Patient Safety in Surgery最新文献

{"title":"The Challenges of Transition to Practice Expressed Through the Lived Experience of New-to-Practice Nurses","authors":"Rebecca D. Toothaker, Marijo Rommelfaenger, R. Flexner, Lora K. Hromadik","doi":"10.33940/culture/2022.12.1","DOIUrl":"https://doi.org/10.33940/culture/2022.12.1","url":null,"abstract":"Background: The nurse’s transition into practice is challenging. The need to facilitate a safe transition into practice and retain nurses is crucial in today’s healthcare.\u0000\u0000Objective and Design: The qualitative study aim was to describe the lived experiences of new nurses’ safe transition into practice and their perceptions of functioning as safe practitioners.\u0000\u0000Method: This descriptive, phenomenological arm of a larger, mixed methods study (Safety Transition Education to Practice study) interviewed 11 nurses with varied clinical backgrounds regarding their first six months as licensed nurses. Semistructured, one-to-one interviews with nurses representing geographical locations across the nation were conducted. Colaizzi’s method of analysis was used to extract themes.\u0000\u0000Results: The data revealed five themes with subthemes. The most universal theme was lack of practical knowledge (skills dexterity, real-world knowledge), followed by impostor syndrome, safety culture (unsafe environment, lack of supplies, lack of mentoring/management), internalized fear, and seeking the sage.\u0000\u0000Conclusion: The experiences support the understanding that transition to practice is overwhelming and uncertain. Academic faculty and practice nurses’ cooperative efforts can aid novice nurses in safe transition to practice through academic curriculum enhancement, preceptors, and nurse residency programs working toward narrowing the academic practice gap.","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90108020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Onward and Upward: The Future of Nursing Education","authors":"Eileen Fruchtl, Caitlyn Allen","doi":"10.33940/interview/2022.12.5","DOIUrl":"https://doi.org/10.33940/interview/2022.12.5","url":null,"abstract":"As nurses around the globe battled COVID, one inconvenient truth became glaring: There were not enough nurses to provide care. And those shortages will only get worse. Now that we have emerged from the pandemic, nurse educators have become more important than ever. What does future curricula look like? How can technology augment training and staffing? How can we ensure the next generation of nurses is dynamic enough for whatever might come their way? Patient Safety managing editor, Caitlyn Allen, sat down with Cedar Crest College senior instructor Eileen Fruchtl to learn more.","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83819635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Perioperative Intervention to Prevent and Treat Emergence Delirium at a Veterans Affairs Medical Center","authors":"Matthew Taylor, William Pileggi, M. Boland, M. Boudreaux-Kelly, David Julian, Amanda Beckstead","doi":"10.33940/med/2022.12.3","DOIUrl":"https://doi.org/10.33940/med/2022.12.3","url":null,"abstract":"Emergence delirium (ED) is a temporary condition associated with a patient awakening from an anesthetic and/or adjunct agent (e.g., sedatives and analgesics). During the condition, patients risk harming themselves or staff by engaging in dangerous behavior, which may include thrashing, kicking, punching, and attempting to exit the bed/table.\u0000\u0000A multidisciplinary team at Veterans Affairs Pittsburgh Healthcare System (VAPHS) developed and implemented a multicomponent intervention to reduce the severity and occurrence of ED. The intervention consists of a training component and 21 clinical components. The 21 clinical components are implemented on a patient-by-patient basis and include routine screening for risk factors, enhanced communication among staff, adjusting the environment, following a specific medication strategy, and application of manual restraint (hands-on). The authors provide 15 online Supplemental Materials (S1–S15) to promote replication of the intervention.\u0000\u0000To our knowledge, this is the first manuscript that describes this type of multicomponent intervention in sufficient detail to allow others to replicate it. Following implementation of the intervention at VAPHS, perioperative staff reported that they observed a substantial reduction in the occurrence and severity of ED, ED-related patient and staff injuries, and ED-related loss of intravenous access and airway patency. Despite staff’s reported success of the intervention, rigorous research is needed to evaluate the efficacy of the intervention.","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83014543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower Extremity Staged Revascularization (LESR) as a new innovative concept for lower extremity salvage in acute popliteal artery injuries: a hypothesis.","authors":"Joseph Edwards,&nbsp;Rebecca N Treffalls,&nbsp;Hossam Abdou,&nbsp;David P Stonko,&nbsp;Patrick F Walker,&nbsp;Jonathan J Morrison","doi":"10.1186/s13037-022-00349-2","DOIUrl":"https://doi.org/10.1186/s13037-022-00349-2","url":null,"abstract":"<p><p>Popliteal artery injury following knee dislocation is associated with significant morbidity and high amputation rates. The complex and multi-disciplinary input required to manage this injury effectively can take time to arrange, prolonging the time to revascularization. Furthermore, open surgical bypass or interposition graft can be technically challenging in the acute setting, further prolonging ischemic time.Temporary intravascular shunts can be used to temporarily restore flow but require surgical exposure which takes time. Endovascular techniques can decrease the time to revascularization; however, endovascular popliteal stent-grafting is controversial because the biomechanical forces relating to flexion and extension of the knee may increase the risk of stent thrombosis. An ideal operation would result in rapid revascularization, eventually leading to a definitive and durable surgical solution.We hypothesize that a staged approach combing extracorporeal shunting, temporary endovascular covered stent placement, external fixation of bony injury, and definitive open repair provides for a superior approach to popliteal artery injury than current standard of care. We term this approach lower extremity staged revascularization (LESR) and the aim is to minimize the known factors contributing to poor outcomes after traumatic popliteal artery injury.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9756456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10382049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid-free anesthesia: the next frontier in surgical patient safety.","authors":"Jason McLott,&nbsp;Philip F Stahel","doi":"10.1186/s13037-022-00346-5","DOIUrl":"https://doi.org/10.1186/s13037-022-00346-5","url":null,"abstract":"","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9719141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9486354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous bone adhesive application for Jones fracture \"at-risk\" of nonunion or delayed union: a hypothesis.","authors":"Niaz Ahankoob,&nbsp;Vincent P Stahel","doi":"10.1186/s13037-022-00348-3","DOIUrl":"https://doi.org/10.1186/s13037-022-00348-3","url":null,"abstract":"<p><strong>Background: </strong>Bone adhesives have been on the forefront of orthopedic surgery research for decades due to the potential benefit they may have in fracture management. Current publications and research being conducted on bone adhesive could be applied to our current hypothesis for the benefit of a novel minimally invasive treatment option for a select cohort of fractures, Jones fractures. The select fracture's gold standard of treatment would be nonoperative, but with risk of complications including nonunion and delayed union.</p><p><strong>Presentation of hypothesis: </strong>We hypothesize that percutaneous application of bone adhesive will provide an additional treatment option for fracture patterns that do not require operative fixation, but would benefit from additional stability. The primary outcome measures would be (1) duration of time required for bony consolidation (defined as 3 of 4 bridging cortices) and (2) duration of absenteeism (inability to work), and pain levels within the first week after the procedure. Secondary outcome measures would be the incidence of nonunion or delayed union. We hypothesize that the select bone adhesive would accelerate bony consolidation, decrease absenteeism, decrease pain levels within the first week after procedure, and decrease the incidence of delayed union and/or nonunion.</p><p><strong>Testing of hypothesis: </strong>We propose a prospective multicenter, randomized, and open label trial clinical trial to test the bone adhesive via percutaneous injection into acute non-displaced or minimally displaced Jones fractures.</p><p><strong>Implications of hypothesis: </strong>Bone adhesives are a new frontier in treatment of fractures, currently in laboratory and animal testing phases. The appropriate bone adhesive formula has not been approved for clinical trial use, but the implications of the bone adhesive may go beyond decreased complications and ease of stabilizing a select cohort of closed fractures. With the injectable compound illustrated (Fig. 1), the adhesive could be applied percutaneously in hopes of achieving improved outcomes compared to non-operative treatment. The overall goal of the clinical trial is to provide patients a safe treatment option for improved bone union rates of nonoperative fractures compared to the current gold standard management of the same fracture with earlier pain control, early bony consolidation and lower risk of delayed union/nonunion. The ideal patient population for use of a percutaneous bone adhesive in future studies would be for those with multiple medical comorbidities for whom surgical risks outweigh the benefits, in addition to patients at high risk for nonunion based on fracture pattern or systemic biology.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9719172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40457927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of artificial intelligence for detection and grading of prostate cancer in human prostatectomy specimens: a validation study.","authors":"Maíra Suzuka Kudo,&nbsp;Vinicius Meneguette Gomes de Souza,&nbsp;Carmen Liane Neubarth Estivallet,&nbsp;Henrique Alves de Amorim,&nbsp;Fernando J Kim,&nbsp;Katia Ramos Moreira Leite,&nbsp;Matheus Cardoso Moraes","doi":"10.1186/s13037-022-00345-6","DOIUrl":"https://doi.org/10.1186/s13037-022-00345-6","url":null,"abstract":"<p><strong>Background: </strong>The Gleason grading system is an important clinical practice for diagnosing prostate cancer in pathology images. However, this analysis results in significant variability among pathologists, hence creating possible negative clinical impacts. Artificial intelligence methods can be an important support for the pathologist, improving Gleason grade classifications. Consequently, our purpose is to construct and evaluate the potential of a Convolutional Neural Network (CNN) to classify Gleason patterns.</p><p><strong>Methods: </strong>The methodology included 6982 image patches with cancer, extracted from radical prostatectomy specimens previously analyzed by an expert uropathologist. A CNN was constructed to accurately classify the corresponding Gleason. The evaluation was carried out by computing the corresponding 3 classes confusion matrix; thus, calculating the percentage of precision, sensitivity, and specificity, as well as the overall accuracy. Additionally, k-fold three-way cross-validation was performed to enhance evaluation, allowing better interpretation and avoiding possible bias.</p><p><strong>Results: </strong>The overall accuracy reached 98% for the training and validation stage, and 94% for the test phase. Considering the test samples, the true positive ratio between pathologist and computer method was 85%, 93%, and 96% for specific Gleason patterns. Finally, precision, sensitivity, and specificity reached values up to 97%.</p><p><strong>Conclusion: </strong>The CNN model presented and evaluated has shown high accuracy for specifically pattern neighbors and critical Gleason patterns. The outcomes are in line and complement others in the literature. The promising results surpassed current inter-pathologist congruence in classical reports, evidencing the potential of this novel technology in daily clinical aspects.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9686032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10690480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased CO₂ levels in the operating room correlate with the number of healthcare workers present: an imperative for intentional crowd control.","authors":"Gregory T Carroll, David L Kirschman, Angela Mammana","doi":"10.1186/s13037-022-00343-8","DOIUrl":"10.1186/s13037-022-00343-8","url":null,"abstract":"<p><p>The air in an operating room becomes more contaminated as the occupancy of the room increases. Individuals residing in a room can potentially emit infectious agents. In order to inhibit and better understand the epidemiology of surgical site infections, it is important to develop procedures to track room occupancy level and respiration. Exhaled CO₂ provides a respiratory byproduct that can be tracked with IR light and is associated with human occupancy. Exhaled CO₂ can also be used as an indirect measure of the potential release and level of infectious airborne agents. We show that non-dispersive infrared CO₂ sensors can be used to detect CO₂ in operating room air flow conditions of 20 air changes per hour and a positive pressure of 0.03 in. H₂O. The CO₂ concentration increased consecutively for occupation levels of one to four individuals, from approximately 65 ppm above the background level when one individual occupied the operating room for twenty minutes to approximately 300 ppm above the background when four individuals were present for twenty minutes. The amount of CO₂ detected increases as the number of occupants increase, the activity level increases, the residency time increases and when the ventilation level is reduced.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9672642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40483357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The implementation of physicians assistant in a surgical ward improves continuity in daily clinical work and increases comprehensibility of nurses and physicians.","authors":"Sascha Halvachizadeh,&nbsp;Sarper Goezmen,&nbsp;Sibylle Schuster,&nbsp;Michel Teuben,&nbsp;Matthias Baechtold,&nbsp;Pascal Probst,&nbsp;Fabian Hauswirth,&nbsp;Markus K Muller","doi":"10.1186/s13037-022-00344-7","DOIUrl":"https://doi.org/10.1186/s13037-022-00344-7","url":null,"abstract":"<p><strong>Introduction: </strong>Physician Assistant (PA) have been deployed to increase the capacity of a team, supporting continuity and medical cover. The goal of this study was to assess the implementation of PAs on continuity of surgical rounds, on the collaboration of nurses and physicians and on support of administrative work.</p><p><strong>Methods: </strong>This cross-sectional survey was performed on nurses and physicians who work full-time at a surgical ward in a Swiss reference center. PAs were introduced in our institution in 2019. Participants answered a self-developed questionnaire 6 and 12 months after the implementation of PAs. Administrative work, teamwork, improvement of workflow, and training of physicians has been assessed. Participants answered questions on a 5-point Likert scale and were stratified according to profession (nurse, physician).</p><p><strong>Results: </strong>Participants (n = 53) reported a positive effect on the regular conduct of rounds (2.9, SD 1.1 points after 6 weeks and 3.5, SD 1.1 points after 12 weeks, p = 0.05). A significant improvement of nurse-doctor collaboration has been reported (3.6, SD 1.0 and 4.2, SD 0.8, p = 0.05). Nurses (n = 28, 52.8%) reported the that PAs are integrated in the physicians team rather than the nurses team (4.0, SD 0.0 points and 4.4, SD 0.7 points, p = 0.266) and a significant beneficial effect on the surgical clinic (3.7, SD 1.0 points and 4.4, SD 0.8 points, p = 0.043). Improved overall management of surgical cases was reported by the physicians (n = 25, 47.2%) (4.8, SD 0.4 and 4.3, SD 0.6, p = 0.046).</p><p><strong>Conclusion: </strong>The implementation of PA has improved the collaboration of physicians and nurses substantially. Continuity of rounds has improved and the administrative workload for residents decreased substantially. Overall, the implementation of PA was reported to be beneficial for the surgical clinic.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9641915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40453124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The \"teach-back\" method improves surgical informed consent and shared decision-making: a proof of concept study.","authors":"Kevin D Seely,&nbsp;Jordan A Higgs,&nbsp;Lindsey Butts,&nbsp;Jason M Roe,&nbsp;Colton B Merrill,&nbsp;Isain Zapata,&nbsp;Andrew Nigh","doi":"10.1186/s13037-022-00342-9","DOIUrl":"https://doi.org/10.1186/s13037-022-00342-9","url":null,"abstract":"<p><strong>Introduction: </strong>The teach-back method is a communication tool that can improve patient safety and shared decision-making. Its utility in patient care has been studied extensively in many areas of clinical medicine. However, the literature on teach-back in surgical patient education and informed consent is limited, and few studies have been conducted to test its impact on perioperative patient interactions. The objective of this study was to evaluate if the teach-back method can improve informed consent and surgeon trust. An assessment of the time required to be implemented was also evaluated.</p><p><strong>Methods: </strong>A standardized interaction role-playing a pre-operative informed consent discussion was designed. Laparoscopic cholecystectomy was selected as the proposed procedure. Standardized patients were split into two groups: teach-back and a control group. The control group was delivered a script that discloses the risks and benefits of laparoscopic cholecystectomy followed by a concluding prompt for any questions. The teach-back group was presented the same script followed by the teach-back method. Interactions were timed and patients completed a quiz assessing their knowledge of the risks and benefits and a survey assessing subjective perceptions about the interaction. Statistical analysis through Generalized Linear Models (GLMs) was used to compare visit length, performance on the comprehension quiz, and subjective surgeon trust perceptions.</p><p><strong>Results: </strong>34 participants completed the scenario, the comprehension quiz, and the survey (n = 34). Analysis of the subjective evaluation of the physician and encounter was significant for increased physician trust (p = 0.0457). The intervention group performed higher on the knowledge check by an average of one point when compared to the control group (p = 0.0479). The visits with intervention took an average of 2.45 min longer than the control group visits (p = 0.0014). People who had the actual procedure in the past (evaluated as a confounder) were not significantly more likely to display the same effect as the teach-back method, suggesting that the knowledge and trust gained were not based on previous experiences with the procedure.</p><p><strong>Conclusion: </strong>When employed correctly by surgeons in the perioperative setting, the teach-back method enhances shared decision-making, comprehension, and surgeon trust. Incorporating the teach-back method into risk and benefit disclosures effectively informs and more fully engages patients in the informed consent process. Notably, the added benefits from using teach-back can be obtained without a burdensome increase in the length of visit.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9617437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40435433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}