Peterson (Norway)

Grimshaw, Crystal MS; Keteyian, Steven J. PhD; Benzo, Roberto MD, MS; Finkelstein, Joseph MD, PhD; Forman, Daniel E. MD; Gaalema, Diann E. PhD; Peterson, Pamela N. MD, MSPH; Einhorn, Paula T. MD; Punturieri, Antonello MD, PhD; Shero, Susan RN, MS; Fleg, Jerome L. MD Author Information

A cultura de segurança do paciente é um eixo estrutural para implementação de práticas seguras e a redução de eventos adversos relacionados à assistência à saúde. O presente estudo teve como objetivo analisar a cultura de segurança do paciente sob a ótica dos profissionais de enfermagem. Tratou-se de um estudo transversal com abordagem quantitativa. A pesquisa foi realizada com 100 profissionais de enfermagem de um hospital privado do município de São Luís, Maranhão, durante o mês de novembro de 2020. Observou-se que 60% dos profissionais possuem entre dois e três vínculos de trabalho na área, 48% afirmaram que recebem treinamentos regulares, porém para 66% ainda há problemas com a perda de informações na troca de turnos. Concluiu-se que há incidência de falhas nos protocolos e na transição do cuidado especialmente durante as trocas de turnos, o que pode produzir impactos negativos na qualidade da assistência prestada pelos profissionais.
 Descritores: Segurança do Paciente, Profissionais de Enfermagem, Indicadores de Qualidade em Assistência à Saúde.
 
 Patient safety culture from the perspective of nursing professionals
 Abstract: The patient safety culture is a structural axis for implementing safe practices and reducing adverse events related to health care. This study aimed to analyze the patient safety culture from the perspective of nursing professionals. This was a cross-sectional study with a quantitative approach. The survey was carried out with 100 nursing professionals from a private hospital in the city of São Luís, Maranhão, during the month of November 2020. It was observed that 60% of the professionals have between two and three jobs in the area, 48% stated that they receive regular training, but for 66% there are still problems with the loss of information when changing shifts. It was concluded that there is an incidence of failures in protocols and in the transition of care, especially during shift changes, which can have a negative impact on the quality of care provided by professionals.
 Descriptors: Patient Safety, Nurse Practitioners, Quality Indicators, Health Care.
 
 La cultura de seguridad del paciente desde la perspectiva de los profesionales de enfermería
 Resumen: La cultura de seguridad del paciente es un eje estructural para la implementación de prácticas seguras y la reducción de eventos adversos relacionados con la atención a la salud. Este estudio tuvo como objetivo analizar la cultura de seguridad del paciente desde la perspectiva de los profesionales de enfermería. Este fue un estudio transversal con un enfoque cuantitativo. La encuesta fue realizada con 100 profesionales de enfermería de un hospital privado en la ciudad de São Luís, Maranhão, durante el mes de noviembre de 2020. Se observó que el 60% de los profesionales tienen entre dos y tres trabajos en el área, el 48% afirmaron que reciben capacitación regular, pero para el 66% todavía hay problemas con la pérdida de información al cambiar de turno. Se concluyó que existe una incidencia de fallas en los protocolos y en la transición de la atención, especialmente durante los cambios de turno, lo que puede tener un impacto negativo en la calidad de la atención brindada por los profesionales.
 Descriptores: Seguridad del Paciente, Enfermeras Practicantes, Indicadores de Calidad de la Atención de Salud.

The CO2e Economic Analysis Tool (CEAT) is a spreadsheet-based application for comparing project alternatives that are sensitive to GHG emission rates, emission levies, or other financial parameters. The tool is applicable to hydrocarbon transportation systems, with an emphasis on natural gas transmission. CEAT provides a comparative forecast of benefits and expenses (including levies) from initial cash flow to arrival at the forecast horizon. Along with financial forecasting functions, the tool estimates the emissions associated with a wide range of hydrocarbon fluids (gas and liquid), electricity, thermal energy, and upstream transportation. The forecast model provides flexible configuration of CAPEX and O and M expenses and a customizable levy structure. This download includes a copy of the report and a copy of the Excel-based CO2e Economic Analysis Tool software (aka CEAT). The spreadsheet and the associated report are licensed to single users as noted in the end-user license agreement that is contained in the zip file.

Officially chartered in 1998, the J. Robert Gladden Orthopaedic Society (JRGOS) is a multicultural society dedicated to improving the diversity of the orthopaedic surgeon workforce and ending disparities in musculoskeletal health care. The purpose of this article is to discuss why an organization such as the JRGOS was needed within the American Academy of Orthopaedic Surgeons and highlight the key figures in orthopaedic history who supported the formation of the JRGOS. It also highlights the present efforts of the JRGOS, which include mentorship of Black, indigenous people of color medical students, residents and fellows in training, and support of research related to disparities in musculoskeletal care. As the JRGOS enters its third decade of existence, additional partnerships with the American Academy of Orthopaedic Surgeons, American Orthopaedic Association, AALOS, Orthopaedic Diversity Leadership Consortium, RJOS, Nth Dimensions, BWOS, and industry will help to realize the dream of making the orthopaedic workforce as diverse as the United States.

Krise- og sorgreaktioner hos partnere til per- soner, der rammes af livsforandrende sygdom kan ses som naturlige reaktioner. Til trods for et stort fokus på sorg i samfundsdebatten er forskning i sorg og sorgforståelser i forbindelse med livforandrende sygdom begrænset (Calvete & López de Arroyabe, 2012). Derfor under- søger dette studie sorgoplevelser hos partnere til personer med en erhvervet hjerneskade og udforsker, hvordan den enkeltes sorgoplevelse påvirkes af aktuelle kulturelle og sociale dis- kurser.Undersøgelsen tager udgangspunkt i fire semistrukturerede interviews med partnere til personer med erhvervet hjerneskade, 2-5 år efter hjerneskaden indtraf. Deltagerne er to kvinder og to mænd, i alderen 50-66 år.Gennem en diskurspsykologisk analyse un- dersøges de fire deltageres oplevelse af sorg og hvordan denne influeres af egne forståelser af begrebet sorg, samt kulturelle og samfundsmæssige diskurser (Davies & Harre, 1990).Resultaterne viser store forskelle i sorgoplevelsen mellem de enkelte informanter. Ligeledes kommer analysen ind på, hvordan sorgen kan opleves som miskendt. Analysens resul- tater diskuteres op mod samtidens sorgforståelser, hvor sorg på den ene side kan ses sommiskendt og hvor sorg på den anden side er blevet en diagnose. (Prolonged Grief Disorder) På baggrund af studiet anbefales fremadret- tet et øget fokus på anerkendelsen af forskelligartede tab i forbindelse med det at blive pårørende, samt en øget accept og normalisering af sorgens forskelligartede udtryksformer.

The CO2e Economic Analysis Tool (CEAT) is a spreadsheet-based application for comparing project alternatives that are sensitive to GHG emission rates, emission levies, or other financial parameters. The tool is applicable to hydrocarbon transportation systems, with an emphasis on natural gas transmission. CEAT provides a comparative forecast of benefits and expenses (including levies) from initial cash flow to arrival at the forecast horizon. Along with financial forecasting functions, the tool estimates the emissions associated with a wide range of hydrocarbon fluids (gas and liquid), electricity, thermal energy, and upstream transportation. The forecast model provides a flexible configuration of CAPEX and O and M expenses and a customizable levy structure. This updated version of the tool includes enhancements based on feedback from the first edition such as greater control of fuel use patterns. It also includes pre-designed, easily customizable analysis templates for situations that are likely to be repeated often in the field. The tool is Excel-based and requires version 16 or newer. This download includes a copy of the report and a copy of the Excel-based Check Mate software (aka Checkmate). The spreadsheet and the associated report are licensed to single users as noted in the end-user license agreement that is contained in the zip file.

To evaluate the relationship between burnout and professional behaviors and beliefs among US nurses. We used data from 2256 nurses who completed a survey that included the Maslach Burnout Inventory and items exploring their professional conduct (documented something they had not done so they could "close out" an encounter in the EHR or part of the assessment not completed, requested continuing education credit for an activity not attended) and beliefs about reporting impaired colleagues. On multivariable analysis, burnout was independently associated with higher odds of reporting 1 or more unprofessional behaviors in the last year and not believing nurses have a duty to report impairment among colleagues due to substance use or mental health problems. Occupational burnout is associated with self-reported unprofessional behaviors and less favorable beliefs about reporting impaired colleagues among nurses.

Background: The recommendations for dual antiplatelet (DAPT aspirin + clopidogrel) for secondary stroke prevention has evolved over time. Following the publication of CHANCE trial (07/2013), the AHA/ASA updated the DAPT recommendations from Class III harm (10/2010) for patient with noncardioembolic ischemic stroke, to Class IIb benefit ≥ risk (02/2014), and Class IIa benefit >> risk (03/2018) for a subgroup of patients with minor stroke (NIHSS≤3). Subsequent to the last guideline update, the POINT trial (05/2018) provided further support for the effectiveness of DAPT. Methods: We evaluated antiplatelet prescription patterns of 1,024,074 noncardioembolic ischemic stroke survivors (median age 65 years and 46% women) eligible for antiplatelet therapy (no contraindications) and discharged from the Get With The Guidelines-Stroke Hospitals between Q1 2011 and Q1 2019. Results: Baseline patient characteristics were similar within the four periods: pre-CHANCE (01/2011-07/2013), pre-2014 guideline update (08/2013-02/2014), pre-POINT/2018 guideline update (03/2014-05/2018), and post-POINT (06/2018-03/2019). Use of DAPT gradually increased from 16.7% in the pre-CHANCE period, to 19.4% pre-2014 guideline update, 23.3% pre-POINT/2018 guideline update, and 29.8% post-POINT period (p<0.001, Figure). Yet increase in DAPT use was observed over time for individuals with NIHSS≤3 (17.1%, 19.9%, 24.1%, and 31.4%, p<0.001) and those with NIHSS>3 (18.7%, 22.8%, 28.3%, and 28.3%, p<0.001). Conclusions: A sustained increase in DAPT use for secondary stroke prevention was observed after publication of pivotal trials and AHA guideline updates. While recommended for minor strokes or TIA only, such increase was also observed in ischemic stroke patients with NIHSS>3, where the risk-benefit ratio of DAPT remains to be established.

Background: While CT angiography is the standard tool to identify the site of large vessel occlusion (LVO) in acute ischemic stroke (AIS), CTP may be confirmatory or facilitate identification of the occluded vessel especially in distal LVOs. This study aims to examine the utility of CTP in localizing the site of intracranial large vessel occlusions (LVOs). Method: We reviewed our prospective database of all patients between January 2017 and July 2019 who underwent CTP for suspected AIS. Vascular territories with perfusion abnormalities were recorded. Reference standard for occlusion was defined as confirmed LVO by CTA or digital substraction angiogram (DSA). CTP results were deemed true positive when the identified area with perfusion abnormality was the same as or overlapped with the territory of the occluded vessel on CTA/DSA. Result: We identified 280 stroke alert patients with median NIHSS 11. LVOs were confirmed in 155 patients, of whom 146 showed corresponding perfusion abnormality (sensitivity 94.2%), and 129 with ischemic penumbra. CT perfusion was highly sensitive for occlusions in the MCA (sensitivity 95.7%, 111/116), ICA (100%, 21/21), and PCA (100%, 10/10). CTP only identified 2 of 5 (40%) basilar artery occlusions. CTP sensitivity was 97.2% (69/71), 97.5% (39/40), and 60% (3/5) for occlusions at M1, M2, and M3, respectively. Of the 125 patients who did not have LVO, 54 had falsely positive CT perfusion studies (41 with penumbra) due to stenotic processes, microvascular ischemia, chronic infarcts, or artifacts. In this cohort, 90 patients underwent mechanical thrombectomy, all with confirmed LVOs. 86/90 thrombectomy recipients (95.6%) had perfusion penumbra on initial imaging. Of the remaining 4 thrombectomy recipients who did not demonstrate perfusion mismatch on CTP, 3 had basilar occlusions. Conclusion: CTP is highly sensitive for identifying the site of LVO in the ICA, MCA, and PCA and may be particularly useful in cases of difficult to detect LVOs particularly in M2 and PCA vessels. However, the low specificity of CTP continues to emphasize the importance of correlation with CTA and clinical findings.