Translation and Comprehensive Validation of the Hebrew Survey on Patient Safety Culture (HSOPS 2.0).

OBJECTIVES: The study aim was to create an updated valid translation into Hebrew of the AHRQ's survey on patient safety culture for hospitals, version 2.0. It also suggested a supplementary section about workers' safety. Comparable and valid measurement tools are important for national and international benchmarking of patient safety culture in hospitals. METHODS: The process was carried out by a designated committee according to AHRQ translation guidelines. Methodology included several translation cycles, 6 semistructured cognitive interviews with health workers, and a web-based pilot survey at 6 general hospitals. Main analyses included an exploratory factor analysis, a comparison of the differences in results between versions 1 and 2 of the survey to the differences reported by AHRQ, and content analysis of open-ended questions. RESULTS: A total of 483 returned questionnaires met the inclusion criterion of at least 70% completion of the questionnaire. The demographic distributions suggested this sample to be satisfactory representative. Cronbach's alpha for the translated questionnaire was 0.95, meaning a high internal consistency between the survey items. An exploratory factor analysis revealed 8 underlying factors, and a secondary analysis further divided the first factor into 2 components. The factors structure generally resembled HSOPS 2.0 composite measures. Analyses of the new section about health workers' safety showed high involvement and possible common themes. CONCLUSIONS: The study demonstrated good psychometric properties-high reliability and validity of the new translated version of the questionnaire. This paper may serve other countries who wish to translate and adapt the safety culture survey to different languages.

[INFORMED CONSENT FOR SURGERY: WHAT'S REALLY GOING ON THERE?]

INTRODUCTION: The process of "informed consent" is currently being evaluated by the Ministry of Health, with the intent to recommend steps to improve patients' and doctors' satisfaction. Following the committee meetings, we decided to initiate an evaluation of the patient's perceptions regarding technical and logistic aspects of the process. AIMS: To learn about patients' perceptions on the informed consent process, by evaluating different aspects and variables. METHODS: One hundred patients who underwent an "informed consent" process, followed by general surgery, were interviewed using a formulated call-script. All the patients had surgery at Ramat Hayal Hospital during January 2020. RESULTS: All the interviewed patients reported that their surgeon was the one who participated in the informed consent process. The majority of the patients (70%) reported that the meeting lasted between 10-20 minutes. Only 35% of the patients reported that the surgeon used auxiliary materials during the meeting. Almost all patients (96-99%) noted that the explanations delineated by the surgeon during their meeting were clear, satisfactory, and congruent with their real experiences of their surgery. CONCLUSIONS: Based on the results of this study, we confirm that the informed consent process for patients having surgery at the Ramat Hayal Hospital, is adequate and follows the recommendations of the law. Analyzing our data by the funding agent did not disclose meaningful differences except regarding the use of auxiliary materials. This issue will be examined in a future study. DISCUSSION: These study results show a high compliance with the informed consent process in accordance with the law and MOH regulations.

Addressing the important error of missing surgical items in an operated patient.

BACKGROUND: We aim to analyze the characteristics of incidences of missing surgical items (MSIs) and to examine the changes in MSI events following the implementation of an MSI prevention program. METHODS: All surgical cases registered in our medical center from January 2014 to December 2019 were retrospectively analyzed. RESULTS: Among 559,910 operations, 154 MSI cases were reported. Mean patient age was 48.67 years (standard deviation, 20.88), and 56.6% were female. The rate of MSIs was 0.259/1000 cases. Seventy-seven MSI cases (53.10%) had no consequences, 47 (32.41%) had mild consequences, and 21 (14.48%) had severe consequences. These last 21 cases represented a rate of 0.037/1000 cases. MSI events were more frequent in cardiac surgery (1.82/1000 operations). Textile elements were the most commonly retained materials (28.97% of cases). In total, 15.86% of the cases were not properly reported. The risk factors associated with MSIs included body mass index (BMI) above 35 kg/m2 and prolonged operative time. After the implementation of the institutional prevention system in January 2017, there was a gradual decrease in the occurrence of severe events despite an increase in the number of MSIs. CONCLUSION: Despite the increase in the rate of MSIs, an implemented transparency and reporting system helped reduce the cases with serious consequences. To further prevent the occurrence of losing surgical elements in a surgery, we recommend educating OR staff members about responsibility and obligation to report all incidents that are caused during an operation, to develop an event reporting system as well as "rituals" within the OR setting to increase the team's awareness to MSIs. Trial registration Clinicaltrials.gov (NCT04293536). Date of registration: 08.01.2021. https://clinicaltrials.gov/ct2/show/NCT04293536 .

The effect of chemotherapy on telomere dynamics: clinical results and possible mechanisms.

Telomeres are the chromosomal end components, and their length in hematopoietic stem cells correlates with the bone marrow proliferative reserve. There are few data regarding telomere dynamics in hematopoietic stem cells after exposure to chemotherapy. We show that the attrition of telomeres after cytotoxic treatment correlates with the intensity of chemotherapy. Using cytotoxic drugs with differential effects on hematopoietic stem cells, our data imply that chemotherapy-induced telomere shortening results from direct damage to hematopoietic stem cells and/or the induction of proliferative stress on bone marrow while sparing repopulating stem cells. These results gain importance considering the current long survival of patients with cancer.

Early recognition of acutely deteriorating patients in non-intensive care units: assessment of an innovative monitoring technology.

BACKGROUND: Continuous vital sign monitoring has the potential to detect early clinical deterioration. While commonly employed in the intensive care unit (ICU), accurate and noninvasive monitoring technology suitable for floor patients has yet to be used reliably. OBJECTIVE: To establish the accuracy of the Earlysense continuous monitoring system in predicting clinical deterioration. DESIGN: Noninterventional prospective study with retrospective data analysis. SETTING: Two medical wards in 2 academic medical centers. PATIENTS: Patients admitted to a medical ward with a diagnosis of an acute respiratory condition. INTERVENTION: Enrolled patients were monitored for heart rate (HR) and respiration rate (RR) by the Earlysense monitor with the alerts turned off. MEASUREMENTS: Retrospective analysis of vital sign data was performed on a derivation cohort to identify optimal cutoffs for threshold and 24-hour trend alerts. This was internally validated through correlation with clinical events recognized through chart review. RESULTS: Of 113 patients included in the study, 9 suffered major clinical deterioration. Alerts were found to be infrequent (2.7 and 0.2 alerts per patient-day for threshold and trend alert, respectively). For the threshold alerts, sensitivity and specificity in predicting deterioration was found to be 82% and 67%, respectively, for HR and 64% and 81%, respectively, for RR. For trend alerts, sensitivity and specificity were 78% and 90% for HR, and 100% and 64% for RR, respectively. CONCLUSIONS: The Earlysense monitor was able to continuously measure RR and HR, providing low alert frequency. The current study provides data supporting the ability of this system to accurately predict patient deterioration.

Prevalência de anticorpos séricos contra rubéola em doenças autoimunes / Prevalence of rubella serum antibody in autoimmune diseases

INTRODUÇÃO: A associação entre infecções e doenças autoimunes (DAIs) está bem descrita na literatura médica. Vários agentes infecciosos foram implicados como indutores de respostas autoimunes, tais como o parvovírus B19, o vírus Epstein-Barr, o citomegalovírus e os vírus da hepatite. PACIENTES E MÉTODOS: Foram examinamos 1.173 soros de pacientes com 14 doenças autoimunes diferentes e 238 soros de controles saudáveis pareados geograficamente na busca por evidência de infecção rubeólica prévia. Todas as amostras foram testadas para a presença de anticorpos séricos contra rubéola usando-se o sistema Bio-Rad BioPlex 2200. RESULTADOS: Como um grupo, os pacientes com DAIs apresentaram maior prevalência de anticorpos IgM antirrubéola em comparação aos controles saudáveis (11,7% versus 5,4%; P = 0,001). A prevalência de anticorpos IgM antirrubéola foi significativamente maior em 5/14 DAIs, a saber: arterite de células gigantes (33,3%), cirrose biliar primária (24%), síndrome antifosfolipídica (20,6%), polimiosite (16%) e doença intestinal inflamatória (16%). Detectou-se prevalência semelhante de anticorpos IgM antirrubéola nos controles de diferentes países. Detectou-se alta prevalência de anticorpos IgG antirrubéola em pacientes com DAIs (89,9%) e controles. CONCLUSÃO: A prevalência aumentada de anticorpos IgM antirrubéola em DAIs sugere que a rubéola possa desempenhar um papel na etiopatogênese de várias DAIs.

INTRODUCTION: The association between infections and autoimmune diseases (AID) has been well described in the medical literature. Several infectious agents have been implicated as inducers of autoimmune responses, such as Parvovirus B19, Epstein-Barr virus, cytomegalovirus, and hepatitis viruses. PATIENTS AND METHODS: We examined 1,173 sera from patients with 14 different AID and 238 sera from geographically matched healthy controls, for evidence of prior infection with rubella. All samples were tested for the presence of serum antibodies against rubella using the Bio-Rad BioPlex 2200 system. RESULTS: As a group, patients with AID had a higher prevalence of IgM anti-rubella antibodies as compared to healthy controls (11.7% versus 5.4%; P = 0.001). The prevalence of IgM anti-rubella antibodies was significantly higher in 5/14 AID, namely in patients with giant cell arteritis (33.3%), primary biliary cirrhosis (24%), antiphospholipid syndrome (20.6%), polymyositis (16%), and inflammatory bowel disease (16%). A similar prevalence of IgM anti-rubella antibodies was detected among controls from different countries. A high prevalence of IgG anti-rubella antibodies was detected among patients with AID (89.9%) and controls. CONCLUSION: The increased prevalence of IgM anti-rubella antibodies in AID suggests a possible role for rubella in the etiopathogenesis of several AID.

Prevalence of rubella serum antibody in autoimmune diseases.

INTRODUCTION: The association between infections and autoimmune diseases (AID) has been well described in the medical literature. Several infectious agents have been implicated as inducers of autoimmune responses, such as Parvovirus B19, Epstein-Barr virus, cytomegalovirus, and hepatitis viruses. PATIENTS AND METHODS: We examined 1,173 sera from patients with 14 different AID and 238 sera from geographically matched healthy controls, for evidence of prior infection with rubella. All samples were tested for the presence of serum antibodies against rubella using the Bio-Rad BioPlex 2200 system. RESULTS: As a group, patients with AID had a higher prevalence of IgM anti-rubella antibodies as compared to healthy controls (11.7% versus 5.4%; P = 0.001). The prevalence of IgM anti-rubella antibodies was significantly higher in 5/14 AID, namely in patients with giant cell arteritis (33.3%), primary biliary cirrhosis (24%), antiphospholipid syndrome (20.6%), polymyositis (16%), and inflammatory bowel disease (16%). A similar prevalence of IgM anti-rubella antibodies was detected among controls from different countries. A high prevalence of IgG anti-rubella antibodies was detected among patients with AID (89.9%) and controls. CONCLUSION: The increased prevalence of IgM anti-rubella antibodies in AID suggests a possible role for rubella in the etiopathogenesis of several AID.

Immunology, autoimmunity, and autoantibodies in Parkinson's disease.

Recent revelations of immune alterations in Parkinson's disease have led to the convergence that an autoimmune mechanism may play a role in the etiopathogenesis of this neurodegenerative disease. In the current study, 77 Parkinson's disease patients and 77 matched healthy controls were analyzed for the presence of seven autoantibodies previously found to be associated with central nervous system manifestations namely: antineuronal-cells, anti-brain lysate, anti-dsDNA, anti-phosphatidylserine, anti-cardiolipin, anti-serotonin, and anti-melanocytes antibodies. Patients underwent systematic assessments of demographics, clinical, and biochemical manifestations. Three autoantibodies were found to be more prevalent among Parkinson's disease patients (antineuronal cells10.3% vs. 1.3%, p = 0.017; anti-brain lysate 9.1% vs. 1.3%, p = 0.032; anti-dsDNA 10.3% vs. 2.6%, p = 0.049). Clinical manifestations of Parkinson's disease, particularly dyskinesia and depression, were found to be associated with the presence of these autoantibodies.

Using continuous motion monitoring technology to determine patient's risk for development of pressure ulcers.

OBJECTIVES: To perform initial validation of a continuous motion monitoring technology that can potentially be used as a risk assessment tool to determine risk for developing pressure ulcers (PUs). METHODS: We have used the EverOn system (Earlysense LTD, Ramat Gan, Israel) as a bed movement and activity monitor. The EverOn is a contactless continuous measurement system based on a piezoelectric sensor that is placed under the patient's mattress. The study was a noninterventional study performed in 2 medical departments in 2 medical centers. Recorded movement data from enrolled patients were retrospectively analyzed, and patients were assigned a motion level score. Motion scores for the first night of hospitalization were correlated with the Norton scale as calculated per patient on admission. RESULTS: Overall, 116 patients were included in the study from the 2 sites. Motion score was significantly different between the PU risk groups as determined by the Norton scale (10.7 ± 6.2 for low, 5.4 ± 4.9 for intermediate, and 1.6 ± 3.2 for high risk; P < 0.001). Using the Norton scale as a gold standard to define high risk for developing PU (≤14), the sensitivity of the motion score was 85%, and the specificity was 93%. With regard to individual risk components, we found that activity, mobility, physical condition, and incontinence correlated highly with motion level. CONCLUSIONS: The high correlation between the EverOn motion score and the calculated Norton scale indicates the potential of this technology to serve as a risk assessment tool for the development of PUs.

[The dilemma regarding treatment of pulmonary embolism among elderly patients].

Pulmonary embolism is a medical condition associated with significant morbidity and mortality. However, there are serious side effects to the anticoagulation therapy. We report on a 97-year-old woman who was admitted to the internal medicine department due to dyspnea and pleuritic chest pain. In the differential diagnosis we considered pulmonary embolism. In this article we present the diagnostic and therapeutic steps according to the guidelines, and compare them to a hypothetical situation of a younger woman who is presented with the same clinical findings. We discuss the risks that are attributed to pulmonary embolism on the one hand, and to the anticoagulation therapy on the other hand, with respect to elderly patients more than 80 and 90 years old versus younger patients.

Delayed allergic reaction after coronary angiography.

Contrast-enhanced angiography is a very useful tool for the diagnosis and evaluation of vascular diseases. Contrast media (CM) were first introduced in the 1930s and since then they have become an important diagnostic method. Nonetheless, using CM have their price, as some patients may develop adverse reactions to them. These reactions to CM are divided into chemotoxic and allergic/pseudoallergic. Both reactions range in their time of appearance, clinical manifestations, severity, pathomechanisim, diagnostic methods and the way they are managed. Late adverse reactions to CM may be easily overlooked as they are less reported. In the present case report, the authors present a patient who developed a delayed response to nonionic CM used during an elective coronary angiography, followed by a review of the current literature and suggested recommendations.

Ferritin and prolactin levels in multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a common demyelnating disorder of the central nervous system (CNS) and ethiopathogenesis has yet to be fully elucidated. The disease may present in several clinical forms that are closely associated with disease morbidity. In recent years various environmental and hormonal factors have been implicated in the pathogenesis of autoimmunity. OBJECTIVES: To evaluate ferritin and prolactin levels in MS patients and their correlation with clinical manifestations of the disease. METHODS: Serum samples from 150 multiple sclerosis patients were evaluated for demographic characteristics, clinical parameters as well as prolactin and ferritin levels utilizing the Liaison chemiluminescent immunoassays (DiaSorin, Italy). Sera from 100 matched healthy donors were used as controls. RESULTS: Hyperprolactinemia was documented in 10 of 150 MS patients (6.7%) and hyperferritinemia in 12 (8%), both of which were significantly more common in this group compared with healthy controls (P < 0.01 and P = 0.02 respectively). Among female MS patients, elevated prolactin levels were related to the secondary-progressive type of disease (P = 0.05), whereas hyperferritinemia was associated with male gender (P = 0.03) and with the relapsing-progressive type of the disease (P = 0.02). An inverse association was found between hyperferritinemia and the relapsing-remitting type of MS in male patients (P = 0.05) CONCLUSIONS: Our results suggest a plausible association between these biomarkers and certain clinical types and gender among MS patients. Further studies combining clinical data, CNS imaging and these markers are warranted.

A comprehensive evaluation of serum autoantibodies in primary biliary cirrhosis.

In primary biliary cirrhosis (PBC) serum markers other than anti-mitochondrial antibodies (AMA) are promising in terms of disease severity and comorbidities, as well represented by anti-nuclear antibodies (ANA). The aim of the present study was thus to evaluate the prevalence and clinical significance of a large profile of serum autoantibodies in PBC sera. We utilized 69 sera from European patients with PBC (including 20 AMA-negative) and 297 sera from geographically and sex-matched healthy controls. All sera were tested for the presence of ANA and autoantibodies associated with thrombophilia, vasculitis, and gastrointestinal disease. Autoantibodies other than AMA were detected in 53/69 (76%) PBC sera vs. 105/297 (35%) among controls. The prevalence of ANA (targeting dsDNA, Sm, chromatin, ribosomal-P, RNP, SmRNP, SSA, SSB, and centromere) and thrombophilia-associated autoantibodies (i.e. anti-beta2GPI, phosphatydilserine, prothrombin) was common among patients with PBC. When clinical features were compared, the presence of anti-prothrombin IgM was associated with a worse prognosis as represented by a higher Mayo score. We demonstrate an increased prevalence of ANA and thrombophilia-associated autoantibodies in PBC sera and an association between the latter autoantibodies and PBC stage. The role of thrombophilia-associated antibodies will warrant further studies, based in particular on the incidence of portal hypertension at early stages of PBC.

[Smell: integrating neurodegeneration and autoimmunity - a personal view]. / Olfacto: uma visão pessoal integrando neurodegeneração e autoimunidade.

Throughout human evolution, smell lost its important role to be replaced by other senses. Although, it retained a "role"in several "healing" practices. The aim of this review was to analyze the possible roles and influences of olfaction on higher brain functions, like mood and memory, and in contrast heightened the influence of pathologies such as Alzheimer's disease and schizophrenia on the olfactory function, based on recent animal and human data. In this neuro-psychiatric approach, the immune system could have a central role.