Evaluation of Continuous Inhaled Epoprostenol in the Treatment of Acute Respiratory Distress Syndrome, Including Patients With SARS-CoV-2 Infection

Background Acute respiratory distress syndrome (ARDS) management is primarily supportive. Pulmonary vasodilators, such as inhaled epoprostenol (iEPO), have been shown to improve PaO2:FiO2 (PF) and are used as adjunctive therapy. Objective To identify the positive response rate and variables associated with response to iEPO in adults with ARDS. A positive response to iEPO was defined as a 10% improvement in PF within 6 hours. Methods This retrospective study included adults with ARDS treated with iEPO. The primary endpoint was the variables associated with a positive response to iEPO. Secondary endpoints were positive response rate and the change in PF and SpO2:FiO2 within 6 hours. Statistical analysis included multivariable regression. Results Three hundred thirty-one patients were included. As baseline PF increased, the odds of responding to iEPO decreased (odds ratio [OR], 0.752, 95% CI, 0.69-0.819, p < 0.001). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related ARDS (OR 0.478, 95% CI, 0.281-0.814, p = 0.007) was associated with decreased odds of a positive response to iEPO. The total population had a 68.3% positive response rate to iEPO. SARS-CoV-2-related ARDS and non-SARS-CoV-2-related ARDS had a 59.5% and 72.7% positive response rate, respectively. iEPO significantly improved PF (71 vs 95, P < 0.001) in the whole population. Conclusion and Relevance iEPO was associated with a positive effect in a majority of moderate-to-severe ARDS patients, including patients with SARS-CoV-2-related ARDS. Lower baseline PF and non-SARS-CoV-2-related ARDS were significantly associated with a positive response to iEPO. The ability to predict which patients will respond to iEPO can facilitate better utilization.

Feasibility of a surveillance programme based on gargle samples and pool testing to prevent SARS-CoV-2 outbreaks in schools

School closures have a negative impact on physical and mental well-being, and education, of children and adolescents. A surveillance programme to detect asymptomatic SARS-CoV-2 infection could allow schools to remain open, while protecting the vulnerable. We assessed the feasibility of a programme employing gargle samples and pool testing of individually extracted RNA using rRT-qPCR in a primary and a secondary school in Germany, based on programme logistics and acceptance. Twice a week, five participants per class were selected to provide samples, using an algorithm weighted by a risk-based priority score to increase likelihood of case detection. The positive response rate was 54.8% (550 of 1003 pupils). Logistics evaluation revealed the rate-limiting steps: completing the regular pre-test questionnaire and handing in the samples. Acceptance questionnaire responses indicated strong support for research into developing a surveillance programme and a positive evaluation of gargle tests. Participation was voluntary. As not all pupils participated, individual reminders could lead to participant identification. School-wide implementation of the programme for infection monitoring purposes would enable reminders to be given to all school pupils to address these steps, without compromising participant anonymity. Such a programme would provide a feasible means to monitor asymptomatic respiratory tract infection in schools.

Existing perception of Patient safety among health personnel in operating room at CHICH (Children Hospital & Institute of Child Health, Lahore.

Background: Patient Safety is the key concept of every healthcare setup worldwide as it depicts the perception of health care personnel about patient safety and quality of care delivered to patients. The World Health Organization along with other major organizations has taken initiatives to deal with patient safety challenges. Objective: To assess the existing perception of patient safety among health personnel in operating rooms of tertiary care hospital in Pakistan. Study Design: Cross Sectional study. Setting: Children Hospital & Institute of Child Health Lahore. Period: July 2018 to December 2018. Material & Method: Participants were selected through proportionate simple random sampling. The WHO patient safety survey was used to assess perception of patient safety culture. Data was collected after taking consent. The data was entered in SPSS version 25 and analyzed by it. “Composite positive response rate” for the various dimensions were calculated. Reliability was checked by Cronabach alpha which was more than 0.7 (70%). Results: The overall response rate in the study was 100%. Average composite positive response percentage was 65.17% and it varied among different cadres of HCPs ranged from 51% to 88%. The dimensions “Personal attitude to Patient safety” and “Personal influence over safety” showed highest positive response among all cadres (88 % and 67 %) respectively. composite Positive percent response about patient safety culture varied among different cadres of health personnel, nurses showed highest positive response percentage of 71.2%. Conclusion: Safety culture assessment is a useful tool for evaluation of patient safety interventions, measuring organization’s safety culture and raising awareness. WHO patient safety study tool showed the average positive response rate of 65.17% but the dimension “Safety of health care system”, and “Error and patient safety” have least positive response which shifts the focus to organizational conditions that lead to adverse events and patient harm in healthcare organizations. The result also highlighted areas that required improvement, as perceived by health care workers.

Half-life of surgical truth in general surgery

Introduction Karl Popper’s hypothetico-deductive model contends that an assertion is true if it agrees with the facts, and that science progresses via paradigms held to be true until replaced by better approximations of reality. Our study aimed to estimate the half-life of surgical dogma. Methods The first 15 general surgery articles at 5-year intervals were extracted from the British Journal of Surgery since its inception in 1913. A statement summarising each article’s conclusion was formatted, and non-conducive articles were excluded (n=22). A total of 293 article statements were reviewed and marked as true or false by a cohort of 15 senior general surgeons, with a majority positive response denoting a true statement. Regression analysis of the relationship between perceived truth and time was performed. Results Median reviewer positive response rate was 49.5% (range 35.8–64.2%), with over 80% of responders in total agreement regarding 151 statements (51.5%) and deeming 137 (46.8%) currently true. Publication year correlated with percentage of true responses (rho 0.647, p=0.002). Linear modelling of true responses related to 5-year intervals (R2=0.398, p=0.002) estimated the annual rate of loss of truth to be 0.25%, equating to a half-life of 200.0 years. Conclusions Contrary to popular belief, it appears THAT surgical dogma does not lose its lustre for some seven generations. Regression line extrapolation is contentious but would suggest that the current era of surgical knowledge extends from 1769 – the days of John Hunter, the ‘father of modern surgery’ – to 2176, although relative rates of innovation may accelerate and move the nexus point.

Assessment of the Perceived Just Culture Among Nurses: A Cross- Sectional Study

Background Achieving a highly reliable system and processes in the healthcare industry is a classic conundrum. As safe and quality healthcare has its increasing complexity, where errors are more likely to occur. Hence, most healthcare organizations have promoted the practice of Just Culture. The research study quantified and explained key aspects on the strengths and weaknesses of just culture dimensions which facilitated understanding in implementing a safety culture in Hamad General Hospital (HGH). Design: Perception was measured using the adapted JCAT through a descriptive, cross- sectional research design. Independent T-tests and One-way ANOVA were used to investigate the relationship between the demographic profile and just culture perception among 212 staff nurses in HGH. Results A strong positive perception among the staff nurses of Just Culture was found out based on its six (6) dimensions in Medical and Surgical In-Patient Units of HGH. Positive response rate is highest at Continuous Improvement dimension which is 88.66%. Balance dimension received the lowest rating with only 52.31% positive response rate.

Thực trạng và một số yếu tố ảnh hưởng đến văn hóa an toàn người bệnh của nhân viên y tế Bệnh viện Hữu Nghị Việt Nam – Cu Ba năm 2020

Objective: To describe the situation and analyze some related factors on the patient safety culture of health workers at Vietnam - Cuba Friendship Hospital in 2020 Methods: This is a cross-sectional study that combines qualitative and quantitative methods, conducted at Vietnam - Cuba Friendship Hospital, from February to November 2020. The quantitative research was using HSOPSC toolkit to consult 165 doctors, nurses/technicians; and conducting 12 in-depth interviews. Quantitative data were analyzed by using SPSS software and the qualitative one was recorded, analyzed, and synthesized with each group of influencing factors. Main findings: The overall positive response rate with patient safety culture is 73.9%. The highest positive response rate is 94.2% with “Teamwork within units” dimension and the lowest rated dimension was 50.1% with “Nonpunitive response to error” dimension. The low and middle-income group rated the level of internal safety higher than the high-income group (p = 0.001), and positively response rate to patient safety culture of health workers at Internal Medicine Department is higher than that at Surgery and Subclinical Departments (p <0.05). In-depth interviews showed management concerns, process/regulation systems, patient safety training, adverse event reporting systems, punishment mechanism and monitoring activities are factors affecting patient safety culture. Conclusions and recommendation: Communication about medical adverse event management for all health staff of the hospital and application of the patient safety culture should be improved. Keywords: patient safety culture, impacting factors, Vietnam – Cuba Friendship Hospital

Association of shared decision making with inpatient satisfaction: a cross-sectional study

Background We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China. Methods A cross-sectional survey of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models. Results The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to “My physician informed me of different treatment alternatives” was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals). Conclusions Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.

Association of shared decision making with inpatient satisfaction: A cross-sectional study

Background: We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China. Methods: A cross-sectional survey of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models. Results: The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to “My physician informed me of different treatment alternatives” was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals). Conclusions: Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.

Assessment of Patient Safety Culture in Public General Hospital in Capital City of Vietnam

Patient safety culture is a vital component in ensuring high quality and safe patient care. Assessment of staff perception on existing hospital patient safety culture (PSC) is the first step to promote PSC. This paper is aimed to assess the patient safety culture in 1 big public autonomous general hospital in Hanoi, Vietnam. This cross-sectional study surveyed 638 healthcare professional utilizing the validated (Hospital Survey on Patient Safety Culture [HSOPSC]) in an online format. This study adhered to STROBE guidelines. The positive response rate was high, with a percentage of 74.2. The strongest areas are teamwork within units (91.3%) and organizational learning/continuous improvement (88.4%). The areas for improvement are staffing (49.4%) and non-punitive response to error (53.1%). Hospital administrators should strengthen the culture of patient safety by formulating strategies and implementing interventions with emphasis on adequate staffing and promoting blame-free working environment.

Association of shared decision making with inpatient satisfaction: A cross-sectional study

Background: We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China.Methods: A cross-sectional survey was of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models.Results: The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to “My physician informed me of different treatment alternatives” was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals).Conclusions: Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.