Analysis of The Impact of Excellent Event Management on the Safety of Patients and Clinical Caregivers

Objective: To investigate the impact of excellent event management in improving patient safety and nursing staff care satisfaction. Methods: The study was analyzed by retrospective comparison, and routine management from January 2022 to December 2022 was set as the control group, and excellent event management from January 2023 to January 2024 was set as the study group. The differences in nursing outcomes between both groups were compared. Results: The rate of adverse events in the study group (0.61%) was lower than that in the control group (0.96%), and the rate of excellent events in the study group (2.57%) was higher than that in the control group (0.97%) (P < 0.05). Meanwhile, the satisfaction level of nursing safety in the study group reached 98.81%, which was much higher than in the control group (92.21%) (P < 0.05). Conclusion: Nursing excellent event management had a positive impact on improving patient care safety satisfaction, reducing the rate of adverse events, and increasing the rate of reporting excellent events.

Palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease

BACKGROUND Long-term abdominal drains(LTAD)are a cost-effective palliative measure to manage malignant ascites in the community,but their use in patients with end-stage chronic liver disease and refractory ascites is not routine practice.The safety and cost-effectiveness of LTAD are currently being studied in this setting,with preliminary positive results.We hypothesised that palliative LTAD are as effective and safe as repeat palliative large volume paracentesis(LVP)in patients with cirrhosis and refractory ascites and may offer advantages in patients’quality of life.AIM To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver disease.METHODS A retrospective,observational cohort study comparing the effectiveness and safety outcomes of palliative LTAD and regular palliative LVP as a treatment for refractory ascites in consecutive patients with end-stage chronic liver disease followed-up at our United Kingdom tertiary centre between 2018 and 2022 was conducted.Fisher’s exact tests and the Mann-Whitney U test were used to compare qualitative and quantitative variables,respectively.Kaplan-Meier survival estimates were generated to stratify time-related outcomes according to the type of drain.RESULTS Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular LVP.The baseline characteristics were similar between the groups.Prophylactic antibiotics were more frequently prescribed in patients with LTAD(P=0.012),while the incidence of peritonitis did not differ between the two groups(P=0.46).The incidence of acute kidney injury(P=0.014)and ascites/drain-related hospital admissions(P=0.004)were significantly higher in the LVP group.The overall survival was similar in the two groups(log-rank P=0.26),but the endpoint-free survival was significantly shorter in the LVP group(P=0.003,P<0.001,P=0.018 for first ascites/drain-related admission,acute kidney injury and drain-related complications,respectively).CONCLUSION The use of LTAD in the management of refractory ascites in palliated end-stage liver disease is effective,safe,and may reduce hospital admissions and utilisation of healthcare resources compared to LVP.

The Role and Safety of Personalized Care in Improving Thrombocytopenia after Lymphoma Chemotherapy

Objective:To explore and analyze the effect and safety of personalized nursing in improving thrombocytopenia after lymphoma chemotherapy.Methods:80 lymphoma patients with thrombocytopenia after lymphoma chemotherapy in the Department of Hematology of our hospital from May 2021 to May 2023 were selected as the research objects,and they were divided into an experimental group and reference group by random drawing,with 40 cases in each group.The experimental group received individualized nursing,and the reference group received routine nursing.The platelet count,platelet-related indicators,incidence of adverse reactions,and life scores were compared between the two groups.Results:Before the intervention,there was no significant difference in platelet count between the groups(P>0.05);after the intervention,the platelet count in the experimental group was significantly higher compared to the reference group(P<0.05).In the experimental group,the duration for platelet decline and the time for platelets to normalize were notably shorter compared to the reference group(P<0.05).Moreover,the personality group displayed a significantly lower incidence of adverse reactions than the reference group(P<0.05).Prior to the intervention,there were no statistically significant differences(P>0.05)in the life scores between the two groups,such as functional condition,symptom manifestation,and health scores among the groups.However,post-intervention,the personality group exhibited a significant improvement in those scores compared to the reference group(P<0.05).Conclusion:Individualized nursing can optimize the platelet level in thrombocytopenia after lymphoma chemotherapy,improve symptoms,and reduce the occurrence of adverse reactions.

Effect of cetuximab plus FOLFOX4 regimen on clinical outcomes in advanced gastric carcinoma patients receiving evidence-based care

BACKGROUND Although chemotherapy is effective for treating advanced gastric carcinoma(aGC),it may lead to an adverse prognosis.Establishing a highly effective and low-toxicity chemotherapy regimen is necessary for improving efficacy and outcomes in aGC patients.AIM To determine the efficacy and safety of cetuximab(CET)combined with the FOLFOX4 regimen(infusional fluorouracil,folinic acid,and oxaliplatin)as firstline therapy for patients with aGC,who received evidence-based care(EBC).METHODS A total of 117 aGC patients who received EBC from March 2019 to March 2022 were enrolled.Of these,60 in the research group(RG)received CET+FOLFOX4 as first-line therapy,whereas 57 in the control group(CG)received FOLFOX4.The efficacy[clinical response rate(RR)and disease control rate(DCR)],safety(liver and kidney dysfunction,leukopenia,thrombocytopenia,rash,and diarrhea),serum tumor marker expression[STMs;carbohydrate antigen(CA)19-9,CA72-4,and carcinoembryonic antigen(CEA)],inflammatory indicators[interleukin(IL)-2 and IL-10],and quality of life(QOL)of the two groups were compared.RESULTS A markedly higher RR and DCR were observed in the RG compared with the CG,with an equivalent safety profile between the two groups.RG exhibited notably reduced CA19-9,CA72-4,CEA,and IL-2 levels following treatment,which were lower than the pre-treatment levels and those in the CG.Post-treatment IL-10 was statistically increased in RG,higher than the pre-treatment level and the CG.Moreover,a significantly improved QOL was evident in the RG.CONCLUSION The CET+FOLFOX4 regimen is highly effective as first-line treatment for aGC patients receiving EBC.It facilitates the suppression of STMs,ameliorates the serum inflammatory microenvironment,and enhances QOL,without increased adverse drug effects.

Safety and Quality of Care Evaluation in Japanese Long-Term Facilities Focused on the Activity Condition and Cognitive Function of Residents

Objective: Currently, standards for evaluating long-term care facilities do not exist in Japan. This study aimed to evaluate the quality of healthcare services in Japan’s long-term care facilities and identify the structural and process indicators associated with the facilities’ outcome indicators. Methods: This retrospective study assessed changes in residents’ abilities to participate in physical activities, their cognitive function, and their vulnerability to injuries. From 2012 to 2013, we collected information on the healthcare services at 1067 long-term care facilities registered with Japan’s Welfare, Health and Medical Care Information Network in the Welfare and Medical Service Agency. We examined 12 structural indicators, 26 process indicators, and 7 outcome indicators. We used multivariate linear regression models adjusted to analyze relationships between outcome indicators and structural or process indicators. Results: Residents’ activity and cognitive function indicators either improved by 80% - 90% or were maintained for one year. The Geriatric Functional Independence Measures, the Barthel Index, and holding conferences related to care were all considered activities of daily living. Three adverse events—tumbles and falls, behavioral problems, and aimless wandering or leaving the facility without permission—were factors that restricted residents’ behavior and number of residents per care staff member. Conclusions: Maintaining or improving levels of independence and cognition in daily living requires a care process system that enables ongoing monitoring of residents’ activities of daily living and cognitive functioning. Ensuring the safety of residents and improving the quality of care in long-term care facilities without securing adequate care staff are not possible.

Evaluating Improvement in the Care of Depressed Elderly Patients: An Empirical Approach to the WHO Patient Safety Model

Depression among the elderly is a public health issue. This paper demonstrates the value of patient safety research for future strategies in this area. The aim of the present study was to analyse the relationship between the World Health Organization (WHO) Patient Safety (PS) Model and empirical research on depressed elderly patients’ experiences of quality and safe care. The research question was: Which patients’ experiences could be linked to quality and safe care as recommended by the WHO? We adopted an implementation approach as the starting point for this interdisciplinary project. A total of 29 individual narrative-based, in-depth interviews were performed to explore patients’ experiences and two healthcare teams participated in the focus group interviews. Interpretation of the results revealed that the 23 components of the PS model were linked to elderly patients’ experiences of quality and that safe care was not achieved. There was evidence of low quality and lack of safe care due to psychological distress, stress and fatigue, the absence of involvement in decision-making, misdiagnosis, sleep problems as a result of harm from medical error and a poor physical state. Patients’ experiences of loneliness gave rise to suicidal thoughts. In conclusion, quality improvement is necessary in all components of the WHO PS model. We recommend structural, process and outcome improvements, more specifically: active involvement, shared decision-making and increased self-management.

Attitude toward Safety among Staffs in the Iranian Maternity Care Units of Public Hospitals with High Maternal Death Rate, 2015-2016

Background: Although extensive Mother-friendly Hospital initiatives have been improved the quality of maternity care in Iran, recent national reports have been indicated that obstetrics errors are still common. The current study aimed to assess safety attitude in the maternity care units of public hospitals in a region with high rate of maternal death in Iran. Materials and Methods: Data was collected from 314 midwives, specialist and also managers working in all public hospitals in 2016. The Cronbach’s alpha coefficient was used to analyze psychometric features of the Safety Attitudes Questionnaire (SAQ). Results: 86.2% of the participants (n = 314) completed the questionnaire. Results showed that lower scores in teamwork, safety climate and also job satisfaction subcomponents. The working conditions and stress recognition had the highest negative scores. There was a significant relationship between the following subcomponents and work load: teamwork (r = ﹣0.416, P-value = 0.05), stress recognition (r = 0.40, P-value = 0.05) and also working conditions (r = 0.421;P-value = 0.02). The score of midwives was significantly lower than specialists regarding job satisfaction (P-value = 0.014), working conditions (P-value = 0.02) and also the overall safety attitude score (P-value = 0.001). About 63% of respondents reported no error during the last year. The mean of error reporting during the last year significantly increased among specialists compared to midwives (P-value = 0.001). Conclusion: Maternity care units in the region with high maternal death have been faced with many intangible barriers related to safety attitude such as poor teamwork climate, working condition and also poor stress recognition. It is now needed to promote supportive environment for midwives and also strengthening staff cohesion through guiding the strategic direction of current maternity risk management system in creating open and just culture, improving leadership behaviors among senior managers and also addressing poor staffing levels.

The effects of Professional Commitment and Patient Safety knowledge-attitude-practice on Undergraduate nursing students’ Humanistic Care Ability in clinical practice

Objective:To describe the status quo of humanistic care ability,the knowledge-attitude-practice of Patient Safety and professional commitment among Undergraduate Nursing Students in clinical practice,and to determine the effects of professional commitment and patient safety knowledge-attitude-practice on humanistic care ability.Methods:Two hundred and thirty-two undergraduate nursing students in clinical practice were investigated with the general questionnaire,Caring Ability Inventory(CAI),Patients Safety knowledge-attitude-practice(KAP)Questionnaire and the Nursing Professional Commitment Scale.Results:The score of humanistic care ability of nursing undergraduates was 185.19±20.95,patients safety KAP score was 106.94±11.62,professional commitment score was 74.93±10.44.Undergraduate nursing students’humanistic care ability were positively correlated with professional commitment and patients safety KAP(P<0.05).Multiple Linear regression analysis showed that professional commitment,patient safety KAP entered the humane care equation(F=24.051,P<0.001),and explained 39.1%of the total variation in humane care.Intermediate effect analysis shows that patient safety played a partial mediating role in professional commitment and humane care.Conclusion:The professional commitment and patient safety KAP of undergraduate nursing students were positively related to their humanistic care ability.Improving the professional commitment and knowledge and patients safety KAP of nursing students can strengthen their humanistic care ability to provide high-quality nursing for patients.

Evidence of Linkages between Patient Safety and Person-Centred Care in the Maternity and Obstetric Context—An Integrative Review

The aim was to evaluate the current state of knowledge pertaining to patient safety and its link to person-centred care. The international relevance of patient safety has expanded, as have the models of person-centred care. Inspired by this new trend, we collated and summarized the literature for evidence of the two topics. The study was guided by Russell, Whittemore and Knafl’s integrative review framework. An electronic database search was conducted for relevant articles from 2005 to 2016. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The structure and process of the evaluation of the evidence are described and the findings interpreted by means of a thematic synthesis. One theme emerged: trustful, safe communication in the relationship between the patient, family members and healthcare professionals and two domains;safety culture and multidisciplinary capacity building. The dominant dimension in the safety culture domain is respectful communication, which implies sharing experiences that lead to a sense of control during labour and birth and is related to the women’s feeling of personal capacity. The dominant dimensions in the multidisciplinary capacity building domain are collaborative teamwork, coordination and risk management, knowledge sharing and patient-centred communication. In conclusion, to enhance patient safety, it is necessary to develop patient-focused, evidence-based skills and guidelines as well as a supportive organization. Due to their interaction with patients, midwives’ communication competence on the part of midwives is essential for supporting the birth and fulfilling the women’s needs and expectations.

Discussion on the Application of Operating Room Nursing in Patients with Uterine Fibroids and Diabetes

Objective: To analyze the application value of surgical nursing in patients with uterine fibroids and diabetes. Method: Sixty diabetic patients who agreed to undergo surgery for uterine fibroids at the Sun Yat-sen University Cancer Center from January 2021 to May 2022 were randomly selected as the study subjects. According to criteria such as number of patients, age, nursing methods, and treatment methods, the patients were evenly divided into an observation group and a control group. The control group received routine nursing measures, while the observation group received focused surgical nursing measures based on the routine ones. The blood glucose and blood lipid metabolism status, the incidence of adverse reactions, and nursing satisfaction were compared between the two groups. Results: The blood glucose and blood lipid metabolism status of the observation group were safer than those of the control group (P < 0.05). The observation group had advantages in terms of the incidence of adverse reactions and nursing satisfaction compared to the control group (P Conclusion: Systematic surgical nursing for patients with uterine fibroids and diabetes during surgery can help patients control their blood glucose and blood lipid metabolism status, reduce the incidence of adverse reactions, and improve the patient’s experience during the treatment stage.

A mixed method analysis of patients' complaints: Underpinnings of theory-guided strategies to improve quality of care

Purpose:Patients'complaints can be predictors of patient care quality and safety.Understanding patients'complaints could help healthcare organizations target the areas for improvements.The purpose of this study is to use a mixed method analysis to a)examine the characteristics and categories of patients'complaints,b)explore the relationships of patients'complaints with professions and units,and c)propose theory-based strategies to improve care quality.Methods:This is a descriptive mixed method study.Data examined are patients'complaints filed at a university-affiliated hospital in China from January 2016 to December 2017.A qualitative content analysis was conducted to categorize complaints.A TwoStep cluster analysis was performed to provide an overall profile of patients'complaints.Chi-Square tests were conducted to investigate the relationships among complaints,professions,and units.Results:838 complaints were filed,with 821 valid cases for analysis.Six categories surfaced from the qualitative analysis:uncaring attitudes,unsatisfactory quality of treatment or competence,communication problems,the process of care,fees and billing issues,and other miscellaneous causes.Physicians received most of the complaints(56.6%).The unit receiving the most complaints were outpatient clinics and medical support units(52.7%).The cluster analysis indicated four distinct clusters.Significant relationships existed between complaints and professions(x2(20)=178.82,P<0.01),and between complaints and units(x2(15)=42.72,P<0.01).Conclusions:Patients'complaints are valuable sources for quality improvements.Healthcare providers should be not only scientifically knowledgeable,but also humanistic caring.Caring-based theories may provide guidance in clinical practice.

Nursing Diagnoses of the Domain Safety/Protection and Socioeconomic and Clinical Aspects of Critical Patients

Objective: The objective is to correlate the nursing diagnoses of the domain Safety/Protection of NANDA-I in critically ill patients with sociodemographic and clinical data. Method: A cross-sectional study with 86 individuals was conducted, from October 2013 to May 2014 in the Intensive Care Unit of a university hospital in northeastern Brazil, through a formal interview and physical examination. Results: It was possible to identify a total of 20 significant statistical associations, and 15 were clinically justified by the literature, namely: risk for aspiration and reason for admission;impaired dentition and age;risk for peripheral neurovascular dysfunction and sex and comorbidity;skin integrity and comorbidity;risk for impaired skin integrity and gender and reason for admission;impaired tissue integrity and gender and reason for admission;risk for perioperative positioning injury and reason for admission;risk for thermal injury and age and comorbidity;delayed surgical recovery and reason for admission;risk for poisoning and years of schooling;and risk for imbalanced body temperature and age. Conclusions: By understanding the relationship between customers’ answers and the sociodemographic and clinical profile, positive health outcomes can be achieved in particular in the prevention of risks facing vulnerability characteristics, providing greater safety and protection for the critical customer.

Opportunities for nurses in the era of electronic health records

Nursing leaders are currently faced with opportunities to advance nursing’s role in the use of electronic health records (EHRs). Nurse leaders can advance the design of EHRs with nurse informaticists to improve health outcomes of individual and populations of patients.

Force application of laparoscopic surgeons under the impact of heavy personal protective equipment during COVID-19 pandemic

Objective:Surgeons are required to wear heavy personal protective equipment while delivering care to patients during the COVID-19 pandemic.We examined the impact of wearing double gloves on surgeons’performance in laparoscopic surgery.Methods:Eleven surgeons-in-training at the Surgical Simulation Research Lab of the University of Alberta were recruited to perform laparoscopic cutting tasks in simulation while wearing none,one pair,and two pairs of surgical gloves.Forces applied to laparoscopic instruments were measured.Results:Wearing gloves prolonged task times(one pair of gloves:301.6±61.7 s;two pairs of gloves:295.8±65.3 s)compared with no gloves(241.7±46.9 s;p=0.043).Wearing double gloves increased cutting errors(20.4±5.1 mm^(2))compared with wearing one pair of gloves(16.9±5.5 mm^(2))and no gloves(14.4±4.6 mm^(2);p=0.030).Wearing gloves reduced the peak force(one pair of gloves:2.4±0.7 N;two pairs of gloves:2.7±0.6 N;no gloves:3.4±1.4 N;p=0.049),and the total force(one pair of gloves:10.1±2.8 N;two pairs of gloves:10.3±2.6 N;no glove:12.6±1.9 N;p=0.048)delivered onto lapa-roscopic scissors compared with wearing no glove.Conclusion:The combined effects of wearing heavy gloves and using tools reduced the touching sensation,which limited the surgeons’confidence in performing surgical tasks.Increasing practice in simulation is suggested to allow surgeons to overcome difficulties brought by personal protective equipment.

Consideration of Safety Management When Using Pepper, a Humanoid Robot for Care of Older Adults

Pepper, a humanoid robot, is 1.2 m in height and is designed to move its limbs. There are risks of the older adults experiencing falling and collision accidents when they interact with Pepper. When physical interaction happens between a humanoid robot and human beings, potential harmful physical contact might occur. The aim of this report was to examine the safety management aspects when using Pepper, a humanoid robot for the care of older adults. The older adults’ reactions to Pepper’s functions cannot be predicted. Hence, it is necessary to clarify methods to guarantee its safety in advance and to increase the safety and properties of the robots. The benefits of introducing support robots such as Pepper for aging medical and nursing care settings are obvious. Therefore, engagement in robot development while considering both the risks and benefits is critical. Our academic initiatives have just begun. Through information exchange among researchers, users, engineers, and law specialists, we need to identify latent and prominent risks in situations where Pepper and the older adults interact and deepen our examination of measures against such risks.

The Use and Misuse of Mobile Phones in the Maternity Ward—A Threat to Patient Safety?

An important task for the midwife is following up mother-child interaction to facilitate mother-infant attachment. The aim of this study was to explore midwives’ perceptions of parents’ use of mobile phones in the maternity ward. The research question was: Is the use of mobile phones in the maternity ward a threat to patient safety? Two focus group interviews exploring midwives’ perceptions (n = 10) of parent’ use of mobile phones during and after the birth were conducted in January 2016. Systematic text condensation was used to analyse the data, revealing three themes pertaining to safety concerns: Interrupted communication due to parents’ excessive use of mobile phones during labour and postnatally, Unsafe care caused by lack of attention to the newborn baby’s signals as a result of being disturbed by the mobile phone and Unsafe care because of parents interrupting their conversation with the midwife by answering the mobile, acting in a disrespectful manner and failing to pay attention. The midwives’ descriptions of parents’ use of mobile phones in the maternity ward included reflections on mobile phone usage as a permanent phenomenon. They were concerned that parents’ use of mobile phones in the maternity ward could negatively affect the attachment process and considered that it interrupted their work. In conclusion, there is a need for increased awareness of parents’ use of mobile phones in the maternity ward. Further research is required to gain greater insight into the consequences of mobile phone use in order to promote patient safety by ensuring effective communication between parents and midwives. In addition, research is needed to explore the safety discourse, clinical risks and/or health problems involved in the development of infant-parent attachment in newborn babies.

Value Choice and System Enlightenment of the U.S.Business Judgment Rule

Through analyzing theories and legislative cases in respect of Business Judgment Rule in American justice systems with the com parison method,this article reveals that the business judgment system is conducive to the protection of rights and interests of the directors in decision making,and enables the court to avoid the substantive review on business management in an effective manner;at the same time,in view of the blanks and deficiencies in the legislation of China in the "Company Law" and other relevant laws,it is recommended that the Business Judgment Rule be introduced into China and the legislation in respect of director accountability be strengthened,while the direc tors fiduciary duty and other supporting systems be improved,with the reference of the U.S.practice,to clarify the legal boundary between rights and responsibilities of directors.

Unlicensed Personnel’s Experience of Digital Signing for Medication Administration in Municipal Healthcare

Aim: To describe unlicensed personnel’s experience of digital signing lists via a smartphone application for the distribution of medication in municipal healthcare in Western Sweden. Design: A qualitative and quantitative design was used. Methods: The study included 48 unlicensed personnel, 28 of whom answered an open-ended questionnaire, while an additional 20 volunteered for individual interviews. The material was analysed by qualitative content analysis. Results: The results indicate that digital signing lists via a smartphone application are feasible, and efficient and facilitate the work. However, some aspects negatively affected the sense of security, meetings with patients and quality of care, such as an insufficient internet signal in some rural areas, difficulty remembering the password, as well as the change of focus from patient to smartphone. To improve quality of care and the meeting with the patient, it is crucial that the technology works and that unlicensed personnel develop technical skills.

Process of Designing Robust, Dependable, Safe and Secure Software for Medical Devices: Point of Care Testing Device as a Case Study

This paper presents a holistic methodology for the design of medical device software, which encompasses of a new way of eliciting requirements, system design process, security design guideline, cloud architecture design, combinatorial testing process and agile project management. The paper uses point of care diagnostics as a case study where the software and hardware must be robust, reliable to provide accurate diagnosis of diseases. As software and software intensive systems are becoming increasingly complex, the impact of failures can lead to significant property damage, or damage to the environment. Within the medical diagnostic device software domain such failures can result in misdiagnosis leading to clinical complications and in some cases death. Software faults can arise due to the interaction among the software, the hardware, third party software and the operating environment. Unanticipated environmental changes and latent coding errors lead to operation faults despite of the fact that usually a significant effort has been expended in the design, verification and validation of the software system. It is becoming increasingly more apparent that one needs to adopt different approaches, which will guarantee that a complex software system meets all safety, security, and reliability requirements, in addition to complying with standards such as IEC 62304. There are many initiatives taken to develop safety and security critical systems, at different development phases and in different contexts, ranging from infrastructure design to device design. Different approaches are implemented to design error free software for safety critical systems. By adopting the strategies and processes presented in this paper one can overcome the challenges in developing error free software for medical devices (or safety critical systems).

A Comparison between the Corporation Law System of the United States and the Corporation Law of China

The corporation law system of the United States is greatly different from the related rules and regulations of China.In this paper,the two sides are compared only in terms of director’s duties to corporation.Because of the demand of corporation for business specialization,the shareholders of corporation are divorced from the management of corporation affairs,and thus director’s duty of loyalty and duty of care to corporation are especially important for the interests of the corporation.In the stipulation of China for the two duties,however,specific discretion standards are absent,but also unreasonably aggravated duties of director have emerged.By comparing with the corporation law of the United States,the judgment for the reasonable and unreasonable aspects of Chinese corporation law is conducive to improve the duties of director in China.