Patient Safety & Quality
Perspective | Diagnostic stewardship to prevent diagnostic error
6 Mar, 2023 | 14:18h | UTCDiagnostic Stewardship to Prevent Diagnostic Error – JAMA (free for a limited period)
Commentary on Twitter
This #Viewpoint discusses diagnostic stewardship and its uses and challenges in preventing diagnostic error. https://t.co/VtiqHsrlwU pic.twitter.com/Q0VVOPCrF2
— JAMA (@JAMA_current) March 2, 2023
An overview of systematic reviews and meta-analyses on the effect of medication interventions targeting polypharmacy for frail older adults
3 Mar, 2023 | 14:07h | UTCSummary: This overview of published systematic reviews examined the effectiveness of medication reviews on managing polypharmacy in frail older adults. The overview identified 10 systematic reviews, which included 154 studies. Medication reviews were the most common intervention, and the evidence suggests that they help reduce inappropriate medication use in frail older adults, but their impact on frailty scores and hospital admission is unclear. Pharmacist-led medication interventions were the most common, reducing inappropriate prescriptions in various settings. Tools, such as clinical decision-making computer support tools, were also found to be effective. The evidence quality ranged from moderate to critically low, highlighting the need for further research to establish if interventions directed at polypharmacy could have an impact on frailty syndromes.
Related:
RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care
Deprescribing proton pump inhibitors – Australian Journal of General Practice
Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports
Deprescribing in Palliative Cancer Care – Life
Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360
Polypharmacy Management in Older Patients – Mayo Clinic Proceedings
Eliminating Medication Overload: A National Action Plan – Lown Institute
Common ED Medication Errors: Polypharmacy – emDocs
Current and future perspectives on the management of polypharmacy – BMC Family Practice
Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international
Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety
Physicians are more burned out than ever — here’s what can be done about it
28 Feb, 2023 | 13:57h | UTCPhysicians Are More Burned Out Than Ever—Here’s What Can Be Done About It – JAMA (free for a limited period)
Related Report: Addressing Health Worker Burnout – The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Related:
AAP Clinical Report | Physician health and wellness.
M-A | Physicians suffering burnout are twice as likely to be involved in patient safety incidents.
Systematic Review | Predictors of burnout among healthcare providers.
Physician Well-being 2.0: Where Are We and Where Are We Going? – Mayo Clinic Proceedings
Assessment of Risk Factors for Suicide Among US Health Care Professionals
Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures of Health Care
Hospital administration response to physician stress and burnout – Journal of Hospital Practice
Opinion: It’s Time to Talk About Physician Burnout and Moral Injury
Systematic Review: Effect of Organization-Directed Workplace Interventions on Physician Burnout
The 3 Causes Of Physician Burnout (And Why There’s No Simple Solution) – Forbes
Physician Burnout: A Global Crisis
The Burnout Crisis in American Medicine – The Atlantic
Physician burnout costs up to $17B a year, task force says – HealthcareDive
Systematic Review: Prevalence of Burnout Among Physicians
Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction
Fatal accident calls MRI safety standards into question—are more regulations needed?
28 Feb, 2023 | 13:44h | UTC
Perspective | Beware of overdiagnosis harms from screening, lower diagnostic thresholds, and incidentalomas
27 Feb, 2023 | 13:18h | UTCSummary: This article discusses the concept of overdiagnosis and its relevance to clinical practice guidelines. Overdiagnosis is the diagnosis of a condition that, if unrecognized, would not result in symptoms or cause a patient harm during their lifetime, such as discovering a low-grade cancer that will never lead to symptoms at the end of life. But, unlike false positives, overdiagnosed individuals truly have the condition; they just don’t benefit from the diagnosis. Overdiagnosis can also result from lowering diagnostic thresholds for diagnosing a disease, which inflates diagnosis rates among patients and leads to recommendations for subsequent interventions without clear benefits. The article highlights the importance of providing accurate information to patients about the possibility and burden of overdiagnosis to inform shared decision-making and minimize the harms of screening interventions.
Related:
Overdiagnosis: it’s official – The BMJ
Overdiagnosis: what it is and what it isn’t – BMJ Evidence Based Medicine
Overdiagnosis across medical disciplines: a scoping review – The BMJ Open
Too much medical care: bad for you, bad for health care systems – STAT News
Overdiagnosis: causes and consequences in primary health care – Canadian Family Physician
Five warning signs of overdiagnosis – The Conversation
What is overdiagnosed cancer? And why does it matter? – Croakey
Blame rising cancer overdiagnosis on ‘irrational exuberance’ for early detection – STAT
A food allergy epidemic… or just another case of overdiagnosis?
An epidemic of overdiagnosis: Melanoma diagnoses sky rocket
Innovative models of healthcare delivery: an umbrella review of reviews
27 Feb, 2023 | 12:37h | UTCInnovative models of healthcare delivery: an umbrella review of reviews – BMJ Open
Cluster RCT | Effect of an antibiotic stewardship intervention to improve antibiotic prescribing for suspected UTI in older adults
24 Feb, 2023 | 13:58h | UTCSummary: The study evaluated the effectiveness of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections (UTI) in frail older adults. The study was a pragmatic, parallel, cluster-randomized controlled trial conducted in four European countries and included 1041 frail older adults aged 70 or older. The intervention involved a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. The control group provided care as usual. The primary outcome was the number of antibiotic prescriptions for suspected UTI per person year, and secondary outcomes included incidence of complications, hospital referrals, admissions, and mortality. The results showed that the intervention group had a lower rate of receiving an antibiotic prescription for a suspected UTI (0.27 per person year) compared to the control group (0.58 per person year), with no increase in complications or adverse events.
Commentary: Trial: Stewardship intervention cuts antibiotic prescribing for suspected urinary infections – CIDRAP
Related:
Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
M-A | Global and regional prevalence of multimorbidity in the adult population in community settings
22 Feb, 2023 | 12:47h | UTCSummary: The article presents a systematic review and meta-analysis of surveys that estimate the prevalence of multimorbidity among adults in community settings. The study analyzed data from 126 peer-reviewed studies, including nearly 15.4 million people from 54 countries worldwide. The overall global prevalence of multimorbidity was 37.2%, with South America having the highest prevalence, followed by North America, Europe, and Asia. The study also found that females have a higher prevalence of multimorbidity than males, and that more than half of the adult population worldwide above 60 years of age had multimorbid conditions.
Related:
Costs of multimorbidity: a systematic review and meta-analyses – BMC Medicine
Systematic review of high-cost patients’ characteristics and healthcare utilization – BMJ Open
Multimorbidity: a priority for global health research – The Academy of Medical Sciences
The global burden of multiple chronic conditions: a narrative review – Preventive Medicine Reports
Redesigning Care for High-Cost, High-Risk Patients – Harvard Business Review
Multimorbidity: clinical assessment and management – NICE Guideline
Richard Smith: The challenge of high need, high cost patients – The BMJ Blogs
Better Care for People with Complex Needs – Institute for Healthcare Improvement
Gadolinium nanoparticles detected in kidney tissue of patients after MRI with gadolinium contrast, raising safety concerns
20 Feb, 2023 | 12:24h | UTCSummary: Researchers have discovered that tiny particles of the rare earth metal gadolinium can infiltrate kidney cells, potentially causing side effects. These particles, used to enhance MRI scans, were found in human and rodent specimens in a study that used electron microscopy to detect them. Gadolinium is typically tightly bound to chelating molecules in MRI contrast agents so that it can be eliminated via the kidneys, but the researchers found that some particles can leach out and build up in tissues. This raises questions about the safety of contrast agents containing gadolinium, which are used in around 50% of MRI scans, and highlights the need for further research into the risks and potential harms associated with these agents.
Commentary: Expert left ‘astounded’ by gadolinium discovery – Health Imaging
Digital health interventions for adult patients with cancer evaluated in randomized controlled trials: scoping review
16 Feb, 2023 | 14:45h | UTC
Editorial | Top-down and bottom-up approaches to low-value care
15 Feb, 2023 | 16:08h | UTCTop-down and bottom-up approaches to low-value care = BMJ Quality & Safety
Original Study: Evaluation of the NHS England evidence-based interventions programme: a difference-in-difference analysis – BMJ Quality & Safety
Commentary on Twitter
In this editorial, @andreapatey & @christinesoong discuss combining top-down ⬇️ and bottom-up ⬆️ approaches to effectively de-implement and reduce low-value care. https://t.co/mYJHkkJpSk
— BMJ Quality & Safety (@BMJ_Qual_Saf) February 10, 2023
SR | Effect of remote patient monitoring for patients with chronic kidney disease who perform dialysis at home
15 Feb, 2023 | 15:47h | UTC
Podcast | “Things we do for no reason” pearls
14 Feb, 2023 | 10:56h | UTC#381 LIVE! Patient Centered Things We Do For No Reason – The Curbsiders
Consensus Statement | Development of an Enhanced Recovery After Surgery (ERAS) surgical safety checklist
10 Feb, 2023 | 14:03h | UTC
Commentary from the author on Twitter (thread – click for more)
The @WHO Surgical Safety Checklist and the @ErasSociety guidelines come together.🔥
#ERAS teams can leverage 2 tools in 1 to improve care in critical perioperative communication moments https://t.co/EaXYyj7b56
via @JAMANetworkOpen part of @JAMANetwork pic.twitter.com/WHJMjThubO— Mary Brindle (@MaryEBrindle) February 8, 2023
Review | Recommendations for reducing exposure to medical X ray irradiation
10 Feb, 2023 | 13:43h | UTCRecommendations for reducing exposure to medical X‑ray irradiation (Review) – Medicine International
M-A | Incidence and characteristics of adverse events in pediatric inpatient care
9 Feb, 2023 | 13:32h | UTC
Opinion | Let’s do the Cochrane review of physical measures to reduce the spread of viruses
7 Feb, 2023 | 14:11h | UTCOriginal Study: SR | Physical interventions to interrupt or reduce the spread of respiratory viruses
Related: Hospital masking should be optional – Sensible Medicine
Updating international consensus on best practice in care of the dying: a Delphi study
6 Feb, 2023 | 13:41h | UTC
Opinion | Hospital masking should be optional
6 Feb, 2023 | 13:37h | UTCHospital masking should be optional – Sensible Medicine
Related: SR | Physical interventions to interrupt or reduce the spread of respiratory viruses
SR | Which interventions decrease ED attendances or hospital admissions from long-term care facilities?
6 Feb, 2023 | 13:04h | UTC
Commentary from the author on Twitter (thread – click for more)
🚨 FIRST PUBLICATION: Which interventions are effective at decreasing or increasing emergency department attendances or hospital admissions from long-term care facilities? A systematic review. #generalpractice #gp #research https://t.co/p53a3RnPyc
— Ben Searle (@bsearle92) February 3, 2023
Ten recommendations for child-friendly visiting policies in critical care
3 Feb, 2023 | 14:14h | UTCTen recommendations for child-friendly visiting policies in critical care – Intensive Care Medicine
Commentary on Twitter
Child visiting #ICU?
➡️ plan in team
➡️ strengthen parents
➡️ ensure child‑friendly info
➡️ prepare, accompany, follow‑up
➡️ offer support particularly if palliation/ED
➡️ create culture/address barriers
➡️ integrate quality/risk management
➡️ document
📎 https://t.co/B383AigZew pic.twitter.com/OH9Felh1Vr— Intensive Care Medicine (@yourICM) January 31, 2023
AAP Policy Statement | The hospitalized adolescent
3 Feb, 2023 | 14:09h | UTCPolicy Statement: The Hospitalized Adolescent – Pediatrics
Clinical Report: The Hospitalized Adolescent – Pediatrics
News Release: American Academy of Pediatrics Issues New Recommendations on Hospitalized Adolescents – American Academy of Pediatrics
Choosing Wisely | Five things physicians and patients should question in general internal medicine
2 Feb, 2023 | 15:08h | UTCSociety of General Internal Medicine: Five Things Physicians and Patients Should Question
Commentary: Patients don’t need to be ‘checked for everything’ – Northwestern University
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
A primer on home infusion administration methods
2 Feb, 2023 | 14:57h | UTCA Primer on Home Infusion Administration Methods – Open Forum Infectious Diseases
Report | Tranexamic acid at cesarean delivery: drug-error deaths
31 Jan, 2023 | 13:39h | UTC