Narjis Fikri-Benbrahim

Terms used in patient safety related to medication: a literature review

There is a lack of homogeneity in the terminology used in the context of patient safety related to medication. The aim of this review was to identify the terms and definitions used in patient safety related to medication within the scientific literature.

Effect of a pharmacist intervention in Spanish community pharmacies on blood pressure control in hypertensive patients

PURPOSE The effect of a protocol-based pharmacist intervention on blood pressure (BP) control among treated hypertensive patients who use community pharmacies was studied. METHODS A quasi-experimental study with a control group was conducted at 13 community pharmacies in Jaén and Granada in Spain. Hypertensive patients over age 18 years who were receiving antihypertensive treatment were eligible for participation. The protocol-based intervention consisted of three components: (1) patient education about hypertension, (2) home blood pressure monitoring (HBPM), and (3) referral to a physician through personalized reports when necessary. The control group received the standard of care. BP control was assessed at the beginning and end of the study. Results Data were collected from 176 patients. In the intervention group (n = 87), significant baseline-to-endpoint reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were observed: 6.8 mm Hg (p < 0.001) and 2.1 mm Hg (p = 0.032), respectively. The changes in SBP and DBP in the intervention group at the end of the study were significantly greater than those in the control group (difference between adjusted mean change, 5.7 mm Hg for SBP [p = 0.001] and 2.6 mm Hg for DBP [p = 0.013]). The odds of achieving BP control in the intervention group was 2.46 times higher than in the control group (95% confidence interval, 1.15-5.24; p = 0.020). CONCLUSION A protocol-based community pharmacist intervention in combination with HBPM significantly reduced SBP and DBP and increased the percentage of patients with controlled BP compared with patients receiving the standard of care.

Intraocular lens dislocation in pseudoexfoliation: a systematic review and meta-analysis.

To evaluate the impact of pseudoexfoliation syndrome on intraocular lens (IOL) dislocation after phacoemulsification cataract surgery and explore possible associations related to surgical technique.

Pain Associated With Treatment of Dupuytren Contracture With Collagenase Clostridium histolyticum

PURPOSE The primary objective of this study was to quantify the degree of pain associated with collagenase Clostridium histolyticum (CCH) injection and to determine whether it is related to other factors in the intervention. METHODS A prospective study of 135 patients was performed to evaluate pain at 3 points during treatment: (1) after CCH injection, using a numerical rating scale (NRS), (2) a binary (positive/negative) assessment before manipulation 24 hours after CCH and after removing the bandage, and (3) after joint manipulation performed with wrist block anesthesia. RESULTS The average NRS for pain during infiltration was 4.7. Pain was present before manipulation in 52.6% of patients. Pain from manipulation showed an average NRS score of 3.6. The amounts of pain at CCH infiltration, pain after 24 hours, and pain from the manipulation were correlated because patients who experienced pain during CCH infiltration were more likely to report experiencing pain during manipulation. CONCLUSIONS Collagenase Clostridium histolyticum injection for treating Dupuytren contracture can be a painful process. There is a clear relationship between a patients level of pain during injection of CCH and the likelihood that the patient will experience pain during manipulation, even with the use of local anesthesia. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.

Relación entre la satisfacción laboral y la cultura de seguridad del paciente

OBJECTIVE To evaluate the relationship between safety culture and job satisfaction in a medium-stay hospital, showing the relationships between the dimensions that define both constructs and identifying the dimensions with the greatest impact on both variables. METHODS Cross-sectional study conducted in 2015, using the Basque Health Service Job Satisfaction Survey and the Spanish version of the «Hospital Survey on Patient Safety» questionnaire (Agency for Healthcare Research and Quality). Result Variables: high job satisfaction and high degree of perceived security (score ≥75th percentile). Predictor variables: socio-demographic characteristics and perception of the evaluated dimensions. The association between variables was quantified by adjusted odds ratio (OR) and the 95% confidence interval. RESULTS The mean job satisfaction was 7.21 (standard deviation [SD]: 2.01) and the mean of perceived safety was 7.48 (SD=1.98). The 75th percentile of the distribution in both cases was 9. The socio-demographic variables had little significance, while a positive perception of many of the considered dimensions, was associated with high perception of the result variables. In the data analysis were obtained multiple significant correlations and cross-relations between the dimensions that define both constructs, as well as between the degree of satisfaction of the dimensions considered and the outcome variables. CONCLUSION The results obtained evidenced the relationship between job satisfaction and safety culture and quantify the association degree between the studied variables. The adjusted OR identifies the variables most strongly associated with the effect and helps to select improvement areas.

Intraoperative complications of phacoemulsification in pseudoexfoliation: Metaanalysis

&NA; This review analyzed the effect of pseudoexfoliation (PXF) syndrome on the risk for surgical complications during phacoemulsification. Peer‐reviewed literature in Medline, Embase, Lilacs, Web of Science, and Cochrane databases was systematically searched, along with gray literature in the Teseo and National Institutes of Health clinical trials database. Clinical trial, cohort, case‐control, and cross‐sectional studies comparing phacoemulsification complications in patients with and without PXF were identified, and 22 of 30 studies were selected for analysis. Odds ratios (ORs) for posterior capsule rupture or zonular dialysis were calculated and pooled using random‐effects models. A random‐effects meta‐regression model was also generated. Using the random‐effects model, the pooled OR was 2.1363 (95% confidence interval, 1.5394‐2.9648), which corresponds to a risk of more than 10%. No significant changes to this risk were observed in the cumulative or stratified analyses. Although advances in surgical technique have been made, PXF syndrome continues to be a risk factor in phacoemulsification. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Burnout in the staff of a chronic care hospital

ABSTRACT OBJECTIVE To estimate the prevalence of Burnout in a medium or long-stay hospital, to monitor its evolution and to highlight the importance of cut-off points used to avoid distortions in the interpretation of the results. METHODS Two cross-sectional studies (2013–2016) were carried out, applying the Spanish version of the Maslach Burnout Inventory to the staff of a chronic care hospital (n = 323). Result variables were: Burnout prevalence and a high degree of affectation of the subscales and predictor variables: sociodemographic characteristics and factors that trigger and modulate the syndrome. The association between variables was quantified using odds ratio. RESULTS The participation rate went from 31.5% to 39.3%. The professionals presented a mean level of Burnout in both moments, observing a lower degree of affectation of the depersonalization subscales and personal accomplishment in the 2016 cut-off. The average score of the subscales in 2016 was 21.5 for emotional fatigue, 4.7 for depersonalization and 41.7 for personal fulfillment, compared to the values of emotional fatigue = 21.6, depersonalization = 6.9 and personal fulfillment = 36.3 obtained in 2013. The emotional fatigue score was slightly higher than the mean value of the national studies (19.9), while the rest of the values were similar to the mean values of the studies considered. The prevalence of Burnout and the interpretation of the results varied significantly according to the cut-off points considered. In both studies, sociodemographic variables showed little significance, while social support and interpersonal relationships were associated with the degree of burnout among professionals. CONCLUSIONS Our prevalence of Burnout was similar to that of other studies consulted, although the emotional component is more marked in our environment. The interpretation of the results varied significantly according to the cut-off points applied, due to the cross-cultural differences.

Evolución de la cultura de seguridad del paciente en un hospital de media-larga estancia: indicadores de seguimiento

Background. Patient safety is a challenge for health care. The aim of this study is to identify the dimensions with the greatest impact on patient safety culture of healthcare staff in a medium-stay hospital; to asses its evolution over time and to check the sensitivity of monitoring indicators. Methods. Two cross-sectional studies (2013 to 2015) were conducted. The safety culture assessment tool used was the Spanish version of the “Hospital Survey on Patient Safety” (AHRQ). Outcome variable is high perception of safety (score ≥ 75th percentile). Independent variables: socio-demographic characteristics and perceptions of the evaluated dimensions. The association between variables was quantified by Odds Ratio. Results. The mean of perceived safety was similar in both studies: (7.81 and 7.48, N 2013= 66 ; N 2015=92 ). The best aspects evaluated were: “Supervisor actions” and “Teamwork within unit”; the worst evaluated were: “Staffing”, “Management support” and “Teamwork across units”. Socio-demographic variables had little significance, while a positive perception in some of the considered dimensions was associated with high perceived safety. The most strongly associated aspects were: “Supervisor actions”, “Communication openness” and “Problems in transitions”. In the comparative study, indicators based on individual dimensions detected changes better than the assessment of the degree of perceived safety. Conclusion. The regular assessment of Patient Safety Culture makes it possible to know the status and evolution of professionals’ perceptions. The choice of appropriate indicators optimises the information obtained through these surveys.