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Applying a grounded theory approach, we investigate how professionals cope with making errors that unintentionally harm others. We purposively sampled medical clinicians to study this phenomenon, as these professionals understand themselves as "enablers of patient health." When unintentionally harming others, clinicians experienced initial feelings of guilt. Triggered by the error experience, these professionals engaged in a cognitive sensemaking process, aiming to determine the root causes of the error and evaluate their level of responsibility. In this process, clinicians considered aspects of themselves and their social environment (i.e., supervisors, organization, colleagues, and clients) as either sensemaking assets or liabilities. The self and others became sensemaking assets when helping to alleviate initial feelings of guilt, and sensemaking liabilities when aggravating them. Depending on the outcome of their sensemaking process, clinicians engaged in control-focused or escape-focused identity work. This identity work, in turn, influenced the thriving or deterioration of their future professional identity. [ABSTRACT FROM AUTHOR]

Many older adults who are certified for long‐term care services live or stay in long‐term care facilities (LTCFs), where they receive medical and nursing care. These individuals often encounter medication‐related problems, such as polypharmacy and complex medication regimens, including frequent administration schedules. Although considerable attention has been paid to polypharmacy in the context of optimizing medication use in older adults, little emphasis has been placed on simplifying these regimens. Recently, the Japanese Society of Geriatric Pharmacy issued statements on medication simplification in LTCFs based on a scoping review of the literature and expert opinions. In these statements, medication simplification is defined as the process of reducing the number of medication administration times, ideally to once during lunchtime. The statements outline principles and processes to achieve medication simplification through interprofessional collaboration, including consolidating and reducing the number of medication administration times a day to minimize the risk of medication errors and ensure medical safety. Medication simplification will play a substantial role in alleviating the burden of medication intake for residents, and in reducing and equalizing the workload of medication administration for staff members throughout the day in LTCFs. These statements suggest that administering medication during lunchtime is beneficial when an adequate number of staff members are available in LTCFs. We hope that these statements will help ensure patient safety, and facilitate successful medication optimization for all medical, nursing and social care professionals working in LTCFs. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

Background: The Australian Government began implementing Medicare policies in the late 1990s aiming to improve Indigenous Peoples' access to the primary care. No aggregate central list of what policies have been implemented exists. The aim of this review was twofold: first to perform a scoping review to identify any literature mentioning a policy implemented between 1996 and 2023 regarding Indigenous Peoples' access to Medicare or the Pharmaceutical Benefits Scheme for primary care, and secondly to synthesise and describe any policies to enable learning from past successes and failures. Methods: Scoping review following the PRISMA-ScR process. Seven electronic databases were searched for any papers identifying any policy implemented between 1996–2023 to improve Indigenous Peoples' access to primary care. This was supplemented with searches in Google, key government databases, hand searching and expert input. Results: Sixteen policies were implemented and organised into six categories according to the primary care barrier they targeted: Medicare Benefits Schedule (MBS) funding structure; lack of Indignenous-appropriate MBS items; Pharmaceutical Benefits Scheme (PBS) access barriers; inappropriate care from mainstream general practitioners; bureaucratic impediments to MBS and PBS access; and data gaps. Discussion/conclusion: This is the first synthesis of Medicare and PBS policy history to improve Indigenous Peoples' access to primary health care, and provides a platform for future analysis. Identifying the names of relevant policies in any area is key to accountability and reliance on individual expertise is no substitute for transparent and durable policy record-keeping. A searchable long-term policy repository should be established to ensure that related policies can be identified, and that key policy documentation is publicly available in perpetuity. [ABSTRACT FROM AUTHOR]

Background: The topic of patient safety and attitudes toward patient safety among health professionals is a main priority of healthcare systems globally. This study aims to investigate the psychometric properties of APSQ-III among Iranian nursing students. Methods: There were 307 undergraduate nursing students who participated in the cross-sectional methodological study, from December 2022 to January 2023. Content validity, Construct validity and reliability of the APSQ-III was evaluated. Results: In the exploratory factor analysis, three factors were identified from 11 items, accounting for 58% of the total variance. The confirmatory factor analysis indices confirmed the model fit (χ2(38) = 91.851, p < 0.001, χ2/df = 2.417, CFI = 0.966, PNFI = 0.652, IFI = 0.966, TLI = 0.951 and RMSEA = 0.068). The results of the reliability evaluation indicated that the factors demonstrated a satisfactory level of internal consistency, as evidenced by Cronbach's alpha (α) and McDonald's omega (ω) values. Additionally, the Composite Reliability (CR) and Maximal Reliability H were both above 0.8, further supporting the reliability of the factors. Conclusion: The results of this study support the valid and reliable APSQ-III with 11 items and three factors. This questionnaire can be used to assess patient safety attitude among nursing students. [ABSTRACT FROM AUTHOR]

The emergence of Artificial Intelligence (AI) has already brought several advantages to the healthcare sector. Computer Vision (CV) is one of the growing modern AI technologies. The distribution and administration of medications are about to change by using CV for medication management. This system scans pharmaceutical labels and keeps track of the process from delivery to administration using cameras, sensors, and computer algorithms. In order to assure accuracy in medicine delivery and dose, the system also makes it easier for doctors, nurses, and chemists to communicate. The computer vision-driven medication management system can significantly lower the number of medical mistakes that result from inaccurate or missing prescriptions, improper doses, or simply forgetting to take a particular drug. An exhaustive literature review has been done to identify work related to the research objectives. This paper is about CV and their need in healthcare. Various tasks associated with CV in the healthcare domain are discussed. Targeted healthcare goals through CV traits are briefed. Finally, the significant applications of CVs in healthcare were identified and discussed. Nowadays, CV has practical uses in healthcare. Its methods are widely used since they have shown excellent utility in several medical contexts, including medical imaging and surgical planning. The CV is used to study how to program computers to comprehend digital pictures. Numerous medical applications utilise this technology, such as automated abnormality identification, illness diagnosis, and surgical procedure guiding. CV is expanding quickly and has enormous promise to enhance healthcare. Some of the many CV applications in the healthcare sector include patient identification systems, medical picture analysis, surgical simulation and illness diagnosis. [ABSTRACT FROM AUTHOR]

Background: Guidewire retention (GWR) poses a patient safety risk during Central Venous Catheter (CVC) insertions and is listed as a 'Never Event' by the National Health Service England (NHSE). WireSafe™ is an intervention to prevent GWR, but its cost-effectiveness is uncertain. This study is an early economic evaluation comparing WireSafe™ to standard care from a UK healthcare perspective. Methods: We conducted (i) a primary analysis of GWR related NHSE Never Events data in England between 2016 and 2020; and (ii) a cost-utility analysis, including healthcare costs and quality-adjusted life years (QALYS) for populations receiving CVC-insertions. We applied a cost-effectiveness threshold of £30,000 per QALY and considered three WireSafe™ costing scenarios (£18.50, £4.50, and £2.50). Results: NHSE Never Events data showed 61 GWR cases, averaging 1 per month. Most incidents (92%) were identified during hospital stays, with one serious adverse outcome reported (peri-arrest). In a population of 200,000, we estimate WireSafe™ would prevent 59.92 wire retentions, 5.61 procedural adverse events, 0.3 cardiac adverse events, and 0.19 deaths, improving QALYs by 4.87. In the base case analysis WireSafe™ was not cost-effective and had an economically justifiable price of £2.44. There were high levels of uncertainty in the lowest cost-scenario (ICER 95% credible interval: Dominant; £793,398). Conclusions: The health benefits of WireSafe™ are limited due to low GWR rates and high identification rates, making WireSafe™ viable only at low costs. Future research should prioritise obtaining more precise estimates of these parameter values which are key determinants of cost-effectiveness. [ABSTRACT FROM AUTHOR]

Proving the causal connection between a medical error and the personal injury suffered by a patient might turn out to be very difficult, if not impossible. If the claimant manages to substantiate that connection by reaching the required degree of probability, they will be fully compensated, and if not, they will not be indemnified at all, even though fault has been established on the part of the medical professional. This 'all-or-nothing' approach means that slight differences in the degree of probability (values slightly lower versus values slightly higher than the required threshold) result in fundamental differences in the amount of damages. In order to prevent this unjust outcome and to provide at least partial compensation to those who are unable to demonstrate the existence of a causal link, several legal systems resort to the concept of loss of a chance, which redefines the object of legal protection and regards as recoverable loss the lost or diminished chance of avoiding traditionally understood damage (personal injury). Another proposed alternative to the 'all-or-nothing' approach is proportional liability based on potential causation. The present contribution examines the advantages and disadvantages of both concepts and discusses the possibility of their application under Polish law. [ABSTRACT FROM AUTHOR]

Background: Patient safety incidents, such as adverse events and medical errors, are often caused by ineffective communication and collaboration. Interprofessional education is an effective method for promoting collaborative competencies and has attracted great attention in the context of patient safety. However, the effectiveness of interprofessional education interventions on patient safety remains unclear. This scoping review aimed to synthesize existing studies that focused on improving patient safety through interprofessional education interventions for healthcare professionals. Methods: Six databases, including Medline (via PubMed), Embase, Cochrane Library, CINAHL (via EBSCO), Scopus and Web of Science, were last searched on 20 December 2023. The search records were independently screened by two researchers. The Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies was used for quality appraisal. The data were extracted by two researchers and cross-checked. Finally, a narrative synthesis was performed. The protocol for this scoping review was not registered. Results: Thirteen quasi-experimental studies with moderate methodological quality were included. The results revealed that the characteristics of current interprofessional education interventions were diverse, with a strong interest in simulation-based learning strategies and face-to-face delivery methods. Several studies did not assess the reduction in patient safety incidents involving adverse events or medical errors, relying instead on the improvements in healthcare professionals' knowledge, attitude or practice related to patient safety issues. Less than half of the studies examined team performance, based primarily on the self-evaluation of healthcare professionals and observer-based evaluation. There is a gap in applying newer tools such as peer evaluation and team-based objective structured clinical evaluation. Conclusion: Additional evidence on interprofessional education interventions for improving patient safety is needed by further research, especially randomized controlled trials. Facilitating simulation-based interprofessional education, collecting more objective outcomes of patient safety and selecting suitable tools to evaluate teamwork performance may be the focus of future studies. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study explored nurse leaders' perspectives and experiences in supporting nurses following a serious medical error. BACKGROUND: Appropriate support is crucial for nurses following an error. Authentic leadership provides an environment of psychological safety and establishes a patient safety culture. METHODS: A cross-sectional survey research design was conducted to determine nurse leader's (NLs') perspectives on supporting nurses following a medical error. RESULTS: NL training on handling serious medical errors varied. NLs indicated experiencing a variety of formal support programs: peer support, education, error examination, employee assistance, and just culture. Following an error, NLs reported these interventions were helpful, including education/retraining, psychological safety, time off the unit, identifying system failures, nurse involvement in disclosure, and peer support. CONCLUSION: This study illuminates how NLs support nurses following an error. It provides insight into the education of NLs on assisting nurses and the need to implement formal caregiver support programs. [ABSTRACT FROM AUTHOR]

Background: Missed nursing care is a global issue that refers to any aspect of patient care that is partially or entirely omitted or delayed. Although many studies have examined the relationship between missed nursing care and nurse job satisfaction, there is no synthesized evidence of these findings. Objective: To evaluate the relationship between missed nursing care and nurse job satisfaction. Methods: A systematic review and meta-analysis was carried out by searching the following databases: Web of Science, Scopus, EBSCO, PubMed, Science Direct, Cochrane, and Springer Link. The risk of bias was assessed using the Quality Assessment and Validity Tool for Correlational Studies. A random-effects model was used in the meta-analysis. Results: Out of 13 619 identified reports, 8 studies involving 10 418 nurses were identified as eligible for the meta-analysis. A significant negative relationship between missed nursing care and nurse job satisfaction was identified, with the summary effect size of r = −0.294 (95% CI: −0.364 to −0.219, P <.001). Conclusions: The meta-analysis presented evidence regarding the significance of missed care in influencing nurse job satisfaction. As missed nursing care decreases, nurses' job satisfaction may increase. [ABSTRACT FROM AUTHOR]

Introduction: First‐line managers in Swedish communities have responsibility for that care to older people is provided, staffing is sufficient and the budget is balanced in their unit. It is a struggle with limited resources due to a growing population in need of care. This can lead to missed nursing care. The aim was to describe first‐line managers´ perceptions of missed nursing care in community health care for older people. Methods: A qualitative design with a phenomenographic approach, interviewing 24 first‐line managers. Ethics approval for the study was received from the Research Ethics Committee at Karlstad University (Dnr HNT 2020/566). Results: The results are shown in six descriptive categories containing 15 perceptions. The descriptive categories are 'occurrence of missed nursing care', 'becoming aware of missed nursing care', 'reasons for missed nursing care', 'missed nursing care has consequences for the older persons', 'missed nursing care has consequences for the staff' and 'taking action to decrease missed nursing care'. Conclusions: It is important for first‐line managers to become aware of the existence and reasons for missed nursing, as it has consequences for older people and staff. Managers need to take missed nursing care seriously in order to work with improvements for maintaining good quality of care and patient safety. [ABSTRACT FROM AUTHOR]

Objective: Physicians experience scary cases in the course of usual medical practice. Cases of near misses, legal and ethical dilemmas, or unique clinical challenges are great sources of education. However, there is no format for presentation and dissemination of cases that do not meet criteria for morbidity and mortality (M&M) conferences. The Scary Cases Conference is an innovative educational forum for scrutiny and analysis of these challenging clinical cases. Scary Cases differs from traditional Morbidity and Mortality conferences as it explores outcomes beyond the scope of medical or surgical errors. Methods: From 2011 to 2021: 11 regional and 10 national "Otolaryngology Scary Cases" conferences and mini-seminars were held. The cases presented were analyzed for case specialty, area of management deemed troublesome, and compared to M&M conference criteria. Results: 187 cases were presented. 62% percent of cases included traditional medical problems, whereas 21% involved legal issues, and 17% focused on ethical dilemmas. For the cases with medical problems, 31% involved airway obstruction, 17% nerve injuries, and 17% malignancy. 49% of cases would have met criteria for presentation at traditional M&M conferences. Of all the "scary cases," 25% were near misses and 26% represented ethical or legal dilemmas which would not be classified as morbitidy, mortality, or near miss. Conclusions: The Scary Cases provides a forum conducive to learning amongst peers and experts. It allows medical and surgical specialties to share the cases deemed most impactful. The M&M conference would only include half of such cases, but could be expanded beyond the traditional scope in the future. [ABSTRACT FROM AUTHOR]

Background & aims: Work–family conflict, an important issue in nursing management, has been examined extensively worldwide among nurses. Nurses' inability to handle these conflicts affect their quality of care and may lead to missed nursing care. This study aimed to investigate the relationship between work-family conflict and missed nursing care in Iran. Materials & methods: This cross-sectional descriptive-analytical study was conducted on 270 nurses working in two hospitals affiliated to Tehran University of Medical Sciences (Sina & Shariati) from September to December 2023. The research community included all nurses working in medical-surgical wards in the designated hospitals. The research samples were included in the study in a targeted and quota sampling after obtaining organizational permits, ethical approval and informed consent. Data collection was done using three questionnaires including: Demographic information form, Carlson's work-family conflict and Kalisch MISSCARE Questionnaire. The collected data was analyzed in SPSS software, version 25. Results: The results of Pearson's correlation test showed that there is a positive relationship between nurses' work-family conflict and missed nursing care scores (r = 0.21) (p = 0.001). The mean (SD) score of nurses' work-family conflict was reported at a moderate level (61.58(11.57)) and the mean (SD) score of missed nursing care was reported at a low level (47.84(16.48)). Nurses under 29 years old and male nurses had more missed nursing care other than their participants. No more relationship was observed between other demographic variables with missed nursing care and nurses' work-family conflict. Conclusion: According to the results of this research, it can be concluded that the existence of work-family conflict can be an obstacle for the correct implementation of nursing care. In such a way that nurses exposed to higher work-family conflict level had higher missed nursing care. Based on the findings of this research, it is recommended for health care providers and nursing managers to identify nurses exposed to high work-family conflicts, adopt programs to decrease their conflicts and consequently reduce missed nursing care. [ABSTRACT FROM AUTHOR]

Introduction. Nursing education involves a robust blend of theory and hands‐on practice, crucial for cultivating the intricate abilities required to safely progress from being a student to becoming a proficient nursing professional. This training process was disrupted by the COVID‐19 pandemic when the imposition of lockdowns compelled the transition of classes from in‐person to online formats. Aim. This study aimed to assess the challenges in clinical training for nursing students during the COVID‐19 pandemic, specifically examining how reductions in hands‐on clinical practice have impacted their job satisfaction upon entering the workforce. Methods. It was an exploratory, descriptive, and cross‐sectional study, using the Font Roja Questionnaire on job satisfaction as an instrument for data collection. The population was made up of Spanish nurses who graduated in 2020, 2021, and 2022. Results. The sample consisted of 390 nurses, 81.5% female, averaging 24.35 years old, with 76% having missed at least one month of clinical practice during their training. We found significant levels of dissatisfaction with job pressure and professional competence (52.3% and 40.8%, respectively). Statistically significant differences were found between gender, job pressure, year of graduation, and professional competence. Conclusion. The loss of clinical practice periods, a vital element in nursing education, has influenced the early careers of these nurses, particularly affecting certain aspects of their job satisfaction such as job pressure and professional competence. [ABSTRACT FROM AUTHOR]

Background: Increased attention among healthcare workers, particularly nurses, is crucial for preventing medical errors and patient harm. This study uses an objective approach that overcomes the limitations of the subjective self-report measures employed in prior research on nurses' attention. Methods: This cross-sectional study was conducted from January to March 2023 among 108 nurses at Besat Hospital in Tehran, Iran. The data collected included demographic information, the NASA Task Load Index (NASA-TLX) for mental workload assessment, and the CogLab signal detection test for attention sensitivity measurement. Results: The participants exhibited a median mental workload of 68.5 (IQR = 14.9) and a median attention sensitivity of 52.5 (IQR = 39.2). Daily sleep duration was positively correlated with attention sensitivity (r = 0.644, p < 0.001), whereas mental workload was negatively correlated with attention sensitivity (r = -0.655, p < 0.001). Men demonstrated greater attention sensitivity (p = 0.040), and women reported greater mental workload (p = 0.043). Conclusion: Reducing daily sleep duration and increasing mental workload can diminish nurses' attention sensitivity. Prioritizing adequate sleep and implementing strategies to reduce mental workload are crucial for enhancing nurse performance and patient safety. Key points: • Insufficient sleep and excessive mental workload can significantly impair nurses' attention. • Female nurses may be particularly vulnerable to these factors. • Implementing strategies to optimize sleep schedules and reduce mental workload is crucial for enhancing overall nurse performance and patient safety. [ABSTRACT FROM AUTHOR]

Introduction: The frozen section intra-operative consultation is a pathology procedure that provides real-time evaluations of tissue samples during surgery, enabling quick and informed decisions. In the pre-analytical phase, errors related to sample collection, transport, and identification are common, and tools like failure mode, effects, and criticality analysis help identify and prevent risks. This study aims to enhance patient safety and diagnostic quality by analyzing risks and optimizing sample management. Materials and Methods: The failure mode, effects, and criticality analysis was conducted by a multidisciplinary team to analyze the workflow of frozen section sample handling from collection in the operating theater to acceptance at the pathology lab. Six steps were identified, each assigned tasks and responsibilities, with risks assessed through the risk priority number, calculated from severity, occurrence, and detectability. Severity was classified based on the WHO framework, ranging from "No Harm" to "Death", to prioritize risks effectively. Results: The study identified 12 failure modes across 11 sub-processes, prioritized by risk. Key failures included missing patient identification, incorrect sample retrieval, missing labels, misdirected samples, and samples sent to the wrong lab. Discussion: Pre-analytical errors in pathology pose risks to diagnosis and patient care, with most errors occurring in this phase. A multidisciplinary team identified key issues, such as sample mislabeling and delays due to staff unavailability, and implemented corrective actions, including improved signage, staff re-training, and sample tracking systems. Monitoring and regular checks ensured ongoing adherence to protocols and reduced the risks of misidentification, transport delays, and procedural errors. Conclusions: The frozen section intra-operative consultation is vital in surgical pathology, with the pre-analytical phase posing significant risks due to potential errors in sample handling and labeling. Failure mode, effects, and criticality analysis has proven effective in identifying and prioritizing these failures, despite resource demands, by allowing corrective actions that enhance patient safety and healthcare quality. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to investigate the effect of nurses' Machiavellian and deontic justice personality on the tendency to make medical errors. Additionally, conducted to investigate the other factors associated with nurses' tendency to make medical errors. Methods: This cross-sectional study consisted of 345 nurses working in a state university medical faculty health application and research hospital, and data were collected using the Medical Error Tendency in Nursing Scale, the Machiavellian Personality Scale, and the Deontic Justice Scale. Results: Machiavellian and deontic justice personality of nurses effect in low level their tendency to make medical errors (R = 0.284, p = 0.001). As the nurses' Machiavellian tendencies increased, their propensity toward making medical errors also increased. The increase in Nurses' deontic justice reduced their tendency toward medical errors (p < 0.05). A significant difference was found between nurses' mean tendency to medical errors scores and their age, working life/years, the number of night shifts, the daily number of patients provided with care, the status of working in the COVID-19 service, and the status of having received education on medical errors (p < 0.05). Conclusions: Nurses' Machiavellian tendencies and deontic justice approach affect their propensity to make medical errors. Nurses who have a Machiavellian tendency and poor deontic justice have a high tendency to make medical errors. Nurses' age, working life/years, the number of night shifts, the daily number of patients they provide care for, working in the COVID-19 service, and having received education on medical errors were the other factors affecting their tendency to make medical errors. This study demonstrated that nurses' personality traits can cause medical errors. Generations are changing in the world and personality are also changing. Therefore, including personal development in nursing education could be a positive approach for medical errors. [ABSTRACT FROM AUTHOR]

Medical errors can occur in many areas of healthcare, including hospitals, clinics, and surgery centers. They can result in negative consequences for patients and their loved ones. Over the years, different methods have been used to reduce medical errors. Zero Trust is an information security model that denies access to applications and data by default. Other industries have successfully used Zero Trust Model (ZTM), and it has been shown to improve outcomes. This editorial analyzes how the ZTM can be introduced to prevent medical errors in healthcare settings. ZTM application in healthcare could potentially revolutionize patient safety by tightly controlling and monitoring access to sensitive patient data and critical systems. By enhancing security measures, the ZTM could address the paramount concerns of patient data privacy and safety in healthcare. The zero-trust approach offers a potential solution by identifying consistent causes of errors and providing viable solutions to prevent their recurrence. In the era of worsening ransomware attacks on healthcare systems, the ZTM could also have enormous implications in other cybersecurity aspects. With this manuscript, the authors advocate for the broader application of ZTM across other facets of healthcare cybersecurity. [ABSTRACT FROM AUTHOR]

Background: Medication errors are among the most prevalent medical errors and result in significant morbidity and mortality. They pose a major threat to patient safety in psychiatric hospitals. However, the lack of a comprehensive investigation into the root causes of these errors restricts the development of effective corrective measures. Objective: This study aimed to characterize the types of errors, determine the stages of the medication use process, and identify factors associated with errors occurring among government psychiatric hospitals in Saudi Arabia. Methods: This cross-sectional study was conducted from August 2019 to June 2020. All medication error reports submitted to the Ministry of Health General Administration of Pharmaceutical Care database from 18 government psychiatric hospitals in Saudi Arabia were assessed. The database is de-identified and contains information on all medication errors, including patient demographics, medication information, error information, causes of errors, and reporter information. Medication use was categorized as ordering/prescribing, transcribing, dispensing, administration, and monitoring. The present findings represent a descriptive analysis of the data using Statistical Analysis Software (SAS) version 9.4. Result: A total of 23,355 medication error reports were reported to the database during the study period. Among Saudi Arabian cities, Riyadh (n = 8972, 38.4%) had the highest medication error reporting rate, followed by Taif (n = 3705, 15.9%) and Jeddah (n = 2621, 11.2%). Most reported errors were frequently made by physicians (n = 20,284, 86.9%) and were primarily detected by pharmacists (n = 20,974, 89.8%). Approximately half of them (n = 13,150, 56.3%) were classified as "Category B" that occurred, but they did not reach patients. Most medication errors were reported in adults (n = 22,589, 96.7%) and male patients (n = 16,393, 70.2%). Most error reports were detected at the prescription stage (n = 16,481; 70.6%) during the medication-use process. Work overload of the staff (n = 2911, 12.8%) and drug labeling, packaging, and nomenclature (n = 2826, 12.1%) were the most common contributing factors associated with the reported errors. Olanzapine (n = 1650, 7.1%), omeprazole (n = 1350, 5.8%), and quetiapine (n = 1273, 5.5%) were the most common medications associated with medication errors. Conclusions: Preventable medication errors are typical in psychiatric hospitals and may result in severe consequences. Increased efforts are needed to control and minimize prescribing errors and improve reporting in Saudi Arabia. [ABSTRACT FROM AUTHOR]

The article in Clinical & Translational Allergy discusses the reliability of the FricTest 4.0 tool for diagnosing symptomatic dermographism, a subtype of chronic inducible urticaria. The study conducted at the Urticaria Center of Reference and Excellence in Berlin, Germany, aimed to assess inter-rater and intra-rater agreement of the tool. Results showed substantial inter-rater agreement and high consistency in measurements, validating the FricTest as a reliable diagnostic and monitoring tool for symptomatic dermographism. The study acknowledges limitations and calls for further real-world evidence to confirm the tool's reproducibility and clinical validity. [Extracted from the article]

The article discusses the use of nursing safety event database in enhancing patient care. Topics mentioned include a description of the development of the database, the trends in nursing practice among travel nurses and the modification of onboarding processes for travel nurses, night shift nurses and medication errors.

Utilizing scientifically validated statistical approaches, our research underscores the significance of safety climate in the healthcare industry, emphasizing how interpersonal trust and locus of control impact organization safety. Findings inspire more informed, scientifically grounded preventative strategies and advocate for a psychologically safe error disclosure culture, prompting advancements in occupational interventions. Objectives: The current study aims to identify individual and joint drivers that significantly influence the safety climate in healthcare industries by using Bayesian network (BN) simulations for an in-depth analysis. Methods: Survey data were collected from 452 employees from two branches of one hospital in China for a study about workplace safety. The original English surveys were translated into Chinese using the back-translation procedure recommended by Brislin. Employees were asked to complete two online surveys with 1 month in between each administration. The sample was 42% doctors and 58% nurses. A BN model, based on theory, was updated and complemented with expert knowledge. A graphical model based on expert knowledge and data-driven machine learning approaches was used to refine the BN structure, representing interrelationships among all studied variables. The BN model was employed to identify the best key drivers and joint strategies for safety climate improvement. Results: The BN model demonstrated a good overall fit. The Euclidean distance metric was used to assess the influence between connected variables, with interpersonal trust and locus of control having the strongest independent effects on safety climate among the five contributing factors. Joint strategies, particularly joint optimization of error disclosure culture and interpersonal trust, as well as error disclosure culture and self-efficacy, were most effective in promoting a safe climate. Conclusions: The findings suggest that hospital safety climate can be improved by providing a psychologically safe error disclosure culture and enhancing interpersonal trust among employees and their self-efficacy. [ABSTRACT FROM AUTHOR]

In modern healthcare services, patient safety is a primary goal. With technological advancements, the complexity of healthcare services increases, which in turn creates increased pressure on health professionals during decision-making processes and can lead to errors worldwide. Communication gaps, human factors, patientoriginated issues, technical failures, and inadequate policies have been identified as the main causes of medical errors. While research shows that errors stem from human nature and are inevitable, it is emphasized that it is possible to develop methods that enhance patient safety. Utilizing digital technologies to improve the quality and efficiency of healthcare services is a crucial strategy. Innovations such as wearable technologies, mobile devices, digital media-delivered education and consulting services, telehealth applications, 3D printers, clinical decision support systems, and implantable biosensors encompass advancements in the digital health field. This research aims to analyze the complex and dynamic structure of healthcare services in the 21st century, especially considering the opportunities presented by the integration of artificial intelligence and genomic data, within the scope of the relevant literature. [ABSTRACT FROM AUTHOR]

Medical providers have an ethical duty to disclose clinically significant errors involving gametes and embryos. Although not mandatory, disclosure of errors causing no harm or near misses is recommended. In addition, clinics should have written policies in place for reducing and disclosing errors. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate a questionnaire to evaluate missed nursing care (MNC) in a home care setting. Design: A new instrument was developed and tested performing a preliminary analysis of a multicenter cross‐sectional study in Italy. Reporting was performed according to COnsensus‐based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines. Sample: Eight hundred out of a total of 2549 home care nurses enrolled in AIDOMUS‐IT were considered for the validation of the Missed Nursing Care in Home Care (MNC_HC). Measurements: The MNC_HC instrument was developed by a panel of experts and underwent content and face validation. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted. Results: EFA revealed a one‐factor solution, explaining 56% of the total variance for MNC_HC. CFA confirmed excellent structural validity, with a one‐factor model showing an exceptional fit (χ2 (27) = 141.39, p <.001, RMSEA = 0.04, SRMR = 0.04, CFI = 0.99, TLI = 0.99, factor loadings > 0.5). MNC_HC also demonstrated high reliability (Cronbach's α = 0.92). The activity with the highest rate of missed care was the documentation of nursing care (77%), while activities related to nursing techniques (e.g., injections, dressings, etc.) were reported to be missed less (33.63%). Conclusions: MNC_HC is a quick‐filling, valid, reliable, and psychometrically sound instrument for measuring MNC in home care useful for future research. [ABSTRACT FROM AUTHOR]

Insertion of a nasogastric tube (NGT) is generally considered safe; however, it is not without risk, and in cases of misplacement, complications and even death may occur. In this article, we reported a case of NGT misplacement in a 75‐year‐old male, which resulted in aspiration pneumonia. We also reviewed published cases of NGT misplacement. Clinicians should pay enough attention to the confirmation of the proper placement of an NGT. A systematic approach for NGT insertion and confirmation is required to prevent misplacement. [ABSTRACT FROM AUTHOR]

Background: Vital signs assessment is critical for patient surveillance and safety. Research has found, however, that this assessment is often neglected in clinical practice. The reasons for this are unclear as few studies have explored this issue. Those studies that have are small, single site studies and found that culture and poor understanding are contributing factors. Aim: The aim was to explore the link between the clinical neglect of vital signs assessment and patient mortality and provide a better understanding of factors influencing vital signs assessment in the context of acute patient care. Coroners' reports represent an untapped source of information regarding shortfalls in vital signs assessment. Using a framework analysis, an audit was conducted of the Australian National Coronial Information System for cases where vital signs' assessment was mentioned in coronial reports. Results: Fifty‐eight cases met the eligibility criteria, with deceased patients aged from 7 days to 93 years. Key themes related to absence of reassessment of vital signs, inappropriate delegation, passing responsibility to another staff member and not following policy. Conclusions: The findings reflect a combination of individual and institutional failings and suggest that vital signs assessment was not considered a priority aspect of care. Relevance to Clinical Practice: Vital signs assessment must be considered an essential aspect of clinical care in all patients. This important aspect of care should be emphasized across all domains of patient care. [ABSTRACT FROM AUTHOR]

Patients with congenital heart disease are living longer due to improved medical and surgical care. Congenital heart disease encompasses a wide spectrum of defects with varying pathophysiology and unique anesthetic challenges. These patients often present for noncardiac surgery before or after surgical repair and are at increased risk for perioperative morbidity and mortality. Although there is no singular safe anesthetic technique, identifying potential error traps and tailoring perioperative management may help reduce morbidity and mortality. In this article, we discuss five error traps based on the collective experience of the authors. These error traps can occur when providing perioperative care to patients with congenital heart disease for noncardiac surgery and we present potential solutions to help avoid adverse outcomes. [ABSTRACT FROM AUTHOR]

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The field of healthcare quality and safety has been informed by the study of Human Factors contributing to adverse events. Hitherto, much of the study of Human Factors has been focused on a narrow lens of human error, identifying cognitive‐based or knowledge‐based errors and cognitive processes such as loss of situational awareness contributing to error. While these factors are important, this narrow approach fails to consider the complexity of relational and systemic factors that also contribute to adverse events. We aimed to explore the relational and systemic human factors, including shared clinician attitudes and behavior, that contribute to serious adverse patient events in a public health setting. The study, set in a metropolitan local health district in New South Wales, Australia, was conducted using a retrospective qualitative multi‐incident content analysis design. Serious adverse event reviews (SAER) over 6 months (2022–2023) were subject to qualitative content analysis until data saturation was reached. Data saturation reached at 20 reports. Emergent themes related to human factors in serious adverse events included: (i) delays and inertia—with a subtheme of inertia of ageism; (ii) "All‐or‐nothing" approach to end‐of‐life care and planning; (iii) communication lapses; and (iv) implementation gap between standards and practice. Error‐based incidents accounted for only 35% of the serious adverse events examined. The sample studied involved mostly (65%) male patients, with a mean age of 69 (70% aged >65), managed across the gamut of specialties, with the most common incident being the management of acutely deteriorating patients. In conclusion, there is more to Human Factors in adverse events than cognitive or knowledge‐based error. While identifying and correcting errors is absolutely essential, we need adjunctive "soft measures" to address clinical attitudes, behaviors, and relationships in health care, particularly in increasingly complex, fraught, and stressful health care environments. [ABSTRACT FROM AUTHOR]

This study aimed to determine the relationship between nurses' personality profiles, perception of conscience, and their tendency to medical error. This cross-sectional study was conducted with 241 nurses between 05.03.2023 and 10.04.2023 in two private hospitals in Türkiye. There was a negative correlation between neuroticism and tendency to medical error (r = −0.348; p < 0.05) and a positive correlation between agreeableness, extroversion, conscientiousness, and openness and tendency to medical error (r = 0.157; r = 0.248; r = 0.276; r = 0.241; p < 0.05, respectively). A positive correlation (r = 0.172; p < 0.05) was revealed between the authority subscale of the Perception of Conscience Questionnaire and hospital infection subdimension. According to the regression analysis conducted to determine the predictive levels of conscience and personality traits, it was found that conscientiousness, neuroticism, and authority explained 17.4% of the tendency to medical error. Accordingly, it was revealed that the neuroticism personality trait (β = −0.260, p < 0.05) increased the tendency to medical error, whereas the conscientiousness personality trait (β = 0.165, p < 0.05) and the authority subscale (β = 0.164, p < 0.05) decreased the tendency to medical error. In this regard, managers should determine the work and responsibility areas of nurses by making personality and perception of conscience evaluations to reduce the tendency to medical error. [ABSTRACT FROM AUTHOR]

Background: Patient safety is a critical concern in dentistry. Adverse events (AEs) can harm patients, increase costs, and decrease satisfaction. Understanding AE types and frequencies is crucial for effective risk management and quality improvement. This study analyzes incident reports to identify preliminary incident patterns as a starting point for developing risk management strategies. However, under-reporting limits the ability to identify true incident patterns, highlighting the need for improved reporting systems and encouragement of incident reporting. Further research is underway to develop such a system and promote reporting to ensure sufficient data quality for effective risk management. Methods: A retrospective analysis of 1,618 incident reports from December 2018 to August 2023 was conducted. A validated classification system, developed from a 5-year retrospective analysis and approved by 14 experts, categorized patient safety incidents, aligning with Thailand's Hospital Accreditation standards. Descriptive statistics summarized AE frequency and distribution. Results: Of the reports, 752 were patient safety, 503 personnel safety, and 363 organizational safety incidents. Top patient safety incidents included medical record errors (176), accidental damage (66), post-operative complications (65), medical emergencies (64), and communication errors (53). Personnel safety incidents involved inappropriate working conditions (135) and work-related injuries with contact transmission risk (117). Organizational safety incidents mainly concerned policy and operational processes (131). Conclusions: This study reveals the preliminary patterns of adverse events (AEs) in dental settings and underscores the limitations due to under-reporting, which affect the ability to fully understand true incident patterns. To effectively manage risks, there is a critical need for improving the existing incident reporting system and encouraging a culture of comprehensive reporting among dental professionals. Future efforts should focus on enhancing reporting systems to ensure high-quality data, enabling better identification of incident trends and supporting targeted risk management strategies to improve patient safety in dentistry. [ABSTRACT FROM AUTHOR]

Background: It is noteworthy that there is an increase in medical lawsuits filed against nurses in Turkey and in the rest of the world. The purpose of this article is to examine nurses' criminal liability and senior nursing students' awareness of these responsibilities. Methods: All senior students (n = 309) of the Faculty of Nursing who were studying in the 2020–2021 academic year of the university constituted the population of the research. The study was completed with 300 students who were studying between the dates of the research and who agreed to participate in the research. Data was collected online via Google Forms. The data obtained from the research was analyzed with the program SPSS 20. Numbers and percentages, averages, and chi-square tests were used to evaluate the data. Results: This article provides an overview of nurses' criminal liability and senior nursing students' awareness of these responsibilities. The article offers striking implications regarding the awareness of trainee nurses who have not yet started their careers regarding the criminal liability of nurses. Conclusion: The result of our research clearly revealed that the majority of senior nursing students have insufficient knowledge about professional criminal responsibilities, that they are not aware of their duties, powers, and criminal responsibilities as defined in legislation, and that they do not know the types of criminal responsibilities. [ABSTRACT FROM AUTHOR]

Objectives: The main objective of the study was to explore the perspectives of healthcare professionals (HCPs) regarding artificial intelligence (AI) and to identify challenges in its incorporation in the healthcare sector of Pakistan. Methods: A qualitative exploratory study design was adopted. The study was conducted from January 15th to February 29th, 2024, and HCPs (doctors, pharmacists and nurses) from two tertiary care teaching hospitals in southern Punjab, Pakistan were taken as the study population. The interviews were conducted with the help of a semi structured interview schema. A thematic approach was adopted to analyse the data. Results: Out of 40 HCPs approached, 25 participated in the study with a response rate of 62%. The participants included in the study were doctors (14), pharmacists (6) and nurses (5). The participants had limited knowledge regarding AI and its basics. However, they showed positive perceptions about its incorporation. They believed that many of the problems faced by the healthcare sector of Pakistan can be minimized by AI incorporation. They believed that AI can boost up the efficiency of healthcare providers, reduce their workload, save time and minimize medical errors. Four main themes with multiple subthemes were identified: (1) Cognizance of AI, (2) Acceptability of AI among HCPs and training requirements for effective incorporation, (3) Merits and Demerits of AI, and (4) Challenges in incorporation of AI with proposed solutions. Conclusion: HCPs showed a willingness to embrace AI incorporation and believed that it may bring numerous benefits to the health system. Policymakers should take necessary steps to ensure AI incorporation in our healthcare sector. [ABSTRACT FROM AUTHOR]

Background: Working long consecutive hours' is common for anaesthesia and critical care physicians. It is associated with impaired medical reasoning's performance of anaesthesiology and serious medical errors. However, no study has yet investigated the impact of working long consecutive hours' on medical reasoning. Objective: The present study evaluated the impact of working long consecutive hours' on the medical reasoning's performance of anaesthesiology and intensive care physicians (residents and seniors). Methods: This multicentric, prospective, cross-over study was conducted in 5 public hospitals of Normandy region. Two groups of anaesthesia and critical care physicians were formed. One was in a rest group, RG (after a 48-hours weekend without hospital work) and the other in Sleep Deprivation Group (SDG) after a 24 h-consecutives-shift. Changes in medical reasoning's performance were measured by 69-items script concordance tests (SCT) through to the two tests. Group A completed the first part of the assessment (Set A) after a weekend without work and the second part (Set B) after a 24 h-shift; group B did the same in reverse order. The primary outcome was medical reasoning's performance as measured by SCT in RG and SDG. The secondary outcomes included association between the performance with the demographic data, variation of the KSS (Karolinska sleepiness scale) daytime alertness score, the number of 24 h-shift during the previous 30 days, the vacations during the previous 30 days, the presence of more or less than 4 h consecutives hours slept, the management of a stressful event during the shift, the different resident years, the place where the shift took place (University hospital or general hospitals) and the type of shift (anaesthesia or intensive care). Results: 84 physicians (26 physicians and 58 residents) were included. RG exhibited significantly higher performance scores than SDG (68 ± 8 vs. 65 ± 9, respectively; p = 0.008). We found a negative correlation between the number of 24 h-shifts performed during the previous month and the variation of medical reasoning's performance and no significant variation between professionals who slept 4 h or less and those who slept more than 4 h consecutively during the shift (-4 ± 11 vs. -2 ± 11; p = 0.42). Conclusion: Our study suggests that medical reasoning' performance of anaesthesiologists, measured by the SCT, is reduced after 24 h-shift than after rest period. Working long consecutive hours' and many shifts should be avoided to prevent the occurrence of medical errors. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this scoping review was to summarize the literature pertaining to burnout and chiropractic. Methods: A literature review was performed in accordance with Preferred Reporting of Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). A literature review was performed by combining the term "chiropractic" with terms relevant to professional burnout (e.g., "work-related stress," "emotional exhaustion"). We included all publications addressing burnout within the chiropractic profession, including all study designs in only peer-reviewed literature. Results: Our search yielded 126 citations and 10 met the inclusion criteria. The studies identified consisted of eight surveys and two narrative reviews published from 2011 to 2024. Six of the studies utilized the Maslach Burnout Inventory to assess burnout. Chiropractic students reported greater burnout than the general population. Factors reported to increase burnout risk include higher workload, insurance mandates, and physical demands of daily practice. Factors reported to be protective against burnout included longer duration in clinical practice and philosophy-based practices. Conclusions: Research on burnout within the chiropractic profession is limited and may not be generalizable. However, the reported factors contributing to burnout are well-documented. Future research should be conducted to improve understanding of the prevalence and causes of burnout in chiropractic. [ABSTRACT FROM AUTHOR]

The article discusses the potential for new legislation in the UK, known as the "Hillsborough Law," which aims to strengthen the concept of candour in public life, particularly in health and social care. Topics include the current statutory duty of candour in the NHS, the need for a broader and more effective duty of candour, and the impact of public inquiries, such as the Hillsborough and Infected Blood inquiries, in driving legislative change.

Introduction: Neonates are very sensitive and vulnerable individuals. They require multiple medications during their stay in the Neonatal Intensive Care Unit (NICU), which can lead to pharmacological errors and Drug-related Problems (DRPs), like drug-drug interactions and adverse drug effects. Aim: To assess DRPs in the NICU to improve the quality of pharmaceutical care. Materials and Methods: This prospective observational study was conducted from June 2023 to August 2023 in a tertiary-level, well-equipped NICU at JNU Hospital, Jaipur, Rajasthan, India. All 61 neonates admitted to the NICU were included, except for those who were admitted for less than 24 hours and had not been prescribed any medications. All DRPs were documented using the Pharmaceutical Care Network Europe (PCNE V9.1). The problems related to DRPs, their causes, planned interventions, acceptance of interventions, and outcomes were assessed. The final analysis was conducted with the Statistical Package for Social Sciences (SPSS) software version 25.0. A p-value <0.05 was considered statistically significant. Results: A total of 61 newborns were enrolled, of which 34 (55.74%) were males. DRPs were present in 47 (77.05%) of the total 61 patients. The total number of DRPs identified was 98. The most common problems were 'unnecessary drug treatment' 63 (64.29%) cases and 'effect of drug treatment not optimal' 28 (28.57%) cases. The most common cause of DRPs was 'dose selection' 105 (62.87%) cases. The intervention was accepted in 96 (97.96%) of the DRPs, and the problem was totally resolved in 70.41% of the cases. However, the problem remained unsolved in 17.35% of DRPs, primarily due to the 'lack of cooperation from the prescriber' in 9.18% of cases. Conclusion: Unnecessary and ineffective treatments, along with inappropriate doses, are the major problems and causes of DRPs. The need for clinical pharmacologists in NICUs, along with planned interventions and their acceptance, could help address these issues and ultimately lead to improved quality of care. [ABSTRACT FROM AUTHOR]

In this commentary, we propose the use of video‐reflexive ethnography (VRE) as a means to support integration of patient‐reported outcomes (PROs) in cancer care screening. As for any policy or intervention, the optimization of PROs depends on moving beyond their mere formal introduction, and depends on the integration of PROs in the everyday practice contexts of health care professionals (HPEs). The use of VRE allows for video‐playback sessions among oncology professionals to support team‐based learning and practice‐change grounded in "reflexivity." Through a review of previous methods used to support organizational change in healthcare settings (e.g., policies, quality improvement initiatives, simulation sessions), we present some unsung advantages of VRE that can be applied to a complex integrated setting, such as cancer care. As opposed to other methods to create change, VRE does not dictate new measures, but rather supports "bottom‐up" provider‐initiated changes to health care practices and contexts, grounded in collaborative day‐to‐day practice. We argue that VRE optimizes PROs in cancer care by facilitating their effective and sustainable integration, to promote improved patient care. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study measured patient reactions to medical metaphors used in musculoskeletal specialty offices and asked: (1) Are there any factors associated with patient thoughts and emotions in response to common metaphors? (2) Is there a difference between patient ratings of metaphors rated as potentially reinforcing misconceptions and those that are more neutral? Methods: In a cross-sectional study, 228 patients presenting to multiple musculoskeletal specialty offices rated reactions to 4 metaphors presented randomly from a set of 14. Two were categorized as potentially reinforcing common misconceptions and 2 as relatively neutral. Bivariate tests and multivariable regression identified factors associated with patient ratings of levels of emotion (using the standard assessment manikins) and aspects of experience (communication effectiveness, trust, and feeling comfortable rated on 11-point ordinal scales) in response to each metaphor. Results: Levels of patient unhelpful thinking or distress regarding symptoms were not associated with patient ratings of patient emotion and experience in response to metaphors. Metaphors that reinforce misconceptions were associated with higher ratings of communication effectiveness, trust, and comfort (P < .05). Conclusion: The observation that metaphors that validate a person's understanding of his or her illness may elicit trust even if those metaphors have the potential to reinforce misconceptions may account for the common usage of such metaphors. Clinicians can work to incorporate methods for building trust without reinforcing misconceptions. [ABSTRACT FROM AUTHOR]

Background: Current cancer screening guidelines for transgender individuals are guided primarily by expert opinion, and are extrapolated from guidelines for cisgender populations, despite the additional unique risks that transgender populations face in cancer risk and cancer care. Aims: We examined adherence to current recommended screening guidelines as well as drivers of cancer screening in 192 transgender and gender-nonbinary (TGNB) individuals participating in Project AFFIRM, a multi-site longitudinal cohort study of TGNB individuals. Methods: We used a chi-squared analysis to look for significant associations between predictors and adherence to breast, cervical, prostate and colon cancer screening. We analyzed predictors by 3 different categories: sex/gender identity, healthcare access, and socioeconomic status. Results: Screening rates were low for breast, cervical, prostate and colon cancer in TGNB populations compared to national rates for cisgender populations. Among several significant predictors, gender-affirming surgery (hysterectomy) (p-value = <0.0001) and telling others they are transgender at a younger age (< 18) (p-value = 0.0344) were associated with increased screening adherence, while having HIV was associated with decreased screening adherence (p-value = 0.0045). Discussion: Our results suggest that interacting with the healthcare system to obtain comprehensive cancer screening can be difficult to navigate among the other healthcare needs of TGNB individuals both on an individual and systems level. Future efforts to mitigate the barriers to screening adherence should be targeted at the healthcare system level. [ABSTRACT FROM AUTHOR]

The article "Causality of Medical Errors" deals with the legal aspects of medical errors in the healthcare sector. It is pointed out that the patient's side in the medical liability process must carefully examine the content of the informed consent discussion. The causality of a medical error for the patient's health damage is also discussed. The article deals with a specific case of a motorcyclist who was seriously injured in a traffic accident and is demanding reimbursement of treatment costs from the statutory health insurance. It also addresses the substantiation of recovery claims by a health insurance company. [Extracted from the article]

Since the publication of the Institute of Medicine's landmark report on medical errors in 2000, a large number of safety programs have been implemented in American hospitals. Concurrently, there has been a dramatic increase in the rate of burnout among physicians. Although there are many unrelated causes of burnout (eg, loss of autonomy), and multiple safety programs that are applauded by physicians (eg, The Safe Motherhood Initiative), other programs created in the name of safety improvements may be contributing to physician distress. In this piece, we review several of those programs, describe their limitations and costs to physician wellbeing, and discuss the manner in which they might be modified to retain their benefits while mitigating the burdens they place on physicians. [ABSTRACT FROM AUTHOR]

Background: Accumulating evidence suggests that synovial inflammation plays a pivotal role in knee osteoarthritis. Although biomechanical findings have shown that medial open-wedge proximal tibial osteotomy (OWPTO) decreases medial compartment loading by correcting knee alignment, the relationship between knee alignment and synovial inflammation in the biological microenvironment has not yet been elucidated. Purposes: To investigate the relationship between preoperative and postoperative knee alignment and synovial gene expression and to determine the cutoff point of postoperative knee alignment at which gene expression of synovial inflammation improves. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 36 patients with osteoarthritis who underwent OWPTO between June 2018 and May 2020 were enrolled. Synovial tissue was collected from affected knees during initial OWPTO and plate removal surgeries, and gene expression associated with the pathogenesis of osteoarthritis in the synovial tissue was investigated using real-time polymerase chain reaction. The correlation between weightbearing line ratio (WBLR) and synovial gene expression was determined. Receiver operating characteristic curve analysis was used to determine the cutoff values of WBLR for improving gene expression. The participants were divided into 2 groups, according to the cutoff values of their WBLR, and compared according to Knee injury and Osteoarthritis Outcome Score (KOOS) and synovial gene expression. Results: Postoperative WBLR was correlated with gene expression of interleukin 1β (IL1B) (ρ = −0.43; P =.008) and of interleukin 6 (IL6) (ρ = −0.41; P =.01). The cutoff value to predict improvement of IL6 was postoperative WBLR of 52%, with an area under the curve of 0.74 (P =.03). Patients with WBLR of <52% showed higher postoperative inflammatory gene (IL1B [ P =.04] and IL6 [ P =.03]) and inferior postoperative KOOS values compared with those with WBLR of >52%. Conclusion: The novel cutoff alignment for biological improvement after OWPTO in patients with medial compartment osteoarthritis was determined to be WBLR of 52%, and WBLR of <52% was associated with higher residual intra-articular inflammation and poor clinical outcomes. After accounting for surgical errors, the surgeon should set the target surgical alignment so that the postoperative WBLR does not fall below 52%. [ABSTRACT FROM AUTHOR]

Background: Simulation and video-based assessment (VBA) offer residents the opportunity to develop operative skills while ensuring patient safety. This study aims to determine whether simulation training can predict residents' operative performance, focusing on the gastrojejunal (GJ) anastomosis during robotic pancreatoduodenectomy. Methods: Twenty-seven general surgery residents completed simulated robotic GJ drills and subsequently performed GJs in the operating room (OR). Both simulated and intraoperative performances were video recorded and retrospectively assessed by two blinded graders using the Objective Structural Assessment of Technical Skills (OSATS) scale, time to completion, and occurrence of errors. Intraoperative GJ OSATS scores were compared in cases with and without Clinically Relevant Delayed Gastric Emptying (CRDGE). Statistical analysis was performed using Spearman's rho, Chi-square, and Kruskal–Wallis tests. Results: For simulated GJs, the median OSATS score was 29 (IQR 27–33), time to completion was 30 min (IQR 27–35), and 11 cases had at least one error. Intraoperative GJs had a median OSATS of 30 (IQR 27–31), time to completion of 41 min (IQR 36–51), and errors occurred in nine cases. The OSATS score on the simulated GJs demonstrated a significant positive correlation to the OSATS score on the operative GJs (r = 0.74; p < 0.001) and less time to completion (r = − 0.68; p < 0.001). A shorter simulated GJ completion time significantly correlated with a higher intraoperative OSATS score (r = − 0.52; p < 0.01). Residents with at least one error in the simulated GJs had lower OSATS scores and higher times intraoperatively. Those cases with CRDGE had significantly lower intraoperative OSATS scores than those without CRDGE. Conclusion: Performance on a simulated robotic GJ environment is a robust predictor of OR GJ performance, demonstrating predictive validity. VBA of residents' operative GJ performance is associated with the presentation of CRDGE. Simulation-based training may be crucial to optimizing surgical outcomes before operating on patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Examine family safety-reporting after implementing a parent--nurse--physician--leader coproduced, health literacy-informed, family safety-reporting intervention for hospitalized families of children with medical complexity. METHODS: We implemented an English and Spanish mobile family-safety-reporting tool, staff and family education, and process for sharing comments with unit leaders on a dedicated inpatient complex care service at a pediatric hospital. Families shared safety concerns via predischarge surveys (baseline and intervention) and mobile tool (intervention). Three physicians with patient safety expertise classified events. We compared safety-reporting baseline (via survey) versus intervention (via survey and/or mobile tool) with generalized estimating equations and sub-analyzed data by COVID-19-era and educational attainment. We also compared mobile tool-detected event rates with hospital voluntary incident reporting. RESULTS: 232 baseline and 208 intervention parents participated (78.2% consented); 29.5% of baseline families versus 38.2% of intervention families reported safety concerns (P = .09). Adjusted odds ratio (95% CI) of families reporting safety concerns intervention versus baseline was 1.6 (1.0-2.6) overall, 2.6 (1.3-5.4) for those with< college education, and 3.1 (1.3-7.3) in the COVID-19--era subgroup. Safety concerns reported via mobile tool (34.6% of enrolled parents) included 42 medical errors, 43 nonsafety-related quality issues, 11 hazards, and 4 other. 15%ofmobile tool concernswere also detectedwith voluntary incident reporting. CONCLUSIONS: Family safety-reporting was unchanged overall after implementing a mobile reporting tool, though reporting increased among families with lower educational attainment and during the COVID-19 pandemic. The tool identified many events not otherwise captured by staff-only voluntary incident reporting. Hospitals should proactively engage families in reporting to improve safety, quality, and equity. [ABSTRACT FROM AUTHOR]

Background: While clinicians routinely observe issues with safety and quality, they may not always speak up and intervene. Peer feedback supports nurses to speak up about errors or near misses and actively improve nursing care quality. Effective peer feedback requires addressing barriers to speaking up. Purpose: The purpose of this mixed methods study was to evaluate a 'brain-friendly' peer feedback program's effect on clinical nurses' perceptions of peer review. Methods: Nurses were surveyed before and after the implementation of a peer feedback program that integrated social cognitive neuroscience principles. Open comments were analyzed using thematic analysis. Results: Responses to nearly half of survey questions improved. Thematic analysis identified institutional and personal barriers to peer feedback use, revealing the personal and social complexity of speaking up. Conclusions: Social cognitive neuroscience may enhance peer feedback programs. Research using immersive qualitative methods is needed to better understand factors supporting or impeding peer feedback. [ABSTRACT FROM AUTHOR]

This study aimed to measure the attitudes of radiotherapy staff members in Saudi Arabia regarding reporting errors and near misses in radiation therapy practice. It also examined the participants' reporting patterns and behaviors and explored the potential barriers to reporting errors and near misses as perceived by the participants. Methods: A cross-sectional study utilizing an online questionnaire was implemented. A sample of 70 health professionals working in radiation oncology departments in Saudi Arabia, including radiation oncologists, medical physicists, and radiotherapists, were recruited to participate in this study from January to June 2023. The data was analyzed using chi-squared testing to compare different groups, and the Kruskal–Wallis was used to find any statistically significant differences between different groups. Results: The study included 70 radiotherapy staff members. Professional roles did not significantly impact participants' decisions to report minor or major errors, with most consistently reporting errors to their supervisors regardless of role. The study revealed that fear of professional sanctions and the potential negative impact on a department's reputation are significant barriers to reporting errors or near misses. However, Only 17% of radiation oncologists did consider departmental sanctions as a barrier. Participants identified communication failure as the most significant source of errors in radiation oncology departments. The study also found a high level of agreement among the participants regarding the responsibility of reporting errors and near misses. Conclusion: The study investigated reporting errors and near misses in radiotherapy and considered the factors influencing them. The findings highlight the importance of effective communication and the implementation of an electronic reporting system. [ABSTRACT FROM AUTHOR]