Automated Detection of Patient Harm: Implementation and Prospective Evaluation of a Real-Time Broad-Spectrum Surveillance Application in a Hospital With Limited Resources.

OBJECTIVES: This study aimed to prospectively validate an application that automates the detection of broad categories of hospital adverse events (AEs) extracted from a basic hospital information system, and to efficiently mobilize resources to reduce the level of acquired patient harm. METHODS: Data were collected from an internally designed software, extracting results from 14 triggers indicative of patient harm, querying clinical and administrative databases including all inpatient admissions (n = 8760) from October 2019 to June 2020. Representative samples of the triggered cases were clinically validated using chart review by a consensus expert panel. The positive predictive value (PPV) of each trigger was evaluated, and the detection sensitivity of the surveillance system was estimated relative to incidence ranges in the literature. RESULTS: The system identified 394 AEs among 946 triggered cases, associated with 291 patients, yielding an overall PPV of 42%. Variability was observed among the trigger PPVs and among the estimated detection sensitivities across the harm categories, the highest being for the healthcare-associated infections. The median length of stay of patients with an AE showed to be significantly higher than the median for the overall patient population. CONCLUSIONS: This application was able to identify AEs across a broad spectrum of harm categories, in a real-time manner, while reducing the use of resources required by other harm detection methods. Such a system could serve as a promising patient safety tool for AE surveillance, allowing for timely, targeted, and resource-efficient interventions, even for hospitals with limited resources.

[Evaluation of the effects of a nursing intervention on the therapeutic adherence of people with type 2 diabetes]. / Évaluation des effets d'une intervention infirmière sur l'adhésion thérapeutique des personnes diabétiques de type 2.

INTRODUCTION: Diabetes mellitus is a major public health problem. ContextBackground: Educational programs have been shown to be effective demonstrated their effectiveness in improving diabetes control. In Lebanon, no action has been taken to date. OBJECTIVE: The objective is to evaluate the effects of a that an educational intervention has on the therapeutic adherence of patients with type 2 diabetes on therapeutic adherence. METHOD: An experimental design was used. The sample was composed of comprised 136 patients with type 2 diabetes. They were randomized and assigned to either an experimental group, who received a nursing intervention including that involved two education sessions followed by five telephone calls within two months of the procedure, or a and in control group. Measurements were taken before the nursing intervention and three months later. RESULTS: Compared to the control group, the experimental group demonstrated a significant improvement in the level of self-efficacy levels, self-care behaviors (general diet, specific diet, physical exercise and glycemic monitoring), the application of implementing the recommendations (diet and foot care), and HbA1c levels. DISCUSSION: The results were consistent with the studies reviewed. CONCLUSION: Nursing education improves health behaviors, enhances self-efficacy, and promotes adherence in patients with type 2 diabetes.

Breast Cancer Risk Factors: a Cross- Cultural Comparison between the West and the East

Background: The incidence of breast cancer in Lebanon is higher than any other Middle ­Eastern country, is diagnosed at a younger age than women in Western countries, and is more aggressive and fatal. Therefore addressing risk factors in this population is of paramount importance. Methods: A descriptive cross-sectional, comparative design evaluated the risk factors for breast cancer in a convenient sample of 105 Lebanese-American women with 250 Lebanese. Odds Ratio, Chi square t-tests or ANOVA were used to compare the two groups' risk factors and knowledge of screening tools. Associations found to be statistically significant were included in three multiple logistic regression models to estimate the odds of each variable for performing a mammography, a clinical breast exam (CBE) and a breast self-exam (BSE). Results: There were more Muslims in the Lebanese-American sample who perceived having a better income, and had a better understanding of the effectiveness of the mammogram, the CBE and the BSE. The Lebanese group reached menopause at an older age, t = 2.66, p = 0.05, smoked more, OR = 1.42, p = 0.001 and were five times more likely to live close to a main road or highway, OR = 5.75, p = 0.001 than the Lebanese-American group. The Lebanese- Americana group breast fed longer χ2= 11.68, p = .008, used contraceptives more, OR = 1.74, p = 0.027, exercised more, OR = 1.61, p < 0.001, and consumed more vegetables and fruits than their Lebanese counterparts, OR= 1.22, p = 0.002, and OR = 1.27 p = 0.001, respectively. For ever having a mammogram, the duration of breastfeeding (>6 months), effectiveness of the mammogram, and exercise were significant predictors. While for ever having a CBE, smoking, eating fruits, and exercise were significant. No variables were related to performing a BSE. Conclusion: The Lebanese women had higher risk factors for developing breast cancer, and had less knowledge of the benefits of breast cancer screening tools, calling for the importance of promoting healthy life styles and education.