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Objectives: Extracorporeal membrane oxygenation (ECMO) is a complex life support modality. To appropriately educate ECMO clinicians, a comprehensive program is required. However, there is no universal ECMO education (EE) program exclusively for intensive care unit Registered Nurses (RNs). Moreover, with the recent Coronavirus Disease 2019 (COVID-19) pandemic, the existing nursing shortage and the ability of ECMO programs to maintain an established EE program worsened. This continuous quality improvement (CQI) aims to reestablish the quality of an EE program at a large academic medical center at one of the past pandemic epicenters. Method(s): A CQI process with the Plan-Do-Study-Act (PDSA) cycle and Ishikawa diagram for root cause analysis (RCA), intervention implementation from July 2022 to June 2023 Results: The RCA revealed intrahospital pandemicrelated restrictions for employee gathering, EE instructor unavailability, increased nursing turnover, increased nursing shortage, and incomplete recordkeeping of ECMO educational activity (EEA) RN attendance as dominant factors disrupting the established EE processes. Six interventions were implemented, with one added in later: 1. Schedule 1 Certification Lecture Day/Quarter (Q), 1 Re-Certification Lecture/Q, and 1 Circuit Skills Class/ month, and 1 Simulation Lab/month 2. Reserve an education room for all EE activities, as COVID-19 policies allow 3. Increase the number of EE instructors 4. Increase Nursing Leadership-ECMO Manager collaboration for optimal RN signup 5. Optimize EEA schedule to help balance RN staffing needs 6. Develop a Master ECMO Folder in Google Drive and maintain updated attendance Five interventions showed positive preliminary results, whereas it was too soon for any conclusion for one (Table 1). Conclusion(s): While preliminary, the achieved results justify that restoring the quality of an ECMO education program after the negative impact of the recent pandemic is possible. However, final results are necessary to infer the effectiveness of each intervention. (Figure Presented).
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Background Socioeconomic development,lifestyle changes and the COVID-19 pandemic all have an impact on people's mental and physical health,which may affect the prevalence of mental disorders. Currently,there is still no sufficient epidemiological information of mental disorders in Xinjiang. Objective To investigate the prevalence and influencing factors of common mental disorders among people aged 15 and above in northern Xinjiang,then compare the data with those of their counterparts in southern Xinjiang,and summarize the overall prevalence of common mental disorders in Xinjiang,providing a scientific basis for the formulation of corresponding mental health plans. Methods From November 2021 to July 2022,a multistage,stratified,random sampling method was used to select 3 853 residents from northern Xinjiang to attend a survey. General Demographic Questionnaire,and self-assessment scales(the 12-Item General Health Questionnaire,Mood Disorder Questionnaire,Symptom Checklist-90,etc.) and other assessment scales(Hamilton Depression Inventory,Bech-Rafaelsen Mania Rating Scale,Brief Psychiatric Rating Scale,etc.) were used as survey instruments. Mental disorders were diagnosed by the ICD-10 classification of mental and behavioral disorders by two psychiatrists with at least five years' working experience, or by a chief or associate chief psychiatrist when there is an inconsistency between the diagnoses made by the two psychiatrists. Results The point prevalence rate and age-adjusted rate of common mental disorders in northern Xinjiang were 9.71% (374/3 853) and 10.07%,respectively. The point prevalence rate and age-adjusted rate of common mental disorders in the whole Xinjiang were 9.69%(750/7 736)and 9.90%,respectively. The point prevalence rates of mood disorders,anxiety disorders,schizophrenia,organic mental disorders,and mental retardation in northern Xinjiang were 4.83%(374/7 736),3.63% (281/7 736),0.63%(49/7 736),0.23%(18/7 736),and 0.36%(28/7 736),respectively. Multivariate Logistic regression analysis for northern Xinjiang showed that:the risk of mood disorders in females was 1.854 times higher than that in males 〔95%CI(1.325,2.593)〕;The risk of mood disorders increased by 5.210 times in 25-34-year-olds 〔95%CI(1.348, 20.143)〕 and 3.863 times in 35-44-year-olds 〔95%CI(1.030,14.485)〕 compared with that in those aged ≥ 65 years;The risk of mood disorders increased by 0.199 times in those with high school or technical secondary school education 〔95%CI (0.078,0.509)〕 and 0.147 times in those with two- or three-year college and above education 〔95%CI(0.056,0.388)〕 compared with that in illiteracies. The risk of anxiety disorder in females was 1.627 times higher than that in males 〔95%CI (1.144, 2.315)〕;The risk of anxiety disorder increased by 0.257 times in 15-24-year-olds 〔95%CI(0.091,0.729)〕,0.243 times in 45-54-year-olds 〔95%CI(0.101,0.583)〕,and 0.210 times in 55-64-year-olds 〔95%CI(0.067,0.661)〕 compared to that of those aged ≥ 65 years old. The risk of schizophrenia among people living in villages or towns was 4.762 times higher than that of those living in cities 〔95%CI(1.705,13.300)〕;The risk of schizophrenia among people with high school or technical secondary school education was 0.079 times higher than that of illiteracies 〔95%CI(0.015,0.405)〕. Conclusion The prevalence of mood disorders and anxiety disorders is high among all types of mental disorders in Xinjiang. Females,rural people,or low educated people in northern Xinjiang are more prone to various types of mental disorders. © 2023 Chinese General Practice. All rights reserved.
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Background/Aims Long Rheumatology waiting lists in the UK were further affected by the COVID-19 pandemic;resulting in negative impacts upon the timeliness and efficiency of patient care. The use of Advanced Practitioners within Rheumatology care pathways has been shown to be safe and effective;they can support the Rheumatology workforce and expedite care where patients are appropriately triaged to them. As part of a service provision change in a NHS Trust, an Advanced Practice Physiotherapist (APP) post was funded with the intent to harness these benefits. Initial utilisation of the APP appointments within the Rheumatology provision was found to be low and could be improved. A Quality Improvement (QI) Project was initiated, with the aim to increase APP appointment utilisation to at least 85% over a period of four months, and for at least 75% of these appointments to contain patients who had been appropriately triaged. Methods The 'Model for Improvement' was chosen as the QI approach. The project was led by an APP. Firstly, a stakeholder analysis was performed to identify staff with influence and interest in the project. A root cause analysis found lack of awareness of triaging clinicians and challenges with booking processes as potential reasons for lowerthan- expected appointment utilisation. Change interventions were devised and tested over three Plan, Do, Study, Act (PDSA) cycles. PDSA one developed communication with booking and triage staff to clarify these processes with them. PDSA two educated clinical staff about the APP role, triage criteria and the booking procedures confirmed in PDSA one. PDSA three focused upon sustaining change by reinforcement of the topics established in PDSA two among staff. Outcome measures used were the percentage of available APP appointments utilised per week, and the percentage of these which contained patients who were appropriately triaged. Results APP appointment utilisation increased from a mean of 22% pre-project to 61% during the change intervention period. Sixty-three patients were seen over the 17-week change intervention period;of which 86% had been appropriately triaged. Data showed that 70% of the patients directed to the APP were managed by them (24% discharged and 46% reviewed). Of the remaining patients, 13% were followed up by a Rheumatologist, 12% did not attend and 5% had an alternative outcome such as awaiting advice. Conclusion This QI project led to an improvement in Rheumatology care provision locally. Engagement with support staff, education of clinical staff and implementation of clear standard operating procedures improved the utilisation of the Rheumatology APP resource. Results suggest that the APP role was effective locally in managing appropriately triaged patients, without a negative effect on patient care or other services. Continuing to improve utilisation will support management of the Rheumatology waiting list and improve patient care.
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Background China has made some achievements in the construction of hierarchical medical system，but the development of its primary healthcare settings is still relatively slow. Objective To analyze the changes in patient visits and associated determinants in primary healthcare settings in Guangdong during 2013 to 2020，providing a basis for deepening the construction of hierarchical medical system. Methods In December 2021，this study extracted patient visits in primary healthcare institutions of Guangdong from Guangdong Health Statistics Yearbook（2013—2015），Guangdong Health and Family Planning Statistical Yearbook（2016—2017），and Guangdong's Hygiene and Health Statistical Yearbook（2018—2020） as the reference sequence，and extracted the population data and per capita disposable income from Guangdong Statistical Yearbook 2021，and the financial subsidy for primary healthcare institutions and the number of medical insurance participants from China Health and Family Planning Statistical Yearbook（2015—2017） and China's Hygiene and Health Statistical Yearbook（2018—2021） as the comparative sequence. Grey relational analysis was used to evaluate the strength of correlation between the number of patient visits and its potential associated determinants involving demographic and socioeconomic status，health resource allocation and medical insurance participation. Results The number of hospital visits in Guangdong increased from 334.592 million in 2013 to 401.317 million in 2019，with an average annual growth of 3.08%. The number of patient visits in primary healthcare settings in the province reached 437.317 million in 2019，and the average annual growth in these settings was 2.10% during 2013 to 2019. In 2020，the number of patient visits in hospitals and in primary healthcare settings both decreased significantly because of the COVID-19 pandemic. The number of patients visits in primary healthcare settings accounted for 50.7% of all patients visits in medical institutions in 2013，which declined to 48.1% in 2020. Grey relational analysis showed that both the number of residents（r=0.913） and the number of people aged over 65 years old（r=0.913） had the strongest correlation with the number of patient visits in primary healthcare settings，followed by the number of urban-rural resident basic medical insurance participants（r=0.899），the number of beds in primary healthcare settings（r=0.893），the number of primary healthcare settings（r=0.886） and the number of urban employee basic medical insurance participants（r=0.872）. Conclusion At present，many patients still choose to hospitals for medical services，which calls for actions to strengthen the first contact in primary care system. It is suggested to meet the needs of residents for nearby medical treatment by enriching the connotation of primary care services，widening the gap of healthcare expenses reimbursed by medical insurance among medical institutions and improving the service capacity of primary healthcare settings under the background of population aging. © 2023 Chinese General Practice. All rights reserved.
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The rapid adoption of technology and digitization of work, which has affected every facet of life including pedagogy, has created an opportunity to develop novel ways to teach technical and management skills to students to make them industry ready. However, several studies have highlighted that students studying engineering related disciplines within higher educational institutions are often disconnected from the management units within their programme curriculum, irrespective of the level of complexity. Additionally, there are concerns that the recent shifts towards predominantly hybrid or online & blended learning (OBL) approach advocated by most institutions due to restrictions imposed by COVID-19 pandemic has further eroded the already exiguous interest levels. This study therefore attempts to understand how engineering students at a department within the University of Manchester perceive management units and the possible root causes of previously observed attitudes. The unit examined was Operations Management (MACE30461), which is mandatory for all final year undergraduates studying for graduate degrees in aerospace, civil and mechanical engineering. The fundamental rationales behind selecting this unit are its coverage of several disciplines and cohort size, with an average of approximately 350 registered engineering students per year over the last five years. To achieve the overarching aim of this study, data was innovatively obtained from five separate cohorts, through a popular continuous improvement technique - the Fishbone diagram (FBD). The benefits of this data collection approach is multi-faceted. Firstly, it reinforces learning and familiarity of the students with the applied tools, which is crucial to the achievement of the intended learning outcomes (ILOs). Secondly, it enhances direct extraction of root causes (RCs) of the identified limiters as well as their possible causal relationships. Out of approximately 1758 students that have been registered on this unit over five years, 962 returned their solutions to the exercise. As it would be very unrealistic to present all of the individual FBDs constructed by each student, a harmonised FBD was reconstructed based on all the identified RCs. The results of the study generally depict two overwhelming findings. Firstly, there is a general misconception of the meaning of engineering, as most students believe that engineering programmes should only encompass core technical elements such as thermodynamics, design, fluid mechanics, vibrations, etc. Secondly, majority of students find the contents of most management units offered to engineering students uninteresting, particularly because of a lack of well-established link between such contents and what they perceive as real engineering. The authors therefore argue for innovative teaching methods that embed tools that are coherent with core technical units through hybrid or OBL, which is both cost effective and practical given the prevailing pandemic environment. Copyright © 2022 by ASME.
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The very hazardous respiratory illness known as COVID-2 (SARS-CoV-2), which is the root cause of the even more serious illness known as COVID-19, was caused by the COVID-2 virus. The COVID-19 virus was identified in Wuhan City, China, in the month of December in 2019. It began in China and then spread to other parts of the world before it was officially classified as a pandemic. It has had a significant impact on day-To-day life, the welfare of people in general, and the economy of the whole globe. It is of the utmost importance, particularly in the beginning stages of treatment, to pinpoint the constructive experiences that are useful at the proper time. The identification of this virus involves a substantial number of tests, each of which takes a certain amount of time;nevertheless, there are currently no other automated tool kits that can be used in their place. X-ray photos of the chest that are obtained via the use of radiology imaging methods may provide significant insight into the COVID-19 infection if they are analysed carefully. An accurate diagnosis of the infection may be obtained via the application of deep learning techniques, which are applied to radiological images and make use of cutting-edge technology such as artificial intelligence. Patients who reside in distant places, where it may not be feasible for them to have rapid access to medical facilities, may benefit from this kind of analysis throughout the course of their therapy. One of the deep learning strategies that are used in the creation of the model that has been proposed is the use of convolutional neural networks. The images of chest X-rays are analysed by these networks to detect whether a person has a positive or negative result for the Covid gene. © 2022 IEEE.
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BACKGROUND: Root cause analysis (RCA) is a structured investigation methodology aimed at identifying systems factors to prevent recurrence of incidents. To enhance staff's knowledge and skills, a hybrid RCA training course was conducted in February 2021. Overseas instructors conducted training online and local participants attended the training together physically with onsite facilitator support. This study aimed at understanding the experiences of trainees who have undergone the training, evaluated its effectiveness and identified opportunities to enhance RCA training quality in the future. METHODS: A qualitative study using virtual synchronous focus group interviews was conducted. Purposive sampling was adopted to invite all trainees from the RCA training course to join. A semistructured interview was used to guide the study participants to share their experiences. All groups were audio-recorded, transcribed verbatim and anonymised for data analysis. RESULTS: Overall, 6 focus groups with 19 participants were held between July and November 2021. Five key themes were identified including: (1) training contents, (2) perceptions of RCA, (3) challenges in RCA, (4) hybrid training and (5) future perspectives. Participants felt the RCA training was useful and broadened their understanding in incident investigation. More in-depth training in interviewing skills, report writing with practical sessions could further enhance their competencies in RCA. Participants accepted the use of hybrid online-offline training well. Most participants would welcome an independent organisation to conduct RCA as findings would be more objective and recommendations more effective. CONCLUSIONS: This study provided an evaluation on the effectiveness of a hybrid RCA training course. Healthcare and training organisations can consider this training mode as it could reduce the cost of training and enhance flexibility in course arrangement while preserving quality and effectiveness. Virtual focus groups to interview participants were found to be convenient as it minimised travelling time and onsite arrangement while maintaining the quality of discussion.
Subject(s)
Health Facilities , Root Cause Analysis , Humans , Qualitative Research , Delivery of Health CareABSTRACT
Healthcare providers are obliged to reduce the risk of harm to patients using their services. Robust risk management embraces a blame-free reporting culture and learning from clinical errors whilst adopting a proactive approach to the measurement of patient safety indicators. A good safety culture within an organisation provides assurance to service users, staff, and the public, that there is commitment to provision of high quality safe and effective care. Risk management is everybody's responsibility. Therefore, all clinicians must possess an understanding of risk management processes. This review outlines the key elements of risk management within gynaecology and explains how risks are identified, assessed, quantified and managed. Examples from within the gynaecological setting and the challenges and the emergent risks posed by the COVID19 pandemic, are also discussed. © 2022
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Background The worldwide COVID-19 pandemic has turned into a global catastrophic public health crisis，and the conclusion about the risk factors of hospital death in COVID-19 patients is not uniform. Objective To explore risk factors of in-hospital death in patients with COVID-19 by a meta-analysis. Methods Case-control studies about risk factors of in-hospital death in COVID-19 patients were searched from databases of the Cochrane Library，ScienceDirect，PubMed，Medline，Wanfang Data，CNKI and CQVIP from inception to October 1，2021. Literature screening，data extraction and methodological quality assessment were conducted. Meta-analysis was performed using Stata 15.1. Meta-regression was used to explore the potential sources of heterogeneity. Results Eighty studies were included which involving 405 157 cases〔349 923 were survivors（86.37%），and 55 234 deaths（13.63%）〕，that were rated as being of high quality by the Newcastle-Ottawa Scale. Meta-analysis showed that being male〔OR=1.49，95%CI（1.41，1.57），P<0.001），older age〔WMD=10.44，95%CI（9.79，11.09），P<0.001〕，dyspnoea〔OR=2.09，95%CI（1.80，2.43），P<0.001〕，fatigue〔OR=1.49，95%CI（1.31，1.69），P<0.001〕，obesity〔OR=1.46，95%CI（1.43，1.50），P<0.001〕，smoking〔OR=1.18，95%CI （1.14，1.23），P<0.001〕，stroke〔OR=2.26，95%CI（1.41，3.62），P<0.001〕，kidney disease〔OR=3.62，95%CI （3.26，4.03），P<0.001〕，cardiovascular disease〔OR=2.34，95%CI（2.21，2.47），P<0.001〕，hypertension〔OR=2.23，95%CI（2.10，2.37），P<0.001〕，diabetes〔OR=1.84，95%CI（1.74，1.94），P<0.001〕，cancer〔OR=1.86，95%CI （1.69，2.05），P<0.001〕，pulmonary disease〔OR=2.38，95%CI（2.19，2.58），P<0.001〕，liver disease〔OR=1.65，95%CI（1.36，2.01），P<0.001〕，elevated levels of white blood cell count〔WMD=2.03，95%CI（1.74，2.32），P<0.001〕，neutrophil count〔WMD=1.77，95%CI（1.49，2.05），P<0.001〕，total bilirubin〔WMD=3.19，95%CI（1.96，4.42），P<0.001〕，aspartate transaminase〔WMD=13.02，95%CI（11.70，14.34），P<0.001〕，alanine transaminase 〔WMD=2.76，95%CI（1.68，3.85），P<0.001〕，lactate dehydrogenase〔WMD=166.91，95%CI（150.17，183.64），P<0.001〕，blood urea nitrogen〔WMD=3.11，95%CI（2.61，3.60），P<0.001〕，serum creatinine〔WMD=22.06，95%CI （19.41，24.72），P<0.001〕，C-reactive protein〔WMD=76.45，95%CI （71.33，81.56），P<0.001〕，interleukin-6 〔WMD=28.21，95%CI（14.98，41.44），P<0.001〕，and erythrocyte sedimentation rate〔WMD=8.48，95%CI（5.79，11.17），P<0.001〕were associated with increased risk of in-hospital death for patients with COVID-19，while myalgia〔OR=0.73，95%CI（0.62，0.85），P<0.001〕，cough〔OR=0.87，95%CI（0.78，0.97），P=0.013〕，vomiting〔OR=0.73，95%CI （0.54，0.98），P=0.030〕，diarrhoea〔OR=0.79，95%CI（0.69，0.92），P=0.001〕，headache〔OR=0.55，95%CI（0.45，0.68），P<0.001〕，asthma〔OR=0.73，95%CI（0.69，0.78），P<0.001〕，low body mass index〔WMD=-0.58，95%CI （-1.10，-0.06），P=0.029〕，decreased lymphocyte count〔WMD=-0.36，95%CI（-0.39，-0.32），P<0.001〕，decreased platelet count 〔WMD=-38.26，95%CI（-44.37，-32.15），P<0.001〕，increased D-dimer〔WMD=0.79，95%CI（0.63，0.95），P<0.001〕，longer prothrombin time〔WMD=0.78，95%CI（0.61，0.94），P<0.001〕，lower albumin〔WMD =-1.88，95%CI（-2.35，-1.40），P<0.001〕，increased procalcitonin〔WMD=0.27，95%CI（0.24，0.31），P<0.001〕，and increased cardiac troponin〔WMD=0.04，95%CI（0.03，0.04），P<0.001〕were associated with decreased risk of in-hospital death due to COVID-19. According to the meta-regression result，the heterogeneity in gender，renal disease，cardiovascular diseases，asthma，white blood cell count，neutrophil count，platelet count，hemoglobin，and urea nitrogen differed siangificnatly by country（P<0.05）. Conclusion The risk of in-hospital death due to COVID-19 may be increased by 25 factors（including being male，older age，dyspnoea，fatigue，obesity，smoking，stroke，kidney disease，cardiovascular disease，hypertension，diabetes，cancer，pulmonary disease，liver disease，elevated levels of white blood cells，neutrophil count，total bilirubin，aspartate transaminase，alanine transaminase，lactate dehydrogenase，blood urea nitrogen，serum creatinine，C-reactive protein，interleukin-6，and erythrocyte sedimentation rate），and may be decreased by 13 factors（including myalgia，cough，vomiting，diarrhoea，headache，asthma，low body mass index，decreased lymphocyte count and platelet count，increased D-dimer，longer prothrombin time，lower albumin，increased procalcitonin and cardiac troponin）. The conclusion drawn from this study needs to be further confirmed by high-quality，multicenter，large-sample，real-world studies. © 2023 Chinese General Practice. All rights reserved.
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Background The worldwide COVID-19 pandemic has turned into a global catastrophic public health crisis，and the conclusion about the risk factors of hospital death in COVID-19 patients is not uniform. Objective To explore risk factors of in-hospital death in patients with COVID-19 by a meta-analysis. Methods Case-control studies about risk factors of in-hospital death in COVID-19 patients were searched from databases of the Cochrane Library，ScienceDirect，PubMed，Medline，Wanfang Data，CNKI and CQVIP from inception to October 1，2021. Literature screening，data extraction and methodological quality assessment were conducted. Meta-analysis was performed using Stata 15.1. Meta-regression was used to explore the potential sources of heterogeneity. Results Eighty studies were included which involving 405 157 cases〔349 923 were survivors（86.37%），and 55 234 deaths（13.63%）〕，that were rated as being of high quality by the Newcastle-Ottawa Scale. Meta-analysis showed that being male〔OR=1.49，95%CI（1.41，1.57），P<0.001），older age〔WMD=10.44，95%CI（9.79，11.09），P<0.001〕，dyspnoea〔OR=2.09，95%CI（1.80，2.43），P<0.001〕，fatigue〔OR=1.49，95%CI（1.31，1.69），P<0.001〕，obesity〔OR=1.46，95%CI（1.43，1.50），P<0.001〕，smoking〔OR=1.18，95%CI （1.14，1.23），P<0.001〕，stroke〔OR=2.26，95%CI（1.41，3.62），P<0.001〕，kidney disease〔OR=3.62，95%CI （3.26，4.03），P<0.001〕，cardiovascular disease〔OR=2.34，95%CI（2.21，2.47），P<0.001〕，hypertension〔OR=2.23，95%CI（2.10，2.37），P<0.001〕，diabetes〔OR=1.84，95%CI（1.74，1.94），P<0.001〕，cancer〔OR=1.86，95%CI （1.69，2.05），P<0.001〕，pulmonary disease〔OR=2.38，95%CI（2.19，2.58），P<0.001〕，liver disease〔OR=1.65，95%CI（1.36，2.01），P<0.001〕，elevated levels of white blood cell count〔WMD=2.03，95%CI（1.74，2.32），P<0.001〕，neutrophil count〔WMD=1.77，95%CI（1.49，2.05），P<0.001〕，total bilirubin〔WMD=3.19，95%CI（1.96，4.42），P<0.001〕，aspartate transaminase〔WMD=13.02，95%CI（11.70，14.34），P<0.001〕，alanine transaminase 〔WMD=2.76，95%CI（1.68，3.85），P<0.001〕，lactate dehydrogenase〔WMD=166.91，95%CI（150.17，183.64），P<0.001〕，blood urea nitrogen〔WMD=3.11，95%CI（2.61，3.60），P<0.001〕，serum creatinine〔WMD=22.06，95%CI （19.41，24.72），P<0.001〕，C-reactive protein〔WMD=76.45，95%CI （71.33，81.56），P<0.001〕，interleukin-6 〔WMD=28.21，95%CI（14.98，41.44），P<0.001〕，and erythrocyte sedimentation rate〔WMD=8.48，95%CI（5.79，11.17），P<0.001〕were associated with increased risk of in-hospital death for patients with COVID-19，while myalgia〔OR=0.73，95%CI（0.62，0.85），P<0.001〕，cough〔OR=0.87，95%CI（0.78，0.97），P=0.013〕，vomiting〔OR=0.73，95%CI （0.54，0.98），P=0.030〕，diarrhoea〔OR=0.79，95%CI（0.69，0.92），P=0.001〕，headache〔OR=0.55，95%CI（0.45，0.68），P<0.001〕，asthma〔OR=0.73，95%CI（0.69，0.78），P<0.001〕，low body mass index〔WMD=-0.58，95%CI （-1.10，-0.06），P=0.029〕，decreased lymphocyte count〔WMD=-0.36，95%CI（-0.39，-0.32），P<0.001〕，decreased platelet count 〔WMD=-38.26，95%CI（-44.37，-32.15），P<0.001〕，increased D-dimer〔WMD=0.79，95%CI（0.63，0.95），P<0.001〕，longer prothrombin time〔WMD=0.78，95%CI（0.61，0.94），P<0.001〕，lower albumin〔WMD =-1.88，95%CI（-2.35，-1.40），P<0.001〕，increased procalcitonin〔WMD=0.27，95%CI（0.24，0.31），P<0.001〕，and increased cardiac troponin〔WMD=0.04，95%CI（0.03，0.04），P<0.001〕were associated with decreased risk of in-hospital death due to COVID-19. According to the meta-regression result，the heterogeneity in gender，renal disease，cardiovascular diseases，asthma，white blood cell count，neutrophil count，platelet count，hemoglobin，and urea nitrogen differed siangificnatly by country（P<0.05）. Conclusion The risk of in-hospital death due to COVID-19 may be increased by 25 factors（including being male，older age，dyspnoea，fatigue，obesity，smoking，stroke，kidney disease，cardiovascular disease，hypertension，diabetes，cancer，pulmonary disease，liver disease，elevated levels of white blood cells，neutrophil count，total bilirubin，aspartate transaminase，alanine transaminase，lactate dehydrogenase，blood urea nitrogen，serum creatinine，C-reactive protein，interleukin-6，and erythrocyte sedimentation rate），and may be decreased by 13 factors（including myalgia，cough，vomiting，diarrhoea，headache，asthma，low body mass index，decreased lymphocyte count and platelet count，increased D-dimer，longer prothrombin time，lower albumin，increased procalcitonin and cardiac troponin）. The conclusion drawn from this study needs to be further confirmed by high-quality，multicenter，large-sample，real-world studies. © 2023 Chinese General Practice. All rights reserved.
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COVID-19, A Pandemic with its increasing pace has spread across the globe. The medical care system was badly hit by it as the number of patients fared the number of available hospital beds and other facilities required to treat patients. To rescue, various Internet of Things (IoT) based devices were proposed to combat COVID-19 by offering a helping hand to the medical care system. The pace at which the death rate was increasing, it became the need to combat the root cause of COVID-19, the root cause being the quick spread. ID-Card though not so famous IoMT (Internet of Medical Things) device can be made to work smart, smart enough to monitor the home isolated patients, to keep a check on a precautionary distance measure and much more. The study aims to explore and discuss the state-of-the-art of various IoT to control the novel Coronavirus (COVID-19) spread by tracing out positive patients and stopping this chain by tracing symptoms just a click away. The IoMT Smart-ID-Card is proposed to easefully detect, monitor, and combat COVID-19. © 2022 IEEE.
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The Internet of Things (IoT) is a highly capable technology in the health industry. Research articles and upcoming technologies relating IoT to the healthcare industry are examined to determine the vast capabilities of technology in the future. This analysis would aid experts in devising solutions to issues and combating pandemics. IoT is emerging as a technology that enables many improvements in the health sector, such as accurate records maintenance, sample analysis, and illness root-cause analysis. The sensor-based technology can mitigate the potential risks associated with surgery. The study examines and correlates various applications of IoT in the industry, with a comprehensive analysis of their objectives, limitations, and outcomes. The study would help pave way for a technology-backed healthcare ecosystem in the future, which would include the best of all technologies. © 2022 IEEE.
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Healthcare providers are obliged to reduce the risk of harm to patients using their services. Robust risk management embraces a blame-free reporting culture and learning from clinical errors whilst adopting a proactive approach to the measurement of patient safety indicators. A good safety culture within an organisation provides assurance to service users, staff, and the public, that there is commitment to provision of high quality safe and effective care. Risk management is everybody's responsibility. Therefore, all clinicians must possess an understanding of risk management processes. This review outlines the key elements of risk management within gynaecology and explains how risks are identified, assessed, quantified and managed. Examples from within the gynaecological setting and the challenges and the emergent risks posed by the COVID19 pandemic, are also discussed.
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Introduction: A pathways streamlining stone management identified four rate-limiting processes causing delay and affecting outcome. Key performance indicators (KPI) with set targets were created to address them. These are: 1) Time to CT with report (< 24hrs). 2) Time to operative care (< 48hrs). 3) Time to discussion at stone MDT ≤2 weeks. 4) Indwelling stent time (IDST) ≤12 weeks Ureteric-stents cause morbidity if left in-situ long-term. This includes bacterial colonization and encrustation. Methods: Aim: a) identify IDST during pre-COVID and COVID periods, b) review encrusted-stents removed within the study timeframe and c) root-cause for delayed stent removal and encrustation. Stent register reviewed between Jan-2019 and Mar-2021. Mean IDST pre- and post-COVID calculated. Information on indication, insertion date and removal retrieved from register and clinical-notes. Root-cause analysis to identify factors influencing delayed removal and encrustation. Results: 841 stents inserted within study timeline;436 pre-COVID and 405 during COVID. Identical stent-times for both periods, 86% cases pre-COVID and 85% during COVID having IDST <12 weeks. Average IDST of 6 weeks and 5 weeks in pre-COVID and COVID periods respectively. 11 encrusted-stents removed (7 pre-COVID, and 4 COVID), with average encrusted-stent duration of 29 weeks pre-COVID and 16 weeks during COVID. Factors involved in encrustation and delayed removal include systems and patient-related factors, failed initial removal, complex surgical planning, ESWL and dissolution therapy. Discussion & Conclusions: No difference in IDST during pre-COVID and COVID periods. A lowered encrusted IDST during COVID, likely attributed to departmental prioritisation of stone-pathway, stent register, and use of a green-listed operative site.
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Hospitals are the most common option for health checks, illness diagnosis, and treatment for sick people. This practice is followed by almost everyone in the world. But there is a drawback with this method of getting diagnosed. There are a lot of patients with various diseases/viruses which have a potential to spread in the hospital premises. People never considered the diseases/viruses present in the hospital atmosphere. People are aware of the risk of viral transmissions in hospital environments, post COVID era. Getting diagnosed and going through the reports with an efficient accuracy takes time and some people in emergency may not have enough time to perform the conventional procedures. Users have a necessity of an online website which can help them diagnose their health problems at the comfort of their homes. This would benefit people as they don't have to travel to the hospitals and reduce their risks of transmitting hospital acquired infections. This paper presents an interactive interface that functions as a virtual therapist which accepts input in the form of text, voice, or video. Data is pushed into the machine learning pipeline that generates results. The end result of this model is a report containing root cause of the disease, a tentative prescription, and any estimated treatment expenses. This model helps to prevent hospital-acquired infections, reduces the costs of treatment as users would be able to diagnose earlier and would prefer frequent testing, reducing surgeries and also reduces the tasks of doctors. © 2022 IEEE.
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Background: Current literature on virtual cases illustrates increased student self-directed learning and satisfaction. Yet, the use of virtual cases has not been explored in the context of patient or medication safety. Description: The Virtual Interactive Case (VIC) System allows educators to create online clinical reasoning scenarios with a bridge between theory and practice. We aimed to share our experience in the development and evaluation of 3 VIC teaching modules on patient or medication safety. Action: We created VIC training modules on medication incident disclosure, root cause analysis (RCA), and failure mode and effects analysis (FMEA). We piloted tested them during the COVID-19 pandemic. Evaluation: We administered a 16-item online questionnaire from May 22, 2020, to June 8, 2020 and obtained feedback from pharmacy students and practitioners in Ontario, Canada. Most of our 18 respondents had 1-5 years of practice experience. Their practice settings ranged from associations, academia, to community pharmacies and hospitals. Respondents found the VIC platform easy to navigate. They perceived the content to be relevant and easy to implement in patient care settings. Majority of them indicated that they were confident in carrying out incident disclosure, RCA, and FMEA at their practice settings. Implications: The VIC System can be used to educate students and practitioners on patient or medication safety. It is a safe and user-friendly platform to support patient safety in virtual pharmacy care.
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BACKGROUND: Highly reliable organizations (HROs) are exemplified by forest fire-fighting crews, aircraft carrier flight deck personnel, and operators of nuclear reactors. More recently health care organizations have started to implement principles of HRO acknowledging that we need to create a system for managing the unexpected. Those working in highly reliable organizations apply 5 principles.1 (see Table 1) Hospital Medicine Divisions require these skills in order to anticipate and manage unexpected surges in patient volume and the challenges we are facing managing highly infectious COVID-19 patients. METHODS: We created a voluntary questionnaire to explore these 5 components of HROs to determine what training our faculty require to better manage the unexpected. We applied standard qualitative analysis identifying recurrent themes using N-Vivo software, and accumulating representative quotes related to the 5 elements of HROs. Narrative transcripts have been analyzed using a “memoing” techniques to create an ongoing audit trail to document study findings and to trackmethodological and substantive decisions made during the analysis.2 As more narratives were analyzed, codes were grouped into new and refined thematic categories by applying constant comparative analysis.3 This process was continued until saturation was reached.2,3 RESULTS: We have summarized the themes in Table 1. 1) Faculty are preoccupied with what could go wrong and they identified impediments to care. 2) While our faculty did not ignore these impediments the majority did not use a “root-cause analysis” approach. 3) Faculty were continually looking into standardized protocols to address the challenges. 4) High reliability organizations maintain a positive attitude and our hospitalists found that social connectedness, exercise and teamwork were sources of stability. 5) Our hospital has established an excellent collaborative relationship with our consultants. There was initial hesitancy to see COVID-19 patients which later improved. CONCLUSIONS: Our study shows that there are elements of high reliability that our HospitalMedicine Division displays, particularly around identification of impediments to care. The main area of opportunity for training was around the use of root-cause analysis. The comments about the Division's response to the COVID-19 surges were positive and focused on leadership support. Our results give us guidance on next steps to prepare and improve our organization to achieve the principles of HROs. Hospital Medicine faculty are always tackling challenges in the inpatient setting. Additional training and application of principles of HROs can help in the response to the unexpected.
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STATEMENT OF PROBLEM/QUESTION: Although hypertension is a leading cause of preventable cardiovascular disease, rates of blood pressure (BP) control remain suboptimal, particularly among racial and ethnic minority groups. DESCRIPTION OF PROGRAM/INTERVENTION: The COVID-19 pandemic has led to delays in chronic disease management and has exacerbated pre-existing racial disparities in BP control. Our quality improvement project aimed to improve BP control rates in our clinic. Our initial root cause analysis identified several contributors to suboptimal BP control in our clinic: 1) lack of follow up, 2) patient nonadherence, and 3) lack of home BP monitoring capability for telehealth encounters. To address these, we designed a comprehensive intervention which included: 1) a standardized 2 week follow up interval for patients with elevated BPs, 2) a standardized quicktext to be used at BP follow up appointments to reduce variability in provider management, and 3) home BP cuff distribution, free of cost, to those lacking this equipment. We followed the first 200 BP cuff recipients through a 6-month period. MEASURES OF SUCCESS: Our outcome measure was the percent of patients with controlled BP (defined as <140/90) through the 6-month follow up period. Our process measure was the percent of patients who had a BP follow up appointment during this time. Race-stratified data was monitored to ensure we were not worsening racial disparities in BP control. FINDINGS TO DATE: Three patients expired during the 6-month follow up period. Of the remaining 197 patients, the rate of overall BP control was 20% (39/197) at time of cuff distribution. This overall rate of BP control improved to 51% (101/197) at the 6-month time period. 85% (168/197) successfully followed up within the 6-month timeframe. In the initial cohort, 75% (147/197) identified as Black, 14% (27/197) identified as White, and the remaining 11% (23/197) identified as Hispanic/Latinx, Native American/Alaskan, biracial, multiple, or other;each of these groups achieved similar BP control rates during the 6-month follow up period [51% (75/147), 52% (14/27), and 52% (12/23), respectively]. KEY LESSONS FOR DISSEMINATION: Standardization of care and successful follow up are key elements in improving BP control in the outpatient setting. Our results also suggest that standardizing provider workflows and reducing barriers to telehealth visits can also decrease racial disparities in BP control. Our next steps including identifying patients who remain uncontrolled and leveraging additional system resources, including community health workers, for continued support outside of the office setting.
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STATEMENT OF PROBLEM/QUESTION: Racial bias impacts health outcomes however, little is known about patient perspectives about this at San Francisco VA's Downtown Clinic (DTC), an urban clinic serving a higher proportion of Black and Latinx Veterans. DESCRIPTION OF PROGRAM/INTERVENTION: Patient satisfaction survey responses for DTC have historically been low with 34 patients (4%) completing surveys in 2019-20. To develop a novel survey assessing patient perspectives on satisfaction and the impact of bias and racism on care delivery in DTC, we modified two well-studied instruments, the Interpersonal Processes of Care (IPC-18) and Microaggressions in Health Care Scale (MHCS), and gave opportunities for free text feedback. We surveyed Veterans in 2021. Using root cause analysis, we identified barriers to survey response including those related to: process (surveys only sent via mail but many patients unhoused), patients (low motivation), providers/staff (no unified messaging about surveys, no interprofessional teamwork), and the COVID-19 pandemic (few in-person visits). Our interventions targeted: 1) ease of access: having electronic and paper surveys, and electronic tablets to use;2) maximizing patient engagement: surveys at COVID vaccine clinics and gifts for participation;and 3) communication/teamwork: posters advertising surveys, frequent staff check-ins. MEASURES OF SUCCESS: We assessed survey response rates and analyzed responses. FINDINGS TO DATE: N=236 Veterans completed surveys (25% of all clinic;93% male, 39% White). Overall, participants did not report microaggressions. On a 3-point scale (1=never happened, 2=happened but it didn't bother me, 3=happened & I was bothered by it) mean score on the MHCS=1.05 for the statement: “staff/providers were insensitive about your cultural group when trying to understand/treat your issues” and 1.02 for the statement: “staff/providers seemed to have stereotypes about your cultural group even if they did not express them directly”. Scores varied minimally by race. The Interpersonal Style domain of the IPC was scored the worst by African-American and Mixed Race Veterans, including that they felt the most discriminated against due to race/ethnicity (1.76 on a 1-5 scale, higher=worse). Patient-Centered Decision Making was scored worst by White Veterans, and overall Communication was scored the worst by Asian Veterans. N=18 (12% of respondents) preferred/strongly preferred a racially concordant PCP. N=10 (9%) disagreed/strongly disagreed that police officers at clinic treat all patients fairly with no significant differences by race using Fisher's exact test. Feedback mentioned: Veterans want providers to ask instead of assume about identities related to race, gender, sex, sexuality or those related to disabilities or chronic illnesses. Several suggested more minority representation in staff and trauma-informed care. KEY LESSONS FOR DISSEMINATION: Through accounting for multifactorial barriers to survey participation using Lean principles, we dramatically increased responses. Our survey elicited valuable perspectives to inform leadership.
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Background: Colorectal cancer (CRC) screening is essential in preventive care (1, 2, 3). Societies, such as the American College of Gastroenterology (ACG) and the National Colorectal Cancer Roundtable (NCCRT), have a goal of reaching colorectal cancer screening rates of 80 % per community (4, 5). The screening rate in our clinic was 42.8 % in 2019;however, the majority of the residents were only offering invasive measures;such as colonoscopy. We aimed to improve the CRC screening rate by multiple modalities including;reeducating residents, implementing changes to the electronic medical record, and scheduling patients for wellness/preventative care visits to increase the colon cancer screening rate. Methods: Multiple methods were used as follows;An initial questionnaire to inquire about the CRC screening options given by the residents to the patient, then a didactic lecture to further explain different options, and a follow-up lecture in the clinic. Also, The Electronic medical record was adjusted to have a particular notification tab and preventive care options if the patient qualifies for CRC screening. The percent change, percent difference and the absolute difference were used to analyze the results. The Institutional Review Board approved this study. Results: CRC screening rates increased from 42.8% in 2019 to 67.4% in July 2020 with an absolute difference of 24.6, a percent difference of 44.65 %, and a percent change of 57.48 % (Figure 1). Discussion: Colonoscopy remains the gold standard for CRC screening;however other modalities are also approved including;stool testing and virtual colonoscopies (1, 2, 3, 6). Multiple societies in the United States have set a goal to reach 80% screening per community (4, 5). In 2019, the screening rate at our institution was 42.8 %. After noticing this, we decided to conduct this QI project to improve our screening rates. Our experience focused on a survey-based approach, mainly on assessing what residents offer for colon cancer screening, especially when the patients refuse colonoscopy as a form of screening (3). Residents were educated in their regular didactic sessions and with small seminars during their continuity clinic. Patient visits were also changed and focused on scheduling patients during regular wellness/preventative health care visits. Screening rates showed an absolute difference increase of 24.6 despite being affected by the COVID pandemic. We anticipate further increase in the following years and hopefully, we will reach the 80% screening goal of ACG and NCCRT (4, 5). Conclusions: Interventions that address root cause analysis and education continue to be the answer to most of our questions.(Figure Presented)