bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adding Contralaterally Controlled Electrical Stimulation of the Triceps to Contralaterally Controlled Functional Electrical Stimulation of the Finger Extensors Reduces Upper Limb Impairment and Improves Reachable Workspace but not Dexterity
Authors: Knutson Jayme S. , Makowski Nathaniel S. , Harley Mary Y. , Hisel Terri Z. , Gunzler Douglas D. , Wilson Richard D. , Chae John 
Published: March 2020

Objective
Different methods of neuromuscular electrical stimulation may be used for poststroke upper limb rehabilitation. This study evaluated the effects of contralaterally controlled functional electrical stimulation of the triceps and finger extensors.

Design
This is a randomized controlled trial of 67 participants who were less than 2 yrs poststroke and assigned to the following: (a) arm + hand contralaterally controlled functional electrical stimulation, (b) hand contralaterally controlled functional electrical stimulation, or (c) arm + hand cyclic neuromuscular electrical stimulation. Participants were prescribed 10 sessions/week of assigned electrical stimulation at home plus 24 sessions of functional task practice in the laboratory for 12 wks. The primary outcome measure was the Box and Blocks Test. Secondary measures included reachable workspace, Upper Extremity Fugl-Meyer, Stroke Upper Limb Capacity Scale, Arm Motor Abilities Test, and Motor Activity Log.

Results
There were no significant between-group differences on the Box and Blocks Test. At 6 mos after treatment, arm + hand contralaterally controlled functional electrical stimulation improved reachable workspace more than hand contralaterally controlled functional electrical stimulation, between-group difference of 264 (95% confidence interval = 28–500) cm2 and more than arm + hand cyclic neuromuscular electrical stimulation, between-group difference of 281 (95% confidence interval = 22–540) cm2. Arm + hand contralaterally controlled functional electrical stimulation improved Upper Extremity Fugl-Meyer score more than hand contralaterally controlled functional electrical stimulation, between-group difference of 6.7 (95% confidence interval = 0.6–12.7). The between-group differences on the Stroke Upper Limb Capacity Scale and Arm Motor Abilities Test were not significant.

Conclusions
Adding contralaterally controlled elbow extension to hand contralaterally controlled functional electrical stimulation does not improve on gains in hand dexterity, but it further reduces upper limb impairment and improves reachable workspace measured in the laboratory. However, these additional benefits may not be large enough to be perceived by stroke survivors when they are performing activities of daily living at home.
Utilization of Outpatient Physical and Occupational Therapy in People With Spinal Cord Injury in Germany
Authors: Martini Luiza , Maus Uwe , Bökel Andrea , Geng Veronika , Kalke Yorck-Bernhard , Liebscher Thomas , Weidner Norbert , Hoffmann Falk 
Published: March 2020

Objective
The aim of the study was to assess factors determining the utilization of physical and occupational therapy in people with spinal cord injury.

Design
Data from the German Spinal Cord Injury study conducted in 2017 were analyzed. The 12-mo prevalence of physical therapy and occupational therapy utilization was determined. To identify underlying determinants, multivariable logistic regression was used.

Results
Of 1479 participants (response = 26.4%), 72.9% were male, with a mean (SD) age of 55.3 (14.6) yrs and a mean (SD) time since injury of 14.0 (12.0) yrs; 51.2% were people with paraplegia and 66.3% had an incomplete spinal cord injury. In the past 12 mos, 78.1% received physical and 29.3% occupational therapy. Physical therapy and occupational therapy were significantly associated with time since spinal cord injury occurrence, participation in lifelong care programs, and electric wheelchair dependency. Spinal cord injury characteristics, level of impairment, and time since spinal cord injury had a greater impact on occupational therapy than on physical therapy utilization.

Conclusions
The use of physical therapy and occupational therapy is much higher in Germans with spinal cord injury than in the general population and in people with similar neurological conditions. Further research should focus on the frequency of use and the types of interventions. Guidelines for lifelong care should include recommendations on physical therapy and occupational therapy.
New Guidelines for Electrical Stimulation Parameters in Adult Patients With Knee Osteoarthritis Based on a Systematic Review of the Current Literature
Authors: Novak Sarah , Guerron Gabriela , Zou Zhiwei , Cheung Gavin , Berteau Jean-Philippe 
Published: March 2020

Objective
The goal of this systematic review was to provide guidelines for treatment parameters regarding electrical stimulation by investigating its efficacy in improving muscle strength and decreasing pain in patients with knee osteoarthritis.

Design
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard, three electronic databases (CINAHL, PubMed, and PEDro) and gray literature were used. Randomized control trials comparing electrical stimulation and conservative physical therapy were critically appraised using the 2005 University of Oxford standard.

Results
Nine randomized control trials were included in our review. First, our review confirmed that neuromuscular electrical stimulation is the most effective electrical stimulation treatment in the management of knee OA, and its efficiency is higher when combined with a strengthening program. Second, frequency of at least 50 Hz and no more than 75 Hz with a pulse duration between 200 and 400 μs and a treatment duration of 20 mins is necessary for successful treatment.

Conclusions
For the first time, our review provides standardized clinical treatment parameters for neuromuscular electrical stimulation to be included in a strengthening program for the adult patient with knee OA.

To Claim CME Credits
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives
Upon completion of this article, the reader should be able to: (1) Recall the impact of quadriceps femoris weakness on joint stability; (2) Summarize the mechanism of action of neuromuscular electrical stimulation (NMES) on reducing pain and increasing muscle strength; and (3) Plan the clinical treatment parameters of NMES to be included in a strengthening program for an adult patient with knee osteoarthritis.

Level
Advanced.

Accreditation
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Patients’ Perspectives of Diagnostic Error: A Qualitative Study
Authors: Sacco Alden Y. , Self Quinn R. , Worswick Erica L. , Couperus Cody J. , Kolli Sree S. , Muñoz Sergio A. , Carney Jan K. , Repp Allen B. 
Published: March 2020

Objectives
The Institute of Medicine (IOM) defines diagnostic error as the failure to establish an accurate or timely explanation for the patient’s health problem(s) or effectively communicate the explanation to the patient. Using this definition, we sought to characterize diagnostic errors experienced by patients and describe patient perspectives on causes, impacts, and prevention strategies.

Methods
We conducted interviews of adults hospitalized at an academic medical center. We used the framework of the IOM definition of diagnostic error to perform thematic analysis of qualitative data. Descriptive statistics were used to summarize quantitative data.

Results
Based on the IOM’s definition of diagnostic error, 27 of the 69 included patients reported at least one diagnostic error in the past 5 years. The errors were distributed evenly across the following three dimensions of the IOM definition: accuracy, communication, and timeliness. Limited time with doctors, communication, clinical assessment, and clinical management emerged as major themes for causes of diagnostic error and for strategies to reduce diagnostic error. Impacts of errors included emotional distress, adverse health outcomes, and impaired activities of daily living.

Conclusions
This study uses the recent IOM definition of diagnostic error to provide insights into diagnostic error from the patient perspective. We found that diagnostic errors were commonly reported by hospitalized adults and have a profound impact on patients’ well-being. Patients’ insights regarding potential causes and prevention strategies may help identify opportunities to reduce diagnostic errors.
Observational Study of Drug Formulation Manipulation in Pediatric Versus Adult Inpatients
Authors: Spishock Samantha , Meyers Rachel , Robinson Christine A. , Shah Pooja , Siu Anita , Sturgill Marc , Kimler Katelin 
Published: March 2020

Objectives
Medications often require manipulations to measure and administer the correct dose for pediatric patients. These manipulations pose medication safety risks. The objective of this study was to determine the frequency of drug formulation manipulations in the pediatric inpatient population and compare the findings to a parallel adult inpatient population.

Methods
Observations were conducted at four sites with 1 day of data collection per week by a randomized schedule for 5 weeks. All pediatric inpatients at each study site were included as well as an equivalent number of medication orders from adult inpatients with similar levels of care. The percentage of medication orders requiring a manipulation were evaluated and compared between pediatric and adult patients.

Results
A total of 15,722 medication orders were analyzed. Drug formulation manipulation was required in 3925 (49.9%) of 7861 pediatric orders versus 1301 of 7861 adult orders (16.6%) (P < 0.05). By pediatric service, drug manipulations were required most frequently (71.5% of orders) in the neonatal intensive care unit. The most common dosage forms requiring manipulation for pediatric patients were oral liquids (45.7% of orders) and intravenous medications (44.6% of orders). By pediatric patient age, drug manipulation was required most often in patients aged 1 to 12 months (69.8% of orders).

Conclusions
Drug formulation manipulation was three times more common in pediatric inpatient practice compared with adult inpatient practice in this study. This study demonstrated a statistically significant difference in the prevalence of drug formulation manipulation between pediatric and adult inpatients.
Reason for Exam Imaging Reporting and Data System: Consensus Reached on Quality Assessment of Radiology Requisitions
Authors: Tofighi Salar , Abedi Aidin , Salehi Sana , Myers Lee , Reddy Sravanthi , Gholamrezanezhad Ali 
Published: March 2020

Objective
The aim of this study was to reach consensus on quality assessment of clinical information in imaging requisitions using Reason for exam Imaging Reporting and Data System (RI-RADS).

Methods
A Delphi study was conducted in September 2018 with a panel of 87 radiologists with diverse levels of experience from various settings (community hospitals, private hospitals, university hospitals, and clinics), of which 74.7% completed the survey. The agreement was assessed in the following subjects: (a) presumed effect of standardization, (b) the standardized system for information, (c) the scoring system for evaluation of requisitions, and (d) the implementation of RI-RADS. The consensus threshold was set at 51% responding (strongly) agree. The rate of lawsuits preventable with clinical information was also assessed.

Results
Consensus was reached on all objectives of the study with a high level of agreement. Radiologists agreed on the need for standardization of imaging requisitions and attributed it to increased speed and accuracy of interpretations. Three categories of information were determined as key indicators of quality: impression, clinical findings, and clinical question. The scoring system is intended to grade requisitions based on the presence of these categories. Radiologists also agreed that RI-RADS will encourage physicians to improve requisitions. Among radiologists who responded to the survey, 12.6% had experienced at least one lawsuit potentially preventable with sufficient information in requisitions.

Conclusions
Reason for exam Imaging Reporting and Data System can be used as a standard for quality assessment of requisitions. Its use may improve the quality of patient care and reduce lawsuits against radiologists.
Dealing With Adverse Events: A Meta-analysis on Second Victims’ Coping Strategies
Authors: Busch Isolde M. , Moretti Francesca , Purgato Marianna , Barbui Corrado , Wu Albert W. , Rimondini Michela 
Published: March 2020

ObjectivesDespite the critical need to understand the diverse responses by second victims to adverse events, there has not been a meta-analysis examining coping by second victims. We aimed to analyze the coping strategies applied by second victims in the aftermath of adverse events.MethodsWe performed a systematic search of nine electronic databases up to October 2018 and screened additional sources, such as gray databases. Two independent reviewers conducted the search, selection process, quality appraisal, data extraction, and synthesis. In case of dissent, a third reviewer was involved to reach consensus. Quantitative studies of the frequency with which coping strategies were applied by second victims were eligible for inclusion. We calculated the overall frequency of coping strategies andI2statistic using random effects modeling.ResultsOf 10,705 records retrieved, 111 full-text articles were assessed for eligibility and 14 studies eventually included. The five most frequent coping strategies wereChanging work attitude(89%, 95% confidence interval [CI] = 80–94), Following policies and guidelines more accurately and closely(89%, 95% CI = 54–98), Paying more attention to detail(89%, 95% CI = 78–94) (task oriented),Problem-solving/concrete action plan(77%, 95% CI = 59–89) (task oriented), andCriticizing or lecturing oneself(74%, 95% CI = 47–90) (emotion oriented).ConclusionsSecond victims frequently used task- and emotion-oriented coping strategies and, to a lesser degree, avoidance-oriented strategies. To better support second victims and ensure patient safety, coping strategies should be evaluated considering the positive and negative effects on the clinician’s personal and professional well-being, relationships with patients, and the quality and safety of healthcare.
Safety Analysis of 13 Suspicious Deaths in Intensive Care: Ergonomics and Forensic Approach Compared
Authors: Tartaglia Riccardo , Prineas Stavros , Poli Daniela , Albolino Sara , Bellandi Tommaso , Biancofiore Gianni , Bertolini Guido , Toccafondi Giulio 
Published: March 2020

Objectives
Thirteen suspicious deaths occurred in an intensive care unit of Tuscany, Italy, in 2015. All patients developed sudden unexplained coagulopathy leading to severe bleeding. None of them had been prescribed heparin, but supertherapeutic concentrations of heparin were found. After a nurse was arrested on suspicion of murdering Human Factor and Ergonomics (HF/E) experts received a mandate to identify system failures. According to the judgment of the Court of First Instance on April 2019, the nurse was found guilty.

Methods
The HF/E group used a two-pronged safety analysis: understanding the conditions in which the healthcare practitioners were working in the period when the suspicious deaths emerged and reviewing the clinical records.

Results
Fourteen patients admitted to the intensive care unit in 2014 and 2015 were selected on the basis of markedly abnormal coagulation tests (n = 13) or a family member’s complaint (n = 1). In 13 cases, a massive, abrupt hemorrhage in the presence of an unexpected abnormality of coagulation tests occurred, whereas the fourteenth patient had the only prolongation of coagulation markers without bleeding. All cases examined classified as adverse events related to a coagulation disorder. Human factor and ergonomics analysis identified a number of latent and active failures that contributed to the event and provided a set of important recommendations for safety improvement.

Conclusions
When presented with a manifest, albeit suspected, wrongdoing with lethal consequences for patients, forensic investigators and safety investigators have distinctly different goals and methods. We believe that a memorandum of understanding between HF/E and forensic investigative teams provides an operative framework for allowing co-existence and fosters collaboration. The pursuit of safe care as a new emerging right for patients and balancing the right to legal justice with the right to safer healthcare merit further investigation and discussion.
Ranking Quality and Patient Safety Challenges: A Nationwide Survey of Healthcare Quality Experts From General Hospitals in Spain
Authors: Gordo Cristina , Mateo Ricardo , Labiano Juana , Núñez-Córdoba Jorge M. 
Published: March 2020

Objective
The aim of the study was to identify and rank leading healthcare quality and patient safety challenges of general hospitals in Spain.

Methods
A novel online cross-sectional survey for hospitals with 150 or more beds carried out between June and September 2018. Sample frame is hospitals of the National Catalogue of Hospitals of the Ministry of Health in Spain (N = 888). Eligibility criteria are quality experts of clinical quality and/or patient safety services of general hospitals with 150 or more beds. Challenges were ranked using a risk priority number (RPN) calculated from the product of severity, frequency, and detectability scores.

Results
Targeted hospitals were 234. The contact rate was 97.4%, representing 63% of total beds nationwide. One hundred hospitals completed the questionnaire. According to the RPN, the top five challenges were incorrect hand hygiene of health professionals (mean RPN = 334.5, SD = 198.5), ineffective interprofessional communication (mean RPN = 334.3, SD = 169.5), medication errors in transitions of care (mean RPN = 254.0, SD = 151.0), low reporting rates of patient safety incidents and adverse events (mean RPN = 252.3, SD = 176.3), and antimicrobial resistance due to inappropriate use of antibiotics (mean RPN = 243.5, SD = 158.7).

Conclusions
This pioneer study of ranking quality and patient safety challenges of hospitals in Spain provides an evidence-based and context-specific foundation for quality improvement decision-making.
Does an Orthopedic Ward Round Pro Forma Improve Inpatient Documentation?
Authors: Vukanic Danilo , Kelly Enda G. , Cleary Susan May 
Published: March 2020

Introduction
Thorough documentation is of utmost importance in a patient hospital experience. It forms an accurate record of an inpatient stay, facilitates handover between medical colleagues, and is also a legal document. Medical notes tend to be detailed and insightful on admission, but the daily ward round notes have often fallen short of expectation. With most patient records entered by junior level of staff, it is important to ensure that adequate documentation occurs.

Methods
We analyzed notes entered in patient charts at set periods and compared them against standards set out in the Royal College of Surgeons Ireland and England, as well as Medical Council guidelines from the two countries. After this, a pro forma was established to standardize the medical record keeping on patient ward rounds. Compliance with guidelines was assessed by comparing notes before introduction of the pro forma and after their introduction.

Results
Before its introduction, 0% of notes fulfilled the full criteria selected for the pro forma documentation. After intervention, there was a good initial response, with notes capturing an average 86% of the required information. A reaudit of compliance 2 months after introduction showed a 9% decrease of information completeness to 75%.

Conclusions
Introduction of a pro forma for the documentation of daily ward rounds improved compliance of ward round notes when compared with internationally recognized guidelines, with no additional time required during ward rounds. Despite improved compliance, continued effort is needed to achieve a better standard of care.
Evaluation of the Green Cross Method Regarding Patient Safety Culture and Incidence Reporting
Authors: Källman Ulrika , Rusner Marie , Schwarz Anneli , Nordström Sophia , Isaksson Stina 
Published: March 2020

Objectives
The Green Cross (GC) method is a visual method for health service staff to recognize risks and preventable adverse events (PAEs) on a daily basis. The aim was to compare patient safety culture and the number of reported PAEs in units using the GC method with units that do not.

Methods
This study has a retrospective cross-sectional design in the setting of psychiatric and somatic care departments in a Swedish hospital. In total, 1476 staff members from 62 different units participate in the study.

Results
Units who had implemented the GC method scored higher than non-GC units in overall quality. The dimensions Feedback and communication about error, Nonpunitive response to errors, Organizational learning-continuous improvement, Handoffs and transitions between units and shifts, and Teamwork within units scored significantly higher in GC units. More risks were reported in the incident reporting system in GC units than in non-GC units, but the number of PAEs was similar. Units with nursing staff who used the GC method scored higher on patient safety culture than those who did not use the method. This difference was not seen in physician units.

Conclusions
The implementation of the GC method has a positive impact on patient safety culture and PAE reporting. However, the method does not seem to have the same impact in physician units as in units with nursing staff, which calls for further investigation.