bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Incidence and Nature of Adverse Medical Device Events in Dutch Hospitals: A Retrospective Patient Record Review Study
Authors: Porte Petra J. , Smits Marleen , Verweij Lisanne M. , de Bruijne Martine C. , van der Vleuten Cees P. M. , Wagner Cordula 
Published: March 2020

Objectives
Despite widespread use of medical devices and their increasing complexity, their contribution to unintended injury caused by healthcare (adverse events, AEs) remains relatively understudied. The aim of this study was to gain insight in the incidence and types of AEs involving medical devices (AMDEs).

Methods
Data from two patient record studies for the identification of AEs were used. Identification of AMDEs was part of these studies. Patient records of 6894 admissions of a random sample of 20 hospitals in 2011/2012 and 19 hospitals in 2015/2016 were reviewed for AMDEs by trained nurses and physicians.

Results
In 98.7% of the admissions, a medical device was used. Adverse events involving medical devices were present in 2.8% of the admissions, with 24% of the AMDEs being potentially preventable. Of all AEs, in 40%, medical devices were involved. Of all potentially preventable AEs, in 44%, medical devices were involved. Implants were most often involved in potentially preventable AMDEs.

Conclusions
Medical devices are substantially involved in potentially preventable AEs in hospitals. Research into AMDEs is of great importance because of the increasing use and complexity of medical devices. Based on patient records, most improvements could be made for placement of implants and prevention of infections related to medical devices. Safety and safe use of medical devices should be a subject of attention and further research.
Intersystem Medical Error Discovery: A Document Analysis of Ethical Guidelines
Authors: Duffy Blake , Miller Jacquelyn , Vitous C. Ann , Dossett Lesly A. 
Published: March 2020

Objectives
Patient safety programs aim to improve transparency regarding medical errors, and there is broad consensus on how providers should communicate about their own errors. How providers should respond to other providers’ errors is less clear, especially when they occur outside the provider’s facility or system (intersystem medical error discovery [IMED]). To understand what guidance is available to healthcare professionals in this scenario, we conducted a document analysis of ethical guidelines.

Methods
We searched for ethics codes primarily using databases and lists of professional associations. We used thematic analysis to examine documents in relation to our research questions: is there guidance on (a) what a provider should do after discovering another provider’s error that occurred in a different health system, (b) interacting with other providers, or (c) other subjects relevant to IMED?

Results
Our search identified 150 documents from 120 organizations. These documents contained ambiguous terminology and guidance limiting practical application to IMED scenarios, with most guidance potentially applicable to IMED rendered irrelevant to most IMED scenarios by its restriction to incompetence. In addition, guidelines often sent conflicting signals about prioritizing honesty with and autonomy of patients versus not criticizing the care provided by a fellow practitioner.

Conclusions
Ethics codes provide little guidance on communication regarding IMED scenarios, and in some cases, the guidance is internally conflicting. National professional and patient safety organizations should work to provide a framework for providers and facilities to communicate regarding these ethically and professionally challenging scenarios.
In-Hospital Fall and Fracture Risk With Conditions in the Elixhauser Comorbidity Index: An Analysis of State Inpatient Data
Authors: Davis Jonathan , Casteel Carri , Peek-Asa Corinne 
Published: March 2020

Objective
In-hospital falls (IHFs) are a significant burden to the healthcare industry and patients seeking inpatient care. Many falls lead to injuries that could be considered a hospital-acquired condition (HAC). We demonstrated how administrative data can be used to quantify how many IHFs occur and identify what conditions increase the risk for these falls.

Methods
Iowa State Inpatient Database records from 2008 to 2014 for adults older than 50 years were used to quantify IHFs, falls resulting in an HAC (HAC IHFs), and fractures during in-hospital treatment. The medical conditions used in the Elixhauser Comorbidity Index were evaluated for the risk of the separate fall-related outcomes using Poisson regression.

Results
There were 1770 records that had an IHF for an IHF rate of 0.26 per 1000 patient days. Psychoses (rate ratio = 1.95, 95% confidence interval = 1.63–2.34) and alcohol abuse (rate ratio = 1.77, 95% confidence interval = 1.40–2.24) showed the greatest increase in IHF risk. These conditions also increased the risk of HAC IHFs and in-hospital fractures. Fluid and electrolyte disorders, deficiency anemias, and chronic pulmonary disease increased the risk for IHFs/HAC IHFs but did not increase the risk of in-hospital fractures.

Conclusions
Administrative data can be used to track various fall-related outcomes occurring during inpatient treatment. Several conditions of the Elixhauser Comorbidity Index were identified as increasing the risk of fall-related outcomes and should be considered when evaluating a patient’s risk of falling.
Factors Related to Medication Administration Incidents in England and Wales Between 2007 and 2016: A Retrospective Trend Analysis
Authors: Härkänen Marja , Vehviläinen-Julkunen Katri , Franklin Bryony Dean , Murrells Trevor , Rafferty Anne Marie 
Published: March 2020

Objectives
The aims of the study were to describe medication administration incidents reported in England and Wales between 2007 and 2016, to identify which factors (reporting year, type of incident, patients’ age) are most strongly related to reported severity of medication administration incidents, and to assess the extent to which relevant information was underreported or indeterminate.

Methods
Medication administration incidents reported to the National Reporting & Learning System between January 1, 2007, and December 31, 2016 were obtained. Characteristics of the data were described using frequencies, and relationships between variables were explored using cross-tabulation.

Results
A total of 517,384 incident reports were analyzed. Of these, 97.1% (n = 502,379) occurred in acute/general hospitals, mostly on wards (69.1%, n = 357,463), with medicine the most common specialty area (44.5%, n = 230,205). Medication errors were most commonly omitted doses (25.8%, n = 133,397). The majority did not cause patient harm (83.5%, n = 432,097). When only incidents causing severe harm or death (n = 1,116) were analyzed, the most common type of error was omitted doses (24.1%). Most incidents causing severe harm or death occurred in patients aged 56 years or older. For the 10-year period, the percentage of incidents with “no harm” increased (74.1% in 2007 to 86.3% in 2016). For some variables, data were often missing or indeterminate, which has implications for data analysis.

Conclusions
Medication administration incidents that do not cause harm are increasingly reported, whereas incidents reported as severe harm and death have declined. Data quality needs to be improved. Underreporting and indeterminate data, inaccuracies in reporting, and coding jeopardize the overall usefulness of these data.
Predictors of Seclusion and Restraint Following Injurious Assaults on Psychiatric Units
Authors: Staggs Vincent S. 
Published: March 2020

Objectives
The aim of this study was to describe use of seclusion and restraint after injurious assaults by psychiatric inpatients in U.S. hospitals, including examination of hospital, unit, assaultive patient, and assault characteristics as predictors of seclusion/restraint use.

Methods
Data from 2004 to 2017 on 23,630 injurious assaults reported by 747 psychiatric units in 482 general hospitals were analyzed. Odds of seclusion, odds of three restraint types (device, hold, pharmacological), and duration of seclusion and device restraint were modeled as functions of hospital, unit, assaultive patient, and assault characteristics.

Results
Compared with teaching hospitals, nonteaching hospitals had lower rates of seclusion but higher rates of all three types of restraint. Seclusion and restraint rates were lower in government hospitals and hospitals in metropolitan settings. Pharmacological restraint was most common in for-profit hospitals; seclusion was most common in nonprofit hospitals. Episodes of seclusion and device restraint were approximately 20% shorter in teaching hospitals than in nonteaching hospitals and lasted markedly longer in federal government hospitals. Hospitals in metropolitan settings reported 30% longer time spent in seclusion, on average. Involuntary admission was associated with higher odds of seclusion, device restraint, and hold. Female patients were less likely than males to be restrained with a device, and their seclusion and device restraint episodes tended to be shorter. The number of persons injured in an assault predicted odds of seclusion and all three types of restraint. The maximum level of injury sustained predicted odds of seclusion, device restraint, and hold, as well as duration of both seclusion and device restraint. Odds of seclusion/restraint were lower when the most severely injured person was a patient rather than a clinical health care worker.

Conclusions
Inconsistencies were observed in seclusion and restraint use, which varied by hospital type, patient sex and admission status, maximum level of injury sustained, and type of person most severely injured. Thus, there may be room for improvement in hospital and unit policies and practices. More comprehensive data are needed for further research on use of seclusion and restraint in response to incidents other than injurious assault.
Social Determinants of Health and Patient Safety: An Analysis of Patient Safety Event Reports Related to Limited English-Proficient Patients
Authors: Benda Natalie C. , Wesley Deliya B. , Nare Matthew , Fong Allan , Ratwani Raj M. , Kellogg Kathryn M. 
Published: March 2020

Background
Racial and ethnic disparities in healthcare safety have persisted for decades, particularly for patients with language barriers. Previous studies have investigated the frequency and nature of safety events impacting patients with language barriers; others have proposed solutions to fix them. A gap analysis, however, of how we are currently addressing safety issues and why these efforts have not been effective is lacking.

Method
This analysis uses reports from a patient safety event reporting system. Reports contain information regarding no-harm (near miss) events and events where harm may have reached the patient. Reports occurring with patients with a preferred language other than English were extracted and analyzed to determine whether the language barrier contributed to the safety event, the language barrier was mentioned in the resolution, and themes were mentioned for addressing language barriers.

Results
A subset of 1553 events pertaining to non-English–speaking patients were first categorized as “likely” (3%), “plausibly” (10%), or “unlikely” (87%) related to the patient’s language barrier. Second, events related to the patient’s language barrier were categorized as directly addressing (19%), indirectly addressing (3%), not mentioning (69%) the language barrier, or containing insufficient information to determine whether the language barrier was addressed (7%). Third, thematic analysis revealed that the most common methods for addressing language barriers included presenting issues to interpreter services and subsequent use of interpreter services.

Conclusions
This study found that it is challenging to determine the direct role of certain social determinants of health (e.g., language barriers) in safety events. In many cases, the language barrier was not addressed in the event report. Furthermore, when the language barrier was addressed, solution themes typically involved weaker, less sustainable suggested actions.
A Systematic Review of Methods for Medical Record Analysis to Detect Adverse Events in Hospitalized Patients
Authors: Klein Dorthe O. , Rennenberg Roger J.M.W. , Koopmans Richard P. , Prins Martin H. 
Published: March 2020

Objective
In this systematic review, we evaluate 2 of the most used trigger tools according to the criteria of the World Health Organization for evaluating methods.

Methods
We searched Embase, PubMed, and Cochrane databases for studies (2000–2017). Studies were included if medical record review (MRR) was performed with either the Global Trigger Tool or the Harvard Medical Practice Study in a hospital population. Quality assessment was performed in duplicate. Fifty studies were included, and results were reported for every criterion separately.

Results
Medical record review reveals more adverse events (AEs) than any other method. However, at the same time, it detects different AEs. The costs of an AE were on average €4296. Considerable efforts have been made worldwide in health care to improve safety and to reduce errors. These have resulted in some positive effects. The literature showed that MRR is focused on several domains of quality of care and seems suitable for both small and large cohorts. Furthermore, we found a moderate to substantial agreement for the presence of a trigger and a moderate to good agreement for the presence of an AE.

Conclusions
Medical record review with a trigger tool is a reasonably well-researched method for the evaluation of the medical records for AEs. However, looking at the World Health Organization criteria, much research is still lacking or of moderate quality. Especially for the cost of detecting AEs, valuable information is missing. Moreover, knowledge of how MRR changes quality and safety of care should be evaluated.
Patient Safety Education 20 Years After the Institute of Medicine Report: Results From a Cross-sectional National Survey
Authors: Arora Sonal , Tsang Fiona , Kekecs Zoltan , Shah Nisha , Archer Stephanie , Smith Jason , Darzi Ara 
Published: March 2020

Objectives
Educating healthcare professionals in patient safety is essential to achieving sustainable improvements in care. This study aimed to identify the key constituents of patient safety education alongside its facilitators and barriers from a frontline perspective.

Methods
An electronic survey was sent to 592 healthcare professionals and educators in patient safety education in the United Kingdom. Two independent reviewers conducted a thematic analysis of the free-text data. Themes focused on effective content, learning practices and facilitators and barriers to patient safety education.

Results
Of 592 individuals completing the survey, 545 (92%) submitted analyzable responses. Interrater reliability of coding was high with Cohen k value of 0.86. Participants endorsed experiential and interactive learning as ideal modalities for delivery and expressed a need for content to be based on real clinical cases and tailored to the needs of the learners. The most commonly mentioned facilitators were standardization of methods and assessment (49%), dedicated funding (21%), and culture of openness (20%). Staffing problems and high workload (41%) and lack of accessibility of training (23%) were identified as primary barriers of efficacy and uptake.

Conclusions
This study identified key factors to the success of patient safety education in terms of content and delivery alongside facilitators and barriers. Future curricula developers and interventions should improve standardization, funding, culture, and access so as to optimize education programs to enhance patient safety.
Defining the Epidemiology of Safety Risks in Neonatal Intensive Care Unit Patients Requiring Surgery
Authors: France Daniel J. , Slagle Jason , Schremp Emma , Moroz Sarah , Hatch L. Dupree , Grubb Peter , Vogus Timothy J. , Shotwell Matthew S. , Lorinc Amanda , Lehmann Christoph U. , Robinson Jamie , Crankshaw Marlee , Sullivan Maria , Newman Timothy A. , Wallace Tamara , Weinger Matthew B. , Blakely Martin L. 
Published: March 2020

Objective
The aim of the study was to determine the incidence, type, severity, preventability, and contributing factors of nonroutine events (NREs)—events perceived by care providers or skilled observers as a deviations from optimal care based on the clinical situation—in the perioperative (i.e., preoperative, operative, and postoperative) care of surgical neonates in the neonatal intensive care unit and operating room.

Methods
A prospective observational study of noncardiac surgical neonates, who received preoperative and postoperative neonatal intensive care unit care, was conducted at an urban academic children’s hospital between November 1, 2016, and March 31, 2018. One hundred twenty-nine surgical cases in 109 neonates were observed. The incidence and description of NREs were collected via structured researcher-administered survey tool of involved clinicians. Primary measurements included clinicians’ ratings of NRE severity and contributory factors and trained research assistants’ ratings of preventability.

Results
One or more NREs were reported in 101 (78%) of 129 observed cases for 247 total NREs. Clinicians reported 2 (2) (median, interquartile range) NREs per NRE case with a maximum severity of 3 (1) (possible range = 1–5). Trained research assistants rated 47% of NREs as preventable and 11% as severe and preventable. The relative risks for National Surgical Quality Improvement Program – pediatric major morbidity and 30-day mortality were 1.17 (95% confidence interval = 0.92–1.48) and 1.04 (95% confidence interval = 1.00–1.08) in NRE cases versus non-NRE cases.

Conclusions
The incidence of NREs in neonatal perioperative care at an academic children’s hospital was high and of variable severity with a myriad of contributory factors.
Reported preexposure prophylaxis use among male sex partners of HIV-positive men: 2016–2018
Authors: Beer Linda , Tie Yunfeng , Smith Dawn K. , Fagan Jennifer L. , Shouse R. Luke 
Published: March 2020

Objective:
To estimate the proportion of US HIV-positive men who report a male HIV-negative/unknown status (HIV-discordant) sexual partner taking preexposure prophylaxis (PrEP), and the use of multiple HIV prevention strategies within partnerships.

Design:
The Medical Monitoring Project is a complex sample survey of US adults with diagnosed HIV.

Methods:
We used data collected during June 2016 to May 2018 among sexually active HIV-positive men who had at least one HIV-discordant male partner (N = 1871) to estimate the weighted prevalence of reporting at least one partner taking PrEP. Among HIV-discordant partnerships (N = 4029), we estimated PrEP use, viral suppression among HIV-positive partners, and condomless anal sex. We evaluated significant (P < 0.05) differences between groups using prevalence ratios with predicted marginal means.

Results:
Twenty-eight percent of sexually active HIV-positive MSM reported at least one HIV-discordant male partner taking PrEP. Twenty percent of HIV-discordant partners were reported to be taking PrEP; 73% were taking PrEP or the HIV-positive partner was virally suppressed. PrEP use was lower among black and Hispanic partners compared with white partners (12% and 19% vs. 27%). Fewer black than white MSM were in partnerships in which PrEP was used or the HIV-positive partner had sustained viral suppression (69% vs. 77%). Condomless anal intercourse was more prevalent in partnerships involving PrEP use and in partnerships involving either PrEP use or sustained viral suppression among the HIV-positive partner.

Conclusion:
PrEP use was reported among one in five partners, with disparities between black and white partners. Increasing PrEP use and decreasing racial/ethnic disparities could reduce disparities in HIV incidence and help end the US HIV epidemic.
Virtual Noncontrast Images From Portal Venous Phase Spectral-Detector CT Acquisitions for Adrenal Lesion Characterization
Authors: Laukamp Kai Roman , Kessner Rivka , Halliburton Sandra , Zopfs David , Gupta Amit , Große Hokamp Nils 
Published: March 2020

Objective
The aim of this study was to investigate if Hounsfield unit (HU) values from virtual noncontrast (VNC) images derived from portal venous phase spectral-detector computed tomography can help to differentiate adrenal adenomas and metastases.

Methods
Spectral-detector computed tomography datasets of 33 patients with presence of adrenal lesions and standard of reference for lesion origin by follow-up/prior examinations or dedicated magnetic resonance imaging were included. Conventional and VNC images were reconstructed from the same scan. Region of interest–based image analysis was performed in adrenal lesions and contralateral healthy adrenal tissue.

Results
The 33 lesions consisted of 23 adenomas and 10 metastases. Hounsfield unit values of all lesions in VNC images were significantly lower compared with conventional images (18.2 ± 12.6 HU vs 59.6 ± 21.7 HU, P < 0.001). Hounsfield unit values in adenomas were significantly lower in VNC images (11.3 ± 6.5 HU vs 34.1 ± 9.1 HU, P < 0.001).

Conclusions
Virtual noncontrast HU values differed significantly between adrenal adenomas and metastases and can therefore be used for improved characterization of incidental adrenal lesions and definition of adrenal adenomas.
Long-term Evaluation of Teres Major to Infraspinatus Transfer for Treatment of Shoulder Sequelae in Obstetrical Brachial Plexus Palsy
Authors: El-Gammal Tarek Abdalla , Ali Amr El-Sayed , Kotb Mohamed Mostafa , Saleh Waleed Riad , El-Gammal Yousif Tarek 
Published: March 2020

Background
The long-term results of soft tissue rebalancing procedures of the shoulder in obstetric brachial plexus palsy have been scarcely reported. The effect of this procedure on the evolution of secondary bone changes has been a subject of controversy.

Methods
Twenty-six children are included in this study. All initially had postganglionic C5-6 or C5-7 (Narakas types I and II) obstetric brachial plexus palsy, which spontaneously recovered. Children included are those who had persistent external rotation weakness with or without internal rotation contracture, nondysplastic glenohumeral joint, and functioning teres major. All had anterior shoulder release and teres major to infraspinatus transfer to correct internal rotation deformity and/or increase active shoulder external rotation. Patients were 18 males and 8 females. The right upper limb was affected in 16 patients, and the left in 10. Surgery was performed at an average age of 3.01 years (range, 1–10 years). Follow-up averaged 8.2 years (range, 5–16 years). Eight cases (30%) were followed up for 10 years or greater. Age at final follow-up averaged 10.5 years (range, 6–17.8 years).

Results
The results showed to be significant: 67 degrees (63%), 71.3 degrees (412%), and −32 degrees (−35%), respectively. There was no single recurrence of internal rotation deformity. Global Mallet score averaged 20 ± 2.7. Global abduction and external rotation averaged 3.5 ± 0.8 and 4 ± 0.3, respectively. Shoulder abduction range included an average of 45 degrees glenohumeral and 65 degrees scapulothoracic motion. Postoperative internal rotation in adduction was limited to 55.96 ± 25.65 degrees and was significantly lower that the preoperative value. Radiological measurements showed no significant differences between the operated and normal sides.

Conclusions
We conclude that the long-term results after soft tissue rebalancing, combined with open reduction when required, demonstrated significant improvement of abduction and external rotation and significant loss of internal rotation. The difference in glenoid version and humeral head subluxation continued to be insignificant compared with the normal side.