scholarly journals Prevalence and determinants of intravenous admixture preparation errors: A prospective observational study in a university hospital

2021 ◽  
Author(s):  
Janique G. Jessurun ◽  
Nicole G. M. Hunfeld ◽  
Joost van Rosmalen ◽  
Monique van Dijk ◽  
Patricia M. L. A. van den Bemt
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Time Window ◽  
Single Step ◽  
University Hospital ◽  
Preparation Technique ◽  
Patient Harm ◽  
Preparation Errors ◽  
Infusion Fluid ◽  
Insight Into

AbstractBackground Intravenous admixture preparation errors (IAPEs) may lead to patient harm. Insight into the prevalence as well as the determinants associated with these IAPEs is needed to elicit preventive measures. Aim The primary aim of this study was to assess the prevalence of IAPEs. Secondary aims were to identify the type, severity, and determinants of IAPEs. Method A prospective observational study was performed in a Dutch university hospital. IAPE data were collected by disguised observation. The primary outcome was the proportion of admixtures with one or more IAPEs. Descriptive statistics were used for the prevalence, type, and severity of IAPEs. Mixed-effects logistic regression analyses were used to estimate the determinants of IAPEs. Results A total of 533 IAPEs occurred in 367 of 614 admixtures (59.8%) prepared by nursing staff. The most prevalent errors were wrong preparation technique (n = 257) and wrong volume of infusion fluid (n = 107). Fifty-nine IAPEs (11.1%) were potentially harmful. The following variables were associated with IAPEs: multistep versus single-step preparations (adjusted odds ratio [ORadj] 4.08, 95% confidence interval [CI] 2.27–7.35); interruption versus no interruption (ORadj 2.32, CI 1.13–4.74); weekend versus weekdays (ORadj 2.12, CI 1.14–3.95); time window 2 p.m.-6 p.m. versus 7 a.m.-10 a.m. (ORadj 3.38, CI 1.60–7.15); and paediatric versus adult wards (ORadj 0.14, CI 0.06–0.37). Conclusion IAPEs, including harmful IAPEs, occurred frequently. The determinants associated with IAPEs point to factors associated with preparation complexity and working conditions. Strategies to reduce the occurrence of IAPEs and therefore patient harm should target the identified determinants.

scholarly journals The Incidence, Risk Factors, Predictors, and Prognoses of Cytomegalovirus Reactivation in Immunocompetent Mechanical Ventilation Patients: A Prospective Observational Study

2021 ◽  
Author(s):  
Zhihui Zhang ◽  
Xuesong Liu ◽  
Ling Sang ◽  
Sibei Chen ◽  
Zhan Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Area Under The Curve ◽  
University Hospital ◽  
Laboratory Findings ◽  
Cytomegalovirus Reactivation ◽  
Cmv Reactivation ◽  
Immunocompetent Patients

Abstract Background: Cytomegalovirus (CMV) reactivation can seriously affect the clinical prognoses of critically ill patients. However, the epidemiology and predictors of CMV in immunocompetent patients with mechanical ventilation are not very clear. Methods: A single-center, prospective observational study (conducted from June 30, 2017 to July 01, 2018) with a follow-up of 90 days (September 29, 2018) that included 71 CMV-seropositive immunocompetent patients with mechanical ventilation at a 37-bed university hospital general intensive care unit (ICU) in China. Routine detection of CMV DNAemia was performed once a week until 28 days (Day1, 7, 14, 21, 28) and serology, laboratory findings, and clinical data were obtained at admission.Results: Among 71 patients, 13 (18.3%) showed CMV reactivation within ICU 28-day admission. The median time to reactivation was 7 days. CMV reactivation was related to various factors, including body weight, body mass index (BMI), sepsis, NT-proBNP, BUN, and Hb levels (P< 0.05). In the multivariate regression model, BMI, Hb level, and sepsis were associated with CMV reactivation patients (P< 0.05). Moreover, the area under the curve (AUC) of BMI, Hb and BMI combined Hb was 0.69, 0.70, 0.76, respectively. The rate of complications, duration of mechanical ventilation, hospitalization expense, length of ICU stay, and 90-day all-cause mortality rate in patients with CMV reactivation was significantly higher than in those without CMV reactivation (P< 0.05).Conclusions: Among immunocompetent patients with mechanical ventilation, the incidence of CMV reactivation was high. CMV reactivation can lead to various adverse prognoses. BMI, Hb, and sepsis were independent risk factors for CMV reactivation. BMI and Hb may predict CMV reactivation.

Transoral Dermoid Cyst Excision: A Multicenter Prospective Observational Study

2018 ◽  
Vol 159 (6) ◽  
pp. 981-986 ◽  
Author(s):  
Jin Pyeong Kim ◽  
Dong Kun Lee ◽  
Jeong Hwan Moon ◽  
Jung Je Park ◽  
Seung Hoon Woo
Keyword(s):  
Observational Study ◽  
Oral Cavity ◽  
Dermoid Cyst ◽  
Prospective Observational Study ◽  
University Hospital ◽  
Secondary Outcome ◽  
Transoral Surgery ◽  
Cyst Excision ◽  
Surgery Group ◽  
Multicenter Prospective Observational Study

Objective Transoral surgery is becoming a preferred technique because it does not leave any scar after surgery. However, transoral surgery for a dermoid cyst of the oral cavity is not standardized yet, due to the anatomic complexity of this region. The aim of this study was to evaluate the safety and efficacy of a transoral dermoid cyst excision. Study Design Multicenter prospective observational study. Setting University hospital. Subjects and Methods This study was designed as a 4-year prospective multicenter evaluation of dermoid cyst excisions within the floor of mouth. Clinical outcomes and complications related to procedures were evaluated among patients. The primary outcome was the efficacy of the procedure, and the secondary outcome was cosmetic satisfaction of each procedure. Results Twenty-one patients underwent transoral dermoid cyst excisions, and 22 underwent transcervical excisions. In the transoral surgery group, the mean size of the dermoid cyst was 5.35 cm (95% CI, 4.79-5.91), and in the transcervical surgery group, it was 6.19 cm (95% CI, 5.67-6.71). There was no significant differences with respect to overall demographic characteristics between the groups. However, the duration of the operation was shorter with the transoral group than with the transcervical group ( P = .001), and cosmetic satisfaction was much better in the transoral group ( P < .001). Conclusion Transoral dermoid cyst excision is a potentially safe and effective method that can lead to easy and quick removal of an oral cavity dermoid cyst, with excellent cosmetic outcomes.

Evaluation of measured postpartum blood loss after vaginal delivery using a collector bag in relation to postpartum hemorrhage management strategies: a prospective observational study

2016 ◽  
Vol 44 (4) ◽  
Author(s):  
Christian Bamberg ◽  
Katja Niepraschk-von Dollen ◽  
Laura Mickley ◽  
Anne Henkelmann ◽  
Larry Hinkson ◽  
...  
Keyword(s):  
Blood Loss ◽  
Observational Study ◽  
Vaginal Delivery ◽  
Postpartum Hemorrhage ◽  
Prospective Observational Study ◽  
Management Strategies ◽  
Population Based ◽  
University Hospital ◽  
Hemoglobin Content ◽  
Vaginal Deliveries

AbstractTo evaluate the incidence of postpartum hemorrhage (PPH) and severe PPH via routine use of a pelvic drape to objectively measure blood loss after vaginal delivery in connection with PPH management.This prospective observational study was undertaken at the obstetrical department of the Charité University Hospital from December 2011 to May 2013 and evaluated an unselected cohort of planned vaginal deliveries (n=1019 live singletons at term). A calibrated collecting drape was used to meassure blood loss in the third stage of labor. PPH and severe PPH were defined as blood loss ≥500 mL and ≥1000 mL, respectively. Maternal hemoglobin content was evaluated at admission to delivery and at the first day after childbirth.During the study period, 809 vaginal deliveries were analysed. Direct measurement revealed a median blood loss of 250 mL. The incidences of PPH and severe PPH were 15% and 3%, respectively. Mean maternal hemoglobin content at admission was 11.9±1.1 g/dL, with a mean decrease of 1.0±1.1 g/dL. Blood loss measured after vaginal delivery correlated significantly with maternal hemoglobin decrease.This study suggests that PPH incidence may be higher than indicated by population-based data. Underbuttocks drapes are simple, objective bedside tools to diagnose PPH. Blood loss should be quantified systematically if PPH is suspected.

scholarly journals Factors associated with weaning practices in term infants: a prospective observational study in Ireland

2010 ◽  
Vol 104 (10) ◽  
pp. 1544-1554 ◽  
Author(s):  
Roslyn C. Tarrant ◽  
Katherine M. Younger ◽  
Margaret Sheridan-Pereira ◽  
Martin J. White ◽  
John M. Kearney
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
University Hospital ◽  
Term Infants ◽  
Professional Advice ◽  
Dietary History ◽  
Targeted Interventions ◽  
Improve Compliance ◽  
History Of ◽  
Usual Diet

The WHO (2001) recommends exclusive breast-feeding and delaying the introduction of solid foods to an infant's diet until 6 months postpartum. However, in many countries, this recommendation is followed by few mothers, and earlier weaning onto solids is a commonly reported global practice. Therefore, this prospective, observational study aimed to assess compliance with the WHO recommendation and examine weaning practices, including the timing of weaning of infants, and to investigate the factors that predict weaning at ≤ 12 weeks. From an initial sample of 539 pregnant women recruited from the Coombe Women and Infants University Hospital, Dublin, 401 eligible mothers were followed up at 6 weeks and 6 months postpartum. Quantitative data were obtained on mothers’ weaning practices using semi-structured questionnaires and a short dietary history of the infant's usual diet at 6 months. Only one mother (0·2 %) complied with the WHO recommendation to exclusively breastfeed up to 6 months. Ninety-one (22·6 %) infants were prematurely weaned onto solids at ≤ 12 weeks with predictive factors after adjustment, including mothers’ antenatal reporting that infants should be weaned onto solids at ≤ 12 weeks, formula feeding at 12 weeks and mothers’ reporting of the maternal grandmother as the principal source of advice on infant feeding. Mothers who weaned their infants at ≤ 12 weeks were more likely to engage in other sub-optimal weaning practices, including the addition of non-recommended condiments to their infants’ foods. Provision of professional advice and exploring antenatal maternal misperceptions are potential areas for targeted interventions to improve compliance with the recommended weaning practices.

scholarly journals Antibiotic overuse in obstetric and gynecologic procedures at Zagazig university hospitals: A prospective observational study

Pharmacia ◽  
2021 ◽  
Vol 68 (4) ◽  
pp. 883-889
Author(s):  
Ahmed M. Magdy ◽  
Mahmoud A. Seksaka ◽  
Gehan F. Balata
Keyword(s):  
Observational Study ◽  
Antibiotic Prophylaxis ◽  
Prospective Observational Study ◽  
Prophylactic Antibiotic ◽  
Prophylactic Antibiotics ◽  
Poor Adherence ◽  
University Hospital ◽  
World Health ◽  
Utilization Rate ◽  
Antibiotic Selection

Surgical site infection (SSI) constitutes a major problem in healthcare in terms of healthcare cost, morbidity and mortality. Surgical antibiotic prophylaxis (SAP) is one of the effective strategies for SSI prevention. Poor adherence to SAP guidelines across different countries has been observed. Misuse of prophylactic antibiotics threatens patient safety and leads to an increase in the acquisition of antibiotic resistance. The aim of this study was to assess the utilization of SAP in obstetric and gynecologic procedures in terms of indication for prophylaxis, antibiotic selection, timing of administration and prophylaxis duration. A prospective observational study was conducted at the obstetrics and gynecology department of Zagazig University Hospital during the period from January 2020 to June 2020. Medical records of 264 women were recorded and evaluated. The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines, World Health Organization (WHO) recommendations and The American College of Obstetricians and Gynecologists (ACOG) practice bulletin were used for data evaluation and hence women were stratified into two groups. For women who underwent procedures in which guidelines recommended the use of SAP (200 patients; 75.75%), 198 women (99%) received preoperative prophylaxis. None of women (0%) received the recommended first line antibiotic by guidelines while the most commonly used prophylactic antibiotics were Cefotaxime (86 patients; 43.43%) and Ampicillin-sulbactam (62 patients; 31.31%). Preoperative antibiotic prophylaxis timing was 0-60 minutes before skin incision. All women received postoperative prophylaxis that extended to an average of 7 days. Regarding the other group who underwent procedures in which prophylactic antibiotics weren’t recommended by guidelines (64 patients; 24.24%), 37 women (57.81%) followed the guidelines and didn’t receive SAP while 27 women (42.18%) received SAP. Poor adherence to guidelines recommendations regarding prophylactic antibiotic selection and prophylaxis duration was observed. High utilization rate of prophylactic antibiotics in procedures that didn’t require their use was reported..

Risk events during intrahospital transport of patients from the emergency department: a prospective observational study

2021 ◽  
Vol 38 (10) ◽  
pp. 776-779
Author(s):  
Tom Neal-Williams ◽  
Kimberly Walker ◽  
Travis Lines ◽  
Antony Ugoni ◽  
David McDonald Taylor
Keyword(s):  
Observational Study ◽  
Patient Outcomes ◽  
Prospective Observational Study ◽  
Predisposing Factors ◽  
Cardiac Monitoring ◽  
Patient Harm ◽  
Intrahospital Transport ◽  
N 93 ◽  
Rate Ratios ◽  
Abnormal Temperature

BackgroundWe aimed to determine the incidence, nature of and predisposing factors for risk events (REs) that occur during the intrahospital transport of patients from the ED.MethodsWe undertook a prospective, observational study of intrahospital patient transports from a single ED between 30 January and 20 March 2020. An investigator attended each transport and recorded any RE on a specifically designed data collection document. An RE was any mishap, even if not foreseen, that had the potential to cause the patient harm. A patient equipment number was assigned based on the number of pieces of equipment required during the transport. Poisson regression generated incidence rate ratios (IRRs) and determined risk factors for REs.ResultsOf 738 transports, 289 (39.1%, 95% CI 35.6% to 42.8%) had at least one RE. The total of 521 REs comprised 125 patient-related, 279 device-related and 117 line/catheter-related REs. The most common included trolley collisions (n=142), intravenous fluid line catching/tangling (n=93), agitation/aggression events (n=31) and cardiac monitoring issues (n=31). Thirty-four (6.5%) REs resulted in an undesirable patient outcome, most commonly distress and pain. Predisposing factors for REs included an equipment number ≥3 (IRR 5.68, 95% CI 3.95 to 8.17), transport to a general ward (IRR 2.68, 95% CI 2.12 to 3.39), hypertension (IRR 1.93, 95% CI 1.07 to 3.50), an abnormal temperature and a GCS<14.ConclusionsREs are common in transport of patients from the ED and can result in undesirable patient outcomes. Adequate pre-transfer preparation, especially securing equipment and lines, would result in a reduced risk.

scholarly journals Relationships between sites of abdominal pain and the organs involved: a prospective observational study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e034446 ◽  
Author(s):  
Shun Yamashita ◽  
Masaki Tago ◽  
Naoko E Katsuki ◽  
Tomoyo M Nishi ◽  
Shu-ichi Yamashita
Keyword(s):  
Abdominal Pain ◽  
Urinary Tract ◽  
Observational Study ◽  
Biliary Tract ◽  
Prospective Observational Study ◽  
General Medicine ◽  
University Hospital ◽  
Likelihood Ratios ◽  
Left Flank ◽  
Tertiary Centre

ObjectivesAbdominal pain is one of the most frequent chief complaints in primary care settings. The aim of the present study was to determine the positive likelihood ratios (PLRs) and negative likelihood ratios (NLRs) of the relationships between the sites of abdominal pain and the organs involved.DesignProspective observational study.SettingA single tertiary centre, a university hospital in Japan.ParticipantsA total of 2591 new outpatients visited the Department of General Medicine at a university hospital from April 2017 to March 2018. Of these, 326 patients aged ≥20 years with abdominal pain were enrolled.ResultsSites of abdominal pain were classified into 11 categories including nine different abdominal sections, ‘generalised abdomen’ and ‘site-indeterminate’. The PLRs between ‘right subcostal’ and ‘liver and biliary tract’; between ‘right subcostal’ and ‘musculoskeletal’ ; between ‘epigastric’ and ‘oesophagus, stomach and duodenum’; between ‘right or left flank’ and ‘urinary tract’; between ‘left flank’ and ‘dermatological’; and between ‘mid-lower’ and ‘intestinal’ ranged from 2.17 to 4.14. The PLRs between ‘epigastric’ and ‘urinary tract’; between ‘mid-lower’ and ‘liver and biliary tract’; between ‘periumbilical’ and ‘urinary tract’; and between ‘generalised abdomen’ and ‘oesophagus, stomach and duodenum’ were low, ranging from 0.17 to 0.25. The NLR ranged from 0.5 to 1.5, excluding the relationship between ‘left flank’ and ‘dermatological’.ConclusionThe presence of pain at right subcostal, epigastric, right or left flank and mid-lower sites might be useful for identifying the organs involved. Additionally, the presence of pain at mid-lower, epigastric, periumbilical and generalised abdominal sites might be helpful for denying the involvement of some organs. Some sites of abdominal pain can be indicative of the organs involved.Trial registration numberUMIN000037686

scholarly journals Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: a prospective observational study

2007 ◽  
Vol 7 (1) ◽  
Author(s):  
Julian Mettler ◽  
Mathew Simcock ◽  
Pedram Sendi ◽  
Andreas F Widmer ◽  
Roland Bingisser ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
University Hospital
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