clinical studies (AZA-001 and CALGB 9221 respectively)). Considering that 5-AZA is often the only treatment we can offer these patients and considering its high cost, it would be of highest importance to wisely choose patients to whom we offer this treatment and to periodically re-evaluate its use (at least after the 6th cycle) to confirm the patient is benefiting from treatment. Disclosures Olney: Cellgene: Honoraria; Pfizer: Consultancy; BMS: Consultancy; Novartis: Consultancy.

scholarly journals P049: Post-intubation sedation in the emergency department: a survey of national practice patterns

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S80
Author(s):  
S. Freeman ◽  
M. Columbus ◽  
T. Nguyen ◽  
S. Mal ◽  
J. Yan
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Respiratory Failure ◽  
Improve Patient Safety ◽  
Teaching Hospitals ◽  
Emergency Physicians ◽  
Cross Sectional ◽  
Canadian Association ◽  
Clinical Scenarios ◽  
Post Intubation

Introduction: Endotracheal intubation (ETI) is a lifesaving procedure commonly performed by emergency department (ED) physicians that may lead to patient discomfort or adverse events (e.g., unintended extubation) if sedation is inadequate. No ED-based sedation guidelines currently exist, so individual practice varies widely. This study's objective was to describe the self-reported post-ETI sedation practice of Canadian adult ED physicians. Methods: An anonymous, cross-sectional, web-based survey featuring 7 common ED scenarios requiring ETI was distributed to adult ED physician members of the Canadian Association of Emergency Physicians (CAEP). Scenarios included post-cardiac arrest, hypercapnic and hypoxic respiratory failure, status epilepticus, polytrauma, traumatic brain injury, and toxicology. Participants indicated first and second choice of sedative medication following ETI, as well as bolus vs. infusion administration in each scenario. Data was presented by descriptive statistics. Results: 207 (response rate 16.8%) ED physicians responded to the survey. Emergency medicine training of respondents included CCFP-EM (47.0%), FRCPC (35.8%), and CCFP (13.9%). 51.0% of respondents work primarily in academic/teaching hospitals and 40.4% work in community teaching hospitals. On average, responding physicians report providing care for 4.9 ± 6.8 (mean ± SD) intubated adult patients per month for varying durations (39.2% for 1–2 hours, 27.8% for 2–4 hours, and 22.7% for ≤1 hour). Combining all clinical scenarios, propofol was the most frequently used medication for post-ETI sedation (38.0% of all responses) and was the most frequently used agent except for the post-cardiac arrest, polytrauma, and hypercapnic respiratory failure scenarios. Ketamine was used second most frequently (28.2%), with midazolam being third most common (14.5%). Post-ETI sedation was provided by &gt; 98% of physicians in all situations except the post-cardiac arrest (26.1% indicating no sedation) and toxicology (15.5% indicating no sedation) scenarios. Sedation was provided by infusion in 74.6% of cases and bolus in 25.4%. Conclusion: Significant practice variability with respect to post-ETI sedation exists amongst Canadian emergency physicians. Future quality improvement studies should examine sedation provided in real clinical scenarios with a goal of establishing best sedation practices to improve patient safety and quality of care.

scholarly journals Invasive pulmonary aspergillosis in immunocompetent patients hospitalised with influenza A-related pneumonia: a multicenter retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Liang Chen ◽  
Xiudi Han ◽  
Yanli Li ◽  
Chunxiao Zhang ◽  
Xiqian Xing
Keyword(s):  
Risk Factors ◽  
Influenza A ◽  
Invasive Pulmonary Aspergillosis ◽  
Neuraminidase Inhibitor ◽  
Teaching Hospitals ◽  
Multivariate Logistic Regression Model ◽  
Pulmonary Aspergillosis ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Immunocompetent Patients

Abstract Background Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown. Methods Data of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients. Results Of the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio (HR) 4.336, 95% confidence interval (CI) 1.191–15.784, p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio (OR) 1.147, 95% CI 1.048–1.225, p = 0.003), systemic corticosteroids use before IPA diagnosis (OR 33.773, 95% CI 5.681–76.764, p <  0.001), leukocytes > 10 × 109/L (OR 1.988, 95% CI 1.028–6.454, p = 0.029) and lymphocytes < 0.8 × 109/L on admission (OR 34.813, 95% CI 1.676–73.006, p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use (OR 0.290, 95% CI 0.002–0.584, p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients. Conclusions Our results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA.

Cross-Sectional Study on Patient Safety Culture, Patient Safety Competency, and Adverse Events

2019 ◽  
Vol 42 (1) ◽  
pp. 32-40 ◽  
Author(s):  
Yonghee Han ◽  
Ji-Su Kim ◽  
YeJi Seo
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Safety Culture ◽  
Improve Patient Safety ◽  
Patient Safety Culture ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
University Hospitals ◽  
Cross Sectional ◽  
Nurses Perceptions

This study aims to examine the associations between nurses’ perceptions of patient safety culture, patient safety competency, and adverse events. Using convenience sampling, we conducted a cross-sectional study from February to May 2018 in two university hospitals. Furthermore, we performed multiple logistic regression to examine associations between patient safety culture, patient safety competency, and adverse events. Higher mean scores for “communication openness” in patient safety culture were significantly correlated with lower rates for pressure ulcers and falls; furthermore, higher mean scores for “working in teams with other health professionals” in patient safety competency were significantly correlated with reductions in ventilator-associated pneumonia. We recommend that a well-structured hospital culture emphasizing patient safety and continuation of in-service education programs for nurses to provide high-quality, clinically safe care is required. Moreover, further research is required to identify interventions to improve patient safety culture and competency and reduce the occurrence of adverse events.

scholarly journals Evaluation of patient safety culture: comparative study in university hospitals

2018 ◽  
Vol 52 (0) ◽  
Author(s):  
Cintia Silva Fassarella ◽  
Flávia Giron Camerini ◽  
Danielle de Mendonça Henrique ◽  
Luana Ferreira de Almeida ◽  
Maria do Céu Barbieri Figueiredo
Keyword(s):  
Patient Safety ◽  
Comparative Study ◽  
Safety Culture ◽  
Patient Safety Culture ◽  
Teaching Hospitals ◽  
Management Support ◽  
University Hospitals ◽  
Cross Sectional ◽  
Significant Difference ◽  
Comparative Survey

ABSTRACT Objective: To conduct a benchmarking comparison of the composites of patient safety culture based on the evaluation of Brazilian and Portuguese nurses working in university hospitals. Method: Quantitative, cross-sectional, comparative survey. Data collected between April and December 2014, in two teaching hospitals, applying the instrument Hospital Survey on Patient Safety Culture, in the versions translated and adapted to the countries. Results: 762 nurses distributed in four services participated in the study, 195 Brazilians and 567 Portuguese. Seven of the 12 composites of safety culture showed significant differences between hospitals. The highlights were those related to: “management support for patient safety” (±17); “handoffs and transitions” (±15); “teamwork across units” (±14); and “overall perceptions of patient safety” (±10). Conclusion: The dimension that had the highest significant difference between the studied institutions was “management support for patient safety”. These data may support the managers of the study hospitals, enabling continuous improvements and advancements.

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