International Journal of Risk & Safety in Medicine - Volume 33, issue 4
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The International Journal of Risk and Safety in Medicine is concerned with rendering the practice of medicine as safe as it can be; that involves promoting the highest possible quality of care, but also examining how those risks which are inevitable can be contained and managed.
This is not exclusively a drugs journal. Recently it was decided to include in the subtitle of the journal three items to better indicate the scope of the journal, i.e. patient safety, pharmacovigilance and liability and the Editorial Board was adjusted accordingly. For each of these sections an Associate Editor was invited. We especially want to emphasize patient safety. Our journal wants to publish high quality interdisciplinary papers related to patient safety, not the ones for domain specialists. For quite some time we have also been devoting some pages in every issue to what we simply call WHO news. This affinity with WHO underlines both the International character of the journal and the subject matter we want to cover. Basic research, reports of clinical experience and overviews will all be considered for publication, but since major reviews of the literature are often written at the invitation of the Editorial Board it is generally advisable to consult with the Editor in advance. Submission of news items will be appreciated, as will be the contribution of letters on topics which have been dealt with in the journal.
Abstract: BACKGROUND: Adverse events in hospitals may jeopardize the safety of patients. Failure in professional autonomy, organizational learning or in the contact between these two factors may explain the occurrence of injurious incidents in hospitals. OBJECTIVE: To study reasons for failure in contact between professional autonomy and organizational learning in resilient management of specialized health care through document analysis. METHODS: A total of 20 reports from the Norwegian Board of Health Supervision were evaluated by a retrospective in-depth document analysis. In the analysis of adverse events, we applied the Braut model to identify function or failure of…1. Professional autonomy, 2. Organizational learning and 3. Contact between professional autonomy and organizational learning. RESULTS: Multivariable regression analysis showed that failure in organizational learning was the only explanatory variable for failure in contact between doctors and nurses autonomy and organizational learning. Failure in organizational learning had the strongest effect on failure in contact between doctors and nurse’s autonomy and organizational learning (B = 1.69; 95% CI = 0.45 to 2.92). Failure in professional autonomy showed no significant effect on this contact. CONCLUSIONS: Failure in organizational learning is associated with failure in contact between professional autonomy and organizational learning. Failure in professional autonomy did not influence this contact.
Keywords: Professional autonomy, organizational learning, resilience management, hospital, specialized health care, Norwegian Board of Health Supervision, Norway
Abstract: BACKGROUND: In India, antibiotic resistance is high and by 2050, two million people will be affected. OBJECTIVE: To review antibiotic practices in India and the variables that impact them. METHODS: For this narrative review, research articles on antibiotic awareness, perception and practices were retrieved from PubMed and Google Scholar using search terms such as ‘India AND antibiotic use AND cross sectional AND awareness’. A total of 1730 results were found on 30 June 2020, of which 35 articles were eligible for summarizing the common antibiotic practices. RESULTS: We found that there are deficiencies in…the implementation of existing policies in India. Several issues such as overprescribing of antibiotics, use without prescription and non-adherence to treatment regimens are contributing to irrational antibiotic practices in the country. CONCLUSION: There is a need for policies at the institute level to help curb the problem of antibiotic resistance.
Abstract: BACKGROUND: Safety culture in Emergency Departments (EDs) requires special attention due to unique operational feature of the ED environment. Which may influence a culture of patients’ safety in the ED. OBJECTIVE: To identify the factors that influence patient safety culture in EDs. METHODS: A qualitative study using semi-structured interviews with 12 ED staff was carried out in two Australian EDs. The data was thematically analysed to identify and describe the factors perceived by staff as influencing patient safety culture. RESULTS: The findings revealed four super-ordinate themes and 19 categories. The themes were the following:…(1) Environmental and Organisational; (2) Healthcare Professional (3) Managerial factors; and (4) Patients factors. CONCLUSIONS: Safety culture in the ED is influenced by complex set of factors. The results of this study may help ED workers with improving patient safety culture and healthcare quality in the ED.
Keywords: Emergency department, patient safety culture, patient safety, quality health care
Abstract: BACKGROUND: Fluoxetine was approved for depression in children and adolescents based on two placebo-controlled trials, X065 and HCJE, with 96 and 219 participants, respectively. OBJECTIVE: To review these trials, which appear to have been misreported. METHODS: Systematic review of the clinical study reports and publications. The primary outcomes were the efficacy variables in the trial protocols, suicidal events, and precursors to suicidality or violence. RESULTS: Essential information was missing and there were unexplained numerical inconsistencies. (1) The efficacy outcomes were biased in favour of fluoxetine by differential dropouts and missing data. The efficacy on…the Children’s Depression Rating Scale-Revised was 4% of the baseline score, which is not clinically relevant. Patient ratings did not find fluoxetine effective. (2) Suicidal events were missing in the publications and the study reports. Precursors to suicidality or violence occurred more often on fluoxetine than on placebo. For trial HCJE, the number needed to harm was 6 for nervous system events, 7 for moderate or severe harm, and 10 for severe harm. Fluoxetine reduced height and weight over 19 weeks by 1.0 cm and 1.1 kg, respectively, and prolonged the QT interval. CONCLUSIONS: Our reanalysis of the two pivotal trials showed that fluoxetine is unsafe and ineffective.
Abstract: BACKGROUND: The patients’ guide by the Batz Patient Safety Foundation promotes patients’ active participation in healthcare and a safe hospital experience. OBJECTIVE: The aim was to adapt the Spanish version of the guide to the local context and evaluate its acceptability from healthcare professionals’ and patients’ perspectives in two hospitals in Buenos Aires, Argentina. METHODS: This implementation study had a formative research phase to adapt the guide with input from individual interviews and focus group discussions. The intervention comprised training sessions for professionals on patient-centered care and use of the guide, the appointment of coordinators, and…distribution of the guide. The adapted guide (section During Admission) was distributed in two hospitals. Before and after intervention, we administered surveys to explore acceptability, utility, and patient satisfaction. RESULTS: Findings from formative research showed that the Batz guide needed to be shortened and adapted to the local healthcare context Although professionals had agreed on the importance of clinical guidelines; after using the Batz guide, they found it complex and difficult to implement. Patients’ satisfaction with healthcare before and after implementing the guide did not differ significantly. Best scores were found in items related to availability of nurses, staff competence and staff kindness. A 78% of patients found the Batz guide useful. CONCLUSION: It is of critical importance to adapt the guide to the local culture, pilot it, and provide training to promote its implementation, improving acceptability and utility.
Keywords: Patient-centered care, patient guide, readmissions, hospital care
Abstract: BACKGROUND: Health care workers face a wide range of chemical, physical, and biological occupational hazards in their jobs. OBJECTIVE: The present study aimed to investigate research trends on post-exposure prophylaxis (PEP) against blood-borne viral infections among health care workers. METHOD: Keywords related to health care workers, PEP, and blood-borne viruses were entered in the Scopus database for the period from 1950 to 27 January 2022. RESULTS: The search query returned 271 papers. The earliest publication was in 1984. The Pan African Medical Journal ranked first (n = 8, 3.0%), followed…by the Infection Control and Hospital Epidemiology and Journal of Hospital Infection with 6 (2.2%) papers for each. One hundred ninety-one journals took part in publishing the retrieved papers. Authors from 63 different countries took part in publishing the retrieved papers. The United States (US) ranked first (n = 53, 19.6%) followed by India (n = 26, 9.6%). The United States Centers for Disease Control and Prevention contributed the most (n = 9, 3.3%) and ranked first in the top active institutions. The mean number of authors per paper was 4.4 and the mean number of citations per paper was 17.0. The most frequent author keywords focused on PEP, health care workers, occupational exposure, HIV, hepatitis B, anti-retroviral and needle-stick injuries. Research themes in the retrieved papers focused on knowledge/attitude/practice and management and epidemiology of occupational exposure and PEP. There was a limited number of research publications in this field. CONCLUSION: Research activity in this field needs to be strengthened in low- and middle-income countries through reporting and training of HCWs.
Keywords: Post-exposure prophylaxis, health care workers, HIV, bibliometric, occupational exposure