Support opportunities for second victims lessons learned: a qualitative study of the top 20 US News and World Report Honor Roll Hospitals

Abstract Background Second Victim Programs (SVPs) provide support for healthcare providers involved in a near-miss, medical error, or adverse patient outcomes. Little is known about existence and structure of SVPs in top performing US hospitals. Methods We performed a prospective study and interviewed individuals representing SVPs from 20 US News and World Report (USNWR) Honor Roll Hospitals. Telephone interviews were recorded, transcribed, and de-identified. To allow identification of both quantitative and qualitative themes that unified or distinguished programs with SVPs from each other, a content analysis approach was used. Results Of the Top 20 UNSWR hospitals, nineteen individuals with knowledge of or involvement in SVPs were identified. One individual represented two hospital systems for the same institution. Thirteen representatives agreed to participate, 12 declined, and 5 did not respond. One individual who initially agreed to participate did not attend the interview. Among twelve representatives interviewed, 10 reported establishment of SVPs at their hospitals between 2011 and 2016. Most program representatives reported that participants sought support voluntarily. Four domains were identified in the qualitative analysis: (a) identification of need for Second Victim Program (SVP); (b) challenges to program viability; (c) structural changes following SVP creation, and (d) insights for success. Driving SVP creation was the need support medical providers following a traumatic patient event. Poor physician participation due to the stigma associated with seeking support was commonly reported as a challenge. However, acceptance of the mission of SVPs, growing recognition of the value of the program across hospital departments, and systematic safety enhancements were cited as key advantages. To ensure success, participants suggested training a variety of volunteers and incorporating SVPs within quality improvement processes. Conclusions In this convenience sample, programs for healthcare providers that experience psychosocial or emotional trauma from clinical care were uncommon. Variation in structure, performance, and measures of success among SVPs was observed. A systematic approach to evaluating SVPs is needed to help inform institutions of how to best serve their second victims.

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Identification of Current Best Practices for Short-term Medical Mission Trips and Adherence to Current Common Principles and Guidelines

Christian Journal for Global Health ◽

10.15566/cjgh.v7i2.341 ◽

2020 ◽

Vol 7 (2) ◽

pp. 67-82

Author(s):

Susan Andrews

Keyword(s):

Best Practices ◽

Global Health ◽

Language Proficiency ◽

Survey Methodology ◽

Healthcare Providers ◽

Final Analysis ◽

Short Term ◽

Convenience Sample ◽

Operational Practices ◽

Descriptive Survey

Background: Recent reviews of published guidelines for conducting short-term medical missions (STMM) identify significant concerns about the lack of adherence and of formal regulations concurrent with the increasing number of individuals and organizations participating in STMM. Method: A descriptive survey methodology was used. A 44-item survey that identifies current practices utilized by healthcare providers (HCP) who have participated in STMM was used based on the literature and prior research, and distributed electronically to HCP participating in STTM to identify current best practices and compare findings with the most recent recommendations for short-term global health activities. A focus on current operational practices was surveyed and analyzed to develop operational recommendations for the ethical and safe care provided during STMM. Results: Eighty-seven surveys were included in the final analysis, with 33% (N=29) serving as coordinators for the trip. The majority of the respondents were female (67%) and the primary roles represented were: MD (N=17; 20%), nurse practitioner (N=20; 23%), and registered nurse (N=18; 21%). A majority (N=48; 67%) traveled to South America or Latin America, with 38% (N=33) having participated in four or more STMM. Language proficiency was reported as deficient (N=35; 40%) along with little or no knowledge of the basic culture (N=39; 45%). Additional data were collected on trip preparation, clinic operations, and outcomes follow up. Conclusions: Using a convenience sample, the results of the survey provide information on the current best practices utilized by HCP who have participated in STMM and compare the findings to assess for adherence with the most recent recommendations for short-term global health activities. There was variation in the degree to which HCP were knowledgeable about specific aspects related to knowledge of local culture, language proficiency, and adherence to recommended practices for STMM. Additional research on STMM is needed, along with further exploration of how evidence based practices for STMM can be implemented to improve access and safety to the care provided while in the host country.

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Neurodevelopmental Trajectories and Psychiatric Morbidity: Lessons Learned From the 22q11.2 Deletion Syndrome

Current Psychiatry Reports ◽

10.1007/s11920-021-01225-z ◽

2021 ◽

Vol 23 (3) ◽

Author(s):

Ania M. Fiksinski ◽

Maude Schneider ◽

Janneke Zinkstok ◽

Danielle Baribeau ◽

Samuel J. R. A. Chawner ◽

...

Keyword(s):

Genetic Variants ◽

Clinical Care ◽

Psychiatric Morbidity ◽

Phenotypic Expression ◽

22Q11.2 Deletion Syndrome ◽

Autism Spectrum ◽

Lessons Learned ◽

Deletion Syndrome ◽

22Q11.2 Deletion ◽

Variable Expression

AbstractPurpose of ReviewThe 22q11.2 deletion syndrome (22q11DS) is associated with a broad spectrum of neurodevelopmental phenotypes and is the strongest known single genetic risk factor for schizophrenia. Compared to other rare structural pathogenic genetic variants, 22q11DS is relatively common and one of the most extensively studied. This review provides a state-of-the-art overview of current insights regarding associated neurodevelopmental phenotypes and potential implications for 22q11DS and beyond.Recent FindingsWe will first discuss recent findings with respect to neurodevelopmental phenotypic expression associated with 22q11DS, including psychotic disorders, intellectual functioning, autism spectrum disorders, as well as their interactions. Second, we will address considerations that are important in interpreting these data and propose potential implications for both the clinical care for and the empirical study of individuals with 22q11DS. Third, we will highlight variable penetrance and pleiotropy with respect to neurodevelopmental phenotypes in 22q11DS. We will discuss how these phenomena are consistently observed in the context of virtually all rare pathogenic variants and that they pose substantial challenges from both a clinical and a research perspective.SummaryWe outline how 22q11DS could be viewed as a genetic model for studying neurodevelopmental phenotypes. In addition, we propose that 22q11DS research can help elucidate mechanisms underlying variable expression and pleiotropy of neurodevelopmental phenotypes, insights that are likely relevant for 22q11DS and beyond, including for individuals with other rare pathogenic genetic variants and for individuals with idiopathic neurodevelopmental conditions.

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Challenges and opportunities for ovarian cancer management in the epidemic of Covid-19: lessons learned from Wuhan, China

Journal of Ovarian Research ◽

10.1186/s13048-021-00784-2 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Zhilan Chen ◽

Chun Zhang ◽

Jiu Yin ◽

Xin Xin ◽

Hemei Li ◽

...

Keyword(s):

Ovarian Cancer ◽

Large Scale ◽

Treatment Plan ◽

Clinical Care ◽

Gynecologic Cancer ◽

Treatment Phase ◽

Tumor Stage ◽

Current Treatment ◽

Lessons Learned ◽

Cancer Management

AbstractChina and the rest of the world are experiencing an outbreak of the 2019 novel coronavirus disease (COVID-19). Patients with cancer are more susceptible to viral infection and are more likely to develop severe complications, as compared to healthy individuals. The growing spread of COVID-19 presents challenges for the clinical care of patients with gynecological malignancies. Ovarian debulking surgery combined with the frequent need for chemotherapy is most likely why ovarian cancer was rated as the gynecologic cancer most affected by COVID-19. Therefore, ovarian cancer presents a particular challenging task. Concerning the ovarian cancer studies with confirmed COVID-19 reported from large-scale general hospitals in Wuhan, we hold that the treatment plan was adjusted appropriately and an individualized remedy was implemented. The recommendations discussed here were developed mainly based on the experience from Wuhan. We advise that the management strategy for ovarian cancer patients should be adjusted in the light of the local epidemic situation and formulated according to the pathological type, tumor stage and the current treatment phase. Online medical service is an effective and convenient communication platform during the pandemic.

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Lasting effects of prenatal exposure to Cannabis in the retina of the offspring: an experimental study in mice

International Journal of Retina and Vitreous ◽

10.1186/s40942-021-00314-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Paulo Roberto Arruda Zantut ◽

Mariana Matera Veras ◽

Sarah Gomes Menezes Benevenutto ◽

Angélica Mendonça Vaz Safatle ◽

Ricardo Augusto Pecora ◽

...

Keyword(s):

Young Adult ◽

Light Microscopy ◽

Prenatal Exposure ◽

Structural Changes ◽

Volume Fraction ◽

Clinical Care ◽

Retinal Layer ◽

Exposed Population ◽

The Central Nervous System ◽

The Impact

Abstract Background Prenatal exposure to Cannabis is a worldwide growing problem. Although retina is part of the central nervous system, the impact of maternal Cannabis use on the retinal development and its postnatal consequences remains unknown. As the prenatal period is potentially sensitive in the normal development of the retina, we hypothesized that recreational use of Cannabis during pregnancy may alter retina structure in the offspring. To test this, we developed a murine model that mimics human exposure in terms of dose and use. Methods Pregnant BalbC mice were exposed daily for 5 min to Cannabis smoke (0.2 g of Cannabis) or filtered air, from gestational day 5 to 18 (N = 10/group). After weaning period, pups were separated and examined weekly. On days 60, 120, 200, and 360 after birth, 10 pups from each group were randomly selected for Spectral Domain Optical Coherence Tomography (SD-OCT) analysis of the retina. All retina layers were measured and inner, outer, and total retina thickness were calculated. Other 37 mice from both groups were sacrificed on days 20, 60, and 360 for retinal stereology (total volume of the retina and volume fraction of each retinal layer) and light microscopy. Means and standard deviations were calculated and MANOVA was performed. Results The retina of animals which mother was exposed to Cannabis during gestation was 17% thinner on day 120 (young adult) than controls (P = 0.003) due to 21% thinning of the outer retina (P = 0.001). The offspring of mice from the exposed group presented thickening of the IS/OS in comparison to controls on day 200 (P < 0.001). In the volumetric analyzes by retinal stereology, the exposed mice presented transitory increase of the IS/OS total volume and volume fraction on day 60 (young adult) compared to controls (P = 0.008 and P = 0.035, respectively). On light microscopy, exposed mice presented thickening of the IS/OS on day 360 (adult) compared to controls (P = 0.03). Conclusion Gestational exposure to Cannabis smoke may cause structural changes in the retina of the offspring that return to normal on mice adulthood. These experimental evidences suggest that children and young adults whose mothers smoked Cannabis during pregnancy may require earlier and more frequent clinical care than the non-exposed population.

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Lessons Learned From an Early Hotspot During the COVID-19 Pandemic

The American Surgeon ◽

10.1177/0003134821994757 ◽

2021 ◽

pp. 000313482199475

Author(s):

Brett M. Chapman ◽

George M. Fuhrman

Keyword(s):

Decision Making ◽

Surgical Education ◽

Clinical Care ◽

Well Being ◽

Educational Environment ◽

Lessons Learned ◽

Residency Programs ◽

Surgical Residency ◽

The Impact

The Covid-19 pandemic has provided challenges for surgical residency programs demanding fluid decision making focused on providing care for our patients, maintaining an educational environment, and protecting the well-being of our residents. This brief report summarizes the impact of the impact on our residency programs clinical care and education. We have identified opportunities to improve our program using videoconferencing, managing recruitment, and maintaining a satisfactory caseload to ensure the highest possible quality of surgical education.

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A free, open-source, offline digital health system for refugee care (Preprint)

10.2196/preprints.33848 ◽

2021 ◽

Author(s):

Henry Ashworth ◽

Senan Ebrahim ◽

Hassaan Ebrahim ◽

Zahra Bhaiwala ◽

Michael Chilazi

Keyword(s):

Health Systems ◽

Digital Health ◽

Healthcare Providers ◽

Lessons Learned ◽

Extreme Weather Events ◽

Mobile Clinic ◽

Low Resource ◽

Displaced Populations ◽

Weather Events ◽

Displaced People

BACKGROUND Rise of conflict, extreme weather events, and pandemics have led to larger displaced populations worldwide. Displaced populations have unique acute and chronic health needs that need to be met by low resource health systems. Electronic Health Records (EHRs) have been shown to improve health outcomes in displaced populations but need to be adapted to meet the constraints of these health systems. OBJECTIVE To describe the development and deployment of a EHR designed to care for displaced populations in low resource settings. METHODS Using a human-centered design approach we conducted in-depth interviews and focus groups with patients, healthcare providers, and administrators in Lebanon and Jordan to identify the essential EHR features. These features including modular workflows, multilingual interfaces, and offline-first capabilities led to the development of the Hikma Health EHR which has been deployed in Lebanon and Nicaragua. RESULTS We report the successes and challenges from 12 months of Hikma Health EHR deployment in a mobile clinic providing care to Syrian Refugees in the Bekaa Valley, Lebanon. Successes include the EHR’s ability to (1) increase clinical efficacy by providing detailed patient records, (2) prove adaptable to the threats of COVID-19, and (3) improve organizational planning. Lessons learned include technical fixes to methods of identifying patients through name or their medical record ID. CONCLUSIONS As the number of displaced people continues to rise globally, it is imperative that solutions are created to help maximize the healthcare they receive. Free, open-sourced and adaptable EHRs can enable organizations to better provide for displaced populations.

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Managing the Digital Disruption Associated with COVID-19-Driven Rapid Digital Transformation in Brisbane, Australia

Applied Clinical Informatics ◽

10.1055/s-0041-1740190 ◽

2021 ◽

Vol 12 (05) ◽

pp. 1135-1143

Author(s):

Amalie Dyda ◽

Magid Fahim ◽

Jon Fraser ◽

Marianne Kirrane ◽

Ides Wong ◽

...

Keyword(s):

Care Delivery ◽

Digital Health ◽

Clinical Care ◽

Models Of Care ◽

Digital Transformation ◽

Lessons Learned ◽

Digital Data ◽

Routine Practice ◽

Action Research Project ◽

Digital Disruption

Abstract Background The COVID-19 pandemic has forced rapid digital transformation of many health systems. These innovations are now entering the literature, but there is little focus on the resulting disruption. Objective We describe the implementation of digital innovations during the COVID-19 response of Australia's largest health service, Metro North (in Brisbane, Queensland), the challenges of the subsequent digital disruption, how these were managed, and lessons learned. Methods Prior to the COVID-19 pandemic, the Australian state of Queensland created the Queensland Digital Clinical Charter, which provides guidance for the development of digital health programs. The guidelines utilize three horizons: digitizing workflows, leveraging digital data to transform clinical care, and reimagining new and innovative models of care. The technical response to COVID-19 in Metro North is described across these horizons. The rapid digital response caused significant disruption to health care delivery; management of the disruption and the outcomes are detailed. This is a participatory action research project, with members of the research team assisting with leading the implementation project informing the case report content. Results Several digital innovations were introduced across Metro North during the COVID-19 response. This resulted in significant disruption creating digital hypervigilance, digital deceleration, data discordance, and postdigital “depression.” Successful management of the digital disruption minimized the negative effects of rapid digital transformation, and contributed to the effective management of the pandemic in Queensland. Conclusion The rapid digital transformation in Metro North during COVID-19 was successful in several aspects; however, ongoing challenges remain. These include the need to improve data sharing and increase interoperability. Importantly, the innovations need to be evaluated to ensure that Metro North can capitalize on these changes and incorporate them into long-term routine practice. Moving forward, it will be essential to manage not only the pandemic, but increasingly, the resultant digital disruption.

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Initiating Collaboration among Organ Transplant Professionals through Web Portals and Mobile Applications

OJIN: The Online Journal of Issues in Nursing ◽

10.3912/ojin.vol18no02ppt03 ◽

2013 ◽

Vol 18 (2) ◽

Author(s):

Susan Alexander ◽

Haley Hoy ◽

Manil Maskey ◽

Helen Conover ◽

John Gamble ◽

...

Keyword(s):

Mobile Applications ◽

Healthcare Providers ◽

Organ Transplant ◽

Pilot Project ◽

Mobile App ◽

Lessons Learned ◽

Ease Of Use ◽

Future Directions ◽

Efficient Access ◽

Health Related

The knowledge base for healthcare providers working in the field of organ transplantation has grown exponentially. However, the field has no centralized ‘space’ dedicated to efficient access and sharing of information.The ease of use and portability of mobile applications (apps) make them ideal for subspecialists working in complex healthcare environments. In this article, the authors review the literature related to healthcare technology; describe the development of health-related technology; present their mobile app pilot project assessing the effects of a collaborative, mobile app based on a freely available content manage framework; and report their findings. They conclude by sharing both lessons learned while completing this project and future directions.

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Medication understanding and health literacy among patients with multiple chronic conditions: a study conducted in Bangladesh

Journal of Public Health Research ◽

10.4081/jphr.2020.1792 ◽

2020 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Fahad Imtiaz Rahman ◽

Farina Aziz ◽

Sumaiya Huque ◽

Sadia Afruz Ether

Keyword(s):

Health Literacy ◽

Chronic Conditions ◽

Chronic Condition ◽

Healthcare Providers ◽

Poor Health ◽

Multiple Chronic Conditions ◽

Multiple Chronic Condition ◽

Convenience Sample ◽

Individual Interviews ◽

Reduce Medication Error

Objectives: Medication understanding is critical for patients who suffer from multiple chronic conditions in order to reduce medication error and is often associated with poor health outcomesand low adherence. This study aims to identify the gap of medication knowledge among multiple chronic condition patients in Bangladesh, in order to aid physicians and other healthcare providers in improving health literacy.Methods: Individual interviews of a convenience sample of multiple chronic condition patients in Bangladesh were heldwhere they were asked a number of questions for assessing medication related literacy.Results: More than 26% patients failed to cite the brand name of all their prescribed medications while the rate of patients not knowing the generic names was far worse (88.1%). Nearly 1 out of every 4 patients did not know the purpose of all their medications and more than half of the participants (55%) did not know the strengths of their drugs. While knowledge about medication routes and regimen was satisfactory, awareness regarding risk factors of medicine was lowest of all. Only 1 out of every 4 patients had a habit of reading drug information leaflet. Patient’s ability to correctly state the purpose of their medication seemed to be positively associated with age (p=0.004) and negatively associated with number of medicines taken (p=0.03).Conclusions: Many patients demonstrated poor health literacy regarding medication. Routine review of medications from physician or health provider can significantly improve their health literacy, leading to better treatment outcome and medication adherence.

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