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Journal articleAl-Fageh B, Aljadhey H, Mahmoud MA, et al., 2018,
Perceived causes of prescribing errors by physicians: A qualitative study
, TROPICAL JOURNAL OF PHARMACEUTICAL RESEARCH, Vol: 17, Pages: 1415-1422, ISSN: 1596-5996- Author Web Link
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- Citations: 3
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Journal articleMurray AC, Markar S, Mackenzie H, et al., 2018,
An observational study of the timing of surgery, use of laparoscopy and outcomes for acute cholecystitis in the USA and UK
, Surgical Endoscopy, Vol: 32, Pages: 3055-3063, ISSN: 0930-2794BACKGROUND: Evidence supports early laparoscopic cholecystectomy for acute cholecystitis. Differences in treatment patterns between the USA and UK, associated outcomes and resource utilization are not well understood. METHODS: In this retrospective, observational study using national administrative data, emergency patients admitted with acute cholecystitis were identified in England (Hospital Episode Statistics 1998-2012) and USA (National Inpatient Sample 1998-2011). Proportions of patients who underwent emergency cholecystectomy, utilization of laparoscopy and associated outcomes including length of stay (LOS) and complications were compared. The effect of delayed treatment on subsequent readmissions was evaluated for England. RESULTS: Patients with a diagnosis of acute cholecystitis totaled 1,191,331 in the USA vs. 288 907 in England. Emergency cholecystectomy was performed in 628,395 (52.7% USA) and 45,299 (15.7% England) over the time period. Laparoscopy was more common in the USA (82.8 vs. 37.9%; p < 0.001). Pre-treatment (1 vs. 2 days; p < 0.001) and total ( 4 vs. 7 days; p < 0.001) LOS was lower in the USA. Overall incidence of bile duct injury was higher in England than the USA (0.83 vs. 0.43%; p < 0.001), but was no different following laparoscopic surgery (0.1%). In England, 40.5% of patients without an immediate cholecystectomy were subsequently readmitted with cholecystitis. An additional 14.5% were admitted for other biliary complications, amounting to 2.7 readmissions per patient in the year following primary admission. CONCLUSION: This study highlights management practices for acute cholecystitis in the USA and England. Despite best evidence, index admission laparoscopic cholecystectomy is performed less in England, which significantly impacts subsequent healthcare utilization.
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Journal articlePuaar SJ, Franklin BD, 2018,
Impact of an inpatient electronic prescribing system on prescribing error causation: a qualitative evaluation in an English hospital
, BMJ QUALITY & SAFETY, Vol: 27, Pages: 529-538, ISSN: 2044-5415- Author Web Link
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- Citations: 10
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Conference paperDeligianni F, Singh H, Modi H, et al., 2018,
Expertise Related Disparity in Prefrontal-Motor Brain Connectivity
, Hamlyn Symposium on Medical Robotics -
Journal articleMartin G, Ghafur S, Kinross J, et al., 2018,
WannaCry-a year on
, BMJ: British Medical Journal, Vol: 361, ISSN: 0959-8138 -
Journal articleGarfield S, Furniss D, Husson F, et al., 2018,
Use of patient-held information about medication (PHIMed) to support medicines optimisation: protocol for a mixed-methods descriptive study
, BMJ OPEN, Vol: 8, ISSN: 2044-6055- Author Web Link
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- Citations: 1
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Journal articleGarfield S, Bell H, Nathan C, et al., 2018,
A quality improvement project to increase self-administration of medicines in an acute hospital
, INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol: 30, Pages: 396-407, ISSN: 1353-4505- Author Web Link
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- Citations: 4
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Journal articleHassen Y, Singh P, Pucher PH, et al., 2018,
Identifying quality markers of a safe surgical ward: an interview study of patients, clinical staff, and administrators
, Surgery, Vol: 163, Pages: 1226-1233, ISSN: 0039-6060BACKGROUND: Postoperative care quality is variable. Risk-adjusted mortality rates differ between institutions despite comparable complication rates. This indicates that there are underlying factors rooted in how care is delivered that determines patient safety. This study aims to evaluate systematically the surgical ward environment with respect to process-driven and structural factors to identify quality markers for safe care, from which new safety metrics may be derived. METHODS: Semistructured interviews of clinicians, nurses, patients and administrators were undertaken for the study. RESULTS: In the study, 97% of staff members recognized the existence of variation in patient safety between surgical wards. Four main error-prone processes were identified: ward rounds (57%), medication prescribing and administration (49%), the presence of outliers (43%), and deficiencies in communication between clinical staff (43%). Structural factors were categorized as organizational or environmental; organizational included shortage in staffing (39%) and use of temporary staff (27%). Environmental factors considered layout and patient visibility to nurses (49%) as well as cleanliness (29%). Safety indicators identified included staff experience level (31%), overall layout of the ward, cleanliness and leadership (all 27% each). The majority of patients (87%) identified staff attentiveness as a safety indicator. CONCLUSION: This study demonstrates that there are a number of factors that may contribute to safety on the surgical ward spanning multiple processes, organizational, and environmental factors. Safety indicators identified across all these categories presents an opportunity to develop broader and more effectual safety improvement measures focusing on multiple areas simultaneously.
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Journal articleKwasnicki RM, Cross GW, Geoghegan L, et al., 2018,
A lightweight sensing platform for monitoring sleep quality and posture: a simulated validation study
, EUROPEAN JOURNAL OF MEDICAL RESEARCH, Vol: 23, ISSN: 0949-2321BackgroundThe prevalence of self-reported shoulder pain in the UK has been estimated at 16%. This has been linked with significant sleep disturbance. It is possible that this relationship is bidirectional, with both symptoms capable of causing the other. Within the field of sleep monitoring, there is a requirement for a mobile and unobtrusive device capable of monitoring sleep posture and quality. This study investigates the feasibility of a wearable sleep system (WSS) in accurately detecting sleeping posture and physical activity.MethodsSixteen healthy subjects were recruited and fitted with three wearable inertial sensors on the trunk and forearms. Ten participants were entered into a ‘Posture’ protocol; assuming a series of common sleeping postures in a simulated bedroom. Five participants completed an ‘Activity’ protocol, in which a triphasic simulated sleep was performed including awake, sleep and REM phases. A combined sleep posture and activity protocol was then conducted as a ‘Proof of Concept’ model. Data were used to train a posture detection algorithm, and added to activity to predict sleep phase. Classification accuracy of the WSS was measured during the simulations.ResultsThe WSS was found to have an overall accuracy of 99.5% in detection of four major postures, and 92.5% in the detection of eight minor postures. Prediction of sleep phase using activity measurements was accurate in 97.3% of the simulations. The ability of the system to accurately detect both posture and activity enabled the design of a conceptual layout for a user-friendly tablet application.ConclusionsThe study presents a pervasive wearable sensor platform, which can accurately detect both sleeping posture and activity in non-specialised environments. The extent and accuracy of sleep metrics available advances the current state-of-the-art technology. This has potential diagnostic implications in musculoskeletal pathology and with the addition of aler
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Journal articleFlott K, Darzi A, Gancarczyk S, et al., 2018,
Improving the usefulness and use of patient survey programmes: Views from the frontline
, Journal of Medical Internet Research, Vol: 20, Pages: e141-e141, ISSN: 1438-8871Background: A growing body of evidence suggests a concerning lag between collection of patient experience data and its application in service improvement. This study aims to identify what health care staff perceive to be the barriers and facilitators to using patient-reported feedback and showcase successful examples of doing so.Objective: This study aimed to apply a systems perspective to suggest policy improvements that could support efforts to use data on the frontlines.Methods: Qualitative interviews were conducted in eight National Health Service provider locations in the United Kingdom, which were selected based on National Inpatient Survey scores. Eighteen patient-experience leads were interviewed about using patient-reported feedback with relevant staff. Interviews were transcribed and underwent thematic analysis. Staff-identified barriers and facilitators to using patient experience feedback were obtained.Results: The most frequently cited barriers to using patient reported feedback pertained to interpreting results, understanding survey methodology, presentation of data in both national Care Quality Commission and contractor reports, inability to link data to other sources, and organizational structure. In terms of a wish list for improved practice, staff desired more intuitive survey methodologies, the ability to link patient experience data to other sources, and more examples of best practice in patient experience improvement. Three organizations also provided examples of how they successfully used feedback to improve care.Conclusions: Staff feedback provides a roadmap for policy makers to reconsider how data is collected and whether or not the national regulations on surveys and patient experience data are meeting the quality improvement needs of local organizations.
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