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1.
Medicine and Law ; 41(1):55-66, 2022.
Article in English | Scopus | ID: covidwho-2027000

ABSTRACT

One consequence of the Covid19 pandemic in 2020 was disrupted supply chains for medical devices. In response, many providers began onsite 3d printing medical devices, without special training or custom tailored instructions. Traditional laws protecting patient safety and tort liability regarding possible malfunction of medical devices are not prepared to address the manufacture of medical devices by enduser health care facilities. The USA Food and Drug Administration (FDA) is one regulatory body that has expressed its desire to validate these uses of 3d printing in emergencies, despite concern about these home-grown devices from the standpoint of patient safety. This article explores the uncharted legal landscape concerning the growing need for national or international regulation addressing 3D printed medical devices in Health care facilities (HCFs) and point of care (POCs) venues. New laws may be needed to protect the integrity of medical products within an overarching duty to protect patient safety. © 2022, William S. Hein & Co., Inc.. All rights reserved.

2.
Medicine and Law ; 41(1):135-148, 2022.
Article in English | Scopus | ID: covidwho-2026979

ABSTRACT

This article aims to provide a reflection on the defensive medicine (DM) fifty years after this concept was first explored in 1972. This phenomenon combines the deviation from good medical practice and the avoidance of claims against physicians. In this climate of litigation and medical errors with consequences for professionals, both human and professional, the term "second victim" was also coined, resulting in the compromising of patient safety. In depth analysis is done, aiming to gather different measures, causes, effects, excuses, and response to this global problem. After the covid-19 pandemic, scientific societies and authors offer a fresh view identifying DM as a cause of overuse of resources and updating the critical vision of the early authors from the seventies. Evidence seems to indicate that we are witnessing a return to the beginning. © 2022, William S. Hein & Co., Inc.. All rights reserved.

3.
Telehealth and Medicine Today ; 7(3), 2022.
Article in English | ProQuest Central | ID: covidwho-2026498

ABSTRACT

The increased amount of virtual care during the COVID-19 pandemic has exacerbated the challenge of providing appropriate medical board oversight to ensure proper quality of care delivery and safety of patients. This is partly due to the conventional model of each state medical board (SMB) holding responsibility for medical standards and oversight only within the jurisdiction of that state board and partly due to regulatory waivers and reduced enforcement of privacy policies. Even with a revoked license in one state, significant number of physicians have continued to practice by obtaining a medical license in a different state. Individualized requests were sent to 63 medical boards with questions related to practice of telemedicine and digital health by debarred or penalized medical doctors. The responses revealed major deficiencies and the urgent need to adopt a nationwide framework and to create an anchor point to serve as the coordinator of all relevant information related to incidents of improper medical practice. The ability to cause damage to large number of patients is significantly more now. Federal and state agencies urgently need to provide more attention and funding to issues related to quality of care and patient care in the changing ecosystem that includes medical specialists at a distance and the use of evolving digital health services and products. The creation, maintenance, and use of an integrated information system at national and multinational levels is increasingly important.

4.
Telehealth and Medicine Today ; 6(3), 2021.
Article in English | ProQuest Central | ID: covidwho-2026478

ABSTRACT

Most analysts and healthcare systems agree that telehealth volumes will continue to be markedly higher than levels prior to the COVID-19 pandemic.1 The rapid increase required clinicians, including trainees across various specialties, to practice medicine via telehealth for the first time. Research shows that very few residency programs offer formal training and education around telehealth.2,3 Although recent research has detailed telehealth training at the undergraduate medical education level, little of this research is available at the Graduate Medical Education (GME) level. [...]the Association of American Medical Colleges (AAMC) has set standards for telehealth education, outlining guidelines to create curricula.4 This contrasts with the finding that very few Accreditation Council for Graduate Medical Education (ACGME) milestones mention telehealth or competencies related to the delivery of care via this modality.5 We set out to quantify this education gap in order to better understand its impact on trainees providing care via telehealth. If the core competencies highlighted in the table are not incorporated into GME curricula, we run the risk of telehealth becoming a substandard modality of care delivery that cannot maintain the same quality of care due to a lack of appropriate training of the providers responsible for its delivery. With the incorporation of program-specific telehealth competencies, this modality of care delivery has the ability to expand access, improve outcomes of chronic disease management, and strengthen the patient–provider relationship across all specialties.

5.
Telehealth and Medicine Today ; 6(2), 2021.
Article in English | ProQuest Central | ID: covidwho-2026475

ABSTRACT

[...]a global telemedicine ecosystem will incorporate three prongs: people in proximity to the patient, such as primary care doctor, nurse, technician, or family member;domain experts in different medical specialties who are at a distance from the patient and located in a different suburb, city, district, state, country, or continent;and advanced computer and communication technologies. The second paper ‘The AmbuPod Project: Learnings of a Government-certified, Telemedicine-enabled, Rural Healthcare Startup in India’ by Lavanian Dorairaj and the third paper ‘The Mobile Tele-Ophthalmology Unit in Rural and Underserved Areas of South India’ by Lavanya Allimuthu, Ranjitha Kannan, Ramesh BabuSekar, Martin Manoj Mathiyazahan, Padmavathy Appasamy, Sangeetha Srinivasan, and Sheila John reveal examples of new rural efforts that can be gradually replicated in other states and nations using a bottom-up approach to foster transformation and improvement of healthcare services in terms of quality of healthcare services, the speed at which it is provided, and the number of patients who receive care. The sixth paper ‘Telepsychiatry During the COVID-Pandemic: Reflections from India’ by Harihara Suchandra, Dinakaran Damodaran, Barikar C. Malathesh, Lakshmi Nirisha, Narayana Manjunatha, C. Naveen Kumar, Gopi Gajera, Sujai Ramachandraiah, Chethan Basavarajappa, Rajendra Gowda, and Suresh Bada Math and the seventh paper ‘Tele-Mentoring and Monitoring of National Mental Health Program: A Bird’s-eye View of Initiatives from India’ by Gopi Gajera, Barikar C Malathesh, Lakshmi Nirisha, C. Naveen Kumar, Narayana Manjunatha, Harihara Suchandra, Sujai Ramachandraiah, Chethan Basavarajappa, Rajendra Gowda, and Suresh Bada Math focus on addressing mental health issues in a vast country.

6.
Blockchain in Healthcare Today ; 5, 2022.
Article in English | ProQuest Central | ID: covidwho-2026460

ABSTRACT

Regulating and monitoring a traditionally fragmented pharma supply chain has been a global challenge for decades. Without a trusted system and strong collaboration between stakeholders, threats such as counterfeits can easily intercept the supply chain and cause monumental disruptions. Today, the Covid-19 pandemic has accelerated the need for greater data transparency, better deployment of technology, and improved ways of connecting stakeholder information along the supply chain. There is a need for improved ways of working to help build up supply chain resilience, and one way is by implementing better end-to-end traceability using blockchain technology such as Hyperledger Fabric. This paper will explore the business value that blockchain brings to the pharma supply chain with better end-to-end traceability, with the example of an industry-grade blockchain solution called eZTracker. Through six key features, pharmaceutical manufacturers, patients, and Healthcare Practitioners (HCPs) can now participate in data-sharing, with extended use cases of integrating blockchain with warehouse platforms, a patient-facing mobile application, and an interactive dashboard for real-time verification and data transparency. Beyond anti-counterfeit verification, other potential use cases include effective product recall management, cold chain monitoring, e-product information and more. The effectiveness of a traceability solution is heavily dependent on the amount of data collected and is affected by poor adoption and scalability. Existing limitations that need to be addressed include the lack of mandated serialisation in Asia and blockchain interoperability. To maximise the value of blockchain, collaboration is key. Pharmaceutical manufacturers need to invest in new technologies such as blockchain, to help them break out of data silos, and operationalise data to build supply chain resilience.

7.
Blockchain in Healthcare Today ; 4, 2021.
Article in English | ProQuest Central | ID: covidwho-2026452

ABSTRACT

Objective: Despite the implementation of quality assurance procedures, current clinical trial management processes are time-consuming, costly, and often susceptible to error. This can result in limited trust, transparency, and process inefficiencies, without true patient empowerment. The objective of this study was to determine whether blockchain technology could enforce trust, transparency, and patient empowerment in the clinical trial data management process, while reducing trial cost. Design: In this proof of concept pilot, we deployed a Hyperledger Fabric-based blockchain system in an active clinical trial setting to assess the impact of blockchain technology on mean monitoring visit time and cost, non-compliances, and user experience. Using a parallel study design, we compared differences between blockchain technology and standard methodology. Results: A total of 12 trial participants, seven study coordinators and three clinical research associates across five sites participated in the pilot. Blockchain technology significantly reduces total mean monitoring visit time and cost versus standard trial management (475 to 7 min;P = 0.001;€722 to €10;P = 0.001 per participant/visit, respectively), while enhancing patient trust, transparency, and empowerment in 91, 82 and 63% of the patients, respectively. No difference in non-compliances as a marker of trial quality was detected. Conclusion: Blockchain technology holds promise to improve patient-centricity and to reduce trial cost compared to conventional clinical trial management. The ability of this technology to improve trial quality warrants further investigation.

8.
Blockchain in Healthcare Today ; 4, 2021.
Article in English | ProQuest Central | ID: covidwho-2026450

ABSTRACT

With coronavirus (COVID) spreading across the world and the health care system being pushed toward more digitization and technology, last year was a unique year of human tragedy. There is a silver lining to this tragedy, that is, providers, payers, and pharma companies have shifted quickly toward better technologies, including artificial intelligence (AI) blockchain, and so on.

9.
Cancer Nursing Practice ; 21(5):23-28, 2022.
Article in English | CINAHL | ID: covidwho-2025351

ABSTRACT

AUTH Why you should read this article: • To learn about the experience of two trusts that set up a home denosumab self-administration service for patients during the coronavirus disease 2019 (COVID-19) pandemic • To recognise the need for a robust, comprehensive and consistent training process for patients to self-administer denosumab at home safely • To identify the benefits for patients and their families of a home denosumab self-administration service In October 2012 the National Institute for Health and Care Excellence approved the use of subcutaneous denosumab for the management of bone metastases from solid tumours. For patients receiving intravenous chemotherapy, denosumab can be administered in parallel with this, obviating the need for additional hospital visits. However, patients receiving oral chemotherapy or denosumab alone often must attend hospital solely for a subcutaneous injection of the latter. This article describes the experience of two NHS trusts in setting up a home self-administration service for denosumab during the coronavirus disease 2019 (COVID-19) pandemic. The service development project took place during 2020-2021. The article explores the barriers to and facilitators of this project and reports the results of a patient feedback survey which showed that all respondents wished to continue self-administration of denosumab at home.

10.
AACN Advanced Critical Care ; 33(3):280-282, 2022.
Article in English | CINAHL | ID: covidwho-2024644
11.
Journal of Personalized Medicine ; 12(8):1308, 2022.
Article in English | ProQuest Central | ID: covidwho-2023830

ABSTRACT

The precision health era is likely to reduce and respond to antimicrobial resistance (AMR). Our stewardship and precision efforts share terminology, seeking to deliver the “right drug, at the right dose, at the right time.” Already, rapid diagnostic testing, phylogenetic surveillance, and real-time outbreak response provide just a few examples of molecular advances we dub “precision stewardship.” However, the AMR causal factors range from the molecular to that of global health policy. Mirroring the cross-sectoral nature of AMR science, the research addressing the ethical, legal and social implications (ELSI) of AMR ranges across academic scholarship. As the rise of AMR is accompanied by an escalating sense of its moral and social significance, what is needed is a parallel field of study. In this paper, we offer a gap analysis of this terrain, or an agenda for “the ELSI of precision stewardship.” In the first section, we discuss the accomplishments of a multi-decade U.S. national investment in ELSI research attending to the advances in human genetics. In the next section, we provide an overview of distinct ELSI topics pertinent to AMR. The distinctiveness of an ELSI agenda for precision stewardship suggests new opportunities for collaboration to build the stewardship teams of the future.

12.
Journal of Clinical Medicine ; 11(17):4997, 2022.
Article in English | ProQuest Central | ID: covidwho-2023793

ABSTRACT

Background: To explore the feasibility and effectiveness of multifaceted quality improvement intervention based on the clinical decision support system (CDSS) in VTE prophylaxis in hospitalized patients. Methods: A randomized, department-based clinical trial was conducted in the department of respiratory and critical care medicine, orthopedic, and general surgery wards. Patients aged ≥18 years, without VTE in admission, were allocated to the intervention group and received regular care combined with multifaceted quality improvement intervention based on CDSS during hospitalization. VTE prophylaxis rate and the occurrence of hospital-associated VTE events were analyzed as primary and secondary outcomes. Results: A total of 3644 eligible residents were enrolled in this trial. With the implementation of the multifaceted quality improvement intervention based on the CDSS, the VTE prophylaxis rate of the intervention group increased from 22.93% to 34.56% (p < 0.001), and the incidence of HA-VTE events increased from 0.49% to 1.00% (p = 0.366). In the nonintervention group, the VTE prophylaxis rate increased from 24.49% to 27.90% (p = 0.091), and the incidence of HA-VTE events increased from 0.47% to 2.02% (p = 0.001). Conclusions: Multifaceted quality improvement intervention based on the CDSS strategy is feasible and expected to facilitate implementation of the recommended VTE prophylaxis strategies and reduce the incidence of HA-VTE in hospital. However, it is necessary to conduct more multicenter clinical trials in the future to provide more reliable real-world evidence.

13.
Journal of Clinical Medicine ; 11(16):4706, 2022.
Article in English | ProQuest Central | ID: covidwho-2023786

ABSTRACT

Adverse events (AEs) during intensive care unit (ICU) rehabilitation and serious AEs during acute care hospital stays have been reported previously. However, no AEs have been reported for all patients needing rehabilitation in a non-ICU setting at an acute care hospital. This study aimed to investigate all AEs during acute-phase rehabilitation. Reports of AEs occurring during acute-phase rehabilitation in a university hospital from 1 April 2021 to 31 March 2022 were retrospectively analyzed. Minor and severe AEs were defined as those that did not require new treatment and those that required intensive treatment and/or prolonged hospitalization, respectively. There were 113 incidences of AEs during rehabilitation. The majority of AEs were minor (93.8%) and did not require new treatment. Only one serious AE was documented. The most common AEs were peripheral intravenous tube removal, decreased level of consciousness, poor mood due to low blood pressure, and falling down. There was no significant correlation between years of experience and the frequency of AEs. The neurosurgery department had the highest cases of AEs. Physical, occupational, and speech-language-hearing therapists had different characteristics and experiences of AEs. Risk management strategies should consider exercise load and targeted disorders due to differences in therapists’ specialties.

14.
Journal of Clinical Medicine ; 11(16):4705, 2022.
Article in English | ProQuest Central | ID: covidwho-2023785

ABSTRACT

Background: Medication Regimen Complexity (MRC) refers to the combination of medication classes, dosages, and frequencies. The objective of this study was to examine the relationship between the scores of different MRC tools and the clinical outcomes. Methods: We conducted a retrospective cohort study at Roger William Medical Center, Providence, Rhode Island, which included 317 adult patients admitted to the intensive care unit (ICU) between 1 February 2020 and 30 August 2020. MRC was assessed using the MRC Index (MRCI) and MRC for the Intensive Care Unit (MRC-ICU). A multivariable logistic regression model was used to identify associations among MRC scores, clinical outcomes, and a logistic classifier to predict clinical outcomes. Results: Higher MRC scores were associated with increased mortality, a longer ICU length of stay (LOS), and the need for mechanical ventilation (MV). MRC-ICU scores at 24 h were significantly (p < 0.001) associated with increased ICU mortality, LOS, and MV, with ORs of 1.12 (95% CI: 1.06–1.19), 1.17 (1.1–1.24), and 1.21 (1.14–1.29), respectively. Mortality prediction was similar using both scoring tools (AUC: 0.88 [0.75–0.97] vs. 0.88 [0.76–0.97]. The model with 15 medication classes outperformed others in predicting the ICU LOS and the need for MV with AUCs of 0.82 (0.71–0.93) and 0.87 (0.77–0.96), respectively. Conclusion: Our results demonstrated that both MRC scores were associated with poorer clinical outcomes. The incorporation of MRC scores in real-time therapeutic decision making can aid clinicians to prescribe safer alternatives.

15.
International Journal of Environmental Research and Public Health ; 19(16):10112, 2022.
Article in English | ProQuest Central | ID: covidwho-2023652

ABSTRACT

Unlike inpatient care, clinicians and patients usually only have the chance to see each other weeks or months apart [6]. [...]it is essential to ensure that patients and caregivers are involved in their care and establish contingency plans in case of treatment failure or emergency. Diagnostic errors are related to different patient processes, such as issues with referral, patient-related factors such as no-shows and language issues, missed opportunities to follow-up on diagnostic tests, and clinicians’ interpretations of the tests [8]. Since we only have limited time in ambulatory encounters, clinicians often use system 1 thinking, an intuitive process based on their own experiences. Burnout in Primary Care There is substantial evidence that burnout may negatively affect patient safety, which is multifactorial, with depersonalization and emotional exhaustion decreasing productivity, quality of care, and increasing diagnostic errors [15]. [...]primary care physicians or general practitioners are known to suffer from a higher prevalence of burnout than other specialties, reaching up to 70% depending on the research [16].

16.
Healthcare ; 10(8):1517, 2022.
Article in English | ProQuest Central | ID: covidwho-2023393

ABSTRACT

This study was conducted to check the extent of nursing professionalism, time pressure, infection control, organizational culture, and the infection control practices of nurses, and to assess the factors that impart an influence on their infection control practices. This is a descriptive survey study aimed at the assessment of factors that impart an influence on the infection control practice of nurses by using a structuralized questionnaire. As the result of this study, the infection control practices of nurses have a positive correlation with the time pressure (r = 0.16, p = 0.034) and the organizational culture for infection control (r = 0.29, p < 0.001). Factors that affect the infection control practices included the organizational culture for infection control (β = 0.29, p < 0.001) and time pressure (β = 0.16, p = 0.024), with the explanation power of 10%. It was possible to confirm that the affirmative organizational culture for infection control plays an important role in enhancing the infection control practices of nurses. Accordingly, it is necessary to provide administrative and financial support from the organization, including support by the management and administrators of clinical practices, as well as the provision of required commodities in order for nurses to execute infection control in accordance with the prescribed regulations.

17.
Pharmacy (Basel) ; 10(4)2022 Jun 22.
Article in English | MEDLINE | ID: covidwho-2023995

ABSTRACT

This study applied a human factors and ergonomics approach to describe community-based pharmacy personnel perspectives regarding how work environment characteristics affect the ability to perform the duties necessary for optimal patient care and how contributors to stress affect the ability to ensure patient safety. Data were obtained from the 2021 APhA/NASPA National State-Based Pharmacy Workplace Survey, launched in the United States in April 2021. Promotion of the online survey to pharmacists and pharmacy technicians was accomplished through social media, email, and online periodicals. Responses continued to be received through the end of 2021. A data file containing 6973 responses was downloaded on 7 January 2022 for analysis. Qualitative thematic analysis was applied for developing operational definitions and coding guidelines for content analysis of the data. The patterns of responses for the dependent variables were compared among community-based practice setting types (chain, supermarket/mass merchandiser, and independent) and work positions (manager, staff pharmacist, technician/clerk, and owner). Chi-square analysis was used for determining statistically significant differences. The findings showed that personnel working in community-based pharmacies reported undesirable work environments and work stress that affected their ability to perform assigned duties for optimal patient care and ensure patient safety. Four work system elements were identified that were both facilitators and barriers to the ability to perform duties and ensure patient safety: (1) people, (2) tasks, (3) technology/tools, and (4) organizational context. Acknowledging local contexts of workplaces, giving adequate control, applying adaptive thinking, enhancing connectivity, building on existing mechanisms, and dynamic continuous learning are key elements for applying the HFE (human factors ergonomics) approach to improving the experience of providing care in community-based pharmacies.

18.
BMC Prim Care ; 23(1):230, 2022.
Article in English | PubMed | ID: covidwho-2021243

ABSTRACT

INTRODUCTION: The significance of the role of receptionists during the recent shift to remote triage has been widely recognised and they will have a significant role to play in UK general practice as it continues to cope with a huge increase in demand exacerbated by the COVID-19 pandemic. To maximise their contribution, it is important the social and occupational characteristics of the modern receptionist are understood, alongside their attitudes towards the role and their perceptions of the support and training they receive . METHODS: We used convenience and cross-sectional sampling to survey the demographic characteristics of receptionists and various aspects of their role and responsibilities. This included the training received, specific tasks performed, job satisfaction, the importance of the role, and their interaction with clinical and non-clinical colleagues. We also captured data on the characteristics of their practice including the number of GPs and location. RESULTS: A total of 70 participants completed the survey (16 postal and 54 online responses) of whom the majority were white (97.2%), female (98.6%), and aged 40 and over (56.7%). The majority of the training focussed on customer service (72.9%), telephone (64.3%), and medical administration skills (58.6%). Just over a quarter had received training in basic triage (25.7%). A standard multiple regression model revealed that the strongest predictor of satisfaction was support from practice GPs (β = .65, p <.001) there were also significant positive correlations between satisfaction and appreciation from GPs, r(68) = .609, p < .001. CONCLUSION: This study has provided a much-needed update on the demographics, duties, and job satisfaction of GP receptionists. The need for diversification of the workforce to reflect the range of primary care patients warrants consideration in light of continuing variation in access along lines of gender andethnicity. Training continues to focus on administrative duties not on the clinically relevant aspects of their role such as triage.

19.
Nordic Journal of Nursing Research ; 42(3):117-122, 2022.
Article in English | CINAHL | ID: covidwho-2020804

ABSTRACT

In this article, we describe and critically reflect on how the PEPPA framework, a Participatory Evidence-based Patient-focused Process for Advanced Practice Nursing, was used to develop a new model of care including the nurse practitioner (NP) role in an emergency department in Norway, where the role is in its infancy. While there is limited earlier research on the applicability of the PEPPA framework, it was here found to be useful. Supported by the framework, we mapped the current model of care, identified stakeholders and participants, determined the need for a new model of care, identified priority problems and goals, and defined the new model of care and the NP role. The PEPPA framework is recommended to develop new models of care including the NP role. Nonetheless, the process has not been straightforward. It is noted that to communicate and establish the new role in a setting as demanding as an emergency department takes time. Support from the management team is essential to succeed in developing and establishing new models of care and new nursing roles, such as the nurse practitioner role.

20.
BMJ Leader ; 2022.
Article in English | ProQuest Central | ID: covidwho-2020223

ABSTRACT

IntroductionIt is 20 years since the Institute of Medicine advocated a national approach to improve care and patient safety. Patient safety infrastructure has greatly improved in certain countries. In Ireland, patient safety infrastructure is in ongoing development. To contribute to this, the Royal College of Physicians of Ireland/International Society for Quality in Healthcare Scholar in Residence Programme was launched in 2016. This programme aims to improve patient safety and develop a movement of future clinician leaders to drive improvements in patient safety and the quality of care.MethodsDoctors in postgraduate training complete a year-long immersive mentorship. This involves monthly group meetings with key patient safety opinion makers, one-on-one mentorship, leadership courses, conference attendance and presentations. Each scholar undertakes a quality improvement (QI) project.ResultsA QI project was associated with a decrease in caesarean section rates from 13.7% to 7.6% (p=0.0002) among women in spontaneous labour at term with a cephalic presentation. Other projects are ongoing.ConclusionMedical error, patient safety and QI must be addressed comprehensively at both undergraduate and postgraduate level. We believe the Irish mentorship programme will help to change the paradigm and improve patient safety.

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