Thanks John for replying It means start with the 3rd child then select every 4th child after that. Posting to the forum is only allowed for members with active accounts. Please sign in or sign up to post. I forgot my password. Three independent adaptations represented by solid, dotted and dashed lines, respectively were pursued for each compound.
In recent years, host cell-directed antivirals have experienced growing recognition as a new concept for the development of advanced generation antivirals with the potential to counteract the challenge of preexisting or rapidly emerging viral resistance  , . Novel automated genomics and proteomics analyses have greatly advanced our insight into host-pathogen interactions  ,  ,  ,  ,  ,  ,  , . These studies have underscored the notion that several cellular pathways are exploited for virus replication  ,  , supporting the hypothesis that a host-directed antiviral may enjoy an expanded viral target range, rendering it effective for the treatment of several related viral diseases.
Technologies applied for host-directed drug discovery include cDNA and siRNA-based microarray analyses combined with pathway-guided data mining  ,  ,  ,  ,  , loss-of-function screens using aptamers or small oligonucleotides  ,  ,  ,  ,  ,  ,  , protein array analyses  and chemical library screening  , .
By combining automated library screening  with counter screens against a variety of related viral pathogens of the myxovirus families, we have identified a candidate scaffold that, after moderate hit-to-lead chemistry, adheres to the profile of a host-directed antiviral based on several lines of evidence: I antiviral activity is host cell species-dependent, indicating specific interaction with a distinct host factor rather than a viral component. Host cell-specific activity is incompatible with compound docking to conserved viral factors.
For example, carbohydrate structures exposed on viral envelope glycoproteins that are targeted by antiviral lectins such as pradimicin A . Equivalent active concentrations argue against compound docking to distinct viral components and suggest that inhibition of distinct myxovirus families follows the same mechanism of action; III in vitro adaptation attempts to induce viral resistance were unsuccessful even after extended exposure times to the drug. A full assessment of the frequency of viral escape from inhibition by JMN will certainly need to include in vivo virus adaptation attempts in suitable animal models, since the rate of resistance build-up may vary between tissue culture and in vivo settings.
We nevertheless reliably induced resistance in less than 30 days to a pathogen-directed MeV RdRp inhibitor that was analyzed in parallel, which is fully consistent with our previous experience  and provides confidence for the validity of our overall experimental design for viral adaptation.
Current libraries of chemical analogs of JMN do not yet permit a definitive conclusion as to whether both activities adhere to discrete structure-activity relationships or are causally linked, but a bulk of experimental data demonstrate that host cell cycle arrest per se has no inhibitory effect on replication of paramyxoviruses such as MeV.
Likewise consistent with the notion that the antiviral activity of JMN is not based on cell cycle arrest itself, virus inhibition was not restricted to the context of immortalized, rapidly dividing tissue culture cell lines but extended with equal potency to primary human PBMCs. Reversible cell cycle arrest and block of virus replication indicate non-covalent docking of JMN to its target structures, which is corroborated by the compound's stability, low chemical reactivity profile and the complete absence of virucidal activity in pre-incubation settings.
An inhibition profile of JMN closely mimicking that of ASA, the pathogen-directed blocker of MeV RdRp targeting the viral L polymerase protein  , and the block in viral RdRp activity in the context of viral infection and minireplicon reporter assays by JMN consistently point towards interaction of the compound with a host cofactor essential for RdRp function as the basis for its antiviral activity.
While viral RdRp depends on a variety of host cell components  , unperturbed cellular mRNA synthesis and, thus, uninterrupted host RNA polymerase function in the presence of compound exclude interference of JMN with essential transcription initiation factors.
Recently, accumulating evidence has implicated host cell kinases as regulators of the activity of RdRp complexes of different negative-strand RNA viruses  : host cell kinases of the PI3K-Akt pathway manipulate paramyxovirus RdRp activity through Akt-mediated phosphorylation of the viral phosphoprotein, an essential component of the RdRp complex. In the case of MeV, however, published data  ,  and our own observations Krumm and Plemper, unpublished demonstrate that Akt inhibition causes a moderate reduction in virus release, whereas titers of cell-associated progeny particles remain unchanged.
While this rules out the PI3K-Akt pathway as a direct target for JMN, it illuminates the intricate regulatory interactions between pathogen and host, which provide a wealth of possible points of entry for antiviral intervention.
Future identification of the molecular target of JMN carries high potential to further our understanding of these interactions and may conceivably provide a basis for pharmacophore extraction and structure-driven scaffold optimization. We note that the central sulfur in the JMN chemical scaffold could potentially render the molecule vulnerable to rapid phase I oxidation and thus compromise both metabolic stability and bioavailability.
However, the high stability of JMN in the presence of human hepatocyte subcellular fractions and human plasma argues against an undesirable short in vivo half-life of the substance. This is corroborated by good metabolic stability of the structurally similar HIV reverse transcriptase inhibitor RDEA  ,  , which shares the central 2-thio-acetamide connector with JMN and has achieved success in clinical trials: the compound was well tolerated in both Phase 1 and 2a studies after single or multiple oral doses and showed no drug-related CNS toxicity  ,  , creating a clinical precedence for the applicability of the broader scaffold.
Although RDEA follows a different mechanism of action than JMN and lacks any anti-paramyxovirus activity, the structural similarities provide sufficient confidence for the overall developmental potential of the JMN class to recommend it as a promising candidate for advanced synthetic optimization towards preclinical validation and development.
In toto , we have identified a novel chemical class of viral inhibitors that block viral RdRp activity with a host factor-mediated profile. A complete activity workup after synthetic identification of a clinical lead analog will be required to fully appreciate the range of the different viral families inhibited by the substance.
However, we consider human pathogens of the myxovirus families that are primarily associated with acute disease among the most suitable for host-directed antiviral efforts due to anticipated short treatment regimens. While we cannot exclude that resistance to JMN may eventually emerge in in vivo settings, our in vitro adaptation efforts support the hypothesis that the mechanism of action of this compound class establishes a strong barrier against rapid viral escape from inhibition.
Lipofectamine Invitrogen was used for cell transfections. Red blood cells were lysed with RBC lysis solution Sigma , followed by repeated washing of extracted PBMCs with phosphate buffered saline and transfer to tissue culture plates pre-coated with poly-L-lysine Sigma. Other primary human cell lines were obtained from PromoCell, Germany. Cell-associated paramyxovirus and vaccinia virus particles were harvested by scraping cells in OPTIMEM Invitrogen , followed by release of virus through two consecutive freeze-thaw cycles.
Influenza virus and sindbis virus particles were harvested from cell culture supernatants. Primers and probe are based on recent reports  and universally reactive with all influenza A strains including the recent S-OIV H1N1 isolates.
For each TaqMan reaction, fold serial dilutions of the linearized plasmid ranging from 10 7 to 10 1 were amplified in parallel. At 96 hours post-infection, cell monolayers were subjected to crystal violet staining 0. When vehicle treated controls approached the end of the logarithmical growth phase, progeny viral particles were harvested and titered by TCID 50 titration, plaque assay or TaqMan real-time PCR, respectively, as described above.
Plotting virus titers as a function of compound concentration allowed quantitative assessment of resistance. A non-radioactive cytotoxicity assay CytoTox 96 Non-Radioactive Cytotoxicity Assay, Promega was employed to determine the metabolic activity of cell after exposure to the compound. Substrate was then added and color development measured at nm using a BioRad plate reader.
Values were plotted in dose-response curves and, if applicable, CC 50 concentrations calculated. JMN was mixed with liver S9 fractions protein concentration 2. Positive controls to assess the metabolic competency of the liver S9 fractions were 7-Ethoxycoumarin, Propranolol, and Verapamil Sigma , which were analyzed in parallel to the article.
To determine compound plasma stability, articles were mixed with freshly prepared human plasma at a final concentration of 0. Values are expressed as percent of compound remaining at each time relative to the amount of that compound present at the starting time point. For comparison, unstained and stained, solvent-only exposed cells were examined in parallel. For densitometry, signals were quantified using the QuantityOne software package Bio-Rad.
Cells were reseeded as before when fastest growing cultures approached confluency. Growth rates were calculated for each hour time interval using the Prism software package GraphPad Software Inc. Melting curves were generated at the end of each reaction to verify amplification of a single product.
Final quantification was based on three independent experiments in which each treatment condition and RT primer setting were assessed in triplicate. Samples were standardized for GAPDH as before and normalized values expressed relative to the equally analyzed vehicle-treated controls. Single transfections of plasmids encoding MeV F served as controls. Four hours post-overlay, cells were lysed using Bright Glo lysis buffer Promega , and the luciferase activity determined in a luminescence counter PerkinElmer after addition of Britelite substrate PerkinElmer.
The instrument's arbitrary values were analyzed by subtracting the relative background provided by values of the controls, and these values were normalized against the reference constructs indicated in the figure legends.
Reference wells were kept at 1. Cell-associated viral particles were harvested 24 hours post-infection and infectious titers determined by TCID 50 titration. Immediately before infection, cells were reseeded at a density of 2. Inocula were replaced with growth media four hours post-infection and cells incubated for approximately 20 hours.
Cell-associated viral particles were then harvested and infectious titers determined by TCID 50 titration. Controls received vehicle only. All wells were harvested 19 hours post-infection and titers of cell-associated progeny virus determined by TCID 50 titration.
Control wells included identical amounts of reporter and helper plasmids but lacked the L-encoding plasmid. At the time of transfection, JMN was added as specified, while control wells received vehicle only for comparison. Thirty-six hours post-transfection, cells were lysed with Bright GLO lysis buffer and relative luciferase activities determined using the Britelite substrate and a luminescence counter as outlined above. Adaptations were carried out essentially as we have previously described .
Equally infected cells treated with the virus polymerase targeted RdRp inhibitor ASA were examined in parallel. When cultures became over confluent, cells were reseeded for continued incubation in the presence of the same compound concentration as before. At detection of extensive cell-to-cell fusion, cell-associated viral particles were harvested, diluted fold and used for parallel infections of fresh cell monolayers in the presence of compound at unchanged and doubled concentrations.
Cultures treated with the highest compound concentrations in which virus-induced cytopathicity became detectable were used for further adaptation. We are grateful to D. Liotta and R. Hammond for critical reading of the manuscript. Steinhauer Emory University , respectively. Polyphyletic evolution of the ECM lifestyle is marked not only by convergent losses of different components of the ancestral saprotrophic apparatus but also by rapid genetic turnover in symbiosis-induced genes Kohler et al.
The ECM symbiosis is the most prominent mycorrhiza occurring in forest ecosystems. Thus, this mutualistic interaction relies on a constant nutrient exchanges between partners and contributes to better tree growth and health by improving mineral nutrition, strengthening plant defenses and directly contributing to the exclusion of competitive microbes Wallander et al.
Fungi release in the extracellular matrix a wide range of proteins to decay their substrates and to interact with their microbial, plant, or animal competitors and partners Stergiopoulos and de Wit, ; Tian et al. The fungal secretomes are composed of several protein categories, including proteases, lipases, Carbohydrate-Active enZymes CAZymes , secreted proteins of unknown function and small-secreted proteins SSP Alfaro et al.
These secreted proteins either participate in organic matter degradation with hydrolytic enzymes such as CAZymes Zhao et al. ECM fungi have a reduced set of plant cell wall-degrading enzymes Kohler et al. This MiSSP is targeted to the host-plant nuclei where it interacts with the jasmonate co-receptor JAZ6 suppressing the plant defense reactions and allowing the development of the apoplastic Hartig net Plett et al.
However, despite their ecological importance, little is known about the secretome of ECM fungi as most published analyses focused on the full genome repertoire of CAZymes, either secreted or not Kohler et al.
Only a few studies combined both in silico prediction of secretome and proteomic analysis of secretome Vincent et al. To investigate whether the various components of the fungal secretome CAZymes, proteases, lipases, SSPs differ between ECM, pathogenic and saprotrophic species, we predicted, annotated and compared the secretomes of 49 fungal species, including 11 ECM symbionts recently sequenced Kohler et al.
Using this large set of predicted gene repertoires, we showed that the secretome size is not related to the fungal lifestyle. Predicted secreted proteins contain an N-terminus type II secretion signal peptide, no transmembrane domain and do not contain sequences that retain them in organelles mitochondria, plasts, ER, Golgi, etc. Within the Basidiomycota, soil decayers and white-rot fungi display the largest secretomes.
Most of the 49 secretomes analyzed Plant pathogenic fungi have the largest proportion of secreted proteins. The size of the secretome from pathogenic- and white rot-fungi correlates with their proteome size, with a correlation coefficient r 2 of 0.
In contrast, the secretome size from brown-rot decayers and ECM fungi does not correlate with the proteome size as they display a correlation coefficient of 0. The fungi with the smallest secretomes are the ECM Tuber melanosporum , the mycoparasitic Tremella mesenterica , the litter decayer Phycomyces blakesleeanus , the plant biotrophic pathogen Ustilago maydis and the yeast Pichia stipitis.
Pipeline used to identify and annotate fungal secretome. Prediction uses combined characteristics: proteins with signal-peptide as detected by SignalP v4. Secretome size and richness in Small Secreted Proteins of each fungal species.
Species are ordered according to their lifestyles. Secretome size number of proteins is indicated on the y-axis. Size of the dot indicates richness in SSPs number of proteins. Data obtained with Spherobollus stellatus and Auricularia subglabra have to be taken with caution due to poor annotation quality.
Most of the PFAM domains identified in secreted proteins are related to enzymatic activities [proteases, lipases, and glycosyl hydrolases GH ]. PFAM enrichment analysis in secreted proteins compared to non-secreted proteins has been performed according to Saunders et al. Enriched PFAM domains shared by all members of one fungal lifestyle plant pathogen, white rot, brown rot, litter decayers, and ectomycorrhizal are shown.
Our analysis then focused on four categories i. In this study, we defined SSPs as predicted secreted proteins smaller than amino acids. Global composition of 49 fungal secretomes. Sizes of secretomes are presented as absolute number.
Bars represent number of proteins in each category of secreted proteins. Phylogenetic tree is adapted from Kohler et al. A detailed analysis of the CAZyme families and their evolution is provided in Kohler et al. We then subdivided the proteases into exoproteases and endoproteases. No significant differences were found between biotrophic and saprotrophic species Supplementary Image 3 , indicating that ECM fungi have conserved the protease ability of their saprotrophic cousins.
Fungal secretome's composition in exoproteases and endoproteases. The secreted proteins were subdivided in two main categories: exoproteases and endoproteases. Exoproteases: S08 Subtilisin family ; S09 carboxypeptidase family ; M28 aminopeptidase family. Lipases are the less represented secreted proteins, regardless of the fungal lifestyles.
The secretome of the white-rot fungus S. ECM fungi display a low repertoire of filamentous fungal lipases compared with white rot fungi Supplementary Image 4.
Lipasic ability of fungal secretome. There is a positive correlation between the number of SSPs and the secretome size, with the largest secretomes having the highest number of SSPs Supplementary Image 1B. Boxplots showing proportion of SSP in secretome across lifestyles gray and proportion of species-specific SSPs, defined as SSPs with no homology in other species white. Only fungal lifestyles containing at least five fungal species have been taken in account. Only the latter clusters have been kept for further analysis.
Most of the defined clusters are species-specific clusters with only one species Supplementary Data sheet 2. Shared Small-Secreted Proteins among four different lifestyles. A Number of clusters involving at least three different species. C Phylogenetic tree inferred from bootstraps using maximum likelihood phylogeny of the largest cluster containing SSPs from both ECM fungi and each of saprotrophic fungal species white rot, brown rot, litter decayer.
Bootstrap values are shown at the corresponding node. Colors indicate fungal lifestyle and orders of the different fungi are given.
List of clusters containing only small-secreted proteins from ectomycorrhizal fungal species ECM , both ectomycorrhizal and saprotrophic fungal species and only saprotrophic fungal species white rot, brown rot, litter decayers. Two clades are highly supported by bootstraps. These two clades are highly consistent with taxonomy and are thus not independent from it.
Most interestingly, clade I is enriched but not exclusively with ECM fungi, whereas clade II is enriched but not exclusively with saprotrophic fungi. What do doctors mean when they talk about teamwork? Possible implications for interprofessional care. Full-text available. Oct The concept of teamwork has been associated with improved patient safety, more effective care and a better work environment. However, the academic literature on teamwork is pluralistic, and there are reports on discrepancies between theory and practice.
We also investigate what doctors think is important in order to achieve good teamwork, and how the empirical findings relate to theory. Finally, we discuss the methodological implications for future studies.
The research design was explorative. The main data consisted of semi-structured interviews with twenty clinically active doctors, analyzed with conventional content analysis. Additional data sources included field observations and interviews with management staff. The only characteristic they shared in common was that team members should have specific roles. This could have consequences for practice, because the rationale behind different behaviors depends on how teamwork is conceptualized.
Several of the teamwork-enabling factors identified concerned non-technical skills. It is noted by Makary and his colleagues , and Mill . Assessment of non-technical skills of operating room nurses. Anna Ribakova Liana Deklava. Training of non-technical skills helps to achieve reduction of human errors that could contribute to safety of patients. For assessment of non-technical skills of Operating Room OR nurses, researchers of the University of Aberdeen developed intra-operative work organization protocol for observation of non-technical behaviour.
This system includes taxonomy of non-technical skills, definitions, desirable and adverse behavioural markers, and Likert scale for behavioural assessment. The objective of this research is to assess non-technical skills of OR nurses in work environment and compare the findings with OR nurses self-assessment of non-technical skills.
The study involved 15 interviews with OR nurses in sterile position scrub nurses and 15 observations of their work in four hospitals. Providing self-assessment, OR nurses note a tendency to minimal communication. In practice, nurses often show good ability to think analytically, to predict events and needs and are able to act decisively during surgery. OR nurses in Latvia partially associate their work with non-technical skills, however in practice these skills are used, and they were relatively highly valued during the study.
Insufficient self-assessment of such skills of nurses as cooperation in performance of physical tasks, promotion of personnel safety and decisive action, indicates the need for development of scrub nurse's work standards with clearly defined area of responsibility and duties.
Implementation a safe surgery and handoff protocol in a pediatric cardiac surgery program in Latin America. Perioperative safety is essential in pediatric cardiac surgery programs and implementation of high reliability practices in them has been recommended to improve outcomes. Such practices include institution of surgical checklist, perfusion verification checklist, transfer protocol of critical patients, and a safe handover checklist to the cardiovascular intensive care unit, along with other strategies in order to achieve success.
In our Division we promoted effective communication between medical and paramedical staff in order to establish a safe perioperative attention program, and without being able to attribute outcomes completely to it, we observed an important reduction in mortality since its institution.
We describe all the stages related with the implementation of a edigraphic. All rights reserved. Such tools serve as building blocks for Robust Process Improvement capability and sometimes even overlap with Robust Process Improvement methods. For example, includ- ing evidence of system-focused tools for example, use of chart review or Health Failurecare Mode and Effects Analysis in the Background: The lack of a tool for categorizing and differentiating hospitals according to their high reliability organization HRO -related characteristics has hindered progress toward implementing and sustaining evidence-based HRO practices.
Hospitals would benefit both from an understanding of the organizational characteristics that support HRO practices and from knowledge about the steps necessary to achieve HRO status to reduce the risk of harm and improve outcomes. A study was conducted to examine the content validity of the HRHCM model and evaluate whether it can differentiate hospitals' maturity levels for each of the model's components. Methods: Staff perceptions of patient safety at six US Department of Veterans Affairs VA hospitals were examined to determine whether all 14 HRHCM components were present and to characterize each hospital's level of organizational maturity.
Results: Twelve of the 14 components from the HRHCM model were detected; two additional characteristics emerged that are present in the HRO literature but not represented in the model-teamwork culture and system-focused tools for learning and improvement. Each hospital's level of organizational maturity could be characterized for 9 of the 14 components.
Discussion: The findings suggest the HRHCM model has good content validity and that there is differentiation between hospitals on model components. Additional research is needed to understand how these components can be used to build the infrastructure necessary for reaching high reliability. Some evidence has shown that individual members of surgical teams possess different perceptions of their combined culture of teamwork, communication, and collaboration, and this has important implications for ethical decision making.
Deep Brain Stimulation as Clinical Innovation. Emily Bell Philip Leger. However, there are rare circumstances in which DBS could be offered to psychiatric patients as a form of surgical innovation, therefore potentially blurring the lines between these research trials and health care.
In this article, we discuss the conditions under which surgical innovation may be accepted as a practice falling at the frontiers of standard clinical care and research per se. However, recognizing this distinction does not settle all ethical issues.
Our article offers ethical guideposts to allow clinicians, surgical teams, institutions, and international review boards to deliberate about some of the fundamental issues that should be considered before surgical innovation with psychiatric DBS is undertaken. We provide key guiding questions to sustain this deliberation.
Then we review the normative and empirical literature that exists to guide reflection about the ethics of surgical innovation and psychiatric DBS with respect to general ethical questions pertinent to psychiatric DBS, multidisciplinary team perspectives in psychiatric DBS, mechanisms for oversight in psychiatric DBS, and capacity and consent in psychiatric DBS. The considerations presented here are to recognize the very specific nature of surgical innovation and to ensure that surgical innovation in the context of psychiatric DBS remains a limited, special category of activity that does not replace appropriate surgical research or become the standard of care based on limited evidence.
Although seemingly diverse and unrelated, the common thread among the chapters of this final volume of The Vignettes is the continued demonstration of the critical importance of teamwork within our increasingly complex health-care systems.
Again highlighted are the key elements of communication, collaboration, and coordination  . Feb Patient safety PS is inextricably linked to quality of care.
In the value-driven paradigm of modern health-care systems, focus on these critical elements is required for institutions wishing to stay relevant and competitive. This is the fourth and final volume of the Vignettes in Patient Safety. The previous three volumes featured a total of 31 chapters, covering a multitude of topics in PS and related fields. Discussed among a variety of concepts were PS education, institutional culture, application of evidence-based practices, handoff communication, disruptive behaviors, fatigue and burnout, team collaboration, and a plethora of discipline-specific topics.
The current book adds eight additional chapters, including in-depth discussions on communication, medication errors, patient safety culture, alarm fatigue, radiation safety, complications of intravenous therapy, as well as health-care policy and operations. The loss of confidence in our cohort's patient safety skills that ac- companied the transition from a classroom to clinical setting suggests that workplace culture detrimentally impacts on nurses' confidence levels.
This notion is supported by the findings of several studies that have shown that nurses have less positive perceptions of collaboration and communication than physicians Mills et al. Such differences in perceptions tend to result from physicians' privileged position within the healthcare system Leape et al.
Performance based situation awareness observations in a simulated clinical scenario pre and post an educational intervention. Feb Nurse Educ Pract. RenderX CPR competence among future physicians is mirrored by our previous results that demonstrated differences in self-efficacy beliefs before virtual world training among males and females .
In medicine, insufficient teamwork skills have been identified as a common cause for suboptimal performance and harm  .
This problem also seems to be true during CPR [36,37]. Dec Background: Emergency medical practices are often team efforts. Training for various tasks and collaborations may be carried out in virtual environments.
Although promising results exist from studies of serious games, little is known about the subjective reactions of learners when using multiplayer virtual world MVW training in medicine. Methods: Twelve Swedish medical students participated in semistructured focus group discussions after CPR training in an MVW with partially preset options. Using qualitative methodology, discussions were analyzed by a phenomenological data-driven approach.
Quality measures included negotiations, back-and-forth reading, triangulation, and validation with the informants. We interpreted the results, compared them to findings of others, and propose advantages and risks of using virtual worlds for learning.
Conclusions: Beneficial aspects of learning CPR in a virtual world were confirmed. To achieve high participant engagement and create good conditions for training, well-established procedures should be practiced.
Furthermore, students should be kept in an active mode and frequent feedback should be utilized. It cannot be completely ruled out that the use of virtual training may contribute to erroneous self-beliefs that can affect later clinical performance. On the other hand, a multi-specialized operation room in Al-Zahra health center which has a total of 20 operating rooms for different specialties and meanwhile has the highest number of samples among all health centers, received a considerable mean score for the attitude and gained the third place.
According to a study by Mills et al. But in the study of Kalantari et al. Akram Aarabi elahe mousavi. The influence of situation awareness training on nurses' confidence about patient safety skills: A prospective cohort study. Background: Several studies report that patient safety skills, especially non-technical skills, receive scant attention in nursing curricula.
Hence, there is a compelling reason to incorporate material that enhances non-technical skills, such as situation awareness, in nursing curricula in order to assist in the reduction of healthcare related adverse events. Objectives: The objectives of this study were to: 1 understand final year nursing students' confidence in their patient safety skills; and 2 examine the impact of situation awareness training on final year nursing students' confidence in their patient safety skills.
Methods: Participants were enrolled from a convenience sample comprising final year nursing students at a Western Australia university. Self-reported confidence in patient safety skills was assessed with the Health Professional in Patient Safety Survey before and after the delivery of a situation awareness educational intervention. However, confidence in patient safety skills significantly decreased between settings i.
Conclusion: The educational intervention delivered in this study did not seem to improve confidence in patient safety skills, but substantial ceiling effects may have confounded the identification of such improvement.
Further studies are required to establish whether the findings of this study can be generalised to other university nursing cohorts. Teamwork in health services provide increase in the performances and the satisfaction and decrease in the stress levels of health service officials as well as the benefits for the patients such as: obtaining safe patient care, increase in the service quality, decrease in recovery time.
For this reason, in health services, it is important to apply a sufficient teamwork and to measure and improve teamwork.
Coordination of cancer care between family physicians and cancer specialists: Importance of communication. Objective: To explore health care provider HCP perspectives on the coordination of cancer care between FPs and cancer specialists. Design: Qualitative study using semistructured telephone interviews. Setting: Canada. Using a constructivist grounded theory approach, telephone interviews were conducted with HCPs involved in cancer care.
Invitations to participate were sent to a purposive sample of HCPs based on medical specialty, sex, province or territory, and geographic location urban or rural. A coding schema was developed by 4 team members; subsequently, 1 team member coded the remaining transcripts. The resulting themes were reviewed by the entire team and a summary of results was mailed to participants for review.
Main findings: Communication challenges emerged as the most prominent theme. Five key related subthemes were identified around this core concept that occurred at both system and individual levels. System-level issues included delays in medical transcription, difficulties accessing patient information, and physicians not being copied on all reports. Individual-level issues included the lack of rapport between FPs and cancer specialists, and the lack of clearly defined and broadly communicated roles.
Conclusion: Effective and timely communication of medical information, as well as clearly defined roles for each provider, are essential to good coordination of care along the cancer care trajectory, particularly during transitions of care between cancer specialist and FP care. Despite advances in technology, substantial communication challenges still exist. This can lead to serious consequences that affect clinical decision making.
Mar J Perioperat Pract. Arron Gill. Effective teamwork in the operating theatre is important for safe patient care. In robotic surgery, the surgeon is physically separated from the operating theatre team, which could potentially have an impact on teamwork.
Smart pumps are designed with drug-specific safety software to help nurses solve programming errors [15, 16]. However, this fully integrated approach is still rare [15, 16]. Jan Secure systems aimed at preventing medication error are the essential.
Our objective was to describe and map the medication system of a large hospital in Brasilia, DF, Brazil and propose risk management strategies for their principal weaknesses. For this cross-sectional, exploratory, and descriptive study, the data was collected with the support of two nurses trained by the researcher. Direct observations and semi-structured interviews of professionals involved in the medication system covered the processes: prescription, dispensing, preparation, and administration of medications.
The data collection period was from May 8 to 22, Eight nursing technicians from this study site, who are responsible for the preparation and administration of medications, participated in the study. We identified 34 activities, undertaken by different professionals, which show the complexity and greater possibility of error. The weaknesses identified include interruptions, displacement, environmental problems, human resources, lack of patient identification, infrastructure, technical problems during preparation and administration, as well as deficiencies in compliance with rules and security protocols.
It was concluded that the more the process is computerized the less weaknesses are present. Therefore, implementation of risk management strategies and the use of technologies are needed to detect and reduce risks to ensure the quality of the executed processes. Interruptions during the clinical practice of nursing, especially during the administration of medication, interferes directly on patient safety, the quality of care and workload 4, This study thus enabled a more detailed analysis of this occurrence.
This is the second most common factor among the causes for medication errors 20 that affect the risk of death Interruptions and nursing workload during medication administration process. Aug Renata Longhi Sassaki. Objective: To investigate the sources and causes of interruptions during the medication administration process performed by a nursing team and measure its frequency, duration and impact on the team's workload.
Resultados: 63 In each round, the number of interruptions that happened ranged from , for in total; these occurred mainly during the preparation phase, 97 The main interruption sources were: nursing staff - 48 The main causes were: information exchanges - 54 The increase in the mean time ranged from A nurse follows a prescription issued by the clinician, and is guided by principles called 'Five Rights' to medication administration that stipulate giving: the right drug, to the right patient, at the right dose, at the right time and using the right route 8.
This task is becoming more complex and difficult for nurses 9. Factors that contribute to AMR are directly linked to the five rights of medication administration, such that if the five rights are not followed there is ill timed dosing, inadequate antibiotics given, and this may lead to AMR There were discrepancies between what nurses said they know and what they actually do.
These findings are similar to one study where it was found that antibiotics were the leading type of drug involved in medication errors as they are widely used with variations in their fixed intervals of administration q6h, q8h, q12h, etc.
Jul Specifically for antibiotics, this helps to minimize resistance and reduce hospital costs. There is a dearth in literature on how nurses apply this standard when administering antibiotics to inpatients. Methods This was a cross sectional case study using prospective observation of 23 nurses and 49 patients with pneumonia and follow up interviews with 13 nurses.
Participants were selected between November and February The study setting was two medical wards of a tertiary hospital. Observations were guided using a checklist to collect quantitative data. This was followed by semistructured in-depth interviews with nurses. Results From the quantitative data, untimely administration of antibiotics was common,with only Nurses gave the right prescribed antibiotics in The right documentation of dose initiation and continuation occurred in This has been attributed to both a competency gap and challenges within the hospital system.
Key words: Nurses, Antimicrobial resistance. Jun Background: Adherence to 'Five Rights' of medication administration guidelines namely the right drug, the right patient, the right dose, the right time and the right route is the basic nursing standard and a crucial component in medication safety.
This study explored nurses' adherence to the 'Five Rights' of antibiotic administration and factors influencing their practices. Methods: This was a cross sectional case study using prospective observation of 23 nurses and 49 patients with pneumonia and follow up interviews with 13 nurses. This was followed by semi-structured in-depth interviews with nurses. Results: From the quantitative data, untimely administration of antibiotics was common, with only Conclusions: We found poor compliance with the 'Five Rights' of antibiotic administration.
Tang and colleagues advocate for the need to have in place pro-active management processes aimed at reducing MEs in healthcare facilities . A pro-active risk management system like the use of root-cause analysis can help reduce and prevent potential AEs. The rootcause analysis entails an analytical system that can be used to identify underlying risks that facilitate care providers, patients, and other stakeholders to commit avoidable errors .
Stubbs and colleagues also advocate the use of technology systems to increase patient safety through computerisation where errors of prescription, medications, synchronising data between departments, and information technology can be used to improve communication and reduce potential bias resulting from mislabelling, wrong spellings, and poor handwriting .
Medical errors are of economic importance and can contribute to serious adverse events for patients. Medical errors refer to preventable events resulting from healthcare interactions, whether these events harm the patient or not.
In Kuwait, there is a paucity literature detailing the causes, forms, and risks of medical errors in their state-funded healthcare facilities. The recruited healthcare professionals in this study included pharmacists, nurses, physicians, dentists, radiographers, hospital administrators, surgeons, nutritionists, and physiotherapists.
The collected data were analysed quantitatively using descriptive statistics. A total of participants filled and completed the survey questionnaire. The frequency of medical errors in Kuwait was found to be high at The common medical errors result from incomplete instructions, incorrect dosage, and incorrect route of administration, diagnosis errors, and labelling errors.
The perceived causes of these medical errors include high workload, lack of support systems, stress, medical negligence, inadequate training, miscommunication, poor collaboration, and non-adherence to safety guidelines among the healthcare professionals. To understand drug errors, it is important to distinguish one error from another . Some common medication errors are: errors of dosage, missing of doses or not completing a regimen, taking an extra dose, wrong timing, giving drugs of expired date, giving a drug to the wrong patient, preparing an incorrect dilution of a drug, failure to administer the drug, continuing to give a drug after it has been discontinued, etc.
Medication errors happen during prescribing incorrect diagnosis, an unauthorized drug, an extra dose, and an incorrect drug selection . According to Frith et al. A heavy workload, shortage of nurses, weak pharmacological knowledge, poor arithmetic skills in nurses and lack of experienced nurses per shift are the main cause of medication errors by nurses [88, ]. Haradhan Kumar Mohajan. After the Institute for Medicine's landmark report, medical errors are considered serious problems in healthcare, and attempts are taken globally to reduce them.
Medical error is believed as the second victim to the healthcare providers. At present the medical errors become great challenges for healthcare professionals, and health policy makers. These are responsible to delay in recovery of patients' diseases, and sometimes impossible to recover. Although it is true that deaths from medical errors are the grievous for the bereaved families, some of these errors are unavoidable due to the complex healthcare systems.
But most of them are avoidable and happen due to the negligence of the healthcare providers. Unfortunately, many of these errors are not disclosed to patients and their families. Reduction of these errors are necessary to maintain safe, and quality patient care for the welfare both patients and healthcare providers. Objectives of this study are to create consciousness among the patients about avoidable medical errors and to reduce the medical errors for the better treatment to the patients.
If medical errors are reduced, the sufferings of the patients will be relieved and medical costs will be decreased.
This article discusses aspects of medical errors and their effects on the patients and society. In this study an attempt has been taken to reduce medical errors in healthcare for the welfare of the global humanity.
Thus, past evidence suggests that the type of unit is an important covariate to include in the study because the number of errors reported can vary depending on the type of nursing unit. The nursing characteristics identified in the literature as being relevant to this study were: nurse education Aiken et al. The nursing unit characteristics also derived from the literature and relevant to this study included the following: nurse manager education, nurse manager tenure, unit size Shah et al.
Error reporting is the primary way that hospitals identify errors and near misses, and it is essential for organizational learning and improvement to occur. However, it is widely recognized that errors in hospitals are significantly under-reported.
As a result, there are numerous lost opportunities for health care organizations to learn from errors and improve the care delivered to patients. The purpose of this study was to use the model of work-team learning as the theoretical foundation to examine the error reporting behaviors of nurses.
A cross-sectional, descriptive design was used for the study. Data were collected from nurses and nurse managers through self-administered surveys. The research questions of the study were answered with data from up to nurses and 43 nurse managers using methods for modeling correlated outcomes.
Bootstrap confidence intervals with bias correction were used to determine the mediating effect of psychological safety. Furthermore, the results indicated that these same team factors of safety climate, leader inclusiveness, and psychological safety negatively predicted the number of error reports that nurses reported submitting over a month period.
This study lays the groundwork for future study by demonstrating the importance of safety climate, leader inclusiveness, and psychological safety to help explain error reporting by nurses.
The higher rate of medication errors may relate to the high workload and fatigue of nurses in the day shift, disturbance by nursing managers and supervisor's visits, and confusion by physicians' orders and rounds. The findings were congruent with those of a previous study by Shahin et al. On the other hand, these results contradicted with those of a study that concluded that the night shift medication error rate was consistently higher than that for the day shift Hughes, Background: Medication errors represent a serious problem in the hospital setting and remain a challenge to navigate among hospitalized patients in all departments.
Mistakes in medication administration are considered a significant issue that threatens a patient's safety and may increase their hospital stay, treatment costs, and mortality rate.
Medication errors commonly committed by nurses may include medication preparation or administration errors, which are associated with the highest risk areas in nursing practice.
Methodology: A pretest-posttest, quasi-experimental, observational design was used. Convenience sampling was employed to include all intravenous medication errors committed by nurses in three ICUs of Jordan University Hospital pretest: errors and post-test: 68 errors, respectively.
A designed incident report was used for data collection. Data collection was carried out simultaneously in the three ICUs during nurses' preparation and administration of intravenous medications over two months for pretest and posttest data May and June A tailored evidenced-based educational program designed using Phillips's Manual of I. Therapeutics: Evidence-based Practice for Infusion Therapy was furnished to all registered nurses utilizing structured classroom lectures and on-the-job training; moreover, educational medals of common medications and illustration posters were used as additional reminders.
Results and Conclusion: More than half of nurses were females and held bachelor's degrees. Half of the observed medication errors were identified in the surgical ICU. Intravenous medication errors observed during the day shift were significantly higher in number than those in the night shift. A significant reduction in the number of medication errors was noted after the implementation of a bundle of interventions i.
Giving 1 an omeprazole push and then 2 administering vancomycin rapidly thereafter, followed by 3 administering omeprazole at the wrong time, were the three most observed medication errors in BioBacta the ICUs. Most medication errors were not reported officially using incident reports. Based on the category of the intravenous medication error, 'wrong medication rate' followed by 'wrong medication time', and then 'mixing the medication with another drug' were the most prominent errors noticed.
The rate of reported medication errors was significantly higher after program implementation. An ongoing surveillance system is required to monitor intravenous medication errors and to know the causes so as to find a solution to further decrease them and their consequences. Also, all nurses should receive an intensive specialized evidence-based educational program about medication handling, utilizing clinical training and frequent reminding.
Shahin, M. Journal of Bioscience and Applied Research. Al-Dawailie in his practice report described that a huge variety of errors were associated with hand written prescribing practice as our study reported at site 2 with HWP . A cross-sectional study: medication safety among cancer in-patients in tertiary care hospitals in KPK, Pakistan. Background: Medication safety in cancer patients receiving complex medication regimens is an important problem in various settings.
Medication related events, interceptions and interventions are not well described in this area. We intended to study incidence, types, settings and stages involved, root cause analysis, medication classes involved and the level of harm cause by medication errors in two hospitals providing oncology services comparatively. The severity of incidents and interventions are studied. Methods: It was a prospective cross sectional study among cancer in-patients of two tertiary care hospitals of KPK.
Potential ADEs incidence was found high at site 2 Most events occur at prescribing level Types highly reported involved improper dose Medications involved in these incidents were antibiotics 44 and Severity of 3.
Root causes were human factors Contributing factors including staff training Intervention was taken in Conclusion: Medication related events are high among cancer in-patients at the site lacking updated electronic system for medication prescribing. Proper training about medication safety, reporting and interventions are required. The most common type of medication error in this study was the wrong dose of medication, which was in line with results of several other studies [37,47e49].
The second common medication error was the wrong prescription, which was in line with results of Tang et al .
In the study of Tissot et al, the second common medication error was the wrong time and procedure . Dec Tahere Yeke Zaree. Background Patient safety and accurate implementation of medication orders are among the essential requirements of par nursing profession. In this regard, it is necessary to determine and prevent factors influencing medications errors. Although many studies have investigated this issue, the effects of psychosocial factors have not been examined thoroughly.
Methods The present study aimed at investigating the impact of psychosocial factors on nurses' medication errors by evaluating the balance between effort and reward. This cross-sectional descriptive study was conducted in public hospitals of Tehran in The population of this work consisted of nurses. A multisection questionnaire was used for data collection. Most frequent errors were related to wrong dosage, drug, and patient. Conclusion It seems that several factors play a role in the occurrence of medication errors, and psychosocial factors play a crucial and major role in this regard.
Therefore, it is necessary to investigate these factors in more detail and take them into account in the hospital management. Experts estimate, that among other factors caring culture is also needed for patient safety, however, there is a lack of research confirming the link between caring culture and quality indicators and patient safety.
Therefore, we wanted to research perception of causes of errors in medication administration, barriers of reporting, estimation of reported errors and caring culture expressed as caring of care providers, co-workers, managers and in a working environment and determine their correlations. Methods: A multicentre cross-sectional observational study using mixed methods sequential explanatory design was conducted on a population of employees in nursing working on internal and surgical wards in eleven Slovenian hospitals.
Data within quantitative strand were gathered using five psychometric valid and reliable questionnaires and then analysed using descriptive and inferential statistics. The grounded theory approach was used within qualitative strand.
Data were gathered using open ended survey questions and semi-structured interviews. Results: Results showed there are organizational and individual causes of medication errors. Nurse staffing and work processes, physician communication and knowledge were assessed with highest average values. Underreporting is influenced by several factors at the organizational and individual level. Response and fear were found with highest average values.
Results also showed that perception of medication administration error causes, reporting barriers and estimation of reported errors are dependent on certain demographic characteristics of individuals, wards and institutions.
Caring culture is average, as respondents assessed all elements of caring culture with average mean values. Person-centred climate was assessed as the average, while caring of the provider was assessed better than caring of managers and co-workers. Results of a qualitative strand provided even more in-depth insight into the researched problem. Discussion and conclusions: Caring culture is the foundation for ensuring medication administration safety, but the latter is dependent on several other mainly organizational, system factors.
A system approach is needed to manage medication administration safety. Non-punitive, non-blaming learning culture is needed on hospital wards and especially at the institutional level, so nurses can report errors without fear.
Rezultati: Ugotovili smo, da so vzroki za nastanek napak organizacijske in individualne narave. Indeed, a. Nonetheless, in this ward, every nurse is responsible for two patients and nursing workload is high. Apr Selecting the most suitable dosage form in such patients is a challenge. The current study was conducted to assess the frequency and types of errors of oral medication administration in patients with enteral feeding tubes or suffering swallowing problems.
Patients were assessed for the incidence and types of medication errors occurring in the process of preparation and administration of oral medicines. Findings Ninety-four patients were involved in this study and 10, administrations were observed. Totally, errors occurred among the studied patients. The most commonly used drugs were pantoprazole tablet, piracetam syrup, and losartan tablet.Fungi are major players in the carbon cycle in forest ecosystems due to the wide range of interactions they have with plants either through soil degradation processes by litter decayers or biotrophic interactions with pathogenic and ectomycorrhizal britpop.frostbrewjojolemaverad.infoinfo by:
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